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The effects of insulin antibodies during diabetic pregnancy on newborn infants
K Murata1, N Toyoda, Y Sugiyama
1Department of Obstetrics and Gynecology, Mie University School of Medicine, Japan.
Insights
Maternal insulin antibodies cross the placenta, increasing neonatal hypoglycemia risk, especially with high levels. Bovine insulin use is discouraged due to higher antibody responses in diabetic mothers.
Area of Science:
- Endocrinology
- Perinatology
- Immunology
Background:
- Diabetic pregnancies require careful monitoring of maternal and infant health.
- Insulin therapy in diabetic mothers can lead to the development of insulin antibodies.
- The impact of insulin antibodies on perinatal outcomes is not fully understood.
Purpose of the Study:
- To investigate the relationship between maternal insulin antibody levels and perinatal complications in diabetic pregnancies.
- To compare insulin antibody responses to different insulin preparations (bovine/porcine vs. human).
- To assess the transfer of insulin antibodies from mother to infant and their correlation with neonatal outcomes.
Main Methods:
- Measurement of insulin antibody levels (insulin binding capacity; IBC), free insulin, and total insulin in 35 diabetic mothers and their newborns.
- Categorization of mothers based on insulin treatment: bovine/porcine, porcine, and human insulin.
- Correlation analysis of insulin antibody levels with birth weight, neonatal hypoglycemia, and cord hematocrit.
Main Results:
- Higher insulin antibody levels (IBC) were observed in mothers treated with bovine/porcine insulin compared to human insulin.
- Maternal insulin antibody levels were closely mirrored in their infants, indicating placental transfer.
- Neonatal hypoglycemia and increased cord hematocrit were associated with maternal insulin antibody levels exceeding 20%.
Conclusions:
- Insulin antibodies are effectively transferred across the placenta from mother to infant.
- Elevated maternal insulin antibody levels pose a significant risk for neonatal hypoglycemia.
- Bovine insulin preparations are associated with higher insulin antibody formation and should be avoided in diabetic pregnancies.
Abstract:
Levels of insulin antibody, free insulin, and total insulin in the blood of diabetic mothers and their newborn infants were measured, and the relations of these findings to perinatal complications were studied. The subjects were 35 patients: 8 treated with bovine/porcine insulin, 15 with porcine, and 12 with human insulin. Insulin antibody levels (insulin binding capacity; IBC) in patients injected with bovine/porcine insulin were higher. There was no difference in the insulin antibody levels between the groups treated with porcine and human insulin preparations. Infant insulin antibody levels were close to the mother's levels. Free insulin levels did not correlate with total insulin nor antibody levels, but correlated with plasma glucose levels in the infants. The birth weight did not correlate with insulin antibody levels. The frequency of neonatal hypoglycemia and cord hematocrit levels were increased when the mother's insulin antibody levels were over 20%. We conclude the following: 1) Insulin antibodies are transferred through the placenta; 2) The risk of neonatal hypoglycemia is high if the mother's insulin antibody levels are high; 3) Bovine insulin preparations should not be used.