Skip to main content Accessibility help
×
Home
Hostname: page-component-544b6db54f-dkqnh Total loading time: 0.466 Render date: 2021-10-25T08:07:53.443Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

5 - Potential mechanisms contributing to gestational diabetes and pre-eclampsia in the obese woman

from Section 2 - Pregnancy outcome

Published online by Cambridge University Press:  05 August 2012

Matthew W. Gillman
Affiliation:
Harvard Medical School
Lucilla Poston
Affiliation:
King's College London
Get access

Summary

Introduction

The previous chapter and prior reviews demonstrate clear associations between maternal obesity and a range of pregnancy complications. Chief among these are gestational diabetes mellitus (GDM) and pre-eclampsia (PE), but other complications are also overrepresented including greater miscarriage risk, more cesarean sections, and even a heightened risk for intrauterine growth restriction (IUGR). The present chapter will discuss potential mechanisms linking obesity to GDM and PE. It will discuss postulated pathways, particularly for the obesity–PE link, and will show that many of these causal inferences are generally unfounded or exaggerated. The chapter will also provide a framework for future studies and describe potential strategies whereby the causal pathways may be explored.

Obesity and GDM

The strong epidemiological association between obesity and type 2 diabetes mellitus (T2DM) is well described [1]. Similarly, as noted in the previous chapter, the same is also true for the obesity–GDM link. However, in recent years our understanding of the mechanisms linking obesity to diabetes in the non-pregnant arena has advanced considerably. A brief description of this highly relevant background is helpful for subsequent considerations of the pathways linking obesity to GDM.

