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Fornes R, Simin J, Nguyen MH, Cruz G, Crisosto N, van der Schaaf M, Engstrand L, Brusselaers N. Pregnancy, perinatal and childhood outcomes in women with and without polycystic ovary syndrome and metformin during pregnancy: a nationwide population-based study. Reprod Biol Endocrinol 2022; 20:30. [PMID: 35130922 PMCID: PMC8819934 DOI: 10.1186/s12958-022-00905-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/30/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that affects women in reproductive age and represents an unfavourable risk factor for several pregnancy and perinatal outcomes. Despite, no guidelines or pharmaceutical strategies for treating PCOS during pregnancy are available. The aim of this study is to determine the association between polycystic ovary syndrome with or without metformin and the pregnancy, perinatal outcomes as well as the risk of obesity in children born to these mothers. METHODS In this nationwide population-based cohort study based in Swedish population, all singleton births (n = 1,016,805) from 686,847 women since 2006 up to 2016 were included. Multivariable logistic and Cox regression modelling with odds ratios (OR) and hazard ratios (HR) and 95% confidence intervals were used to study the association between the exposure of maternal PCOS, metformin during pregnancy (or the combination of both) and: 1) Pregnancy outcomes: preeclampsia, gestational diabetes, caesarean section, and acute caesarean section, 2) Perinatal outcomes: preterm birth, stillbirth, low birth weight, macrosomia, Apgar < 7 at 5 min, small for gestational age and large for gestational age, and 3) Childhood Obesity. RESULTS PCOS in women without metformin use during pregnancy was associated with higher risks of preeclampsia (OR = 1.09, 1.02-1.17), gestational diabetes (OR = 1.71, 1.53-1.91) and caesarean section (OR = 1.08, 1.04-1.12), preterm birth (OR = 1.30, 1.23-1.38), low birth weight (OR = 1.29, 1.20-1.38), low Apgar scores (OR = 1.17, 1.05-1.31) and large for gestational age (OR = 1.11, 1.03-1.20). Metformin use during pregnancy (in women without PCOS) was associated with a 29% lower risks of preeclampsia (OR = 0.71, 0.51-0.97), macrosomia and large for gestational age. Obesity was more common among children born to mothers with PCOS without metformin (HR = 1.61, 1.44-1.81); and those with metformin without PCOS (HR = 1.67, 1.05-2.65). PCOS with metformin was not associated with any adverse outcome. CONCLUSION PCOS was associated with increased risks of adverse pregnancy and perinatal outcomes and childhood obesity. Metformin appears to reduce these risks in mothers with polycystic ovary syndrome and their children; but may increase the risk of childhood-obesity in children form women without PCOS.
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Affiliation(s)
- Romina Fornes
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Biomedicum kvarter 8A, Tomtebodavägen 16, SE-171 65, Stockholm, Sweden
| | - Johanna Simin
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Biomedicum kvarter 8A, Tomtebodavägen 16, SE-171 65, Stockholm, Sweden
| | - Minh Hanh Nguyen
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Gonzalo Cruz
- Centro de Neurobiología y Fisiopatología Integrativa (CENFI), Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
| | - Nicolás Crisosto
- Centro de Neurobiología y Fisiopatología Integrativa (CENFI), Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
- Laboratory of Endocrinology and Metabolism, West Division, Faculty of Medicine, University of Chile, Santiago, Chile
- Endocrinology Unit, Clínica Las Condes, Las Condes, Chile
| | | | - Lars Engstrand
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Biomedicum kvarter 8A, Tomtebodavägen 16, SE-171 65, Stockholm, Sweden
| | - Nele Brusselaers
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Biomedicum kvarter 8A, Tomtebodavägen 16, SE-171 65, Stockholm, Sweden.
- Global Health Institute, Antwerp University, Antwerpen, Belgium.
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Shen Y, Li J, Tian H, Ji Y, Li Z, Lu J, Lu H, Liu B, Liu F. High level of complement factor Ba within first prenatal test of gestation increases the risk of subsequent gestational diabetes: a propensity score-matched study. Gynecol Endocrinol 2022; 38:158-163. [PMID: 34643127 DOI: 10.1080/09513590.2021.1989400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study was to assess the alteration of circulating complement factor Ba (CFBa) within 11 to 17 weeks of gestation and its association with subsequent gestational diabetes mellitus (GDM) and its delivery outcome. METHODS Biochemical parameters and blood samples were collected from 399 pregnant women within 11 to 17 weeks of gestation. At 24 to 28 weeks of gestation, all participants underwent 75-g oral glucose tolerance test and were assigned to GDM group (n = 80) and normal control group (n = 319). Perinatal data were collected after delivery. A propensity score-matched (PSM) analysis was performed to reduce the impact of confounding factors on glucose metabolism during pregnancy between the two groups. RESULTS Two groups of 74 well-matched patients who maintained balance in terms of baseline characteristics. The levels of CFBa in pregnant women who later developed GDM were significantly higher than those in healthy pregnant women [0.4(0.1-0.8) vs. 0.2(0.2-0.3), p = 0.024]. Logistic regression analysis results confirmed that the level of CFBa was an independent impact factor for the occurrence of GDM (OR = 1.57, 95% CI: 1.118-2.210, p = 0.009). Further grouping according to the median level of CFBa, it was found that the incidence of GDM in category two (>0.23 ng/ml, n = 74) was markedly higher than that in the first category (≤0.23 ng/ml, n = 74) (p = 0.021). CONCLUSIONS High level of the CFBa within 11 to 17 weeks of gestation increases the risk of subsequent GDM, and maybe a biomarker for predicting GDM.
