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Am J Perinatol 2020; 37(11): 1094-1101
DOI: 10.1055/s-0040-1702988
SMFM Fellowship Series Article

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

Andrea W. Johnson
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Section of Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut
,
Denis Snegovskikh
2   Division of Obstetric and Gynecological Anesthesiology, Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
,
Lisa Parikh
3   Department of Internal Medicine, Section of Endocrinology and Metabolism, Yale School of Medicine, New Haven, Connecticut
,
Renata B. DeAguiar
3   Department of Internal Medicine, Section of Endocrinology and Metabolism, Yale School of Medicine, New Haven, Connecticut
,
Christina S. Han 
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Section of Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut
,
Janice J. Hwang
3   Department of Internal Medicine, Section of Endocrinology and Metabolism, Yale School of Medicine, New Haven, Connecticut
› Author Affiliations Funding This research was funded by HD 047018 (C.S.H.), the Endocrine Fellows Foundation Marilyn Fishman Grant (J.J.H.)
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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.

Keywords

insulin - leptin - pregnancy - central nervous system - obesity

Authors' Contributions

A.W.J. and J.J.H. conceived and performed the experiments, data collection, data analysis, and manuscript preparation. C.S.H. conceived the experiments and was involved in data analysis and manuscript preparation. D.S., L.P., and R.B.D.A. collected and analyzed the data. All authors were involved in writing the paper and had final approval of the submitted and published versions.




Publication History

Received: 05 September 2019

Accepted: 19 January 2020

Article published online:
02 March 2020

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