Insulin therapy and its consequences for the mother, foetus, and newborn in gestational diabetes mellitus

BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR BASIS OF DISEASE

卷:1864

Review

Subiabre, Mario¹  Silva, Luis^1,2  Toledo, Fernando^1,3  Paublo, Mario⁴  Lopez, Marcia A.⁴  Boric, Mauricio P.⁵  Sobrevia, Luis^1,6,7 

[1] Pontificia Univ Catolica Chile, Fac Med, Sch Med, CMPL,Div Obstet & Gynaecol, POB 114-D, Santiago 8330024, Chile

[2] Univ Groningen, UMCG, Dept Pathol & Med Biol, Immunoendocrinol,Div Med Biol, NL-9700 RB Groningen, Netherlands

[3] Univ Bio Bio, Dept Basic Sci, Fac Sci, Chillan 3780000, Peoples R China

[4] Hosp San Juan Dios, Gynaecol & Obstet Serv, Santiago 8330024, Chile

[5] Pontificia Univ Catolica Chile, Fac Biol Sci, Dept Physiol, Santiago 8330024, Chile

[6] Univ Seville, Fac Pharm, Dept Physiol, E-41012 Seville, Spain

[7] Univ Queensland, Fac Med & Biomed Sci, UQCCR, Herston, Qld 4029, Australia

关键词: Diabetes;    Insulin therapy;    Diet;    Human;    Placenta;   

DOI  :  10.1016/j.bbadis.2018.06.005

来源: Elsevier

【 摘 要 】

Gestational diabetes mellitus (GDM) is a disease characterised by glucose intolerance and first diagnosed in pregnancy. This condition relates to an anomalous placental environment and aberrant placental vascular function. GDM-associated hyperglycaemia changes the placenta structure leading to abnormal development and functionality of this vital organ. Aiming to avoid the GDM-hyperglycaemia and its deleterious consequences in the mother, the foetus and newborn, women with GDM are firstly treated with a controlled diet therapy; however, some of the women fail to reach the recommended glycaemia values and therefore they are passed to the second line of treatment, i.e., insulin therapy. The several protocols available in the literature regarding insulin therapy are variable and not a clear consensus is yet reached. Insulin therapy restores maternal glycaemia, but this beneficial effect is not reflected in the foetus and newborn metabolism, suggesting that other factors than D-glucose may be involved in the pathophysiology of GDM. Worryingly, insulin therapy may cause alterations in the placenta and umbilical vessels as well as the foetus and newborn additional to those seen in pregnant women with GDM treated with diet. In this review, we summarised the variable information regarding indications and protocols for administration of the insulin therapy and the possible outcomes on the function and structure of the foetoplacental unit and the neonate parameters from women with GDM.

【 授权许可】

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