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What Is The Pathophysiology Of Gestational Diabetes?

The Pathogenesis And Pathophysiology Of Gestational Diabetes Mellitus: Deductionsfrom A Three-part Longitudinal Metabolomics Study In China.

The Pathogenesis And Pathophysiology Of Gestational Diabetes Mellitus: Deductionsfrom A Three-part Longitudinal Metabolomics Study In China.

1. Clin Chim Acta. 2017 May;468:60-70. doi: 10.1016/j.cca.2017.02.008. Epub 2017 Feb14. The pathogenesis and pathophysiology of gestational diabetes mellitus: Deductionsfrom a three-part longitudinal metabolomics study in China. (1)Mass Spectrometry Centre, China-Canada-New Zealand Joint Laboratory of Maternal and Foetal Medicine, Chongqing Medical University, Chongqing, China; Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: [email protected] (2)Mass Spectrometry Centre, China-Canada-New Zealand Joint Laboratory of Maternal and Foetal Medicine, Chongqing Medical University, Chongqing, China; Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Gestational diabetes mellitus (GDM) is a form of diabetes that is firstrecognised during pregnancy, with no evidence of pre-existing type 1 or type 2diabetes. The prevalence of GDM has been rising steadily over the past fewdecades, coinciding with the ongoing epidemic of obesity and type 2 diabetes.Although GDM normally disappears after delivery, women who have been previouslydiagnosed with GDM are at a greater risk of developing gestational diabetes insubsequent pregnancies, and type 2 diabetes later in life. Infants born tomothers with GDM also have a higher risk of developing type 2 diabetes in theirteens or early adulthood. There are many possible causes of insulin resistance,and multiple metabolic aberrants are known to be involved in the development ofdifferent forms of diabetes. Increasing evidence suggests that different forms ofdiabetes share common pathogenesis and pathophysiological dysregulation resultingfrom a progressive -cell demise or dysfuncti Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes definition and facts Risk factors for gestational diabetes include a history of gestational diabetes in a previous pregnancy, There are typically no noticeable signs or symptoms associated with gestational diabetes. Gestational diabetes can cause the fetus to be larger than normal. Delivery of the baby may be more complicated as a result. The baby is also at risk for developing low blood glucose (hypoglycemia) immediately after birth. Following a nutrition plan is the typical treatment for gestational diabetes. Maintaining a healthy weight and following a healthy eating plan may be able to help prevent or minimize the risks of gestational diabetes. Women with gestational diabetes have an increased risk of developing type 2 diabetes after the pregnancy What is gestational diabetes? Gestational diabetes is diabetes, or high blood sugar levels, that develops during pregnancy. It occurs in about 4% of all pregnancies. It is usually diagnosed in the later stages of pregnancy and often occurs in women who have no prior history of diabetes. What causes gestational diabetes? Gestational diabetes is thought to arise because the many changes, hormonal and otherwise, that occur in the body during pregnancy predispose some women to become resistant to insulin. Insulin is a hormone made by specialized cells in the pancreas that allows the body to effectively metabolize glucose for later usage as fuel (energy). When levels of insulin are low, or the body cannot effectively use insulin (i.e., insulin resistance), blood glucose levels rise. What are the screening guidelines for gestational diabetes? All pregnant women should be screened for gestational diabetes during their pregnancy. Most pregnant women are tested between the 24th and 28th weeks of pregnancy (see Continue reading >>

