Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: The diabetes in early pregnancy study

Mills, James L.; Jovanovič, Lois; Knopp, Robert H.; Aarons, Jerome H.; Conley, Mary; Park, Eunsik; Lee, Y. Jack; Holmes, Lewis B.; Simpson, Joe Leigh; Metzger, Boyd E.

doi:10.1016/s0026-0495(98)90290-6

Cited by 166 publications

(101 citation statements)

References 19 publications

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“…This confirms other reports (2) and is possibly due to a ϳ15% increase in plasma volume (11) and higher insulin sensitivity, as suggested by lower insulin concentrations. Thereafter, insulin sensitivity decreased, and insulin secretion and C-peptide levels increased with gestation.…”

Section: Proinsulinsupporting

confidence: 92%

“…Fasting glucose concentrations are lower in pregnant women than in nonpregnant women, but the postprandial increase in glucose and insulin is substantially higher in the third trimester of pregnancy than in nonpregnant control subjects (2). Because transplacental transfer of glucose is directly proportional to maternal blood glucose (3), these higher maternal postprandial glucose levels would render more of the ingested glucose available to the fetus.…”

mentioning

confidence: 99%

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Glucose Metabolism in Pregnancy at High Altitude

et al. 2001

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OBJECTIVE -To assess insulin sensitivity and ␤-cell function associated with lower maternal fasting plasma glucose levels at high altitude compared with sea level.RESEARCH DESIGN AND METHODS -We studied 215 pregnant women at 8 -42 weeks of gestation in Peru. The women were recruited from Cerro de Pasco, which is situated 4,370 m (14,340 feet) above sea level, and Lima, which is at sea level. We also examined 53 nonpregnant control subjects (22 in Cerro de Pasco and 31 in Lima). Fasting plasma glucose, insulin, C-peptide, and proinsulin concentrations were measured in samples obtained from the antecubital vein between 8:00 A.M. and 10:00 A.M. after an overnight period of fasting for 10 -14 h. Insulin resistance and ␤-cell function were calculated using homeostasis model assessment.RESULTS -Fasting C-peptide levels and ␤-cell function were similar, fasting concentrations of insulin and proinsulin were lower, and insulin sensitivity was higher at high altitude compared with sea level.CONCLUSIONS -Maternal fasting plasma glucose that is lower at high altitude than at sea level in the presence of similar insulin secretion is associated with higher peripheral insulin sensitivity. This may partly explain the lower birth weights at high altitudes.

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Section: Proinsulinsupporting

confidence: 92%

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confidence: 99%

Glucose Metabolism in Pregnancy at High Altitude

et al. 2001

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“…Declines in glucose levels as a result of overnight fasts of 10 to 12 hours in length have been observed in women as early as the sixth to tenth weeks of pregnancy (Mills et al 1998). The availability of glucose is a key indicator of the fetal environment, and its absence is thought to alter the trajectory of fetal development (Gluckman and Hanson 2005).…”

Section: B Mazumder and Z Seeskinmentioning

confidence: 99%

“…Pregnant women who extend the overnight fast by skipping breakfast experience a sharp drop in glucose levels and other associated biochemical changes referred to as "accelerated 188 B. Mazumder and Z. Seeskin starvation" (Metzger et al 1982). Declines in glucose levels as a result of overnight fasts of 10 to 12 hours in length have been observed in women as early as the sixth to tenth weeks of pregnancy (Mills et al 1998). The availability of glucose is a key indicator of the fetal environment, and its absence is thought to alter the trajectory of fetal development (Gluckman and Hanson 2005).…”

