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Shen H, Chen D, Wang S, Jin Y, Cheng W. Effects of dietary fiber on maternal health in pregnant women with metabolic syndrome risk: a randomized controlled trial. Food Funct 2024; 15:6597-6609. [PMID: 38809131 DOI: 10.1039/d3fo05120j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Metabolic Syndrome (MetS) during pregnancy can lead to complications such as gestational diabetes mellitus (GDM) and hypertensive disorders. In this study, we sought to examine the influence of dietary fiber, from both food sources and soluble fiber supplementation, on the metabolic health and overall pregnancy outcomes of women at high risk of MetS. We conducted a randomized controlled trial involving 376 women between 11 and 13 weeks of gestation. To evaluate dietary fiber intake, we performed an exhaustive dietary component analysis using a food frequency questionnaire. Additionally, the participants in the intervention group received daily soluble fiber supplements until delivery. All participants underwent nutritional consultations and metabolic health assessments at three distinct stages of pregnancy (GW 11-13, GW 24-26, and GW 32-34). Our findings revealed a significant correlation between insufficient dietary fiber intake and an increased risk of GDM, even after adjusting for variables such as maternal age and pre-pregnancy BMI. We also noted that a high total dietary fiber intake was associated with reduced changes in triglyceride levels. In addition, the intervention group showed lower need for constipation medication, and soluble fiber supplementation may offer potential benefits for GDM patients. Importantly, our study verified the safety of long-term soluble fiber supplementation during pregnancy. Our results underscore the importance of adequate fiber intake, particularly from dietary sources, for the metabolic health of pregnant women. Moreover, our findings suggest that early fiber supplementation may benefit pregnant women experiencing constipation or those diagnosed with GDM.
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Affiliation(s)
- Hong Shen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
| | - Dan Chen
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuying Wang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
| | - Yan Jin
- Nutrition Department, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Cheng
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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Jayasinghe IU, Agampodi TC, Dissanayake AK, Agampodi SB. Early pregnancy metabolic syndrome and risk for adverse pregnancy outcomes: findings from Rajarata Pregnancy Cohort (RaPCo) in Sri Lanka. BMC Pregnancy Childbirth 2023; 23:231. [PMID: 37020187 PMCID: PMC10074348 DOI: 10.1186/s12884-023-05548-y] [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: 10/27/2022] [Accepted: 03/25/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Despite the intergenerational effects of metabolic disorders, evidence is greatly lacking on early pregnancy metabolic syndrome (MetS) and its effects on pregnancy outcomes from low- and middle-income countries. Thus, this prospective cohort of South Asian pregnant women aimed to evaluate how early pregnancy MetS would affect pregnancy outcomes. METHODS A prospective cohort study was conducted among first-trimester (T1) pregnant women of Anuradhapura district, Sri Lanka recruited to the Rajarata Pregnancy Cohort in 2019. MetS was diagnosed by the Joint Interim Statement criteria before 13 weeks of gestational age (GA). Participants were followed up until their delivery, and the major outcomes measured were large for gestational age (LGA), small for gestational age (SGA), preterm birth (PTB) and miscarriage (MC). Gestational weight gain, gestational age at delivery and neonatal birth weight were used as measurements to define the outcomes. Additionally, outcome measures were re-assessed with adjusting fasting plasma glucose (FPG) thresholds of MetS to be compatible with hyperglycemia in pregnancy (Revised MetS). RESULTS 2326 T1 pregnant women with a mean age of 28.1 years (SD-5.4), and a median GA of 8.0 weeks (IQR-2) were included. Baseline MetS prevalence was 5.9% (n = 137, 95%CI-5.0-6.9). Only 2027 (87.1%) women from baseline, had a live singleton birth, while 221(9.5%) had MC and 14(0.6%) had other pregnancy losses. Additionally, 64(2.8%) were lost to follow-up. A higher cumulative incidence of LGA, PTB, and MC was noted among the T1-MetS women. T1-MetS carried significant risk (RR-2.59, 95%CI-1.65-3.93) for LGA, but reduced the risk for SGA (RR-0.41, 95%CI-0.29-0.78). Revised MetS moderately increased the risk for PTB (RR-1.54, 95%CI-1.04-2.21). T1-MetS was not associated (p = 0.48) with MC. Lowered FPG thresholds were significantly associated with risk for all major pregnancy outcomes. After adjusting for sociodemographic and anthropometric confounders, revised MetS remained the only significant risk predictor for LGA. CONCLUSION Pregnant women with T1 MetS in this population are at an increased risk for LGA and PTB and a reduced risk for SGA. We observed that a revised MetS definition with lower threshold for FPG compatible with GDM would provide a better estimation of MetS in pregnancy in relation to predicting LGA.
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Affiliation(s)
- Imasha Upulini Jayasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
| | - Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Ajith Kumara Dissanayake
- Department of Gynaecology and Obstetrics, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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First Trimester Evaluation of Maternal Visceral Fat and Its Relationship with Adverse Pregnancy Outcomes. BIOLOGY 2023; 12:biology12020144. [PMID: 36829423 PMCID: PMC9953059 DOI: 10.3390/biology12020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
Obese women are more likely to experience pregnancy complications. The distribution of fat, and more particularly the rise in visceral fat, is well established to be more closely linked to the onset of cardiovascular disease and metabolic syndrome than obesity itself. We aim to examine the relationship between maternal visceral fat assessment in the first trimester and the appearance of adverse pregnancy outcomes. A prospective cohort study including 416 pregnant women was conducted. During the first trimester scan (11-13 + 6 weeks), all individuals had their visceral fat and subcutaneous thicknesses measured by ultrasonography. Blood samples were obtained, and maternal demographics and clinical information were documented. After delivery, the obstetric outcomes were evaluated. We contrasted two groups: one with healthy pregnancies and the other with adverse pregnancy outcomes (APO), defined as the development of at least one of the following complications: gestational diabetes mellitus, hypertensive disorders of pregnancy, abnormal fetal growth, preterm delivery or preterm premature rupture of membranes. Median maternal age was 33 and 34 years old for the uncomplicated and adverse pregnancy outcomes groups, respectively. We found that women with adverse pregnancy outcomes had higher VFT (median 30 vs. 26.5 mm, p = 0.001) and SFT (median 18.9 vs. 17.1 mm, p = 0.03). However, the visceral/subcutaneous fat ratio was not statistically different between groups. Finally, we performed a subanalysis for metabolic and placental vascular dysfunction complications. After performing a multivariate logistic regression analysis adjusted for maternal age, smoking, and mean arterial pressure, both the VFT (aOR 1.03, p < 0.001) and the ratio of visceral/subcutaneous fat (aOR 1.37, p = 0.04) were significantly associated with the development of adverse pregnancy outcomes; however, the associations of VFT and the VFT-to-SFT ratio were higher for the occurrence of gestational diabetes (aOR 1.07, p < 0.001; aOR 2.09, p = 0.001; respectively) and showed no relationships with placental complications. When conducting a first-trimester ultrasound assessment, sonographers may measure VFT without additional time or cost involved. Identification of pregnant women with increased VFT (>37 mm) may benefit from a close follow-up, especially for the development of gestational diabetes, independent of BMI.
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Abascal-Saiz A, Duque-Alcorta M, Fioravantti V, Antolín E, Fuente-Luelmo E, Haro M, Ramos-Álvarez MP, Perdomo G, Bartha JL. The Relationship between Angiogenic Factors and Energy Metabolism in Preeclampsia. Nutrients 2022; 14:2172. [PMID: 35631313 PMCID: PMC9145768 DOI: 10.3390/nu14102172] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
Antiangiogenic factors are currently used for the prediction of preeclampsia. The present study aimed to evaluate the relationship between antiangiogenic factors and lipid and carbohydrate metabolism in maternal plasma and placenta. We analyzed 56 pregnant women, 30 healthy and 26 with preeclampsia (including early and late onset). We compared antiangiogenic factors soluble Fms-like Tyrosine Kinase-1 (sfLt-1), placental growth factor (PlGF), and soluble endoglin (sEng)), lipid and carbohydrate metabolism in maternal plasma, and lipid metabolism in the placenta from assays of fatty acid oxidation, fatty acid esterification, and triglyceride levels in all groups. Antiangiogenic factors sFlt-1, sFlt-1/PlGF ratio, and sEng showed a positive correlation with triglyceride, free fatty acid, and C-peptide maternal serum levels. However, there was no relationship between angiogenic factors and placental lipid metabolism parameters. Free fatty acids were predictive of elevated sFlt-1 and sEng, while C-peptide was predictive of an elevated sFlt1/PlGF ratio. The findings in this study generate a model to predict elevated antiangiogenic factor values and the relationship between them with different products of lipid and carbohydrate metabolism in maternal serum and placenta in preeclampsia.
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Affiliation(s)
- Alejandra Abascal-Saiz
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain; (A.A.-S.); (E.A.)
| | - Marta Duque-Alcorta
- Department of Clinical Chemistry, La Paz University Hospital, 28046 Madrid, Spain;
| | - Victoria Fioravantti
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesus, 28009 Madrid, Spain;
| | - Eugenia Antolín
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain; (A.A.-S.); (E.A.)
| | - Eva Fuente-Luelmo
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, CEU-San Pablo University, 28668 Madrid, Spain; (E.F.-L.); (M.H.); (M.P.R.-Á.)
| | - María Haro
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, CEU-San Pablo University, 28668 Madrid, Spain; (E.F.-L.); (M.H.); (M.P.R.-Á.)
| | - María P. Ramos-Álvarez
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, CEU-San Pablo University, 28668 Madrid, Spain; (E.F.-L.); (M.H.); (M.P.R.-Á.)
| | - Germán Perdomo
- Unidad de Excelencia Instituto de Biología y Genética Molecular, University of Valladolid-CSIC, 47003 Valladolid, Spain;
| | - José L. Bartha
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain; (A.A.-S.); (E.A.)