Etiology And Pathogenesis Of Gestational Diabetes

Etiology And Pathogenesis Of Gestational Diabetes

Proceedings of the Fourth International Workshop-Conference on These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. Etiology and Pathogenesis of Gestational Diabetes A significant amount of information regarding the pathogenesis of gestational diabetes mellitus (GDM) has been gathered since the Third Workshop-Conference on GDM. In spite of this, it is still not known why GDM develops in 23% of all pregnant women. Similar frequencies of HLA-DR2, DR3, and DR4 antigens in healthy pregnant women and women with GDM and low prevalences of markers for autoimmune destruction of the -cells in GDM pregnancy rule out the possibility that GDM is a disease of autoimmune origin. Insulin secretion during an oral glucose tolerance test (OGTT) or a meal is substantially increased in women with GDM compared with the same women postpartum. However, insulin secretion increases less in women with GDM than in pregnant women who retain normal glucose tolerance (NGT). Peak insulin concentrations during an OGTT occur later in women with GDM, and following intravenous glucose, a reduced first-phase insulin response is also seen in these women. Second-phase insulin responses are similar in pregnant women with NGT and GDM. Excessive secretion of proinsulin, which does not always return to normal postpartum, is often observed in women with GDM. It is conceivable that this might reflect a stress on the -cells are stressed because they try to counter the decreased insulin sensitivity that develops during pregnancy. Thus, insulin sensitivity decreases by 5070% in both normal and GDM pregnancy, but whereas insulin sensitivity returns to normal postpartum Continue reading >>

Gestational Diabetes Pathophysiology

Gestational Diabetes Pathophysiology

The exact pathophysiology of gestational diabetes is unknown. One main aspect of the underlying pathology is insulin resistance, where the bodys cells fail to respond to the hormone insulin in the usual way. Several pregnancy hormones are thought to disrupt the usual action of insulin as it binds to its receptor, most probably by interfering with cell signalling pathways. Insulin is the primary hormone produced in the beta cells of the islets of Langerhans in the pancreas. Insulin is key in the regulation of the bodys blood glucose level. Insulin stimulates cells in the skeletal muscle and fat tissue to absorb glucose from the bloodstream. In the presence of insulin resistance, this uptake of blood glucose is prevented and the blood sugar level remains high. The body then compensates by producing more insulin to overcome the resistance and in gestational diabetes, the insulin production can be up to 1.5 or 2 times that seen in a normal pregnancy. Western diet during pregnancy may increase obesity risk in offspring The glucose present in the blood crosses the placenta via the GLUT1 carrier to reach the fetus. If gestational diabetes is left untreated, the fetus is exposed to an excess of glucose, which leads to an increase in the amount of insulin produced by the fetus. As insulin stimulates growth, this means the baby then develops a larger body than is normal for their gestational age. Once the baby is born, the exposure to excess glucose is removed. However, the newborn still has increased insulin production, meaning they are susceptible to low blood glucose levels. Some of the symptoms of gestational diabetes include: Recurrent infections including thrush or yeast infection Gestational diabetes raises the risk of birth complications and future health conditions. Som Continue reading >>

Classification, Pathophysiology, Diagnosis And Management Of Diabetes Mellitus

Classification, Pathophysiology, Diagnosis And Management Of Diabetes Mellitus

University of Gondar, Ethopia *Corresponding Author: Habtamu Wondifraw Baynes Lecturer Clinical Chemistry University of Gondar, Gondar Amhara 196, Ethiopia Tel: +251910818289 E-mail: [email protected] Citation: Baynes HW (2015) Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus. J Diabetes Metab 6:541. doi:10.4172/2155-6156.1000541 Copyright: © 2015 Baynes HW. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Diabetes Mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglycemia either immune-mediated (Type 1 diabetes), insulin resistance (Type 2), gestational or others (environment, genetic defects, infections, and certain drugs). According to International Diabetes Federation Report of 2011 an estimated 366 million people had DM, by 2030 this number is estimated to almost around 552 million. There are different approaches to diagnose diabetes among individuals, The 1997 ADA recommendations for diagnosis of DM focus on fasting Plasma Glucose (FPG), while WHO focuses on Oral Glucose Tolerance Test (OGTT). This is importance for regular follow-up of diabetic patients with the health care provider is of great significance in averting any long term complications. Keywords Diabetes mellitus; Epidemiology; Diagnosis; Glycemic management Abbreviations DM: Diabetes Mellitus; FPG: Fasting Plasma Glucose; GAD: Glutamic Acid Decarboxylase; GDM: Gestational Diabetes Mellitus; HDL-cholesterol: High Density Lipoprotein cholesterol; HLA: Human Leucoid Antigen; IDD Continue reading >>

