Page 169 - PCC07

Insulin resistance and pregnancy: physiological aspects
Puberty
• growth for the individuals
Pregnancy
• growth for the fetuses
Catalano PM, Am J Obstet Gynecol 1995; Jaquiery Obstetrics & Gynecology 2009
A key adaptation to pregnancy involves the development of insulin resistance in peripheral tissues, predominantly muscle, resulting in decreased maternal tissue glucose uptake, and thus greater glucose availability to the conceptus.
Pregnancy: metabolic changes
EARLY GESTATION:
• adipose tissue accretion
• increase in insulin secretion
• insulin sensitivity is unchanged, decreased, or may
even increase
LATE GESTATION:
• •
• •
maternal adipose tissue depots decline
facilitated lipolysis, which increases postprandial free fatty acid (FFA) levels
increased hepatic glucose production
insulin-mediated glucose disposal worsens by 40– 60% compared with prepregnancy, thus promoting a state of severe insulin-resistance
Catalano PM, Am J Physiol 1993 Catalano PM, Am J Obstet Gynecol 1999 Friedman JE, Diabetes 1999
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PRECONGRESS COURSE 07 I BARCELONA, SPAIN – 1 JULY 2018 169