Maternal and fetal placental growth hormone and IGF axis in type 1 diabetic pregnancy.

Mary F Higgins,Noirin E Russell,Derek P Brazil,Kristine C Nyhan,Paul A Crossey,Fionnuala M Mcauliffe

doi:10.1371/journal.pone.0029164

Mary F Higgins, Noirin E Russell + Show 4 more

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https://doi.org/10.1371/journal.pone.0029164

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Abstract

AimPlacental growth hormone (PGH) is a major growth hormone in pregnancy and acts with Insulin Like Growth Factor I (IGF-I) and Insulin Like Growth Hormone Binding Protein 3 (IGFBP3). The aim of this study was to investigate PGH, IGF-I and IGFBP3 in non-diabetic (ND) compared to Type 1 Diabetic (T1DM) pregnancies.MethodsThis is a prospective study. Maternal samples were obtained from 25 ND and 25 T1DM mothers at 36 weeks gestation. Cord blood was obtained after delivery. PGH, IGF-I and IGFBP3 were measured using ELISA.ResultsThere was no difference in delivery type, gender of infants or birth weight between groups. In T1DM, maternal PGH significantly correlated with ultrasound estimated fetal weight (r = 0.4, p = 0.02), birth weight (r = 0.51, p<0.05) and birth weight centile (r = 0.41, p = 0.03) PGH did not correlate with HbA1c.Maternal IGF-I was lower in T1DM (p = 0.03). Maternal and fetal serum IGFBP3 was higher in T1DM. Maternal third trimester T1DM serum had a significant band at 16 kD on western blot, which was not present in ND.ConclusionMaternal T1DM PGH correlated with both antenatal fetal weight and birth weight, suggesting a significant role for PGH in growth in diabetic pregnancy.IGFBP3 is significantly increased in maternal and fetal serum in T1DM pregnancies compared to ND controls, which was explained by increased proteolysis in maternal but not fetal serum. These results suggest that the normal PGH-IGF-I-IGFBP3 axis in pregnancy is abnormal in T1DM pregnancies, which are at higher risk of macrosomia.

Highlights

Type 1 Diabetes (T1DM) affects less than 1% of the obstetric population but is a significant cause of fetal and neonatal morbidity and mortality [1,2,3]
There was no difference in crude birth weight measurements, women with T!DM delivered at an earlier gestational age and the birth weight centile was higher in the T1DM group compared to the non-diabetic group T1DM
Maternal Insulin Like Growth Factor I (IGF-I) was lower in T1DM mothers compared with nondiabetic controls

Summary

Introduction

Type 1 Diabetes (T1DM) affects less than 1% of the obstetric population but is a significant cause of fetal and neonatal morbidity and mortality [1,2,3]. Many of these complications are related to fetal macrosomia [4] that, despite enhancements in glycaemic control, is still common in diabetic pregnancies [4,5]. Fetal growth is a complex process influenced by genetics, maternal factors, uterine environment and maternal and fetal hormones [4,9]. The influence of growth factors, both maternal and fetal, may be of importance [4]

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