Pancreatic islet adaptation in pregnancy and postpartum.

In addition to insulin-secreting β-cells, other islet endocrine and non-endocrine cells exhibit adaptive changes during pregnancy. The postpartum period and lactation also regulate islet structure and function, including changes that reverse gestational adaptations. Single-cell transcriptomics and other recent studies have identified regulators of gestational and postpartum adaptations, including transcription factors, secreted proteins, and ion channels. Aspects of gestational and postpartum adaptations may be unique and distinct from other compensatory adaptations to metabolic stress. Pancreatic islets, particularly insulin-producing β-cells, are central regulators of glucose homeostasis capable of responding to a variety of metabolic stressors. Pregnancy is a unique physiological stressor, necessitating the islets to adapt to the complex interplay of maternal and fetal–placental factors influencing the metabolic milieu. In this review we highlight studies defining gestational adaptation mechanisms within maternal islets and emerging studies revealing islet adaptations during the early postpartum and lactation periods. These include adaptations in both β and in 'non-β' islet cells. We also discuss insights into how gestational and postpartum adaptation may inform pregnancy-specific and general mechanisms of islet responses to metabolic stress and contribute to investigation of gestational diabetes. [ABSTRACT FROM AUTHOR]