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Duygulu D, Mutlu Sütcüoğlu B, Turgut E, Özdemir H, Karçaaltıncaba D. Prospective evaluation of ultrasonographic fetal cardiac morphometry and functions in the third trimester of pregnancies with gestational diabetes mellitus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39123201 DOI: 10.1002/jcu.23776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/08/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE This study aimed to compare cardiac morphological and functional changes in fetuses of patients with diet-regulated gestational diabetes mellitus (GDM-A1), insulin-regulated GDM (GDM-A2), and a control group. METHOD A prospective cohort study included pregnant women aged 18-40 years with singleton pregnancies. Fetal biometric, cardiac morphological, and functional measurements were recorded using Z-scores at 34-37 weeks of gestation. RESULTS The study included 87 patients. Both right and left ventricular wall thicknesses were significantly different between the three groups (p < 0.001 and p < 0.001, respectively). Z-scores of the mitral valve, left and right EDD were significantly lower in GDM-A1 and GDM-A2 groups compared to the control group (p < 0.001, p < 0.001, p = 0.002, respectively). Right and left ventricular areas were decreased only in GDM-A2 group compared to the control group (p = 0.003 and p = 0.001, respectively). MPI and IVRT values were also significantly higher in the same groups (p = 0.016, p < 0.001, respectively). CONCLUSION Gestational diabetes increased IVS and ventricular wall thicknesses in both right and left ventricles, irrespective of whether it was controlled by diet or insulin. Cardiac functional changes were observed in the GDM-A2 group.
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Affiliation(s)
- Dilara Duygulu
- Department of Obstetrics and Gynaecology, Gazi University, Ankara, Turkey
| | - Bengü Mutlu Sütcüoğlu
- Department of Obstetrics and Gynaecology, Ankara Atatürk Sanatoryum Research and Training Hospital, Ankara, Turkey
| | - Ezgi Turgut
- Department of Perinatology, Gazi University, Ankara, Turkey
| | - Halis Özdemir
- Department of Perinatology, Gazi University, Ankara, Turkey
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Zubrzycki M, Schramm R, Costard-Jäckle A, Grohmann J, Gummert JF, Zubrzycka M. Cardiac Development and Factors Influencing the Development of Congenital Heart Defects (CHDs): Part I. Int J Mol Sci 2024; 25:7117. [PMID: 39000221 PMCID: PMC11241401 DOI: 10.3390/ijms25137117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
The traditional description of cardiac development involves progression from a cardiac crescent to a linear heart tube, which in the phase of transformation into a mature heart forms a cardiac loop and is divided with the septa into individual cavities. Cardiac morphogenesis involves numerous types of cells originating outside the initial cardiac crescent, including neural crest cells, cells of the second heart field origin, and epicardial progenitor cells. The development of the fetal heart and circulatory system is subject to regulatation by both genetic and environmental processes. The etiology for cases with congenital heart defects (CHDs) is largely unknown, but several genetic anomalies, some maternal illnesses, and prenatal exposures to specific therapeutic and non-therapeutic drugs are generally accepted as risk factors. New techniques for studying heart development have revealed many aspects of cardiac morphogenesis that are important in the development of CHDs, in particular transposition of the great arteries.
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Affiliation(s)
- Marek Zubrzycki
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany;
| | - Rene Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (R.S.); (A.C.-J.); (J.F.G.)
| | - Angelika Costard-Jäckle
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (R.S.); (A.C.-J.); (J.F.G.)
| | - Jochen Grohmann
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany;
| | - Jan F. Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (R.S.); (A.C.-J.); (J.F.G.)
| | - Maria Zubrzycka
- Department of Clinical Physiology, Faculty of Medicine, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland
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Duchette C, Perera M, Arnett S, White E, Belcher E, Tinius R. Benefits of Resistance Training During Pregnancy for Maternal and Fetal Health: A Brief Overview. Int J Womens Health 2024; 16:1137-1147. [PMID: 38912201 PMCID: PMC11193983 DOI: 10.2147/ijwh.s462591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open
Abstract
Research demonstrates resistance training is not only safe but also beneficial for pregnant women. However, exercise recommendations for pregnant women still minimize the importance of resistance exercise and provide minimal guidance. With a large increase in strength-focused sports among women, it is critical to re-evaluate the risk/benefit ratio of these exercises and ensure the latest recommendations reflect the latest clinical research. The purpose of this review is to highlight the safety and benefits of resistance training for both maternal and fetal health, particularly focusing on recent work. Relevant research involving resistance training during pregnancy was accessed and analyzed via a quasi-systematic search. Results demonstrate that appropriate prenatal resistance training can help alleviate some of the common symptoms of pregnancy, such as fatigue, back pain, and poor mental health. Resistance exercise can assist with glucose control in gestational diabetes mellitus, as well as decrease the risk of infant macrosomia and childhood metabolic dysfunction associated with uncontrolled gestational diabetes. Resistance training can also increase the likelihood of a vaginal delivery, which is beneficial for both mother and baby. Concerning fetal health, resistance training increases uterine blood flow, decreases the risk of neonatal macrosomia, and improves cognitive function and metabolic health in childhood. As with all forms of exercise, pregnant women should avoid resistance exercises that involve the supine position for extended bouts of time, trauma (or risk of trauma) to the abdomen, ballistic movements, movements that rely heavily on balance, and conditions that prohibit appropriate temperature control. With these considerations in mind, resistance training's benefits far surpass the lack of risk to the fetus. Resistance training is a safe and effective way to improve and maintain physical fitness during pregnancy and represents no risk to fetal health and development. Thus, healthcare providers should recommend resistance training for pregnant women.
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Affiliation(s)
| | - Madhawa Perera
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Scott Arnett
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Erin White
- Health, Exercise, and Rehabilitative Sciences, Winona State University, Winona, Minnesota, USA
| | - Elizabeth Belcher
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Rachel Tinius
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
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Vasinchatchawal C, Suntratonpipat S, Ruangroj C, Chitsrisakda N, Chungsangfah A, Chanvorachote P, Suksumek N. Maternal poor glycemic control increases risk of neonatal left ventricular hypertrophy. Minerva Pediatr (Torino) 2024; 76:321-327. [PMID: 38842379 DOI: 10.23736/s2724-5276.21.06055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is an important complication of infants of diabetic mothers (IDMs). However, the defined factors, such as the influence of glycemic control, insulin administration of diabetic mothers and large for gestational age (LGA) in infants, are largely unknown on the incidence of LVH. Therefore, this study aimed to evaluate the prevalence of maternal and neonatal risk factors associated with LVH in IDMs. METHODS This prospective analytic study was conducted at tertiary care hospitals in a 1-year period. Inborn IDMs were enrolled, and ventricular hypertrophy was identified by 2D echocardiography in the first 72 hours after birth. RESULTS A total of 160 IDMs met the inclusion criteria, 33 (20.6%) of which had LVH. The incidence of infants with LVH born to mothers with poor glycemic control (fasting blood sugar >95 mg/dL) was significantly elevated than those with good glycemic control (45.5% vs. 14.4%, P<0.001). Twelve IDMs (12/33, 36.5%) of LVH and 17 IDMs (17/127, 13.4%) of non-LVH were LGA. IDMs with LVH, compared those with non-LVH, had significantly increased left ventricular (LV) geometry; IVSd (6.5±0.8 vs. 4.0±0, 7 mm), LV IDd (16.8±3.3 mm vs. 18.4±1.1), left ventricular ejection fraction (LVEF) (68.3±8.5% vs. 62.9±17.5%), left ventricular fraction shortening (LVFS) (35.9±6.6% vs. 32.2±5.5%), LV mass (15.3±11.6 vs. 9.3±2.5 g) and LV mass index (66.2±17.5 vs. 46.6±9.7 g/m2), all with P<0.001. There was significant correlation in LV mass with infants' weight, height and body surface area (BSA) (r=0.408, 0.337 and 0.424, respectively; P<0.001). CONCLUSIONS The prevalence of neonatal ventricular hypertrophy in IDMs was 20.6%. Maternal poor glycemic control and LGA status in IDMs were dominant risk factors of LVH.
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Affiliation(s)
- Chayaporn Vasinchatchawal
- Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Somjate Suntratonpipat
- Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chokchai Ruangroj
- Department of Pediatrics, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | | | | | - Pithi Chanvorachote
- Departments of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Nithipun Suksumek
- Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand -
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Lu JQ, Luo ZY, Sun C, Wang SM, Sun D, Huang RJ, Yang X, Ding Y, Wang G. Baicalin administration could rescue high glucose-induced craniofacial skeleton malformation by regulating neural crest development. Front Pharmacol 2024; 15:1295356. [PMID: 38515837 PMCID: PMC10955141 DOI: 10.3389/fphar.2024.1295356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Hyperglycemia in pregnancy can increase the risk of congenital disorders, but little is known about craniofacial skeleton malformation and its corresponding medication. Our study first used meta-analysis to review the previous findings. Second, baicalin, an antioxidant, was chosen to counteract high glucose-induced craniofacial skeleton malformation. Its effectiveness was then tested by exposing chicken embryos to a combination of high glucose (HG, 50 mM) and 6 μM baicalin. Third, whole-mount immunofluorescence staining and in situ hybridization revealed that baicalin administration could reverse HG-inhibited neural crest cells (NCC) delamination and migration through upregulating the expression of Pax7 and Foxd3, and mitigate the disordered epithelial-mesenchymal transition (EMT) process by regulating corresponding adhesion molecules and transcription factors (i.e., E-cadherin, N-cadherin, Cadherin 6B, Slug and Msx1). Finally, through bioinformatic analysis and cellular thermal shift assay, we identified the AKR1B1 gene as a potential target. In summary, these findings suggest that baicalin could be used as a therapeutic agent for high glucose-induced craniofacial skeleton malformation.
