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On the decrease of glucose tolerance in pregnancy. A review.

P J Hornnes

    Diabete & Metabolisme
    |October 1, 1985
    PubMed
    Summary

    Pregnancy alters glucose metabolism, increasing insulin but causing insulin resistance. Hormonal changes and higher cortisol levels contribute to impaired glucose tolerance, affecting both normal and gestational diabetes pregnancies.

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    Area of Science:

    • Endocrinology
    • Metabolic Physiology
    • Reproductive Biology

    Background:

    • Normal pregnancy and gestational diabetes mellitus (GDM) are associated with impaired glucose tolerance.
    • Understanding the hormonal and physiological changes is crucial for managing these conditions.

    Purpose of the Study:

    • To review the pathogenesis of altered glucose metabolism during pregnancy.
    • To examine modifications in glucagon and insulin secretion and action.

    Main Methods:

    • Review of existing literature on glucagon and insulin dynamics in pregnancy.
    • Analysis of hormonal influences (progesterone, estradiol, hPL, prolactin, cortisol) on glucose metabolism.
    • Examination of animal and human studies on pancreatic beta-cell function.

    Main Results:

    • Fasting glucagon is elevated in pregnancy; its suppression after glucose is enhanced.
    • Insulin levels and secretion are significantly increased in pregnancy, especially in overweight GDM patients.
    • Pregnancy is characterized by insulin resistance, potentially due to postreceptor defects linked to elevated cortisol.

    Conclusions:

    • Altered glucagon secretion is secondary to glucose levels, while increased insulin response is hormone-driven.
    • Despite enhanced insulin secretion, pregnancy induces insulin resistance.
    • Cortisol may play a role in pregnancy-induced insulin resistance and decreased glucose tolerance.

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