Gestational diabetes mellitus (GDM) is one of the most common endocrine disorders during gestation and affects around 15% of all pregnancies worldwide, paralleling the global increase in obesity and type 2 diabetes. Normal pregnancies are critically dependent on the development of maternal insulin resistance balanced by an increased capacity to secrete insulin, which allows for the allocation of nutrients for adequate foetal growth and development. Several factors including placental hormones, inflammatory mediators and nutrients have been proposed to alter insulin sensitivity and insulin response and underpin the pathological outcomes of GDM. However, other factors may also be involved in the regulation of maternal metabolism and a complete understanding of GDM pathophysiology requires the identification of these factors, and the mechanisms associated with them. Recent studies highlight the potential utility of tissue‐specific extracellular vesicles (EVs) in the diagnosis of disease onset and treatment monitoring for several pregnancy‐related complications, including GDM. To date, there is a paucity of data defining changes in the release, content, bioactivity and diagnostic utility of circulating EVs in pregnancies complicated by GDM. Placental EVs may engage in paracellular interactions including local cell‐to‐cell communication between the cell constituents of the placenta and contiguous maternal tissues, and/or distal interactions involving the release of placental EVs into biological fluids and their transport to a remote site of action. Hence, the aim of this review is to discuss the biogenesis, isolation methods and role of EVs in the physiopathology of GDM, including changes in maternal insulin sensitivity during pregnancy.

中文翻译：

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细胞外囊泡及其在妊娠期糖尿病期间诱导母体胰岛素敏感性变化的潜在作用

妊娠期糖尿病 (GDM) 是妊娠期间最常见的内分泌疾病之一，影响全球约 15% 的妊娠，与全球肥胖和 2 型糖尿病的增加平行。正常妊娠严重依赖于母体胰岛素抵抗的发展，并通过分泌胰岛素的能力增加来平衡，从而为胎儿的足够生长和发育分配营养。包括胎盘激素、炎症介质和营养素在内的几个因素已被提议改变胰岛素敏感性和胰岛素反应，并支持 GDM 的病理结果。然而，其他因素也可能参与母体代谢的调节，对 GDM 病理生理学的完整理解需要识别这些因素，以及与之相关的机制。最近的研究强调了组织特异性细胞外囊泡 (EVs) 在诊断疾病发作和监测几种妊娠相关并发症（包括 GDM）方面的潜在效用。迄今为止，尚缺乏定义妊娠合并 GDM 中循环 EV 的释放、含量、生物活性和诊断效用变化的数据。胎盘 EVs 可能参与细胞旁相互作用，包括胎盘细胞成分与邻近母体组织之间的局部细胞间通讯，和/或涉及将胎盘 EVs 释放到生物体液中并将其运输到远程作用部位的远端相互作用. 因此，本综述的目的是讨论 EV 在 GDM 病理生理学中的生物发生、分离方法和作用，