Gestational diabetes mellitus (GDM) is a condition characterised by glucose
intolerance first diagnosed in pregnancy. The first line of treatment for women
diagnosed with GDM is diet control (GDMd). However, some of these women even
after diet persist continue showing hyperglycaemia. The second line of treatment is
insulin therapy (GDMi). The latter protocol is reported to be effective in restoring
glycaemia of the mother and the baby at birth. However, it is difficult to reach a
consensus between the variety of protocols for insulin therapy since it depends on
several factors including the population studied, ethnicity, among others. GDMd
associates with deleterious effects on the foetoplacental vascular function, mainly due
to endothelial dysfunction. These alterations regard with alterations in the Larginine/
nitric oxide signalling pathway, as well as in the expression of insulin
receptors A and B, and insulin response. More recent studies suggest that c-Jun Nterminal
kinase 1–mediated insulin resistance may result from increased endoplasmic
reticulum stress in this type of cells from the human placenta. Interestingly, the insulin
therapy is a protocol that does not restore the dysfunctional endothelium as seen in
GDMd. Indeed, insulin therapy may associate with additional deleterious effects on the
mother, the placenta and foetus, and the newborn in GDM. In this chapter, we
summarised some examples of the wide variety of protocols for insulin therapy and the
potential consequences of this protocol on the foetoplacental unit and the neonate from
women with GDM.
Keywords: Diabetes, Diet, Endothelium, Endoplasmic reticulum stress,
Gestational diabetes, Human, Insulin, Insulin therapy, Placenta.