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
