A new study has identified that a deficit in the placental expression of the gene insulin-like growth factor 1 (IGFBP1) and low IGFBP1 circulating levels are associated with insulin resistance during pregnancy, highlighting a potential risk factor for the development of gestational diabetes. Gestational diabetes, a disease that can lead to multiple pregnancy and delivery complications, is the most common pregnancy metabolic complication, affecting 1 in 7 pregnancies. Existing research has shown that excess insulin resistance in pregnancy contributes to gestational diabetes, but the exact causes of this resistance remain unclear. The placenta, the major driver of changes in insulin physiology in pregnancy is likely a key source of hormones involved in the development of gestational diabetes. The goal was to discover novel placental factors that are implicated in gestational diabetes, by studying all proteins expressed in placenta tissues, across the human genome. The identified placental insulin-like growth factor 1 (IGFBP1) as a secreted placental factor that is likely implicated in regulation of glucose in human pregnancy. The study builds on extensive research into the determinants of gestational diabetes using genetics and other omics approaches, and their interaction with lifestyle and environmental factors. The study team conducted genome-wide RNA sequencing on maternal-facing placental tissue samples, and measured identified proteins in blood collected in multiple pregnancy cohorts with diverse backgrounds. The team identified 14 genes whose placental RNA expression levels were associated with insulin resistance, finding the strongest association with gene IGFBP1. By measuring the IGFBP1 protein levels in circulation, they found that IGFBP1 levels rise over the course of pregnancy and are 5 times higher in pregnant people compared to outside of pregnancy, arguing for the placenta being one of the major sources of this protein during pregnancy. Results also show that low levels of circulating IGFBP1 in early pregnancy could predict who is likely to develop gestational diabetes in late second trimester of pregnancy. Finally, the team found that the trajectory of IGFBP1 levels across pregnancy differs in people who have a subtype of gestational diabetes characterized by insulin resistance previously shown more likely to develop pregnancy complications. It's possible that measuring IGFBP1 in the first trimester could help identify people at risk of developing gestational diabetes early in pregnancy, potentially offering a window for prevention.

People who take acid-reducing drugs may have a higher risk of migraine and other severe headache than people who do not take these medications, according to a new study. The acid-reducing drugs include proton pump inhibitors such as omeprazole and esomeprazole, histamine H2-receptor antagonists, or H2 blockers, such as cimetidine and famotidine, and antacid supplements. Acid reflux is when stomach acid flows into the esophagus, usually after a meal or when lying down. People with acid reflux may experience heartburn and ulcers. People with frequent acid reflux may develop gastroesophageal reflux disease, or GERD, which can lead to cancer of the esophagus. These drugs are often considered to be overprescribed, and new research has shown other risks tied to long-term use of proton pump inhibitors, such as an increased risk of dementia. A total of 25% of participants taking proton pump inhibitors had migraine or severe headache, compared to 19% of those who were not taking the drugs. A total of 25% of those taking H2 blockers had severe headache, compared to 20% of those who were not taking those drugs. And 22% of those taking antacid supplements had severe headache, compared to 20% of those not taking antacids. When researchers adjusted for other factors that could affect the risk of migraine, such as age, sex and use of caffeine and alcohol, they found that people taking proton pump inhibitors were 70% more likely to have migraine than people not taking proton pump inhibitors. Those taking H2 blockers were 40% more likely and those taking antacid supplements were 30% more likely. It's important to note that many people do need acid-reducing medications to manage acid reflux or other conditions, and people with migraine or severe headache who are taking these drugs or supplements should talk with their doctors about whether they should continue. The study looked only at prescription drugs. Some of the drugs became available for over-the-counter use at non-prescription strength during the study period, but use of these over-the-counter drugs was not included in this study. Other studies have shown that people with gastrointestinal conditions may be more likely to have migraine, but relationship is not likely to fully explain the tie between acid-reducing drugs and migraine found in the study. A limitation of the study is that a small number of people were taking the drugs, especially the H2 blockers.