Читать книгу Gestational Diabetes - Группа авторов - Страница 19

During pregnancy, maternal insulin resistance develops, primarily during the second and third trimesters. Placental hormones and adipocytokines contribute to this phenomenon. Insulin resistance allows glucose and amino acid sparing for fetal construction, while the mother utilizes lipolysis for her nutritional needs during fasting.

© 2020 S. Karger AG, Basel

Pregnancy requires that the gravida provide an adequate supply of nutrients and amino acids to build the fetus and prepare for subsequent lactation. Nutrient needs increase as pregnancy progresses and are greatest in the third trimester. Maternal metabolic changes anticipate these needs and initiate the storage of nutrients during early pregnancy, then switch from anabolism to catabolism as pregnancy progresses and energy stores are utilized. Striking modifications of maternal metabolism are necessary to accomplish these ends. Initially, nutrients are stored in body fat, while normal or possibly increased insulin sensitivity favors lipogenesis. Subsequently, increasing insulin resistance favors lipolysis to meet maternal energy needs with sparing of glucose and amino acids for transfer to the fetus. This chapter describes the metabolic adaptations taking place in uncomplicated pregnancy that ensure appropriate fetal nutrition and maternal readiness for lactation.