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Andlib N, Sajad M, Thakur SC. Association of diabetes mellitus with risk of reproductive impairment in females: A comprehensive review. Acta Histochem 2024; 126:152173. [PMID: 39004007 DOI: 10.1016/j.acthis.2024.152173] [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: 02/20/2024] [Revised: 05/31/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
Reproductive impairment is the most prevalent yet most ignored complication of diabetes mellitus. In diabetes, the problem associated with reproductive health is comprehensive in both males and females. Diabetic females have problems like delayed menarche, irregular menstrual cycle, subfertility, complications in pregnancy and early menopause. This may decrease reproductive age in diabetic females as the menarche is delayed and menopause is early in them. Like diabetic males, diabetic females also have the negative effect of oxidative stress on the reproductive system. This may lead to dysfunction of the ovary. It affects the physiological cycle like the ovary's maturation, embryo development and pregnancy. These complications also affect the offspring, and they may also become diabetic. This review aims to concentrate on the effect of diabetes on the reproductive system of females and the impairment caused by it. We will also discuss in detail the role of the hypothalamus-pituitary ovary axis, diabetes impact on different reproductive phases of females, and the sexual disorders that occur in them.
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Affiliation(s)
- Nida Andlib
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mohd Sajad
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Sonu Chand Thakur
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India..
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Sandin S, Järnbert-Pettersson H, Persson M. Preterm delivery and maternal obesity remain common complications in pregnancies with type 1 diabetes-A nationwide study in Sweden. Diabet Med 2024; 41:e15278. [PMID: 38206174 DOI: 10.1111/dme.15278] [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] [Received: 08/29/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
AIM A primary goal of obstetric care of women with type 1 diabetes (T1D) is to reduce the risks of preterm birth (PTB). Besides hyperglycaemia, maternal obesity is an important risk factor for PTB in T1D. However, it's unclear if public health efforts decreased risks of maternal obesity and PTB in pregnancies with T1D. We examined time-trends over the last 20 years in the distribution of gestational ages at birth (GA) in offspring of women with T1D in Sweden, and in maternal BMI in the same mothers. METHODS Population-based cohort study, using data from national registries in Sweden. To capture differences not only in the median values, we used quantile regression models to compare the whole distributions of GA's and early pregnancy BMI between deliveries in 1998-2007 (P1) and 2008-2016 (P2). Multivariable models were adjusted for differences in maternal age, smoking and education between periods 1 and 2. RESULTS The study included 7639 offspring of women with T1D between 1998 and 2016. The 10% percentile GA, increased with 0.09 days (95% CI: -0.11 to 0.35) between P1 and P2. The 90% percentile for BMI was 1.20 kg/m2 higher (95% CI: 0.57 to 1.83) in P2. Risks of PTB remained stable over time also when adjusting for maternal BMI. CONCLUSION Despite modern diabetes management, the distribution of GA, and consequently the risk of PTB in T1D, remained unchanged from 1998 to 2016. During the same time, maternal BMI increased, particularly in the already obese.
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Affiliation(s)
- Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Martina Persson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Diabetes and Endocrinology, Sachsska Childrens' and Youth Hospital, Stockholm, Sweden
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Belfort GP, Farias DR, Padilha PDC, da Silva LBG, dos Santos K, dos Santos MS, Zajdenverg L, Keating E, Saunders C. Influence of the DASH Diet on Gestational Weight Gain and Perinatal Outcomes in Women with Pre-Existing Diabetes Mellitus: A Randomized, Single-Blind, Controlled Clinical Trial. Life (Basel) 2023; 13:2191. [PMID: 38004331 PMCID: PMC10671988 DOI: 10.3390/life13112191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND This study aimed to investigate the influence of the dietary approaches to stop hypertension (DASH) diet on gestational weight gain and perinatal outcomes in pregnant women with pre-existing diabetes mellitus (PDM). METHODS A randomized, single-blind, controlled clinical trial was conducted with 68 pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital in Rio de Janeiro, Brazil (2016-2020). The standard diet adopted by the control group (standard diet group-SDG) contained 45-55% carbohydrates, 15-20% protein, and 25-30% lipids of the total energy intake. An adapted DASH diet, with a similar macronutrient composition, but with higher calcium, potassium, magnesium, fiber, and reduced saturated fat, was prescribed for the intervention group (DASH diet group-DDG). Student's t- or Mann-Whitney U tests were used to compare outcomes between groups. To assess the trajectory of gestational weight gain throughout the intervention between the study groups, linear mixed-effects regression models were used. RESULTS The DDG had lower gestational weight gain at the fifth (p = 0.03) and seventh appointment (p = 0.04), with no difference in average total gestational weight gain (SDG: 10 kg [SD = 4]; DDG: 9 kg [SD = 5], p = 0.23). There was a trend for a lower length of stay of the newborns (p = 0.08) in the DDG without differences for other perinatal outcomes. CONCLUSIONS The DASH diet promoted less variation in gestational weight gain without promoting a difference in total gestational weight gain, and there was no difference between the study groups for perinatal outcomes.
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Affiliation(s)
- Gabriella P. Belfort
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- School of Nutrition, Federal University of the State of Rio de Janeiro, Pasteur Ave, 296, Urca, Rio de Janeiro 22290-240, RJ, Brazil
| | - Dayana R. Farias
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Patricia de C. Padilha
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Letícia B. G. da Silva
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Karina dos Santos
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- School of Nutrition, Federal University of the State of Rio de Janeiro, Pasteur Ave, 296, Urca, Rio de Janeiro 22290-240, RJ, Brazil
| | - Mayara S. dos Santos
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
| | - Lenita Zajdenverg
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
| | - Elisa Keating
- Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, Prof. Hernâni Monteiro Ave, 4200-319 Porto, Portugal
| | - Claudia Saunders
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
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Meek CL, Stewart ZA, Feig DS, Furse S, Neoh SL, Koulman A, Murphy HR. Metabolomic insights into maternal and neonatal complications in pregnancies affected by type 1 diabetes. Diabetologia 2023; 66:2101-2116. [PMID: 37615689 PMCID: PMC10542716 DOI: 10.1007/s00125-023-05989-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/19/2023] [Indexed: 08/25/2023]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes in pregnancy is associated with suboptimal pregnancy outcomes, attributed to maternal hyperglycaemia and offspring hyperinsulinism (quantifiable by cord blood C-peptide). We assessed metabolomic patterns associated with risk factors (maternal hyperglycaemia, diet, BMI, weight gain) and perinatal complications (pre-eclampsia, large for gestational age [LGA], neonatal hypoglycaemia, hyperinsulinism) in the Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT). METHODS A total of 174 CONCEPTT participants gave ≥1 non-fasting serum sample for the biorepository at 12 gestational weeks (147 women), 24 weeks (167 women) and 34 weeks (160 women) with cord blood from 93 infants. Results from untargeted metabolite analysis (ultrahigh performance LC-MS) are presented as adjusted logistic/linear regression of maternal and cord blood metabolites, risk factors and perinatal complications using a modified Bonferroni limit of significance for dependent variables. RESULTS Maternal continuous glucose monitoring time-above-range (but not BMI or excessive gestational weight gain) was associated with increased triacylglycerols in maternal blood and increased carnitines in cord blood. LGA, adiposity, neonatal hypoglycaemia and offspring hyperinsulinism showed distinct metabolite profiles. LGA was associated with increased carnitines, steroid hormones and lipid metabolites, predominantly in the third trimester. However, neonatal hypoglycaemia and offspring hyperinsulinism were both associated with metabolite changes from the first trimester, featuring triacylglycerols or dietary phenols. Pre-eclampsia was associated with increased abundance of phosphatidylethanolamines, a membrane phospholipid, at 24 weeks. CONCLUSIONS/INTERPRETATION Altered lipid metabolism is a key pathophysiological feature of type 1 diabetes pregnancy. New strategies for optimising maternal diet and insulin dosing from the first trimester are needed to improve pregnancy outcomes in type 1 diabetes.
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Affiliation(s)
- Claire L Meek
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Zoe A Stewart
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Denice S Feig
- Mount Sinai Hospital, Sinai Health System, New York, NY, USA
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Samuel Furse
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Core Metabolomics and Lipidomics Laboratory, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Sandra L Neoh
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
- Department of Endocrinology, Northern Health, Melbourne, VIC, Australia
| | - Albert Koulman
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Core Metabolomics and Lipidomics Laboratory, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Helen R Murphy
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Belfort GP, de Padilha PC, Farias DR, da Silva LBG, dos Santos K, Gomes EDS, Lima TSV, Bornia RBRG, Rezende KBC, Saunders C. Effect of the Dietary Approaches to Stop Hypertension (DASH) diet on the development of preeclampsia and metabolic outcomes in pregnant women with pre-existing diabetes mellitus: a randomised, controlled, single-blind trial. J Nutr Sci 2023; 12:e73. [PMID: 37457679 PMCID: PMC10345782 DOI: 10.1017/jns.2023.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Preeclampsia (PE) affects up to five times more women with pre-existing diabetes mellitus (PDM) than women without it. The present study aimed to identify the effect of the DASH diet on PE incidence (primary outcome) and blood pressure, glycated haemoglobin (GH), serum lipids, glutathione peroxidase (GP), C-reactive protein (CRP - secondary outcomes) in pregnant with PDM. This randomised, controlled, single-blind trial studied sixty-eight pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital, Brazil. The standard diet group (SDG) received a diet containing 45-65 % carbohydrates, 15-20 % protein and 25-30 % lipids. The DASH diet group (DDG) received the adapted DASH diet with a similar macronutrient distribution, but with a higher concentration of fibres, unsaturated fats, calcium, magnesium and potassium as well as lower saturated fat. Student's t, Mann-Whitney U and the Chi-square tests were used to compare outcomes. PE incidence was 22⋅9 % in the SDG and 12⋅1 % in the DDG (P = 0⋅25). GP levels significantly increased in the DDG (intra-group analysis; mean difference = 1588 [CI 181, 2994], P = 0⋅03) and tended to be different from the variation in the SDG (mean difference = -29⋅5 [CI -1305; 1⋅365]; v. DDG: 1588 [CI 181; 2994], P = 0⋅09). GH levels decreased significantly and similarly between groups (SDG: -0⋅61 [CI -0⋅26, -0⋅96], P = 0⋅00) v. DDG: -1⋅1 [CI -0⋅57, -1⋅62], P = 0⋅00). There was no evidence of a difference in PE incidence at the end of the intervention between the two diets. The DASH diet seems to favour PE-related biochemical markers.
