Gestational diabetes is the most common medical complication in pregnancy. Historically, gestational diabetes was considered a pregnancy complication involving treatment of rising glycaemia late in the second trimester. However, recent evidence challenges this view. Pre-pregnancy and pregnancy-specific factors influence gestational glycaemia, with open questions regarding roles of non-glycaemic factors in the aetiology and consequences of gestational diabetes. Varying patterns of insulin secretion and resistance in early and late pregnancy underlie a heterogeneity of gestational diabetes in the timing and pathophysiological subtypes with clinical implications: early gestational diabetes and insulin resistant gestational diabetes subtypes are associated with a higher risk of pregnancy complications. Metabolic perturbations of early gestational diabetes can affect early placental development, affecting maternal metabolism and fetal development. Fetal hyperinsulinaemia can affect the development of multiple fetal tissues, with short-term and long-term consequences. Pregnancy complications are prevented by managing glycaemia in early and late pregnancy in some, but not all women with gestational diabetes. A better understanding of the pathophysiology and heterogeneity of gestational diabetes will help to develop novel management approaches with focus on improved prevention of maternal and offspring short-term and long-term complications, from pre-conception, throughout pregnancy, and beyond.

中文翻译：

---

受孕前、怀孕期间及之后的病理生理学


妊娠糖尿病是妊娠期最常见的医学并发症。从历史上看，妊娠糖尿病被认为是一种妊娠并发症，涉及妊娠中期后期血糖升高的治疗。然而，最近的证据挑战了这一观点。孕前和妊娠特异性因素影响妊娠血糖，关于非血糖因素在妊娠糖尿病病因和后果中的作用仍存在疑问。妊娠早期和晚期胰岛素分泌和抵抗的不同模式是妊娠糖尿病在时间和病理生理亚型方面的异质性的基础，具有临床意义：早期妊娠糖尿病和胰岛素抵抗妊娠糖尿病亚型与妊娠并发症的较高风险相关。妊娠早期糖尿病的代谢紊乱会影响早期胎盘发育，从而影响母体代谢和胎儿发育。胎儿高胰岛素血症会影响胎儿多种组织的发育，产生短期和长期后果。对于一些（但并非所有）患有妊娠期糖尿病的女性来说，通过控制妊娠早期和晚期的血糖可以预防妊娠并发症。更好地了解妊娠糖尿病的病理生理学和异质性将有助于开发新的管理方法，重点是改善从受孕前、整个怀孕期间及以后对母体和后代短期和长期并发症的预防。