Glucose Metabolism in

Pregnancy

• Normal Pregnancy - DIABETOGENIC STATE

• Increase in Plasma Glucose levels

• Increase Insulin Resistance

Glucose Metabolism
in Pregnancy
• Early Pregnancy - ANABOLIC STATE

• Increase in Maternal Fat Storage

• Decrease Free Fatty Acid Conc.

• Decrease in Insulin Requirements

 AS PREGNANCY
ADVANCES…

• Progressive increase in tissue resistance to

Insulin

• Insulin Desensitisation: Increased Prolactin,

Cortisol, HCS, Placental Growth Hormone, TNF-
alpha. Skeletal Muscle shows reduced insulin
receptor activation
 How Pancreas React
• Increased Insulin secretion to maintain
Euglycemia {3 Times more Insulin secreted}

• This is called Plasticity of Beta Cells and is the

hallmark feature of Normal glucose homeostasis
during pregnancy.

• 95% women - compensation works, 5% women

- get GDM
 CONGENITAL
ABNORMALITIES

• Embryopathy

• Hyperglycemia-induced teratogenesis - Glucose

is a proven teratogen and interfere with
development of embryo or fetus.
 Macrosomia
in GDM
• Macrosimia Risk: Poorly controlled diabetes,
maternal obesity, and excessive maternal weight
gain. Why?

• Hyperglycemia in the fetus —> stimulation of

insulin, insulinlike growth factors, growth hormone,
and other growth factors, —> stimulate fetal
growth and deposition of fat and glycogen —
>Macrosomia

• Large for Gestational Age {LGA}

Summarise

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