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Affiliation(s)
- Jia-Qi Lu
- The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development and Prenatal Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhi-Yan Luo
- The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development and Prenatal Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Chengyang Sun
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development and Prenatal Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Si-Miao Wang
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development and Prenatal Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Dixiang Sun
- Department of Pathology, Mengyin County Hospital of Traditional Chinese Medicine, Linyi, China
| | - Ruo-Jing Huang
- The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Xuesong Yang
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development and Prenatal Medicine, School of Medicine, Jinan University, Guangzhou, China
- Key Laboratory for Regenerative Medicine of the Ministry of Education of China, Jinan University, Guangzhou, China
| | - Yong Ding
- The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Guang Wang
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development and Prenatal Medicine, School of Medicine, Jinan University, Guangzhou, China
- Key Laboratory for Regenerative Medicine of the Ministry of Education of China, Jinan University, Guangzhou, China
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Menekse Beser D, Oluklu D, Uyan Hendem D, Yildirim M, Turgut E, Sahin D. Effect of glycemic control on fetal hearts of pregestational diabetic women by tissue doppler and M-mode imaging. Echocardiography 2023; 40:822-830. [PMID: 37458597 DOI: 10.1111/echo.15649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/25/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE To determine whether changes in fetal heart function according to glycemic control in pregnant women with Type 1 and Type 2 diabetes using spectral tissue Doppler imaging (TDI) and M-mode imaging. METHODS This study included 68 pregestational diabetic women (DM) at 30-32 gestational weeks. All participants were divided into two groups: type 1(n = 17) and type 2(n = 51), and then these groups were divided into the subgroups as well-controlled and poorly controlled, according to fasting glucose (FG) and 1-h postprandial glucose (PPG) values. Cardiac parameters were compared for well- and poorly-controlled groups with TDI and M-mode imaging. The correlation of cardiac parameters with FG, PPG, and HbA1c values was evaluated. Their roles in predicting neonatal outcomes were also assessed. RESULTS Thickness measurements, early diastolic annular peak velocity (E'), late diastolic annular peak velocity (A'), tissue isovolumetric relaxation time (IRT'), and tissue myocardial performance index (MPI') were increased in both poorly controlled groups. Tissue ejection time (ET') was significantly reduced in the poorly controlled groups, while tissue isovolumetric contraction time (ICT') was not significantly changed in any group. Tricuspid, mitral, and septal annular plane excursions (TAPSE, MAPSE, and SAPSE, respectively) were significantly decreased in all poorly controlled subgroups. E', E'/A', MPI', IRT', ET', and M-mode imaging parameters significantly correlated with FG notably. CONCLUSION Maternal hyperglycemia leads to subtle changes in systolic and diastolic functions both in the interventricular septum and ventricles, so it is essential to ensure glycemic control in both Type 1 and Type 2 DM.
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Affiliation(s)
- Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Santanapipatkul P, Luewan S, Sittiwangkul R, Krongphaiklang N, Jatavan P, Tongsong T. Comparison of fetal and neonatal cardiac morphology between the infants of mothers with well-controlled gestational diabetes mellitus and normal controls. Diab Vasc Dis Res 2023; 20:14791641231190531. [PMID: 37463129 PMCID: PMC10357059 DOI: 10.1177/14791641231190531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To compare fetal and neonatal cardiac morphology in fetuses of mothers with gestational diabetes mellitus (GDM) with the controls. PATIENTS AND METHODS Pregnant women at average risk of GDM underwent 100-g, 3-h-OGTT at 24-28 weeks of gestation for diagnosis of GDM. Both GDM group and the control group underwent fetal echocardiography at 32-36 weeks to assess cardiac dimensions. The neonates underwent echocardiography within 48 h after birth to assess cardiac morphology. RESULTS A total of 154 pregnant women were recruited, including 60 in the GDM group and 94 in the control group. All of the study group were well controlled for GDM. Most baseline characteristics of both groups were comparable. All obstetric outcomes were not significantly different between the two groups. Morphological cardiac dimensions in the fetuses and newborns of both groups were also not significant different. Subgroup analysis in the study group showed no significantly different in cardiac morphology between the group with diet control and that of insulin control. CONCLUSION Fetal and neonatal cardiac morphologic changes among mothers with well-controlled GDM are not significantly different from those in the controls. It is possible that good control of maternal blood glucose can prevent fetal and neonatal cardiac abnormalities.
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Affiliation(s)
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rekwan Sittiwangkul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Thailand Heart Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nopparat Krongphaiklang
- The Northern Thailand Heart Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phudit Jatavan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Lemaitre M, Bourdon G, Bruandet A, Lenne X, Subtil D, Rakza T, Vambergue A. Pre-gestational diabetes and the risk of congenital heart defects in the offspring: A French nationwide study. DIABETES & METABOLISM 2023; 49:101446. [PMID: 37031733 DOI: 10.1016/j.diabet.2023.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
AIM To compare the frequencies and types of congenital heart defects for infants of women without and with pre-gestational diabetes, type 1 and type 2 diabetes (T1DM, T2DM) and to identify risk factors. METHODS All live births between 2012 and 2020 were screened for maternal diabetes and infant congenital heart defects using the French Medical Information System Program in Medicine, Surgery and Obstetrics database (PMSI-MCO). Incidences of these defects were estimated, and a logistic model evaluated maternal and fetal prognostic risk factors. RESULTS Overall, 6,038,703 mothers did not have pre-gestational diabetes (no-diabetes), 23,147 had T1DM, and 14,401 had T2DM. The incidence of infant congenital disease was 6.2% for the no-diabetes group, 8.0%, for women with T1DM, and 8.4% for women with T2DM (P < 0.001); for congenital heart defects, incidences were respectively 0.8%, 3.0% and 2.7% (P < 0.001). In comparison with the no-diabetes group, the odds ratios (95%CI) of coronary heart defects were 2.07 (1.91;2.24) (P < 0.001) for women with T1DM and 2.20 (1.99;2.44) (P < 0.001) for women with T2DM, with no difference between T1DM and T2DM (P = 0.336). cesarian section, small and large for gestational age, and prematurity were also associated with an increased risk of congenital heart defects. CONCLUSION In this study we observed higher incidences of congenital heart defects in infants of women with pre-gestational diabetes compared to women without pre-gestational diabetes, with no difference between women with T1DM or T2DM. These data call for intensifying preconception care and justify systematic cardiac echography in selected fetuses.
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Affiliation(s)
- Madleen Lemaitre
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, F-59000 Lille, France; University of Lille, F-59000 France; ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Gurvan Bourdon
- University of Lille, F-59000 France; CHU Lille, Department of Pediatrics, Lille University Hospital, F-59000 Lille, France
| | - Amélie Bruandet
- CHU Lille, Department of Medical Information, Lille University Hospital, F-59000 Lille, France
| | - Xavier Lenne
- CHU Lille, Department of Medical Information, Lille University Hospital, F-59000 Lille, France
| | - Damien Subtil
- University of Lille, F-59000 France; ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, F-59000 Lille, France
| | - Thameur Rakza
- CHU Lille, Department of Pediatrics, Lille University Hospital, F-59000 Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, F-59000 Lille, France; University of Lille, F-59000 France; European Genomic Institute for Diabetes, University School of Medicine, F-59000 Lille, France.
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Maduro C, Castro LFD, Moleiro ML, Guedes-Martins L. Pregestational Diabetes and Congenital Heart Defects. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:953-961. [PMID: 36446562 PMCID: PMC9708403 DOI: 10.1055/s-0042-1755458] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.
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Affiliation(s)
- Catarina Maduro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Address for correspondence Catarina Maduro, MSc Rua Jorge de Viterbo Ferreira 228, 4050-313, PortoPortugal
| | - Luís Ferreira de Castro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal,Unidade de Investigação e Formação, Centro Materno Infantil do Norte, Porto, Portugal,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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10
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Chowdhury D, Toms R, Brumbaugh JE, Bindom S, Ather M, Jaquiss R, Johnson JN. Evaluation and Management of Noncardiac Comorbidities in Children With Congenital Heart Disease. Pediatrics 2022; 150:189884. [PMID: 36317973 DOI: 10.1542/peds.2022-056415e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 02/25/2023] Open
Abstract
Outcomes for patients with neonatal heart disease are affected by numerous noncardiac and genetic factors. These can include neonatal concerns, such as prematurity and low birth weight, and congenital anomalies, such as airway, pulmonary, gastrointestinal, and genitourinary anomalies, and genetic syndromes. This section will serve as a summary of these issues and how they may affect the evaluation and management of a neonate with heart disease. These noncardiac factors are heavily influenced by conditions common to neonatologists, making a strong argument for multidisciplinary care with neonatologists, cardiologists, surgeons, anesthesiologists, and cardiovascular intensivists. Through this section and this project, we aim to facilitate a comprehensive approach to the care of neonates with congenital heart disease.
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Affiliation(s)
- Devyani Chowdhury
- Cardiology Care for Children, Lancaster, Pennsylvania Nemours Cardiac Center.,These two co-first authors contributed equally to this manuscript
| | - Rune Toms
- Division of Neonatal-Perinatal Medicine, Joe DiMaggio Children's Hospital, Hollywood, Florida.,These two co-first authors contributed equally to this manuscript
| | | | - Sharell Bindom
- Division of Neonatal-Perinatal Medicine, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Mishaal Ather
- Cardiology Care for Children, Lancaster, Pennsylvania Nemours Cardiac Center
| | - Robert Jaquiss
- Division of Pediatric and Congenital Cardiothoracic Surgery, Children's Medical Center, Dallas, Texas
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota
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11
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Turgut E, Turan G, Özdemir H, Aktulum F, Bayram M, Karcaaltincaba D. Fetal cardiac morphology and geometry in pregnancies with class A1 and A2 gestational diabetes mellitus. J Matern Fetal Neonatal Med 2022; 35:1023-1027. [PMID: 35105246 DOI: 10.1080/14767058.2022.2035712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate whether certain parameters on fetal cardiac morphology and geometry measured at 20-22 weeks of gestation differ in subsequently diagnosed gestational diabetes mellitus (GDM) pregnancies and whether these changes are associated with disease severity as indicated by class A1 and A2 GDM. METHOD It was designed as a retrospective study. All measurements were taken between 20 and 22 weeks of gestation. We compared fetal cardiac structural measurements of 200 uncomplicated pregnancies (control group) with those of 307 GDM patients (160 of the them were regulated with diet (GDM A1) and 147 of them received insulin treatment (GDM A2) during pregnancy). GDM were diagnosed between 24-28 weeks of gestation with 75 gram (g) oral glucose tolerance test. RESULTS The interventricular septum (IVS) was thicker in both in GDM A2 and GDM A1 than control (p < .001, p < .001), and there was statistically significant difference between GDM A2 and GDM A1 (p = .012). In both left and right wall thickness in GDM A1 and GDM A2 were remarkably higher than control group (p < .001, p < .001, p < .001, p < .001). The left and right spherical indices were higher in both GDM A1 and GDM A2 groups than controls (p = .021 and p = .028). Left and right area in GDM A1 and GDM A2 groups were significantly smaller than control groups (p < .001 and p = .001). CONCLUSION Gestational diabetes is a common obstetric morbidity, which causes fetal cardiac structural changes. Our study shows that these changes can occur during the early weeks of pregnancy.
