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There are significant alterations in maternal metabolism during pregnancy, which provide for adequate nutritional stores in early gestation to meet the increased maternal and fetal demands of late gestation and lactation. Although diabetes mellitus is thought of as a disorder exclusively of maternal glucose metabolism, it affects all aspects of maternal nutrient metabolism. Herein we consider maternal glucose metabolism as it relates to pancreatic beta cell production of insulin and insulin clearance, endogenous hepatic glucose production and suppression with insulin, and peripheral glucose insulin sensitivity. We also address maternal protein and lipid insulin metabolism. Lastly, we examine the impact of these alterations on maternal metabolism related to fetal growth.

Normal pregnancy has been characterized as a “diabetogenic state” because of the progressive increase in postprandial glucose and insulin response in late gestation. However, early gestation can be viewed as an anabolic...

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