Role of Insulin Resistance in Gestational Diabetes Mellitus: A Literature Review
Abstract
Several physiologic, hormonal, and molecular processes contribute to the emergence of hyperglycaemia during pregnancy. Increased insulin resistance is seen during the course of a healthy pregnancy. During the early stages of normal pregnancies, the pancreatic β-cells secrete more insulin, which slows the rise in plasma glucose levels. This regulation explains the abnormally modest increases in plasma glucose levels brought on by elevated insulin resistance. The aim of this review was to evaluate the role of insulin resistance in gestational diabetes mellitus (GDM). The authors extensively searched various electronic databases like PubMed, Scopus, and Google Scholar for the collection of material regarding the role of insulin resistance in GDM. It was seen that hyperglycaemia results from the combination of the pregnancy’s increased insulin tolerance and pancreatic beta-cell insufficiency. Scientific studies have revealed that individuals who present with GDM are more likely to acquire chronic insulin resistance because of the superimposition of lower insulin production by the cells in that condition (GDM). Due to their significance in the development of postpartum diabetes mellitus, inflammation markers in GDM have been widely researched. Inflammation during GDM induces adaptive reactions in the placenta, which can have a substantial effect on the programming of foetal development.
How to cite this article:
Ara I, Maqbool M, Gani I. Role of Insulin Resistance in Gestational Diabetes Mellitus: A Literature Review. Chettinad Health City Med J. 2022;11(2):69-74.
DOI: https://doi.org/10.24321/2278.2044.202218
References
HAPO Study Cooperative Research Group. The hyperglycemia and adverse pregnancy outcome (HAPO) study. Int J Gynecol Obstet. 2002;78:69-77. [Google Scholar]
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477-86. [PubMed] [Google Scholar]
Biswas T, Uddin MJ, Mamun AA, Pervin S, Garnett SP. Increasing prevalence of overweight and obesity in Bangladeshi women of reproductive age: findings from 2004 to 2014. PloS One. 2017;12:e0181080. [PubMed] [Google Scholar]
Balarajan Y, Villamor E. Nationally representative surveys show recent increases in the prevalence of overweight and obesity among women of reproductive age in Bangladesh, Nepal, and India. J Nutr. 2009;139:2139-44. [PubMed] [Google Scholar]
Kühl C. Insulin secretion and insulin resistance in pregnancy and GDM: implications for diagnosis and management. Diabetes. 1991;40:18-24. [PubMed] [Google Scholar]
Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EA. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol. 1991;165:1667-72. [PubMed] [Google Scholar]
Moyce BL, Dolinsky VW. Maternal β-cell adaptations in pregnancy and placental signalling: implications for gestational diabetes. Int J Mol Sci. 2018;19:3467. [PubMed] [Google Scholar]
Phelps RL, Metzger BE, Freinkel N. Carbohydrate metabolism in pregnancy: XVII. Diurnal profiles of plasma glucose, insulin, free fatty acids, triglycerides, cholesterol, and individual amino acids in late normal pregnancy. Am J Obstet Gynecol. 1981;140:730-6. [PubMed] [Google Scholar]
Catalano PM, Kirwan JP, Haugel-de Mouzon S, King J. Gestational diabetes and insulin resistance: role in short- and long-term implications for mother and fetus. J Nutr. 2003;133:1674S-83S. [PubMed] [Google Scholar]
Dirar AM, Doupis J. Gestational diabetes from A to Z. World J Diabetes. 2017;8:489. [PubMed] [Google Scholar]
Ryan EA, Enns L. Role of gestational hormones in the induction of insulin resistance. J Clin Endocrinol Metab. 1988;67:341-7. [PubMed] [Google Scholar]
Sonagra AD, Biradar SM, Dattatreya K, Murthy JD. Normal pregnancy-a state of insulin resistance. J Clin Diagn Res. 2014;8:CC01. [PubMed] [Google Scholar]
Briana DD, Malamitsi-Puchner A. Reviews: adipocytokines in normal and complicated pregnancies. Reprod Sci. 2009;16:921-37. [PubMed] [Google Scholar]