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Affiliation(s)
- Gabriella P. Belfort
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
- Applied Nutrition Department, Federal University of the State of Rio de Janeiro, 296, Pasteur Ave, Rio de Janeiro, RJ 22290-240, Brazil
| | - Patricia C. de Padilha
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Dayana R. Farias
- Social and Applied Nutrition Department, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Letícia B. G. da Silva
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Karina dos Santos
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
- Public Health Nutrition Department, Federal University of the State of Rio de Janeiro, 296, Pasteur Ave, Rio de Janeiro, RJ 22290-240, Brazil
| | - Erlaine de S. Gomes
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Thaissa S. V. Lima
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Rita Bernardete R. G. Bornia
- Maternity School of the Federal University of Rio de Janeiro, 180 Laranjeiras St, Rio de Janeiro, RJ, 22240-003, Brazil
| | - Karina B. C. Rezende
- Maternity School of the Federal University of Rio de Janeiro, 180 Laranjeiras St, Rio de Janeiro, RJ, 22240-003, Brazil
| | - Claudia Saunders
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
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Phonyiam R, Baernholdt M, Hodges EA. Self-management of type 2 diabetes mellitus in pregnancy and breastfeeding experiences among women in Thailand: Study protocol. PLoS One 2023; 18:e0286646. [PMID: 37307256 DOI: 10.1371/journal.pone.0286646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/18/2023] [Indexed: 06/14/2023] Open
Abstract
Women with type 2 diabetes mellitus are at a higher risk of pregnancy complications. Although traditional beliefs and practices influence diabetes management and breastfeeding, recommendations integrating Thai cultural beliefs in maternal care are lacking. The purpose of this study is to describe diabetes self-management in pregnancy and breastfeeding experiences in women with preexisting type 2 diabetes mellitus from Thailand. A convergent parallel mixed-methods study will be conducted. Data will be collected from 20 pregnant women with preexisting type 2 diabetes mellitus in Thailand who are either primigravida or multigravida, aged 20-44 years old, speak the Thai language, and provide consent. The National Institute on Minority Health and Health Disparities Framework's sociocultural and behavioral domains guides the research aims. Data will be collected two times. The first time is during pregnancy (T1); study participants will complete questionnaires and engage in an interview about diabetes self-management, breastfeeding confidence, and breastfeeding intention. The second time is at 4-6 weeks postpartum (T2); study participants will be interviewed about their breastfeeding experiences. We will review and extract maternal health outcomes including body mass index, gestational weight gain, and glycated hemoglobin for T1 as well as fasting plasma glucose for T2. Qualitative data will be analyzed using directed content analysis. Quantitative data will be analyzed using descriptive statistics. Data sources will be triangulated with relative convergence in the results. This proposed study is significant because the findings will be used as a preliminary guide to developing a culturally tailored approach to enhance health outcomes of Thai women with diabetes in pregnancy and postpartum periods.
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Affiliation(s)
- Ratchanok Phonyiam
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Marianne Baernholdt
- School of Nursing, University of Virginia, Charlottesville, Virginia, United States of America
| | - Eric A Hodges
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Cypryk K, Wender-Ozegowska E, Cyganek K, Sieradzki J, Skoczylas K, Chen X, Cordero TL, Shin J, Cohen O. Insulin pump therapy with and without continuous glucose monitoring in pregnant women with type 1 diabetes: a prospective observational Orchestra Foundation study in Poland. Acta Diabetol 2023; 60:553-561. [PMID: 36653533 PMCID: PMC10033617 DOI: 10.1007/s00592-022-02020-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023]
Abstract
AIMS The effects of continuous subcutaneous insulin infusion (CSII) therapy with or without continuous glucose monitoring (CGM) on neonatal outcomes and glycemic outcomes of pregnant women with type 1 diabetes (T1D), living in Poland, were assessed. METHODS This prospective observational study enrolled women with T1D (N = 481, aged 18-45 years) who were pregnant or planned pregnancy. All used CSII therapy and a subset used CGM with CSII (CSII + CGM). Neonatal outcomes (e.g., rate of large for gestational age [LGA] delivery [birth weight > 90th percentile]) and maternal glycemia (e.g., HbA1c and percentage of time at sensor glucose ranges) were evaluated. RESULTS Overall HbA1c at trimesters 1, 2, and 3 was 6.8 ± 1.1% (50.9 ± 12.3 mmol/mol, N = 354), 5.8 ± 0.7% (40.1 ± 8.0 mmol/mol, N = 318), and 5.9 ± 0.7% (41.4 ± 8.0 mmol/mol, N = 255), respectively. A HbA1c target of < 6.0% (42 mmol/mol) at each trimester was achieved by 20.9% (74/354), 65.1% (207/318), and 58.0% (148/255), respectively. For women using CSII + CGM versus CSII only, HbA1c levels at trimesters 1, 2, and 3 were 6.5 ± 0.9% versus 7.1 ± 1.3% (47.8 ± 9.7 mmol/mol versus 54.3 ± 14.0 mmol/mol, p < 0.0001), 5.7 ± 0.6% versus 6.0 ± 0.9% (38.9 ± 6.5 mmol/mol versus 41.6 ± 9.3 mmol/mol, p = 0.0122), and 5.8 ± 0.6% versus 6.1 ± 0.8% (40.3 ± 6.9 mmol/mol versus 42.9 ± 9.1 mmol/mol, p = 0.0117), respectively. For the overall, CSII only, and CSII + CGM groups, rates of LGA delivery were 22.7% (74/326), 24.6% (34/138), and 21.3% (40/188), respectively. CONCLUSIONS Observational assessment of women with T1D using CSII therapy demonstrated low HbA1c throughout pregnancy and low rates of LGA. The addition of CGM to CSII therapy compared to CSII therapy alone was associated with some improved maternal glycemic and neonatal outcomes. GOV IDENTIFIER NCT01779141 (January 2013).
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Affiliation(s)
- Katarzyna Cypryk
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Pomorska Str. 251, 92-213, Lodz, Poland.
| | - Ewa Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poznań, Poland
| | - Katarzyna Cyganek
- Department of Metabolic Diseases, The University Hospital in Krakow, Krakow, Poland
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
| | - Jacek Sieradzki
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
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Todorovic J, Dugalic S, Sengul D, Stanisavljevic D, Detanac DA, Sengul I, Veiga ECDA, Terzic-Supic Z, Đurić B, Gojnic M. Revisiting type II diabetes mellitus in pregnancy and pregnancy outcomes such as in thyroidology: do you mind? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:447-451. [PMID: 36921200 PMCID: PMC10004289 DOI: 10.1590/1806-9282.20221371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/23/2022] [Indexed: 03/12/2023]
Abstract
OBJECTIVE There is an increase in the prevalence of pre-gestational diabetes in the past decades, mainly due to the increase in the prevalence of obesity in the general population and consequently type 2 diabetes among women of reproductive age. METHODS This study purposed to describe the delivery characteristics, pregnancy complications, and outcomes among women in Serbia with the pre-gestational type 2 diabetes in the past decade, as well as their pregnancy complications, deliveries, and neonatal outcomes. The study included data from all the pregnant women with pre-gestational type 2 diabetes in Belgrade, Serbia during the period between 2010 and 2020. The final sample consisted of 138 patients. RESULTS More than half, i.e., 70 (50.7%) had a vaginal delivery, while 48 (34.8%) had elective and 20 (14.5%) had emergency caesarean sections. Throughout the period, there was 1 patient with preeclampsia (0.7%), 5 with pregnancy-induced hypertension (3.6%), 7 had newborns with small for gestational age (5.1%), 28 with macrosomia (20.3%), 12 (8.7%) had preterm births, and one-fifth, i.e., 28 (20.3%) of the newborns had Apgar score under 8. CONCLUSION The present study revealed that women with type 2 diabetes in pregnancy have a significant burden of pregnancy complications, related to pregnancy, delivery, and newborns.
