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GESTATIONAL DIABETES http://www.nature.com/nrendo/journal/v8/n11/full/nrendo.2012.96.html Margus: 425-753-7219 Mackenzie: 425-443-4120 Katrina: 206-504-9993 Deric: 425-442-7261 Emma: 206-755-3159

Biology/General Info


 * Occurs during pregnancy
 * Often increases chances of type 2 diabetes
 * placenta produces high levels of hormones
 * majority of these hormones produced by the placenta impair the functioning of insulin
 * insulin causes glucose absorption from the blood, therefore when it is impaired blood sugar increases
 * the larger the placenta, the more insulin-blocking hormones produced therefore gestational diabetes usually develops during the last half of pregnancy
 * some risk factors include: older than 25, elevated blood glucose levels pre-pregnancy, previous pregnancy with gestational diabetes, 30 or higher bmi, nonwhite race

Gestational diabetes. (n.d.). Retrieved February 29, 2016, from http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/definition/con-20014854


 * occurs in 6-10% of pregnancies
 * the cause is still unknown but there are suggestions that beta cell impairment or vitamin D deficiency may be a cause
 * it can cause the baby to be too large to pass through the birth canal
 * the child has increased risk for developing type 2 diabetes later in life
 * an additional suggested cause is that woman need to consume more calories because they need to support the nutritional needs of the developing baby leading to an overload of stress on the pancrease
 * lack of vitamin D is also suggested as a possible cause

Monin, D. (n.d.). Gestational Diabetes. Retrieved February 29, 2016, from http://fisherpub.sjfc.edu/cgi/viewcontent.cgi?article=1002&context=biology_undergrad


 * heterogeneous disorder with multiple contributors (age, obesity, and genetic background)
 * Butte, Nancy F. "The American Journal of Clinical Nutrition." Carbohydrate and Lipid Metabolism in Pregnancy: Normal Compared with Gestational Diabetes Mellitus. American Society for Clinical Nutrition, May 2000. Web. 01 Mar. 2016.


 * a study on the effects of gestational diabetes on T cells
 * gestational diabetes modifies the phenotypes of t cells and cytokines in the mothers cord blood and colostrum

Fagundes, D. L., França, E. L., Fernandes, R. T., Hara, C. D., Morceli, G., Honorio-França, A. C., & Calderon, I. D. (2015). Changes in T-cell phenotype and cytokines profile in maternal blood, cord blood and colostrum of diabetic mothers. The Journal of Maternal-Fetal & Neonatal Medicine, 29(6), 998-1004.


 * a study provided evidence that serum cystatin C is associated with insulin resistance and GDM

Zhao, W., Pan, J., Li, H., Huang, Y., Liu, F., Tao, M., & Jia, W. (2016). Relationship between High Serum Cystatin C Levels and the Risk of Gestational Diabetes Mellitus. PLOS ONE PLoS ONE, 11(2).


 * this study looked at the effect of mothers diets on risk of GDM
 * they found that adhering to prudent dietary patterns during pregnancy was significantly associated with lower risk of GDM, particularly in at risk women (obese,etc)

Tryggvadottir, E. A., Medek, H., Birgisdottir, B. E., Geirsson, R. T., & Gunnarsdottir, I. (2015). Association between healthy maternal dietary pattern and risk for gestational diabetes mellitus. European Journal of Clinical Nutrition Eur J Clin Nutr, 70(2), 237-242.

- how do ancestors play into risk of diabetes? risk of gestational diabetes?
 * Gestational diabetes may have been a response of selective pressure, where individuals with the variants of glucose-dependent insulinotropic polypeptide (GIP) were more suited to produce healthy offspring during times of famine.
 * GIP is believed to be a mechanism to better conserve energy and maintain glucose homeostasis during pregnancy.
 * With the abundance of high-starch foods, the body responds with over secretion of insulin and insulin resistance.
 * Chang, Chia Lin et al. “Identification of Metabolic Modifiers That Underlie Phenotypic Variations in Energy-Balance Regulation.” Diabetes 60.3 (2011): 726–734. PMC. Web. 29 Feb. 2016.
 * Conger, Krista. "Evolution Led to Genetic Variation That May Affect Diabetes, Scientist Says." Stanford Medicine News Center. Standford Medicine, 7 Feb. 2011. Web. 28 Feb. 2016.
 * Other hypotheses:
 * GDM could be an early indicator of type 2 diabetes or metabolic disorders where it is unmasked during pregnancy. Women diagnosed with GDM have an increased risk to develop type 2 diabetes later in life. This is promotes GDM screening during pregnancy in hopes of diabetes prevention in mother and child.
 * Butte, Nancy F. "The American Journal of Clinical Nutrition." Carbohydrate and Lipid Metabolism in Pregnancy: Normal Compared with Gestational Diabetes Mellitus. American Society for Clinical Nutrition, May 2000. Web. 01 Mar. 2016.
 * Vaag, A. A., L. G. Grunnet, G. P. Arora, and C. Brøns. "The Thrifty Phenotype Hypothesis Revisited." Diabetologia. Springer-Verlag, 30 May 2012. Web. 01 Mar. 2016.