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Affiliation(s)
- Ezgi Turgut
- Department of Obstetrics and Gynecology, School of Medicine, Gazi University, Ankara, Turkey
| | - Gökçe Turan
- Department of Obstetrics and Gynecology, School of Medicine, Gazi University, Ankara, Turkey
| | - Halis Özdemir
- Department of Obstetrics and Gynecology, School of Medicine, Gazi University, Ankara, Turkey
| | - Fatma Aktulum
- Department of Obstetrics and Gynecology, School of Medicine, Gazi University, Ankara, Turkey
| | - Merih Bayram
- Department of Obstetrics and Gynecology, School of Medicine, Gazi University, Ankara, Turkey
| | - Deniz Karcaaltincaba
- Department of Obstetrics and Gynecology, School of Medicine, Gazi University, Ankara, Turkey
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Environmental Alterations during Embryonic Development: Studying the Impact of Stressors on Pluripotent Stem Cell-Derived Cardiomyocytes. Genes (Basel) 2021; 12:genes12101564. [PMID: 34680959 PMCID: PMC8536136 DOI: 10.3390/genes12101564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/16/2022] Open
Abstract
Non-communicable diseases (NCDs) sauch as diabetes, obesity and cardiovascular diseases are rising rapidly in all countries world-wide. Environmental maternal factors (e.g., diet, oxidative stress, drugs and many others), maternal illnesses and other stressors can predispose the newborn to develop diseases during different stages of life. The connection between environmental factors and NCDs was formulated by David Barker and colleagues as the Developmental Origins of Health and Disease (DOHaD) hypothesis. In this review, we describe the DOHaD concept and the effects of several environmental stressors on the health of the progeny, providing both animal and human evidence. We focus on cardiovascular diseases which represent the leading cause of death worldwide. The purpose of this review is to discuss how in vitro studies with pluripotent stem cells (PSCs), such as embryonic and induced pluripotent stem cells (ESC, iPSC), can underpin the research on non-genetic heart conditions. The PSCs could provide a tool to recapitulate aspects of embryonic development “in a dish”, studying the effects of environmental exposure during cardiomyocyte (CM) differentiation and maturation, establishing a link to molecular mechanism and epigenetics.
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Sirico A, Raffone A, Maruotti GM, Travaglino A, Paciullo C, Diterlizzi A, Mollo A, Rizzo G, Zullo F, Lanzone A. Third Trimester Myocardial Performance Index in Fetuses from Women with Hyperglycemia in Pregnancy: A Systematic Review and Meta-Analysis. ULTRASCHALL IN DER MEDIZIN 2021; 44:e99-e107. [PMID: 34425601 DOI: 10.1055/a-1499-7265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The myocardial performance index (MPI) has been proposed to evaluate cardiac dysfunction in newborns from diabetic mothers. Although MPI is routinely assessed in newborns, its role in the evaluation of fetuses from women with hyperglycemia in pregnancy (HIP) is still under evaluation. We aimed to evaluate the differences in third trimester fetal MPI in pregnant women with hyperglycemia compared to healthy controls. MATERIALS AND METHODS Seven electronic databases were searched for all studies assessing women with HIP who underwent evaluation of fetal left MPI during pregnancy compared to a control group. The summary measures were reported as mean differences (MD) in the mean fetal left MPI between women with HIP and healthy controls, with a 95 % confidence interval (CI). A post hoc subgroup analysis based on the type of HIP - pregestational diabetes, GDM, or gestational impaired glucose tolerance (GIGT) - was performed as an additional analysis. RESULTS 14 studies assessing 1326 fetuses (580 from women with HIP and 746 from controls) were included. Women with HIP had a significantly higher mean left fetal MPI compared to controls (MD 0.08; 95 %CI: 0.05 to 0.11; p < 0.00 001). Subgroup analysis according to the type of HIP concurred with the overall analysis for women with DM (MD 0.07; 95 %CI: 0.01 to 0.13; p = 0.02) and for women with GDM (MD 0.012; 95 %CI: 0.07 to 0.17; p < 0.00 001) but not for women with GIGT (MD -0.01, 95 % CI -0.28 to 0.27; p = 0.96). CONCLUSION Fetal left MPI is increased in pregnancies with HIP appearing as a potential marker of cardiac dysfunction.
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Affiliation(s)
- Angelo Sirico
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Carmela Paciullo
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alice Diterlizzi
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re - University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology The First I.M. Sechenov Moscow State Medical University
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Lanzone
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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Al-Biltagi M, El razaky O, El Amrousy D. Cardiac changes in infants of diabetic mothers. World J Diabetes 2021; 12:1233-1247. [PMID: 34512889 PMCID: PMC8394229 DOI: 10.4239/wjd.v12.i8.1233] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/11/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is a systemic chronic metabolic disorder characterized by increased insulin resistance and/or β- cell defects. It affects all ages from the foetal life, neonates, childhood to late adulthood. Gestational diabetes is a critical risk factor for congenital heart diseases (CHDs). Moreover, the risk increases with low maternal education, high body mass index at conception, undiagnosed pre-gestational diabetes, inadequate antenatal care, improper diabetes control, and maternal smoking during pregnancy. Maternal DM significantly affects the foetal heart and foetal–placental circulation in both structure and function. Cardiac defects, myocardial hypertrophy are three times more prevalent in infants of diabetic mothers (IDMs). Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography. Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography, detection of early atherosclerotic changes by measuring aortic intima-media thickness, and retinal vascular changes by retinal photography. Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention. However, other measures to reduce the risk, such as using medications, nutritional supplements, or probiotics, still need more research. This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM, the various cardiac outcomes of gestational DM on the foetus and offspring, cardiac evaluation of foetuses and IDMs, and how to alleviate the consequences of gestational DM on the offspring.
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Affiliation(s)
- Mohammed Al-Biltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 35127, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
| | - Osama El razaky
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 35127, Egypt
| | - Doaa El Amrousy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 35127, Egypt
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15
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da Silva CM, Perdoná GDSC, Sartoreli DS. Behavior of pregnant women regarding physical activity in gestational diabetes mellitus: secondary analysis of a descriptive cross-sectional study. J Matern Fetal Neonatal Med 2021; 35:7216-7221. [PMID: 34325601 DOI: 10.1080/14767058.2021.1946778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: The purposeof this study was to compare the physical activity of pregnant women with and without gestational diabetes mellitus regarding the physical activity domains and to verify possible associations between socio-demographic characteristics, nutritional status, and lifestyle with gestational diabetes.Design /Methods: Consists in a study including 798 adult pregnant women attended by the Unique Health System in Ribeirão Preto, Brazil from 2011 to 2012. The variables studied were recorded using questionnaires, as well as frequency (weekly), duration (minutes) and the metabolic equivalent. The frequency of the categorical variables and the mean and standard deviation (SD) of the continuous variables were calculated and the Mann Whitney test, Student's t test and the X2test calculated the differences of the study variables according to the presence of diabetes. The adopted significance level was α = 5%.Results:Indicate that pregnant women with diabetes have lower average energy expenditure in the physical activity domains. However, we found a significant difference between groups regarding the average energy expenditure related to the occupational domain. Considering the Physical Activity (PA) pattern, we found that the sedentary percentage was higher in both groups. However, there were no relevant differences between them. The variables: previously diabetes, nutritional status, pre-gestational and current body mass index were associated with the development of diabetes.Conclusion: Further studies are needed to explore physical activities in different domains in pregnancy and its relationship with gestational diabetes, especially in the occupational domain.
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Affiliation(s)
- Carla Micheli da Silva
- Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Daniela Saes Sartoreli
- Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Nakano H, Fajardo VM, Nakano A. The role of glucose in physiological and pathological heart formation. Dev Biol 2021; 475:222-233. [PMID: 33577830 PMCID: PMC8107118 DOI: 10.1016/j.ydbio.2021.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/30/2020] [Accepted: 01/29/2021] [Indexed: 02/08/2023]
Abstract
Cells display distinct metabolic characteristics depending on its differentiation stage. The fuel type of the cells serves not only as a source of energy but also as a driver of differentiation. Glucose, the primary nutrient to the cells, is a critical regulator of rapidly growing embryos. This metabolic change is a consequence as well as a cause of changes in genetic program. Disturbance of fetal glucose metabolism such as in diabetic pregnancy is associated with congenital heart disease. In utero hyperglycemia impacts the left-right axis establishment, migration of cardiac neural crest cells, conotruncal formation and mesenchymal formation of the cardiac cushion during early embryogenesis and causes cardiac hypertrophy in late fetal stages. In this review, we focus on the role of glucose in cardiogenesis and the molecular mechanisms underlying heart diseases associated with hyperglycemia.
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Affiliation(s)
- Haruko Nakano
- Department of Molecular, Cell, and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Viviana M Fajardo
- Department of Pediatrics, Division of Neonatology and Developmental Biology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Atsushi Nakano
- Department of Molecular, Cell, and Developmental Biology, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA 90095, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA.
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17
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Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review. Int J Mol Sci 2021; 22:2965. [PMID: 33803995 PMCID: PMC7999044 DOI: 10.3390/ijms22062965] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
In spite of the huge progress in the treatment of diabetes mellitus, we are still in the situation that both pregestational (PGDM) and gestational diabetes (GDM) impose an additional risk to the embryo, fetus, and course of pregnancy. PGDM may increase the rate of congenital malformations, especially cardiac, nervous system, musculoskeletal system, and limbs. PGDM may interfere with fetal growth, often causing macrosomia, but in the presence of severe maternal complications, especially nephropathy, it may inhibit fetal growth. PGDM may also induce a variety of perinatal complications such as stillbirth and perinatal death, cardiomyopathy, respiratory morbidity, and perinatal asphyxia. GDM that generally develops in the second half of pregnancy induces similar but generally less severe complications. Their severity is higher with earlier onset of GDM and inversely correlated with the degree of glycemic control. Early initiation of GDM might even cause some increase in the rate of congenital malformations. Both PGDM and GDM may cause various motor and behavioral neurodevelopmental problems, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most complications are reduced in incidence and severity with the improvement in diabetic control. Mechanisms of diabetic-induced damage in pregnancy are related to maternal and fetal hyperglycemia, enhanced oxidative stress, epigenetic changes, and other, less defined, pathogenic mechanisms.