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Affiliation(s)
- Jovana Todorovic
- Univerzitet u Beogradu, Institute of Social Medicine, Faculty of Medicine - Belgrade, Serbia
| | - Stefan Dugalic
- Univerzitet u Beogradu, University Clinical Centre of Serbia, Clinic for Obstetrics and Gynecology, Faculty of Medicine - Belgrade, Serbia
| | - Demet Sengul
- Giresun Üniversitesi, Faculty of Medicine, Department of Pathology - Giresun, Turkey
| | - Dejana Stanisavljevic
- Univerzitet u Beogradu, Institute for Medical Statistics and Informatics, Faculty of Medicine - Belgrade, Serbia
| | - Dzenana A Detanac
- General Hospital of Novi Pazar, Department of Ophthalmology - Novi Pazar, Serbia
| | - Ilker Sengul
- Giresun Üniversitesi, Faculty of Medicine, Division of Endocrine Surgery - Giresun, Turkey.,Giresun Üniversitesi, Faculty of Medicine, Department of General Surgery - Giresun, Turkey
| | - Eduardo Carvalho de Arruda Veiga
- Universidade de São Paulo, Faculty of Medicine of Ribeirão Preto, Department of Gynecology and Obstetrics - São Paulo (SP), Brazil
| | - Zorica Terzic-Supic
- Univerzitet u Beogradu, Institute of Social Medicine, Faculty of Medicine - Belgrade, Serbia
| | - Biljana Đurić
- Univerzitet u Beogradu, Institute of Medical Physiology, Faculty of Medicine - Belgrade, Serbia
| | - Miroslava Gojnic
- Univerzitet u Beogradu, University Clinical Centre of Serbia, Clinic for Obstetrics and Gynecology, Faculty of Medicine - Belgrade, Serbia
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Gundersen TW, Ebbehoj A, Knorr S, Jensen D, Damm P, Løkkegaard ECL, Mathiesen E, Thomsen RW, Clausen TD. Validation of Danish registry-cases of type 1 diabetes in women giving live birth using a clinical cohort as gold standard. Endocrinol Diabetes Metab 2022; 6:e374. [PMID: 36412090 PMCID: PMC9836239 DOI: 10.1002/edm2.374] [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: 04/22/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of this study was to validate type 1 diabetes in women giving live birth in the Danish national registries against a clinical cohort of confirmed cases (the Danish Diabetes Birth Registry [DDBR] cohort). METHODS National registries including diagnosis codes, redeemed prescriptions and background data were combined. Three main algorithms were constructed to define type 1 diabetes in women giving live birth: (1) Any diabetes diagnosis registered before delivery and before age of 30, (2) a specific type 1 diabetes diagnosis registered before delivery regardless of maternal age and (3) a 'preexisting type 1 diabetes in pregnancy' diagnosis registered before delivery. In additional sub-algorithms, we added information on anti-diabetic medicine and gestational diabetes diagnosis. We calculated positive predictive value (PPV) and completeness using the DDBR cohort as gold standard. Since DDBR included between 75 and 93% of women with confirmed type 1 diabetes giving live birth, we used quantitative bias analysis to assess the potential impact of missing data on PPV and completeness. RESULTS Main algorithm 2 had the highest PPV (77.4%) and shared the highest completeness (92.4%) with main algorithm 1. Information on anti-diabetic medicine and gestational diabetes increased PPV, on expense of completeness. All algorithms varied with PPV between 65.7 and 87.6% and completeness between 73.6 and 92.4%. The quantitative bias analysis indicated that PPV was underestimated, and completeness overestimated for all algorithms. For algorithm 2, corrected PPV was between 82.1 and 94.6% and corrected completeness between 84.7 and 91.2%. CONCLUSIONS The Danish national registries can identify type 1 diabetes in women giving live birth with a reasonably high accuracy. The registries are a valuable source for future comparative outcome studies and may also be suitable for monitoring prevalence and incidence of type 1 diabetes in women giving live birth.
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Affiliation(s)
- Tina Wullum Gundersen
- Department of Gynecology and ObstetricsNordsjællands Hospital and University of CopenhagenHillerødDenmark
| | - Andreas Ebbehoj
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
| | - Sine Knorr
- STENO Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| | - Dorte Møller Jensen
- STENO Diabetes Center OdenseOdense University HospitalOdenseDenmark,Department of Gynecology and ObstetricsOdense University HospitalOdenseDenmark,Department of Clinical Research, Faculty of Health ScienceUniversity of Southern DenmarkOdenseDenmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of ObstetricsRigshospitalet and University of CopenhagenCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynecology and ObstetricsNordsjællands Hospital and University of CopenhagenHillerødDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Elisabeth R. Mathiesen
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Center for Pregnant Women with Diabetes, Department of EndocrinologyRigshospitalet and University of CopenhagenCopenhagenDenmark
| | - Reimar W. Thomsen
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University and Aarhus University HospitalAarhusDenmark
| | - Tine Dalsgaard Clausen
- Department of Gynecology and ObstetricsNordsjællands Hospital and University of CopenhagenHillerødDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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10
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Oliveira LMD, Belfort GP, Padilha PDC, Rosado EL, Silva LBGD, Fagherazzi S, Zajdenverg L, Zagury RL, Saunders C. Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:220-230. [PMID: 35139572 PMCID: PMC9948103 DOI: 10.1055/s-0042-1742291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control, maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM). METHODS Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DM and received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n = 51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n = 38), was guided by the traditional method (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes and analysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test, was used to assess postprandial blood glucose. RESULTS Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p = 0.00) and 3rd (p = 0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p = 0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p = 0.047). CONCLUSION Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. REBEC CLINICAL TRIALS DATABASE The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).
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Affiliation(s)
- Larissa Mello de Oliveira
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Gabriella Pinto Belfort
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Patricia de Carvalho Padilha
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Eliane Lopes Rosado
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Letícia Barbosa Gabriel da Silva
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | | | | | | | - Claudia Saunders
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil.,Maternidade Escola da UFRJ, Rio de Janeiro - RJ, Brazil
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11
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Insulin-mediated immune dysfunction in the development of preeclampsia. J Mol Med (Berl) 2021; 99:889-897. [PMID: 33768298 DOI: 10.1007/s00109-021-02068-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 02/08/2023]
Abstract
Epidemiological observations implicate insulin resistance as a predisposing factor in the development of preeclampsia (PE). It is also well established that PE manifests in the context of a dysregulated immune response at the maternal-foetal interface, though all the underlying drivers of such immune dysregulation remains to be accounted for. Although it has long been known that various immune cells express insulin receptors following immune activation, it is only recently that insulin signalling has been shown to play a key role in immune cell differentiation, survival and effector function through its canonical activation of the PI3K/Akt/mTOR pathway. Here we argue that hyperinsulinemia, manifesting either from insulin resistance or from intensive insulin therapy, likely plays a direct role in driving immune cell dysfunction which plays a central role in the development of PE. This line of reasoning also explains the superior results of insulin-sparing interventions compared to intensive insulin therapy as monotherapy.
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12
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Sarkar M, Das T, Roy TB. Determinants or barriers associated with specific routine check-up in antenatal care in gestational period: A study from EAG states, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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13
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Sole KB, Staff AC, Laine K. Maternal diseases and risk of hypertensive disorders of pregnancy across gestational age groups. Pregnancy Hypertens 2021; 25:25-33. [PMID: 34022624 DOI: 10.1016/j.preghy.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/27/2020] [Accepted: 05/08/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To estimate the risk of hypertensive disorders of pregnancy in nulliparous women with diabetes, chronic hypertension or obesity in three gestational age groups. STUDY DESIGN Population-based observational cohort study of 382 618 nulliparous women (94 280 with known BMI) using Medical Birth Registry of Norway and Statistics Norway. Main exposure variables were diabetes, chronic hypertension, Body Mass Index (BMI). Multiple regression analysis was performed without (model 1) and with (model 2) BMI. MAIN OUTCOME MEASURES Preeclampsia stratified by gestational age group at delivery: early (230-336 weeks), intermediate (340-366 weeks) and late (370-436 weeks), and gestational hypertension. RESULTS In model 1, Type 1 diabetes was associated with early (aOR = 5.0, 95%CI 3.8, 6.7), intermediate (aOR = 10.2, 95%CI 8.5, 12.3) and late preeclampsia (aOR = 2.7, 95%CI 2.4, 3.2), compared to no diabetes. Compared to normotensive women, women with chronic hypertension had an increased risk of preeclampsia in all groups: early (aOR = 8.68, 95%CI 6.94, 10.85), intermediate (aOR = 5.59, 95%CI 4.46, 7.02), late (aOR = 3.45, 95%CI 3.00, 3.96). The same trends persisted after adjusting for BMI (model 2). Obesity remained an independent risk factor for hypertensive disorders of pregnancy. CONCLUSIONS Maternal diabetes, chronic hypertension and obesity were associated with an increased risk of hypertensive disorders of pregnancy across all gestational age groups in nulliparous women. Adjusting for BMI did not further modify the risk in these women, although 75% of the women in the study lacked BMI data.
