Characterizing the Effects of Diabetes and Obesity on Insulin and Leptin Levels amongst Pregnant Women

Abstract

Objective In this study, we assess the impact of obesity and diabetes on maternal brain and periphery, as well as fetal exposure to insulin and leptin, and two hormones that play an important role in regulating energy homeostasis. Study Design Fasting maternal plasma, fetal cord vein and artery plasma, and maternal cerebrospinal fluid (CSF) were collected in 37 women (12 lean, nondiabetic [prepregnancy body mass index (BMI): 22.9 ± 1.7 kg/m2]; 12 overweight/obese nondiabetic [BMI: 37.8 ± 7.3 kg/m2]; 13 gestational/type 2 diabetes mellitus [BMI: 29.8 ± 7.3 kg/m2]) with uncomplicated singleton pregnancies undergoing elective Cesarean delivery. HbA1C, insulin, glucose, and leptin levels were measured. Results Compared with lean mothers, mothers with obesity and diabetes mellitus (DM) had significantly lower CSF-to-plasma ratios of insulin. Moreover, mothers with obesity and DM had significantly lower cord arterial and cord venous to maternal plasma ratios of insulin, but not leptin, compared with lean mothers. There were no differences in CSF and cord blood insulin and leptin levels between obese and DM mothers. Conclusion Compared with lean individuals, mothers with obesity and DM have relative deficiencies in insulin exposure. The patterns observed in mothers with obesity and diabetes were similar highlighting the importance of the maternal metabolic environment in obesity and suggesting obese patients warrant further clinical focus.

Significance of Umbilical Cord Leptin Profile during Pregnancy in Gestational Diabetes Mellitus—A Systematic Review and Meta-Analysis

“…Regarding cord leptin levels, Johnson AW et al [39], assessing obese mothers and T2DM/GDM, have observed significantly lower cord venous and cord arterial to maternal plasma ratios of insulin but not leptin compared with lean mothers. However, these authors have reported no differences in cord blood insulin and leptin levels between obese and diabetic mothers [39].…”