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Contreras-Duarte S, Claudette C, Farias M, Leiva A. High total cholesterol and triglycerides levels increase arginases metabolism, impairing nitric oxide signaling and worsening fetoplacental endothelial dysfunction in gestational diabetes mellitus pregnancies. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166216. [PMID: 34314821 DOI: 10.1016/j.bbadis.2021.166216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 12/23/2022]
Abstract
During human pregnancy, maternal physiological dyslipidemia (MPD) supports fetal development. However, some women develop maternal supraphysiological dyslipidemia (MSPD: increased total cholesterol (TC) and triglycerides (TG) levels). MSPD is present in normal and pregnancies with gestational diabetes mellitus (GDM). Both pathologies associate with fetoplacental endothelial dysfunction, producing alterations in nitric oxide (NO)-L-arginine/arginase metabolism. Nevertheless, the effect of MSPD on GDM, and how this synergy alters fetoplacental endothelial function is unknown, which is the aim of this study. 123 women at term of pregnancy were classified as MPD (n=40), MSPD (n=35), GDM with normal lipids (GDM- MPD, n=23) and with increased lipids (GDM-MSPD, n=25). TC ≥291 mg/dL and TG ≥275 mg/dL were considered as MSPD. Endothelial NO synthase (eNOS), human cationic amino acid transporter 1 (hCat1), and arginase II protein abundance and activity, were assayed in umbilical vein endothelial cells. In MSPD and MSPD-GDM, TC and TG increased respect to MPD and MPD-GDM. eNOS activity was reduced in MSPD and MSPD-GDM, but increased in MPD-GDM compared with MPD. No changes were observed in eNOS protein. However, decreased tetrahydrobiopterin levels were observed in all groups compared with MPD. Increased hCat1 protein and L-arginine transport were observed in both GDM groups compared with MPD. However, the transport was higher in GDM-MSPD compared to GDM-MPD. Higher Arginase II protein and activity were observed in MSPD-GDM compared with MPD. Thus, MSPD in GDM pregnancies alters fetal endothelial function associated with NO metabolism.
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Affiliation(s)
- S Contreras-Duarte
- School of Medical Technology, Health Sciences Faculty, Universidad San Sebastian, Santiago 7510156, Chile.
| | - C Claudette
- School of Medical Technology, Health Sciences Faculty, Universidad San Sebastian, Santiago 7510156, Chile
| | - M Farias
- School of Medical Technology, Health Sciences Faculty, Universidad San Sebastian, Santiago 7510156, Chile
| | - A Leiva
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
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Jia XJ, Wang JX, Bai LW, Hua TS, Han ZH, Lu Q. The relationship between hypertriglyceridemic waist circumference phenotype and gestational diabetes mellitus. Gynecol Endocrinol 2021; 37:328-331. [PMID: 33487087 DOI: 10.1080/09513590.2021.1875428] [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] [Indexed: 01/21/2023] Open
Abstract
AIMS To investigate the correlation between hypertriglyceridemic waist circumference (HTWC) phenotype and gestational diabetes mellitus (GDM). METHODS A total of 1083 patients with gestational age ≤8 weeks were divided into four groups: normal triglyceride and waist circumference group (group A, n = 575), simple abdominal obesity group (group B, n = 317), simple high triglyceride group (group C, n = 125), and HTWC group (group D, n = 66). General information and serum biochemical indicators were measured and recorded. Analysis of variance (ANOVA) and logistic regression analysis were used to evaluate the relationship between HTWC with GDM. RESULTS The prevalence of GDM in the HTWC group was significantly greater than in the other three groups. After adjustment by multivariate logistic regression analysis, the proportion of GDM in the HTWC group was 1.753 times higher than in group A. CONCLUSION These findings suggest that there is a significant correlation between HTWC phenotype and GDM, indicating that the HTWC phenotype could be applied as a simple marker for identifying GDM risk factors.
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Affiliation(s)
- Xiao-Jiao Jia
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Jia-Xin Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Li-Wei Bai
- The Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Tian-Shu Hua
- The Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Zhong-Hou Han
- The Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Qiang Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
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Rodrigues IC, Grandi C, Simões VMF, Batista RFL, Rodrigues LS, Cardoso VC. Metabolic profile during pregnancy in BRISA birth cohorts of Ribeirão Preto and São Luís, Brazil. ACTA ACUST UNITED AC 2020; 54:e10253. [PMID: 33295536 PMCID: PMC7727101 DOI: 10.1590/1414-431x202010253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
During pregnancy, metabolic changes that develop in women may increase the risk of diseases and conditions that may also harm the life of the growing fetus. The aim of the present study was to identify and compare the metabolic profile (MP) during pregnancy in two birth cohorts in 2010 in the cities of Ribeirão Preto (RP) and São Luís (SL), Brazil. Pregnant women (1393 in RP and 1413 in SL) were studied; information was obtained through questionnaires in addition to anthropometric, biochemical, and blood pressure measurements. Data are presented as means and proportions. To compare the characteristics of pregnant women in both cities, chi-squared and Student's t-tests were applied, with 5% significance level. Ribeirão Preto presented higher mean values than SL for pre-gestational body mass index (24.5 vs 23 kg/m2, P<0.001), systolic (108.4 vs 102.8 mmHg, P<0.001) and diastolic (65.9 vs 61.8 mmHg, P<0.001) blood pressure, total cholesterol (226.3 vs 213.7 mg/dL, P<0.001) and fractions, and glycemia (84.5 vs 80.2 mg/dL, P<0.001), except for triglycerides (P=0.135). Women from RP also showed higher rates of pre-gestational overweight and obesity compared with SL (40.1 vs 25.8%). In the present study, pregnant women in RP had a worse gestational metabolic profile than those in SL, with higher pre-gestational excess weight, indicating that nutritional transition was more advanced in the more developed city.
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Affiliation(s)
- I C Rodrigues
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C Grandi
- Argentine Society of Pediatrics, Buenos Aires, Argentina
| | - V M F Simões
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - R F L Batista
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - L S Rodrigues
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V C Cardoso
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Vernini JM, Nicolosi BF, Arantes MA, Costa RA, Magalhães CG, Corrente JE, Lima SAM, Rudge MV, Calderon IM. Metabolic syndrome markers and risk of hyperglycemia in pregnancy: a cross-sectional cohort study. Sci Rep 2020; 10:21042. [PMID: 33273522 PMCID: PMC7713292 DOI: 10.1038/s41598-020-78099-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/29/2020] [Indexed: 12/03/2022] Open
Abstract
The aim was to assess the role of Metabolic Syndrome (MetS) diagnostic markers, recommended by three different guidelines, in the prediction of hyperglycemia in pregnancy. This cross-sectional cohort study included 506 non-diabetic women, with a singleton pregnancy, who underwent a diagnostic test for hyperglycemia at 24-28 weeks. Clinical, anthropometric, and laboratory data were obtained. The relationship between MetS markers and the risk of hyperglycemia was evaluated by backward stepwise logistic regression analysis (OR, 95% CI). The limit of statistical significance was 95% (p < 0.05). Triglycerides (TG) ≥ 150 mg/dL, blood pressure (BP) ≥ 130/85 mmHg, fasting glucose (FG) ≥ 100 mg/dL, and waist circumference (WC) > 88 cm were identified as independent risk factors for hyperglycemia in pregnancy. These results might help the selective screening of hyperglycemia in pregnancy.
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Affiliation(s)
- Joice M Vernini
- Graduate Program in Obstetrics, Gynecology and Mastology, Botucatu Medical School, São Paulo State University/Unesp, São Paulo, Brazil
| | - Bianca F Nicolosi
- Graduate Program in Obstetrics, Gynecology and Mastology, Botucatu Medical School, São Paulo State University/Unesp, São Paulo, Brazil
| | - Mariana A Arantes
- Graduate Program in Obstetrics, Gynecology and Mastology, Botucatu Medical School, São Paulo State University/Unesp, São Paulo, Brazil
| | - Roberto A Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/Unesp, Botucatu, SP, Brazil
| | - Claudia G Magalhães
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/Unesp, Botucatu, SP, Brazil
| | - José E Corrente
- Department of Biostatistics, Botucatu Institute of Biosciences, São Paulo State University/Unesp, São Paulo, Brazil
| | - Silvana A M Lima
- Department of Nursing, Botucatu Medical School, São Paulo State University/Unesp, São Paulo, Brazil
| | - Marilza V Rudge
- Graduate Program in Obstetrics, Gynecology and Mastology, Botucatu Medical School, São Paulo State University/Unesp, São Paulo, Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/Unesp, Botucatu, SP, Brazil
| | - Iracema M Calderon
- Graduate Program in Obstetrics, Gynecology and Mastology, Botucatu Medical School, São Paulo State University/Unesp, São Paulo, Brazil.
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/Unesp, Botucatu, SP, Brazil.