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Affiliation(s)
- Kristina Baker Sole
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Katariina Laine
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Department of Obstetrics, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
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14
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Buschur EO, Polsky S. Type 1 Diabetes: Management in Women From Preconception to Postpartum. J Clin Endocrinol Metab 2021; 106:952-967. [PMID: 33331893 DOI: 10.1210/clinem/dgaa931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 01/11/2023]
Abstract
CONTEXT This review presents an up-to-date summary on management of type 1 diabetes mellitus (T1DM) among women of reproductive age and covers the following time periods: preconception, gestation, and postpartum. EVIDENCE ACQUISITION A systematic search and review of the literature for randomized controlled trials and other studies evaluating management of T1DM before pregnancy, during pregnancy, and postpartum was performed. EVIDENCE SYNTHESIS Preconception planning should begin early in the reproductive years for young women with T1DM. Preconception and during pregnancy, it is recommended to have near-normal glucose values to prevent adverse maternal and neonatal outcomes, including fetal demise, congenital anomaly, pre-eclampsia, macrosomia, neonatal respiratory distress, neonatal hyperbilirubinemia, and neonatal hypoglycemia. CONCLUSION Women with T1DM can have healthy, safe pregnancies with preconception planning, optimal glycemic control, and multidisciplinary care.
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Affiliation(s)
| | - Sarit Polsky
- The University of Colorado Barbara Davis Center, Denver, CO, USA
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15
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Thong EP, Burden C. The Double Whammy of Obesity and Diabetes on Female Reproductive Health. Semin Reprod Med 2021; 38:333-341. [PMID: 33598908 DOI: 10.1055/s-0041-1723777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The rising global prevalence of obesity and diabetes, especially in youth, confers substantial metabolic consequences and increased mortality in affected individuals. While obesity is strongly tied to the development of insulin resistance and type 2 diabetes, emerging evidence shows that obesity rates are also increasing exponentially in those with type 1 diabetes, contributing to insulin resistance and cardiometabolic sequelae. In addition, both obesity and diabetes can exert adverse effects on female reproductive health independently, with the presence of both conditions likely to exacerbate reproductive dysfunction in this cohort. If the current trends in obesity and diabetes incidence persist, it is likely that more women will be at risk of obesity- and diabetes-related reproductive disorders. This review aims to describe the epidemiology and mechanisms of obesity in women with diabetes, and summarize current literature regarding reproductive disorders in diabetes and weight management strategies in this cohort.
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Affiliation(s)
- Eleanor P Thong
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
| | - Christy Burden
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
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16
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Lee D, Booth GL, Ray JG, Ling V, Feig DS. Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population-based cohort study in Ontario, Canada. Diabet Med 2020; 37:1696-1704. [PMID: 31994233 DOI: 10.1111/dme.14250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/11/2023]
Abstract
AIM To compare perinatal outcomes in women with undiagnosed diabetes with gestational diabetes alone, pre-existing diabetes and women without diabetes, and to identify risk factors which distinguish them from women with gestational diabetes alone. METHODS This population-based cohort study included administrative data on all women who gave birth in Ontario, Canada, during 2002-2015. Maternal/neonatal outcomes were compared across groups using logistic regression, adjusting for confounders. A nested case control study compared women with undiagnosed type 2 diabetes with women with gestational diabetes alone to determine risk factors that would help identify these women. RESULTS Among 995 990 women, 68 163 had gestational diabetes (6.8%) and, of those women with gestational diabetes,1772 had undiagnosed type 2 diabetes (2.6%). Those with undiagnosed type 2 diabetes were more likely to be older, from a lower income area, have parity > 3 and BMI ≥ 30 kg/m2 compared with gestational diabetes alone. Infants had a higher risk of perinatal mortality (OR 2.3 [1.6-3.4]), preterm birth (OR 2.6 [2.3-2.9]), congenital anomalies (OR 2.1 [1.7-2.5]), neonatal intensive care unit admission (OR 3.1 [2.8-3.5]) and neonatal hypoglycaemia (OR 406.0 [357-461]), which were similar to women with pre-existing diabetes. The strongest predictive risk factors included early gestational diabetes diagnosis, previous gestational diabetes and chronic hypertension. CONCLUSIONS Women diagnosed with gestational diabetes who develop diabetes within 1 year postpartum are at higher risk of adverse pregnancy outcomes, including perinatal mortality. This highlights the need for earlier diagnosis, preferably pre-pregnancy, and more aggressive treatment and surveillance of suspected type 2 diabetes during pregnancy.
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MESH Headings
- Adolescent
- Adult
- Case-Control Studies
- Cesarean Section/statistics & numerical data
- Cohort Studies
- Congenital Abnormalities/epidemiology
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes, Gestational/epidemiology
- Female
- Fetal Macrosomia/epidemiology
- Humans
- Hyperbilirubinemia, Neonatal/epidemiology
- Hypertension, Pregnancy-Induced/epidemiology
- Hypoglycemia/epidemiology
- Income
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Intensive Care Units, Neonatal
- Logistic Models
- Maternal Age
- Middle Aged
- Obesity, Maternal/epidemiology
- Ontario/epidemiology
- Parity
- Perinatal Mortality
- Pregnancy
- Pregnancy in Diabetics/epidemiology
- Premature Birth/epidemiology
- Residence Characteristics
- Respiratory Distress Syndrome, Newborn/epidemiology
- Shoulder Dystocia/epidemiology
- Undiagnosed Diseases/epidemiology
- Young Adult
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Affiliation(s)
- D Lee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - G L Booth
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - J G Ray
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - V Ling
- ICES, Toronto, Ontario, Canada
| | - D S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada
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Gomes RCM, Lopes MVDO, Perrelli JGA, Pontes CM, Linhares FMP, Mangueira SDO. Analysis of the NANDA-I taxonomy "maternal-fetal dyad" concept in high-risk pregnancy: integrative review. Rev Bras Enferm 2020; 73:e20190649. [PMID: 32965424 DOI: 10.1590/0034-7167-2019-0649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/09/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the NANDA-I taxonomy "maternal-fetal dyad" concept in high-risk pregnancy. METHOD an integrative literature review based on the Conceptual Analysis model proposed by Walker and Avant. It was conducted at PUBMED, CINAHL, SCOPUS, LILACS and SciELO, with the descriptors: Complications of pregnancy, Risk Factors, and Pregnancy, High-Risk (from 2008-2020). RESULT the sample consisted of 44 articles, which identified two attributes and 21 antecedents of the concept. CONCLUSION concept analysis allowed to identify the attributes and antecedents of the "maternal-fetal dyad" concept in high-risk pregnancy, in addition to raising and clarifying ideas. It was possible to identify 12 antecedents that are not included in NANDA-I as well as the need to review the definition of the diagnosis proposed by the taxonomy.
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18
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Smith CA, Tuson A, Thornton C, Dahlen HG. The safety and effectiveness of mind body interventions for women with pregnancy induced hypertension and or preeclampsia: A systematic review and meta-analysis. Complement Ther Med 2020; 52:102469. [PMID: 32951719 DOI: 10.1016/j.ctim.2020.102469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To undertake a systematic review of the safety and effectiveness of mind body approaches for women with hypertensive disorders in pregnancy (HDP). DESIGN A search was undertaken of databases from inception to 2019 for randomised and quasi randomised controlled trials. MAIN OUTCOME MEASURES The primary outcome was a reduction in systolic and / or diastolic blood pressure for women with hypertension and or preeclampsia in pregnancy. RESULTS 121 studies were identified and eight studies were included in this review. These included mind body interventions examining yoga, guided imagery, relaxation, music, and acupuncture for HDP. Two studies of relaxation found a reduction in systolic (MD -11.3, 95%CI -13.23 to -9.39) and diastolic blood pressure (MD -6.59, 95%CI -9.43 to -3.75) and reduced stress (MD -11.4, 95%CI -16.5 to -6.3). In one study of yoga, the risk of developing HDP was reduced (RR 0.28, 95% CI 0.09 to 0.91, 59 women) and a second study found a reduction in stress at the end of the intervention of yoga. One trial of guided imagery found a reduction in mean arterial blood pressure compared to the control (4.35, 95% -8.04 to -0.66, p=0.02). Overall there was no effect on the development of preeclampsia, use of anti-hypertensive medication and any neonatal outcomes from the interventions evaluated. Few trials reported on safety outcomes, one trial of acupuncture reported one case of placental abruption and three cases of acupuncture related side effects. CONCLUSION Few high quality trials have examined the effectiveness and safety of mind body interventions to manage HDP. Relaxation, yoga, guided imagery and music may have some potential benefit. Safety issues are completely unclear and thus the risk-benefit ratio of all interventions could not be determined. Further research is recommended.
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Affiliation(s)
- C A Smith
- NICM Health Research Institute, Western Sydney University, Penrith, 2751, Australia.
| | - A Tuson
- Registered Midwife and Western Sydney University Summer Scholar, Western Sydney University Penrith, 2751, Australia.
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Bedford Park, 5042, Australia.
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, 2751, Australia.
