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Departments of 1 Obstetrics and Gynecology and 2 Medicine, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle, Tyne and Wear NE1 4LP, United Kingdom
The effects of pregnancy and type 1 diabetes [insulin-dependent diabetes mellitus (IDDM)] on protein
metabolism are still uncertain. Therefore, six normal and five IDDM
women were studied during and after pregnancy, using
[13C]leucine and
[2H5]phenylalanine with a
hyperinsulinemic-euglycemic clamp and amino acid infusion. Fasting
total plasma amino acids were lower in pregnancy in normal but not IDDM
women (2,631 ± 427 vs. 2,057 ± 471 and 2,523 ± 430 vs. 2,500 ± 440 µmol/l, respectively). Whole body protein
breakdown (leucine) increased in pregnancy [change in normal (
N)
and IDDM women (
D) 0.59 ± 0.40 and 0.48 ± 0.26 g · kg
1 · day
1, both
P < 0.001], whereas reductions in protein breakdown
due to insulin/amino acids (
N
0.57 ± 0.19,
D
0.58 ± 0.20 g · kg
1 · day
1,
both P < 0.001) were unaffected by pregnancy. Protein
breakdown in IDDM women was not higher than normal, and neither
pregnancy nor type 1 diabetes altered the insulin sensitivity of amino
acid turnover. Nonoxidized leucine disposal (protein synthesis)
increased in pregnancy (
N 0.67 ± 0.45,
D 0.64 ± 0.34 g · kg
1 · day
1, both
P < 0.001). Pregnancy reduced the response of
phenylalanine hydroxylation to insulin/amino acids in both groups (
N
1.14 ± 0.74,
D
1.12 ± 0.77 g · kg
1 · day
1, both
P < 0.05). These alterations may enable amino acid
conservation for protein synthesis and accretion in late pregnancy.
Well-controlled type 1 diabetes caused no abnormalities in the
regulation of basal or stimulated protein metabolism.
leucine; phenylalanine; isotope labeling; glucose clamp technique; insulin resistance; insulin-dependent diabetes mellitus
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R. M. Cowett The Infant of the Diabetic Mother NeoReviews, September 1, 2002; 3(9): e173 - 189. [Full Text] [PDF] |
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