We thank Karatas et al for their letter highlighting the potential contribution of the autonomic nervous system (ANS) in mediating the effects of metformin in a model of maternal obesity. Pregnancy, characterized by maternal adaptation to and support of fetal growth, is accompanied by significant ANS changes. ANS activity changes with the progression of gestation, with an increase in vagal activity and lower sympathetic activity during the first trimester followed by lower vagal activity and increased sympathetic activity during the third trimester. Various conditions that accompany pregnancy can also affect ANS activity. As highlighted by Karatas et al, obesity/overfeeding and metabolic syndrome correlate with sympathetic overactivity. Together, these factors, along with the pregnant state, create a complex system/model to analyze.
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