140 |
|
Some genes common in both T2DM and GDM correspond to genetic mutations related to decreased insulin secretion, such as genes CDK5 regulatory subunit-associated protein 1-like 1 (CDKAL1, cyclin-dependent kinase inhibitor 2A/2B (CDKN2A/2B), and hematopoietically expressed homeobox (HHEX).
| | -
Genetic modifications shared between T2DM and GDM:
- -
-
Some genes common in both T2DM and GDM correspond to genetic mutations related to decreased insulin secretion, such as genes CDK5 regulatory subunit-associated protein 1-like 1 (CDKAL1, cyclin-dependent kinase inhibitor 2A/2B (CDKN2A/2B), and hematopoietically expressed homeobox (HHEX).
|
|
[25][26] | [40 | [27] | ,41,42] |
- ▪
-
GDM-related genetic mutations:
- -
-
Genetic mutations in some specific genes are related to the development of GDM, such as the following genes: transcription factor 7-like 2 (TCF7L2), CDKAL1, Transcription factor 2 (TCF2), Fat mass- and obesity-associated gene (FTO), CDKN2A/2B, HHEX, Insulin-like growth factor 2 MRNA binding protein 2, Solute carrier family 30 member 8 gene (IGF2BP2), and SCL30A8.
- -
-
Some women, although uncommon among pregnant women with GDM, have genetic variants that are monogenic forms of diabetes, including genes for subtypes maturity onset diabetes of the young (MODY).
|
- ▪ GDM-related genetic mutations:
-
Genetic mutations in some specific genes are related to the development of GDM, such as the following genes: transcription factor 7-like 2 (TCF7L2), CDKAL1, Transcription factor 2 (TCF2), Fat mass- and obesity-associated gene (FTO), CDKN2A/2B, HHEX, Insulin-like growth factor 2 MRNA binding protein 2, Solute carrier family 30 member 8 gene (IGF2BP2), and SCL30A8.
-
Some women, although uncommon among pregnant women with GDM, have genetic variants that are monogenic forms of diabetes, including genes for subtypes maturity onset diabetes of the young (MODY).
|
[25][27][28] | |
World Health Organization (WHO) (1999) [10] |
Race/ |
| 126 | Ethnicity |
- ▪
-
Hispanic pregnant women would have greater chances of developing GDM, when compared with non-Hispanic ones, which can be considered a confonding factor when the geographic characteristics are inserted.
|
| 75 g of
Glucose | Not
measured | 140 | Not
measured |
World Health Organization (WHO) (1999) [14] | 126 |
- Hispanic pregnant women would have greater chances of developing GDM, when compared with non-Hispanic ones, which can be considered a confonding factor when the geographic characteristics are inserted.
|
|
75 g de |
| glucose | Not
measured | 140 |
[ | 29 | ] | [31][32] |
Not |
| measured |
[ | 30 | ] |
International Association of Diabetes in Pregnancy Study Group (IADPSG (2010) [11] | 24–28
gestational weeks | 92 | 75 g of
Glucose | 180 | 153 |
International Association of Diabetes in Pregnancy Study Group (IADPSG (2010) |
Geographic features |
|
- ▪
-
Depending on the territorial socio-economic limitation, which comprises government and population, data on the GDM may be under or overestimated since they depend on the diagnostic criteria adopted for screening the GDM, and, thus, on the financial and technical resources available in the country/region. -
|
|
[12][16] |
Socio-economic |
|
- ▪
-
Precarious socio-economic conditions, such as low income and education, and unemployment, may be related to worse gestational conditions, ↑ the risk for the development of GDM due to poor quality maternal care. -
|
|
[3033][3134] |
Overweight |
|
- ▪
-
Adipose tissue: -
- -
-
It synthesizes adipokines, which can directly influence the production of pro-inflammatory cytokines (interleukin 1β (IL-1β), nterleukin 6 (IL-6), and Tumor necrosis factor α (TNF-α), and contribute to the increase of serum levels of C-reactive protein (CRP) and RONS. These factors favor the activation of the inflammatory cascade and, consequently, deregulate organic homeostasis, which may exacerbate the factors involved in the physiopathogenesis of GDM. -
-
|
|
[2035][3236] |
|
- ▪
-
Positive energy balance: -
- -
-
Caloric intake above daily needs, associated or not with a sedentary lifestyle, has an essential impact on insulin resistance, favoring the endogenous environment for the development of GDM. -
-
|
|
[3337][3438] |
Westernized diet |
|
- ▪
-
Dietary profile with high intake of red meat, sausages and ultra-processed products, refined products, sweets, pasta, and fried foods, also intensifies the mechanisms of insulin resistance, in addition to contributing to the underlying inflammatory process. -
|
|
[2239][3519] |
Sedentary lifestyle |
|
- ▪
-
The practice of physical activity reduces the chances of developing GDM by up to 46%, since a sedentary lifestyle, in turn, increases nitroxidative and inflammatory stress, and intensifies insulin resistance. -
|
|
[3640][3741] |
Exposure to chemicals |
|
- ▪
-
Perfluorooctanoic acid (PFOA)—commonly found in cleaning products, some types of containers and packaging): -
- -
-
Studies in animal models have found that their contact with offspring could, in a single gestational exposure, have potential effects on postnatal growth and development, causing a delay on them. Furthermore, there is evidence that it can be transmitted through lactation, causing harmful impacts to the health of the offspring. -
- -
-
In humans, it was possible to identify a positive association between serum PFOA concentrations, with cholesterol, TG, and uric acid, which are related to pro-inflammatory pathways, and insulin resistance -
-
|
|
[3842][3922][4043][4120][4221][4323] |
|
- ▪
-
Tobacco and alcohol: -
- -
-
Independent risk factors for GDM, since its consumption may contribute to the endogenous increase in oxidative stress, inflammation, hyperglycemia and insulin resistance, although the exact mechanism of action has not yet been fully elucidated. -
-
|
|
[4424][4525][4626] |
Polycystic Ovary Syndrome (POS) |
|
- ▪
-
Endocrine-metabolic disease that involves multiple hormonal changes related to female infertility, with symptoms such as insulin resistance, one of the most frequently observed, since approximately 50% of women with POS develop GDM during pregnancy. -
|
|
[4728][4844] |
Vitamin D Deficiency |
|
- ▪
-
Both vitamin D and parathormone (PTH) contribute to calcium (Ca) homeostasis. Vitamin D is responsible for the viability of the intestinal absorption of Ca, while PTH for maintaining Ca homeostasis in face of its deficiency. When serum Ca is at suboptimal concentrations, PTH stimulates Ca reabsorption from bone stores, and renal reabsorption, which could increase the risk of GDM, mediated by insulin resistance. -
|
|
[4929][5030] |
Adverse birth conditions of the mother |
| (Fetal program) |
|
-
Mothers who were born in suboptimal conditions, such as premature, with Low birth weight (LBW), or small for gestational age (SGA), could trigger GDM in the pregnancy period, a theory known as fetal programming, postulated by Barker.
-
Changes in somatic growth due to the shortage of nutrients in the pregnancy period lead to damage to the hypothalamus/growth hormone; (GH)/Insulin-like growth (IGF-1) axis. A deficit in the morphology of target organs, such as the pancreas, reduces it in size and affects the function of pancreatic β-cells, culminating in the deficiency in insulin production.
|
|
- ▪
-
These conditions can lead to transgenerational effects, as a vicious cycle, causing serious consequences to public health. -
|
|
[5131][5232][5345][5446][5547] |