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19
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Thong EP, Codner E, Laven JSE, Teede H. Diabetes: a metabolic and reproductive disorder in women. Lancet Diabetes Endocrinol 2020; 8:134-149. [PMID: 31635966 DOI: 10.1016/s2213-8587(19)30345-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
Reproductive dysfunction is a common but little studied complication of diabetes. The spectrum of reproductive health problems in diabetes is broad, and encompasses delayed puberty and menarche, menstrual cycle abnormalities, subfertility, adverse pregnancy outcomes, and potentially early menopause. Depending on the age at diagnosis of diabetes, reproductive problems can manifest early on in puberty, emerge later when fertility is desired, or occur during the climacteric period. Historically, women with type 1 diabetes have frequently had amenorrhoea and infertility, due to central hypogonadism. With the intensification of insulin therapy and improved metabolic control, these problems have declined, but do persist. Additional reproductive implications of contemporary diabetes management are now emerging, including polycystic ovary syndrome and hyperandrogenism, which are underpinned by insulin action on the ovary. The sharp rise in type 2 diabetes incidence in youth suggests that more women of reproductive age will encounter diabetes-related reproductive problems in their lifetimes. With an ever increasing number of young women living with diabetes, clinicians need to be aware of and equipped for the challenges of navigating reproductive health concerns across the lifespan.
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Affiliation(s)
- Eleanor P Thong
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia.
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20
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Oppermann MLDR, Alessi J, Hirakata VN, Wiegand DM, Reichelt AJ. Preeclampsia in women with pregestational diabetes - a cohort study. Hypertens Pregnancy 2019; 39:48-55. [PMID: 31875734 DOI: 10.1080/10641955.2019.1704002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims: To evaluate risk factors for preeclampsia (PE) in women with pregestational diabetes.Methods: Retrospective cohort study of women with pregestational diabetes cared for at a specialized prenatal care facility. Maternal characteristics at booking and during pregnancy were studied for their association with preeclampsia. Multivariable models were tested using Poisson regression with robust estimates; results were expressed as relative risk (RR) and 95% confidence interval (CI).Results: Preeclampsia was diagnosed in 62 of 206 women (30%, 95% CI 24-37%). Previous chronic hypertension was found in 53 subjects (26%; 95% CI 20-32%), of whom 41 (77%, 95% CI 64-88) were type 2 women. Type 1 diabetes, chronic hypertension, systolic blood pressure >124 mmHg at booking and gestational weight gain, either total or excessive for body mass index category, behaved as independent risk factors.Conclusions: In women with pregestational diabetes, some risk factors may predict PE, similar to those found in non-diabetic pregnant women. Two non-modifiable factors (type of diabetes and chronic hypertension) and two modifiable ones (systolic blood pressure levels and gestational weight gain) were found relevant in this cohort. A policy of close monitoring of blood pressure and weight gain, aiming adequate weight gain, may be added to current recommended measures. The high prevalence of PE in women with prepregnancy diabetes, especially those with initial pregnancy systolic blood pressure >124 mmHg, supports a policy of early institution of low dose aspirin. Further multicentric studies will help define the role of these risk factors as contributors to PE in pregestational diabetes.
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Affiliation(s)
- Maria Lúcia Da Rocha Oppermann
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Janine Alessi
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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21
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Phillips-Bell G, Holicky A, Macdonald M, Hernandez L, Watson A, Dawit R. Collaboration Between Maternal and Child Health and Chronic Disease Epidemiologists to Identify Strategies to Reduce Hypertension-Related Severe Maternal Morbidity. Prev Chronic Dis 2019; 16:E162. [PMID: 31831105 PMCID: PMC6936670 DOI: 10.5888/pcd16.190045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Maternal and child health (MCH) and chronic disease programs at state health agencies may not routinely collaborate. The objective of this study was to describe a project that enhanced relationships between MCH and chronic disease epidemiologists at the Florida Department of Health, increased epidemiologic capacity, and informed both programs. Methods We collaborated to assess hypertension-related severe maternal morbidity (H-SMM) and hypertensive disorders (preexisting hypertension, gestational hypertension, and preeclampsia) among women at delivery of their live birth to help determine the burden on health care systems in Florida. We identified ways to improve the health of women before they conceive and to help them manage any chronic diseases during the perinatal period. Results We found differences by maternal characteristics in H-SMM rates among 979,660 women who delivered live births. We proposed strategies to support collaboration between state MCH and chronic disease staff. First, increase the screening, monitoring, and management of hypertension before, during, and after pregnancy. Second, examine H-SMM concurrently with maternal mortality to help find prevention strategies. Third, include reproductive-aged women in ongoing hypertension prevention and intervention efforts. Fourth, expand team-based care to include obstetricians, midwives, and doulas who can work together with primary care providers for hypertension management. And fifth, create and share data products that guide various groups about hypertension and related risk factors among reproductive-aged women. Conclusion The collaboration between the Florida Department of Health MCH and chronic disease epidemiologists produced 1) a program-relevant indicator, H-SMM and 2) strategies for enhancing program and clinical activities, communication, and surveillance to reduce H-SMM rates.
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Affiliation(s)
- Ghasi Phillips-Bell
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida.,Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,4052 Bald Cypress Way, Bin A13, Tallahassee, FL 32399-1721.
| | - Abigail Holicky
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida.,Centers for Disease Control and Prevention, Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Atlanta, Georgia
| | - Megan Macdonald
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida
| | - Leticia Hernandez
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida
| | - Angel Watson
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida
| | - Rahel Dawit
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida
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Spradley FT, Palei AC, Anderson CD, Granger JP. Melanocortin-4 Receptor Deficiency Attenuates Placental Ischemia-Induced Hypertension in Pregnant Rats. Hypertension 2019; 73:162-170. [PMID: 30571561 DOI: 10.1161/hypertensionaha.118.12028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Preeclampsia is a pregnancy-specific disorder of new-onset hypertension linked to placental ischemia. While obesity is a major risk factor for preeclampsia, not all obese pregnant women develop pregnancy-induced hypertension or preeclampsia. Previously, we reported that placental ischemia-induced hypertension is dependent upon intact signaling of the sympathetic nervous system. Moreover, in various models of obesity, blockade of MC4R (melanocortin-4 receptor) signaling protects against the development of hypertension via suppression of the sympathetic nervous system. Less is known about this pathway during obese pregnancy. Although blockade of MC4R may lead to increased body weight during pregnancy, we tested the hypothesis that placental ischemia-induced hypertension is attenuated in obese MC4R-deficient pregnant rats. On gestational day 14, MC4R wild-type or heterozygous-deficient (MC4R-def) rats were subjected to chronic placental ischemia via the reduced uterine perfusion pressure procedure or Sham surgery then examined on gestational day 19. In Sham MC4R-def versus Sham wild-type pregnant rats, there was increased body weight, fat mass, and circulating leptin levels but they had similar fetus weights. Reduced uterine perfusion pressure reduced fetus weights in both strains. Reduced uterine perfusion pressure increased blood pressure in wild-type rats but this response was significantly attenuated in MC4R-def rats, although blood pressure was elevated in Sham MC4R-def over Sham wild-type. These data indicate that while obese MC4R-def pregnant rats have higher blood pressure during pregnancy, placental ischemia-induced hypertension is attenuated in obese MC4R-def pregnant rats. Thus, obese women with abnormal MC4R signaling may be less susceptible to the development of placental ischemia-induced hypertension.
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Affiliation(s)
- Frank T Spradley
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson.,Department of Physiology and Biophysics (F.T.S., J.P.G.), The University of Mississippi Medical Center, Jackson
| | - Ana C Palei
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson
| | - Christopher D Anderson
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson
| | - Joey P Granger
- Department of Physiology and Biophysics (F.T.S., J.P.G.), The University of Mississippi Medical Center, Jackson
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Baykus Y, Yavuzkir S, Ustebay S, Ugur K, Deniz R, Aydin S. Asprosin in umbilical cord of newborns and maternal blood of gestational diabetes, preeclampsia, severe preeclampsia, intrauterine growth retardation and macrosemic fetus. Peptides 2019; 120:170132. [PMID: 31400492 DOI: 10.1016/j.peptides.2019.170132] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/22/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
Pathological pregnancies, such as gestational diabetes, preeclampsia, severe preeclampsia, intrauterine growth retardation and macrosomic fetuses, are among the most fundamental problems of obstetrics clinics that are risk factors for both mother and child. Our main goal here is to compare maternal blood and newborn venous-arterial cord blood asprosin levels in pathological and healthy pregnancies. The study included 30 pregnant women with gestational diabetes, 30 with preeclampsia, 30 with severe preeclampsia, 30 with intrauterine growth retardation, 29 with macrosomic fetuses and 30 healthy pregnant women. All mothers were voluntary participants. Arteries and venous blood samples from both mothers and newborns were taken, in which asprosin levels were measured by ELISA. There was a statistically significant increase in asprosin levels in pregnant women with gestational diabetes, preeclampsia, severe preeclampsia and macrosemic fetuses compared with the control group, whereas in those with intrauterine growth retardation a significant decrease was observed. Venous and arterial cord blood asprosin levels were also close to maternal asprosin levels. Regarding the asprosin levels in venous and arterial cord blood in all newborns, the former was higher, but was not statistically significant.
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Affiliation(s)
- Yakup Baykus
- Department of Obstetrics and Gynecology, School of Medicine, Kafkas University, 36000, Kars, Turkey
| | - Seyda Yavuzkir
- Department of Obstetrics and Gynecology, School of Medicine, Firat University, 23119, Elazig, Turkey
| | - Sefer Ustebay
- Department of Pediatrics, School of Medicine, Kafkas University, 36000, Kars, Turkey
| | - Kader Ugur
- Department of Internal Medicine (Endocrinology and Metabolism Diseases), School of Medicine, Firat University, 23119, Elazig, Turkey
| | - Rulin Deniz
- Department of Obstetrics and Gynecology, School of Medicine, Kafkas University, 36000, Kars, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry and Clinical Biochemistry, (Firat Hormones Research Group), Medical School, Firat University, 23119, Elazig, Turkey.
