Document Detail


Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus.
MedLine Citation:
PMID:  10799399     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This article reviews maternal metabolic strategies for accommodating fetal nutrient requirements in normal pregnancy and in gestational diabetes mellitus (GDM). Pregnancy is characterized by a progressive increase in nutrient-stimulated insulin responses despite an only minor deterioration in glucose tolerance, consistent with progressive insulin resistance. The hyperinsulinemic-euglycemic glucose clamp technique and intravenous-glucose-tolerance test have indicated that insulin action in late normal pregnancy is 50-70% lower than in nonpregnant women. Metabolic adaptations do not fully compensate in GDM and glucose intolerance ensues. GDM may reflect a predisposition to type 2 diabetes or may be an extreme manifestation of metabolic alterations that normally occur in pregnancy. In normal pregnant women, basal endogenous hepatic glucose production (R(a)) was shown to increase by 16-30% to meet the increasing needs of the placenta and fetus. Total gluconeogenesis is increased in late gestation, although the fractional contribution of total gluconeogenesis to R(a), quantified from (2)H enrichment on carbon 5 of glucose (65-85%), does not differ in pregnant women after a 16-h fast. Endogenous hepatic glucose production was shown to remain sensitive to increased insulin concentration in normal pregnancy (96% suppression), but is less sensitive in GDM (80%). Commensurate with the increased rate of glucose appearance, an increased contribution of carbohydrate to oxidative metabolism has been observed in late pregnancy compared with pregravid states. The 24-h respiratory quotient is significantly higher in late pregnancy than postpartum. Recent advances in carbohydrate metabolism during pregnancy suggest that preventive measures should be aimed at improving insulin sensitivity in women predisposed to GDM. Further research is needed to elucidate the mechanisms and consequences of alterations in lipid metabolism during pregnancy.
Authors:
N F Butte
Related Documents :
24942869 - Prenatal vitamin intake during pregnancy and offspring obesity.
11787919 - Sonographic estimation of fetal weight in macrosomic fetuses: diabetic versus non-diabe...
3934619 - Extreme variant of septo-optic dysplasia.
12832369 - Pregnancy outcome in women with pcos and in controls matched by age and weight.
24426239 - Clinical and biochemical effects of environmental tobacco smoking on pregnancy outcome.
6356879 - Reference values for the oral glucose tolerance test at each trimester of pregnancy.
6681649 - Opiate withdrawal increases ornithine decarboxylase activity which is otherwise unalter...
24274419 - Forty years of embryo transfer in cattle: a review focusing on the journal theriogenolo...
2226919 - The role of tubal pathology and other parameters in ectopic pregnancies occurring in in...
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Review    
Journal Detail:
Title:  The American journal of clinical nutrition     Volume:  71     ISSN:  0002-9165     ISO Abbreviation:  Am. J. Clin. Nutr.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-05-25     Completed Date:  2000-05-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376027     Medline TA:  Am J Clin Nutr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1256S-61S     Citation Subset:  AIM; IM    
Affiliation:
US Department of Agriculture, Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA. nbutte@bcm.tmc.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Diabetes, Gestational / metabolism*
Dietary Carbohydrates / metabolism*
Dietary Fats / metabolism*
Female
Humans
Insulin Resistance / physiology
Lipid Metabolism*
Pregnancy / metabolism*
Chemical
Reg. No./Substance:
0/Dietary Carbohydrates; 0/Dietary Fats

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Protein metabolism in pregnancy.
Next Document:  Essential fatty acids in mothers and their neonates.