Central Role of Adipose Tissue in Pregnancy and Lactation

Abstract Pregnancy is characterized by complex metabolic and hormonal adaptations of the mother to meet the increasing physiological and energy demands to provide adequate nutrient flow for optimal growth and development of the fetus. Insulin sensitivity increases in early gestation to facilitate maternal anabolism and fat accretion, but it declines by 40%–50% in the second and third trimesters to increase glucose availability for the fetus. The adaptive insulin resistance during pregnancy is complex and multifactorial, but it appears to be linked to maternal fat accretion. Glucose homeostasis is maintained throughout a normal pregnancy by increased insulin secretion through β-cell hypertrophy and hyperplasia. This chapter focuses on the central role of adipose tissue and its adipocytokines in altering maternal intermediary metabolism and insulin sensitivity in normal and complicated pregnancies, such as gestational diabetes.