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Mohsenzadeh-Ledari F, Taghizadeh Z, Keramat A, Moosazadeh M, Yazdani S, Najafi A, Motaghi Z. The effect of caring intervention (physical activity, diet and counseling) on gestational diabetes for pregnant women with metabolic syndrome. J Matern Fetal Neonatal Med 2020; 35:4168-4174. [PMID: 33243041 DOI: 10.1080/14767058.2020.1849088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Metabolic syndrome and its indexes is one of the critical health problems during pregnancy. This study aimed to examine the effects of a care intervention program on pregnancy outcome in pregnant women with Metabolic Syndrome during 2017-2018. METHODS This randomized clinical trial study was conducted in 120 singleton pregnant women with metabolic syndrome. The participants were selected using purposive sampling method from pregnant women referred to two health centers of Babol. They were randomly divided in two control and intervention groups (60 samples in each group). Intervention group received one motivational interview session for 120 min, two consultation sessions with expert for nutritional recommendations based on Nutrition Guidelines of Ministry of Health for Pregnant Women. They were also theoretically and practically provided by three training sessions for physical activity and pregnancy exercises combining pelvic floor muscles, bodybuilding, muscle strengthening, stretching, and relaxation and walking activities. To follow up on the intervention, the researcher made a phone call with the participants in intervention group every 10 days to two weeks. Pregnancy outcomes were assessed using SPSS software. RESULTS The obtained results showed that there was a significant difference between the two groups in maternal complications including gestational diabetes, hospitalization due to gestational diabetes, nutritional diet for gestational diabetes, pregnancy weight gain and 2-hour post-prandial blood glucose test (p ≤ .01). There was no significant difference in terms of demographic, midwifery and metabolic syndrome indices between the intervention and control groups. CONCLUSION The results of the study indicated that intervention program improved the maternal pregnancy outcome such as gestational diabetes and weight gain during the pregnancy in the intervention group. This program had no adverse effects for the mother who is consistent with pregnancy health objectives.
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Affiliation(s)
- Farideh Mohsenzadeh-Ledari
- Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ziba Taghizadeh
- Faculty Member of Nursing and Midwifery Research care Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Keramat
- Department of Midwifery and Reproductive Health School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research center, Addiction Institute Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahla Yazdani
- Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Najafi
- Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zahra Motaghi
- Department of Midwifery and Reproductive Health School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Are maternal metabolic syndrome and lipid profile associated with preterm delivery and preterm premature rupture of membranes? Arch Gynecol Obstet 2020; 303:113-119. [PMID: 32803396 DOI: 10.1007/s00404-020-05738-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
AIM We aimed to evaluate the association of metabolic syndrome (MetS), its components and lipid profile in mid-pregnancy with preterm delivery and preterm premature rupture of membranes (PPROM). METHODS This prospective cohort study was conducted on 203 pregnant women between 24 and 28 weeks of gestation, undergoing gestational diabetes screening test with 50 g glucose challenge test (GCT). Fasting serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels were measured during the week after GCT assessment. Information on the participants' pre-pregnancy weight, demographic/reproductive characteristics, and height and blood pressure (BP) measurements were documented at baseline entry into the study. Metabolic syndrome was defined as the co-existence of 3 or more of the following criteria: Body mass index (BMI) before pregnancy ≥ 30 kg/m2, BP ≥ 130/85 mmHg, GCT ≥ 140 mg/dl, TG ≥ 150 mg/dl, and HDL-C ≤ 50 mg/dl. All participants were followed through routine prenatal care, up to delivery. Any deliveries or rupture of membranes of less than 37 weeks of pregnancy were considered preterm delivery and PPROM, respectively. Statistical analysis was performed by SPSS V.20, and p value of less than 0.05 was considered significant. FINDINGS MetS was detected in 10 (4.9%) of participants. Logistic regression analysis showed HDL-C levels, and hypertension were associated with spontaneous preterm delivery [(OR 0.952, 95% CI 0.910-0.995), (OR 1.629, 95% CI 1.554-1.709) respectively], but no statistically significant results were found for PPROM. CONCLUSIONS Low HDL-C levels and hypertension in mid-pregnancy are associated with the occurrence of spontaneous preterm deliveries, indicating that MetS and its components should be monitored more closely in pregnancy.
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Osoti AO, Page ST, Richardson BA, Guthrie BL, Kinuthia J, Polyak SJ, Farquhar C. Postpartum metabolic syndrome after gestational hypertension and preeclampsia, a prospective cohort study. Pregnancy Hypertens 2019; 18:35-41. [PMID: 31493627 PMCID: PMC6884686 DOI: 10.1016/j.preghy.2019.08.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/29/2019] [Accepted: 08/17/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We evaluated the 6-month postpartum risk of metabolic syndrome (MetS), a marker of future cardiovascular disease (CVD) risk, comparing women whose most recent pregnancies were complicated with gestational hypertension (GH) or preeclampsia (PE) versus those who had normotensive pregnancies. STUDY DESIGN This was a prospective cohort study in which women with GH or PE and normotensive women were actively enrolled during the first 12 weeks after delivery in Nairobi, Kenya. Participants were interviewed, blood pressures and anthropometric measurements including waist circumference obtained at enrollment and 6 months postpartum. Fasting lipid profile and plasma glucose were measured at 6 months postpartum. A generalized linear regression model with Poisson distribution was used to estimate crude relative risk (RR) of 6-month postpartum MetS and adjusted RR (ARR) after adjusting for apriori potential confounders. RESULTS Among 194 postpartum women, 63 (32%) had experienced GH or PE. Prevalence of MetS at 6 months postpartum was higher among women whose pregnancies were complicated with GH or PE (34.9%) compared to those who were normotensive (11.5%). GH and PE were associated with a 3-fold or greater risk of MetS (ARR) 3.01; 95% Confidence interval [CI] 1.58, 5.71; p < 0.001) overall and three of the five components, namely hypertension (ARR 3.35 [2.04, 5.51], p < 0.001), hypertriglyceridemia (ARR 3.25 [1.16-9.10], p = 0.01), and fasting hyperglycemia (ARR 6.20 [1.07-35.76], p = 0.03), compared to having normal blood pressures during pregnancy. CONCLUSION At 6 months postpartum, GH and PE were associated with three-fold or higher risk of MetS and especially hypertension, fasting hypertriglyceridemia, and fasting hyperglycemia.
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Affiliation(s)
- Alfred O Osoti
- Department of Epidemiology, University of Washington, Seattle, USA; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
| | - Stephanie T Page
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Diabetes Institute, University of Washington, Seattle, USA
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA; Vaccine and Infectious Disease Division, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Brandon L Guthrie
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, USA; Department of Research and Programs and Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Stephen J Polyak
- Department of Laboratory Medicine, University of Washington, Seattle, USA
| | - Carey Farquhar
- Department of Epidemiology, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA; Department of Medicine (Allergy and Infectious Diseases), University of Washington, Seattle, USA
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12
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Misitzis A, Cunha PR, Kroumpouzos G. Skin disease related to metabolic syndrome in women. Int J Womens Dermatol 2019; 5:205-212. [PMID: 31700973 PMCID: PMC6831757 DOI: 10.1016/j.ijwd.2019.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
Sex hormones are involved in pathways of metabolic syndrome (MetS), an observation supported by animal studies. The relationships of sex hormones with components of MetS, such as insulin resistance and dyslipidemia, have been studied in pre- and postmenopausal women. High testosterone, low sex hormone-binding globulin, and low estrogen levels increase the risks of MetS and type 2 diabetes in women. Cutaneous diseases that are sex hormone mediated, such as polycystic ovary syndrome, acanthosis nigricans, acne vulgaris, and pattern alopecia, have been associated with insulin resistance and increased risk for MetS. Furthermore, inflammatory skin conditions, such as hidradenitis suppurativa and psoriasis, increase the risk for MetS. Patients with such skin conditions should be followed for metabolic complications, and early lifestyle interventions toward these populations may be warranted.
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Affiliation(s)
- Angelica Misitzis
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paulo R Cunha
- Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts
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13
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Narvaez-Sanchez R, Calderón JC, Vega G, Trillos MC, Ospina S. Skeletal muscle as a protagonist in the pregnancy metabolic syndrome. Med Hypotheses 2019; 126:26-37. [PMID: 31010495 DOI: 10.1016/j.mehy.2019.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
The pregnant woman normally shows clinical manifestations similar to a metabolic syndrome (MS), due to her metabolic and hemodynamic adaptations in order to share nutrients with the child. If those adjustments are surpassed, a kind of pregnancy MS (PregMS) could appear, characterized by excessive insulin resistance and vascular maladaptation. Skeletal muscle (SKM) must be a protagonist in the PregMS: SKM strength and mass have been associated inversely with MS incidence in non-pregnant patients, and in pregnant women muscular activity modulates metabolic and vascular adaptations that favor better outcomes. Of note, a sedentary lifestyle affects exactly in the other way. Those effects may be explained not only by the old paradigm of SKM being a great energy consumer and store, but because it is an endocrine organ whose chronic activity or deconditioning correspondingly releases myokines modulating insulin sensitivity and cardiovascular adaptation, by direct or indirect mechanisms not well understood. In this document, we present evidence to support the concept of a PregMS and hypothesize on the role of the SKM mass, fiber types composition and myokines in its pathophysiology. Also, we discuss some exercise interventions in pregnancy as a way to test our hypotheses.
