Glucose homeostasis during canine pregnancy: Insulin resistance, ketosis, and hypoglycemia

Body Condition and Fertility in Dogs

Ideal body condition and nutritional status in dogs is essential for quality of life, including reproductive health. Herein, we review the implications body condition, particularly fat, has on puberty, fertility, pregnancy, and parturition in dogs. Ideal body condition at puberty is necessary for dogs to achieve sexual maturity and reproduce. Moreover, over and under conditioned female dogs have increased risk of adverse pregnancy, parturition, and neonatal outcomes. Less is known about body condition and male dog fertility but some evidence is provided in this article. Finally, recommendations for maintaining an ideal body condition in intact adult dogs for optimal fertility are provided.

Cushing Syndrome and Other Causes of Insulin Resistance in Dogs

The most common causes of insulin resistance in diabetic dogs are Cushing syndrome, diestrus, and obesity. Cushing-associated effects include insulin resistance, excessive postprandial hyperglycemia, perceived short duration of insulin action, and/or substantial within-day and/or day-to-day glycemic variability. Successful strategies to manage excessive glycemic variability include basal insulin monotherapy and combined basal-bolus insulin treatment. Ovariohysterectomy and insulin treatment can achieve diabetic remission in about 10% of cases of diestrus diabetes. Different causes of insulin resistance have an additive effect on insulin requirements and the risk of progression to clinical diabetes in dogs.

Metabolomics during canine pregnancy and lactation

During pregnancy and parturition, female dogs have to cope with various challenges such as providing nutrients for the growth of the fetuses, hormonal changes, whelping, nursing, milk production, and uterine involution. Metabolomic research has been used to characterize the influence of several factors on metabolism such as inter- and intra-individual factors, feeding, aging, inter-breed differences, drug action, behavior, exercise, genetic factors, neuter status, and pathologic processes. Aim of this study was to identify metabolites showing specific changes in blood serum at the different phases of pregnancy and lactation. In total, 27 privately owned female dogs of 21 different breeds were sampled at six time points: during heat, in early, mid and late pregnancy, at the suspected peak of lactation and after weaning. A validated and highly automated canine-specific NMR metabolomics technology was utilized to quantitate 123 measurands. It was evaluated which metabolite concentrations showed significant changes between the different time points. Metabolites were then grouped into five clusters based on concentration patterns and biochemical relationships between the metabolites: high in mid-pregnancy, low in mid-pregnancy, high in late pregnancy, high in lactation, and low in lactation. Several metabolites such as albumin, glycoprotein acetyls, fatty acids, lipoproteins, glucose, and some amino acids show similar patterns during pregnancy and lactation as shown in humans. The patterns of some other parameters such as branched-chain amino acids, alanine and histidine seem to differ between these species. For most metabolites, it is yet unstudied whether the observed changes arise from modified resorption from the intestines, modified production, or metabolism in the maternal or fetal tissues. Hence, further species-specific metabolomic research may support a broader understanding of the physiological changes caused by pregnancy that are likely to be key for the normal fetal growth and development. Our findings provide a baseline of normal metabolic changes during healthy canine pregnancy and parturition. Combined with future metabolomics findings, they may help monitor vital functions of pre-, intra-, and post-partum bitches and may allow early detection of illness.

Macronutrient Proportions and Fat Type Impact Ketogenicity and Shape the Circulating Lipidome in Dogs

Many physiological processes including ketogenesis are similar in dogs and humans, but there is little information available on the effect of carbohydrate restriction in dogs. Here, the ketogenicity and serum metabolic profiles of dogs were assessed after they had consumed high carbohydrate (HiCHO); high protein, low carbohydrate (PROT_LoCHO); or high fat, low carbohydrate (FAT_LoCHO) foods. Thirty-six dogs were fed HiCHO for 4 weeks, then randomized to PROT_LoCHO or FAT_LoCHO for 5 weeks. Dogs then crossed over to the other food for an additional 5 weeks. Generally, reduction of dietary carbohydrate by replacement with either protein or fat increased the energy required to maintain body weight, and fat had a greater effect. Postabsorptive energy availability derived mainly from glucose and triglycerides with HiCHO, from gluconeogenic amino acids and fatty acids with PROT_LoCHO, and from fatty acids and β-hydroxybutyrate with FAT_LoCHO. This study demonstrated that the reduction of carbohydrate in canine foods is potentially beneficial to dogs based on improvements in metabolism and supports the use of low-carbohydrate foods as safe and effective for healthy adult dogs.

