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Metabolomic insights into maternal and neonatal complications in pregnancies affected by type 1 diabetes

Claire L Meek1,2, Zoe A Stewart3, Denice S Feig4,5,6

  • 1Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK. clm70@cam.ac.uk.

Diabetologia
|August 24, 2023
PubMed

Insights

Maternal hyperglycemia in type 1 diabetes pregnancy alters lipid metabolism, impacting offspring health. Early interventions targeting maternal diet and insulin are crucial for better pregnancy outcomes.

Area of Science:

  • Metabolomics
  • Endocrinology
  • Obstetrics

Background:

  • Type 1 diabetes in pregnancy presents risks like maternal hyperglycemia and offspring hyperinsulinism.
  • Perinatal complications such as pre-eclampsia and large for gestational age (LGA) are associated with suboptimal pregnancy outcomes.
  • Understanding metabolomic patterns can identify risks and complications in type 1 diabetes pregnancies.

Purpose of the Study:

  • To assess metabolomic patterns linked to risk factors and perinatal complications in type 1 diabetes pregnancies.
  • To investigate associations between maternal hyperglycemia, diet, BMI, weight gain, and specific metabolite profiles.
  • To correlate metabolomic profiles with adverse perinatal outcomes including pre-eclampsia, LGA, neonatal hypoglycemia, and hyperinsulinism.

Main Methods:

  • Utilized serum samples from 174 participants in the Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT).
  • Performed untargeted metabolite analysis using ultrahigh performance liquid chromatography-mass spectrometry (LC-MS).
  • Applied adjusted logistic/linear regression to analyze maternal and cord blood metabolites against risk factors and complications.

Main Results:

  • Maternal time-above-range in glucose monitoring correlated with increased maternal triacylglycerols and cord blood carnitines.
  • Distinct metabolomic profiles were observed for LGA, neonatal hypoglycemia, and offspring hyperinsulinism, with LGA linked to carnitines and steroid hormones.
  • Neonatal hypoglycemia and hyperinsulinism showed early metabolic changes (first trimester) involving triacylglycerols and dietary phenols; pre-eclampsia was associated with phosphatidylethanolamines.

Conclusions:

  • Altered lipid metabolism is a central pathophysiological aspect of type 1 diabetes during pregnancy.
  • Metabolomic analysis reveals distinct profiles associated with specific pregnancy complications.
  • Optimizing maternal diet and insulin therapy from the first trimester is essential for improving pregnancy outcomes in type 1 diabetes.
Abstract

Keywords:
Cord bloodLGALipidomicsMetabolomicsNeonatal hypoglycaemiaPre-eclampsiaPredictionPregnancyPregnancy complicationsPregnancy in people with diabetesPregnancy outcomeType 1 diabetes

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