Adipose tissue function in healthy pregnancy, gestational diabetes mellitus and pre-eclampsia

Figures

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  Fig. 1. Adipocyte function in healthy, obese, GDM and pre-eclampsia pregnancy. A In healthy pregnancy gestational fat storage is accommodated by adipocyte hypertrophy. The physiologically healthy level of insulin resistance permits controlled adipocyte lipolysis in order to supply triglycerides to the fetus via placental uptake of fatty acids from maternal VLDL. B Obese women already exhibit SAT and VAT adipocyte hypertrophy prior to pregnancy. During pregnancy they develop a greater degree of insulin resistance than lean women which reduces the ability of insulin to downregulate adipocyte lipolysis. This results in increased FFA flux to the liver and increased liver VLDL production. C In women who develop GDM, it is hypothesised that there is reduced hyperplasia and SAT hypertrophy resulting in fatty acid spillover. These fatty acids can cascade to ectopic sites including VAT, the liver and the pancreas and may lead to pancreatic dysfunction β-cell failure and the development of GDM. D In women who develop pre-eclampsia, it is hypothesised that there is an innate maternal insulin resistance manifest in both SAT and VAT. This insulin resistance reduces adipocyte differentiation, reducing…

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  Fig. 2. Body mass index is a poor discriminator of obesity-related adverse pregnancy outcome. Approximately 20% of all pregnancies are in mothers who are obese at the time of antenatal booking (around 11 weeks’ gestation) and undergo expensive, intensive antenatal monitoring. However, this percentage varies widely across different countries. Approximately one-third of obese mothers have an adverse pregnancy outcome. Obese mothers appear to be twice as likely to suffer an adverse pregnancy outcome than non-obese mothers, yet there is little information on how this varies between populations. There are a variety of obesity-related adverse outcomes of varying prevalence (represented by circle size). The underlying cause of adverse outcomes in obese mothers is often linked to metabolic dysregulation.