Dead or Alive? A Review of Perinatal Factors That Determine Canine Neonatal Viability

Simple Summary

The article summarizes the current knowledge on factors related to pregnancy, parturition, and newborns that affect the health status of a puppy and determine its chances for survival and development. The detailed information is provided in terms of breed predispositions, objectives of pregnancy monitoring, potential sources of complications, and veterinary advances in care and treatment of perinatal conditions. Successful pregnancy outcomes still pose challenges in veterinary neonatology; thus, publications presenting the current state of knowledge in this field are in demand.

Abstract

The perinatal period has a critical impact on viability of the newborns. The variety of factors that can potentially affect the health of a litter during pregnancy, birth, and the first weeks of life requires proper attention from both the breeder and the veterinarian. The health status of puppies can be influenced by various maternal factors, including breed characteristics, anatomy, quality of nutrition, delivery assistance, neonatal care, and environmental or infectious agents encountered during pregnancy. Regular examinations and pregnancy monitoring are key tools for early detection of signals that can indicate disorders even before clinical signs occur. Early detection significantly increases the chances of puppies’ survival and proper development. The purpose of the review was to summarize and discuss the complex interactions between all elements that, throughout pregnancy and the first days of life, have a tangible impact on the subsequent fate of the offspring. Many of these components continue to pose challenges in veterinary neonatology; thus, publications presenting the current state of knowledge in this field are in demand.

Magnesium supplementation for glycemic status in women with gestational diabetes: a systematic review and meta-analysis

OBJECTIVE

The effect of magnesium supplementation on glycemic status in women with gestational diabetes remains controversial and this meta-analysis aims to explore the efficacy of magnesium supplementation for gestational diabetes.

METHODS

We have searched PubMed, Excerpta Medica database, Web of science, Elton B. Stephens. Company, and Cochrane library databases. The meta-analysis included randomized controlled trials (RCTs) assessing the effect of magnesium supplementation for gestational diabetes and was performed using the random-effect model.

RESULTS

Four RCTs were included in the meta-analysis. Overall, compared with placebo in gestational diabetes, magnesium supplementation was associated with significantly reduced fasting plasma glucose (standard mean difference [SMD] = -0.99; 95% confidence interval [CI] = -1.28 to -0.70; p < .00001), serum insulin (SMD = -0.75; 95% CI = -1.24 to -0.26; p = .003), homeostasis model assessment of insulin resistance (SMD = -0.74; 95% CI = -1.10 to -0.39; p < .0001) and increased quantitative insulin sensitivity check index (SMD = 0.47; 95% CI = 0.12 to 0.82; p = .008). In addition, low-density lipoprotein-cholesterol (SMD = -0.39; 95% CI = -0.73 to -0.04; p = .03) and total cholesterol (SMD = -0.62; 95% CI = -0.97 to -0.27; p = .0005) were also obviously decreased in the magnesium group than those in the control group.

CONCLUSION

Magnesium supplementation benefits glycemic control for gestational diabetes.

Comparison of a human portable blood glucose meter and automated chemistry analyser for measurement of blood glucose concentrations in healthy dogs

