Interventional strategies to improve outcome in obese pregnancies: insulin resistance and gestational diabetes

TL;DRAbstract

This chapter addresses the metabolic sequelae of maternal obesity, and by detailing effects on glucose, lipid, and protein metabolism, parallels with type 2 diabetes are highlighted. In normal pregnancy, dynamic changes in maternal glucose homeostasis and insulin sensitivity accompany the alterations in lipid and protein metabolism. Pre-existing diabetes and poor maternal glycemic control have classically been associated with adverse pregnancy outcome. Lifestyle intervention is now a critical component of the treatment strategy for diabetes, hypertension, cardiovascular disease, and obesity in non-pregnant patients. Epidemiological studies have suggested that physical activity prior to and during pregnancy may significantly reduce the risk of gestational diabetes. Some preliminary evidence suggests that combining simple maternal demographic and clinical characteristics will allow detection rates similar to those for type 2 diabetes, but external validation is still required. The matern

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