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Affiliation(s)
- Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Maria Becker
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
- Medical Center, Hadassah Hebrew University, Mount Scopus, Jerusalem 91240, Israel
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18
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Rykiel G, Gray M, Rongish B, Rugonyi S. Transient increase in VEGF-A leads to cardiac tube anomalies and increased risk of congenital heart malformations. Anat Rec (Hoboken) 2021; 304:2685-2702. [PMID: 33620155 DOI: 10.1002/ar.24605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
Vascular endothelial growth factor (VEGF) plays a critical role during early heart development. Clinical evidence shows that conditions associated with changes in VEGF signaling in utero are correlated with an increased risk of congenital heart defects (CHD) in newborns. However, how malformations develop after abnormal VEGF exposure is unknown. During embryogenesis, a primitive heart, consisting of an endocardial tube enveloped by a myocardial mantle, is the first organ to function. This tubular heart ultimately transforms into a four-chambered heart. To determine how a transient increase in VEGF prior to heart tube formation affects heart development leading to CHD, we applied exogenous VEGF or a control (vehicle) solution to quail embryos in ovo at Hamburger-Hamilton (HH) stage 8 (28-30 hr of incubation), right before heart tube formation. Light microscopy analysis of embryos re-incubated after treatment for 13 hrs (to approximately HH11/HH12) showed that increased VEGF leads to impaired heart tube elongation accompanied by diameter expansion. Micro-CT analysis of embryos re-incubated for 9 days (to approximately HH38), when the heart is fully formed, showed that VEGF treatment increased the rate of cardiac malformations in surviving embryos. Despite no sex differences in survival, female embryos were more likely to develop cardiac malformations. Our results further suggest that heart tube malformations after a transient increase in VEGF right before heart tube formation may be reversible, leading to normal hearts.
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Affiliation(s)
- Graham Rykiel
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
| | - MacKenzie Gray
- Department of Biology, Portland State University, Portland, Oregon, USA
| | - Brenda Rongish
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
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Fetal Cardiac Functional Abnormalities Assessed by Echocardiography in Mothers Suffering Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2020; 46:100658. [PMID: 32861465 DOI: 10.1016/j.cpcardiol.2020.100658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 01/26/2023]
Abstract
Abnormal cardiovascular changes especially hypertrophic cardiomyopathy is potentially expected in the fetuses of the diabetic pregnancy women. However, there is still little consensus on quantitative cardiac abnormalities in infants with diabetic mothers. The present study comprehensively analyzed the studies on functional changes in heart in infants of diabetic mothers with a greater focus on occurrence of hypertrophic cardiomyopathy. All comparative studies evaluating and comparing quantitatively the changes in cardiac parameters using echocardiography in fetuses with and without diabetic mothers were eligible for assessment. The included studies were identified through electronically reviewing the manuscripts databases of MEDLINE, EMBASE, Web of knowledge, and Google Scholar from inception to May 2020. The meta-analysis included 11 comparative with overall 849 fetuses for gestational diabetic mothers and 1247 for healthy mothers. Assessing cardiac diameters by fetal echocardiography showed significantly lower mitral E/A ratio, lower tricuspid E/A ratio, higher interventricular septal thickness, higher myocardial performance index, higher isovolumic relaxation time, and higher isovolumic contraction time in fetuses of gestational diabetes mellitus group as compared to healthy group adjusting for gestational diabetes mellitus. The presence of gestational diabetes mellitus can potentially affect the fetal cardiac parameters especially as hypertrophic cardiomyopathy leading both cardiac systolic and diastolic dysfunction.
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20
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Down-regulation of the insulin signaling pathway by SHC may correlate with congenital heart disease in Chinese populations. Clin Sci (Lond) 2020; 134:349-358. [PMID: 31971563 DOI: 10.1042/cs20190255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS Congenital heart disease (CHD) is one of the most common and severe congenital defects. The incidence of fetal cardiac malformation is increased in the context of maternal gestational diabetes mellitus (GDM). Therefore, we wanted to determine whether abnormalities in the insulin signaling pathway are associated with the occurrence of nonsyndromic CHD (ns-CHD). METHODS We used digital gene expression profiling (DGE) of right atrial myocardial tissue samples from eight ns-CHD patients and four controls. The genes potentially associated with CHD were validated by real-time fluorescence quantitative PCR analysis of right atrial myocardial tissues from 37 patients and 10 controls and the H9C2 cell line. RESULTS The results showed that the insulin signaling pathway, which is mediated by the SHC gene family, was inhibited in the ns-CHD patients. The expression levels of five genes (PTPRF, SHC4, MAP2K2, MKNK2, and ELK1) in the pathway were significantly down-regulated in the patients' atrial tissues (P<0.05 for all). In vitro, the H9C2 cells cultured in high glucose (33 mmol/l) expressed less SHC4, MAP2K2, and Elk-1 than those cultured in low glucose (25 mmol/l). Furthermore, the high glucose concentration down-regulated the 25 genes associated with blood vessel development based on Gene Ontology (GO) term enrichment analyses of RNA-seq data. CONCLUSION We considered that changes in the insulin signaling pathway mediated by SHC might be involved in the heart development process. This mechanism might account for the increase in the incidence of fetal cardiac malformations in the context of GDM.
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21
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Aleksenko L, Quaye IK. Pregnancy-induced Cardiovascular Pathologies: Importance of Structural Components and Lipids. Am J Med Sci 2020; 360:447-466. [PMID: 32540145 DOI: 10.1016/j.amjms.2020.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/09/2020] [Accepted: 05/07/2020] [Indexed: 01/22/2023]
Abstract
Pregnancy leads to adaptations for maternal and fetal energy needs. The cardiovascular system bears the brunt of the adaptations as the heart and vessels enable nutrient supply to maternal organs facilitated by the placenta to the fetus. The components of the cardiovascular system are critical in the balance between maternal homeostatic and fetus driven homeorhetic regulation. Since lipids intersect maternal cardiovascular function and fetal needs with growth and in stress, factors affecting lipid deposition and mobilization impact risk outcomes. Here, the cardiovascular components and functional derangements associated with cardiovascular pathology in pregnancy, vis-à-vis lipid deposition, mobilization and maternal and/or cardiac and fetal energy needs are detailed. Most reports on the components and associated pathology in pregnancy, are on derangements affecting the extracellular matrix and epicardial fat, followed by the endothelium, vascular smooth muscle, pericytes and myocytes. Targeted studies on all cardiovascular components and pathological outcomes in pregnancy will enhance targeted interventions.
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Affiliation(s)
- Larysa Aleksenko
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Isaac K Quaye
- Regent University College of Science and Technology, Accra, Ghana
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22
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Li L, Jing Y, Dong MZ, Fan LH, Li QN, Wang ZB, Hou Y, Schatten H, Zhang CL, Sun QY. Type 1 diabetes affects zona pellucida and genome methylation in oocytes and granulosa cells. Mol Cell Endocrinol 2020; 500:110627. [PMID: 31639403 DOI: 10.1016/j.mce.2019.110627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 11/17/2022]
Abstract
Diabetes affects oocyte nuclear and cytoplasmic quality. In this study, we generated a type 1 diabetes (T1D) mouse model by STZ injection to study the effects of T1D on zona pellucida and genomic DNA methylation of oocytes and granulosa cells. T1D mice showed fewer ovulated oocytes, reduced ovarian reserve, disrupted estrus cycle, and significantly ruptured zona pellucida in 2-cell in vivo embryos compared to controls. Notably, diabetic oocytes displayed thinner zona pellucida and treatment of oocytes with high concentration glucose reduced the zona pellucida thickness. Differential methylation genes in oocytes and granulosa cells were analyzed by methylation sequencing. These genes were significantly enriched in GO terms by GO analysis, and these GO terms were involved in multiple aspects of growth and development. Most notably, the abnormal methylation genes in oocytes may be related to oocyte zona pellucida changes in diabetic mice. These findings provide novel basic data for further understanding and elucidating dysgenesis and epigenetic changes in type 1 diabetes mellitus.
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Affiliation(s)
- Li Li
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Ying Jing
- Reproductive Medicine Center of People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan Province, PR China; Reproductive Medicine Center of Henan Provincial People's Hospital, Zhengzhou, 450003, Henan Province, PR China
| | - Ming-Zhe Dong
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Li-Hua Fan
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Qian-Nan Li
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Zhen-Bo Wang
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Yi Hou
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Heide Schatten
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, 65211, USA
| | - Cui-Lian Zhang
- Reproductive Medicine Center of People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan Province, PR China; Reproductive Medicine Center of Henan Provincial People's Hospital, Zhengzhou, 450003, Henan Province, PR China.
| | - Qing-Yuan Sun
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China; University of Chinese Academy of Sciences, Beijing, 100101, China.
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Lorenzo-Almorós A, Hang T, Peiró C, Soriano-Guillén L, Egido J, Tuñón J, Lorenzo Ó. Predictive and diagnostic biomarkers for gestational diabetes and its associated metabolic and cardiovascular diseases. Cardiovasc Diabetol 2019; 18:140. [PMID: 31666083 PMCID: PMC6820966 DOI: 10.1186/s12933-019-0935-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as the presence of high blood glucose levels with the onset, or detected for the first time during pregnancy, as a result of increased insulin resistance. GDM may be induced by dysregulation of pancreatic β-cell function and/or by alteration of secreted gestational hormones and peptides related with glucose homeostasis. It may affect one out of five pregnancies, leading to perinatal morbidity and adverse neonatal outcomes, and high risk of chronic metabolic and cardiovascular injuries in both mother and offspring. Currently, GDM diagnosis is based on evaluation of glucose homeostasis at late stages of pregnancy, but increased age and body-weight, and familiar or previous occurrence of GDM, may conditionate this criteria. In addition, an earlier and more specific detection of GDM with associated metabolic and cardiovascular risk could improve GDM development and outcomes. In this sense, 1st-2nd trimester-released biomarkers found in maternal plasma including adipose tissue-derived factors such as adiponectin, visfatin, omentin-1, fatty acid-binding protein-4 and retinol binding-protein-4 have shown correlations with GDM development. Moreover, placenta-related factors such as sex hormone-binding globulin, afamin, fetuin-A, fibroblast growth factors-21/23, ficolin-3 and follistatin, or specific micro-RNAs may participate in GDM progression and be useful for its recognition. Finally, urine-excreted metabolites such as those related with serotonin system, non-polar amino-acids and ketone bodies, may complete a predictive or early-diagnostic panel of biomarkers for GDM.