Blood glucose measurement is one of the most commonly performed clinical diagnostic tests used to monitor glycaemia in several animal diseases. Usually, these laboratory analyses are performed on blood venous samples in remote laboratories, and the results are delayed, at best. The use of portable glucometers could evidently solve many constraints but veterinary‐use glucometers are not usually available. The present study aimed to compare blood glucose levels obtained by Bionime glucometer to the reference method using glucose oxidase. Venous blood was collected from a total number of 140 healthy dogs (72 males and 68 females), of different breeds (28 German Shepherd, 27 Pitt bull, 21 Boxer, 24 Rottweiler and 40 cross‐bred dogs) and different ages (range: 3 months–14 years) for glucose measurement using the reference laboratory method. Capillary blood samples were used to conduct a glucose measurement with a human‐use glucometer. Our results revealed that there was no significant difference between the mean capillary blood glucose (CBG) measured with the human‐use glucometer (5.06 ± 0.84 mmol/L) and the mean venous blood glucose (VBG) measured with the laboratory reference method (4.90 ± 0.73 mmol/L) (p = 0.42). Similarly, there was no significant difference of the mean CBG and VBG in male dogs (5.11 ± 0.88 and 4.97 ± 0.75 mmol/L, respectively) and female dogs (5.01 ± 0.81 and 5.07 ± 0.72 mmol/L, respectively) (p = 0.73 and 0.21, respectively), and no correlation to neither age (5.43 ± 0.90 and 5.20 ± 0.70 mmol/L in 3 to 6 month‐old dogs, 5.03 ± 0.82 and 4.94 ± 0.79 mmol/L in 6 months to 1 year‐old, 4.94 ± 0.67 and 5.13 ± 0.66 mmol/L in 1 to 4 year‐old dogs; 4.88 ± 0.94 and 4.80 ± 0.75 mmol/L in dogs older than 4 years, respectively, p < 0.05), nor to breed (4.94 ± 1.01 and 4.99 ± 0.79 mmol/L in German Shepherd, 5.13 ± 0.84 and 4.99 ± 0.79 mmol/L in Pitt Bull, 5.07 ± 0.94 and 5.07 ± 0.77 mmol/L in Boxer, 5.40 ± 0.59 and 5.48 ± 0.55 mmol/L in Rottweiler and 4.89 ± 0.75 and 4.77 ± 0.59 mmol/L in cross‐bred dogs, respectively, p < 0.05). The present study confirms that human glucometer can be used to measure glucose in dogs with a good accuracy.

Synbiotic supplementation for glycemic status in pregnant women: a meta-analysis of randomized clinical trials

BACKGROUND

The effect of synbiotic supplementation on glycemic status in pregnant women remained controversial and this meta-analysis aimed to explore the efficacy of synbiotic supplementation on glycemic status in pregnant women.

METHODS

We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases and randomized controlled trials (RCTs) assessing the effect of synbiotic on glycemic status in pregnant women were included. The meta-analysis was performed using the random-effect model.

RESULTS

Four RCTs were included in the meta-analysis. Overall, compared with control intervention in pregnant women, synbiotic supplementation was associated with significantly reduced serum insulin (SMD = -0.69; 95%CI = -1.06 to -0.32; p = .0002) and homoeostasis model assessment of insulin resistance (HOMA-IR, SMD = -0.53; 95%CI = -0.87 to -0.18; p = .003), but had no significant effect on fasting plasma glucose (FPG, SMD = -0.16; 95%CI = -0.43 to 0.11; p = .24), quantitative insulin sensitivity check index (QUICKI, SMD = 0.54; 95%CI = -0.10 to 1.18; p = .10) or CRP (SMD = -0.29; 95%CI = -1.23 to 0.64; p = .54).

CONCLUSIONS

Synbiotic supplementation was beneficial to glycemic control in pregnant women.

Effect of maternal metabolism on fetal supply: Glucose, non-esterified fatty acids and beta-hydroxybutyrate concentrations in canine maternal serum and fetal fluids at term pregnancy

The progressive adaptations in carbohydrate and lipid metabolism during canine pregnancy are reflected in the concentrations of glucose, non-esterified fatty acids (NEFA) and β-hydroxybutyrate (BHB). The levels of these metabolites in the bitch likely affect fetal concentrations and the composition of amniotic and allantoic fluids (AMF and ALF, respectively). We studied 31 canine parturitions (Cesarean sections) and found that glucose, NEFA and BHB concentrations were significantly higher in maternal serum than in AMF or ALF. Glucose levels in maternal serum, AMF and ALF were closely related (R² ≥ 0.821, P < 0.0001) as well as serum and AMF BHB levels (R² = 0.661, P < 0.0001). In maternal serum, increases in NEFA were associated with increased BHB, and both were negatively related to glucose (P ≤ 0.010). To estimate the effect of the metabolic burden of pregnancy, we evaluated these variables in relation to the dam's body weight and to the ratio of litter weight to the dam's body weight (LW/BW). Maternal serum glucose was not influenced by LW/BW, but it was lower in small than in large/giant bitches. Small breed dogs and those with >10% LW/BW had significantly higher serum NEFA and BHB concentrations. Glucose in AMF and ALF was independent of LW/BW (P ≥ 0.399). AMF NEFA was lower and BHB higher, if LW/BW was >10% (P ≤ 0.048). In conclusion, the extent of the metabolic load of pregnancy in bitches depends on breed size and on the ratio of litter weight to dam's body weight. Maternal concentrations of glucose, BHB and NEFA determine the concentrations of these metabolites in fetal fluids.