 * In comparison to non-Hispanic white Americans, people with Native/Latin American family ancestries are nearly twice as likely to develop diabetes. Why?
 * Among people with Native American ancestry the frequency of carrying at least one copy of SLC16A11 is greater than 50 percent.
 * This allele is very rare in Europeans, virtually nonexistent in African populations.
 * SLC16A11 is an allele of a gene which encodes a protein involved in lipid transport to the liver. Five mutations differentiate this version of the gene from the version most common to the American population.
 * The allele finds its origins in Neanderthals who, via interbreeding, introduced it to specific subsets of Homo-sapiens, namely ancient Native American populations.
 * http://evolution.berkeley.edu/evolibrary/news/140204_diabetes

- how do processed foods and current diets or other environmental factors affect risk of gestational diabetes?


 * Gestational diabetes increases risk of diabetes in mother and obesity and diabetes in child
 * Gillman, M. W., S. Rifas-Shiman, C. S. Berkey, A. E. Field, and G. A. Colditz. "Maternal Gestational Diabetes, Birth Weight, and Adolescent Obesity."Pediatrics 111.3 (2003): E221-226. AAP Gateway. Web. 28 Feb. 2016.
 * Bellamy, Leanne, Juan-Pablo Casas, Aroon D. Hingorani, and David Williams. "Type 2 Diabetes Mellitus after Gestational Diabetes: A Systematic Review and Meta-analysis." The Lancet 373.9677 (2009): 1773-779. Web. (this one is a systematic review so it just compares studies that have already been done, does it count as a secondary source or no?)
 * Gestational diabetes can usually be controlled by healthy eating and exercise
 * http://www.cdc.gov/pregnancy/diabetes-gestational.html
 * Risks for gestational diabetes according to the CDC: Had a previous pregnancy with gestational diabetes. •	 Had a baby born weighing over 9 pounds. •	 Are overweight or obese. •	 Are more than 25 years old. •	 Have a family history of diabetes. •	 Are African American, Hispanic, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander. •	 Are being treated for HIV. (http://www.cdc.gov/diabetes/pubs/pdf/gestationalDiabetes.pdf)
 * High glycemic carbohydrates are found to have an increased risk for gestational diabetes by stimulating glucose responses in the blood. Dairy products are also risk since it can produce a large insulin response.
 * Possible inverse correlation of incidence in modern populations and traditional diets of high glycemic carbohydrates.
 * Europeans have the low prevalence of gestational diabetes despite their high consumption of high glycemic carbohydrates and progression of grain-based agriculture.
 * Bangladeshis have the highest prevalence while their diet consist of fish, low glycemic food, and no dairy.
 * Data support the theory that populations without high glycemic foods focused on increasing blood sugars to support the fetus.
 * Brown, Elizabeth A., Maryellen Ruvolo, and Pardis Sabeti. "Many Ways to Die, One Way to Arrive: How Selection Acts through Pregnancy." Trends in Genetics. Elsevier, 8 Apr. 2013. Web. 01 Mar. 2016.
 * Possible Genetic Mechanisms
 * Patients with glucokinase gene mutations had gestational diabetes
 * Characterized by mild, persistent fasting hyperglycaemia, a small increment in glucose in response to an oral load and a dominant family history
 * Ellard, S., L. I.S. Allen, M. Sheppard, E. Ballantyne, R. Harvey, and A.T. Hattersley. "A High Prevalence of Glucokinase Mutations in Gestational Diabetic Subjects Selected by Clinical Criteria." Diabetologia. Springer-Verlag, 2000. Web. 28 Feb. 2016.
 * Some SNPs recently identified as genetic determinants of type 2 diabetes by GWA studies were also associated with GDM in Koreans
 * Three SNPs in particular (rs7756992 and rs7754840 in CDKAL1 and rs10811661 in CDKN2A-CDKN2B) were strongly associated with GDM
 * Cho, Y.M, T.H. Kim, S. Lim, S.H. Choi, H.D. Shin, H.K. Lee, K.S. Park, and H.C. Jang. "Type 2 Diabetes-associated Genetic Variants Discovered in the Recent Genome-wide Association Studies Are Related to Gestational Diabetes Mellitus in the Korean Population." Diabetologia. Springer-Verlag, 11 Nov. 2008. Web. 28 Feb. 2016.