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Affiliation(s)
- Raul Narvaez-Sanchez
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Red iberoamericana de trastornos vasculares y del embarazo, RIVATREM, Colombia.
| | - Juan C Calderón
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Gloria Vega
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Maria Camila Trillos
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Sara Ospina
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
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14
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Mohsenzadeh-ledari F, Taghizadeh Z, Motaghi Z, Keramat A, Moosazadeh M, Najafi A. Appropriate Interventions for Pregnant Women with Indicators of Metabolic Syndrome on Pregnancy Outcomes: A Systematic Review. Int J Prev Med 2019; 10:2. [PMID: 30774836 PMCID: PMC6360852 DOI: 10.4103/ijpvm.ijpvm_46_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 10/07/2018] [Indexed: 11/04/2022] Open
Abstract
Metabolic syndrome (MetS), a series of symptoms, including abdominal obesity, impaired glucose tolerance and insulin metabolism, hypertension, and dyslipidemia, is considered as the risk of developing cardiovascular disease and diabetes that can predispose a pregnant women to serious health problem, women in the developed as well as the developing countries. This study was aimed to investigate the effects of appropriate interventions on pregnant women with indicators of MetS to further improve the outcome of pregnancy. This systematic review was performed to extract articles of randomized controlled trials (RCT) on pregnant women with indicators of (MetS) and focusing on physical activity, dietary or lifestyle interventions on maternal health or perinatal outcomes, with searching in the Web of Science, PubMed, CDSR, Scopus, and Google Scholar were investigated. Two researchers independently evaluated the quality of the studies, being presented in all the articles and ranked the studies as high/low quality; the level of evidence was based on the number of high-quality studies and the coordination of the obtained results. Then, 17 articles, which met the inclusion criteria, were selected; among these, 7 articles studied the physical activity, 3 articles reviewed diets, 6 probed the lifestyle interventions, and 1 article was on counseling. In general, evidence suggested how the physical activity and proper diet impacts on proper weight gain during pregnancy, prevents maternal complications, and improves the outcome of pregnancy. According to the results of this systematic review, proper interventions during pregnancy can have a positive effect on maternal weight gain and the general health condition of pregnant women with indicators of MetS.
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Affiliation(s)
- Farideh Mohsenzadeh-ledari
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ziba Taghizadeh
- Faculty Member of Nursing and Midwifery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Motaghi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Reproductive Studies and Women's Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Najafi
- Shahroud University of Medical Sciences, Shahroud, Iran
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15
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Bhat PV, Vinod V, Priyanka AN, Kamath A. Maternal serum lipid levels, oxidative stress and antioxidant activity in pre-eclampsia patients from Southwest India. Pregnancy Hypertens 2018; 15:130-133. [PMID: 30825910 DOI: 10.1016/j.preghy.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/11/2018] [Accepted: 12/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A study was carried out to evaluate the effects of metabolic syndrome components and oxidative stress factors among preeclamptic women from South West India. STUDY DESIGN A case-control study was carried out by enrolling fifty pre-eclampsia cases and hundred low-risk pregnant women within the age group of 18-40 years, at 28-34 weeks of pregnancy. The fasting glucose level, fasting insulin level, insulin resistance, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), malondialdehyde, the ferric reducing ability of plasma (FRAP assay), cardiac output and aortic wall distensibility were measured. MAIN OUTCOME MEASURES There was a significant rise in the fasting blood glucose, fasting insulin, insulin resistance levels, total cholesterol, triglycerides, LDL, and antioxidant levels in pre-eclamptic women (p < 0.001). The cardiac output and aortic wall distensibility were observed to be low in the cases. CONCLUSION We conclude that abnormal lipid metabolism and high lipid peroxide concentrations observed in pre-eclampsia may result in oxidative stress and vascular dysfunction.
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Affiliation(s)
- Parvati V Bhat
- Department of Obstetrics and Gynecology, Dr T M A Pai Hospital, MMMC, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Vinutha Vinod
- Dr T M A Pai Hospital, MMMC, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Alluri Naga Priyanka
- Department of Obstetrics and Gynecology, Dr T M A Pai Hospital, MMMC, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
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16
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Contreras-Duarte S, Carvajal L, Fuenzalida B, Cantin C, Sobrevia L, Leiva A. Maternal Dyslipidaemia in Pregnancy with Gestational Diabetes Mellitus: Possible Impact on Foetoplacental Vascular Function and Lipoproteins in the Neonatal Circulation. Curr Vasc Pharmacol 2018; 17:52-71. [DOI: 10.2174/1570161115666171116154247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 01/06/2023]
Abstract
Dyslipidaemia occurs in pregnancy to secure foetal development. The mother shows a physiological
increase in plasma total cholesterol and Triglycerides (TG) as pregnancy progresses (i.e. maternal
physiological dyslipidaemia in pregnancy). However, in some women pregnancy-associated dyslipidaemia
exceeds this physiological adaptation. The consequences of this condition on the developing
fetus include endothelial dysfunction of the foetoplacental vasculature and development of foetal aortic
atherosclerosis. Gestational Diabetes Mellitus (GDM) associates with abnormal function of the foetoplacental
vasculature due to foetal hyperglycaemia and hyperinsulinaemia, and associates with development
of cardiovascular disease in adulthood. Supraphysiological dyslipidaemia is also detected in
GDM pregnancies. Although there are several studies showing the alteration in the maternal and neonatal
lipid profile in GDM pregnancies, there are no studies addressing the effect of dyslipidaemia in the
maternal and foetal vasculature. The literature reviewed suggests that dyslipidaemia in GDM pregnancy
should be an additional factor contributing to worsen GDM-associated endothelial dysfunction by altering
signalling pathways involving nitric oxide bioavailability and neonatal lipoproteins.
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Affiliation(s)
- Susana Contreras-Duarte
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile
| | - Lorena Carvajal
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile
| | - Bárbara Fuenzalida
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile
| | - Claudette Cantin
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile
| | - Andrea Leiva
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile
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17
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Jamilian M, Samimi M, Afshar Ebrahimi F, Aghadavod E, Mohammadbeigi R, Rahimi M, Asemi Z. Effects of Selenium Supplementation on Gene Expression Levels of Inflammatory Cytokines and Vascular Endothelial Growth Factor in Patients with Gestational Diabetes. Biol Trace Elem Res 2018; 181:199-206. [PMID: 28528475 DOI: 10.1007/s12011-017-1045-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
Abstract
Selenium is known to exert multiple beneficial effects including anti-inflammatory actions. The aim of the study was to evaluate the effects of selenium supplementation on gene expression levels of inflammatory cytokines and vascular endothelial growth factor (VEGF) in women with gestational diabetes (GDM). This randomized double-blind, placebo-controlled trial was carried out among 40 subjects diagnosed with GDM aged 18-40 years old. Subjects were randomly allocated into two groups to receive either 200 μg/day selenium supplements (n = 20) or placebo (n = 20) for 6 weeks. Gene expression of inflammatory cytokines and VEGF were assessed in lymphocytes of GDM women with RT-PCR method. Results of RT-PCR indicated that after the 6-week intervention, compared with the placebo, selenium supplementation downregulated gene expression of tumor necrosis factor alpha (TNF-α) (P = 0.02) and transforming growth factor beta (TGF-β) (P = 0.01), and upregulated gene expression of VEGF (P = 0.03) in lymphocytes of patients with GDM. There was no statistically significant change following supplementation with selenium on gene expression of interleukin (IL)-1β and IL-8 in lymphocytes of subjects with GDM. Selenium supplementation for 6 weeks in women with GDM significantly decreased gene expression of TNF-α and TGF-β, and significantly increased gene expression of VEGF, but did not affect gene expression of IL-1β and IL-8. Clinical trial registration number http://www.irct.ir : IRCT201612045623N95.
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Affiliation(s)
- Mehri Jamilian
- Endocrinology and Metabolism Research Center, Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mansooreh Samimi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Faraneh Afshar Ebrahimi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Esmat Aghadavod
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, IR, Iran
| | - Robabeh Mohammadbeigi
- Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Rahimi
- Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, IR, Iran.
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18
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Leitner M, Fragner L, Danner S, Holeschofsky N, Leitner K, Tischler S, Doerfler H, Bachmann G, Sun X, Jaeger W, Kautzky-Willer A, Weckwerth W. Combined Metabolomic Analysis of Plasma and Urine Reveals AHBA, Tryptophan and Serotonin Metabolism as Potential Risk Factors in Gestational Diabetes Mellitus (GDM). Front Mol Biosci 2017; 4:84. [PMID: 29312952 PMCID: PMC5742855 DOI: 10.3389/fmolb.2017.00084] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022] Open
Abstract
Gestational diabetes mellitus during pregnancy has severe implications for the health of the mother and the fetus. Therefore, early prediction and an understanding of the physiology are an important part of prenatal care. Metabolite profiling is a long established method for the analysis and prediction of metabolic diseases. Here, we applied untargeted and targeted metabolomic protocols to analyze plasma and urine samples of pregnant women with and without GDM. Univariate and multivariate statistical analyses of metabolomic profiles revealed markers such as 2-hydroxybutanoic acid (AHBA), 3-hydroxybutanoic acid (BHBA), amino acids valine and alanine, the glucose-alanine-cycle, but also plant-derived compounds like sitosterin as different between control and GDM patients. PLS-DA and VIP analysis revealed tryptophan as a strong variable separating control and GDM. As tryptophan is biotransformed to serotonin we hypothesized whether serotonin metabolism might also be altered in GDM. To test this hypothesis we applied a method for the analysis of serotonin, metabolic intermediates and dopamine in urine by stable isotope dilution direct infusion electrospray ionization mass spectrometry (SID-MS). Indeed, serotonin and related metabolites differ significantly between control and GDM patients confirming the involvement of serotonin metabolism in GDM. Clustered correlation coefficient visualization of metabolite correlation networks revealed the different metabolic signatures between control and GDM patients. Eventually, the combination of selected blood plasma and urine sample metabolites improved the AUC prediction accuracy to 0.99. The detected GDM candidate biomarkers and the related systemic metabolic signatures are discussed in their pathophysiological context. Further studies with larger cohorts are necessary to underpin these observations.