Hematological and biochemical findings in pregnant, postfoaling, and lactating jennies

The aims of this study were to (1) verify if significant changes occur in hematological and biochemical parameters in jennies during the last 2 months of pregnancy and the first 2 months of lactation, and (2) determine any differences with mares. Hematological and biochemical parameters were evaluated in jennies every 15 days during late pregnancy, parturition, and early lactation. The Kolmogorov-Smirnov test, analysis of variance for repeated measurements and Tukey's multiple comparison test as post hoc were applied. The significance level was set at P < 0.05. Statistical analysis showed differences related to time for Red Blood Cells (RBC) count and Hematocrit (HCT), White Blood Cells (WBC) count, platelet count (PLT), total proteins, blood urea, triglycerides and total cholesterol concentrations, aspartate aminotransferase, gamma-glutamyltransferase, creatine-phosphokinase activities, sodium (Na) and potassium (K). RBC and HCT were higher in late pregnancy than at foaling and during lactation. The relative anemia might be due to increased water ingestion because of fluid losses. The WBC count was higher at foaling than during late pregnancy and lactation. This could be related to the release of cortisol and catecholamine during delivery. The PLT trend showed lower values from delivery to the first 2 months of lactation compared to late gestation. Blood urea increased near parturition, and then remained constant during delivery and lactation, which might be due to the high energy demand at the beginning of lactation. Triglycerides and total cholesterol showed a decrease from delivery through the lactation period. Thus, jennies seem to have a similar metabolism of fats to ponies and draft horse mares, characterized by a greater fat content and mobilization than light breed horses. Aspartate aminotransferase activity decreased at parturition and early lactation, probably because of a predominance of anabolic over catabolic processes during pregnancy. Gamma-glutamyltransferase activity was lower at delivery and during lactation than at late gestation. This could be due to a physiological load on the liver in the perinatal period. Gamma-glutamyltransferase activity was always higher than in mares, but within the normal range for adult donkeys. Creatine-phosphokinase decreased near delivery, then was constant from parturition through the first 2 months of lactation. Na decreased during lactation, probably due to an increased renal retention mediated by aldosterone release during pregnancy. K showed the same trend as Na, and concentrations are in line with the species. The higher K during pregnancy may be due to reabsorption by the gut. Total proteins decreased more during the postpartum period and lactation than in the gestational period. In conclusion, our results showed significant changes in hematological and biochemical parameters in jennies during the last 2 months of pregnancy and the first 2 months of lactation and these changes are only partially comparable to mares.

Association of Tumor Growth Factor-β and Interferon-γ Serum Levels With Insulin Resistance in Normal Pregnancy

Pregnancy is related to change in glucose metabolism and insulin production. The aim of our study was to determine the association of serum IFN-γ and TGF-β levels with insulin resistance during normal pregnancy. This cross sectional study was carried out on 97 healthy pregnant (in different trimesters) and 28 healthy non-pregnant women. Serum TGF-β and IFN-γ level were measured by ELISA method. Pregnant women had high level TGF-β and low level IFN-γ as compared non-pregnant women. Maternal serum TGF-β concentration significantly increased in third trimester as compared first and second trimester of pregnancy. Maternal serum IFN-γ concentration significantly decreased in third trimester as compared first and second trimester of pregnancy. Pregnant women exhibited higher score of HOMA IR as compared non-pregnant women. There were association between gestational age with body mass index (r=0.28, P=0.005), TGF-β (r=0.45, P<0.001) and IFN-γ (r=-0.50, P<0.001). There was significant association between Insulin resistance and TGF-β (r=0.17, p=0.05). Our findings suggest that changes in maternal cytokine level in healthy pregnant women were anti-inflammatory. Furthermore, Tumor Growth Factor-β appears has a role in induction insulin resistance in healthy pregnant women. However, further studies needed to evaluate role of different cytokines on insulin resistance in normal pregnancy.

