Central actions of insulin during pregnancy and lactation

Automated insulin delivery in pregnant women with type 1 diabetes mellitus: a systematic review and meta-analysis

AIMS

To assess the efficacy and safety of automated insulin delivery (AID) systems compared to standard care in managing glycaemic control during pregnancy in women with Type 1 Diabetes Mellitus (T1DM).

METHODS

We searched MEDLINE, Cochrane Library, registries and conference abstracts up to June 2024 for randomized controlled trials (RCTs) and observational studies comparing AID to standard care in pregnant women with T1DM. We conducted random effects meta-analyses for % of 24-h time in range of 63-140 mg/dL (TIR), time in hyperglycaemia (> 140 mg/dl and > 180 mg/dL), hypoglycaemia (< 63 mg/dl and < 54 mg/dL), total insulin dose (units/kg/day), glycemic variability (%), changes in HbA1c (%), maternal and fetal outcomes.

RESULTS

Thirteen studies (450 participants) were included. AID significantly increased TIR (Mean difference, MD 7.01%, 95% CI 3.72-10.30) and reduced time in hyperglycaemia > 140 mg/dL and > 180 mg/dL (MD - 5.09%, 95% CI - 9.41 to - 0.78 and MD - 2.44%, 95% CI - 4.69 to - 0.20, respectively). Additionally, glycaemic variability was significantly reduced (MD - 1.66%, 95% CI - 2.73 to - 0.58). Other outcomes did not differ significantly.

CONCLUSION

AID systems effectively improve glycaemic control during pregnancy in women with T1DM by increasing TIR and reducing hyperglycaemia without any observed adverse short-term effects on maternal and fetal outcomes.

Altered thermal preference by preoptic estrogen receptor alpha neurons in postpartum females

OBJECTIVE

This study aims to investigate how reproductive experience (RE) alters thermal preference and thermoregulation in female mice, with a focus on estrogen receptor alpha (ERα)-expressing neurons in the preoptic area (POA).

METHODS

Thermal preference and body temperature were measured in female mice with and without RE, and virgin female mice with selective deletion of ERα from the POA (ERαPOA-KO). The number and activity of ERα-expressing POA neurons (ERαPOA) were assessed using immunohistochemistry and in vitro electrophysiology in response to temperature changes and ERα agonist.

RESULTS

We showed that female mice prefer a cooler environment starting from late pregnancy and persisting long term postpartum. Female mice with RE (>4 weeks post-weaning) displayed lower body temperature and a lower thermal preferred temperature, and lost preference for warm environments (30 °C) but preserved avoidance of cold environments (15 °C). This was associated with a significant decrease in the number of ERαPOA neurons. Importantly, virgin female ERαPOA-KO mice displayed lower thermal preferred temperature and impaired warm preference, mimicking RE mice. We further found that distinct ERαPOA subpopulations can be regulated by temperature changes with or without presynaptic blockers, and by ERα agonist. More importantly, RE decreased the number of warm-activated ERαPOA neurons and reduced the excitatory effects of warmth and estrogen-ERα signaling, while cold-activated ERαPOA neurons were slightly enhanced in female mice with RE.

CONCLUSION

Our results support that the thermosensing ability and estrogenic effects in ERαPOA neurons are regulated by reproductive experience, altering thermal preference.

Lipidomic Signature of Pregnant and Postpartum Females by Longitudinal and Transversal Evaluation: Putative Biomarkers Determined by UHPLC-QTOF-ESI+-MS

BACKGROUND

Pregnancy induces significant physiological and metabolic changes in the mother to support fetal growth and prepare for childbirth. These adaptations impact various systems, including immune tolerance, metabolism, and endocrine function. While metabolomics has been utilized to study pregnancy-related metabolic changes, comprehensive comparisons between pregnant and non-pregnant states, particularly using ultra-high-performance liquid chromatography coupled with mass spectrometry (UHPLC-MS), remain limited.

METHODS

This study aimed to explore the dynamic, longitudinal metabolic shifts during pregnancy by profiling plasma samples from 65 pregnant women across three time points (6-14 weeks, 14-22 weeks, and >24 weeks) and 42 postpartum women. Lipidomics was prioritized, and a solvent mixture was employed to enhance lipid extraction, using UHPLC-QTOF-ESI+-MS.

