Metabolism of the mother, placenta, and fetus in diabetes

Abstract

Metabolic changes occur due to the effects of placental hormones such as human chorionic gonadotropin and human placental lactogen in normal pregnancies. These effects enable the development of insulin resistance among all pregnant women, significantly pronounced in the third trimester. In pregnancies complicated by pre-gestational or gestational diabetes mellitus, these changes are more intensive as they affect the fetoplacental unit. In pregnancies complicated by diabetes the increased number of placental macrophages leads to the increased production of different cytokines which include leptin, tumor necrosis factor alpha, and interleukins. This review addresses placental vascular changes that lead to adverse pregnancy outcomes, along with the effects of the maternal hyperglycemia and fetal hyperinsulinemia.

Keywords: pregnancy; pre-gestational diabetes; gestational diabetes; insulin resistance; placental structural abnormalities