The risk of stillbirth is particularly high for women with Type 1 or Type 2 diabetes who suffer four times as many stillbirths as non-diabetic women. The tools currently available to monitor such risks are limited and give results only at late stages of pregnancy. Now research by Warwick Medical School at the University of Warwick is identifying new methods of early & accurate monitoring of the risks faced by such women.
The new research by a Warwick Medical School team, Dr Harpal Randeva, Dr Paul O'Hare & Dr Dimitris Grammatopoulos; Consultant Endocrinologists and Mr Manu Vatish, Consultant Obstetrician, focussed on the profound alterations in the hormonal metabolism of pregnant women and the metabolic signals between mother and fetus. They particularly looked at a key signalling molecule, mainly produced by fat cells, called adiponectin. This is known to have anti-diabetic properties as well as anti-inflammatory and anti-atherogenic actions (it prevents blood clotting which can block arteries). They also closely examined levels of leptin which plays an important role in regulating energy balance and rises during pregnancy.
Given the high perinatal mortality associated with Type 1 diabetes, the researchers investigated adiponectin and leptin levels during both normal and Type 1 diabetic pregnancies. They measured both groups at 20 and 30 weeks into the pregnancy, and after giving birth.
Their novel observations showed that adiponectin levels were higher in pregnant women with type 1 diabetes at all stages of the study compared with the non-diabetic patients. Leptin levels were not different. Furthermore, they have identified adiponectin receptors on the human placenta and detected that the placenta also produces adiponectin. The researchers believe that the fetus produces adiponectin to protect itself from an adverse environment.
This is of vital importance since altered adiponectin levels could now be used to help give effective and early monitoring of the risks faced by women with type 1 diabetes and identify babies who are at risk.
The researchers are now looking for support to extend their studies to develop biological markers for at risk pregnancies. They particularly wish to extend their studies to examine pregnant women with type 2 diabetes and also to pregnant women who are obese (since recent data from the British Journal of Obstetrics & Gynaecology suggests that obese women are at double the risk of stillbirth).
Notes for editors:
1. This research paper is entitled "Raised plasma adiponectin levels in type 1 diabetic pregnancies" in Clinical Endocrinology 65 17-21 (July 2006) and involved staff from Warwick Medical School, University of Warwick, the University of Warwick's Department of Biological Sciences, and University Hospitals Coventry and Warwickshire NHS Trust, UK
2. The placental adiponectin paper is entitled "Chen J, Tan B, Karteris E, Zervou S, Digby J, Hillhouse EW, Vatish M, Randeva HS. Secretion of adiponectin by human placenta: differential modulation of adiponectin and its receptors by cytokines."Diabetologia 49 1292-302 (June 2006) and involved staff from Warwick Medical School, University of Warwick, the University of Warwick's Department of Biological Sciences, and University Hospitals Coventry and Warwickshire NHS Trust, UK
3. The Confidential Enquiry into Maternal and Child Health (CEMACH) studied deaths occurring after birth together with congenital anomalies in babies born to British women with Type-1 or Type-2 March 2002 - February 2003. Of the 2,359 women who had diabetes, 72% had type-1 and 28% had type-2. CEMACH discovered that perinatal death rates among diabetic women were four times higher than the equivalent rates for non-diabetic women.