Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Alcohol Clin Exp Res. 2021 Mar;45(3):500-506. doi: 10.1111/acer.14559. Epub 2021 Feb 24.
Evidence suggests that prenatal alcohol exposure (PAE) may adversely impact insulin production and signaling but there is limited information on the range of these effects and their future health consequences.
A prospective cohort of predominantly African-American individuals identified while in utero and followed into adulthood were used to evaluate differences in various indicators of diabetes, including fasting plasma glucose, hemoglobin A1c (HbA1c), and insulin levels. The homeostatic model assessment of insulin resistance (HOMA-IR) was also computed. Body mass index (BMI) was calculated and normal defined as < 25 kg/m . Participants were categorized as having PAE (n = 39) if their mothers drank at least 1 ounce of absolute alcohol per week or more during the 1 trimester of pregnancy and as Controls (n = 22) if their mothers reported abstaining from alcohol consumption during pregnancy.
Mean age of the sample was 36.0 ± 1.5 years. Indices of glucose metabolism, including fasting plasma glucose and hemoglobin A1c levels, did not vary by group status but insulin levels and HOMA-IR values varied by group status and BMI level. PAE individuals with a normal BMI had lower insulin levels than Controls. However, in PAE subjects, there was a steeper increase in insulin levels relative to their BMI than in Control subjects. A cluster of 5 PAE cases had low levels of insulin and 4 of the 5 had severe cognitive impairment.
The bidirectional effects on insulin level and insulin resistance associated with PAE may indicate differential rates of diabetes disease impact or differential PAE impact in the brain and peripheral areas involved in insulin production and signaling. These alterations may contribute to the metabolic disease risk associated with PAE.
有证据表明，产前酒精暴露（PAE）可能会对胰岛素的产生和信号传递产生不利影响，但关于这些影响的范围及其未来的健康后果的信息有限。
本研究使用了一个主要为非裔美国人的前瞻性队列，这些个体在子宫内就被确定，并一直随访到成年，以评估各种糖尿病指标的差异，包括空腹血糖、糖化血红蛋白（HbA1c）和胰岛素水平。还计算了胰岛素抵抗的稳态模型评估（HOMA-IR）。体重指数（BMI）也进行了计算，正常定义为<25kg/m 。如果母亲在怀孕的第 1 个 trimester 每周至少喝 1 盎司纯酒精或更多，则将参与者归类为有 PAE（n=39），如果母亲报告在怀孕期间不饮酒，则将其归类为对照组（n=22）。
样本的平均年龄为 36.0±1.5 岁。葡萄糖代谢指数，包括空腹血糖和糖化血红蛋白水平，不因组而异，但胰岛素水平和 HOMA-IR 值因组而异，且与 BMI 水平有关。BMI 正常的 PAE 个体的胰岛素水平低于对照组。然而，在 PAE 受试者中，相对于 BMI，胰岛素水平的上升幅度比对照组更大。PAE 病例中有 5 例存在胰岛素水平低，其中 4 例有严重认知障碍。
PAE 相关的胰岛素水平和胰岛素抵抗的双向作用可能表明糖尿病疾病影响的不同速度或参与胰岛素产生和信号传递的大脑和外周区域的不同 PAE 影响。这些改变可能会导致与 PAE 相关的代谢疾病风险。