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Affiliation(s)
- Miriam Leitner
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lena Fragner
- Department of Ecogenomics and Systems Biology, University of Vienna, Vienna, Austria.,Vienna Metabolomics Center, University of Vienna, Vienna, Austria
| | - Sarah Danner
- Department of Ecogenomics and Systems Biology, University of Vienna, Vienna, Austria
| | | | - Karoline Leitner
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Sonja Tischler
- Department of Ecogenomics and Systems Biology, University of Vienna, Vienna, Austria.,Vienna Metabolomics Center, University of Vienna, Vienna, Austria
| | - Hannes Doerfler
- Department of Ecogenomics and Systems Biology, University of Vienna, Vienna, Austria
| | - Gert Bachmann
- Department of Ecogenomics and Systems Biology, University of Vienna, Vienna, Austria
| | - Xiaoliang Sun
- Department of Ecogenomics and Systems Biology, University of Vienna, Vienna, Austria.,Vienna Metabolomics Center, University of Vienna, Vienna, Austria
| | - Walter Jaeger
- Vienna Metabolomics Center, University of Vienna, Vienna, Austria.,Department of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wolfram Weckwerth
- Department of Ecogenomics and Systems Biology, University of Vienna, Vienna, Austria.,Vienna Metabolomics Center, University of Vienna, Vienna, Austria
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Abstract
The relationship of sex hormones to obesity and inflammation has been extensively studied. Research on endogenous and exogenous sex steroids, including studies on animal models of metabolic syndrome (MetS), has indicated that sex hormones are involved in metabolic pathways relevant to MetS. Lower testosterone levels in men and higher levels in women increase risks of MetS and type 2 diabetes mellitus (T2DM). Lower levels of sex hormone-binding globulin increase risks of MetS and T2DM in both sexes. Skin diseases that are sex hormone mediated, such as polycystic ovary syndrome, acanthosis nigricans, acne vulgaris, and pattern alopecia, have been associated with insulin resistance. Insulin resistance increases the risk for metabolic and potentially cardiovascular complications, and patients with such skin diseases should be followed for a prolonged time to determine whether they develop these complications. Early intervention may help delay or prevent the onset of T2DM and decrease cardiovascular risks.
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Affiliation(s)
| | - Nicholas Leader
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - George Kroumpouzos
- Department of Dermatology,Warren Alpert Medical School of Brown University, Providence, RI; Department of Dermatology, Medical School of Jundiaí, Jundiaí, SP, Brazil, Brazil* GK Dermatology, South Weymouth, MA.
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20
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Bugatto F, Quintero-Prado R, Visiedo FM, Vilar-Sánchez JM, Figueroa-Quiñones A, López-Tinoco C, Torrejón R, Bartha JL. The Influence of Lipid and Proinflammatory Status on Maternal Uterine Blood Flow in Women With Late Onset Gestational Diabetes. Reprod Sci 2017; 25:837-843. [DOI: 10.1177/1933719117698576] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Fernando Bugatto
- Division of Fetal-Maternal Medicine, Department of Obstetrics and Gynecology, “Puerta del Mar” University Hospital, Cadiz, Spain
| | - Rocío Quintero-Prado
- Clinicas Ginemed, Sevilla, Spain
- Department of Obstetrics and Gynecology, “Hospital de Jerez” University Hospital, Jerez de la Frontera, Cádiz, Spain
| | | | - José M. Vilar-Sánchez
- Division of Fetal-Maternal Medicine, Department of Obstetrics and Gynecology, “Puerta del Mar” University Hospital, Cadiz, Spain
| | - Alejandro Figueroa-Quiñones
- Division of Fetal-Maternal Medicine, Department of Obstetrics and Gynecology, “Puerta del Mar” University Hospital, Cadiz, Spain
| | - Cristina López-Tinoco
- Department of Endocrinology and Nutrition, “Puerta del Mar” University Hospital, Cadiz, Spain
| | - Rafael Torrejón
- Division of Fetal-Maternal Medicine, Department of Obstetrics and Gynecology, “Puerta del Mar” University Hospital, Cadiz, Spain
| | - José L. Bartha
- Division of Fetal-Maternal Medicine, Department of Obstetrics, “La Paz” University Hospital, Madrid, Spain
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21
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Shen H, Liu X, Chen Y, He B, Cheng W. Associations of lipid levels during gestation with hypertensive disorders of pregnancy and gestational diabetes mellitus: a prospective longitudinal cohort study. BMJ Open 2016; 6:e013509. [PMID: 28011814 PMCID: PMC5223699 DOI: 10.1136/bmjopen-2016-013509] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess associations of elevated lipid levels during gestation with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM). METHODS This prospective cohort study was conducted in a tertiary maternal hospital in Shanghai, China from February to November 2014. Lipid constituents, including triglycerides (TGs), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) of 1310 eligible women were assessed in the first (10-13+ weeks), second (22-28 weeks) and third (30-35 weeks) trimesters consecutively. Associations of lipid profiles with HDP and/or GDM outcomes were assessed. RESULTS Compared with the normal group, maternal TG concentrations were higher in the HDP/GDM groups across the three trimesters (p<0.001); TC and LDL-c amounts were only higher in the first trimester for the HDP and GDM groups (p<0.05). HDL-c levels were similar in the three groups. Compared with intermediate TG levels (25-75th centile), higher TG amounts (>75th centile) were associated with increased risk of HDP/GDM in each trimester with aORs (95% CI) of 2.04 (1.41 to 2.95), 1.81 (1.25 to 2.63) and 1.78 (1.24 to 2.54), respectively. High TG elevation from the first to third trimesters (>75th centile) was associated with increased risk of HDP, with an aOR of 2.09 (1.16 to 3.78). High TG elevation before 28 weeks was associated with increased risk of GDM, with an aOR of 1.67 (1.10 to 2.54). TG elevation was positively correlated with weight gain during gestation (R=0.089, p=0.005). CONCLUSIONS Controlling weight gain during pregnancy could decrease TG elevation and reduce the risk of HDP/GDM. TGs could be used as follow-up parameters during complicated pregnancy, while other lipids are meaningful only in the first trimester.
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Affiliation(s)
- Hong Shen
- Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiaohua Liu
- Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yan Chen
- Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Biwei He
- Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Weiwei Cheng
- Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
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22
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Liu J, Yang H, Yin Z, Jiang X, Zhong H, Qiu D, Zhu F, Li R. Remodeling of the gut microbiota and structural shifts in Preeclampsia patients in South China. Eur J Clin Microbiol Infect Dis 2016; 36:713-719. [PMID: 27988814 DOI: 10.1007/s10096-016-2853-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022]
Abstract
Preeclampsia (PE) is one of the pregnancy metabolic diseases. Since Gut microbiota play important roles in the hosts' metabolism, it is necessary to investigate the gut microbiota in PE patients, so that some intestinal dysbiosis might be detected as a biomarker for PE early diagnosis or as a target for intervention. One hundred subjects were categorized into four groups: 26 PE patients in late pregnancy, healthy individuals in early, middle, and late pregnancy (26/24/24 women). Gut microbiota were analyzed by sequencing the V4 region of the 16S rDNA gene using Illuminal MiSeq. Data were analyzed by multivariate statistics. Bacteroidetes was the dominant bacterium (47.57-52.35%) in the pregnant women in South China. Tenericutes increased while Verrucomicrobia almost disappeared in late pregnancy. In the PE patients, there was an overall increase in pathogenic bacteria, Clostridium perfringens (p = 0.03) and Bulleidia moorei (p = 0.00) but a reduction in probiotic bacteria Coprococcus catus (p = 0.03). Our research suggests that there is a significant structural shift of the gut microbiota in PE patients, which might be associated with the occurrence and development of the disease. However, further studies are required to understand the underlying mechanisms.
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Affiliation(s)
- J Liu
- The First Affiliate Hospital of Jinan University, Guangzhou, 510630, China
| | - H Yang
- Biomedical Translational Research Institute of Jinan University, Guangzhou, 510632, China
| | - Z Yin
- Biomedical Translational Research Institute of Jinan University, Guangzhou, 510632, China
| | - X Jiang
- Computer College of Central China Normal University, Wuhan, 430000, China
| | - H Zhong
- Biomedical Translational Research Institute of Jinan University, Guangzhou, 510632, China
| | - D Qiu
- The First Affiliate Hospital of Jinan University, Guangzhou, 510630, China
| | - F Zhu
- The First Affiliate Hospital of Jinan University, Guangzhou, 510630, China
| | - R Li
- The First Affiliate Hospital of Jinan University, Guangzhou, 510630, China.
