Hormonal profile and glucose tolerance in late pregnancy and postpartum

Prenatal SSRI exposure alters neonatal corticosteroid binding globulin, infant cortisol levels, and emerging HPA function

BACKGROUND

Serotonin influences the development of the hypothalamic-pituitary-adrenal (HPA) system; therefore prenatal exposure to selective serotonin reuptake inhibitor antidepressants (SSRIs) may alter HPA axis development and function. To address this, prenatal exposure to SSRIs and maternal mood were examined in relation to neonatal and infant levels of cortisol and its binding protein, corticosteroid-binding globulin (CBG).

METHODS

Serum cortisol and CBG levels were assayed from SSRI-exposed and non-exposed mothers and their neonates at delivery. Maternal mood symptoms were documented at 36 weeks gestation. To determine the long-term implications of changes in CBG, levels of salivary cortisol were assessed in infants at 3 months of age.

RESULTS

Prenatal SSRI exposure significantly increased serum CBG levels in neonates after vaginal delivery (p ≤ 0.038), even when controlling for maternal depression. Neonatal serum cortisol levels did not vary with SSRI exposure or antenatal maternal mood, but were significantly higher following vaginal delivery (p ≤ 0.003). Neonatal serum CBG levels were associated with infant salivary levels of evening cortisol (p ≤ 0.051). In SSRI-exposed infants, increased levels of neonatal CBG predicted a smaller diurnal change in infant salivary cortisol (p ≤ 0.028), regardless of maternal depression.

CONCLUSIONS

Prenatal SSRI exposure affects the developing HPA system by altering serum CBG levels in neonates and infant salivary cortisol levels. Further research is warranted on the long-term functional implications of the effect of prenatal SSRI exposure on fetal hepatic CBG gene expression and the developing HPA system.

Depression during pregnancy and postpartum: contribution of stress and ovarian hormones

Depression is the most common psychiatric disease among women, exhibiting a prevalence which is 2-3x higher than in men. The postpartum period is considered the time of greatest risk for women to develop major depression and postpartum depression affects approximately 15% of women. A dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis is the most prominent endocrine change seen in depression and normalization of the HPA axis is a major target of recent therapies. Females exhibit different stress sensitivities than males which might contribute to their increased vulnerability for depression. Maternal stress or depression during pregnancy and/or postpartum is particularly concerning as early developmental influences can affect the maturation of the offspring as well as the mental health of the mother. Despite the urgent need for more information on depression in females, especially during pregnancy and postpartum, most animal models of depression have utilized only males. Given the sex differences in incidence of depression and treatment, it is vitally important to create or validate animal models of depression in females. This review will focus on the association between stress, glucocorticoids and depression in humans, with a special focus on depression in women during pregnancy and postpartum and on animal models of postpartum depression and the consequences for the offspring.

Insulin responsiveness to glucose and tissue responsiveness to insulin during lactation in dairy cows

The hyperglycemic clamp and hyperinsulinemic euglycemic clamp techniques were conducted to assess insulin responsiveness to glucose and tissue responsiveness to insulin in lactating and nonlactating Holstein cows. In the hyperglycemic clamp experiment, blood glucose concentrations were clamped at 50 mg/dl above the pre-infusion values by variable rates of glucose infusion. The mean plasma insulin increments over the baseline (insulin responsiveness to glucose) during hyperglycemia were lower (P < .05) in lactating cows than in nonlactating cows (23 vs. 102 microU/ml). In the hyperinsulinemic euglycemic clamp experiment, insulin was infused at the constant rate of 6.0 mU.kgBW-1.min-1 for 2 hr, and glucose was concomitantly infused at a variable rate to maintain the pre-infusion concentrations of blood glucose. Glucose infusion rates (tissue responsiveness to insulin) were similar (3.2 mg.kgBW-1.min-1) for lactating and nonlactating cows. It is concluded that insulin responsiveness to glucose is reduced, and tissue responsiveness to insulin remains unchanged during lactation in Holstein cows.

A study on the hyperinsulinism of late pregnancy

Much research has demonstrated that in late pregnancy glucose administration causes a marked increase of peripheral insulin levels. To ascertain whether this particular increase is due to increased insulin secretion and/or to reduced hepatic insulin removal, we measured blood glucose, plasma C-peptide and plasma insulin during OGTT in 7 nonpregnant women and in 20 nondiabetic women at third trimester of gestation and 60-90 days after delivery. The C-peptide/insulin molar ratio was calculated for all subjects. Data obtained showed that both plasma insulin and C-peptide response to oral glucose is considerably higher in women at third trimester of pregnancy as compared with that observed in the same subjects after delivery and in nonpregnant women. The basal (overnight fasting) C-peptide/insulin molar ratio did not differ significantly between pregnant and nonpregnant women. After the oral glucose load the molar ratio was sharply reduced in all groups of subjects, but the overall decrease in the pregnant women in the three hours following oral glucose was considerably greater than in postpartum and in nonpregnant women. The increased plasma C-peptide response clearly indicates that in pregnancy oral glucose-induced hyperinsulinism is caused by increased insulin release from pancreatic B-cells. Moreover, the marked overall decrease of the C-peptide/insulin molar ratio suggests, even if it does not definitely prove, that hyperinsulinism after glucose in late pregnancy may be a consequence not only of increased insulin secretion, but also of decreased hepatic extraction of insulin.