RESULTS

A total of 290 metabolites were identified and analyzed. Our results revealed significant metabolic differences between pregnant and postpartum women, with lipid molecules such as estrogen derivatives, fatty acids, and ceramides showing strong potential as biomarkers. Further biomarker analysis highlighted distinct metabolic signatures between early and late pregnancy stages, particularly in lipid metabolism (with AUC values > 0.8).

CONCLUSIONS

These findings contribute to a deeper understanding of pregnancy-related metabolic changes and may offer insights into maternal and neonatal health outcomes.

Pentadecanoic acid (C15:0, PA) induces mild maternal glucose intolerance and promotes the growth of the offspring partly through up-regulating liver PPARα and MAPK signaling pathways

Gestational diabetes mellitus (GDM) is one of the most common metabolic disturbances during pregnancy, which poses a serious threat to both maternal and offspring health. Pentadecanoic acid (C15:0, PA) is one of the most common odd-chain saturated fatty acids (OCS-FAs). However, its safety and nutritional value are yet to be verified. Herein, we provide a systematic assessment of the effects of PA on maternal and progeny health and insulin sensitivity for the first time. Our results showed that consumption of 1% PA during pregnancy could increase the contents of PA and heptadecanoic acid (C17:0) in maternal plasma, fetal tissue and offspring plasma, but it had no effect on embryonic development. During pregnancy, PA treatment caused mild insulin resistance, while it had little effect on the maternal body composition. During lactation, PA treatment caused mild insulin resistance and oxidative stress. Maternal body fat deposition was also reduced, but the growth rate of the offspring was faster. It is worth noting that PA treatment decreased plasma and liver TG content and increased the antioxidant capacity of the offspring. The effect of PA on the transcription and expression genes in the liver of pregnant mice was investigated using RNA-seq. PPARα and MAPK signaling pathways, both closely related to lipolysis, inflammation, oxidative stress, and insulin resistance were significantly increased. The expression of c-JUN, ERK, JNK and P65 proteins was also significantly up-regulated. In conclusion, our results suggest that 1% PA can induce a mild decrease in the maternal glucose tolerance and lipolysis mainly by activated MAPK and PPARα signaling. Moreover, low concentrations of PA may be an effective nutrient to alleviate the oxidative stress and reduce blood lipid levels of offspring.

Dietary Sugar and Saturated Fat Consumption Associated with the Gastrointestinal Microbiome during Pregnancy

BACKGROUND

Growing evidence supports changes in the gastrointestinal microbiome over the course of pregnancy may have an impact on the short- and long-term health of both the mother and the child.

OBJECTIVE

Our objective was to explore the association of diet quality, as measured by the Healthy Eating Index (HEI), with the composition and gene ontology (GO) representation of microbial function in the maternal gastrointestinal microbiome during pregnancy.

METHODS

We conducted a retrospective, observational analysis of n = 185 pregnant participants in the Pregnancy Eating Attributes Study. Maternal dietary intake was assessed in the first trimester using the automated self-administered 24-h recall method, from which the HEI 2015 was calculated. Rectal swabs were obtained in the second trimester and sequenced using the NovaSeq 6000 system shotgun platform. We used unsupervised clustering to identify microbial enterotypes representative of maternal taxa and GO functional term composition. Multivariable linear models were used to identify associations between taxa, functional terms, and food components while controlling for relevant covariates. Multinomial regression was then used to predict enterotype membership based on a participant's HEI food component score.

RESULTS

Those in the high diet quality tertile had a lower early pregnancy BMI [mean (M) = 23.48 kg/m2, SD = 3.38] compared with the middle (M = 27.35, SD = 6.01) and low (M = 27.49, SD = 6.99) diet quality tertiles (P < 0.01). There were no statistically significant associations between the HEI components or the total HEI score and the 4 alpha diversity measures. Differences in taxa and GO term enterotypes were found in participants with, but not limited to, a higher saturated fat component score (β = 1.35, P = 0.01), added sugar HEI component (β = 0.07, P < 0.001), and higher total dairy score (β = 1.58, P = 0.01).