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Affiliation(s)
- A Lorenzo-Almorós
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - T Hang
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - C Peiró
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - L Soriano-Guillén
- Department of Paediatrics, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - J Egido
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain
| | - J Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Ó Lorenzo
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain.
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain.
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Si ZP, Wang G, Han SS, Jin Y, Hu YX, He MY, Brand-Saberi B, Yang X, Liu GS. CNTF and Nrf2 Are Coordinately Involved in Regulating Self-Renewal and Differentiation of Neural Stem Cell during Embryonic Development. iScience 2019; 19:303-315. [PMID: 31404831 PMCID: PMC6700439 DOI: 10.1016/j.isci.2019.07.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/04/2019] [Accepted: 07/24/2019] [Indexed: 01/10/2023] Open
Abstract
There is high risk of fetal neurodevelopmental defects in pregestational diabetes mellitus (PGDM). However, the effective mechanism of hyperglycemia-induced neurodevelopmental negative effects, including neural stem cell self-renewal and differentiation, still remains obscure. Neuropoietic cytokines have been shown to play a vital part during nervous system development and in the coordination of neurons and gliocytes. Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) dysfunction might be related to a reduction of self-protective response in brain malformation induced by hyperglycemia. We therefore evaluated the role of Nrf2 and neuropoietic cytokines in fetal neurodevelopmental defects induced by PGDM and determined the mechanisms involved. Our data reveal that PGDM dramatically impairs the developmental switch of neural stem cells from neurogenesis to gliogenesis, principally under the cooperative mediation of neuropoietic cytokine CNTF and Nrf2 antioxidative signaling. This indicates that CNTF and Nrf2 could be potentially used in the prevention or therapy of neurodevelopmental defects of PGDM offspring.
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Affiliation(s)
- Zhen-Peng Si
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Guang Wang
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, Medical College, Jinan University, Guangzhou 510632, China
| | - Sha-Sha Han
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Ya Jin
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Yu-Xuan Hu
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, Medical College, Jinan University, Guangzhou 510632, China
| | - Mei-Yao He
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Beate Brand-Saberi
- Department of Anatomy and Molecular Embryology, Ruhr University Bochum, Bochum, Germany
| | - Xuesong Yang
- International Joint Laboratory for Embryonic Development & Prenatal Medicine, Division of Histology and Embryology, Medical College, Jinan University, Guangzhou 510632, China; Key Laboratory for Regenerative Medicine of the Ministry of Education, Jinan University, Guangzhou 510632, China.
| | - Guo-Sheng Liu
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
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Abstract
Metabolic pathways integrate to support tissue homeostasis and to prompt changes in cell phenotype. In particular, the heart consumes relatively large amounts of substrate not only to regenerate ATP for contraction but also to sustain biosynthetic reactions for replacement of cellular building blocks. Metabolic pathways also control intracellular redox state, and metabolic intermediates and end products provide signals that prompt changes in enzymatic activity and gene expression. Mounting evidence suggests that the changes in cardiac metabolism that occur during development, exercise, and pregnancy as well as with pathological stress (eg, myocardial infarction, pressure overload) are causative in cardiac remodeling. Metabolism-mediated changes in gene expression, metabolite signaling, and the channeling of glucose-derived carbon toward anabolic pathways seem critical for physiological growth of the heart, and metabolic inefficiency and loss of coordinated anabolic activity are emerging as proximal causes of pathological remodeling. This review integrates knowledge of different forms of cardiac remodeling to develop general models of how relationships between catabolic and anabolic glucose metabolism may fortify cardiac health or promote (mal)adaptive myocardial remodeling. Adoption of conceptual frameworks based in relational biology may enable further understanding of how metabolism regulates cardiac structure and function.
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Affiliation(s)
- Andrew A Gibb
- From the Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (A.A.G.)
| | - Bradford G Hill
- the Department of Medicine, Institute of Molecular Cardiology, Diabetes and Obesity Center, University of Louisville School of Medicine, KY (B.G.H.).
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Sirico A, Sarno L, Zullo F, Martinelli P, Maruotti GM. Pregestational diabetes and fetal heart rate in the first trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol 2018; 232:30-32. [PMID: 30465928 DOI: 10.1016/j.ejogrb.2018.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/15/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of our study is to evaluate if pregestational diabetes affects fetal heart rate (FHR) readings at 11-14 weeks of pregnancy. STUDY DESIGN For each patient, we recorded age, body mass index (BMI), presence of pregestational diabetes, nuchal translucency (NT), FHR, crown-rump length (CRL), biparietal diameter (BPD) and gestational age. Pregnancies were grouped according to the presence or absence of pregestational diabetes and maternal and fetal variables were compared. Ordinal regression analysis was performed to assess the influence of maternal and fetal variables on the FHR. RESULTS We included 994 pregnancies from 2009 to 2016. Kruskal-Wallis test showed that median FHR was higher in women with pregestational diabetes than in controls (161; IQR 11 vs. 158; IQR 10, χ2 = 5.13, p = 0.02). Ordinal regression analysis showed that differences in FHR were significantly correlated with the presence of pregestational diabetes (p = 0.007) and the CRL (p = 0.042) but not with the maternal BMI, maternal age, gestational age, BPD and NT. CONCLUSIONS First trimester FHR is higher in diabetic pregnancies than in non-diabetic pregnancies. Therefore, further research is needed to assess whether these pregnancies may benefit from a correction of FHR for a better estimation of the chromosomal abnormalities risk.
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Affiliation(s)
- Angelo Sirico
- Department of Neurosciences, Reproductive and Dentistry Sciences, University Federico II, Naples, Italy
| | - Laura Sarno
- Department of Neurosciences, Reproductive and Dentistry Sciences, University Federico II, Naples, Italy
| | - Fulvio Zullo
- Department of Neurosciences, Reproductive and Dentistry Sciences, University Federico II, Naples, Italy
| | - Pasquale Martinelli
- Department of Neurosciences, Reproductive and Dentistry Sciences, University Federico II, Naples, Italy
| | - Giuseppe M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University Federico II, Naples, Italy.
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Piquereau J, Ventura-Clapier R. Maturation of Cardiac Energy Metabolism During Perinatal Development. Front Physiol 2018; 9:959. [PMID: 30072919 PMCID: PMC6060230 DOI: 10.3389/fphys.2018.00959] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/29/2018] [Indexed: 12/26/2022] Open
Abstract
As one of the highest energy consumer organ in mammals, the heart has to be provided with a high amount of energy as soon as its first beats in utero. During the development of this organ, energy is produced within the cardiac muscle cell depending on substrate availability, oxygen pressure and cardiac workload that drastically change at birth. Thus, energy metabolism relying essentially on carbohydrates in fetal heart is very different from the adult one and birth is the trigger of a profound maturation which ensures the transition to a highly oxidative metabolism depending on lipid utilization. To face the substantial increase in cardiac workload resulting from the growth of the organism during the postnatal period, the heart not only develops its capacity for energy production but also undergoes a hypertrophic growth to adapt its contractile capacity to its new function. This leads to a profound cytoarchitectural remodeling of the cardiomyocyte which becomes a highly compartmentalized structure. As a consequence, within the mature cardiac muscle, energy transfer between energy producing and consuming compartments requires organized energy transfer systems that are established in the early postnatal life. This review aims at describing the major rearrangements of energy metabolism during the perinatal development.
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Affiliation(s)
- Jérôme Piquereau
- Signalling and Cardiovascular Pathophysiology - UMR-S 1180, Université Paris-Sud, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Châtenay-Malabry, France
| | - Renée Ventura-Clapier
- Signalling and Cardiovascular Pathophysiology - UMR-S 1180, Université Paris-Sud, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Châtenay-Malabry, France
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Hauser NS, Solomon BD, Vilboux T, Khromykh A, Baveja R, Bodian DL. Experience with genomic sequencing in pediatric patients with congenital cardiac defects in a large community hospital. Mol Genet Genomic Med 2018; 6:200-212. [PMID: 29368431 PMCID: PMC5902396 DOI: 10.1002/mgg3.357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Congenital cardiac defects, whether isolated or as part of a larger syndrome, are the most common type of human birth defect occurring on average in about 1% of live births depending on the malformation. As there is an expanding understanding of the underlying molecular mechanisms by which a cardiac defect may occur, there is a need to assess the current rates of diagnosis of cardiac defects by molecular sequencing in a clinical setting. METHODS AND RESULTS In this report, we evaluated 34 neonatal and pediatric patients born with a cardiac defect and their parents using exomized preexisting whole genome sequencing (WGS) data to model clinically available exon-based tests. Overall, we identified candidate variants in previously reported cardiac-related genes in 35% (12/34) of the probands. These include clearly pathogenic variants in two of 34 patients (6%) and variants of uncertain significance in relevant genes in 10 patients (26%), of these latter 10, 2 segregated with clinically apparent findings in the family trios. CONCLUSIONS These findings suggest that with current knowledge of the proteins underlying CHD, genomic sequencing can identify the underlying genetic etiology in certain patients; however, this technology currently does not have a high enough yield to be of routine clinical use in the screening of pediatric congenital cardiac defects.
