General Obstetrics and Gynecology: Obstetrics
Adipose tissue from pregnant women with and without gestational diabetes mellitus: Insulin-sensitive but resistant to hyperosomolarity

https://doi.org/10.1016/j.ajog.2005.04.058Get rights and content

Objective

We sought to determine the contribution of adipose tissue to the insulin resistance of pregnancy. We also investigated whether hyperosmolar stress (induced by sorbitol) stimulates glucose uptake in human adipose tissue and, if so, whether this effect is altered in pregnancy and gestational diabetes mellitus.

Study design

Subcutaneous and omental adipose tissue biopsy specimens were obtained at elective abdominal surgery or cesarean delivery from 16 normal glucose-tolerant pregnant women, 13 pregnant women with gestational diabetes mellitus, and 19 body mass index–matched nonpregnant control subjects. Basal, insulin (100 nmol/L)-, and sorbitol (250 mmol/L)-stimulated glucose uptake levels were measured.

Results

Basal and insulin-stimulated glucose uptake into adipose tissue was not impaired in pregnancy or gestational diabetes mellitus compared with control subjects. Hyperosmolarity stimulated glucose uptake in human adipose tissue from the subcutaneous, but not omental depot, and not in adipose tissue from pregnant subjects.

Conclusion

There is no significant difference in insulin sensitivity in adipose tissue from pregnant or nonpregnant women; hyperosmolarity stimulates glucose uptake in subcutaneous adipose tissue from nonpregnant women, and adipose tissue from pregnant women is sorbitol resistant. These findings suggest the phosphotidylinositol 3-kinase–independent pathway may have pathophysiologic relevance to glucose uptake in human adipose tissue and may be impaired in pregnancy.

Section snippets

Material and methods

The study cohort consisted of 16 pregnant women with normal glucose tolerance (NGT), 13 subjects with GDM, and 19 nonpregnant control subjects. Subjects were recruited on the morning of their elective abdominal surgery or elective lower uterine segment cesarean delivery (LUSCS). The pregnant women were all delivered at 37 to 40 weeks of gestation. Retrospectively, information was gathered regarding each pregnant subject's glucose tolerance status. The Australian Diabetes in Pregnancy Society

Results

Table I describes the characteristics of the subjects. The nonpregnant group was older than the pregnant group of subjects (42 ± 8 years old vs 33 ± 6 years old vs 33 ± 4 years old, nonpregnant vs NGT vs GDM. respectively; P < .001 compared with nonpregnant women). There was no difference in BMI between the groups with either the prepregnancy BMI or current BMI. Overall glycemia, as assessed by fructosamine, was comparable between the pregnant women with GDM and NGT.

Comment

The results of this study did not support the initial hypothesis that adipose tissue from pregnant women would demonstrate reduced insulin-stimulated glucose uptake compared with that from nonpregnant control subjects, nor the hypothesis that insulin-stimulated glucose uptake would be impaired in women with GDM compared with pregnant women with NGT. Rather, we found that basal and insulin-stimulated glucose uptake in both subcutaneous and omental adipose tissues are similar in pregnant and

Acknowledgments

We thank P. Imbeault (University of Ottawa, Canada) and E. Bellar (University of Queensland, Australia) for assistance with statistical analysis, the surgeons and obstetricians from the Princess Alexandra and Mater Mother's Hospitals, and especially to the women for their participation.

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  • Supported by Wellcome Senior Research Fellowship in Medical Science and Princess Alexandra Hospital Foundation (J.B.P.), a Wellcome International Travelling Fellowship (J.P.W.), and a NovoNordisk regional diabetes scheme grant and National Health and Medical Research Committee postgraduate medical research scholarship (A.W.R.).

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