Pathogenesis of gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is characterized by carbohydrate intolerance of variable severity, with onset or first recognition during pregnancy. This definition applies whether or not there is a need for insulin and whether or not it disappears after the pregnancy. Tumor necrosis factor-alpha has been implicated in the pathogenesis of insulin resistance in type 2 diabetes mellitus, but only limited data are available with regard to GDM. Adrenomedullin is a newly discovered hypotensive peptide involved in the insulin regulatory system, and it may play a role in modifying diabetes in pregnancy. Insulin is the main hormone controlling blood glucose concentration. Most commonly, assessment of beta-cell function is made by measuring the fasting insulin concentration or the response to glucose infusion. GDM is carbohydrate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during pregnancy. GDM is also a predictor, or even an early manifestation, of the metabolic syndrome.