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Affiliation(s)
- Natalie S. Hauser
- Inova Translational Medicine InstituteFalls ChurchVAUSA
- Inova Children's HospitalInova Health SystemFalls ChurchVAUSA
| | - Benjamin D. Solomon
- Inova Translational Medicine InstituteFalls ChurchVAUSA
- Present address:
GeneDxGaithersburgMDUSA
| | | | | | - Rajiv Baveja
- Inova Children's HospitalInova Health SystemFalls ChurchVAUSA
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Dervisoglu P, Kosecik M, Kumbasar S. Effects of gestational and pregestational diabetes mellitus on the foetal heart: a cross-sectional study. J OBSTET GYNAECOL 2018; 38:408-412. [DOI: 10.1080/01443615.2017.1410536] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pinar Dervisoglu
- Department of Pediatric Cardiology, Sakarya University School of Medicine, Sakarya Research and Education Hospital, Sakarya, Turkey
| | - Mustafa Kosecik
- Department of Pediatric Cardiology, Sakarya University School of Medicine, Sakarya Research and Education Hospital, Sakarya, Turkey
| | - Serkan Kumbasar
- Department of Obstetrics and Gynecology, Sakarya University School of Medicine, Sakarya Research and Education Hospital, Sakarya, Turkey
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He MY, Wang G, Han SS, Jin Y, Li H, Wu X, Ma ZL, Cheng X, Tang X, Yang X, Liu GS. Nrf2 signalling and autophagy are involved in diabetes mellitus-induced defects in the development of mouse placenta. Open Biol 2017; 6:rsob.160064. [PMID: 27383629 PMCID: PMC4967824 DOI: 10.1098/rsob.160064] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/10/2016] [Indexed: 12/18/2022] Open
Abstract
It is widely accepted that diabetes mellitus impairs placental development, but the mechanism by which the disease operates to impair development remains controversial. In this study, we demonstrated that pregestational diabetes mellitus (PGDM)-induced defects in placental development in mice are mainly characterized by the changes of morphological structure of placenta. The alteration of differentiation-related gene expressions in trophoblast cells rather than cell proliferation/apoptosis is responsible for the phenotypes found in mouse placenta. Meanwhile, excess reactive oxygen species (ROS) production and activated nuclear factor erythroid2-related factor 2 (Nrf2) signalling were observed in the placenta of mice suffering from PGDM. Using BeWo cells, we also demonstrated that excess ROS was produced and Nrf2 signalling molecules were activated in settings characterized by a high concentration of glucose. More interestingly, differentiation-related gene expressions in trophoblast cells were altered when endogenous Nrf2 expression is manipulated by transfecting Nrf2-wt or Nrf2-shRNA. In addition, PGDM interferes with autophagy in both mouse placenta and BeWo cells, implying that autophagy is also involved, directly or indirectly, in PGDM-induced placental phenotypes. Therefore, we revealed that dysfunctional oxidative stress-activated Nrf2 signalling and autophagy are probably responsible for PGDM-induced defects in the placental development of mice. The mechanism was through the interference with differentiation-related gene expression in trophoblast cells.
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Affiliation(s)
- Mei-Yao He
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou 510632, People's Republic of China
| | - Guang Wang
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, People's Republic of China Postdoctoral Research Station of Chinese and Western Integrative Medicine, Institute of Integrated Traditional Chinese and Western, Medical College, Jinan University, Guangzhou 510630, People's Republic of China
| | - Sha-Sha Han
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou 510632, People's Republic of China
| | - Ya Jin
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou 510632, People's Republic of China
| | - He Li
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, People's Republic of China
| | - Xia Wu
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou 510632, People's Republic of China
| | - Zheng-Lai Ma
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, People's Republic of China
| | - Xin Cheng
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, People's Republic of China
| | - Xiuwen Tang
- Department of Biochemistry and Genetics, School of Medicine, Zhejiang University, Hangzhou 310058, People's Republic of China
| | - Xuesong Yang
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, People's Republic of China
| | - Guo-Sheng Liu
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou 510632, People's Republic of China
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Comparative Analysis of AGE and RAGE Levels in Human Somatic and Embryonic Stem Cells under H 2O 2-Induced Noncytotoxic Oxidative Stress Conditions. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4240136. [PMID: 29104727 PMCID: PMC5623800 DOI: 10.1155/2017/4240136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/27/2017] [Accepted: 05/03/2017] [Indexed: 12/21/2022]
Abstract
The accumulation of advanced glycation end products (AGEs) occurs in ageing and in many degenerative diseases as a final outcome of persistent oxidative stress on cells and organs. Environmental alterations taking place during early embryonic development can also lead to oxidative damage, reactive oxygen species (ROS) production, and AGE accumulation. Whether similar mechanisms act on somatic and embryonic stem cells (ESC) exposed to oxidative stress is not known; and therefore, the modelling of oxidative stress in vitro on human ESC has been the focus of this study. We compared changes in Nε-carboxymethyl-lysine (CML) advanced glycation end products and RAGE levels in hESC versus differentiated somatic cells exposed to H2O2 within the noncytotoxic range. Our data revealed that hESC accumulates CML and RAGE under oxidative stress conditions in different ways than somatic cells, being the accumulation of CML statistically significant only in somatic cells and, conversely, the RAGE increase exclusively appreciated in hESC. Then, following cardiac and neural differentiation, we observed a progressive removal of AGEs and at the same time an elevated activity of the 20S proteasome. We conclude that human ESCs constitute a unique model to study the consequence of an oxidative environment in the pluripotent cells of the embryo during the human preimplantation period.
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Martinez NG, Niznik CM, Yee LM. Optimizing postpartum care for the patient with gestational diabetes mellitus. Am J Obstet Gynecol 2017; 217:314-321. [PMID: 28455081 DOI: 10.1016/j.ajog.2017.04.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 01/19/2023]
Abstract
Gestational diabetes mellitus poses well-established risks to both the mother and infant. As >50% of women with gestational diabetes mellitus will develop type 2 diabetes mellitus in their lifetime, performing postpartum oral glucose tolerance testing is paramount to initiation of appropriate lifestyle interventions and pharmacologic therapy. Nonetheless, test completion among women with gestational diabetes mellitus is estimated to be <50%, with particularly low rates in Latina patients, as well as patients with public insurance, low education levels, and low health literacy. Data suggest our current health services infrastructure loses patients in the postpartum gap between pregnancy-focused care and primary care. Previous studies have suggested strategies to promote oral glucose tolerance testing completion to identify type 2 diabetes mellitus. Based on existing evidence, we propose best practices for the postpartum care of women with gestational diabetes mellitus: (1) enhanced patient support for identifying long-term health care providers, (2) patient-centered medical home utilization when possible, (3) patient and provider test reminders, and (4) formalized obstetrician-primary care provider hand offs using the Situation Background Assessment Recommendation (SBAR) mnemonic. These strategies deserve future investigation to solidify a multilevel approach for identifying and preventing the continuum of diabetes.
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Dodd JM, Briley AL. Managing obesity in pregnancy – An obstetric and midwifery perspective. Midwifery 2017; 49:7-12. [DOI: 10.1016/j.midw.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/03/2017] [Indexed: 11/15/2022]
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Mohsen L, Akmal DM, Ghonaim EKE, Riad NM. Role of mean platelet volume and ischemia modified albumin in evaluation of oxidative stress and its association with postnatal complications in infants of diabetic mothers. J Matern Fetal Neonatal Med 2017; 31:1819-1823. [DOI: 10.1080/14767058.2017.1330329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lamiaa Mohsen
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina M. Akmal
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Nermine Magdi Riad
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Devido JA, Doswell WM, Braxter BJ, Spatz DL, Dorman JS, Terry MA, Charron-Prochownik D. Experiences of Parish Nurses in Providing Diabetes Education and Preconception Counseling to Women With Diabetes. J Obstet Gynecol Neonatal Nurs 2017; 46:248-257. [PMID: 28104326 DOI: 10.1016/j.jogn.2016.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To explore the role and experiences of the parish nurse in providing diabetes education and preconception counseling to women with diabetes. DESIGN Mixed-methods concurrent embedded design. SETTING Focus groups of community-based parish nurses accessed from a regional database (Pennsylvania, Florida, Ohio, New York, Arizona, and Minnesota). PARTICIPANTS Forty-eight parish nurses recruited from the Parish Nurse and Health Ministry Program database in Western Pennsylvania. METHODS The primary method was focus groups using face-to-face, teleconference, and videoconferencing formats. A secondary method used a quantitative descriptive design with three self-report measures (demographic, preconception counseling self-efficacy, and preconception counseling knowledge). Qualitative content analysis techniques were conducted and combined with descriptive analysis. RESULTS Forty-eight parish nurses participated in 1 of 11 focus groups. Eight qualitative themes emerged: Awareness, Experience, Formal Training, Usefulness, Willingness, Confidence, "Wise Women," and Preconception Counseling Tool for Patients. Participants provided recommendations for training and resources to increase their knowledge and skills. Parish nurses' knowledge scores were low (mean = 66%, range = 40%-100%) with only moderate levels of self-efficacy (mean = 99, range = 27-164). Self-efficacy had a significantly positive association with knowledge (r = .29, p = .05). CONCLUSION Quantitative results were consistent with participants' qualitative statements. Parish nurses were unaware of preconception counseling and lacked knowledge and teaching self-efficacy as it related to preconception counseling and diabetes education. Understanding parish nurses' experiences with women with diabetes and identifying their needs to provide education and preconception counseling will help tailor training interventions that could affect maternal and fetal outcomes.
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Abstract
PURPOSE OF REVIEW Here, we provide a summary of the current knowledge on the impact of early life nutrition on cardiovascular diseases that have emerged from studies in humans and experimental animal models. The involvement of epigenetic mechanisms in the Developmental Origins of Health and Disease will be discussed in relation to the implications for the heart and the cardiovascular system. RECENT FINDINGS Environmental cues, such as parental diet and a suboptimal in utero environment can shape growth and development, causing long-lasting cardiometabolic perturbations. Increasing evidence suggest that these effects are mediated at the epigenomic level, and can be passed onto future generations. In the last decade, epigenetic mechanisms (DNA methylation, histone modifications) and RNA-based mechanisms (microRNAs, piRNAs, and tRNAs) have therefore emerged as potential candidates for mediating inheritance of cardiometabolic diseases. SUMMARY The burden of obesity and associated cardiometabolic diseases is believed to arise through interaction between an individual's genetics and the environment. Moreover, the risk of developing poor cardiometabolic health in adulthood is defined by early life exposure to pathological cues and can be inherited by future generations, initiating a vicious cycle of transmission of disease. Elucidating the molecular triggers of such a process will help tackle and prevent the uncontrolled rise in obesity and cardiometabolic disease.
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Affiliation(s)
- Elena Loche
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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37
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Devido JA, Sereika SM, Cohen SM, Charron-Prochownik D. Race and Religious Beliefs Are Associated With Communication Regarding Reproductive Health and Preconception Counseling in Young Women With Diabetes. DIABETES EDUCATOR 2016; 42:721-727. [DOI: 10.1177/0145721716671008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose The purpose of this study was to examine the relationship between selected internal and external characteristics and communication (intended and actual) with health care providers (HCPs) about reproductive health and preconception counseling among adolescent females with diabetes. Methods A descriptive, correlational design was employed to conduct a secondary analysis of baseline data from a multisite, randomized controlled trial. Participants were 110 female adolescents (92% type 1 diabetes). Analysis included multiple linear regression and multivariate binary logistic regression analyses to examine the association of internal characteristics (age, race, religion, and religious beliefs) and external characteristics (ever sexually active, social support, and type of routine HCP). Results Participants were from 13.3 to 20.0 years of age, 82% were Caucasian, 80% had never been sexually active, and 58% perceived low to moderate amounts of social support. For both internal and external characteristics, no significant main effects were found for actual or intended communication. For internal characteristics, there was an interaction between race and religious beliefs for the probability of actual communication. African American women who reported that their religious beliefs did not influence their sexual behavior had the lowest probability of actual communication compared to all other participants. Conclusion Race and religious beliefs should be considered when providing reproductive health information to young women with diabetes. Further research with a larger, more diverse sample is warranted. These results may be considered for future development of novel interventions with targeted messages based on these personal characteristics to empower young women to initiate conversations with HCPs about reproductive health and preconception counseling.