Type
Chapter
Information
Maternal Obesity , pp. 45 - 55
Publisher: Cambridge University Press
Print publication year: 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Eckel, R H Kahn, S E Ferrannini, E Obesity and type 2 diabetes: what can be unified and what needs to be individualized? J Clin Endocrinol Metab 2011 96 1654 Google Scholar
Cusi, K. The role of adipose tissue and lipotoxicity in the pathogenesis of type 2 diabetes Curr Diab Rep 2010 10 306 Google Scholar
Huang-Doran, I Sleigh, A Rochford, J J Lipodystrophy: metabolic insights from a rare disorder J Endocrinol 2011 207 245 Google Scholar
Stefan, N Kantartzis, K Machann, J Identification and characterization of metabolically benign obesity in humans Arch Intern Med 2008 168 1609 Google Scholar
Cleland, S J Sattar, N. Impact of ethnicity on metabolic disturbance, vascular dysfunction and atherothrombotic cardiovascular disease Diabetes Obes Metab 2005 7 463 Google Scholar
Taylor, R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause Diabetologia 2008 51 1781 Google Scholar
Preiss, D Sattar, N. Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations Clin Sci (Lond) 2008 115 141 Google Scholar
Stefan, N Kantartzis, K Haring, H U Causes and metabolic consequences of fatty liver Endocr Rev 2008 29 939 Google Scholar
Hotamisligil, G S Erbay, E. Nutrient sensing and inflammation in metabolic diseases Nat Rev Immunol 2008 8 923 Google Scholar
Lim, E L Hollingsworth, K G Aribisala, B S Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol Diabetologia 2011 54 2506 Google Scholar
Sjostrom, L Lindroos, A K Peltonen, M Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery N Engl J Med 2004 35 2683 Google Scholar
Timpson, N J Lawlor, D A Harbord, R M C-reactive protein and its role in metabolic syndrome: mendelian randomisation study Lancet 2005 366 1954 Google Scholar
Cook, J R Semple, R K Hypoadiponectinemia – cause or consequence of human “insulin resistance”? J Clin Endocrinol Metab 2010 95 1544 Google Scholar
Mills, J L Jovanovic, L Knopp, R Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: the diabetes in early pregnancy study Metabolism 1998 47 1140 Google Scholar
Catalano, P M Tyzbir, E D Roman, N M Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women Am J Obstet Gynecol 1991 165 1667 Google Scholar
Catalano, P M Drago, N M Amini, S B Longitudinal changes in pancreatic beta-cell function and metabolic clearance rate of insulin in pregnant women with normal and abnormal glucose tolerance Diabetes Care 1998 21 403 Google Scholar
Catalano, P M Hoegh, M Minium, J Adiponectin in human pregnancy: implications for regulation of glucose and lipid metabolism Diabetologia 2006 49 1677 Google Scholar
Sivan, E Homko, C J Whittaker, P G Free fatty acids and insulin resistance during pregnancy J Clin Endocrinol Metab 1998 83 2338 Google Scholar
Sivan, E Boden, G. Free fatty acids, insulin resistance, and pregnancy Curr Diab Rep 2003 3 319 Google Scholar
Sivan, E Chen, X Homko, C J Longitudinal study of carbohydrate metabolism in healthy obese pregnant women Diabetes Care 1997 20 1470 Google Scholar
Catalano, P M Huston, L Amini, S B Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus Am J Obstet Gynecol 1999 180 903 Google Scholar
Ramsay, J E Ferrell, W R Crawford, L Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways J Clin Endocrinol Metab 2002 87 4231 Google Scholar
Stewart, F M Freeman, D J Ramsay, J E Longitudinal assessment of maternal endothelial function and markers of inflammation and placental function throughout pregnancy in lean and obese mothers J Clin Endocrinol Metab 2007 92 969 Google Scholar
Giacca, A Xiao, C Oprescu, A I Lipid-induced pancreatic beta-cell dysfunction: focus on in vivo studies Am J Physiol Endocrinol Metab 2011 300 e255 Google Scholar
Kirwan, J P Hauguel-De Mouzon, S Lepercq, J TNF-alpha is a predictor of insulin resistance in human pregnancy Diabetes 2002 51 2207 Google Scholar
Yudkin, J S Eringa, E Stehouwer, C D Vasocrine” signalling from perivascular fat: a mechanism linking insulin resistance to vascular disease Lancet 2005 365 1817 Google Scholar
Aghamohammadzadeh, R Withers, S B Lynch, F M Perivascular adipose tissue from human systemic and coronary vessels: The emergence of a new pharmacotherapeutic target Br J Pharmacol 2011 Google Scholar
Savvidou, M Nelson, S M Makgoba, M First-trimester prediction of gestational diabetes mellitus: examining the potential of combining maternal characteristics and laboratory measures Diabetes 2010 59 3017 Google Scholar
Sattar, N Wannamethee, S G Forouhi, N G Novel biochemical risk factors for type 2 diabetes: pathogenic insights or prediction possibilities? Diabetologia 2008 51 926 Google Scholar
Prikoszovich, T Winzer, C Schmid, A I Body and liver fat mass rather than muscle mitochondrial function determine glucose metabolism in women with a history of gestational diabetes mellitus Diabetes Care 2011 34 430 Google Scholar
Forbes, S Taylor-Robinson, S D Patel, N Increased prevalence of non-alcoholic fatty liver disease in European women with a history of gestational diabetes Diabetologia 2011 54 641 Google Scholar
Fraser, A Tilling, K MacDonald-Wallis, C Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC) Am J Clin Nutr 2011 93 1285 Google Scholar
Herring, S J Oken, E Rifas-Shiman, S L Weight gain in pregnancy and risk of maternal hyperglycemia Am J Obstet Gynecol 2009 201 61e1 Google Scholar
Whaley-Connell, A Pavey, B S Afroze, A Obesity and insulin resistance as risk factors for chronic kidney disease J Cardiometab Syndr 2006 1 209 Google Scholar
Afshinnia, F Wilt, T J Duval, S Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts Nephrol Dial Transplant 2010 25 1173 Google Scholar
Bodnar, L M Catov, J M Klebanoff, M A Prepregnancy body mass index and the occurrence of severe hypertensive disorders of pregnancy Epidemiology 2007 18 234 Google Scholar
Sattar, N Greer, I A Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening? BMJ 2002 325 157 Google Scholar
Sattar, N Gaw, A Packard, C J Potential pathogenic roles of aberrant lipoprotein and fatty acid metabolism in pre-eclampsia Br J Obstet Gynaecol 1996 103 614 Google Scholar
Endresen, M J Lorentzen, B Henriksen, T. Increased lipolytic activity and high ratio of free fatty acids to albumin in sera from women with preeclampsia leads to triglyceride accumulation in cultured endothelial cells Am J Obstet Gynecol 1992 167 440 Google Scholar
Jarvie, E Hauguel-de-Mouzon, S Nelson, S M Lipotoxicity in obese pregnancy and its potential role in adverse pregnancy outcome and obesity in the offspring Clin Sci (Lond) 2010 119 123 Google Scholar
Freeman, D J McManus, F Brown, E A Short- and long-term changes in plasma inflammatory markers associated with preeclampsia Hypertension 2004 44 708 Google Scholar
Walsh, S W Obesity: a risk factor for preeclampsia Trends Endocrinol Metab 2007 18 365 Google Scholar
Roberts, J M Bodnar, L M Patrick, T E The role of obesity in preeclampsia Pregnancy Hypertens 2011 1 6 Google Scholar
Meher, S Duley, L. Nitric oxide for preventing pre-eclampsia and its complications Cochrane Database Syst Rev 2007 CD006490 Google Scholar
Vadillo-Ortega, F Perichart-Perera, O Espino, S Effect of supplementation during pregnancy with L-arginine and antioxidant vitamins in medical food on pre-eclampsia in high risk population: randomised controlled trial BMJ 2011 342 d2901 Google Scholar
Libby, G Murphy, D J McEwan, N F Pre-eclampsia and the later development of type 2 diabetes in mothers and their children: an intergenerational study from the Walker cohort Diabetologia 2007 50 523 Google Scholar
De Leo, V Musacchio, M C Piomboni, P The administration of metformin during pregnancy reduces polycystic ovary syndrome related gestational complications Eur J Obstet Gynecol Reprod Biol 2011 157 63 Google Scholar
Vanky, E Stridsklev, S Heimstad, R Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study J Clin Endocrinol Metab 2010 95 e448 Google Scholar
Sorensen, T K Williams, M A Lee, I M Recreational physical activity during pregnancy and risk of preeclampsia Hypertension 2003 41 1273 Google Scholar
Talwar, D McConnachie, A Welsh, P Which circulating antioxidant vitamins are confounded by socioeconomic deprivation? The MIDSPAN family study PLoS One 2010 5 1024 Google Scholar
McCance, D R Holmes, V A Maresh, M J Vitamins C and E for prevention of pre-eclampsia in women with type 1 diabetes (DAPIT): a randomised placebo-controlled trial Lancet 2010 376 259 Google Scholar
Rumbold, A Duley, L Crowther, C A Antioxidants for preventing pre-eclampsia Cochrane Database Syst Rev 2008 CD004227 Google Scholar
Bennett, W L Gilson, M M Jamshidi, R Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data BMJ 2010 340 c1662 Google Scholar
Ramsay, J E Jamieson, N Greer, I A Paradoxical elevation in adiponectin concentrations in women with preeclampsia Hypertension 2003 42 891 Google Scholar
Wormser, D Kaptoge, S Di Angelantonio, E Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies Lancet 2011 377 1085 Google Scholar

Send book to Kindle

To send this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats
×

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats
×