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Intermediate metabolism in normal pregnancy and in gestational diabetes
Abstract
Complex though integrated hormonal and metabolic changes characterize pregnancy. In the face of progressive decline in insulin action, glucose homeostasis is maintained through a compensatory increase in insulin secretion. This switches energy production from carbohydrates to lipids, making glucose readily available to the fetus. This precise and entangled hormonal and metabolic condition can, however, be disrupted and diabetic hyperglycemia can develop (gestational diabetes). The increase in plasma glucose level is believed to confer significant risk of complications to both the mother and the fetus and the newborn. Moreover, exposition of fetal tissues to the diabetic maternal environment can translate into an increased risk for development of diabetes and/or the metabolic syndrome in the adult life. In women with previous gestational diabetes, the risk of developing type 2 diabetes is greatly enhanced, to the point that GDM represents an early stage in the natural history of type 2 diabetes. In these women, accurate follow-up and prevention strategies are needed to reduce the subsequent development of overt diabetes. This paper will review current knowledge on the modifications occurring in normal pregnancy, while outlining the mechanisms. In this paper, we will review the changes of intermediary metabolism occurring during pregnancy. In particular, we will outline the mechanisms responsible for gestational diabetes; the link between these alterations and associated maternal and neonatal morbidity will be examined.
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“During early gestation, insulin sensitivity increases, promoting the uptake of glucose into adipose stores in preparation for the energy demands of later pregnancy [5].”
From The Pathophysiology of Gestational Diabetes Mellitus (2018) · cites this paper as [5]
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Taşdemir, D., & Aşıcıoğlu, O. (2026) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.4195
Rossenrode, E., van Tonder, A., Lohse, I., Masetla, F. M., Adam, S., Oberholzer, H. M., & van Rooy, M.-J. (2026) · Ultrastructural Pathology · doi:10.1080/01913123.2026.2706777
Kristiansen, O., Henriksen, T., Sajjad, M. U., Reine, T. M., Haugen, G. N., Eskild, A., Haavaldsen, C., & Michelsen, T. M. (2026) · Placenta · doi:10.1016/j.placenta.2026.10.005
Hiersch, L., Amikam, U., Melamed, N., & Hod, M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-13265-0.00010-0
Mu, Q., Jiawei, F. A. N. G., Guangdi, C. H. E. N., & Du, W. (2026) · Journal of Zhejiang University (Medical Sciences) · doi:10.3724/zdxbyxb-2026-0030
Metadata
- Authors
- Di Cianni, G., Miccoli, R., Volpe, L., Lencioni, C., & Del Prato, S.
- Affiliations
- University of Pisa (IT)
- ORCID
- Miccoli, R.
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2003-07
- Volume
- 19
- Issue
- 4
- Pages
- 259-270
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- OpenAlex
- W2129752055
- Cited by
- 406
- References
- 129
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 26 · 2023: 29 · 2022: 30 · 2021: 44 · 2020: 40 · 2019: 24 · 2018: 26 · 2017: 18 · 2016: 21 · 2015: 14 · 2014: 12 · 2013: 10 · 2012: 12
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- gestational diabetes mellitus, intermediary metabolism, pregnancy, glucose homeostasis, insulin resistance, insulin secretion, maternal hyperglycemia, type 2 diabetes risk, metabolic syndrome, maternal and neonatal morbidity, postpartum follow-up
- MeSH terms
- Female, Glucose, Homeostasis, Hormones, Humans, Insulin, Pregnancy, Reference Values, Diabetes, Gestational
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