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Lei Q, Niu J, Lv L, Duan D, Wen J, Lin X, Mai C, Zhou Y. Clustering of metabolic risk factors and adverse pregnancy outcomes: a prospective cohort study. Diabetes Metab Res Rev 2016; 32:835-842. [PMID: 27037671 DOI: 10.1002/dmrr.2803] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The relative contributions of a cluster of metabolic risk factors to pregnancy complications are not fully understood. We investigated the correlation between clustering of metabolic risk factors and adverse pregnancy outcomes. METHODS This prospective cohort study was performed on pregnant women who sought health care during their whole gestation in a women's and children's hospital. The pregnancy outcomes were also followed. Pre-pregnancy overweight/obesity, as well as pregnancy high triglycerides, low high-density lipoprotein-cholesterol, hyperglycemia and raised blood pressure were defined as metabolic risk factors. Adverse pregnancy outcomes included preterm delivery, small/large for gestational age, preeclampsia, gestational diabetes mellitus, neonatal asphyxia and foetal demise. Stratified analyses were conducted on a total of 5535 women according to classification in each metabolic risk factor. The adjusted odds ratio (OR) for adverse pregnancy outcomes according to the number of clustering metabolic factors was calculated using the logistic regression analysis. RESULTS The number of metabolic risk factors and adverse pregnancy outcomes were positively correlated (Ptrend < 0.001). Compared with women without a metabolic risk factor, women with one metabolic risk factor had a risk (OR = 1.67 95%CI 1.42-1.96) of adverse pregnancy outcomes. Women with a cluster of two metabolic risk factors tended to develop more adverse pregnancy outcomes (OR = 3.32 95% CI 2.69-4.10), and the risk was much higher in women with a cluster of three or more metabolic risk factors (OR = 10.40 95%CI 7.37-14.69). CONCLUSIONS Pregnant women with a cluster of metabolic risk factors are more likely to have adverse pregnancy outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Qiong Lei
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Jianmin Niu
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China.
| | - Lijuan Lv
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Dongmei Duan
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Jiying Wen
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Xiaohong Lin
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Caiyuan Mai
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Yuheng Zhou
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
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Al Thani M, Al Thani AA, Al-Chetachi W, Al Malki B, Khalifa SAH, Haj Bakri A, Hwalla N, Nasreddine L, Naja F. A 'High Risk' Lifestyle Pattern Is Associated with Metabolic Syndrome among Qatari Women of Reproductive Age: A Cross-Sectional National Study. Int J Mol Sci 2016; 17:ijms17060698. [PMID: 27271596 PMCID: PMC4926323 DOI: 10.3390/ijms17060698] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/18/2016] [Accepted: 04/29/2016] [Indexed: 11/16/2022] Open
Abstract
This study investigated the effect of lifestyle patterns, as a combination of diet, physical activity and smoking, on Metabolic Syndrome (MetS) among Qatari women of childbearing age (n = 418), a population group particularly vulnerable to the health sequela of this syndrome. Using data from the National WHO STEPwise survey conducted in Qatar in 2012, Principal Component Factor Analysis was performed to derive lifestyle patterns with survey variables related to the frequency of consumption of 13 foods/food groups, physical activity levels, and smoking status. MetS was diagnosed using ATPIII criteria. Three lifestyle patterns were identified: 'High Risk' pattern, characterized by intakes of fast foods, sweets and sugar sweetened beverages, in addition to lower levels of physical activity and higher smoking prevalence; 'Prudent' pattern, driven mainly by higher intakes of fruits, vegetables, fish, and whole grains; and 'Traditional' pattern which included beans, meat, dairy products, and a low prevalence of smoking. Among these three lifestyle patterns, only the 'High Risk' was associated with MetS, whereby subjects belonging to the third tertile of this pattern's score had 2.5 times the odds of MetS compared to those belonging to the first tertile. The findings of this study demonstrated the synergy among high risk behaviors among Qatari women in increasing the odds of MetS; the latter being a major risk factor for cardiovascular diseases.
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Affiliation(s)
- Mohammed Al Thani
- Public Health Department, Ministry of Public Health, Doha, Al Rumaila West, 42 Doha, Qatar.
| | - Al Anoud Al Thani
- Health Promotion and Non Communicable Disease Prevention Division, Ministry of Public Health, Doha, Al Rumaila West, 42 Doha, Qatar.
| | - Walaa Al-Chetachi
- Health Promotion and Non Communicable Disease Prevention Division, Ministry of Public Health, Doha, Al Rumaila West, 42 Doha, Qatar.
| | - Badria Al Malki
- Health Promotion and Non Communicable Disease Prevention Division, Ministry of Public Health, Doha, Al Rumaila West, 42 Doha, Qatar.
| | - Shamseldin A H Khalifa
- Health Promotion and Non Communicable Disease Prevention Division, Ministry of Public Health, Doha, Al Rumaila West, 42 Doha, Qatar.
| | - Ahmad Haj Bakri
- Health Promotion and Non Communicable Disease Prevention Division, Ministry of Public Health, Doha, Al Rumaila West, 42 Doha, Qatar.
| | - Nahla Hwalla
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236, Riad El Solh, 11072020 Beirut, Lebanon.
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236, Riad El Solh, 11072020 Beirut, Lebanon.
| | - Farah Naja
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236, Riad El Solh, 11072020 Beirut, Lebanon.
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dos Prazeres Tavares H, dos Santos DCDM, Abbade JF, Negrato CA, de Campos PA, Calderon IMP, Rudge MVC. Prevalence of metabolic syndrome in non-diabetic, pregnant Angolan women according to four diagnostic criteria and its effects on adverse perinatal outcomes. Diabetol Metab Syndr 2016; 8:27. [PMID: 27006707 PMCID: PMC4802648 DOI: 10.1186/s13098-016-0139-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/02/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a cluster of risk factors for type 2 diabetes (Type2 DM) and cardiovascular diseases (CVD), and its prevalence varies based on region, population, and sex. Newborns of women with MetS have a greater risk of adverse perinatal outcomes. This study explores the prevalence of metabolic syndrome in non-diabetic, pregnant Angolan women and the adverse perinatal outcomes associated with it. METHODS This cross-sectional study collected the demographic, anthropometric and clinical data of 675 pregnant women in the maternity ward of General Hospital in Huambo, Angola. Metabolic syndrome was defined using four criteria: the third report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII), the Joint Interim Statement (JIS), and definitions by both Bartha et al. and Chatzi et al. RESULTS The crude prevalence of metabolic syndrome was 36.6 % based on the JIS definition, 29.2 % based on NCEP ATPIII, 12.6 % based on Chatzi et al. and 1.8 % based on Bartha et al. In general, the prevalence of adverse perinatal outcomes was 14.1 %. CONCLUSIONS There was a high prevalence of metabolic syndrome, depending on the criteria used, and thus a great need to harmonize the criteria and cutoff points. Perinatal adverse outcomes were higher in pregnant women with metabolic syndrome.
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Affiliation(s)
- Hamilton dos Prazeres Tavares
- />Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP—Univ Estadual Paulista, Botucatu, São Paulo Brazil
| | | | - Joelcio Francisco Abbade
- />Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP—Univ Estadual Paulista, Botucatu, São Paulo Brazil
| | - Carlos Antonio Negrato
- />Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP—Univ Estadual Paulista, Botucatu, São Paulo Brazil
| | - Paulo Adão de Campos
- />Department of Gynecology and Obstetrics, Medical School, University Agostinho Neto (UAN), Luanda, Angola
| | | | - Marilza Vieira Cunha Rudge
- />Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP—Univ Estadual Paulista, Botucatu, São Paulo Brazil
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Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF. Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis. BJOG 2015; 122:643-51. [PMID: 25612005 DOI: 10.1111/1471-0528.13261] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lipid levels during pregnancy in women with gestational diabetes mellitus (GDM) have been extensively studied; however, it remains unclear whether dyslipidaemia is a potential marker of preexisting insulin resistance. OBJECTIVE To evaluate the relationship between lipid measures throughout pregnancy and GDM. SEARCH STRATEGY We searched PubMed-MedLine and SCOPUS (inception until January 2014) and reference lists of relevant studies. SELECTION CRITERIA Publications describing original data with at least one raw lipid (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], or triglyceride) measurement during pregnancy in women with GDM and healthy pregnant controls were retained. DATA COLLECTION AND ANALYSIS Data extracted from 60 studies were pooled and weighted mean difference (WMD) in lipid levels was calculated using random effects models. Meta-regression was also performed to identify sources of heterogeneity. MAIN RESULTS Triglyceride levels were significantly elevated in women with GDM compared with those without GDM (WMD 30.9, 95% confidence interval [95% CI] 25.4-36.4). This finding was consistent in the first, second and third trimesters of pregnancy. HDL-C levels were significantly lower in women with GDM compared with those without GDM in the second (WMD -4.6, 95% CI -6.2 to -3.1) and third (WMD -4.1, 95% CI -6.5 to -1.7) trimesters of pregnancy. There were no differences in aggregate total cholesterol or LDL-C levels between women with GDM and those without insulin resistance. AUTHOR'S CONCLUSIONS Our meta-analysis shows that triglycerides are significantly elevated among women with GDM compared with women without insulin resistance and this finding persists across all three trimesters of pregnancy.
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Affiliation(s)
- K K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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27
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Tavares HDP, Arantes MA, Tavares SBMP, Abbade JF, Santos DCDMDCDMD, Calderon IDMP, Rudge MVC. Metabolic Syndrome and Pregnancy, Its Prevalence, Obstetrical and Newborns Complications. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojog.2015.511087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Harville EW, Juonala M, Viikari JSA, Raitakari OT. Preconception metabolic indicators predict gestational diabetes and offspring birthweight. Gynecol Endocrinol 2014; 30:840-4. [PMID: 25007009 DOI: 10.3109/09513590.2014.937336] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pregnancy conditions such as gestational diabetes (GDM) and macrosomia lead to an increased risk of diabetes and cardiovascular disease in the offspring, perpetuating a cycle of poor health. We hypothesized that (1) pre-pregnancy indicators of metabolism would be associated with GDM and birthweight; and (2) the lipid accumulation product (LAP; incorporating waist circumference and triglycerides) and visceral adiposity index (VAI; incorporating waist circumference, triglycerides, and HDL-c) would be better predictors of GDM and birthweight than other indicators. Data from the Cardiovascular Risk in Young Finns Study were linked to the Finnish birth registry for 349 women. BMI, triglycerides, waist circumference, insulin, HOMA-IR, LAP, and VAI at the visit prior to the pregnancy were examined as predictors of GDM and large-for-gestational-age (LGA) using logistic regression with adjustment for age, parity, and smoking. Waist circumference was the strongest predictor of GDM (adjusted odds ratio [aOR] 1.66, 95% confidence interval 1.16-2.38) and LGA (aOR 1.41, 1.00-1.99). For GDM, all markers had similar discrimination; for LGA, the area under the receiver operating curve for waist circumference was significantly higher than for BMI (p < 0.01). This analysis suggests that pregnancy and even offspring health is affected by risk factors outside the immediate time period of pregnancy.