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Ha AVV, Zhao Y, Pham NM, Nguyen CL, Nguyen PTH, Chu TK, Tang HK, Binns CW, Lee AH. Postpartum weight retention in relation to gestational weight gain and pre-pregnancy body mass index: A prospective cohort study in Vietnam. Obes Res Clin Pract 2019; 13:143-149. [PMID: 30857779 DOI: 10.1016/j.orcp.2019.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of maternal overweight and obesity is increasing in Asia. This study prospectively investigated the association between pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and 12-month postpartum weight retention (PPWR) in a large cohort of Vietnamese mothers. METHODS Of the 2030 pregnant women recruited from three cities in Vietnam at 24-28 weeks of gestation, a total of 1666 mothers were followed up for 12 months after delivery and available for analysis. The outcome variable PPWR was determined by subtracting the pre-pregnancy weight from the 12-month postpartum measured weight, while GWG and pre-pregnancy BMI were classified according to the Institute of Medicine and WHO criteria for adults, respectively. Linear regression models were used to ascertain the association between pre-pregnancy BMI, GWG and PPWR accounting for the effects of plausible confounding factors. RESULTS Both pre-pregnancy BMI and GWG were significantly associated with PPWR (P<0.001). The adjusted mean weight retention in underweight women before pregnancy (3.71kg, 95% confidence interval (CI) 3.37-4.05) was significantly higher than that in those with normal pre-pregnancy weight (2.34kg, 95% CI 2.13-2.54). Women with excessive GWG retained significantly more weight (5.07kg, 95% CI 4.63-5.50) on average at 12 months, when compared to mothers with adequate GWG (2.92kg, 95% CI 2.67-3.17). CONCLUSIONS Being underweight before pregnancy and excessive GWG contribute to greater weight retention twelve months after giving birth. Interventions to prevent postpartum maternal obesity should target at risk women at the first antenatal visit and control their weight gain during the course of pregnancy.
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Affiliation(s)
- Anh Vo Van Ha
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam; School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Yun Zhao
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Ngoc Minh Pham
- Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 250000, Vietnam; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia.
| | - Cong Luat Nguyen
- School of Public Health, Curtin University, Perth, WA 6845, Australia; National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam.
| | - Phung Thi Hoang Nguyen
- School of Public Health, Curtin University, Perth, WA 6845, Australia; Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
| | - Tan Khac Chu
- School of Public Health, Curtin University, Perth, WA 6845, Australia; Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 180000, Vietnam.
| | - Hong Kim Tang
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam.
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
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Stojanovska V, Dijkstra DJ, Vogtmann R, Gellhaus A, Scherjon SA, Plösch T. A double-hit pre-eclampsia model results in sex-specific growth restriction patterns. Dis Model Mech 2019; 12:dmm.035980. [PMID: 30683649 PMCID: PMC6398487 DOI: 10.1242/dmm.035980] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/09/2019] [Indexed: 12/29/2022] Open
Abstract
Pre-eclampsia is a multifactorial pregnancy-associated disorder characterized by angiogenic dysbalance and systemic inflammation; however, animal models that combine these two pathophysiological conditions are missing. Here, we introduce a novel double-hit pre-eclampsia mouse model that mimics the complex multifactorial conditions present during pre-eclampsia and allows for the investigation of early consequences for the fetus. Adenoviral overexpression of soluble fms-like tyrosine kinase (sFlt-1) and lipopolysaccharide (LPS) administration at mid-gestation in pregnant mice resulted in hypertension and albuminuria comparable to that of the manifestation in humans. A metabolomics analysis revealed that pre-eclamptic dams have increased plasma concentrations of phosphadytilcholines. The fetuses of both sexes were growth restricted; however, in males a brain-sparing effect was seen as compensation for this growth restriction. According to the plasma metabolomics, male fetuses showed changes in amino acid metabolism, while female fetuses showed pronounced alterations in lipid metabolism. Our results show that combined exposure to sFlt-1 and LPS mimics the clinical symptoms of pre-eclampsia and affects fetal growth in a sex-specific manner, with accompanying metabolome changes.
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Affiliation(s)
- Violeta Stojanovska
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Dorieke J Dijkstra
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Rebekka Vogtmann
- Department of Gynecology and Obstetrics, University Hospital Duisburg-Essen, 45147 Essen, Germany
| | - Alexandra Gellhaus
- Department of Gynecology and Obstetrics, University Hospital Duisburg-Essen, 45147 Essen, Germany
| | - Sicco A Scherjon
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
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Leptin and Adiponectin as markers for preeclampsia in obese pregnant women, a cohort study. Pregnancy Hypertens 2018; 15:78-83. [PMID: 30825932 DOI: 10.1016/j.preghy.2018.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/20/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Preeclampsia (PE) is a serious complication of pregnancy, the pathogenesis of which is largely unknown. We hypothesize that adipocytokines may play a role in the pathogenesis of PE, particularly in obese women, and evaluate leptin and adiponectin as potential first trimester markers for predicting PE. STUDY DESIGN A cohort of 2503 pregnancies, containing 93 PE pregnancies, was divided into women with normal weight, moderate, or severe obesity. All pregnancies had serum adiponectin and leptin measured in first trimester. Logistic regression was used to model PE with maternal characteristics and concentrations of the biomarkers. RESULTS In obese women a lower concentration of adiponectin was found in PE pregnancies; the concentration was lowest in the severely obese (p = 0.005). No association was found in normal weight women (p = 0.72). Leptin concentration had no association with PE in normal weight and moderately obese (p = 0.175-0.072), however in women with severe obesity a lower level of leptin was found (p = 0.049). The AUC was 0.73 for the ROC curve of combined maternal characteristics and adiponectin. Using adiponectin in women with moderate to severe obesity the sensitivity was 72.9% and the specificity was 49%. CONCLUSIONS In severely obese women, PE is associated with low serum adiponectin and leptin concentrations in first trimester. This indicates that the inability of adipokine regulation to adapt to severe obesity may play a role in the pathogenesis of PE. Adipocytokines may contribute in identification of risk pregnancies among severe obese.
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McCoski SR, Vailes MT, Owens CE, Cockrum RR, Ealy AD. Exposure to maternal obesity alters gene expression in the preimplantation ovine conceptus. BMC Genomics 2018; 19:737. [PMID: 30305020 PMCID: PMC6180665 DOI: 10.1186/s12864-018-5120-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background Embryonic and fetal exposure to maternal obesity causes several maladaptive morphological and epigenetic changes in exposed offspring. The timing of these events is unclear, but changes can be observed even after a short exposure to maternal obesity around the time of conception. The hypothesis of this work is that maternal obesity influences the ovine preimplantation conceptus early in pregnancy, and this exposure will affect gene expression in embryonic and extraembryonic tissues. Results Obese and lean ewe groups were established by overfeeding or normal feeding, respectively. Ewes were then bred to genetically similar rams. Conceptuses were collected at day 14 of gestation. Morphological assessments were made, conceptuses were sexed by genomic PCR analysis, and samples underwent RNA-sequencing analysis. While no obvious morphological differences existed between conceptuses, differentially expressed genes (≥ 2-fold; ≥ 0.2 RPKM; ≤ 0.05 FDR) were detected based on maternal obesity exposure (n = 21). Also, differential effects of maternal obesity were noted on each conceptus sex (n = 347). A large portion of differentially expressed genes were associated with embryogenesis and placental development. Conclusions Findings reveal that the preimplantation ovine conceptus genome responds to maternal obesity in a sex-dependent manner. The sexual dimorphism in response to the maternal environment coupled with changes in placental gene expression may explain aberrations in phenotype observed in offspring derived from obese females. Electronic supplementary material The online version of this article (10.1186/s12864-018-5120-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah R McCoski
- Department of Animal and Poultry Sciences, Virginia Polytechnic Institute and State University, 3430 Litton-Reaves Hall (0306), Virginia, Blacksburg, VA, 24061, USA
| | - McCauley T Vailes
- Department of Animal and Poultry Sciences, Virginia Polytechnic Institute and State University, 3430 Litton-Reaves Hall (0306), Virginia, Blacksburg, VA, 24061, USA
| | - Connor E Owens
- Department of Dairy Science, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
| | - Rebecca R Cockrum
- Department of Dairy Science, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
| | - Alan D Ealy
- Department of Animal and Poultry Sciences, Virginia Polytechnic Institute and State University, 3430 Litton-Reaves Hall (0306), Virginia, Blacksburg, VA, 24061, USA.