CONCLUSIONS

Specific dietary components are associated with microbial composition and function in the second trimester of pregnancy. These findings provide a foundation for future testable hypotheses.

The impact of glycosylated hemoglobin and 75-g oral glucose tolerance test glucose levels on birthweight percentile

OBJECTIVE

Our research objective was to validate and contribute further evidence to the studies regarding large for gestational age and birthweight percentile by examining oral glucose tolerance test and glycosylated hemoglobin levels in both healthy women and those with gestational diabetes mellitus.

METHODS

This retrospective cohort study was conducted at a tertiary care hospital involving 106 women who delivered at gestational week 36 or later between February 2022 and February 2023. Maternal, obstetric, and neonatal data were collected from the participant's medical records. Large for gestational age and non-large for gestational age groups were compared. Correlation analysis was used to determine associations among oral glucose tolerance test, glycosylated hemoglobin levels, and the birthweight percentile.

RESULTS

Mothers of neonates in the large for gestational age category had higher body mass indexes before pregnancy (p=0.002) and delivery (p=0.003), as well as a higher incidence of gestational diabetes mellitus (p=0.027). Mothers of male large for gestational age infants had higher fasting plasma glucose and glycosylated hemoglobin levels compared to male non-large for gestational age infants (p=0.007 and p=0.004, respectively). There was a weak positive correlation between fasting plasma glucose levels and birthweight percentile in the overall group (r=0.342, p<0.006). Further analysis by gender showed a weak positive correlation between birthweight percentile and fasting plasma glucose and glycosylated hemoglobin values in male newborns (r=0.393, p=0.004 and r=0.373, p=0.006, respectively).

CONCLUSION

Our study has established a clear association between the birthweight percentile in male infants and the levels of glycosylated hemoglobin and fasting plasma glucose measured during oral glucose tolerance test. It is imperative to devise potential strategies aimed at achieving optimal glycosylated hemoglobin and fasting plasma glucose parameters to effectively reduce the frequency of large for gestational age in male infants.

Pancreatic islet adaptation in pregnancy and postpartum

Pancreatic islets, particularly insulin-producing β-cells, are central regulators of glucose homeostasis capable of responding to a variety of metabolic stressors. Pregnancy is a unique physiological stressor, necessitating the islets to adapt to the complex interplay of maternal and fetal-placental factors influencing the metabolic milieu. In this review we highlight studies defining gestational adaptation mechanisms within maternal islets and emerging studies revealing islet adaptations during the early postpartum and lactation periods. These include adaptations in both β and in 'non-β' islet cells. We also discuss insights into how gestational and postpartum adaptation may inform pregnancy-specific and general mechanisms of islet responses to metabolic stress and contribute to investigation of gestational diabetes.

The growing complexity of the control of the hypothalamic pituitary thyroid axis and brown adipose tissue by leptin

The balance between food intake and energy expenditure is precisely regulated to maintain adipose stores. Leptin, which is produced in and released from adipose in direct proportion to its size, is a major contributor to this control and initiates its homeostatic responses largely via binding to leptin receptors (LepR) in the hypothalamus. Decreases in hypothalamic LepR binding signals starvation, leading to hunger and reduced energy expenditure, whereas increases in hypothalamic LepR binding can suppress food intake and increase energy expenditure. However, large gaps persist in the specific hypothalamic sites and detailed mechanisms by which leptin increases energy expenditure, via the parallel activation of the hypothalamic pituitary thyroid (HPT) axis and brown adipose tissue (BAT). The purpose of this review is to develop a framework for the complex mechanisms and neurocircuitry. The core circuitry begins with leptin binding to receptors in the arcuate nucleus, which then sends projections to the paraventricular nucleus (to regulate the HPT axis) and the dorsomedial hypothalamus (to regulate BAT). We build on this core by layering complexities, including the intricate and unsettled regulation of arcuate proopiomelanocortin neurons by leptin and the changes that occur as the regulation of the HPT axis and BAT is engaged or modified by challenges such as starvation, hypothermia, obesity, and pregnancy.

