Gestational Diabetes and Maternogenic Preeclampsia: By-products of the Accelerated Metabolic Syndrome in Pregnancy

Abstract

The changes driven by feto-placental unit in maternal organism, tantamount to a cardiovascular and metabolic stress test. The adaptative mechanisms that accommodate energy and nutritional requirements for the placenta and the fetus modify glucose-insulin balance as well as gluconeogenesis and lipid metabolism. The microbiota follows the same purpose. When these changes meet with an unbalanced diet, as typical as the Western supermarket diet, adaptative mechanisms turn into an accelerated metabolic syndrome. Unfortunately, this condition adds its risk factors to the pro-inflammatory TH1 milieu of late gestation. In fact, in late gestation villi crowding and reduced intervillous space produce an oxidative stress similar to that produced since early gestation in the case of shallow trophoblastic invasion (i.e., preeclampsia associated with fetal growth restriction). Decidual vascular atherosis might be nurtured by dyslipidemia of metabolic syndrome to an even worse intervillous perfusion. Increased venous abdominal pressure is enhanced by visceral fat and multiplies its impact on renal venous pressure and the renin-angiotensin-aldosterone balance. All these factors conjure to damage either the energy metabolism (gestational diabetes) or the endothelial function into hypertension and various end-organ damage (preeclampsia with normal grown fetus).

This insight might turn upside and become an opportunity of lifestyle changes. Macro-ethnicity, cultural values, nutritional traditions and family habits, individual intolerance to food, lactose non-persistence, gastrointestinal signs and symptoms – all these elements should be investigated and become the background for nutritional and lifestyle advice to tackle present and future health risks for the mother, her health in advanced age, the fetus and the future adult.