LAY TITLE: Towards Understanding the Cause of High Sugar Levels in Pregnancy – A Magnetic Resonance Spectroscopy Study

High sugar levels during pregnancy (gestational diabetes) complicates up to 5% of pregnancies in the United Kingdom and this figure is rapidly increasing. Gestational diabetes is associated with poor outcomes for both mother and baby, as bad as those seen in mothers with longstanding Type 1 diabetes. Maternal risks include trauma during birth, increased risk of requiring a Caesarean section and an increased lifetime risk of developing type 2 diabetes with its associated complications (eye, kidney and heart disease). Risks to the baby include stillbirth, shoulder dystocia (shoulders getting stuck during birth), birth trauma and hypoglycaemia (low blood sugar) after birth.

Gestational diabetes is thought to be caused by a combination of resistance to insulin as well as lack of production of insulin, resulting in high blood sugar levels. A degree of insulin resistance is, however, part of normal pregnancy, although this is not well understood. The blood sugar levels required for diagnosis and targets for treatment are controversial. Gestational diabetes shares many features with Type 2 diabetes and technological developments in this field have identified that fat (or lipid) metabolism plays an important role. In particular, fat deposition in the liver and muscle contributes significantly to insulin resistance and may be the primary cause of Type 2 diabetes.

Lipid metabolism and storage during pregnancy has not been well characterized. To understand the changes seen in patients with gestational diabetes, it is first important to determine how fat is stored during normal pregnancy. Magnetic resonance spectroscopy is a non-invasive technique that does not involve ionising radiation. This approach allows us to measure fat levels in muscle without the need for muscle biopsies. It will allow us to compare fat levels in normal pregnancy and gestational diabetes to see if this is a contributory factor. A better understanding of the processes that lead to gestational diabetes will guide treatment and thus in the future should improve outcome.

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