Plasma concentrations of metabolic hormones in high and low producing dairy cows

Concentrations of insulin, glucagon, growth hormone, adrenocorticotropin, and cortisol were determined in plasma samples obtained at 20-min intervals for 6 h from low and high producing dairy cows at d 30 and 90 postpartum. Four nonpregnant, nonlactating cows also were sampled. Insulin concentrations were reduced at d 30 in both groups of lactating cows compared with concentrations in nonlactating cows; glucagon concentrations were unchanged. The molar insulin: glucagon was reduced at d 30 in both groups and at d 90 for low, but not high producers. Growth hormone concentrations were higher at d 30 in high producers than at d 90, in low producers at d 30, and higher than in nonlactating cows. Cortisol concentrations were lower in high producing cows at d 30 than at d 90 or in nonlactating cows due to a reduced pulse amplitude. No differences were observed for adrenocorticotropin. Reduced molar insulin: glucagon may be an integral response of the cow to lactation, while the difference in the insulin: glucagon for high and low producers at d 90 postpartum may indicate a continued need for a gluconeogenic stimulus in low producers. The elevated growth hormone and low cortisol concentrations likely participate in the enhanced production observed in high producing dairy cows.

Evaluation of B-cell secretion and peripheral insulin resistance during pregnancy and after delivery in gestational diabetes mellitus with obesity

Nine pregnant women with gestational diabetes mellitus (GDM) were studied. Six normal pregnant women and six normal nonpregnant women were evaluated as control groups. All the women underwent oral glucose tolerance test and glucose clamp during the third trimester of pregnancy and two months after delivery. During OGTT, glucose, C-peptide and insulin plasma levels were determined. C-peptide and insulin values in the late phase of OGTT were higher during pregnancy than after delivery in both groups. In gestational diabetic women, the M-value in the second steady-state during glucose clamp was lower than in controls, both during pregnancy and after delivery. Nevertheless, in both groups the M-value during pregnancy was lower than after delivery. Moreover, in gestational diabetic women there was an inverse correlation between M-value in the second steady-state and ponderal excess index after delivery. In conclusion, the impaired peripheral glucose utilization and the pancreatic pattern of gestational diabetic women compared to normal suggested altered B-cell secretion response, increased peripheral resistance and overweight to be the main changes in GDM.

Pregnancy and diabetes: the maternal response

Pregnancy places remarkable stresses on maternal carbohydrate metabolism and pancreatic insulin reserves. The normal mammal responds to pregnancy by increasing pancreatic islet size and insulin secretion. Pregnancy also causes alterations in concentrations of metabolic fuels in maternal circulation. These changes are partly attributed to gestational increases of estrogen, progesterone and human chorionic somatomammotropin, and are thought to provide a proper metabolic and hormonal incubation medium for the fetus. Conversely, the compromised pancreas of the diabetic is unable to meet the additional demands of pregnancy, and carbohydrate metabolism deteriorates. The character of these metabolic changes depends on the time of gestation and the type of diabetes mellitus.

Glucagon, insulin, and growth hormone responses to glucose infusion in lactating dairy cows

Early lactation in the dairy cow is associated with an increased demand for energy that can only be met by hormone-mediated partitioning of nutrients. The purpose of this study was to determine adaptive responses of basal and glucose-stimulated glucagon (IRG), insulin (IRI), and growth hormone (GH) concentrations to early lactation. Blood was collected via jugular cannulas from nonpregnant nonlactating (NPNL) cows and cows 14 days antepartum (AP) and 5 and 30 days postpartum (PP). Basal concentrations of IRI decreased with lactation, IRG was essentially unchanged, and GH was increased with lactation. The molar IRI/IRG (I/G) ratio was decreased from 4.6 at day 14 AP to 1.3 at day 30 PP. The effects of exogenous glucose (0.56 mM/kg body wt) on IRI were greatest during pregnancy and declined with lactation. IRG responses to glucose were similar except in NPNL cows, which had a minimal but prolonged IRG inhibition, GH responses to glucose infusion were absent in NPNL cows and were most significant at 5 days PP. The decreased I/G and elevated GH concentrations suggests that both IRG and GH play a role in nutrient partitioning during early lactation.