Diabetology of Pregnancy (Frontiers in Diabetes) by J. Djelmiš, G. Desoye, M. Ivaniševic, M. Porta, F.M.

By J. Djelmiš, G. Desoye, M. Ivaniševic, M. Porta, F.M. Matschinsky

Tendencies pointed out while estimating worldwide occurrence recommend the realm is dealing with an endemic of diabetes mellitus. as a result a swift raise within the prevalence of gestational diabetes mellitus is anticipated. This quantity offers a accomplished but concise evaluation of the clinical and medical features of gestational diabetes in addition to sort 1 and kind 2 diabetes mellitus while pregnant. through the ebook the authors undertake a multidisciplinary strategy and canopy facets corresponding to etiology, body structure, molecular biology and genetics, immunology, pathogenesis, analysis, therapy and administration, pathology and evidence-based medication. The function of the placenta as a fetal organ on the interface among mom and fetus is roofed extensive. uncomplicated scientists and clinical researchers will locate numerous chapters reviewing the foundation of our knowing of many facets of the sickness starting from maternal endocrinology to fuel-mediated sensible teratogenesis.

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Example text

Adiponectin concentrations were protective against DM2 [24]. In humans plasma adiponectin was found to be associated with skeletal muscle insulin receptor tyrosine phosphorylation. In pregnant women a decrease of adiponectin was shown with increasing insulin resistance in the third trimester and a further decrease in women with IGT or GDM compared to pregnant women with NT even after adjustment for varying degrees of adiposity [25]. In parallel decreased adiponectin mRNA levels were found in abdominal subcutaneous adipose tissue biopsies from women with GDM.

Under normal conditions, during early pregnancy, basal glucose and insulin concentrations do not differ from nongravid values [9], and hepatic gluconeogenesis is unchanged [10]. However, during late pregnancy the mother tends to develop hypoglycemia, which is especially evident during fasting. Indirect studies in women [11] and direct experiments in rats [12] have shown that the rate of gluconeogenesis is enhanced during pregnancy under fasting conditions, the effect being especially manifest when glycerol is the studied substrate [13].

Several closely interrelated pathways have been shown to be involved in the molecular mechanisms of hyperglycemia-induced tissue Metabolism in Diabetic Pregnancy 35 damage: overproduction of reactive oxygen species, activation of protein kinase C isoforms, alteration in arachidonic acid metabolism leading to altered prostaglandin and nitric oxide production, increased hexosamine pathway flux, enhanced formation of advanced glycation end products and increased polyol formation. Distinct from the impaired development that results from poorly controlled diabetes during early pregnancy, events occurring as a result of poor control during the latter two thirds of gestation include accelerated fetal growth and a risk of large-for-gestational age infants, respiratory distress syndrome, neonatal hypoglycemia, neonatal hypocalcemia and neonatal hypomagnesemia.

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