Gestational Diabetes Mellitus And Macrosomia: A Literature Review

Gestational Diabetes Mellitus And Macrosomia: A Literature Review

Abstract Background: Fetal macrosomia, defined as a birth weight ≥4,000 g, may affect 12% of newborns of normal women and 15-45% of newborns of women with gestational diabetes mellitus (GDM). The increased risk of macrosomia in GDM is mainly due to the increased insulin resistance of the mother. In GDM, a higher amount of blood glucose passes through the placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia, which is also called ‘large for gestational age'. This paper reviews studies that explored the impact of GDM and fetal macrosomia as well as macrosomia-related complications on birth outcomes and offers an evaluation of maternal and fetal health. Summary: Fetal macrosomia is a common adverse infant outcome of GDM if unrecognized and untreated in time. For the infant, macrosomia increases the risk of shoulder dystocia, clavicle fractures and brachial plexus injury and increases the rate of admissions to the neonatal intensive care unit. For the mother, the risks associated with macrosomia are cesarean delivery, postpartum hemorrhage and vaginal lacerations. Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age (during adolescence) and are more likely to develop type II diabetes later in life. Besides, the findings of several studies that epigenetic alterations of different genes of the fetus of a GDM mother in utero could result in the transgenerational transmission of GDM and type II diabetes are of concern. © 2015 S. Karger AG, Basel Key Messages • Fetal macrosomia, resulting from fetal hyperinsulinemia in response to maternal diabetes, might be a predictor of later glucose intolerance. • Maternal diabetes during pregnancy can lead to a transgenerati Continue reading >>

Gestational Diabetes Mellitus

Gestational Diabetes Mellitus

Diabetes is a condition in which blood sugar (glucose) levels are high. This is due to problems with the hormone insulin , which allows sugar (mainly digested from the diet) to be taken up from the blood into the cells and to be processed as the bodys main energy source. If insulin levels are too low, or the body does not respond normally to insulin, sugar is trapped in the blood (known as glucose intolerance ), and diabetes occurs. Gestational diabetes mellitus(GDM) is glucose intolerance that is first diagnosed during pregnancy ( gestation ). GDM is a temporary condition that usually disappears after pregnancy . However, for some women the condition becomes chronic. Rarely, diabetes may have been present before pregnancy. If it has not been diagnosed previously, it is stillknown as GDM. Even if it goes away, GDM signals an increased risk of developing diabetes later in life, which can have serious short term and long term effects on the body. It is important that GDM is diagnosed and treated, because without treatment it may lead to significant health problems for a mother and her baby. About 5% of pregnant women in Australia develop GDM. This means that around 11,000 cases are diagnosed each year in Australia. The rates of GDM are increasing. This may be linked to the increasing average age of women having children. Rates of GDM are 2.3 times higher in Indigenous Australian women than non Indigenous Australian women. Other women with high risk ethnic backgrounds are those from the Pacific Islands, Asia, the Middle East, or the Indian subcontinent. Age (risk increases with age). As women age, their bodys ability to compensate for the hormonal changes of pregnancy is reduced. Obesity or being overweight. People who are overweight are likely to have a greater baseline Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy.[2] Gestational diabetes generally results in few symptoms;[2] however, it does increase the risk of pre-eclampsia, depression, and requiring a Caesarean section.[2] Babies born to mothers with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and jaundice.[2] If untreated, it can also result in a stillbirth.[2] Long term, children are at higher risk of being overweight and developing type 2 diabetes.[2] Gestational diabetes is caused by not enough insulin in the setting of insulin resistance.[2] Risk factors include being overweight, previously having gestational diabetes, a family history of type 2 diabetes, and having polycystic ovarian syndrome.[2] Diagnosis is by blood tests.[2] For those at normal risk screening is recommended between 24 and 28 weeks gestation.[2][3] For those at high risk testing may occur at the first prenatal visit.[2] Prevention is by maintaining a healthy weight and exercising before pregnancy.[2] Gestational diabetes is a treated with a diabetic diet, exercise, and possibly insulin injections.[2] Most women are able to manage their blood sugar with a diet and exercise.[3] Blood sugar testing among those who are affected is often recommended four times a day.[3] Breastfeeding is recommended as soon as possible after birth.[2] Gestational diabetes affects 3–9% of pregnancies, depending on the population studied.[3] It is especially common during the last three months of pregnancy.[2] It affects 1% of those under the age of 20 and 13% of those over the age of 44.[3] A number of ethnic groups including Asians, American Indians, Indigenous Australians, and Pacific Continue reading >>

