Hyperinsulinemia in Cord Blood in Mothers With Type 2 Diabetes and Gestational Diabetes Mellitus in New Zealand

Abstract

OBJECTIVE -In genetically diabetes-prone populations, maternal diabetes during pregnancy increases the risk of their children developing diabetes and obesity (the vicious cycle of type 2 diabetes). Fetal hyperinsulinemia at birth acts as a marker of this risk. We therefore examined whether cord insulin and leptin concentrations are increased in offspring of Maori and Pacific Island mothers with type 2 and gestational diabetes mellitus (GDM) and varying degrees of glycemic control (HbA 1c ). RESEARCH DESIGNS AND METHODS -Maori and PacificIsland mothers were prospectively recruited at Middlemore Hospital, South Auckland. Cord blood was taken from umbilical vein at birth from singleton babies born after 32 weeks of gestation to 138 mothers with GDM, 39 mothers with type 2 diabetes, and 95 control mothers. , and control subjects 13 ng/ml [8 -22]; P Ͻ 0.001) in cord blood. Cord insulin concentrations Ͼ120 pmol/l were found in 29% of offspring of mothers with GDM and 31% of mothers with type 2 diabetes. Many mothers with GDM had abnormalities of glucose tolerance postpartum (20% type 2 diabetes, 34% impaired glucose tolerance or impaired fasting glucose). Higher cord insulin (57 pmol/l [40 -94]) and leptin (26 ng/ml [17-39]) concentrations were found even in offspring of GDM mothers with normal glucose tolerance postpartum. RESULTSCONCLUSIONS -Raised cord insulin and leptin concentrations are a common finding in offspring of mothers with type 2 diabetes and GDM in this population. Diabetes Care 29:1345-1350, 2006F etal hyperinsulinemia is characteristic of pregnancy complicated by maternal diabetes and underpins complications such as macrosomia (1). Cord leptin correlates with measures of adiposity at birth (2-4) and is also raised in offspring of mothers with diabetes (3,4). Assessment of insulin and leptin at birth may be a particularly useful way of monitoring whether the fetus has been exposed to abnormally high levels of glucose in utero. Fetal hyperinsulinism may also have potential prognostic implications. Several studies have suggested that the maternal intrauterine environment might result in "programming" of later disease. An increased risk of obesity (5-8) and abnormal glucose tolerance (9 -12) are observed when offspring have been exposed to maternal diabetes in utero. Fetal hyperinsulinemia acts as a marker of this increased risk, offspring of diabetic mothers with higher insulin levels in utero being at a higher risk of later metabolic complications (7,8,10).The Pacific Island and Maori peoples of New Zealand are populations at high risk of both type 2 and gestational diabetes during pregnancy. We measured concentrations of fetal insulin, insulin propeptides, and leptin, together with weight and skinfold thickness at birth, with the following hypotheses: where the mother has type 2 diabetes and gestational diabetes mellitus (GDM), fetal hyperinsulinism is common despite treatment of disease, and fetal leptin and fat mass are similarly increased; and in subgroup analysis, these effects are most pronounce...

Metabolic parameters in cord blood of newborns of women with polycystic ovary syndrome

“…In this regard, the offspring born to mothers with gestational diabetes, which is strongly associated with hyperinsulinemia and insulin resistance, have shown an increased risk of obesity (12, 15) and abnormal glucose tolerance in adult life (14,16). Moreover, newborns exposed to maternal diabetes in utero exhibit elevated concentrations of insulin, leptin, and lipids in cord blood, which could have implications in the high risk of later metabolic complications (17)(18)(19). In previous studies, we have established that hyperinsulinemia, insulin resistance, and lipid-related abnormalities are enhanced during pregnancy in women with PCOS (20, 21).…”

Placental vascularization and apoptosis in Type-1 and gestational DM

“…Even more, all of the patients in type-1 DM group were on insulin therapy and there are several studies demonstrating the angiogenetic effect of insulin on throphoblasts. (20,21) Thus , a stronger immunoreactivity is expected in type-1 DM group. We believe that, this confusing result can be arised from the different of two subtypes of DM.…”

Influence of maternal HbA1C on fetal insulin levels

“…Jenny A Westgate, Franzcog et al in New Zealand, in their study on newborns of 138 mothers with GDM, 39 mothers with Type 2 DM and 95 control mothers, found hyperinsulinemia in 29% of infants born to diabetic mothers and 31% of infants born to type 2 diabetic mothers compared to controls (3%) and also birth weight was higher in offspring of mothers with both GDM/Type 2 diabetes and cord blood insulin levels correlated with cord glucose and maternal HbA1C. 10 Lindsay RS, Walker JD et al in their study on insulin like molecules in cord blood in relation to birth weight, maternal glycemia and cord glucose in 140 offspring of diabetic mothers and 49 0ffspring of control mothers, found that maternal diabetes was associated with increase in insulin levels in 63.5% compared to 50.3% in controls and insulin was more strongly related to birth weight, cord glucose concentration and maternal HbA1C. 11 Weiss et al reported that a more pronounced and prolonged maternal hyperglycemia in IDM could be presumed to be the main reason for higher fetal and neonatal insulin levels in IDM.…”