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Blood glucose levels in pregnant women should be regulated as strictly as possible. During the first weeks of pregnancy less insulin treatment is required due to tight blood sugar control as well as the extra glucose needed for the growing fetus. [11] At this time basal and bolus insulin may need to be reduced to prevent hypoglycemia. Frequent ...
When insulin binds to the insulin receptor, it leads to a cascade of cellular processes that promote the usage or, in some cases, the storage of glucose in the cell. The effects of insulin vary depending on the tissue involved, e.g., insulin is most important in the uptake of glucose by muscle and adipose tissue. [2]
Since insulin promotes the entry of glucose into most cells, insulin resistance prevents glucose from entering the cells properly. As a result, glucose remains in the bloodstream, where glucose levels rise. More insulin is needed to overcome this resistance; about 1.5–2.5 times more insulin is produced than in a normal pregnancy. [25]
The insulin receptor (IR) is a transmembrane receptor that is activated by insulin, IGF-I, IGF-II and belongs to the large class of receptor tyrosine kinase. [5] Metabolically, the insulin receptor plays a key role in the regulation of glucose homeostasis; a functional process that under degenerate conditions may result in a range of clinical manifestations including diabetes and cancer.
The net effect is an increase of free cortisol. This contributes to insulin resistance of pregnancy and possibly striae. [5] Despite the increase in cortisol, the pregnant mom does not exhibit Cushing syndrome or symptoms of high cortisol. One theory is that high progesterone levels act as an antagonist to the cortisol.
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The sex of the fetus may be discerned by ultrasound as early as 11 weeks' gestation. The accuracy is relatively imprecise when attempted early. [15] [16] [17] After 13 weeks' gestation, a high accuracy of between 99% and 100% is possible if the fetus does not display intersex external characteristics. [18]
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