ABSTRACT
This chapter reviews the genetic etiology of maternal diabetes, factors influencing pregnancy outcome, and what is known of the epigenetic consequences of hyperglycemia in pregnancy. Insulin resistance is a normal physiological alteration that occurs during pregnancy. Gestational diabetes mellitus (GDM) may develop when this normal resistance is coupled with pancreatic beta-cell insufficiency. While GDM is a multifactorial disorder, with a polygenic heritable and environmental component, there are monogenic forms of diabetes that comprise a small but important cohort of patients with diabetic pregnancy. Pharmacogenomics is an area that holds tremendous potential for impact in the care of GDM in the future. The ability to develop individualized regimens based on the patient's genetic makeup may improve treatment outcomes. Though further studies are needed, it is quite possible that in the future testing a patient's genetic makeup to help guide treatment regimens may be a regular part of the care of the gestational diabetes.