Mortality associated with using medetomidine and ketamine for general anesthesia in pregnant and nonpregnant Wistar rats

Medetomidine and ketamine are injectable drugs that can be used in combination to induce general anesthesia in rats. After noticing a high incidence of morbidity and mortality in pregnant Wistar rats given medetomidine and ketamine for anesthesia, the authors further investigated the effects of this combination of anesthetic drugs in both pregnant and nonpregnant Wistar rats. The time to recumbency and the duration of general anesthesia were similar between pregnant and nonpregnant rats. Pregnancy status did not affect the rats' pulse rate, respiratory rate, rectal temperature, oxygen saturation or perfusion index during 2 h of anesthesia. Pregnant rats had significantly lower blood glucose concentrations than nonpregnant rats at all time points, though blood glucose concentrations increased in both groups. The mortality rate was ∼15% both for nonpregnant rats and for pregnant rats. Researchers using medetomidine and ketamine to anesthetize Wistar rats should carefully monitor the rats in order to minimize mortality.

Glucose transporter-4 in white blood cells of young and old sled dogs: a model for human biomarker development

The insulin responsive glucose transporter, GLUT4 is found predominantly in muscle and adipose cells. Maratou and others (2007) reported that there is GLUT4 in white blood cells (WBC) collected from human subjects in response to insulin activation. This study was designed to validate the presence of GLUT4 in white blood cells of sled dogs and furthermore to investigate whether changes in levels of the GLUT4 protein might be associated with aging. Additionally, we examined the blood insulin concentration of two populations of dogs, young and old, before and after a meal to observe their insulin response. It is documented in skeletal muscle that GLUT4 expression is increased as a result of conditioning, making sled dogs an excellent model in the circumpolar north for studying the effects of exercise, nutrition and diabetes (Felsburg 2002; Kararli 2006). Blood was withdrawn from 11 healthy sled dogs: 6 young (1-5 years) and physically fit, conditioned for racing and 5 old (7-13 years), retired from racing. The insulin response was determined using blood plasma and ELISA. The buffy coat (containing WBC) was collected with a glass pipette after centrifugation and washed and suspended in 1x phosphate buffer. GLUT4 was measured using ELISA kits (USCN Life Sciences). The results validate that GLUT4 is present in white blood cells in sled dogs. Age had no significant effect in the concentration of GLUT4 between the populations of old and young dogs. A significant difference in insulin levels pre and post meal in young (0.13 ± 0.03 ng/mL (pre), 0.22 ± 0.04 ng/mL (post), p < 0.05) and old (0.13 ± 0.02 ng/mL (pre), 0.22 ± 0.03 ng/mL (post), p < 0.05) dogs was observed, displaying the typical postprandial insulin spike. No significant difference was found in insulin concentration comparing old versus young dogs. Our data shows that white blood cells in young (40.4 ± 2.4 ng/mL) and old (35.3 ± 8.8 ng/mL) sled dogs have quantifiable but non-significant different GLUT4 levels (p > 0.05). Detecting GLUT4 via an ELISA in white blood cells, opens up minimally invasive avenues for studying the underlying molecular mechanisms associated with insulin resistance in more complex, dynamic and physiological systems. This project was the first step in developing a protocol for this simple, technique with a potential clinical application for diagnosing insulin resistance.

Conditioning causes an increase in glucose transporter-4 levels in mononuclear cells in sled dogs

This study was designed to investigate the effects of physical conditioning on the expression of the insulin sensitive glucose transporter-4 protein (GLUT4) on mononuclear cells and HOMA-IR levels in dogs and compared to results reported in human skeletal muscle and the skeletal muscle of rodent models. Blood was sampled from conditioned dogs (n = 8) and sedentary dogs (n = 8). The conditioned dogs were exercised four months prior the experiment and were following a uniform training protocol, whereas the sedentary dogs were not. GLUT4 expression in mononuclear cells and plasma insulin levels were measured using commercially available enzyme-linked immunosorbent assay (ELISA). Blood glucose levels were determined using blood plasma. HOMA-IR was calculated using plasma insulin and blood glucose levels using the linear approximation formula. Our results indicate that the state of conditioning had a significant effect on the GLUT4 expression at the surface of mononuclear cells. HOMA-IR was also affected by conditioning in dogs. GLUT4 levels in mononuclear cells of sled dogs were inversely correlated with the homeostasis model assessment of insulin sensitivity. This study demonstrates that conditioning increases GLUT4 levels in mononuclear cells of sled dogs as it has been previously reported in skeletal muscle. Our results support the potential of white blood cells as a proxy tissue for studying insulin signaling and may lead to development of a minimally invasive and direct marker of insulin resistance. This may be the first report of GLUT4 in mononuclear cells in response to exercise and measured with ELISA.