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Affiliation(s)
- Emily W Harville
- Tulane School of Public Health and Tropical Medicine , New Orleans , LA
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29
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Korkmazer E, Solak N. Correlation between inflammatory markers and insulin resistance in pregnancy. J OBSTET GYNAECOL 2014; 35:142-5. [DOI: 10.3109/01443615.2014.948408] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Horvath B, Bodecs T, Boncz I, Bodis J. Metabolic Syndrome in Normal and Complicated Pregnancies. Metab Syndr Relat Disord 2013; 11:185-8. [DOI: 10.1089/met.2012.0086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Boldizsar Horvath
- Faculty of Health Sciences, University of Pécs, Szombathely, Hungary
- Department of Obstetrics and Gynecology, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Tamas Bodecs
- Faculty of Health Sciences, University of Pécs, Szombathely, Hungary
| | - Imre Boncz
- Faculty of Health Sciences, University of Pécs, Szombathely, Hungary
| | - Jozsef Bodis
- Faculty of Health Sciences, University of Pécs, Szombathely, Hungary
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López-Tinoco C, Roca M, García-Valero A, Murri M, Tinahones FJ, Segundo C, Bartha JL, Aguilar-Diosdado M. Oxidative stress and antioxidant status in patients with late-onset gestational diabetes mellitus. Acta Diabetol 2013; 50:201-8. [PMID: 21327985 DOI: 10.1007/s00592-011-0264-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/31/2011] [Indexed: 12/28/2022]
Abstract
The relationship between late-onset gestational diabetes mellitus [GDM] and oxidative stress is not well known, and the importance of the oxidant/antioxidant equilibrium in the clinical evolution and its complications require elucidation. The aim of the study was to evaluate the relationships between maternal levels of markers of oxidative stress in women with late-onset GDM that, potentially, may have considerable clinical implications in the pathogenesis and/or the evolution of GDM. Pregnant women (n = 78; 53 with GDM, 25 controls), between the 24th and 29th week of gestation, were enrolled. Both groups were analysed for demographic data, perinatal and obstetrics outcomes together with the levels of the marker's oxidative stress and antioxidant status. Control versus patient results in the univariate analysis were the following: pre-gestational body mass index [BMI] 23.31 ± 4.2 vs. 27.13 ± 4.6 kg/m(2) (P = 0.001); weeks at delivery 39.2 ± 3.05 vs. 38.9 ± 1.8 (P = 0.09); Caesarean delivery 12.5 vs. 43% (P = 0.004); macrosomia 4 vs. 9.4% (P = 0.6); lipoperoxides [LPO] 2.06 ± 1.00 vs. 3.14 ± 1.55 μmol/mg (P = 0.001); catalase 3.23 ± 1.41 vs. 2.52 ± 1.3 nmol/min/ml (P = 0.03); superoxide dismutase [SOD] 0.11 ± 0.04 vs. 0.08 ± 0.01 U/ml (P = 0.0003); glutathione peroxidase [GPX] 0.03 ± 0.006 vs. 0.025 ± 0.006 nmol/min/ml (P = 0.01); glutathione reductase [GSH] 0.004 ± 0.002 vs. 0.004 ± 0.004 nmol/min/ml (P = 0.9)]; and glutathione transferase [GST] 0.0025 ± 0.0012 vs. 0.0027 ± 0.00017 nmol/min/ml (P = 0.7). Multivariate analysis showed catalase might have a protective effect against GDM development and LPO seems to be a risk factor for the disease. These data suggest an increase in oxidative stress and a decrease in antioxidative defence in women with late-onset GDM and, as such, may have considerable clinical implications in the pathogenesis and/or the course of the pregnancy in these patients.
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Alzamendi A, Del Zotto H, Castrogiovanni D, Romero J, Giovambattista A, Spinedi E. Oral metformin treatment prevents enhanced insulin demand and placental dysfunction in the pregnant rat fed a fructose-rich diet. ISRN ENDOCRINOLOGY 2012; 2012:757913. [PMID: 22957268 PMCID: PMC3431097 DOI: 10.5402/2012/757913] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 06/25/2012] [Indexed: 12/14/2022]
Abstract
The intake of a fructose-rich diet (FRD) in the normal female rat induces features similar to those observed in the human metabolic syndrome phenotype. We studied the impact of FRD administration to mothers on pregnancy outcome. On gestational day (Gd) zero rats were assigned to either group: ad libitum drinking tap water alone (normal diet, ND) or containing fructose (10% w/vol; FRD) through pregnancy; all rats were fed a Purina chow diet ad libitum ND and FRD rats were daily cotreated or not with metformin (60 mg/Kg/day oral; ND + MF and FRD + MF) and submitted to a high glucose load test on Gd 14. Additionally, placentas from different groups were studied on Gd 20. Data indicated that: (1) although FRD rats well tolerated glucose overload, their circulating levels of insulin were significantly higher than in ND rats; (2) the mesometrial triangle blood vessel area was significantly lower in placentas from FRD than ND dams; (3) the detrimental effects of FRD administration to mothers were ameliorated by metformin cotreatment. Our study suggests that excessive intake of fructose during pregnancy enhanced the risk for developing gestational diabetes and subsequent preeclampsia, and that metformin prevented the poor pregnancy outcome induced by FRD.
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Affiliation(s)
- Ana Alzamendi
- Neuroendocrine Unit, IMBICE (CONICET La Plata-CICPBA), P.O. Box 403, 1900 La Plata, Argentina
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Baliutavičienė D, Buinauskienė JB, Petrenko V, Danytė E, Žalinkevičius R. Gestational Diabetes, Obesity, and Metabolic Syndrome Diagnosed During Pregnancy. Metab Syndr Relat Disord 2012; 10:214-7. [DOI: 10.1089/met.2011.0067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Dalia Baliutavičienė
- Department of Obstetrics and Gynecology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jūratė B. Buinauskienė
- Department of Neonatology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vladimiras Petrenko
- Department of Endocrinology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Evalda Danytė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Žalinkevičius
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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López-Tinoco C, Roca M, Fernández-Deudero A, García-Valero A, Bugatto F, Aguilar-Diosdado M, Bartha J. Cytokine profile, metabolic syndrome and cardiovascular disease risk in women with late-onset gestational diabetes mellitus. Cytokine 2012; 58:14-9. [DOI: 10.1016/j.cyto.2011.12.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 12/01/2011] [Accepted: 12/05/2011] [Indexed: 12/18/2022]
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Bartha JL, Fernández-Deudero A, Bugatto F, Fajardo-Exposito MA, González-González N, Hervías-Vivancos B. Inflammation and cardiovascular risk in women with preterm labor. J Womens Health (Larchmt) 2012; 21:643-8. [PMID: 22401498 DOI: 10.1089/jwh.2011.3013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women with a history of preterm delivery have about twice the normal risk of cardiovascular disease (CVD). Mechanisms underlying this association are not well understood. The aim of the present study was to evaluate the relationships between selected metabolic CVD risk factors and markers of both systemic inflammation and endothelial dysfunction in women with spontaneous preterm labor (sPL). METHODS This was a case-control study in a university tertiary referral center. Forty pregnant women with sPL were compared to 50 controls during gestation. Maternal serum triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, glycemia, insulinemia, homeostasis model assessment (HOMA), leptin, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), soluble vascular cell adhesion molecule (sVCAM), soluble intercellular adhesion molecule (sICAM), selectin, and myeloperoxidase (MPO) were measured. RESULTS Gestational age at study was similar in both groups (31.56±3.14 weeks of gestation vs. 31.27±2.14 weeks of gestation, p=0.62, for the control and the sPL groups, respectively). Body mass index (BMI) (21.72±2.99 vs. 23.56±3.80, p=0.01), all cholesterol fractions (HDL-C 53.44±18.22 vs. 68.32±18.38, p=0.0003; LDL-C 125.71±35.56 vs. 142.15±36.07, p=0.03, and total cholesterol 219.55±32.29 vs. 240.38±40.01, p=0.009) and MPO (3.07±0.63 vs. 3.48±0.32, p=0.0009) were significantly lower in women with sPL. Serum levels of IL-6 (0.61±0.46 vs. 0.33±0.46, p=0.007) and the ratio of total cholesterol/HDL-C (4.52±1.48 vs. 3.77±1.37, p=0.01) were significantly increased and correlated each other (r=0.21, p=0.04). Logistic regression showed that the best predictive model for sPL (R(2)=0.36, p=0.001) included BMI and total cholesterol. CONCLUSIONS A combination of low maternal BMI, low cholesterol levels, and high total cholesterol/HDL-C ratio is present in women with sPL and is related to inflammation.
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Affiliation(s)
- Jose L Bartha
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital Puerta del Mar, Cádiz, Spain.
