Insulin Antibodies in Diabetic Pregnancy

Exon, P.D.; Dixon, K.; Malins, J. M.

doi:10.1016/s0140-6736(74)91555-4

Cited by 15 publications

(3 citation statements)

References 7 publications

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“…It has been suggested that there is a general immunosuppression in pregnancy enabling the fetus to survive as an allograft [26]. Our sequential measurements of insulin antibody levels (a measure of humoral immunity) during and after pregnancy in patients on the same type of insulin showed no significant change in contrast to those of other workers [8,16,27] who did not specify the type of conventional insulin treatment during and after pregnancy. In our experience, changing patients from one conventional insulin type to another leads to change in insulin antibody levels, particularly from protamine zinc and soluble insulin to conventional isophane and soluble.…”

Section: Discussioncontrasting

confidence: 72%

Insulin immunogenicity in pregnancy: maternal and fetal studies

et al. 1983

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Antibodies to insulin were found in 92% of the 138 insulin-treated pregnant diabetic patients studied. No effect of pregnancy was shown on insulin antibody levels. Higher insulin antibody levels were significantly associated with the previous use of conventional insulins. Change from conventional to highly purified porcine insulin during pregnancy produced a significant reduction in insulin antibody levels. The combination of protamine zinc and soluble insulin used before pregnancy was found to be the most immunogenic. Insulin antibodies were freely transferred to the fetus but not detectable after the first 8 months of life. No insulin antibodies were found in the cord blood or during the next few weeks in the infants of mothers who had no antibodies to their injected insulin. There was a tendency for higher insulin antibody levels to be associated with indices of neonatal morbidity but not with percentile birth weights and C-peptide levels in cord sera.

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Section: Discussioncontrasting

confidence: 72%

Insulin immunogenicity in pregnancy: maternal and fetal studies

et al. 1983

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“…It has been shown that IA levels in women with type 1 diabetes remain quite stable during pregnancy [11,12] or decrease only slightly toward term [13,14]. At the time of delivery, it has been shown that around 74% to 90% of mothers with type 1 diabetes are IA-positive [15,16].…”

Section: Type 1 Diabetes-associated Antibodies During Pregnancymentioning

confidence: 99%

Autoimmunity and familial risk of type 1 diabetes

Hämäläinen

Knip²

2002

Curr Diab Rep

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There is evidence that the process leading to type I diabetes may start in early infancy or already in utero. Even though diabetes-associated antibodies can be detected in up to half of the pregnancies of mothers with type I diabetes, pregnancy itself has no major effect on these antibodies. If such antibodies are present in the mother, they are transferred to the fetal circulation and are detectable in cord blood. Most of the transplacentally transferred antibodies disappear by 6 months of age, but may persist even longer. Antibodies present in cord blood may represent true induction of beta-cell autoimmunity, but such a phenomenon is extremely rare. The offspring of affected mothers have a 2% to 3% risk of type I diabetes, which is about one third of that in the offspring of affected fathers. A novel conceivable explanation is that exogenous insulin transplacentally transferred in immune complexes might lead to the induction of tolerance to insulin, which may be the primary autoantigen in type I diabetes. The possible protective or predisposing effect of diabetes-associated antibodies detectable at birth on progression to clinical type I diabetes later will be assessed in ongoing prospective birth cohort studies.

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“…Controversially, some studies have reported stable IA titres during pregnancy [7,8], while a slight decrease in IA levels has been documented in others [9,10]. No detailed data are available on IAA levels in nondiabetic women during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy induces nonimmunoglobulin insulin-binding activity in both maternal and cord blood serum

Ronkainen

Hämäläinen

Koskela

et al. 2001

Clinical and Experimental Immunology

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SUMMARYTo evaluate whether pregnancy has any effect on insulin antibody levels and to test the concordance between a conventional radioimmunoassay and a new microassay for the detection of insulin antibodies, insulin antibodies were analysed in 104 mothers in early pregnancy and at delivery and in their newborn infants. Thirty-eight of the mothers had type 1 diabetes. The concordance between the assays was high in the samples taken in early pregnancy (95%), but substantially lower in the samples taken at delivery (40%) and in the cord blood samples (68%). A considerable proportion of the mothers at delivery, especially the unaffected mothers (71%), and the newborn infants of the unaffected mothers (32%) were positive for insulin antibodies in the conventional assay but not in the microassay. Insulin antibody levels increased in the mothers, significantly so in the unaffected mothers (P , 0´001), during pregnancy in the conventional assay, whereas in the microassay they decreased significantly (P , 0´01) in affected mothers and remained negative in the unaffected mothers. Since immune complexes are precipitated with protein A specific for IgG in the microassay and with polyethylene glycol lacking specificity for immunoglobulins in the conventional assay, our data indicate that insulin antibody levels decrease on average during pregnancy and that the increasing non-IgG anti-insulin activity observed in the conventional assay is induced by pregnancy and is present in both the maternal and the foetal circulation.

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Insulin Antibodies in Diabetic Pregnancy

Cited by 15 publications

References 7 publications

Insulin immunogenicity in pregnancy: maternal and fetal studies

Insulin immunogenicity in pregnancy: maternal and fetal studies

Autoimmunity and familial risk of type 1 diabetes

Pregnancy induces nonimmunoglobulin insulin-binding activity in both maternal and cord blood serum

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