Gestational Diabetes

6 10 2011

Filtered load = GFR x Px

During pregnancy, there is increased in proteins, increased in Glomerular Filtrate Rate (GFR) in the kidneys and hence increased in Filtration load. This overloads the proximal tubule of the kidneys and so we see glucose in the urine. The question is how much glucose is right and how much is too much for a pregnant woman?

Human chorionic somatomammotropin (hCS) or hPL (human placental lactogen) could this be the culprit?

hPL is secreted by the syncytial trophoblasts from early pregnancy into maternal circulation. This increase in hPL provides glucose to the baby at the expense of the mother. hPL increases as mother’s glucose levels decrease.  hPL stimulates mom’s IGF-1 and could cause insulin resistance and carbohydrates intolerance. While the mom mobilizes free fatty acids, glucose, amino acids, and fatty acids are moved into the fetus to provide nutrition.  hPL could be the cause for insulin resistance in the second half of pregnancy. Playing a key role in increasing insulin production from islet cells,  causing amino acids to decrease while increasing triglycerides, free fatty acids, and cholesterol could further cause insulin resistance. (info from Kaplan review).

I read somewhere that postpartum this could go away for some. Maybe if they work on their diet and get back into healthy BMI range? There’s this concern that the mother would have future diabetes and the baby would be large.  If that is the case, should we monitor the size of the baby?

Birthday cake randoms:

80% of expiratory volume is used to blow out birthday candles in the 1st second. The rest is distinguished by water coming from spit …



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