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Comparison of Serum Placental Protein Hormone Levels in Diabetic and Normal Pregnancy

GLENN D. BRAUNSTEIN, JAMES L. MILLS, GEORGE F. REED, LOIS G. JOVANOVIC^*, LEWIS B. HOLMES, JEROME AARONS, JOE L. SIMPSON and J. L. M, NICHD-DIABETES IN EARLY PREGNANCY STUDY GROUP

Department of Medicine, Cedars-Sinai Medical Center-University of California School of Medicine (G.D.B.) Los Angeles, California 90048
the Epidemiology and Biometry Research Program, National Institute of Child Health and Human Development, National Institutes of Health (J.L.M., G.F.R.) Bethes Maryland 20892
the Departments of Medicine and Obstetrics and Gynecology, Cornell University Medical Center(L.G.J.) New York, New York 10021
the Department of Obstetrics and Gynecology, Brigham and Women’s Hospital (L.B.H.) Boston, Massachusetts 02215
the Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine (J.A.), Pittsburgh Pennsylvania 15213
the Department of Obstetrics and Gynecology, Northwestern University (J.L.S.) Chicago, Illinois 60611

Address requests for reprints to: Glenn D. Braunstein, M.D., Cedars- Sinai Medical Center, 8700 Beverly Boulevard, Room B118, Los Angeles, California 90048.

Conflicting data exist concerning maternal serum concentrations of placental hormones during pregnancy in women with diabetes mellitus. To resolve some of these discrepancies,women participating in the NICHD-Diabetes in Early Pregnancy Study were studied. In this collaborative study, pregnancy was identified within 21 days of conception by serum hCG measurements. We prospectively collected 185 blood samples from 35 insulin-dependent diabetic women and 166 blood samples from 31 control women, all between 5 and 37 weeks gestation. Serum concentrations of hCG, pregnancy-specific β- 1-glycoprotein, placental lactogen,and hCGa were measured serially. The relationship between serum hormone, fasting blood glucose, 1-h postprandial blood glucose, and glycosylated hemoglobin concentrations was compared.

Serum hCG levels were significantly lower in the diabetic women than in control women at multiple time points during the first and second trimesters, while no consistent differences in the serum concentrations of hCG or pregnancy-specific β-1-glycoprotein were found between pregnant diabetic and control women. Serum placental lactogen levels were significantly lower in diabetic women at 9–10 weeks and 20 weeks gestation. There were no correlations between fasting blood glucose, 1-h postprandial blood glucose, or glycosylated hemoglobin and any of the placental protein levels in the diabetic women. These data are consistent with a defect in synthesis and/or secretion of hCG by the cytotrophoblast during the first two trimesters of pregnancy in insulin-requiring diabetic women.

^* Current address: Sansum Medical Research Foundation, 2219 Bath Street, Santa Barbara, California 93105.

Current address: Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee 38163.

Marcia J. Withiam, Ernest Harley, Beverly Trainor (NIH); Charles M. Peterson, Ann Duckies (Cornell); Dan Tulchinsky, Maija Galins, Carolyn Bogal (Brigham and Women’s Hospital); Marguerite Meyer, Ralpha Schmeltz (University of Pittsburgh); and Boyd E. Metzger, Carole Ober, Sherman Elias (Northwestern University).

Received May 11, 1988.

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