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Affiliation(s)
- Ying Shen
- Department of Endocrinology & Metabolism, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Junxian Li
- Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University School of Medicine Affiliated Shanghai General Hospital, Shanghai, China
| | - Hairong Tian
- Department of Endocrinology and Metabolism, Jin Shan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Ye Ji
- Department of Endocrinology and Metabolism, Jin Shan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Ziyun Li
- Department of Endocrinology and Metabolism, Jin Shan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Junxi Lu
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Huijuan Lu
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bo Liu
- Department of Endocrinology and Metabolism, Jin Shan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Fang Liu
- Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University School of Medicine Affiliated Shanghai General Hospital, Shanghai, China
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Chaves C, Cunha F, Martinho M, Garrido S, Silva-Vieira M, Estevinho C, Melo A, Figueiredo O, Morgado A, Almeida MC, Almeida M. Metformin combined with insulin in women with gestational diabetes mellitus: a propensity score-matched study. Acta Diabetol 2021; 58:615-621. [PMID: 33459895 DOI: 10.1007/s00592-020-01665-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/24/2020] [Indexed: 01/22/2023]
Abstract
AIM Metformin use in gestational diabetes (GDM) is a common practice. Although its use in combination with insulin might be advantageous, it was never formally tested. We studied whether combined treatment was associated with better obstetric or neonatal outcomes compared to insulin alone. METHODS This is a retrospective study, using the Portuguese National Registry of GDM (2012-2017), of women treated with insulin ± metformin. Primary endpoints were obstetric and neonatal complications. Secondary endpoints were gestational weight gain (GWG) and insulin dose. A propensity score-matched analysis was performed to balance the distribution of age, BMI, insulin treatment duration, HbA1c, first trimester diagnosis of GDM and previous GDM or macrosomia. Women treated with metformin plus insulin and insulin only were then compared. RESULTS A total of 4034 women were treated with insulin or insulin plus metformin (10.2%). After propensity score matching, we studied two groups of 386 patients. Obstetric and neonatal complications were similar. Women treated with metformin plus insulin had 201 (52.1%) obstetric complications versus 184 (47.7%) in insulin-only group, p = 0.22; and 112 (29.0%) neonatal complications versus 96 (24.9%), p = 0.19. Patients treated with metformin plus insulin had similar GWG, excessive weight gain and insulin dose compared to the insulin-only group. CONCLUSIONS Women with GDM treated with insulin plus metformin had similar obstetric and neonatal complications, weight gained and insulin dose compared to those only treated with insulin.
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Affiliation(s)
- Catarina Chaves
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal.
| | - Filipe Cunha
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Mariana Martinho
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Susana Garrido
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Margarida Silva-Vieira
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Catarina Estevinho
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Anabela Melo
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Odete Figueiredo
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana Morgado
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Maria Céu Almeida
- Serviço de Obstetrícia, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Almeida
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
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Shpakov AO. Improvement Effect of Metformin on Female and Male Reproduction in Endocrine Pathologies and Its Mechanisms. Pharmaceuticals (Basel) 2021; 14:ph14010042. [PMID: 33429918 PMCID: PMC7826885 DOI: 10.3390/ph14010042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
Metformin (MF), a first-line drug to treat type 2 diabetes mellitus (T2DM), alone and in combination with other drugs, restores the ovarian function in women with polycystic ovary syndrome (PCOS) and improves fetal development, pregnancy outcomes and offspring health in gestational diabetes mellitus (GDM) and T2DM. MF treatment is demonstrated to improve the efficiency of in vitro fertilization and is considered a supplementary drug in assisted reproductive technologies. MF administration shows positive effect on steroidogenesis and spermatogenesis in men with metabolic disorders, thus MF treatment indicates prospective use for improvement of male reproductive functions and fertility. MF lacks teratogenic effects and has positive health effect in newborns. The review is focused on use of MF therapy for restoration of female and male reproductive functions and improvement of pregnancy outcomes in metabolic and endocrine disorders. The mechanisms of MF action are discussed, including normalization of metabolic and hormonal status in PCOS, GDM, T2DM and metabolic syndrome and restoration of functional activity and hormonal regulation of the gonadal axis.
