Trying to understand gestational diabetes.
Trying to understand gestational diabetes.
复制标题
DOI：
10.1111/dme.12381
复制
发表时间：
2014-03
期刊：
影响因子：
--
通讯作者：
Catalano PM
中科院分区：
文献类型：
--
作者：
Catalano PM
与糖耐量正常的女性相比，妊娠前糖耐量正常的女性和妊娠晚期发生妊娠糖尿病的女性在受孕前存在亚临床代谢功能障碍。由于正常妊娠时胰岛素敏感性降低60%，这些妇女在妊娠晚期发生临床高血糖症/妊娠期糖尿病。代谢功能障碍包括胰岛素应答受损、胰岛素输注期间肝脏对葡萄糖产生的抑制降低和骨骼肌中胰岛素刺激的葡萄糖摄取降低，即外周胰岛素抵抗。正常糖耐量妊娠中的胰岛素抵抗与受体后胰岛素信号级联反应的减少有关，特别是胰岛素受体底物1酪氨酸磷酸化的减少。在葡萄糖耐量正常的女性中，这在产后逆转。相反，在妊娠期糖尿病中，除了胰岛素受体底物1酪氨酸磷酸化的减少之外，还存在与胰岛素受体蛋白含量无关的胰岛素受体细胞内部分的酪氨酸磷酸化的额外减少。妊娠期糖尿病的产后妇女，妊娠期体重增加，胰岛素敏感性没有显著改善，炎症增加，表现为血浆和骨骼肌肿瘤坏死因子α增加。增加的炎症或间质炎症是肥胖的标志，并且在妊娠期间在白色脂肪组织和胎盘中发展。最新的胎盘基因阵列研究与妊娠期糖尿病与1型糖尿病相比主要与脂质相关的基因表达改变相关，而与葡萄糖代谢途径相反。未来的研究旨在通过各种生活方式和营养干预来减少怀孕前和怀孕期间的炎症。
Women with normal glucose tolerance pre-gravid and developing gestational diabetes in late gestation have subclinical metabolic dysfunction prior to conception compared with women with normal glucose tolerance. Because of the 60 % decrease in insulin sensitivity with normal pregnancy, these women develop clinical hyperglycaemia/gestational diabetes in late gestation. The metabolic dysfunction includes impaired insulin response, decreased hepatic suppression of glucose production during insulin infusion and decreased insulin-stimulated glucose uptake in skeletal muscle, i.e. peripheral insulin resistance. The insulin resistance in normal glucose tolerance pregnancy is related to a decrease in the post-receptor insulin signalling cascade, specifically decreased insulin receptor substrate 1 tyrosine phosphorylation. In women with normal glucose tolerance this is reversed post-partum. In contrast, in gestational diabetes, in addition to the decrease in insulin receptor substrate 1 tyrosine phosphorylation, there is an additional decrease in tyrosine phosphorylation of the intracellular portion of the insulin receptor that is not related to the insulin receptor protein content. Post-partum women with gestational diabetes, who had retention of gestational weight gain, had no significant improvement in insulin sensitivity and increased inflammation expressed as increased plasma and skeletal muscle tumour necrosis factor alpha. The increased inflammation or meta-inflammation is a hallmark of obesity and during pregnancy develops in both white adipose tissue and placenta. Last gene array studies of placenta were associated with alterations in gene expression relating primarily to lipid in contrast to glucose metabolic pathways in gestational diabetes compared with Type 1 diabetes. Future studies are directed at decreasing inflammation prior to and during pregnancy using various lifestyle and nutritional interventions.
登录
查看更多内容
影响因子：
9.8
作者：
Catalano PM;Hauguel-De Mouzon S
通讯作者：
Hauguel-De Mouzon S
DOI：
10.1016/0002-9378(86)90155-9
发表时间：
1986-12-01
影响因子：
9.8
作者：
CATALANO, PM;BERNSTEIN, IM;SIMS, EAH
通讯作者：
SIMS, EAH
影响因子：
7.7
作者：
Friedman, JE;Ishizuka, T;Catalano, P
通讯作者：
Catalano, P
影响因子：
7.7
作者：
POSNER, BI
通讯作者：
POSNER, BI
影响因子：
7.7
作者：
Friedman, Jacob E.;Kirwan, John P.;Catalano, Patrick M.
通讯作者：
Catalano, Patrick M.