OBJECTIVE -In adults, adiponectin is reduced in association with excess adiposity, type 2 diabetes, and hyperinsulinemia. We assessed whether adiponectin was 1) present in the fetal circulation, 2) altered in the fetal circulation in the presence of maternal diabetes, and 3) had relations to fetal cord blood insulin or adiposity.RESEARCH DESIGN AND METHODS -We assessed adiponectin in cord blood in a large cohort of singleton offspring of diabetic mothers (ODM; n ϭ 134) and control mothers (n ϭ 45).RESULTS -Adiponectin was present in cord blood and, in ODM, was higher in those delivered at later gestational ages (Spearman r ϭ 0.18, P ϭ 0.03). Adiponectin was slightly lower in ODM than control subjects (ODM 19.7 Ϯ 6.1 vs. control 21.8 Ϯ 5.3 g/ml; P ϭ 0.04), although this difference could potentially reflect different gestational ages in the two groups (ODM 37.6 Ϯ 1.5 and control 40.1 Ϯ 1.1 weeks). In contrast to adults, adiponectin levels in the fetus were unrelated to the degree of adiposity, blood insulin, or leptin in either control subjects or ODM.CONCLUSIONS -Adiponectin is present in cord blood but does not show expected physiological relations with adiposity as observed in adults. Diabetes Care 26:2244 -2249, 2003A dipose tissue expresses a variety of secretory proteins of importance to metabolic and vascular disease. Recently, adiponectin, a 244 -amino acid adipocyte-derived protein (1) has been described that is paradoxically reduced in obesity (2) and inversely related to leptin concentrations (3), despite being solely derived from adipose tissue in humans. Both type 2 diabetes and relative insulin resistance (in nondiabetic subjects) are associated with decreased adiponectin concentrations (4,5), while improvement of insulin sensitivity by either weight reduction (6) or administration of thiazolidinediones (7) is associated with increased adiponectin concentrations. Furthermore, in people matched for BMI, higher adiponectin concentrations are protective against later development of type 2 diabetes (8).Exposure to maternal diabetes in utero is associated with increased adiposity at birth (9), as well as increases in fetal leptin (10) and insulin (11). Furthermore, the presence of maternal diabetes during pregnancy influences the longterm health of offspring with increases in future risk of obesity (12,13), type 2 diabetes (14), and impaired glucose tolerance (15-17).Adiponectin has not been previously assessed in cord blood specimens. We wished to examine whether 1) adiponectin was present in cord blood, 2) relations to adiposity, sex, and circulating insulin and leptin observed in adults were also present in utero, and 3) offspring of mothers with type 1 diabetes, a group at high risk of later development of metabolic disease, would have lower concentrations of adiponectin at birth. RESEARCH DESIGN AND METHODS Recruitment and clinical protocolRecruitment, which began in January 1999 and ended in May 2001, took place in eight hospital-based antenatal centers in Scotland. A total of 250 women with type 1 ...

Objective: To determine the uptake and acceptability of different methods of a universal offer of voluntary HIV testing to pregnant women. Design: Randomised controlled trial involving four combinations of written and verbal communication, followed by the direct offer of a test. The control group received no information and no direct offer of a test, although testing was available on request. Setting: Hospital antenatal clinic covering most of the population of the city of Edinburgh. Subjects: 3024 pregnant women booking at the clinic over a 10 month period. Main outcome measures: Uptake of HIV testing and women's knowledge, satisfaction, and anxiety. Results: Uptake rates were 6% for those in the control group and 35% for those directly offered the test. Neither the style of leaflet nor the length of discussion had an effect on uptake. Significant independent predictors of uptake were a direct test offer; the midwife seen; and being unmarried, previously tested, and younger age. Knowledge of the specific benefits of testing increased with the amount of information given, but neither satisfaction nor anxiety was affected by the type of offer. Conclusions:The universal offer of HIV testing is not intrusive and is acceptable to pregnant women. A policy of offering the HIV test to all women resulted in higher uptake and did not increase anxiety or dissatisfaction. Uptake depends more on the midwife than the method of offering the test. Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing.

Maternal diabetes during pregnancy is associated with excess fetal growth and increased fetal insulin production. We hypothesized that insulin propeptides (proinsulin and 32-33 split proinsulin) might be more robust indicators of chronic fetal overproduction of insulin. We examined insulin-like molecules in cord blood (ILM) (insulin, proinsulin, and 32-33 split proinsulin) in relation to birth weight, maternal glycemia, and cord glucose in 140 offspring of mothers with type 1 diabetes (ODM) and 49 offspring of mothers who did not have diabetes (CONTROL) as well as degradation of ILM in response to sampling conditions at birth. Insulin propeptides were abundant in cord blood, comprising 50% of ILM in CONTROL and 36% in ODM (P < 0.0001) and more resistant to degradation than insulin (P < 0.05). Concentrations of all three ILM were highly intercorrelated with median values 2- to 5-fold higher in ODM than CONTROL [e.g. median (range): insulin ODM 110 (60-217) pmol/liter; CONTROL 22 (15-37) pmol/liter; P < 0.0001]. In ODM, 32-33 split proinsulin and proinsulin were more closely related to birth weight (Spearman r for ILM: r(32-33 split)= 0.54; r(PROINSULIN): r = 0.54; r(INSULIN) = 0.40: r(32-33 split) and r(PROINSULIN) > r(INSULIN)P < 0.05) and fetal leptin (r(32-33 split)= 0.55; r(PROINSULIN); r = 0.54; r(INSULIN) = 0.22: r(32-33 split) and r(PROINSULIN) > r(INSULIN)P < 0.05) than insulin). By contrast, insulin was more closely related to cord glucose (r(32-33 split) = 0.15; r(PROINSULIN): r = 0.10; r(INSULIN) = 0.42: r(INSULIN) > r(32-33 split) and r(PROINSULIN)P < 0.05). In CONTROL, 32-33 split proinsulin was also more closely related to fetal leptin r(32-33 split)= 0.61; r(PROINSULIN): r = 0.29; r(INSULIN) = 0.33: r(32-33 split) > r(INSULIN)P < 0.05). In ODM, 32-33 split proinsulin and proinsulin have closer relationships to fetal growth and leptin concentrations at birth than insulin. Measurement of insulin propeptides may be advantageous in assessment of the influence of maternal hyperglycemia on the newborn.

Maternal diabetes results in inverse changes of circulating fetal IGF-1 and IGFBP-1 at birth. A decrease in circulating IGFBP-1 and to a lesser extent an increase in circulating IGF-1 may present an important mechanism that contributes to increased birth weight in diabetic pregnancies.