Jci -gestational Diabetes Mellitus

Jci -gestational Diabetes Mellitus

1Departments of Medicine, Obstetrics and Gynecology, and Physiology and Biophysics, and 2Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA. Address correspondence to: Thomas A. Buchanan, Room 6602 GNH, 1200 North State Street, Los Angeles, California 90089-9317, USA. Phone: (323) 226-4632; Fax: (323) 226-2796; E-mail: [email protected] . Find articles by Buchanan, T. in: JCI | PubMed | Google Scholar 1Departments of Medicine, Obstetrics and Gynecology, and Physiology and Biophysics, and 2Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA. Address correspondence to: Thomas A. Buchanan, Room 6602 GNH, 1200 North State Street, Los Angeles, California 90089-9317, USA. Phone: (323) 226-4632; Fax: (323) 226-2796; E-mail: [email protected] . Find articles by Xiang, A. in: JCI | PubMed | Google Scholar Published in Volume 115, Issue 3 (March 1, 2005) J Clin Invest.2005;115(3):485491.doi:10.1172/JCI24531. Copyright 2005, The American Society for Clinical Investigation. Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees that is first detected during pregnancy. GDM is detected through the screening of pregnant women for clinical risk factors and, among at-risk women, testing for abnormal glucose tolerance that is usually, but not invariably, mild and asymptomatic. GDM appears to result from the same broad spectrum of physiological and genetic abnormalities that characterize diabetes outside of pregnancy. Indeed, women with GDM are at high risk for having or developing diabetes when they are not pregnant. Thus, GDM provides a unique opportunity to study the early pathogenesis of diabetes and to develop Continue reading >>

Pathogenesis Of Gestational Dm

Pathogenesis Of Gestational Dm

Gestational diabetes (GDM) describes a heterogeneous group of hyperglycemic metabolic disorders detected in pregnancy. The majority of women with GDM are overweight or obese, and many have latent metabolic syndrome, a genetic predisposition to type 2 diabetes, a physically inactive lifestyle and unhealthy eating habits prior to pregnancy. The risk factors for GDM are similar to those of type 2 diabetes: increased waist circumference, dyslipidemia, hypertension, polycystic ovary syndrome, increasing age, family history of diabetes and ethnicity (Asian, Hispanic). Prenatal programming may also contribute to GDM whereby nutritional stress induced by both maternal undernutrition and overnutrition or maternal hyperglycemia during pregnancy persistently alter metabolism of the offspring. A minority of women develop type 1 diabetes in pregnancy, and clinicians should be alert to this possibility, but GDM may in general be regarded as pre-type 2 diabetes. Gestational diabetes is diabetes first detected in pregnancy [1] [2] . Although type 1 diabetes is more likely to develop in pregnancy, the great majority of women have pre-type 2 diabetes, and many will go on to develop permanent diabetes later in life. If type 1 diabetes is suspected during pregnancy or after delivery, autoimmunity should be confirmed by measurement of antibodies against islet cell antigens (antibodies directed against glutamic acid decarboxylase [GADA], islet antigen-2 [IA-2A]). MODY may also present in pregnancy, and genetic testing is recommended when family history suggests that this phenotype may be present. However, in general GDM can be regarded as pre-Type 2 diabetes. Pregnancy is a state of physiological insulin resistance, and thereforerepresents a physiological model of beta-cell stress [3] [4] . Continue reading >>

