title: New insights into gestational glucose metabolism: lessons learned from 21st century approaches.
abstract: Pregnancy presents a unique physiological challenge that requires changes coordinated by placentally and non-placentally derived hormones to prepare the mother for the metabolic stress presented by fetal development and to ensure appropriate nutrient allocation between mother and fetus. Of particular importance is the maintenance of normal glucose metabolism during pregnancy. Here, we describe physiological changes in glucose metabolism during pregnancy and highlight new insights into these adaptations that have emerged over the past decade using novel methodologies, specifically genome-wide association studies (GWAS) and metabolomics. While GWAS have identified some novel associations with metabolic traits during pregnancy, the majority of the findings overlap with those observed in nonpregnant populations and individuals with type 2 diabetes (T2D). Metabolomics studies have provided new insight into key metabolites involved in gestational diabetes mellitus (GDM). Both of these approaches have suggested that a strong link exists between GDM and T2D. Most recently, a role of the gut microbiome in pregnancy has been observed, with changes in the microbiome during the third trimester having metabolic consequences for the mother. In this Perspectives in Diabetes article, we highlight how these new data have broadened our understanding of gestational metabolism, and emphasize the importance of future studies to elucidate differences between GDM and T2D.
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Angueira
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Ludvik
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC Institute of Genome Science and Policy, Duke University, Durham, NC.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Reddy
authors.affiliation: Kovler Diabetes Center, The University of Chicago, Chicago, IL.
authors.forename: Barton
authors.initials: B
authors.lastname: Wicksteed
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: William L
authors.initials: WL
authors.lastname: Lowe
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL Jesse Brown Veterans Affairs Medical Center, Chicago, IL b-layden@northwestern.edu.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Layden
mesh_terms: D001786:Blood Glucose; D016640:Diabetes, Gestational / Q000378:metabolism*; D005260:Female; D005786:Gene Expression Regulation; D005819:Genetic Markers; D055106:Genome-Wide Association Study; D023281:Genomics; D005943:Gluconeogenesis; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000502:physiology; D011110:Polymorphism, Genetic; D011247:Pregnancy
chemical_list: D001786:Blood Glucose; D005819:Genetic Markers; D005947:Glucose