The Association Between Pregnancy Serum TNF-α Level and Postpartum Insulin Resistance in Pregnant Women With Gestational Diabetes Mellitus
Insulin resistance in gestational diabetes increases maternal and fetal complications. Tumor necrosis factor-alpha (TNF-α) is an inflammatory factor associated with insulin resistance. The aim of this study was to determine the association between pregnancy serum TNF-α level and postpartum insulin resistance in patients with gestational diabetes mellitus. 50 pregnant women, including 25 cases of gestational diabetes and 25 healthy pregnant women, were evaluated. First, during the third trimester of pregnancy, serum TNF-α level of all cases were measured. Two months after delivery, based on the obtained results from insulin levels and a 2-hour glucose tolerance test, HOMA-IR and HOMA-B were calculated, and the association between serum TNF-α level and insulin resistance was determined. Data were analyzed using independent t-test, Mann-Whitney, and chi-square test in SPSS software. The mean serum level of TNF-α in women with gestational diabetes mellitus was higher than healthy subjects, but there was no significant difference between the two groups. The serum level of insulin, HOMA-IR and HOMA-B indices in women with gestational diabetes mellitus were higher than healthy subjects, with a significant difference in all of the measures between two groups (P=0.0001). There was no significant correlation between TNF-α and HOMA-IR levels in insulin-resistant mothers two months after delivery (r=−0.33). Also, no significant correlation was detected between pregnancy TNF-α levels and HOMA-B index. Despite the higher serum levels of insulin, HOMA-IR, and HOMA-B in the diabetic group, the serum TNF-α level did not show any correlation with insulin resistance after delivery.
2. Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel–recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes care. 2012;35(3):526-8.
3. Association AD. Diagnosis and classification of diabetes mellitus. Diabetes care. 2016;39(Supplement 1):S13-S22.
4. Lauenborg J, Hansen T, Jensen DM, Vestergaard H, Mølsted-Pedersen L, Hornnes P, et al. Increasing incidence of diabetes after gestational diabetes: a long-term follow-up in a Danish population. Diabetes care. 2004;27(5):1194-9.
5. Sonagra AD, Biradar SM, Dattatreya K, DS JM. Normal pregnancy-a state of insulin resistance. Journal of clinical and diagnostic research: JCDR. 2014;8(11):CC01.
6. Cheung A, Ree D, Kolls J, Fuselier J, Coy D, Bryer-Ash M. An in vivo model for elucidation of the mechanism of TNF-α-induced insulin resistance: evidence for differential regulation of insulin signaling by TNF-α. Endocrinology. 1998;139:4928-35.
7. Kim HO, Kim H-S, Youn J-C, Shin E-C, Park S. Serum cytokine profiles in healthy young and elderly population assessed using multiplexed bead-based immunoassays. Journal of translational medicine. 2011;9(1):113.
8. Kirwan JP, Hauguel-De Mouzon S, Lepercq J, Challier J-C, Huston-Presley L, Friedman JE, et al. TNF-α is a predictor of insulin resistance in human pregnancy. Diabetes. 2002;51(7):2207-13.
9. Gomes CP, Torloni MR, Gueuvoghlanian‐Silva BY, Alexandre SM, Mattar R, Daher S. Cytokine levels in gestational diabetes mellitus: a systematic review of the literature. American Journal of Reproductive Immunology. 2013;69(6):545-57.
10. Cheng YW, Block-Kurbisch I, Caughey AB. Carpenter-Coustan criteria compared with the national diabetes data group thresholds for gestational diabetes mellitus. Obstetrics & Gynecology. 2009;114(2 Part 1):326-32.
11. Meshkani R, Taghikhani M, Larijani B, Khatami S, Khoshbin E, Adeli K. The relationship between homeostasis model assessment and cardiovascular risk factors in Iranian subjects with normal fasting glucose and normal glucose tolerance. Clinica chimica acta. 2006;371(1-2):169-75.
12. Basraon SK, Mele L, Myatt L, Roberts JM, Hauth JC, Leveno KJ, et al. Relationship of early pregnancy waist-to-hip ratio versus body mass index with gestational diabetes mellitus and insulin resistance. American journal of perinatology. 2016;2(01):114-22.
13. Winkler G, Cseh K, Baranyi É, Melczer Z, Speer G, Hajós P, et al. Tumor necrosis factor system in insulin resistance in gestational diabetes. Diabetes research and clinical practice. 2002;56(2):93-9.
14. McLachlan KA, O'Neal D, Jenkins A, Alford FP. Do adiponectin, TNFα, leptin and CRP relate to insulin resistance in pregnancy? Studies in women with and without gestational diabetes, during and after pregnancy. Diabetes/metabolism research and reviews. 2006;22(2):131-8.
15. Jahromi AS, Zareian P, Madani A. Association of insulin resistance with serum interleukin-6 and TNF-α levels during normal pregnancy. Biomarker insights. 2011;6:BMI. S6150.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.