Adipose Tissue Inflammation and Adrenomedullin Overexpression Contribute to Lipid Dysregulation in Diabetic Pregnancies

J Clin Endocrinol Metab. 2018 Oct 1;103(10):3810-3818. doi: 10.1210/jc.2018-00905.


Context: Impaired maternal lipid metabolism in gestational diabetes mellitus (GDM) has detrimental effects on maternal health and fetal growth. We previously reported the excessive expression of adrenomedullin (ADM) and its receptors in GDM adipose tissues compared with normal glucose-tolerant pregnancies. In the present study, we determined the mechanisms underlying enhanced expression of ADM and its receptors.

Design: Omental adipose tissue (OAT) samples were collected from women during cesarian section of term pregnancy with nonoverweight (NOW; n = 9), overweight (OW; n = 8), obese (OBS; n = 10), and GDM (n = 10) status.

Results: The expression of ADM and its receptors was greater in OATs from GDM than from women who were NOW, OW, and OBS. The expression of adipokines, leptin, and resistin were significantly increased, but adiponectin was decreased in OATs from patients with GDM compared with those without GDM. Macrophage infiltration and TNF-α expression were greater in OAT from pregnant women with GDM than in pregnant women without GDM. Furthermore, TNF-α dose dependently increased mRNA for ADM and its receptor components calcitonin receptor-like receptor and receptor activity-modifying proteins 2 and 3 in OAT explants from women who were NOW. Human adipocytes treated with ADM significantly increased glycerol release in culture medium, and the increases of glycerol in culture medium of OAT from women with GDM were attenuated by ADM antagonists, ADM22-52.

Conclusions: Increased macrophage infiltration and TNF-α expression in adipose tissue from GDM, but not from OBS, tissues stimulate ADM and its receptor overexpression, leading to enhanced lipolysis and hyperlipidemia. This might contribute to fetal macrosomia and adiposity in diabetic pregnancies.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adipose Tissue / immunology*
  • Adipose Tissue / metabolism
  • Adipose Tissue / pathology
  • Adrenomedullin / genetics
  • Adrenomedullin / metabolism*
  • Adult
  • Diabetes, Gestational / metabolism
  • Diabetes, Gestational / physiopathology*
  • Dyslipidemias / etiology*
  • Dyslipidemias / metabolism
  • Dyslipidemias / pathology
  • Female
  • Fetal Macrosomia / etiology*
  • Fetal Macrosomia / metabolism
  • Fetal Macrosomia / pathology
  • Follow-Up Studies
  • Humans
  • Inflammation / complications*
  • Lipids / analysis
  • Lipolysis
  • Omentum / metabolism
  • Omentum / pathology
  • Pregnancy
  • Pregnancy Complications / etiology
  • Pregnancy Complications / metabolism
  • Pregnancy Complications / pathology
  • Prenatal Exposure Delayed Effects / pathology*
  • Prognosis


  • ADM protein, human
  • Lipids
  • Adrenomedullin