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28
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McGrath RT, Glastras SJ, Hocking SL, Fulcher GR. Large-for-Gestational-Age Neonates in Type 1 Diabetes and Pregnancy: Contribution of Factors Beyond Hyperglycemia. Diabetes Care 2018; 41:1821-1828. [PMID: 30030258 DOI: 10.2337/dc18-0551] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/07/2018] [Indexed: 02/03/2023]
Abstract
Despite significant reductions in serious adverse perinatal outcomes for women with type 1 diabetes in pregnancy, the opposite effect has been observed for fetal overgrowth and associated complications, such as neonatal hypoglycemia, shoulder dystocia, and admission to the neonatal intensive care unit. In addition, infants born large for gestational age (LGA) have an increased lifetime risk of obesity, diabetes, and chronic disease. Although exposure to hyperglycemia plays an important role, women who seemingly achieve adequate glycemic control in pregnancy continue to experience a greater risk of excess fetal growth, leading to LGA neonates and macrosomia. We review potential contributors to excess fetal growth in pregnancies complicated by type 1 diabetes. In addition to hyperglycemia, we explore the role of glycemic variability, prepregnancy overweight and obesity, gestational weight gain, and maternal lipid levels. Greater understanding of the stimuli that drive excess fetal growth could lead to targeted management strategies in pregnant women with type 1 diabetes, potentially reducing the incidence of LGA neonates and the inherent risk of acute and long-term complications.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia .,Kolling Institute, St Leonards, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.,Kolling Institute, St Leonards, Sydney, New South Wales, Australia
| | - Samantha L Hocking
- Central Clinical School and The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
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Morgan HL, Butler E, Ritchie S, Herse F, Dechend R, Beattie E, McBride MW, Graham D. Modeling Superimposed Preeclampsia Using Ang II (Angiotensin II) Infusion in Pregnant Stroke-Prone Spontaneously Hypertensive Rats. Hypertension 2018; 72:208-218. [PMID: 29844145 PMCID: PMC6012051 DOI: 10.1161/hypertensionaha.118.10935] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/04/2018] [Accepted: 05/01/2018] [Indexed: 12/31/2022]
Abstract
Hypertensive disorders of pregnancy are the second leading cause of maternal deaths worldwide. Superimposed preeclampsia is an increasingly common problem and often associated with impaired placental perfusion. Understanding the underlying mechanisms and developing treatment options are crucial. The pregnant stroke-prone spontaneously hypertensive rat has impaired uteroplacental blood flow and abnormal uterine artery remodeling. We used Ang II (angiotensin II) infusion in pregnant stroke-prone spontaneously hypertensive rats to mimic the increased cardiovascular stress associated with superimposed preeclampsia and examine the impact on the maternal cardiovascular system and fetal development. Continuous infusion of Ang II at 500 or 1000 ng/kg per minute was administered from gestational day 10.5 until term. Radiotelemetry and echocardiography were used to monitor hemodynamic and cardiovascular changes, and urine was collected prepregnancy and throughout gestation. Uterine artery myography assessed uteroplacental vascular function and structure. Fetal measurements were made at gestational day 18.5, and placentas were collected for histological and gene expression analyses. The 1000 ng/kg per minute Ang II treatment significantly increased blood pressure (P<0.01), reduced cardiac output (P<0.05), and reduced diameter and increased stiffness of the uterine arteries (P<0.01) during pregnancy. The albumin:creatinine ratio was increased in both Ang II treatment groups (P<0.05; P<0.0001). The 1000 ng/kg per minute-treated fetuses were significantly smaller than vehicle treatment (P<0.001). Placental expression of Ang II receptors was increased in the junctional zone in 1000 ng/kg per minute Ang II-treated groups (P<0.05), with this zone showing depletion of glycogen content and structural abnormalities. Ang II infusion in pregnant stroke-prone spontaneously hypertensive rats mirrors hemodynamic, cardiac, and urinary profiles observed in preeclamptic women, with evidence of impaired fetal growth.
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Affiliation(s)
- Hannah L Morgan
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (H.L.M., E. Butler, S.R., E. Beattie, M.W.M., D.G.)
| | - Elaine Butler
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (H.L.M., E. Butler, S.R., E. Beattie, M.W.M., D.G.)
| | - Shona Ritchie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (H.L.M., E. Butler, S.R., E. Beattie, M.W.M., D.G.)
| | - Florian Herse
- Experimental and Clinical Research Center, a Joint Cooperation Between the Max-Delbrück Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (F.H., R.D.).,HELIOS Clinic Berlin-Buch, Germany (F.H., R.D.)
| | - Ralf Dechend
- Experimental and Clinical Research Center, a Joint Cooperation Between the Max-Delbrück Center for Molecular Medicine and the Charité Medical Faculty, Berlin, Germany (F.H., R.D.).,HELIOS Clinic Berlin-Buch, Germany (F.H., R.D.)
| | - Elisabeth Beattie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (H.L.M., E. Butler, S.R., E. Beattie, M.W.M., D.G.)
| | - Martin W McBride
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (H.L.M., E. Butler, S.R., E. Beattie, M.W.M., D.G.)
| | - Delyth Graham
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (H.L.M., E. Butler, S.R., E. Beattie, M.W.M., D.G.)
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Groer M, Fuchs D, Duffy A, Louis-Jacques A, D’Agata A, Postolache TT. Associations Among Obesity, Inflammation, and Tryptophan Catabolism in Pregnancy. Biol Res Nurs 2018; 20:284-291. [PMID: 29141444 PMCID: PMC6346309 DOI: 10.1177/1099800417738363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate relationships among obesity in pregnancy and plasma levels of tryptophan (TRP) and kynurenine (KYN), inflammatory markers, and depressed mood. METHODS Pregnant women ( N = 374) were enrolled, and data were collected at a mean gestation of 20 weeks in this cross-sectional study. Plasma was analyzed for TRP, KYN, neopterin, and nitrite levels. Women completed demographic and mood scales. RESULTS There was a statistically significant inverse correlation between body mass index (BMI) and TRP and positive correlations between BMI and KYN and the kynurenine/tryptophan (KYN/TRP) ratio. Neopterin was correlated with KYN/TRP, suggesting that the indoleamine 2,3-dioxygenase-1 (IDO-1) enzyme was activated. The correlations of neopterin and nitrite with BMI were too small to be clinically meaningful but may provide mechanistic insight. There was a correlation between depressed mood and nitrite levels. Depressed mood was also associated with lower TRP levels. When the sample was divided into pregnant women with or without obesity, TRP was significantly lower and the KYN/TRP ratio was significantly higher in the women with obesity. CONCLUSION The pro-inflammatory state of obesity in pregnancy may drive activation of IDO-1, resulting in diversion of TRP away from serotonin and melatonin production and toward KYN metabolites. This alteration could contribute to depression, impaired sleep, increased production of excitotoxic neurotransmitters, and reinforcement of a pro-inflammatory state in pregnancy.
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Affiliation(s)
- Maureen Groer
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- University of South Florida College of Nursing, Tampa, FL, USA
| | - Dietmar Fuchs
- Division of Biological Chemistry, Innsbruck Medical University, Innsbruck, Austria
| | - Allyson Duffy
- University of South Florida College of Nursing, Tampa, FL, USA
| | - Adetola Louis-Jacques
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- University of South Florida College of Nursing, Tampa, FL, USA
| | - Amy D’Agata
- University of South Florida College of Nursing, Tampa, FL, USA
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Nørgaard SK, Vestgaard MJ, Jørgensen IL, Ásbjörnsdóttir B, Ringholm L, McIntyre HD, Damm P, Mathiesen ER. Diastolic blood pressure is a potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes. Diabetes Res Clin Pract 2018; 138:229-237. [PMID: 29475019 DOI: 10.1016/j.diabres.2018.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/09/2018] [Accepted: 02/06/2018] [Indexed: 11/30/2022]
Abstract
AIMS To identify early clinical, modifiable risk factors for preeclampsia present at first antenatal visit and assess the prevalence of pregnancy-related hypertensive disorders in women with pre-existing diabetes treated with tight glycemic and blood pressure (BP) control. METHODS A population-based cohort study of 494 women with pre-existing diabetes (307 and 187 women with type 1 and type 2 diabetes, respectively), included at their first antenatal visit from 2012 to 2016. The prevalence of chronic hypertension (without diabetic nephropathy or microalbuminuria), gestational hypertension and preeclampsia was recorded. Diabetic microangiopathy included presence of nephropathy, microalbuminuria and/or retinopathy. Treatment target was BP <135/85 mmHg. RESULTS HbA1c was 6.9 ± 2.4% (50 ± 12 mmol/mol) at first antenatal visit and 6.0 ± 0.6% (43 ± 6 mmol/mol) before delivery with no differences between women with type 1 and type 2 diabetes. At the first antenatal visit, the prevalence of microalbuminuria was 6% (6% vs. 6%), nephropathy 2% (1% vs. 2%) and chronic hypertension 6% (3% vs. 10%, p = 0.03). Gestational hypertension developed in 8% (9% vs. 6%) and preeclampsia developed in 8% (9% vs. 7%). Presence of diabetic microangiopathy (adjusted odds ratio (OR) 4.35 (confidence interval 2.12-8.93)) and diastolic BP (adjusted OR 1.72 per 10 mmHg (1.05-2.82)) at the first antenatal visit were independent risk factors for preeclampsia. CONCLUSIONS At the first antenatal visit, diastolic BP was the only independent, potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes in the context of tight glycemic and BP control. One out of four women had hypertensive disorders during pregnancy.
