Objective: Pregnancy is characterized by progressive insulin resistance. The present study evaluated whether the adiponectin/leptin ratio is associated with insulin resistance in pregnancy, since this ratio has been shown to be associated with insulin resistance in obesity, type 2 diabetes mellitus, metabolic syndrome and polycystic ovary syndrome. Methods: In this cross-sectional study, adiponectin and leptin concentrations were measured in pregnant women using enzyme-linked immunosorbent assays. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). Results: Mean AE SD age of the participants (n ¼ 74) was 30.76 AE 4.27 years, mean AE SD gestational age was 26.81 AE 3.52 weeks and median body mass index (BMI) before pregnancy was 22.68 kg/m 2 (interquartile range 20.75-26.79 kg/m 2 ).

Adipo nectin, leptin, resistin, visfatin and RBP4 were not associated with the degree of glucose tolerance in pregnancy. Concentrations of these adipocytokines are not sufficiently sensitive to replace HOMA- IR in pregnancy.

Objective To compare perinatal outcomes before and after implementation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for testing of gestational diabetes mellitus (GDM). Methods A national, perinatal, registry‐based cohort study of prospectively collected data was conducted. Patients with diabetes type 1 or 2 were excluded. Outcomes of 135 786 pregnancies before (January 1, 2004 to May 31, 2010) and 140 524 after (June 1, 2011 to December 31, 2017) the introduction of IADPSG criteria were compared using Student t test and χ2 test (P<0.05 was significant). Multivariable logistic regression was used to compare outcomes controlling for potential confounders. Results Prevalence of GDM increased from 2.6% to 9.7% (adjusted odds ratio 3.92; 95% confidence interval 3.78–4.08). Incidence of large‐for‐gestational age (LGA), macrosomia (birth weight >4500 g), Erb's palsy, and hypertensive disorders in pregnancy decreased despite increasing maternal age and pre‐pregnancy obesity. Rates of cesarean delivery increased in both GDM and non‐GDM groups, with a less pronounced increase in GDM mothers. Incidence of small‐for‐gestational age (SGA) increased in GDM but not in non‐GDM group. Conclusion Implementation of IADPSG criteria in a country with a relatively low prevalence of GDM did not result in higher rates of cesarean delivery and was associated with reductions in LGA and hypertensive disorders in pregnancy.

BackgroundInsulinoma associated with pregnancy is a very rare condition and can be difficult to diagnose. Here, we present an interesting case of insulinoma occurring during pregnancy with special attention paid to the use of a continuous glucose monitoring system to detect hypoglycemia.Case presentationA 36-year-old white woman in the second trimester of pregnancy presented with recurrent episodes of hypoglycemia associated with neuroglycopenic symptoms. The use of a continuous glucose monitoring system confirmed hypoglycemia. Serum insulin, C-peptide, and proinsulin values confirmed endogenous hyperinsulinism. A tumor mass was localized at the tail of her pancreas by endoscopic ultrasound and confirmed by magnetic resonance imaging. Surgery performed at 21 weeks of gestation by distal pancreatectomy confirmed the presence of a 15 mm diameter endocrine tumor at the tail of her pancreas and led to a cure.ConclusionsHypoglycemia during pregnancy could be due to insulinoma. Use of a continuous glucose monitoring system could help to detect hypoglycemia in these patients.

Aims/hypothesis. The cellular mechanisms for the insulin resistance in pregnancy and gestational diabetes mellitus are not known. The membrane protein plasma cell glycoprotein PC-1 has been identified as an inhibitor of insulin receptor tyrosine kinase activity and could have a role in insulin resistance. This study aimed to examine the effects of insulin on glucose transport and changes in insulin receptor tyrosine phosphorylation, IRS-1 and PC-1. Methods. Adipocytes were obtained either during elective cesarean section from three groups of subjects (Type II diabetic pregnant women (n=6) women with gestational diabetes mellitus (n=10) and pregnant women with normal glucose tolerance (n=6) as pregnant control subjects) or during elective gynaecological surgery from non-pregnant (n=6) control subjects. Results. Insulin stimulated glucose transport was reduced by 50% in women with gestational diabetes mellitus and 70% in pregnant women with Type II diabetes, compared to the non-pregnant control subjects. After maximal insulin stimulation of adipocytes, IRTK phosphorylation was reduced by 29.5% in women with gestational diabetes mellitus and 44.5% in women with Type II diabetes, compared to the nonpregnant control subjects. We also found that IRS-1 phosphorylation was reduced by 32% and 48%, respectively. On the other hand, PC-1 content in adipocytes in women with gestational diabetes mellitus increased by 320% and 668% in Type II diabetic women, compared to the non-pregnant control subjects. Conclusions/interpretation. Our results indicate that women with gestational diabetes mellitus and Type II diabetes have increased PC-1 content and suggest that this could contribute to lower phosphorylation levels of IRTK and IRS-1. Furthermore, these postreceptor defects in insulin signalling pathway are greater in both groups compared to the women with normal pregnancy. However, results from women with Type II diabetes show that pre-existing insulin resistance lead to an even greater deterioration of the signalling pathway. [Diabetologia (2002) 45:502-508]