Table 3.

Etiology and pathophysiology of gestational diabetes mellitus

Insulin resistance

Pregnancy and obesity as states of low grade inflammation[48,49]

Adipocytokines

↓ Adiponectin[51-53]

↑ TNF-α[55-58]

↑ IL-6[56,62-64]

↑ Leptin[56,58,65,66]

↑ AFABP[79]

↑ RBP-4[69]

?↑ Resistin[54,62,72]

?↑ Visfatin[76,77]

? Novel adipocytokines (Vaspin, Apelin and Omentin)[50]

Endothelial function and angiogenic growth factors[74,80,81]

↓ EPC

↓ SOD

↑ eNOS

↑ PAI-1

↑ sEng

↑ sICAM-1

↑ sVCAM-1

↑ t-PA

↑ PLGF

↑ sFlt-1

Proteomics biomarkers

Haptoglobin, protein SMG8 and apoptosis inducing factor-1[83]

Apolipoprotein CIII[84]

Peptides precursors of clusterin, isoform 1 of fibrinogen alpha chain and apolipoprotein CII[85]

Glycosylated fibronectin[86]

Transthyretin–retinol binding protein-retinol complex[87]

Pancreatic β-cell dysfunction

Autoimmunity[92]

Glucokinase gene defect[93]

AFABP: Adipocyte fatty acid-binding protein; eNOS: Endothelial nitric oxide synthase; sEng: Soluble endoglin; sFlt-1: Soluble fms-like tyrosine kinase-1; sICAM-1: Soluble intercellular adhesion molecule-1; sVCAM-1: Soluble vascular cell adhesion molecule-1; SOD: Superoxide dismutase; t-PA: Tissue plasminogen activator; TNF-α: Tumor necrosis factor-α; RBP-4: Retinol-binding protein-4; EPC: Endothelial progenitor cells; hPGH: Human placental growth hormone; hPL: Human placental lactogen; IL-6: Interleukin-6; PLGF: Placental growth factor; PAI-1: Plasminogen Activator Inhibitor type-1.