Investigation of Relationships between Intakes of Human Milk Total Lipids and Metabolic Hormones and Infant Sex and Body Composition

Human milk (HM) composition, including metabolic hormones and lipids, is influenced by various factors, including lactation stage and, potentially, infant sex, which may affect infant body composition (BC) development. We aimed to: (a) characterize the longitudinal concentration and intake profiles of HM leptin, adiponectin, insulin, and total lipids; (b) determine if their concentrations and intakes differ by infant sex; and (c) explore the intakes relationships with the development of infant BC. Milk samples (n = 501) were collected from 82 mother-infant dyads during the first 6 months postpartum. Infant 24 h HM intake was measured, and the average cumulative HM component intakes were calculated. The statistical analysis used linear mixed modeling. Intakes of HM leptin, adiponectin, insulin, and total lipids increased to 1 month postpartum and then remained stable. HM intake and total lipids intake but not hormone intakes were positively associated with infant BC (fat-free mass, fat-free mass index, fat mass, fat mass index, percentage fat mass, and fat mass to fat-free mass ratio). HM component concentrations and intakes did not differ by sex. These findings advance our understanding of the temporal nature of HM components, emphasizing the role of infant 24 h HM and total lipids intake in development of infant lean and adipose tissue.

Placental mitochondrial impairment and its association with maternal metabolic dysfunction

The placenta plays an essential role in pregnancy, leading to proper fetal development and growth. As an organ with multiple physiological functions for both mother and fetus, it is a highly energetic and metabolically demanding tissue. Mitochondrial physiology plays a crucial role in the metabolism of this organ and thus any alteration leading to mitochondrial dysfunction has a severe outcome in the development of the fetus. Pregnancy-related pathological states with a mitochondrial dysfunction outcome include preeclampsia and gestational diabetes mellitus. In this review, we address the role of mitochondrial morphology, metabolism and physiology of the placenta during pregnancy, highlighting the roles of the cytotrophoblast and syncytiotrophoblast. We also describe the relationship between preeclampsia, gestational diabetes, gestational diabesity and pre-pregnancy maternal obesity with mitochondrial dysfunction.

Maternal nutrient metabolism in the liver during pregnancy

The liver plays pivotal roles in nutrient metabolism, and correct hepatic adaptations are required in maternal nutrient metabolism during pregnancy. In this review, hepatic nutrient metabolism, including glucose metabolism, lipid and cholesterol metabolism, and protein and amino acid metabolism, is first addressed. In addition, recent progress on maternal hepatic adaptations in nutrient metabolism during pregnancy is discussed. Finally, the factors that regulate hepatic nutrient metabolism during pregnancy are highlighted, and the factors include follicle-stimulating hormone, estrogen, progesterone, insulin-like growth factor 1, prostaglandins fibroblast growth factor 21, serotonin, growth hormone, adrenocorticotropic hormone, prolactin, thyroid stimulating hormone, melatonin, adrenal hormone, leptin, glucagon-like peptide-1, insulin glucagon and thyroid hormone. Our vision is that more attention should be paid to liver nutrient metabolism during pregnancy, which will be helpful for utilizing nutrient appropriately and efficiently, and avoiding liver diseases during pregnancy.

Variations in Blood Copper and Possible Mechanisms During Pregnancy

Copper (Cu), an essential trace element, is crucial for both the mother and fetus. Currently, an increasing number of studies have focused on blood copper levels during pregnancy. Studies have found that blood copper levels in pregnant women are higher than those in reproductive-age women, but the trend, mainly in the 2nd and 3rd trimester, is still controversial. Most studies showed that blood copper levels gradually increased during pregnancy, while some studies found that blood copper levels remained stable or even decreased in the 3rd trimester. The possible mechanisms of variations in blood copper during pregnancy include the influence of estrogen (hepatic uptake and excretion, ceruloplasmin synthesis, maternal-fetal transport, etc.), the interaction of other trace elements (Fe, Zn, etc.) and other factors. Among them, maternal-fetal copper transport caused by elevated estrogen may be the main reason for the inconsistencies observed in the 2nd and 3rd trimester during pregnancy. However, there are some mechanisms require further investigation. In the future, the trend and mechanisms of blood copper during pregnancy should be explored more deeply to help doctors better monitor copper status and detect copper abnormalities in time.

