Question

Discuss the effects of pregnancy on maternal metabolism. For carbohydrate, what are the “diabetogenic effects of pregnancy” and what are strategies to deal with insulin resistance when it develops?

Answer 1

During pregnancy two things happen

1. Increase episodes of hypoglycemia
2. Increase insulin resistance

Increase episodes of hypoglycemia in between meals:

1. There is increased utilization of glucose by the developing fetus.
2. This is more evident during sleep and in-between meals
3. This is because the fetus keeps utilizing the maternal blood glucose

Increase insulin resistance:

1. During the 2nd and the 3rd trimester, there is increased secretion of anti-insulin hormones
   1. Human placental lactogen
   2. Cortisol
   3. Prolactin
   4. Growth hormone
   5. Estrogen
   6. Progesterone
2. This increases insulin resistance. This, in turn, leads to
   1. High postprandial glucose
   2. The low renal threshold for glucose, increase glycosuria
   3. Glucose cannot enter into cells (muscle
   4. This leads to hyperglycemia

Strategies to deal with insulin resistance

Before pregnancy:

• Take a healthy balanced diet
• If overweight, then consider weight reduction.
• Regular exercise.
• If there is a familial history of diabetes or history of gestational diabetes in self or giving birth to a baby who was > 3kgs, regular screening for diabetes with fasting blood glucose and HbA1c ( this test helps to understand the level of glucose control in the past 3 months)

During pregnancy:

• Blood glucose testing at 24 weeks
• Balanced diet at least times 6 times day ( small meals)
• Restrict the total percentage of glucose to 35 -40% of total caloric intake.
• Calcium and Vitamin D supplementation.
• Insulin therapy - basal ( to take care of fasting blood glucose levels) and bolus regime ( to take care of postprandial surge in glucose)
• Some oral drugs can also be used - like glyburide & metformin