Wada T, Hori S, Sugiyama M, Fujisawa E, Nakano T, Tsuneki H, Nagira K, Saito S, Sasaoka T. Progesterone inhibits glucose uptake by affecting diverse steps of insulin signaling in 3T3-L1 adipocytes. Am J Physiol Endocrinol Metab. 2010;298:E881-8. [PubMed] [Google Scholar]
Handwerger S, Freemark M. The roles of placental growth hormone and placental lactogen in the regulation of human fetal growth and development. J Pediatr Endocrinol Metab. 2000;13:343-56. [PubMed] [Google Scholar]
Beck P, Daughaday WH. Human placental lactogen: studies of its acute metabolic effects and disposition in normal man. J Clin Invest. 1967;46:103-10. [PubMed] [Google Scholar]
Worda C, Leipold H, Gruber C, Kautzky-Willer A, Knöfler M, Bancher-Todesca D. Decreased plasma adiponectin concentrations in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2004;191:2120-4. [PubMed] [Google Scholar]
Frost RA, Lang CH. Skeletal muscle cytokines: regulation by pathogen-associated molecules and catabolic hormones. Curr Opin Clin Nutr Metab Care. 2005;8:255-63. [PubMed] [Google Scholar]
Kirwan JP, Mouzon SH, Lepercq J, Challier JC, Huston-Presley L, Friedman JE, Kalhan SC, Catalano PM. TNF-α is a predictor of insulin resistance in human pregnancy. Diabetes. 2002;51:2207-13. [PubMed] [Google Scholar]
McLachlan KA, O’Neal D, Jenkins A, Alford FP. Doadiponectin, TNFα, leptin and CRP relate to insulin resistance in pregnancy? Studies in women with and without gestational diabetes, during and after pregnancy. Diabetes Metab Res Rev. 2006;22:131-8. [PubMed] [Google Scholar]
Altinova AE, Toruner F, Bozkurt N, Bukan N, Karakoc A, Yetkin I, Ayvaz G, Cakir N, Arslan M. Circulating concentrations of adiponectin and tumor necrosis factor-α in gestational diabetes mellitus. Gynecol Endocrinol. 2007;23:161-5. [PubMed] [Google Scholar]
Xu J, Zhao YH, Chen YP, Yuan XL, Wang J, Zhu H, Lu CM. Maternal circulating concentrations of tumor necrosis factor-alpha, leptin, and adiponectin in gestational diabetes mellitus: a systematic review and metaanalysis. ScientificWorldJournal. 2014;2014:926932. [PubMed] [Google Scholar]
Rabe K, Lehrke M, Parhofer KG, Broedl UC. Adipokines and insulin resistance. Mol Med. 2008;14:741-51. [PubMed] [Google Scholar]
Fuglsang J, Lauszus F, Flyvbjerg A, Ovesen P. Human placental growth hormone, insulin-like growth factor I and-II, and insulin requirements during pregnancy in type 1 diabetes. J Clin Endocrinol Metab. 2003;88:5042. [PubMed] [Google Scholar]
Zehravi M, Maqbool M, Ara I. Polycystic ovary syndrome and infertility: an update. Int J Adolesc Med Health. 2022;34:1-9. [PubMed] [Google Scholar]
MacLeod JN, Worsley I, Ray J, Friesen HG, Liebhaber SA, Cooke NE. Human growth hormone-variant is a biologically active somatogen and lactogen. Endocrinology. 1991;128:1298-302. [PubMed] [Google Scholar]
Barbour LA. Metabolic culprits in obese pregnancies and gestational diabetes mellitus: big babies, big twists, big picture: The 2018 Norbert Freinkel Award Lecture. Diabetes Care. 2019;42:718-26. [PubMed] [Google Scholar]
McIntyre HD, Chang AM, Callaway LK, Cowley DM, Dyer AR, Radaelli T, Farrell KA, Huston-Presley L, Amini SB, Kirwan JP, Catalano PM; Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hormonal and metabolic factors associated with variations in insulin sensitivity in human pregnancy. Diabetes Care. 2010;33:356-60. [PubMed] [Google Scholar]
McIntyre HD, Serek R, Crane DI, Veveris-Lowe T, Parry A, Johnson S, Leung KC, Ho KK, Bougoussa M, Hennen G, Igout A, Chan FY, Cowley D, Cotterill A, Barnard R. Placental growth hormone (GH), GH-binding protein, and insulin-like growth factor axis in normal, growthretarded, and diabetic pregnancies: correlations with fetal growth. J Clin Endocrinol Metab. 2000;85:1143-50. [PubMed] [Google Scholar]
Fuglsang J, Ovesen P. Aspects of placental growth hormone physiology. Growth Horm IGF Res. 2006;16:67-85. [PubMed] [Google Scholar]
Zehravi M, Maqbool M, Ara I. Correlation between obesity, gestational diabetes mellitus, and pregnancy outcomes: an overview. Int J Adolesc Med Health. 2021;33(6):339-45. [PubMed] [Google Scholar]
Monget P, Oxvig C. PAPP-A and the IGF system. Ann Endocrinol. 2016;77(2):90-6. [PubMed] [Google Scholar]
