Читать книгу Gestational Diabetes - Группа авторов - Страница 39

Obesity in pregnancy increases the risk for developing GDM by a factor of 3.0 for moderately obese and by 5.6 for morbidly obese women [39]. The prevalence of GDM increases by 0.92% for each unit increase in BMI [39]. Insulin resistance is a hallmark of both obesity and GDM; in skeletal muscle, insulin receptor phosphorylation is reduced by one-third in GDM but there is no change in the number of receptors in lean women, whereas in obese women, both insulin receptor number and phosphorylation are decreased. All pregnant women have reduced quantity and phosphorylation of skeletal muscle insulin receptor substrate 1, the most important and abundant insulin receptor substrate in skeletal muscle. A graphical representation of the mechanisms linking obesity per se (without hyperglycemia) to excess fetal growth is provided in Figure 1. Figure 2 shows potential mechanisms when compensatory insulin secretion is insufficient, leading to hyperglycemia as an added metabolic burden.