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Increased maternal bone formation in type I diabetic pregnancies
1Academic Obstetrics & Gynaecology, Imperial College School of Medicine at Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
Insights
Maternal type I diabetes, or insulin-dependent diabetes, is linked to increased bone formation during pregnancy. This study found higher levels of a bone formation marker in diabetic mothers, suggesting a potential impact on fetal bone development.
Area of Science:
- Endocrinology
- Obstetrics
- Bone Metabolism
Background:
- Infants of mothers with insulin-dependent diabetes mellitus (IDDM) exhibit increased intrauterine bone resorption and reduced bone mineral content at birth.
- Pregnancy can influence maternal bone metabolism, but the specific effects of IDDM on maternal bone turnover are not fully understood.
Purpose of the Study:
- To investigate whether type I diabetes is associated with abnormal maternal bone metabolism during pregnancy.
- To assess bone formation and degradation rates in pregnant women with type I diabetes compared to healthy controls.
Main Methods:
- A case-control study involving 19 pregnant women with type I diabetes and 19 healthy pregnant controls in their third trimester.
- Measurement of circulating levels of carboxyterminal propeptide of type I procollagen (PICP) as a marker of bone formation.
- Measurement of cross-linked carboxyterminal telopeptide of type I collagen (ICTP) as a marker of bone degradation.
- Assessment of diabetic control using hemoglobin A1c levels (mean < 8.5% indicated good control).
Main Results:
- Circulating PICP levels were significantly higher in pregnant women with type I diabetes (median 147 µg/L) compared to controls (median 115 µg/L; P = 0.0014).
- No significant difference was observed in circulating ICTP levels between the type I diabetes group (median 4.6 µg/L) and the control group (median 4.6 µg/L; P = 0.907).
Conclusions:
- Pregnant women with type I diabetes exhibit an increased rate of bone formation.
- This increased bone formation may be influenced by higher insulin doses and improved glycemic control often achieved during pregnancy in women with IDDM.
- Further research is needed to understand the clinical implications of altered maternal bone metabolism in diabetic pregnancies on both mother and fetus.
Abstract:
There is evidence that infants of insulin-dependent diabetics have increased intrauterine bone resorption and reduced bone mineral content at birth. The aim of this study was to determine if type I diabetes is associated with abnormal maternal bone metabolism. We measured the circulating levels of carboxyterminal propeptide of type I procollagen (PICP) and cross-linked carboxyterminal telopeptide of type I collagen (ICTP) in the third trimester of pregnancy in samples obtained from 19 pregnant women with type I diabetes and 19 pregnant controls, to monitor the rate of bone formation and degradation, respectively. Diabetic control was considered to be good as the mean hemoglobin A(1) level was less than 8.5%. The circulating levels of PICP were significantly higher in pregnant women with insulin-dependent diabetes than in controls with uncomplicated pregnancy (median IDDM 147 microgram/liter, control 115 microgram/liter, P = 0.0014), but there was no significant difference in the circulating levels of ICTP between the two groups (median IDDM 4.6 microgram/liter, control 4.6 microgram/liter, P = 0.907). Therefore, our findings suggest that there is an increase in bone formation in pregnant women with type I diabetes which may be related to the increased amount of insulin administered and the improvement in diabetic control associated with pregnancy.