The Role of the Glycemic Index and Glycemic Load in the Dietary Approach of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a common metabolic disorder that often develops during pregnancy, characterized by glucose intolerance and insulin resistance (IR). To ensure the well-being of both the mother and the fetus, the body undergoes multiple metabolic and immunological changes that result in peripheral IR and, under certain hereditary or acquired abnormalities, GDM in predisposed women. The adverse short- and long-term effects of GDM impact both the mother and the fetus. Nutrition seems to play an important role to prevent GDM or improve its evolution. An emphasis has been given to the proportion of carbohydrates (CHO) relative to protein and lipids, as well as dietary patterns, in GDM. The effects of CHO on postprandial glucose concentrations are reflected in the glycemic index (GI) and glycemic load (GL). Diets rich in GI and GL may induce or exacerbate IR, whereas diets low in GI and GL appear to enhance insulin sensitivity and improve glycemic control. These positive outcomes may be attributed to direct interactions with insulin and glucose homeostasis or indirect effects through improved body composition and weight management. This comprehensive narrative review aims to explore the significance of nutrition, with a focus on the critical evaluation of GI and GL in the dietary management of women with GDM.

Kinin B1 receptor controls maternal adiponectin levels and influences offspring weight gain

Given the importance of the kinin B1 receptor in insulin and leptin hormonal regulation, which in turn is crucial in maternal adaptations to ensure nutrient supply to the fetus, we investigated the role of this receptor in maternal metabolism and fetoplacental development. Wild-type and kinin B1 receptor-deficient (B1KO) female mice were mated with male mice of the opposite genotype. Consequently, the entire litter was heterozygous for kinin B1 receptor, ensuring that there would be no influence of offspring genotype on the maternal phenotype. Maternal kinin B1 receptor blockade reduces adiponectin secretion by adipose tissue ex vivo, consistent with lower adiponectin levels in pregnant B1KO mice. Furthermore, fasting insulinemia also increased, which was associated with placental insulin resistance, reduced placental glycogen accumulation, and heavier offspring. Therefore, we propose the combination of chronic hyperinsulinemia and reduced adiponectin secretion in B1KO female mice create a maternal obesogenic environment that results in heavier pups.

Metabolic and feeding adjustments during pregnancy

Eating behaviours are determined by the integration of interoceptive and environmental inputs. During pregnancy, numerous physiological adaptations take place in the maternal organism to provide an adequate environment for embryonic growth. Among them, whole-body physiological remodelling directly influences eating patterns, commonly causing notable taste perception alterations, food aversions and cravings. Recurrent food cravings for and compulsive eating of highly palatable food can contribute to the development and maintenance of gestational overweight and obesity with potential adverse health consequences for the offspring. Although much is known about how maternal eating habits influence offspring health, the mechanisms that underlie changes in taste perception and food preference during pregnancy (which guide and promote feeding) are only just starting to be elucidated. Given the limited and diffuse understanding of the neurobiology of gestational eating patterns, the aim of this Review is to compile, integrate and discuss the research conducted on this topic in both experimental models and humans. This article sheds light on the mechanisms that drive changes in female feeding behaviours during distinct physiological states. Understanding these processes is crucial to improve gestational parent health and decrease the burden of metabolic and food-related diseases in future generations.

Maternal monosaccharide diets evoke cognitive, locomotor, and emotional disturbances in adolescent and young adult offspring rats

Anxiety and depression are the most common mental disorders affecting people worldwide. Recent studies have highlighted that a maternal high-sugar diet (HSD) could be a risk factor for neurobehavioural dysregulations, including mood disorders. Increased consumption of added sugar in food such as refined fructose/glucose can increase the risk of metabolic disorders and impact susceptibility to mental disorders. Furthermore, a few papers have reported disabilities in learning and memory among offspring after maternal HSD, thus suggesting a relationship between maternal nutrition and offspring neurogenesis. In this study, we evaluated the impact of maternal monosaccharide consumption based on a glucose (GLU) or fructose (FRU) diet during pregnancy and lactation in adolescent and young adult offspring rats of both sexes on cognitive, locomotor, and emotional disturbances. Locomotor activity, short-term memory, anxiety-like and depressive-like behavior were evaluated in the offspring. We report for the first time that the maternal GLU or FRU diet is sufficient to evoke anxiety-like behavior among adolescent and young adult offspring. Moreover, we found that maternal monosaccharide diets lead to hyperactivity and depressive-like behavior in male adolescent rats. We also noticed that a maternal FRU diet significantly enhanced novelty-seeking behavior only in young adult male rats. Our novel findings indicated that the maternal monosaccharide diet, especially a diet enriched in FRU, resulted in strong behavioral alterations in offspring rats at early life stages. This study also revealed that male rats were more susceptible to hyperactivity and anxiety- and depressive-like phenotypes than female rats. These results suggest that maternal monosaccharide consumption during pregnancy and lactation is an important factor affecting the emotional status of offspring.

