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Fetal growth and development is dependent upon various growth factors such as glucose, insulin, HGH and IGF-I. These growth factors were measured in maternal serum (MS), amniotic fluid (AF) and umbilical venous serum (UV) in late gestation in normal, insulin dependent diabetic pregnancies (IDDM) and in pregnancies complicated with intrauterine growth retardation (IUGR). The UV glucose values of 1.9 +/- 0.9 mmol/L and UV insulin values of 8.0 +/- 1.8 mU/L were the lowest in IUGR pregnancies, and the highest were in UV serum from IDDM pregnancies, and the difference was statistically significant for this two groups. IGF-I values in UV indicated that there was significant difference in IGF-I concentrations when both, IUGR and IDDM groups were compared to the controls. There was a parallel shift in AF and MS glucose and insulin concentration as birthweight increased. The highest IGF-I values of 7.2 +/- 9.6 mumol/L in AF and MS were found in pregnancies with infants whose birthweight was 3500 grams and greater. Infants from pregnancies complicated with IUGR and IGF-I low values of 0.6 +/- 1.2 mumol/L in AF. HGH concentrations of 15.6 +/- 9.4 micrograms/L in UV were observed in IDDM pregnancies and significantly lower than the values in IUGR and normal pregnancies. HGH umbilical venous values decreased with duration of pregnancy and with increase in fetal size. The high HGH concentrations in the fetus and its dramatic fall after parturition, and the obtained negative correlation between HGH and IGF-I in umbilical vein may exhibit the maturation of the hypothalamic-growth hormone-IGF-I axis. It seems likely that changes in maternal serum, umbilical venous and amniotic fluid insulin-like growth factor I influence birthweight in normal and IUGR infants and in those of diabetic mothers.

Type 1 diabetes (T1DM) is an autoimmune disease characterized by the gradual loss of β-cell function and insulin secretion. In pregnant women with T1DM, endogenous insulin production is absent or minimal, and exogenous insulin is required to control glycemia and prevent ketoacidosis. During pregnancy, there is a partial decrease in the activity of the immune system, and there is a suppression of autoimmune diseases. These changes in pregnant women with T1DM are reflected by Langerhans islet enlargement and improved function compared to pre-pregnancy conditions. N-3 polyunsaturated fatty acids (n-3 PUFA) have a protective effect, affect β-cell preservation, and increase endogenous insulin production. Increased endogenous insulin production results in reduced daily insulin doses, better metabolic control, and adverse effects of insulin therapy, primarily hypoglycemia. Hypoglycemia affects most pregnant women with T1DM and is several times more common than that outside of pregnancy. Strict glycemic control improves the outcome of pregnancy but increases the risk of hypoglycemia and causes maternal complications, including coma and convulsions. The suppression of the immune system during pregnancy increases the concentration of C-peptide in women with T1DM, and n-3 PUFA supplements serve as the additional support for a rise in C-peptide levels through its anti-inflammatory action.