Pociążowe zaburzenia metabolizmu glukozy

Ewa Otto-Buczkowska

Summary
Normal pregnancy is associated with reduced insulin sensitivity. Gestational diabetes mellitus (GDM) occurs when insulin secretion is insufficient to compensate for the insulin resistance of pregnancy.
GDM is characterized by increased CRP (C Reactive Protein) concentration and low levels of adiponectin in pregnancy and in the postpartum. Importantly, antepartum hypoadiponectinemia predicts postpartum insulin resistance, β-cell dysfunction, and fasting glycaemia.
The diagnosis of GDM should initiate monitoring of glucose tolerance to minimize the risk of developing overt diabetes. Any degree of abnormal glucose homeostasis in pregnancy independently predicts an increased risk of glucose intolerance postpartum. A family history of diabetes increase this risk.
Women who develop diabetes during pregnancy are at significant risk of developing type 2 diabetes later in life.
Gestational diabetes possibly be present in women with maturity onset diabetes of the young (MODY) or in early phase type LADA diabetes.
In view of the potential for early, effective prevention of DM, the optimal method for detecting glucose abnormalities in women within six months post partum is a 2-hour OGTT. Insulin resistance can be estimate by HOMA index of insulin resistance HOMA-IR.

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