Gestational Diabetes: Problems in Classification and Implications for Long-Range Prognosis

  • Norbert Freinkel
  • Boyd E. Metzger
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 189)


Pregnancy is the quintessential anabolic event. An accretion of maternal mass consisting largely of fat characterizes the first half of pregnancy; a massive accumulation of new cells coincident with the maturation and full development of the conceptus occurs during the second.? As with all anabolic events, these processes are attended by major changes in insulin economy. During the latter half of pregnancy, the response to exogenous insulin is blunted; basal plasma levels of endogenous insulin increase; and glycemic challenge elicits a two to threefold greater release of insulin than under nongravid conditions.7 The basis for the heightened resistance to insulin action has not been clarified completely. However, within the last few years, four laboratories have independently reported that it cannot be ascribed to a reduction in the number or affinity of insulin receptors. 26,36,37,41,42 In our own Unit, Baumann and colleagues compared the same normal women, pre-and postpartum, to assess these relationships36 (Fig. 1). They demonstrated that insulin binding to monocytes and red blood cells at the time of the insulin resistance of late pregnancy is the same or slightly greater than during the luteal phase of the normal menstrual cycle. The lack of change in insulin receptors, in the absence of pre-receptor antagonists to insulin action, clearly indicts postreceptor phenomena in the insulin resistance of late normal gestation. The striking alterations in intermediary metabolism that normally occur at this time may be implicated.


Gestational Diabetes Mellitus Fast Plasma Glucose Oral Glucose Tolerance Test Gestational Diabetes Late Pregnancy 
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Copyright information

© Springer Science+Business Media New York 1985

Authors and Affiliations

  • Norbert Freinkel
    • 1
  • Boyd E. Metzger
    • 1
  1. 1.Center for Endocrinology, Metabolism and NutritionNorthwestern University Medical SchoolChicagoUSA

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