Pathogenesis Of Gestational Diabetes Zhang, Cuilin U.s. National Inst/child Hlth/human Dev

Pathogenesis Of Gestational Diabetes Zhang, Cuilin U.s. National Inst/child Hlth/human Dev

Gestational diabetes is a common pregnancy complication. Although the precise underlying mechanism has yet to be identified, insulin resistance and inadequate insulin secretion to compensate for it play a central role in the pathophysiology of GDM. Excess adiposity is an important modifiable risk factor for the development of the condition. Mechanisms linking excess adiposity to elevated risk of GDM are not completely understood, but recent evidence points to the crucial role of specific hormones and cytokines (adipokines) secreted by the adipose tissue. The general goal of this project is for research on the pathogenesis of GDM. Under this research theme, the specific aim of this project is to prospectively investigate novel biochemical markers, for instance, biomarkers involved in adipocyte cytokine secretion and metabolism in association with subsequent risk of GDM and fetal overgrowth. This project utilizes bio-specimens from throughout pregnancy from GDM cases and matched controls within the NICHD Fetal Growth Studies. In the past year, we actively worked with the UMN laboratory to obtain data including non-targeted metabolomics data from UC Davis. We are teaming with biostatiticians analyzing the data. Statistical analyses and manuscript preparation on biomarkers of GDM risk are ongoing. The first series of publications have focused on modifiable biomarkers and metabolomics and lipodomic profiling that are functions of major exogenous origin (via dietary intake). In addition, recent analyses examined the insulin-like growth factor (IGF)-axis in early-to-mid pregnancy in relation to subsequent GDM risk. This project identified that dysregulation in the IGF-axis as early as the first trimester in pregnancy may be implicated in the pathogenesis of GDM. Continue reading >>

Gestational Diabetes: Pathogenesis And Consequences To Mother And Offspring

Gestational Diabetes: Pathogenesis And Consequences To Mother And Offspring

Gestational Diabetes: Pathogenesis and Consequences to Mother and Offspring 1Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Satakunta Central Hospital, Pori, Finland 2Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland 1Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Satakunta Central Hospital, Pori, Finland 2Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland Address correspondence to: Risto Kaaja, e-mail: [email protected] Received 2009 Feb 1; Revised 2009 Feb 27; Accepted 2009 Feb 28. Copyright 2008, SBDR - Society for Biomedical Diabetes Research This article has been cited by other articles in PMC. Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. Data from Western countries suggest that the prevalence of GDM is increasing, being almost 10% of pregnancies and probably reflecting the global obesity epidemic. The majority of women with GDM seem to have -cell dysfunction that appears on a background of chronic insulin resistance already present before pregnancy. In less than 10% of GDM patients, defects of -cell function can be due to autoimmune destruction of pancreatic -cells, as in type 1 diabetes, or caused by monogenic mutations, as in several MODY subtypes. Diagnostic criteria for GDM vary worldwide and there are no clear-cut plasma glucose cut-off values for identifying women at a higher risk of developing macrosomia or other fetal complications. Because the oral glucose tolerance test (OGTT) is restricted to high risk individuals, 40% of GDM cases are left undiagnosed. Therefore, in high risk populations almost universal screening is recommended; on Continue reading >>

