Question

The relationship between diabetes mellitus and pregnancy. How metabolism of food is altered during early pregnancy and late pregnancy is slightly confusing to me. I didn’t quite understand how the insulin is affected during this time. PLEASE INCLUDE THE REFERENCE

Answer 1

1) Ans)
Diabetes During Pregnancy

Diabetes is a condition in which the body can't make enough insulin, or can't use insulin normally. Insulin is a hormone. It helps sugar (glucose) in the blood get into cells of the body to be used as fuel. When glucose can’t enter the cells, it builds up in the blood. This leads to high blood sugar (hyperglycemia).

High blood sugar can cause problems all over the body. It can damage blood vessels and nerves. It can harm the eyes, kidneys, and heart. In early pregnancy, high blood sugar can lead to birth defects in a growing baby.

Gestational diabetes. This is a condition in which the blood glucose level goes up and other diabetic symptoms appear during pregnancy in a woman who has not been diagnosed with diabetes before. It happens in about 3 in 100 to 9 in 100 pregnant women.

Some women have diabetes before they get pregnant. This is called pregestational diabetes. Other women may get a type of diabetes that only happens in pregnancy. This is called gestational diabetes. Pregnancy can change how a woman's body uses glucose. This can make diabetes worse, or lead to gestational diabetes.

During pregnancy, an organ called the placenta gives a growing baby nutrients and oxygen. The placenta also makes hormones. In late pregnancy, the hormones estrogen, cortisol, and human placental lactogen can block insulin. When insulin is blocked, it’s called insulin resistance. Glucose can't go into the body’s cells. The glucose stays in the blood and makes the blood sugar levels go up

Pregnancy is a complex metabolic state that involves dramatic alterations in the hormonal milieu in addition to changes in adipocytes and inflammatory cytokines. There are high levels of estrogen, progesterone, prolactin, cortisol, human chorionic gonadotropin, placental growth hormone, human chorionic somatomammotropin (human placental lactogen), leptin, TNFα, and oxidative stress biomarkers. In addition decreases in adiponectin worsen maternal insulin resistance in the second trimester, in order to facilitate fuel utilization by the conceptus

✓There is even data that the maternal human intestinal microbiome dramatically changes to an “obesigenic” microbiome from the first to third trimester.
✓ Remarkably, transfer of the human third trimester microbiome to a sterile mouse results in obesity, likely due to changes in the proportion of energy-harvesting bacteria and production of LPS (lipoprotein saccharide), an endotoxin that can leak out of the maternal gut and result in inflammation and further insulin resistance.

✓In late pregnancy, the hormones estrogen, cortisol, and human placental lactogen can block insulin. When insulin is blocked, it's called insulin resistance. Glucose can't go into the body's cells. The glucose stays in the blood and makes the blood sugar levels go up.
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