Maternal protein restriction during the lactation period disrupts the ontogenetic development of behavioral traits in male Wistar rat offspring

Neonatal undernutrition in rats results in short- and long-term behavioral and hormonal alterations in the offspring. It is not clear, however, whether these effects are present since the original insult or if they develop at some specific age later in life. Here, we assessed the ontogenetic profile of behavioral parameters associated with anxiety, exploration and memory/learning of Wistar rat offspring that were subjected to protein malnutrition during lactation. Dams and respective litters were separated into two groups: (1) protein-restricted (PR), which received a hypoproteic chow (8% protein) from birth to weaning [postnatal day (PN) 21]; (2) control (C), which received normoproteic chow. Offspring's behaviors, corticosterone, catecholamines, T3 and T4 levels were assessed at PN21 (weaning), PN45 (adolescence), PN90 (young adulthood) or PN180 (adulthood). PR offspring showed an age-independent reduction in the levels of anxiety-like behaviors in the Elevated Plus Maze and better memory performance in the Radial Arm Water Maze. PR offspring showed peak exploratory activity in the Open Field earlier in life, at PN45, than C, which showed theirs at PN90. Corticosterone was reduced in PR offspring, particularly at young adulthood, while catecholamines were increased at weaning and adulthood. The current study shows that considerable age-dependent variations in the expression of the observed behaviors and hormonal levels exist from weaning to adulthood in rats, and that protein restriction during lactation has complex variable-dependent effects on the ontogenesis of the assessed parameters.

Role of Perinatal Biological Factors in Delayed Lactogenesis II Among Women With Pre-pregnancy Overweight and Obesity

BACKGROUND

Pre-pregnancy overweight and obesity are negatively associated with delayed onset of lactogenesis II (OL), but the mechanisms by which these conditions affect OL are still unclear.

OBJECTIVES

To identify biological factors related to pre-pregnancy overweight/obesity and determine whether these biological factors were associated with delayed OL in this population.

METHODS

In this prospective observational study, we assigned 72 primipara to a pre-pregnancy overweight/obese group (n = 36) and a normal-weight group (n = 36). Blood samples were collected at 37 w of gestation and 48 h postpartum and assayed for levels of the following hormones: leptin, insulin, estradiol, prolactin (PRL), progesterone, and oxytocin. The primary outcome was timing of OL, estimated by maternal perception of breast fullness. We used linear-regression analysis to determine associations between hormones and delayed OL.

RESULTS

Sixty-three participants (87.5%) had complete data. OL occurred later in overweight/obese than in normal-weight women (p < .001). Compared with the normal-weight group, the overweight/obese group showed higher leptin levels at both times of observation and exhibited a slower drop in estrogen concentrations from 37 w of gestation to 48 h postpartum (all p < .05). After adjusting for confounding factors, leptin concentrations in late pregnancy and the magnitudes of decline in estrogen concentrations at 48 h postpartum were correlated with OL.

CONCLUSION

Women who were overweight/obese before pregnancy had elevated leptin levels in late pregnancy and a delayed decline in estrogen concentrations at 48 h postpartum. Both of these phenomena were related to delayed OL in this population.