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Affiliation(s)
- Alexander O Shpakov
- I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences, 194223 Saint Petersburg, Russia
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Huang SJ, Wang HW, Wu HF, Wei QY, Luo S, Xu L, Guan HQ. Osteoprotegerin, interleukin and hepatocyte growth factor for prediction of diabetes and hypertension in the third trimester of pregnancy. World J Clin Cases 2020; 8:5529-5534. [PMID: 33344543 PMCID: PMC7716305 DOI: 10.12998/wjcc.v8.i22.5529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women. Screening and management of GDM and gestational hypertension (GH) in pregnancy helps to control and reduce these risks and prevent adverse effects on mothers and their fetuses. Currently, the majority criteria used for screening of diabetes mellitus is oral glucose tolerance tests, and blood pressure test is usually used for the screening and diagnosis of hypertension. However, these criteria might not anticipate or detect all GDM or GH cases. Therefore, new specific predictive and diagnostic tools should be evaluated for this population. This study selected three biomarkers of osteoprotegerin (OPG), interleukin (IL) and hepatocyte growth factor (HGF) for GDM and GH predication and diagnosis.
AIM To explore the feasibility of changes in placental and serum OPG, IL and HGF as tools for prediction and diagnosis of diabetes and hypertension in pregnant women.
METHODS From January 2018 to January 2019, 44 pregnant women with GDM and GH were selected as an observation group, and 44 healthy pregnant women were selected as a control group in the same period. Serum OPG, IL and HGF were compared between the two groups.
RESULTS The levels of OPG and HGF in the observation group were lower than in the control group, and the level of IL-1β was higher in the observation group than in the control group (all P < 0.05). Furthermore, OPG and HGF were negatively associated with gestational diabetes and gestational hypertension, while IL-1β was positively associated with GDM complicated with GH (all P < 0.05).
CONCLUSION The evaluation of serum OPG, HGF and IL-1β levels in patients with coexistent gestational diabetes complicated with hypertension can predict the degree of disease and play an important role in the follow-up treatment and prognosis prediction.
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Affiliation(s)
- Su-Jing Huang
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Hong-Wei Wang
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Hai-Fang Wu
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Qiu-Yuan Wei
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Shu Luo
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Lin Xu
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Hong-Qiong Guan
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
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Sun CC, Lai YN, Wang WH, Xu XM, Li XQ, Wang H, Zheng JY, Zheng JQ. Metformin Ameliorates Gestational Diabetes Mellitus-Induced Endothelial Dysfunction via Downregulation of p65 and Upregulation of Nrf2. Front Pharmacol 2020; 11:575390. [PMID: 33162888 PMCID: PMC7581851 DOI: 10.3389/fphar.2020.575390] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/07/2020] [Indexed: 01/14/2023] Open
Abstract
Gestational diabetes mellitus (GDM) causes oxidative stress in mothers and infants and causes vascular endothelial dysfunction, which is a key factor for maternal and fetal cardiovascular diseases in the later stage of GDM, seriously threatening the life and health of mothers and infants. Nowadays, metformin (MET) has been discovered to improve endothelial function, but studies regarding the mechanism of MET improving endothelial cell function and alleviating endothelial function under hyperglycemia are still extremely limited. We aimed to investigate whether MET exerts its protective role against hyperglycemia-induced endothelial dysfunction through p65 and Nrf2. In our studies, applying cell migration assay and tube formation assay, we observed an obvious improvement of endothelial function under MET-treated, as characterized by that MET accelerated GDM-attenuated migration and angiogenesis of HUVECs. And ELISA assay results uncovered that Nrf2 expression level was decreased in GDM placenta, HVUECs and maternal serum comparing with normal group, however activation Nrf2 largely ameliorated tube formation under hyperglycemic condition. Furthermore, MET elevated the Nrf2 expression level and the level of nuclear Nrf2 accumulation in hyperglycemic HUVECs. Besides, preliminary evidence predicted that Nrf2 expression was modulated by transcription factor p65, which was increased in GDM peripheral blood, placenta and HUVECs, and suppression of p65 could recover GDM-induced suppression of angiogenesis. In addition, we also confirmed MET restores the GDM-induced angiogenesis impairment may via downregulation of p65 and upregulation of Nrf2. Taken together, the endothelial protective effect of MET under GDM (HG) conditions could be partly attributed to its role in downregulating p65 and upregulating Nrf2.
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Affiliation(s)
- Cong Cong Sun
- Wenzhou Key Laboratory of Obstetrics and Gynecology, The Third Affiliated Clinical Institute of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
| | - Ya Nan Lai
- Wenzhou Key Laboratory of Obstetrics and Gynecology, The Third Affiliated Clinical Institute of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
| | - Wen Huan Wang
- Wenzhou Key Laboratory of Obstetrics and Gynecology, The Third Affiliated Clinical Institute of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
| | - Xiao Min Xu
- Wenzhou Key Laboratory of Obstetrics and Gynecology, The Third Affiliated Clinical Institute of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
| | - Xiao Qing Li
- Wenzhou Key Laboratory of Obstetrics and Gynecology, The Third Affiliated Clinical Institute of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
| | - Hai Wang
- Wenzhou Key Laboratory of Obstetrics and Gynecology, The Third Affiliated Clinical Institute of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
| | - Jia Yong Zheng
- Wenzhou Key Laboratory of Obstetrics and Gynecology, The Third Affiliated Clinical Institute of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
| | - Jian Qiong Zheng
- Department of Obstetrics and Gynecology, The Third Affiliated Clinical Institute of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
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