Читать книгу Gestational Diabetes - Группа авторов - Страница 23

Tumor necrosis factor alpha (TNF-α) is a proinflammatory cytokine whose activity was originally described as part of the acute phase inflammatory response. It is now known to have a myriad of effects, including blocking insulin signal transduction and impacting appetite by regulating bitter taste perception. The placenta produces large quantities of TNF-α. A longitudinal study demonstrated that TNF-α plasma levels increased from prepregnancy to late pregnancy by about one-third and that the increases in levels of TNF-α, and to a lesser extent leptin and cortisol, correlated with insulin resistance in late pregnancy, while progesterone, estradiol, and prolactin levels were not correlated [34]. A systematic review concluded that maternal TNF-α levels were significantly higher in women with GDM than normal control gravidas, and this was independent of obesity [29]. While most investigators report that TNF-α is significantly associated with insulin resistance in pregnancy [31], a large cross-sectional study at 24–28 weeks found that maternal TNF-α levels were not correlated with insulin resistance, while leptin was significantly associated [23].