Highlighting the trajectory from intrauterine growth restriction to future obesity

During the last decades several lines of evidence reported the association of an adverse intrauterine environment, leading to intrauterine restriction, with future disease, such as obesity and metabolic syndrome, both leading to increased cardiovascular and cancer risk. The underlying explanation for this association has firstly been expressed by the Barker's hypothesis, the "thrifty phenotype hypothesis". According to this hypothesis, a fetus facing an adverse intrauterine environment adapts to this environment through a reprogramming of its endocrine-metabolic status, during the crucial window of developmental plasticity to save energy for survival, providing less energy and nutrients to the organs that are not essential for survival. This theory evolved to the concept of the developmental origin of health and disease (DOHaD). Thus, in the setting of an adverse, f. ex. protein restricted intrauterine environment, while the energy is mainly directed to the brain, the peripheral organs, f.ex. the muscles and the liver undergo an adaptation that is expressed through insulin resistance. The adaptation at the hepatic level predisposes to future dyslipidemia, the modifications at the vascular level to endothelial damage and future hypertension and, overall, through the insulin resistance to the development of metabolic syndrome. All these adaptations are suggested to take place through epigenetic modifications of the expression of genes without change of their amino-acid sequence. The epigenetic modifications leading to future obesity and cardiovascular risk are thought to induce appetite dysregulation, promoting food intake and adipogenesis, facilitating obesity development. The epigenetic modifications may even persist into the next generation even though the subsequent generation has not been exposed to an adverse intrauterine environment, a notion defined as the "transgenerational transfer of environmental information". As a consequence, if the increased public health burden and costs of non-communicable chronic diseases such as obesity, hypertension, metabolic syndrome and type 2 diabetes have to be minimized, special attention should be laid to the healthy lifestyle habits of women of reproductive age, including healthy diet and physical activity to be established long before any pregnancy takes place in order to provide the best conditions for both somatic and mental health of future generations.

Theoretical basis of perinatology therapy in pregnant women with diabetes mellitus

Diabetes mellitus is a metabolic disorder that can occur before pregnancy, be detected during pregnancy, or develop during pregnancy. Therapeutic modalities available today significantly facilitate glycoregulation during pregnancy and childbirth. This review presents different insulin regimens, as well as the advantages and disadvantages of oral antidiabetic agents use with a special focus on hypoglycemia. The importance of maintaining optimal glycemic levels and educating patients in blood glucose self-measurement is explained.

Preliminary reference intervals of Glycated Albumin in healthy Caucasian pregnant women

BACKGROUND AND AIMS

Glycated albumin (GA) could represent a useful biomarker in pregnant women for diagnosing and monitoring gestational diabetes mellitus (GDM). The establishment of reference intervals (RI) is mandatory before assessing its clinical usefulness. The RIs of GA in healthy pregnant women are not well defined. The aim of the current study was to establish the RI in a cohort consisting of Caucasian pregnant women without overt diabetes mellitus or gestational diabetes mellitus.

METHODS

The study included 183 healthy pregnant women. GA was measured on plasma by an enzymatic method (quantILab Glycated Albumin, IL Werfen, Germany). The RI was calculated by the non-parametric and robust methods.

RESULTS

The RI of GA in the whole population was 10.16% (90%CI 9.60-10.70) and 15.44% (90%CI 14.90-16.90). GA levels decreased during pregnancy, with lower levels in the third trimester: 10.11 (90%CI 9.48-10.79) and 15.72 (90%CI 15.15-16.27) in the first trimester, 10.49 (90%CI 10.05-10.96) and 15.49 (90%CI 15.05-15.92) in the second trimester, 9.84 (90%CI 9.50-10.22) and 14.57 (90%CI 14.11-15.01) in the third trimester. Finally, a weak negative correlation was found between GA levels and body mass index.

CONCLUSION

This is the first study establishing the RIs of GA in Caucasian healthy pregnant women.

Insulin as a neuroendocrine hormone

The year 2021 marks 100 years since the discovery of insulin and this Special Issue of the Journal of Neuroendocrinology was conceived as a way to mark that historic breakthrough. The discovery of insulin and its subsequent use in the treatment of diabetes is one of the most striking success stories in biomedical research. From a neuroendocrinology perspective, the recognition that insulin also exerts widespread and varied actions in the brain is more recent, but potentially also of equal importance with relevance for conditions ranging from obesity to dementia. The reviews contained in this Special Issue were selected to cover the range of known actions of insulin in neuroendocrine function, and also to highlight areas where further understanding of insulin actions in the brain hold great promise for further improvements in human health.