Section: Introductionmentioning

confidence: 99%

Breakfast Skipping, Extreme Commutes, and the Sex Composition at Birth

Mazumder

Seeskin

2015

Biodemography and Social Biology

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A growing body of literature has shown that environmental exposures in the period around conception can affect the sex ratio at birth through selective attrition that favors the survival of female conceptuses. Glucose availability is considered a key indicator of the fetal environment, and its absence as a result of meal skipping may inhibit male survival. We hypothesize that breakfast skipping during pregnancy may lead to a reduction in the fraction of male births. Using time use data from the United States we show that women with commute times of 90 minutes or longer are 20 percentage points more likely to skip breakfast. Using U.S. census data we show that women with commute times of 90 minutes or longer are 1.2 percentage points less likely to have a male child under the age of 2. Under some assumptions, this implies that routinely skipping breakfast around the time of conception leads to a 6 percentage point reduction in the probability of a male child. Skipping breakfast during pregnancy may therefore constitute a poor environment for fetal health more generally. IntroductionBreakfast skipping is a common and growing phenomenon among American women. Approximately 40 percent of women of childbearing age are attempting to lose weight (Cohen and Kim 2009), and rates of breakfast skipping have grown steadily over time, especially for adolescent women (Haines, Guilkey, and Popkin 1996;Siega-Riz, Popkin, and Carson 1998). Holtzman (2010) finds that 75 percent of women aged 18 to 26 skip breakfast at least one day a week, 58 percent skip breakfast at least four days a week, and 29 percent skip breakfast every day. Using detailed time use data we find that on a given day, 51 percent of employed women between the ages of 15 and 45 report not eating between the hours of 5 a.m. and 10 a.m. 1 Even among pregnant women, 24 percent report skipping meals (Siega-Riz et al. 2001).Given the vast and growing literature documenting the profound and lasting effects of the prenatal environment on long-term health and socioeconomic success (e.g., Almond and Currie 2011), one might be concerned that the rising incidence of breakfast skipping among women of childbearing age might have important intergenerational ramifications. Pregnant women who extend the overnight fast by skipping breakfast experience a sharp drop in glucose levels and other associated biochemical changes referred to as "accelerated Address correspondence to Bhashkar Mazumder, Federal Reserve Bank of Chicago, 230 S. La Salle Street, Chicago, IL 60604, USA. E-mail: bhash.mazumder@gmail.com 1 This is based on the Eating and Health module subsample of the data, which includes all primary and secondary activities.Color versions of one or more of the figures in the article can be found online at www. tandfonline.com/hsbi. 188 B. Mazumder and Z. Seeskinstarvation" (Metzger et al. 1982). Declines in glucose levels as a result of overnight fasts of 10 to 12 hours in length have been observed in women as early as the sixth to tenth weeks of pregnancy (Mills et al. 1998)....

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“…The latter possibility is supported by the early observations of Abell et al (4) who observed increased perinatal losses in pregnant mothers with a flat glucose tolerance test curve, a risk that was exaggerated by the presence of other indexes of fetal distress. This observation implies a role for fetal malnutrition based on impaired delivery of maternal nutrients to the fetus that could extend to the first trimester as well, which could also be aggravated by additional risk factors (24). To our knowledge, no studies have investigated the potential for a deleterious effect of low glycemic status in the first trimester on spontaneous abortion in normal and diabetic pregnancy.…”

Section: Conclusion -The Diep Addressed the Following Two Questions: 1)mentioning

confidence: 99%

Elevated Pregnancy Losses at High and Low Extremes of Maternal Glucose in Early Normal and Diabetic Pregnancy

et al. 2005

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OBJECTIVE -Early pregnancy losses increase with marked hyperglycemia in diabetic pregnancy. However, mean loss rates do not differ from those of nondiabetic pregnancy. This observation might be explained by increased fetal losses at the extremes of glycemia in diabetic and nondiabetic pregnancy. To test this hypothesis, we examined relationships of proximate measures of prior glycemia, glycated protein and fructosamine, to pregnancy loss. RESEARCH DESIGN AND METHODS-A total of 389 diabetic and 429 nondiabetic pregnant subjects participated in the Diabetes In Early Pregnancy study. Glycated protein and fructosamine measurements were standardized as multiples of control values for each center (Z score). The logarithm of odds of pregnancy loss were plotted against Z scores and tested by logistic models.RESULTS -Mean pregnancy loss rates were 12% in diabetic and 13% in normal pregnancies. However, over six intervals of glycated protein in diabetic pregnancy, fetal loss rates at the upper and lower extremes (24 and 33%, respectively) were approximately threefold higher than the four intervening rates (8 -14%). The odds ratio of pregnancy loss for these extreme intervals to the intervening intervals is 3.0 (P ϭ 0.01). Nondiabetic losses showed a similar pattern. In confirmation, logit pregnancy losses were increased in a J-shaped curve at the glycemic extremes in normal (P Ͻ 0.019) and diabetic (P Ͻ 0.015) pregnancy. The upper glycemic extreme in diabetic pregnancy was two-to fivefold higher than in control pregnancy.CONCLUSIONS -Pregnancy losses are increased at the extremes of glycemia in both normal and diabetic pregnancy but at higher levels in diabetic pregnancy. The data suggest defensive adaptations against hyperglycemia in diabetic pregnancy.

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Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: The diabetes in early pregnancy study

Cited by 166 publications

References 19 publications

Glucose Metabolism in Pregnancy at High Altitude

Glucose Metabolism in Pregnancy at High Altitude

Breakfast Skipping, Extreme Commutes, and the Sex Composition at Birth

Elevated Pregnancy Losses at High and Low Extremes of Maternal Glucose in Early Normal and Diabetic Pregnancy

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