Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, and the Comprehensive Diabetes Center, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
Ann N Y Acad Sci. 2018 Jan;1411(1):120-139. doi: 10.1111/nyas.13552.
Pregnancy places acute demands on maternal physiology, including profound changes in glucose homeostasis. Gestation is characterized by an increase in insulin resistance, counterbalanced by an adaptive increase in pancreatic β cell production of insulin. Failure of normal adaptive responses of the islet to increased maternal and fetal demands manifests as gestational diabetes mellitus (GDM). The gestational changes and rapid reversal of islet adaptations following parturition are at least partly driven by an anticipatory program rather than post-factum compensatory adaptations. Here, I provide a comprehensive review of the cellular and molecular mechanisms underlying normal islet adaptation during pregnancy and how dysregulation may lead to GDM. Emerging areas of interest and understudied areas worthy of closer examination in the future are highlighted.
妊娠对母体生理学提出了迫切要求，包括葡萄糖稳态的深刻变化。妊娠的特征是胰岛素抵抗增加，同时胰岛β细胞产生胰岛素的适应性增加来与之抗衡。当胰岛对增加的母胎需求的正常适应性反应失败时，就会表现为妊娠期糖尿病（GDM）。分娩后，胰岛适应的变化和快速逆转至少部分是由预期程序驱动的，而不是事后补偿性适应。在这里，我全面回顾了妊娠期间正常胰岛适应的细胞和分子机制，以及失调如何导致 GDM。突出了未来值得更密切关注的新兴研究领域和研究不足的领域。
