The Placental Metabolic Derangements and Fetal Complications in Gestational Diabetes Mellitus: A Literature Review

Abstract

Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal complications including longer-term risk for developingT2DM, obesity and cardiovascular complications (CVD) later in their life. The placental derangements play a major role in the pathobiology of GDM. This review is aimed at to discuss the various aspects altered placental pathways in GDM, and where there are gaps in the literature that warrant further exploration. Published scientific manuscripts between 2000 and 2022 that discussed the role of insulin resistance, dyslipidaemia, oxidative stress and low-grade inflammation in the pathogenesis of GDM were reviewed. The main keywords used were insulin resistance, oxidative stress, lipid metabolism, dyslipidaemia, and low-grade inflammation. GDM is associated with maternal insulin resistance, dyslipidaemia, oxidative stress, and inflammation. These maternal derangements in GDM could affect placental and foetal lipid metabolism. The altered placental pathways could enhance the transfer of nutrients like glucose and FFA to the growing foetus causing overgrowth and adiposity. GDM foetuses experienced oxidative stress and inflammation and they could be involved in foetal programming for future metabolic diseases such as T2DM, obesity, CVD, etc. Understanding the various molecular mechanisms of placental derangements involved in the pathogenesis of GDM could expand our vision and open up avenues for therapeutic and preventive strategies for the better management of GDM women.