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Affiliation(s)
- Jessica Anne Devido
- Duquesne University, Pittsburgh, Pennsylvania (Prof Devido)
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Sereika, Dr Cohen, Dr Charron-Prochownik)
| | - Susan M. Sereika
- Duquesne University, Pittsburgh, Pennsylvania (Prof Devido)
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Sereika, Dr Cohen, Dr Charron-Prochownik)
| | - Susan Merle Cohen
- Duquesne University, Pittsburgh, Pennsylvania (Prof Devido)
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Sereika, Dr Cohen, Dr Charron-Prochownik)
| | - Denise Charron-Prochownik
- Duquesne University, Pittsburgh, Pennsylvania (Prof Devido)
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Sereika, Dr Cohen, Dr Charron-Prochownik)
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38
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Liu P, Sun Y, Qiu G, Jiang H, Qiu G. Silencing of TBX20 gene expression in rat myocardial and human embryonic kidney cells leads to cell cycle arrest in G2 phase. Mol Med Rep 2016; 14:2904-14. [PMID: 27572266 PMCID: PMC5042752 DOI: 10.3892/mmr.2016.5660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 07/19/2016] [Indexed: 01/02/2023] Open
Abstract
Congenital heart diseases (CHDs) are the most common birth defects due to abnormal cardiac development. The T-box 20 (TBX20) gene is a member of the T-box family of transcription factors and encodes TBX20, which is essential for early heart development. In the present study, reduced TBX20 expression was observed in CHD tissue samples compared with normal tissues, and the function of TBX20 in Rattus norvegicus myocardial cells [H9c2(2-1)] and human embryonic kidney cells (HEK293) was investigated. TBX20 was silenced in H9c2 and HEK293 cells via transfection of small interfering RNA and short hairpin RNA duplexes, respectively, and TBX20 mRNA and protein levels were subsequently examined using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blot analysis. Cell proliferation was assessed using a cell counting kit and proliferating cell nuclear antigen expression was determined by western blotting. Analysis of cell apoptosis was achieved by annexin V-fluorescein isothiocyanate/propidium iodide staining and a fluorometric terminal deoxynucleotidyl transferase dUTP nick-end labeling system. Cell cycle analysis was achieved using fluorescence-activated cell sorting, and, an RT-qPCR array was used to profile the expression of TBX20-related genes. Silencing of TBX20 in H9c2 and HEK293 cells significantly inhibited cell proliferation, induced cell apoptosis and led to G2/M cell cycle arrest. A reduction in cyclin B1 mRNA levels and an increase in cyclin-dependent kinase inhibitor 1B mRNA levels was observed, which indicated that cells were arrested in G2 phase. Concurrently, the mRNA levels of GATA binding protein 4 were increased in both cell lines, which may provide an explanation for the abnormal cardiac hypertrophy observed in patients with congenital heart disease. These results suggest that TBX20 is required for heart morphogenesis, and inhibition of TBX20 expression may lead to the suppression of cell proliferation and cell cycle arrest.
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Affiliation(s)
- Peiyan Liu
- Department of Medical Genetics, College of Basic Medical Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Yueling Sun
- Department of Medical Genetics, College of Basic Medical Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Guangbin Qiu
- Department of Laboratory Medicine, 202 Hospital of People's Liberation Army, Shenyang, Heping 110003, P.R. China
| | - Hongkun Jiang
- Department of Pediatrics, The First Affiliated Hospital, China Medical University, Shenyang, Heping 110001, P.R. China
| | - Guangrong Qiu
- Department of Medical Genetics, College of Basic Medical Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
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39
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Jin Y, Wang G, Han SS, He MY, Cheng X, Ma ZL, Wu X, Yang X, Liu GS. Effects of oxidative stress on hyperglycaemia-induced brain malformations in a diabetes mouse model. Exp Cell Res 2016; 347:201-211. [PMID: 27497668 DOI: 10.1016/j.yexcr.2016.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/25/2016] [Accepted: 08/03/2016] [Indexed: 01/23/2023]
Abstract
Pregestational diabetes mellitus (PGDM) enhances the risk of fetal neurodevelopmental defects. However, the mechanism of hyperglycaemia-induced neurodevelopmental defects is not fully understood. In this study, several typical neurodevelopmental defects were identified in the streptozotocin-induced diabetes mouse model. The neuron-specific class III beta-tubulin/forkhead box P1-labelled neuronal differentiation was suppressed and glial fibrillary acidic protein-labelled glial cell lineage differentiation was slightly promoted in pregestational diabetes mellitus (PGDM) mice. Various concentrations of glucose did not change the U87 cell viability, but glial cell line-derived neurotrophic factor expression was altered with varying glucose concentrations. Mouse maternal hyperglycaemia significantly increased Tunel(+) apoptosis but did not dramatically affect PCNA(+) cell proliferation in the process. To determine the cause of increased apoptosis, we determined the SOD activity, the expression of Nrf2 as well as its downstream anti-oxidative factors NQO1 and HO1, and found that all of them significantly increased in PGDM fetal brains compared with controls. However, Nrf2 expression in U87 cells was not significantly changed by different glucose concentrations. In mouse telencephalon, we observed the co-localization of Tuj-1 and Nrf2 expression in neurons, and down-regulating of Nrf2 in SH-SY5Y cells altered the viability of SH-SY5Y cells exposed to high glucose concentrations. Taken together, the data suggest that Nrf2-modulated antioxidant stress plays a crucial role in maternal hyperglycaemia-induced neurodevelopmental defects.
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Affiliation(s)
- Ya Jin
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Guang Wang
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, China
| | - Sha-Sha Han
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Mei-Yao He
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Xin Cheng
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, China
| | - Zheng-Lai Ma
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, China
| | - Xia Wu
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Xuesong Yang
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632, China.
| | - Guo-Sheng Liu
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
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40
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Helm BM, Freeze SL. Genetic Evaluation and Use of Chromosome Microarray in Patients with Isolated Heart Defects: Benefits and Challenges of a New Model in Cardiovascular Care. Front Cardiovasc Med 2016; 3:19. [PMID: 27379245 PMCID: PMC4905945 DOI: 10.3389/fcvm.2016.00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/30/2016] [Indexed: 01/26/2023] Open
Abstract
Congenital heart defects (CHDs) are common birth defects and result in significant morbidity and global economic impact. Genetic factors play a role in most CHDs; however, identification of these factors has been historically slow due to technological limitations and incomplete understanding of the impact of human genomic variation on normal and abnormal cardiovascular development. The advent of chromosome microarray (CMA) brought tremendous gains in identifying chromosome abnormalities in a variety of human disorders and is now considered part of a standard evaluation for individuals with multiple congenital anomalies and/or neurodevelopmental disorders. Several studies investigating use of CMA found that this technology can identify pathogenic copy-number variations (CNVs) in up to 15-20% of patients with CHDs with other congenital anomalies. However, there have been fewer studies exploring the use of CMA for patients with isolated CHDs. Recent studies have shown that the diagnostic yield of CMA in individuals with seemingly isolated CHD is lower than in individuals with CHDs and additional anomalies. Nevertheless, positive CMA testing in this group supports chromosome variation as one mechanism underlying the development of isolated, non-syndromic CHD - either as a causative or risk-influencing genetic factor. CMA has also identified novel genomic variation in CHDs, shedding light on candidate genes and pathways involved in cardiac development and malformations. Additional studies are needed to further address this issue. Early genetic diagnosis can enhance the medical management of patients and potentially provide crucial information about recurrence. This information is critical for genetic counseling of patients and family members. In this review, we review CMA for the non-genetics cardiology provider, offer a summary of CNV in isolated CHDs, and advocate for the use of CMA as part of the cardiovascular genetics evaluation of patients with isolated CHDs. We also provide perspective regarding the benefits and challenges that lie ahead for this model in the clinical setting.
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Affiliation(s)
- Benjamin M Helm
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, IU Health , Indianapolis, IN , USA
| | - Samantha L Freeze
- Department of Pediatrics, Indiana University School of Medicine, IU Health , Indianapolis, IN , USA
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Purnell MC, MacKenzie MA. The Intergenerational Cycle of Obesity and Its Implications for Nursing Care of Childbearing Women. Nurs Womens Health 2016; 20:289-297. [PMID: 27287355 DOI: 10.1016/j.nwh.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/25/2015] [Indexed: 06/06/2023]
Abstract
Despite intensive focus and interventions at societal and individual levels, more than a third of people in the United States are overweight or obese, and childhood/adolescent obesity rates have dramatically increased during the past three decades. Biomedical research has shown a clear link between the prenatal environment and lifetime adiposity. Children born to overweight and obese women with impaired glucose metabolism show cardiometabolic consequences throughout their life spans that, in turn, affect their children's adiposity. Awareness of this intergenerational cycle of obesity can prompt nurses to intervene in the preconception, prenatal, and postnatal phases.
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Affiliation(s)
- Molly C Purnell
- College of Nursing at Villanova University in Villanova, PA..
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42
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Affiliation(s)
- Adolfo Correa
- From Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
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43
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Comparing ventricular function in fetuses of diabetic and non-diabetic mothers using tissue doppler imaging. Res Cardiovasc Med 2016. [DOI: 10.5812/cardiovascmed.31864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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44
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High glucose environment inhibits cranial neural crest survival by activating excessive autophagy in the chick embryo. Sci Rep 2015; 5:18321. [PMID: 26671447 PMCID: PMC4680872 DOI: 10.1038/srep18321] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/16/2015] [Indexed: 12/13/2022] Open
Abstract
High glucose levels induced by maternal diabetes could lead to defects in neural crest development during embryogenesis, but the cellular mechanism is still not understood. In this study, we observed a defect in chick cranial skeleton, especially parietal bone development in the presence of high glucose levels, which is derived from cranial neural crest cells (CNCC). In early chick embryo, we found that inducing high glucose levels could inhibit the development of CNCC, however, cell proliferation was not significantly involved. Nevertheless, apoptotic CNCC increased in the presence of high levels of glucose. In addition, the expression of apoptosis and autophagy relevant genes were elevated by high glucose treatment. Next, the application of beads soaked in either an autophagy stimulator (Tunicamycin) or inhibitor (Hydroxychloroquine) functionally proved that autophagy was involved in regulating the production of CNCC in the presence of high glucose levels. Our observations suggest that the ERK pathway, rather than the mTOR pathway, most likely participates in mediating the autophagy induced by high glucose. Taken together, our observations indicated that exposure to high levels of glucose could inhibit the survival of CNCC by affecting cell apoptosis, which might result from the dysregulation of the autophagic process.