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Affiliation(s)
- Sidse Kjærhus Nørgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.
| | - Marianne Jenlev Vestgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Isabella Lindegaard Jørgensen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Harold David McIntyre
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Mater Clinical School and Mater Research, The University of Queensland, Brisbane, Australia
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Gutaj P, Zawiejska A, Mantaj U, Wender-Ożegowska E. Determinants of preeclampsia in women with type 1 diabetes. Acta Diabetol 2017; 54:1115-1121. [PMID: 28975446 PMCID: PMC5680366 DOI: 10.1007/s00592-017-1053-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/08/2017] [Indexed: 01/19/2023]
Abstract
AIMS Despite improvement in diabetic care over the years, the incidence of hypertensive disorders of pregnancy is still very high. Therefore, the aim of our study was to determine risk factors for PE in women with T1DM. METHODS This study was a prospective, nested case-control study on a population of 165 women with T1DM. Women were divided into 3 subgroups: normotensive (N = 141), gestational hypertension (GH) (N = 8), and PE (N = 16). Clinical data were collected in the first trimester (< 12th week), in mid-pregnancy (20-24th weeks), and just prior to delivery (34-39th weeks). IR in the first trimester was quantified using the estimated glucose disposal rate formula (eGDR, milligrams/kilogram/minute). Simple logistic regression was used to search for factors associated with PE and GH. For multivariate comparisons, we used multiple logistic regression with stepwise selection. RESULTS All preeclampsia cases were diagnosed in primiparae. The presence of vasculopathy was the strongest determinant of PE (OR 10.8, 95% CI 3.27-35.97, P = 0.0001), followed by a history of chronic hypertension (6.05, 1.75-20.8, P = 0.004) and the duration of diabetes (1.11, 1.03-1.12, P = 0.009). However, chronic hypertension and duration of diabetes were no longer associated with PE after adjustment for the presence of vasculopathy. Higher gestational weight gain (GWG) was associated with PE, and this association remained significant after adjustment for first trimester body mass index (1.14, 1.02-1.28, P = 0.02). Both systolic and diastolic blood pressure assessed in the first trimester were significant determinants of PE; however, this association was no longer observed after adjustment for the presence of chronic hypertension. Glycated hemoglobin (HbA1c) levels from all 3 trimesters were significantly associated with PE (first trimester: 1.38, 1.01-1.87, P = 0.04; second trimester: 2.76, 1.43-5.31, P = 0.002; third trimester: 2.42, 1.30-4.51, P = 0.005). There was a negative association between eGDR and PE (0.66, 0.50-0.87, P = 0.003). Among lipids, triglycerides (TG) in all 3 trimesters were positively associated with PE, and this association was independent of HbA1c levels (first trimester: 5.32, 1.65-17.18, P = 0.005; second trimester: 2.52, 1.02-6.26, P = 0.05; third trimester: 2.28, 1.39-3.74, P = 0.001. We did not find any predictors of GH in the regression analysis among all analyzed factors. CONCLUSIONS Primiparity and diabetic vasculopathy seem to be the strongest risk factors for PE in women with type 1 diabetes. However, preexisting hypertension and higher GWG were also associated with PE in women with T1DM. Among laboratory results, higher HbA1c and TG levels in all 3 trimesters were associated with PE. The association between higher IR and PE in women with T1DM needs further study.
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Affiliation(s)
- Paweł Gutaj
- Division of Reproduction, Department of Obstetrics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St, 60-535, Poznań, Poland.
| | - Agnieszka Zawiejska
- Division of Reproduction, Department of Obstetrics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St, 60-535, Poznań, Poland
| | - Urszula Mantaj
- Division of Reproduction, Department of Obstetrics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St, 60-535, Poznań, Poland
| | - Ewa Wender-Ożegowska
- Division of Reproduction, Department of Obstetrics, Gynecology and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St, 60-535, Poznań, Poland
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Meiri H, Osol G, Cetin I, Gizurarson S, Huppertz B. Personalized Therapy Against Preeclampsia by Replenishing Placental Protein 13 (PP13) Targeted to Patients With Impaired PP13 Molecule or Function. Comput Struct Biotechnol J 2017; 15:433-446. [PMID: 29034064 PMCID: PMC5633742 DOI: 10.1016/j.csbj.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/27/2017] [Accepted: 09/12/2017] [Indexed: 12/16/2022] Open
Abstract
Hypertensive disorders affect about one third of all people aged 20 and above, and are treated with anti-hypertensive drugs. Preeclampsia (PE) is one form of such disorders that only develops during pregnancy. It affects ten million pregnant women globally and additionally causes fetal loss and major newborn disabilities. The syndrome's origin is multifactorial, and anti-hypertensive drugs are ineffective in treating it. Biomarkers are helpful for predict its development. Generic drugs, such as low dose aspirin, were proven effective in preventing preterm PE. However, it does not cure the majority of cases and many studies are underway for fighting PE with extended use of additional generic drugs, or through new drug development programs. This review focuses on placental protein 13 (PP13). This protein is only expressed in the placenta. Impaired PP13 DNA structure and/or its reduced mRNA expression leads to lower blood PP13 level that predict a higher risk of developing PE. Two polymorphic PP13 variants have been identified: (1) The promoter PP13 variant with an "A/A" genotype in the -98 position (versus "A/C" or "C/C"). Having the "A/A" genotype is coupled to lower PP13 expression, mainly during placental syncytiotrophoblast differentiation and, if associated with obesity and history of previous preeclampsia, it accurately predicts higher risk for developing the disorder. (2) A thymidine deletion at position 221 causes a frame shift in the open reading frame, and the formation of an early stop codon resulting in the formation of DelT221, a truncated variant of PP13. In pregnant rodents, both short- and long- term replenishment of PP13 causes reversible hypotension and vasodilation of uterine vessels. Long-term exposure is also accompanied by the development of larger placentas and newborns. Also, only w/t PP13 is capable of inducing leukocyte apoptosis, providing maternal immune tolerance to pregnancy. Based on published data, we propose a targeted PP13 therapy to fight PE, and consider the design and conduct of animal studies to explore this hypothesis. Accordingly, a new targeted therapy can be implemented in humans combining prediction and prevention.
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Affiliation(s)
- Hamutal Meiri
- Hy Laboratories, Rehovot, and TeleMarpe, Tel Aviv, Israel
| | - George Osol
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Irene Cetin
- Department of Obstetrics and Gynecology, University of Milano, Italy
- Department of Mother and Child, Hospital Luigi Sacco, and Center for Fetal Research “Giorgio Pardi”, Milano, Italy
| | - Sveinbjörn Gizurarson
- Faculty of Pharmaceutical Sciences, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - Berthold Huppertz
- Institute of Cell Biology, Histology and Embryology & Biobank Graz, Medical University of Graz, Graz, Austria
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Taravati A, Tohidi F, Moniri M, Kamali K. Catechol-O-methyltransferase Gene Polymorphism (Val158Met) and Development of Pre-eclampsia. Arch Med Res 2017. [PMID: 28625321 DOI: 10.1016/j.arcmed.2017.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Catechol-O-methyltransferase (COMT) is a key enzyme in degradation pathways of estrogens and catecholamines. The present meta-analysis was done to elucidate the association of COMT Val158Met polymorphism with pre-eclampsia among pregnant women. METHODS A literature search was conducted in electronic databases including PubMed, Scopus, Elsevier, Springer and Google Scholar to find eligible studies. The pooled odds ratios (ORs) with 95% confidence intervals were calculated under dominant, recessive, co-dominant, and allelic models. RESULTS This meta-analysis included 6 eligible studies consisting 2596 cases and 4223 controls. The ORs for the COMT G472A polymorphism and pre-eclampsia were indicative of positive association under several genetic models. The results indicated that COMT Val158Met polymorphism was significantly associated with the increased risk of pre-eclampsia in recessive model (AA vs. AG + GG: OR = 1.522 [95% CI: 1.089-2.127]; p = 0.014), co-dominant model (AA vs. GG: OR = 1.605 [95% CI: 1.102-2.336]; p = 0.014), and allelic model (A vs. T: OR = 1.200 [95% CI: 1.021-1.402]; p = 0.021). CONCLUSIONS In summary, COMT Val158Met polymorphism is positively associated with the increased risk of pre-eclampsia among pregnant women, especially the homozygous carriers. It could be of value to investigate its association with pre-eclampsia in combination with additional risk factors. However, very large studies with different ethnic population are required to accurately demonstrate the role of this candidate gene in development of pre-eclampsia.
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Affiliation(s)
- Ali Taravati
- Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran, Babolsar, Iran.
| | - Fatemeh Tohidi
- Department of Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mehrnaz Moniri
- Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran, Babolsar, Iran
| | - Kasra Kamali
- Department of Molecular and Cell Biology, Faculty of Basic Sciences, University of Mazandaran, Babolsar, Iran
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Vestgaard M, Sommer MC, Ringholm L, Damm P, Mathiesen ER. Prediction of preeclampsia in type 1 diabetes in early pregnancy by clinical predictors: a systematic review. J Matern Fetal Neonatal Med 2017; 31:1933-1939. [DOI: 10.1080/14767058.2017.1331429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Marianne Vestgaard
- Center of Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Miriam Colstrup Sommer
- Center of Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Lene Ringholm
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Center of Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth R. Mathiesen
- Center of Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Spradley FT. Metabolic abnormalities and obesity's impact on the risk for developing preeclampsia. Am J Physiol Regul Integr Comp Physiol 2016; 312:R5-R12. [PMID: 27903516 DOI: 10.1152/ajpregu.00440.2016] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/11/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.
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Affiliation(s)
- Frank T Spradley
- Department of Surgery, Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
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