Zehravi M, Maqbool M, Ara I. Polycystic ovary syndrome and reproductive health of women: a curious association. Int J Adolesc Med Health. 2021;33(6):333-7. [PubMed] [Google Scholar]
Fuglsang J, Sandager P, Møller N, Fisker S, Orskov H, Ovesen P. Kinetics and secretion of placental growth hormone around parturition. Eur J Endocrinol. 2006;154(3):449-57. [PubMed] [Google Scholar]
Lønberg U, Damm P, Andersson AM, Main KM, Chellakooty M, Lauenborg J, Skakkebaek NE, Juul A. Increase in maternal placental growth hormone during pregnancy and disappearance during parturition in normal and growth hormone-deficient pregnancies. Am J Obstet Gynecol. 2003;188:247-51. [PubMed] [Google Scholar]
Roeder HA, Moore TR, Ramos GA. Changes in postpartum insulin requirements for patients with well-controlled type 1 diabetes. Am J Perinatol. 2016;33(7):683-7. [PubMed] [Google Scholar]
Zehravi M, Maqbool M, Ara I. Healthy lifestyle and dietary approaches to treating polycystic ovary syndrome: a review. Open Health. 2022;3:60-5. [Google Scholar]
Clark CM, Qiu C, Amerman B, Porter B, Fineberg N, Aldasouqi S, Golichowski A. Gestational diabetes: should it be added to the syndrome of insulin resistance? Diabetes Care. 1997;20:867-71. [PubMed] [Google Scholar]
Catalano PM. Carbohydrate metabolism and gestational diabetes. Clin Obstet Gynecol. 1994;37:25-38. [PubMed] [Google Scholar]
Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005;115:485-91. [PubMed] [Google Scholar]
Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018;19:3342. [PubMed] [Google Scholar]
Solomon CG, Willett WC, Carey VJ, Rich-Edwards J, Hunter DJ, Colditz GA, Stampfer MJ, Speizer FE, Spiegelman D, Manson JE. A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA. 1997;278:1078-83. [PubMed] [Google Scholar]
Biri A, Onan A, Devrim E, Babacan F, Kavutcu M, DurakI. Oxidant status in maternal and cord plasma and placental tissue in gestational diabetes. Placenta. 2006;27:327-32. [PubMed] [Google Scholar]
Coughlan MT, Vervaart PP, Permezel M, Georgiou HM, Rice GE. Altered placental oxidative stress status in gestational diabetes mellitus. Placenta. 2004;25:78-84. [PubMed] [Google Scholar]
Madazlı R, Tuten A, Calay Z, Uzn H, Uludag S, Ocak V. The incidence of placental abnormalities, maternal and cord plasma malondialdehyde and vascular endothelial growth factor levels in women with gestational diabetes mellitus and nondiabetic controls. Gynecol Obstet Invest. 2008;65:227-32. [PubMed] [Google Scholar]
Radaelli T, Varastehpour A, Catalano P, Mouzon SH. Gestational diabetes induces placental genes for chronic stress and inflammatory pathways. Diabetes. 2003;52:2951-8. [PubMed] [Google Scholar]
Enquobahrie DA, Williams MA, Qiu C, Meller M, Sorenson TK. Global placental gene expression in gestational diabetes mellitus. Am J Obstet Gynecol. 2009;200:206. [PubMed] [Google Scholar]
Toescu V, Nuttall SL, Martin U, Nightingale P, Kendall MJ, Brydon P, Dunne F. Changes in plasma lipids and markers of oxidative stress in normal pregnancy and pregnancies complicated by diabetes. Clin Sci. 2004;106:93-8. [PubMed] [Google Scholar]
Lappas M, Mittion A, Permezel M. In response to oxidative stress, the expression of inflammatory cytokines and antioxidant enzymes are impaired in placenta, but not adipose tissue, of women with gestational diabetes. J Endocrinol. 2010;204:75. [PubMed] [Google Scholar]
Wolf M, Sauk J, Shah A, Smirnakis KV, Jimenez-Kimble R, Ecker JL, Thadhani R. Inflammation and glucose intolerance: a prospective study of gestational diabetes mellitus. Diabetes Care. 2004;27:21-7. [PubMed] [Google Scholar]
Heitritter SM, Solomon CG, Mitchell GF, Skali-Ounis N, Seely EW. Subclinical inflammation and vascular dysfunction in women with previous gestational diabetes mellitus. J Clin Endocrinol Metab. 2005;90:3983-8. [PubMed] [Google Scholar]
Myatt L, Kossenjans W, Sahay R, Eis A, Brockman D. Oxidative stress causes vascular dysfunction in the placenta. J Matern Fetal Med. 2000;9:79-82. [PubMed] [Google Scholar]
Redinger RN. The pathophysiology of obesity and its clinical manifestations. Gastroenterol Hepatol. 2007;3:856. [PubMed] [Google Scholar]
