Determinants of Maternal Insulin Resistance during Pregnancy: An Updated Overview

Abstract

Insulin resistance changes over time during pregnancy, and in the last half of the pregnancy, insulin resistance increases considerably and can become severe, especially in women with gestational diabetes and type 2 diabetes. Numerous factors such as placental hormones, obesity, inactivity, an unhealthy diet, and genetic and epigenetic contributions influence insulin resistance in pregnancy, but the causal mechanisms are complex and still not completely elucidated. In this review, we strive to give an overview of the many components that have been ascribed to contribute to the insulin resistance in pregnancy. Knowledge about the causes and consequences of insulin resistance is of extreme importance in order to establish the best possible treatment during pregnancy as severe insulin resistance can result in metabolic dysfunction in both mother and offspring on a short as well as long-term basis.

Figure 1

Mean daily insulin requirements at the different time intervals during pregnancy for women with type 1 diabetes. The dashed line represents the prepregnancy insulin requirement, and the numbers in percentages indicate the increase or decrease in percentage relative to prepregnancy levels (Skajaa et al. [4]).