Figure 2.

A proposed model of inflammation and insulin resistance in obesity, pregnancy and GDM. Women who are obese have features of chronic low-grade inflammation, manifest by increased tumour necrosis factor alpha (TNF-α), interleukin-6 (IL-6), interleukin-12 (IL-12), and high sensitivity C-reactive protein (hsCRP). Obesity is characterised by insulin resistance, and down-regulation of adiponectin and up-regulation of leptin, resistin and retinol-binding protein-4 (RBP4) contribute to this. Pregnancies occurring in obese women are characterised by further inflammation and a Th-2 predominant immune response, which may contribute to pregnancy complications. Foetal and placental hormones, production of abnormal growth factors and tissue remodelling may contribute to inflammation and increasing insulin resistance. GDM develops when beta cell dysfunction coexists, and may be characterised by further abnormalities in adipokine and cytokine profiles, increased free fatty acids (FFA), triglycerides (TG), low vitamin D and endothelial dysfunction.