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    Home > Active Ingredient News > Endocrine System > JCEM: The effect of weight gain during pregnancy on the physiology of glucose and insulin during pregnancy

    JCEM: The effect of weight gain during pregnancy on the physiology of glucose and insulin during pregnancy

    • Last Update: 2021-10-20
    • Source: Internet
    • Author: User
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      Gestational diabetes (GDM) during pregnancy has negative short-term and long-term effects on mothers and babies
    .
    Women with gestational diabetes mellitus (GDM) are at higher risk of onset during pregnancy (including the risk of gestational hypertension/preeclampsia and complicated childbirth (including caesarean section)), and are more likely to develop type 2 diabetes (T2D) in the future And cardiovascular disease
    .
    GDM pregnancy has a higher risk of neonatal morbidity than the offspring of women with normal blood sugar during pregnancy, including fetal obesity, birth trauma, neonatal hypoglycemia, childhood obesity, and impaired glucose tolerance
    .
    GDM disproportionately affects women of color.
    Nearly 7 percent of Hispanic pregnant women are diagnosed with GDM, and the prevalence of GDM is increasing because the risk of T2D for Hispanic women is in all races in the United States.
    / Gender category is already the highest, 52.
    5% of Hispanic women suffer from T2D.
    Determine the changeable risk factors that can be interfered by GDM during pregnancy, which is useful for improving maternal and child outcomes, reducing pregnancy outcomes and long-term glucose metabolism health.
    The difference is crucial

    .

    Women with gestational diabetes mellitus (GDM) are at higher risk of onset during pregnancy (including the risk of gestational hypertension/preeclampsia and complicated childbirth (including caesarean section)), and are more likely to develop type 2 diabetes (T2D) in the future And cardiovascular disease
    .
    Fetal obesity, birth trauma, neonatal hypoglycemia, childhood obesity and impaired glucose tolerance
    .

      GDM is caused by changes in glucose metabolism, which usually start in the second half of pregnancy, and insulin resistance increases to adapt to the growth of the fetus
    .
    In women without GDM, increased β-cell insulin secretion compensates for insulin resistance to regulate blood sugar levels

    .
    However, patients with GDM do not have sufficient pancreatic function to overcome increased insulin resistance

    .
    Therefore, identifying the modifiable factors that affect insulin sensitivity and β-cell secretion during pregnancy, especially among Hispanic women and other people of color, may be the key to reversing the rising trend of GDM
    .

    Insulin resistance increases to adapt to the growth of the fetus
    .
    In women without GDM, increased β-cell insulin secretion compensates for insulin resistance to regulate blood sugar levels

    .
    However, patients with GDM do not have sufficient pancreatic function to overcome increased insulin resistance

    .

      Lindsay et al.
    hypothesized in the Hispanic population that the pregnancy weight gain rate (GWG) may be related to changes in glucose metabolism during pregnancy

    .
    To test this hypothesis, they performed a post-mortem cross-sectional analysis on the data of 33 overweight and obese non-diabetic Spanish pregnant women to confirm that they did not have GDM

    .
    Using a standardized liquid mixed meal for a 2-hour glucose tolerance test, they examined the relationship between the GWG rate and the area under the glucose and insulin curve, insulin sensitivity index, and insulin secretion sensitivity index (ISSI)

    .
    They found that in their samples, GWG rates at the second and third months were negatively correlated with β-cell function

    .
    They concluded that in this high-risk population, the
    rate of weight gain during pregnancy may be a modifiable factor for insufficient β-cell function, and that insufficient β-cell function may lead to hyperglycemia and long-term development of T2D during pregnancy
    .
    However, after controlling for the covariates (maternal age, parity, and pre-pregnancy BMI), pregnancy weight gain only accounted for 13.
    4% of the variance of ISIS -2, indicating that other important factors also affect β-cell function in late pregnancy

    .

    The rate of weight gain during pregnancy may be a modifiable factor of insufficient β-cell function, and insufficient β-cell function may lead to hyperglycemia and the long-term development of T2D during pregnancy
    .

      The findings of Lindsay et al.
    provide valuable information for us to understand the glucose metabolism of Hispanic women

    .
    However, their cross-sectional study did not evaluate the glucose metabolism at the two critical time points before pregnancy and early pregnancy, leaving the problem that GWG has the greatest impact on glucose metabolism during pregnancy

    .
    Mounting evidence suggests that
    weight gain in early pregnancy may be a key modifiable risk factor
    .
    The GWG in the first and second trimesters of pregnancy is closely related to cord blood hormones, and cord blood hormones are very important for blood sugar control and body growth.
    In addition,
    we recently reported a randomized clinical trial of weight loss intervention before pregnancy.
    The intervention group’s early pregnancy (average 12 Week) The incidence of GDM (mean weight loss-0.
    23 kg/week) was 73% lower than that of the conventional treatment group (mean weight loss-0.
    02 kg/week).
    This finding is consistent with a recent longitudinal study of 46 predominantly white pregnant women The study found that those pregnant women with GDM had lower levels of insulin sensitivity before pregnancy than those with normal glucose tolerance during pregnancy, and the insulin sensitivity between women with GDM during pregnancy and women without GDM There is no significant difference between changes in insulin response

    .
    The results of these studies indicate that
    the metabolic environment in early pregnancy may be essential for the prevention of GDM, which may explain why the correlation between pre-pregnancy BMI and adverse maternal and infant outcomes is stronger than that of weight gain during pregnancy
    .
    This suggests that interventions may need to be started before pregnancy (or at least early) in order to have a large impact on GDM risk
    .

    Weight gain in early pregnancy may be a key modifiable risk factor
    .
    GWG in the first and second trimesters of pregnancy is closely related to cord blood hormones, and cord blood hormones are very important for blood sugar control and body growth.
    In addition,
    the metabolic environment in early pregnancy may be critical to preventing GDM, which may explain why pre-pregnancy BMI is associated with bad The correlation between maternal and infant outcomes is stronger than that of weight gain during pregnancy
    .

      More and more evidences show that GDM is a heterogeneous disease composed of several different phenotypes, including insulin-resistant GDM, insulin-deficient GDM, and mixed GDM (characterized by insulin resistance and insulin deficiency)
    .
    We need more research to give us a more comprehensive understanding of the complex changes in glucose metabolism during pregnancy and in different American populations
    .
    The GO MOMS study (NCT04860336) is currently recruiting more than 2,000 pregnant women representing different BMI and races to conduct longitudinal studies on blood glucose at multiple time points during pregnancy

    .
    This study will be able to build on the results of Lindsay et al.
    and provide comprehensive data to understand the relationship between weight gain from early pregnancy to delivery and changes in glucose metabolism in the entire pregnant population and high-risk subgroups

    .

    GDM is a heterogeneous disease composed of several different phenotypes, including insulin-resistant GDM, insulin-deficient GDM, and mixed GDM (characterized by insulin resistance and insulin deficiency)
    .

    Original source:

     LeBlanc ES, Hillier TA, The impact of gestational weight gain on glucose and insulin physiology in pregnancy-does timing matter? J Clin Endocrinol Metab 2021 Oct 11

    The impact of gestational weight gain on glucose and insulin physiology in pregnancy-does timing matter?

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