Use of aglepristone for the treatment of P4 induced insulin resistance in dogs

Insulin resistance (IR) in dogs is suspected when hyperglycemia is present despite administration of insulin doses greater than 1.0 to 1.5 UI/kg. IR is caused by increases in counter regulatory hormones concentrations (glucagon, glucocorticoids, catecholamines and growth hormone). This study was conducted to investigate the use of aglepristone (RU 46534), a P4 receptor antagonist, for the treatment of IR diabetes mellitus in bitches during the luteal phase. All animals were treated with porcine insulin zinc suspension (Caninsulin) and aglepristone (Alizin) 10 mg/kg subcutaneously at day 1, 2, 9 and 17 from diagnosis. At day 5, no significant variation in glycemia was shown. At day 12 and 20, serum glucose concentrations were significant lower (p < 0.05). From day 12 the insulin dose was reduced to 0.8 IU BID. Insulin was reduced in the following weeks and glycemia was controlled.

Gestational Diabetes Mellitus with Diabetic Ketoacidosis in a Yorkshire Terrier Bitch

A 6 yr old pregnant Yorkshire terrier bitch presented 62 days after mating with an acute history of vomiting and coughing. The owners also reported that the dog was polyuric and polydypsic for the last 2 weeks. Complete blood count, serum biochemistry, and urinalysis revealed hyperglycemia, ketonemia, ketonuria, and metabolic acidosis. Diabetic ketoacidosis was diagnosed and after emergency treatment, including fluid therapy, prophylactic antibiotics, and regular insulin, the bitch whelped six healthy normal puppies. Two weeks after treatment, the bitch was clinically normal with normal fructosamine levels. To the authors' knowledge, this is the first reported case of gestational diabetes mellitus in a small breed dog.

Evolutionary interactions between diabetes and development

Because of the complications of diabetes affecting the mothers and their fetus/newborns are less known, this review examined the epidemiologic and mechanistic issues involved in the developmental programming of diabetic mothers. This overview showed that sperm, egg, zygote or blastocyst derived from diabetic parents may develop into offspring with high risk of any type of diabetes, even if placed in a normal uterus, producing developmental delay, embryopathy, geno- and cyto-toxicity, teratogenic changes, free radicals and apoptosis. These early insults may then lead to an increased rate of miscarriage and congenital anomalies depending on free radicals signaling and cell-death pathways involved by the diabetogenic agents. Furthermore, sperm, egg, zygote or blastocyst from normal parents will have an increased risk of diabetes if placed in a diabetic uterus. Interestingly, diabetes has deleterious effect on male/female reproductive functions and on the development of the blastocysts/embryos. Indeed, this review hypothesized that the long-term effects of diabetes during the pregnancy (gestational diabetes) may influence, generally, on the health of the embryos, newborns (perinatal life) and adulthood. However, there are obvious species differences between pregnant women and animal models. Thus, maintaining normoglycaemia during pregnancy may play an important role in a healthy life for the newborns.

Association of Insulin Resistance with Serum Interleukin-6 and TNF-α Levels During Normal Pregnancy

Overview:

The purpose of this study was to evaluate the role of Tumor Necrosis Factor-α (TNF-α) in insulin resistance (IR) during normal pregnancy.

Approach:

This cross sectional study was carried out on 86 healthy pregnant women including 26, 23 and 37 individuals in the 1st, 2nd and 3rd trimesters, respectively, and in 21 healthy non pregnant women. Serum TNF-α concentration was measured by Enzyme Linked Immunosorbent Assay (ELISA) method.

Results:

There were significant differences between serum TNF-α and IL-6 levels in pregnant women as compared with maternal healthy controls. There was significant correlation between gestational age and Body Mass Index (BMI) (r = 0.28, P = 0.01). There was no significant correlation between gestational age and insulin resistance (IR). We also did not find correlations between IR and TNF-α and IR and IL-6 in pregnant women.

Conclusion:

In conclusion, our findings suggest that TNF-α and IL-6 are not greatly contributed to pregnancy induced insulin resistance in normal pregnancy.