The Role of Adipocyte Mediators, Inflammatory Markers and Vitamin D in Gestational Diabetes

Abstract

Gestational diabetes mellitus (GDM) usually reveals itself in the latter half of pregnancy and it is identified by carbohydrate intolerance of variable severity. The presence of GDM has implications for both the mother and the baby. Perinatal morbidity includes macrosomia, hypoglycemia, hyperbilirubinaemia and respiratory distress syndrome which lead to the subsequent complications (Hod et al., 1991). Long term outcomes for the offspring may include obesity and diabetes independent of genetic factors (Silverman et al., 1995; Van Assche et al., 1992, 2001). For the mother there is an increased risk of overt type 2 diabetes later in life (Mestman, 1987; O'Sullivan, 1989). Both type 2 diabetes and gestational diabetes have common pathogenic mechanisms where pregnancy tends to expose disease in those women who are at risk of developing type 2 diabetes later in life. Similar to all forms of hyperglycemia, GDM is characterized by insulin levels that are inadequate to proper insulin requirement (Metzger et al.,2007).The pathogenesis of GDM has not been clearly defined. The most common hypothesis is that GDM is caused by decreasing insulin sensitivity and increasing anti-insulin hormones that are secreted by the placenta during pregnancy, such as human placental lactogen, prolactin, glucocorticoid and progesterone (Xue-lian et al., 2008). It has become increasingly evident that endocrine/metabolic hormones such as leptin, adiponectin, resistin, proinflammatory mediators including C-reactive protein ( CRP) are strongly linked with abnormal carbohydrate metabolism. In recent times a number of first trimester studies have shown association of different biomarkers with the development of GDM. These include elevated serum or plasma Creactive protein (Wolf et al., 2003), lower sex hormone-binding globulin (Thadhani et al., 2003), increased placental growth factor (Ong et al., 2004) and elevated leptin (Qiu et al., 2004) and decreasing of adiponectin concentration. Some studies have recommended that Vitamin D deficiency could play a role in pathogenesis of gestational diabetes. This chapter will focus on the studies about the role of adipocytes mediators, proinflammatory factors and vitamin D in gestational diabetes.