Pathophysiology Of Gestational Diabetes

Pathophysiology Of Gestational Diabetes

Centre Hospitalier Rgional Universitaire de Lille During pregnancy, a number of maternal metabolic changes occur early and continue throughout pregnancy which help optimize the transfer of nutrients to the fetus. During normal pregnancy, there are a decrease in insulin sensibility which is physiological, progressive and reverse. For glucose tolerance to be maintained in pregnancy it is necessary for maternal insulin secretion to increase sufficiently to counteract the fall in insulin sensitivity. The metabolic characteristic of women with gestational diabetes is insufficient insulin secretion to counteract the pregnancy related fall in insulin sensitivity. There are a lot of factors that could explain the mechanism of insulin secretion and insulin sensitivity during normal pregnancy and gestational diabetes mellitus. Although glucose tolerance normalizes shortly after pregnancy with gestational diabetes in the majority of women, the risk of developing overt diabetes, especially type 2 diabetes is markedly increased. The mechanisms which could explain gestational diabetes are the same as type 2 diabetes mellitus. We could speculate that these two diseases are identical for alterations in carbohydrate metabolism, but at different stages. Continue reading >>

Gestational Diabetes

Gestational Diabetes

Overview Gestational diabetes develops during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby's health. Any pregnancy complication is concerning, but there's good news. Expectant women can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can prevent a difficult birth and keep you and your baby healthy. In gestational diabetes, blood sugar usually returns to normal soon after delivery. But if you've had gestational diabetes, you're at risk for type 2 diabetes. You'll continue working with your health care team to monitor and manage your blood sugar. Symptoms For most women, gestational diabetes doesn't cause noticeable signs or symptoms. When to see a doctor If possible, seek health care early — when you first think about trying to get pregnant — so your doctor can evaluate your risk of gestational diabetes as part of your overall childbearing wellness plan. Once you're pregnant, your doctor will check you for gestational diabetes as part of your prenatal care. If you develop gestational diabetes, you may need more-frequent checkups. These are most likely to occur during the last three months of pregnancy, when your doctor will monitor your blood sugar level and your baby's health. Your doctor may refer you to additional health professionals who specialize in diabetes, such as an endocrinologist, a registered dietitian or a diabetes educator. They can help you learn to manage your blood sugar level during your pregnancy. To make sure your blood sugar level has returned to normal after your baby is born, your health care team wil Continue reading >>

Gestational Diabetes Mellitus

Gestational Diabetes Mellitus

Table 1. Plasma Glucose Values for Screening and Diagnosis of Gestational Diabetes Mellitus [ 1 ] Appendix A. Appendix A. American Diabetes Association recommendations for medical nutritional therapy in gestational diabetes mellitus [ 17 ] Appendix B. Appendix B. Curriculum for education about diabetes self-management [ 27 ] Defining the Diabetes Disease Process and Treatment Options Insulin resistance and its role in gestational diabetes mellitus (GDM) should be defined for the patient. GDM should be differentiated from types 1 and 2 diabetes mellitus. Treatment options should be discussed. Incorporating Nutritional Management Into Lifestyle An individualized meal plan should be devised by a licensed dietitian or another qualified health care professional. Energy needs, the composition of meals, and meal patterns should be discussed. Incorporating Physical Activity Into Lifestyle The importance of exercise should be stressed, but patients should be reminded to start slowly and work up to a personalized goal. Monitoring Blood Glucose and Using the Findings to Improve Blood Glucose Control Patients should be taught to monitor blood glucose four times daily (while fasting and two hours after meals) and when they have symptoms of hyperglycemia or hypoglycemia. The goal fasting blood glucose concentration is 70-105 mg/dL and the two-hour postprandial goal is 80-120 mg/dL.[ 1 ] Preventing, Detecting, and Treating Acute and Chronic Complications All potential complications to mother and fetus, present and future, should be discussed with the patient, and the importance of compliance with medical nutritional therapy, exercise, and prescribed medications should be stressed. Goal Setting for Health and Problem Solving for Daily Living The patient's support system and ability to Continue reading >>

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