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Wang G, Huang WQ, Cui SD, Li S, Wang XY, Li Y, Chuai M, Cao L, Li JC, Lu DX, Yang X. Autophagy is involved in high glucose-induced heart tube malformation. Cell Cycle 2015; 14:772-83. [PMID: 25738919 DOI: 10.1080/15384101.2014.1000170] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Both pre-gestational and gestational diabetes have an adverse impact on heart development, but little is known about the influence on the early stage of heart tube formation. Using early gastrulating chick embryos, we investigated the influence of high glucose on the process of heart tube formation, specifically during the primary heart field phase. We demonstrated that high-glucose exposure resulted in 3 types of heart tube malformation: 1) ventricular hypertrophy, 2) ventricular hypertrophy with dextrocardia and 3) ventricular hypertrophy and dextrocardia with the fusion anomaly of a bilateral primary heart tube. Next, we found that these malformation phenotypes of heart tubes might mainly originate from the migratory anomaly of gastrulating precardiac mesoderm cells rather than cell proliferation in the developmental process of bilateral primary heart field primordia. The treatment of rapamycin (RAPA), an autophagy inducer, led to a similar heart tube malformation phenotype as high glucose. Additionally, high-glucose exposure promoted the expression of the key autophagy protein LC3B in early chick tissue. Atg7 is strongly expressed in the fusion site of bilateral primary heart tubes. All of these data imply that autophagy could be involved in the process of high-glucose-induced malformation of the heart tube.
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Affiliation(s)
- Guang Wang
- a Division of Histology and Embryology ; Key Laboratory for Regenerative Medicine of the Ministry of Education ; Medical College ; Jinan University ; Guangzhou , China
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46
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Gene expression profiling of changes induced by maternal diabetes in the embryonic heart. Reprod Toxicol 2015; 57:147-56. [DOI: 10.1016/j.reprotox.2015.06.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/07/2015] [Accepted: 06/03/2015] [Indexed: 01/04/2023]
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47
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Liu M, Yu J, Fu X, Wan W. Quantitative Assessment of Cardiac Function in Fetuses of Women with Maternal Gestational Thyroid Dysfunction Using VVI Echocardiography. Med Sci Monit 2015; 21:2956-68. [PMID: 26427319 PMCID: PMC4596453 DOI: 10.12659/msm.894381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The study aimed to investigate the clinical value of velocity vector imaging (VVI) in assessing heart function in fetuses of pregnant women with thyroid dysfunction. The inter-observer and intra-observer variability was assessed for all VVI parameters observed. Material/Methods The participants were enrolled from singleton pregnant women with gestational ages ranging 24+0 to 40+1 weeks who visited the Department of Obstetrics and Gynecology at the Affiliated Hospital of Qingdao University, China, for prenatal care from July 2011 to February 2014. Digital 2-dimensional (2D) dynamic 4-chamber images of the heart were collected. A total of qualified 226 images from 125 fetuses of pregnant women with normal thyroid (control group), 64 fetuses of pregnant women with hypothyroidism (hypothyroidism group), and 37 fetuses of pregnant women with hyperthyroidism (hyperthyroidism group) were interrogated offline using VVI software. The echocardiographic parameters including the myocardium peak systolic velocity (Vs), peak diastolic velocity (Vd), peak systolic strain (S), peak systolic strain rate (SRs), peak diastolic strain rate (SRd) of RV and LV, were obtained from the velocity curves of 2D myocardial motion. The heart rate was measured using a virtual M-mode algorithm built into the software. Results The study found that the longitudinal Vs and Vd of both ventricles in the control group gradually decreased from basal segments to apical segments and significantly increased over the gestation. S, SRs, and SRd of both ventricles remained stable after middle gestation. Compared with the control group, the hypothyroidism and hyperthyroidism groups exhibited significantly reduced S, SRs, and SRd, even for fetuses at 24-weeks gestation. There were no significant differences in global Vs and global Vd between the control group and the hyperthyroidism or hypothyroidism groups. Conclusions The thyroid dysfunction of pregnant women may damage fetal heart function, and VVI could be a sensitive technique to measure the variation of fetal heart function.
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Affiliation(s)
- Meixin Liu
- The Affiliated Hospital of Qingdao University, Qingdao, Shinan, China (mainland)
| | - Jing Yu
- The Affiliated Hospital of Qingdao University, Qingdao, Shinan, China (mainland)
| | - Xiuxiu Fu
- The Affiliated Hospital of Qingdao University, Qingdao, Shinan, China (mainland)
| | - Wei Wan
- The Affiliated Hospital of Qingdao University, Qingdao, Shinan, China (mainland)
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48
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Abstract
Maternal metabolism changes substantially during pregnancy, which poses numerous challenges to physicians managing pregnancy in women with diabetes. Insulin is the agent of choice for glycemic control in pregnant women with diabetes, and the insulin analogs are particularly interesting for use in pregnancy. These agents may reduce the risk of hypoglycemia and promote a more physiological glycemic profile than regular human insulin in pregnant women with type 1 (T1D), type 2 (T2D), or gestational (GDM) diabetes. However, there have been concerns regarding potential risk for crossing the placental barrier, mitogenic stimulation, teratogenicity, and embryotoxicity. Insulin lispro protamine suspension (ILPS), an intermediate- to long-acting insulin, has a stable and predictable pharmacological profile, and appears to have a favorable time–action profile and produce desirable basal and postprandial glycemic control. As the binding of insulin lispro is unaffected by the protamine molecule, ILPS is likely to have the same mitogenic and immunogenic potential as insulin lispro. Insulin lispro produces similar outcomes to regular insulin in pregnant women with T1D, T2D, or GDM, does not cross the placental barrier, and is considered a useful treatment option for pregnant women with diabetes. Clinical data support the usefulness of ILPS for basal insulin coverage in non-pregnant patients with T1D or T2D, and suggest that the optimal regimen, in terms of balance between efficacy and hypoglycemic risk, is a once-daily injection, especially in patients with T2D. Available data concerning use of ILPS in pregnant women are currently derived from retrospective analyses that involved, in total, >1200 pregnant women. These analyses suggest that ILPS is at least as safe and effective as neutral protamine Hagedorn insulin. Thus, available experimental and clinical data suggest that ILPS once daily is a safe and effective option for the management of diabetes in pregnant women. Funding: Eli Lilly and Company.
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49
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Han SS, Wang G, Jin Y, Ma ZL, Jia WJ, Wu X, Wang XY, He MY, Cheng X, Li WJ, Yang X, Liu GS. Investigating the Mechanism of Hyperglycemia-Induced Fetal Cardiac Hypertrophy. PLoS One 2015; 10:e0139141. [PMID: 26418041 PMCID: PMC4587747 DOI: 10.1371/journal.pone.0139141] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/08/2015] [Indexed: 12/20/2022] Open
Abstract
Hyperglycemia in diabetic mothers enhances the risk of fetal cardiac hypertrophy during gestation. However, the mechanism of high-glucose-induced cardiac hypertrophy is not largely understood. In this study, we first demonstrated that the incidence rate of cardiac hypertrophy dramatically increased in fetuses of diabetic mothers using color ultrasound examination. In addition, human fetal cardiac hypertrophy was successfully mimicked in a streptozotocin (STZ)-induced diabetes mouse model, in which mouse cardiac hypertrophy was diagnosed using type-M ultrasound and a histological assay. PH3 immunofluorescent staining of mouse fetal hearts and in vitro-cultured H9c2 cells indicated that cell proliferation decreased in E18.5, E15.5 and E13.5 mice, and cell apoptosis in H9c2 cells increased in the presence of high glucose in a dose-dependent manner. Next, we found that the individual cardiomyocyte size increased in pre-gestational diabetes mellitus mice and in response to high glucose exposure. Meanwhile, the expression of β-MHC and BMP-10 was up-regulated. Nkx2.5 immunofluorescent staining showed that the expression of Nkx2.5, a crucial cardiac transcription factor, was suppressed in the ventricular septum, left ventricular wall and right ventricular wall of E18.5, E15.5 and E13.5 mouse hearts. However, cardiac hypertrophy did not morphologically occur in E13.5 mouse hearts. In cultured H9c2 cells exposed to high glucose, Nkx2.5 expression decreased, as detected by both immunostaining and western blotting, and the expression of KCNE1 and Cx43 was also restricted. Taken together, alterations in cell size rather than cell proliferation or apoptosis are responsible for hyperglycemia-induced fetal cardiac hypertrophy. The aberrant expression of Nkx2.5 and its regulatory target genes in the presence of high glucose could be a principal component of pathogenesis in the development of fetal cardiac hypertrophy.
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Affiliation(s)
- Sha-sha Han
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Guang Wang
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou, 510632, China
| | - Ya Jin
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Zheng-lai Ma
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou, 510632, China
| | - Wei-jing Jia
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Xia Wu
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Xiao-yu Wang
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou, 510632, China
| | - Mei-yao He
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Xin Cheng
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou, 510632, China
| | - Wei-jing Li
- Department of Fetal Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Xuesong Yang
- Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou, 510632, China
- * E-mail: (GSL); (XSY)
| | - Guo-sheng Liu
- Department of Pediatrics and Neonatology, Institute of Fetal-Preterm Labor Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
- * E-mail: (GSL); (XSY)
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Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol 2015; 30:1141-52. [PMID: 26377700 PMCID: PMC4684830 DOI: 10.1007/s10654-015-0085-7] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/08/2015] [Indexed: 01/15/2023]
Abstract
Maternal obesity during pregnancy is an important public health problem in Western countries. Currently, obesity prevalence rates in pregnant women are estimated to be as high as 30 %. In addition, approximately 40 % of women gain an excessive amount of weight during pregnancy in Western countries. An accumulating body of evidence suggests a long-term impact of maternal obesity and excessive weight gain during pregnancy on adiposity, cardiovascular and metabolic related health outcomes in the offspring in fetal life, childhood and adulthood. In this review, we discuss results from recent studies, potential underlying mechanisms and challenges for future epidemiological studies.
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