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Reslan OM, Khalil RA. Molecular and vascular targets in the pathogenesis and management of the hypertension associated with preeclampsia. Cardiovasc Hematol Agents Med Chem 2011; 8:204-26. [PMID: 20923405 DOI: 10.2174/187152510792481234] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 08/14/2010] [Indexed: 02/05/2023]
Abstract
Normal pregnancy is associated with significant hemodynamic changes and vasodilation of the uterine and systemic circulation in order to meet the metabolic demands of the mother and developing fetus. Preeclampsia (PE) is one of the foremost complications of pregnancy and a major cause of maternal and fetal mortality. The pathophysiological mechanisms of PE have been elusive, but some parts of the puzzle have begun to unravel. Genetic factors such as leptin gene polymorphism, environmental and dietary factors such as Ca(2+) and vitamin D deficiency, and co-morbidities such as obesity and diabetes may increase the susceptibility of pregnant women to develop PE. An altered maternal immune response may also play a role in the development of PE. Although the pathophysiology of PE is unclear, most studies have implicated inadequate invasion of cytotrophoblasts into the uterine artery, leading to reduced uteroplacental perfusion pressure (RUPP) and placental ischemia/hypoxia. Placental ischemia induces the release of biologically active factors such as growth factor inhibitors, anti-angiogenic factors, inflammatory cytokines, reactive oxygen species, hypoxia-inducible factors, and antibodies to vascular angiotensin II (AngII) receptor. These bioactive factors could cause vascular endotheliosis and consequent increase in vascular resistance and blood pressure, as well as glomerular endotheliosis with consequent proteinuria. The PE-associated vascular endotheliosis could be manifested as decreased vasodilator mediators such as nitric oxide, prostacyclin and hyperpolarizing factor and increased vasoconstrictor mediators such as endothelin-1, AngII and thromboxane A₂. PE could also involve enhanced mechanisms of vascular smooth muscle contraction including intracellular Ca(2+), and Ca(2+) sensitization pathways such as protein kinase C and Rho-kinase. PE-associated changes in the extracellular matrix composition and matrix metalloproteinases activity also promote vascular remodeling and further vasoconstriction in the uterine and systemic circulation. Some of these biologically active factors and vascular mediators have been proposed as biomarkers for early prediction or diagnosis of PE, and as potential targets for prevention or treatment of the disease.
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Affiliation(s)
- Ossama M Reslan
- Vascular Surgery Research Laboratory, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA
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Gallo J, Díaz-López M, Gómez-Fernández J, Hurtado F, Presa J, Valverde M. Síndrome metabólico en obstetricia. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2010. [DOI: 10.1016/j.gine.2010.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Valério EG, Müller ALL, Martins-Costa SH, Lopes Ramos JG, Rodini G. Are insulin resistance index, IGF-1 and metabolic syndrome components correlates with severe preeclampsia? Hypertens Pregnancy 2010; 30:302-10. [PMID: 20701471 DOI: 10.3109/10641950903214609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Analyse the relation between insulin resistance and severe preeclampsia (SPE). METHODS Case control study paired by body mass index and gestational age; including 16 patients with severe SPE and 16 normotensive controls. Insulin resistance was assessed through the HOMA-IR and QUICKI-IS indexes. RESULTS There was no significant difference between the groups regarding the HOMA-IR and QUICKI-IS indexes and HDL cholesterol. Triglyceride levels were higher and the IGF-1 was lower in the SPE group than in the control group. CONCLUSIONS There were no differences in the insulin resitance indexes between the group with SPE and normal controls.
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Affiliation(s)
- Edimárlei Gonsales Valério
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, RS, Brazil.
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Lei Q, Lv LJ, Zhang BY, Wen JY, Liu GC, Lin XH, Niu JM. Ante-partum and post-partum markers of metabolic syndrome in pre-eclampsia. J Hum Hypertens 2010; 25:11-7. [DOI: 10.1038/jhh.2010.29] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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40
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Chatzi L, Plana E, Pappas A, Alegkakis D, Karakosta P, Daraki V, Vassilaki M, Tsatsanis C, Kafatos A, Koutis A, Kogevinas M. The metabolic syndrome in early pregnancy and risk of gestational diabetes mellitus. DIABETES & METABOLISM 2009; 35:490-4. [DOI: 10.1016/j.diabet.2009.07.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 07/01/2009] [Accepted: 07/05/2009] [Indexed: 01/21/2023]
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41
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Scioscia M, Gumaa K, Rademacher TW. The link between insulin resistance and preeclampsia: new perspectives. J Reprod Immunol 2009; 82:100-5. [DOI: 10.1016/j.jri.2009.04.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/06/2009] [Accepted: 04/20/2009] [Indexed: 12/24/2022]
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Horváth B, Kovács L, Riba M, Farkas G, Bödecs T, Bódis J. The metabolic syndrome and the risks of unfavourable outcome of pregnancy. Orv Hetil 2009; 150:1361-5. [DOI: 10.1556/oh.2009.28632] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A metabolikus szindróma jellemzői a hasi elhízás, a magas vérnyomás, az éhhomi glükóz és dyslipidaemia együttes előfordulása. A vizsgálat célja, hogy feltárja a metabolikus anyagcserezavar és egyes terhességi szövődmények kapcsolatát.
Anyag és módszer:
A releváns kódok alapján retrospektíve leválogatott digitális adatbázisból a 2005–2008 közötti vizsgált időszakban (4 év) a kórházi dokumentációkban 5869 várandós anya gondozási adataival rendelkeztek. Százhetvenkettő anya (2,9%) esetében a várandósságuk első harmadában a metabolikus tünetegyüttes jellemzői szerepeltek. Ezen betegek adatait részletesen megvizsgálták, feldolgozták és releváns adataikat a többi várandós hasonló dokumentációival összehasonlították.
Eredmények:
A metabolikus tünetegyüttes tüneteit mutató csoportban a koraszülési arány 15,1% (26/172) volt, míg a metabolikus szindrómától mentes esetekben az idő előtti születés csupán 11,7% volt [OR: 1,52 (95%-os CI: 0,996–2,33) p=0,051]. Az anyagcserezavarban érintettek csoportjában 32 anyánál intrauterin növekedési zavart észleltek, míg ezen tünetegyüttes nélküli esetekben ez csupán 3,6%-ban (205/5697) fordult elő [OR: 6,38 (95%-os CI: 4,24–9,61) p<0,001)]. A vizsgált csoportban 47 praeeclampsiával szövődött várandósságot észleltek (27,3%), szemben a beteganyaguk további részével, ahol a terhességi mérgezés előfordulása 4,7% volt [OR: 7,93 (95%-os CI: 5,54–11,33) p<0,001]. A metabolikus tünetegyüttesben szenvedők körében 67 (38,2%) olyan beteg volt, aki több mint egy, a betegségre jellemző szülészeti szövődményben szenvedett. A kontrollcsoportban ugyanez az arány 17,0%-nak adódott [OR: 3,11 (2,27–4,26) p<0,001]. A metabolikus szindróma által érintett csoportban csupán 47 (27,3%) olyan esetet találtak, akik várandósságuk és szülésük alatt tünetmentesek voltak, míg az 5697 anyából, akiknél az első terhességi harmadban a metabolikus tünetegyüttes jeleit nem észlelték, szignifikánsan kedvezőbb arányban (74,1%, 4220 várandós) voltak olyan anyák, akik minden szövődmény nélkül viselték várandósságukat [OR: 0,132 (0,09–0,18) p<0,001].
Következtetések:
A metabolikus szindróma irodalmi adatok alapján és saját megfigyeléseik szerint is jelentős szerepet játszik a szövődményes várandósságok kialakulásában, elsősorban a gyulladásos faktorok és a fokozott trombóziskészség provokálásával. Számos irodalmi adat utal arra, hogy a metabolikus tünetegyüttes esetén a már a koncepció idején alkalmazott heparinkezelés eredményes lehet. 2007-ben prospektív vizsgálatot indítottak azzal a céllal, hogy megismerjék, vajon az alacsony molekulatömegű heparin megelőző célú kezelés, segít-e elkerülni ennek az anyagcserezavarnak a kedvezőtlen következményeit? Reményeik szerint a 2010-es évektől a heparinkezelés eredményeiről adatokkal rendelkeznek.
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Affiliation(s)
| | | | - Mária Riba
- 1 Vas Megyei Markusovszky Kórház Nonprofit Zrt. Thrombosis Klub Szombathely Markusovszky u. 3. 9700
| | - György Farkas
- 1 Vas Megyei Markusovszky Kórház Nonprofit Zrt. Thrombosis Klub Szombathely Markusovszky u. 3. 9700
| | - Tamás Bödecs
- 2 Pécsi Tudományegyetem Egészségtudományi Kar Pécs
| | - József Bódis
- 2 Pécsi Tudományegyetem Egészségtudományi Kar Pécs
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Valdés G, Quezada F, Marchant E, von Schultzendorff A, Morán S, Padilla O, Martínez A. Association of Remote Hypertension in Pregnancy With Coronary Artery Disease. Hypertension 2009; 53:733-8. [DOI: 10.1161/hypertensionaha.108.127068] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because hypertensive pregnancies have been associated with increased cardiovascular disease, we aimed to identify whether angiographically characterized coronary artery disease differed in women with previous normotensive pregnancies or hypertensive pregnancies (HPs). The study group included 217 parous women, aged 60.9±9.2 (SD) years, who required coronary angiography between January 2006 and December 2007, 36.8±9.9 and 28.8±10.5 years after their first and last pregnancy, respectively; 146 had normotensive pregnancies and 71 had ≥1 HP, according to a questionnaire including reproductive history and cardiovascular risks. Body mass index, smoking, and frequency of diabetes were similar in both groups. Chronic hypertension (93% versus 78%;
P
=0.007), hyperlipidemia (82% versus 69%;
P
=0.049), and premature familial cardiovascular disease (42% versus 20%;
P
=0.001) prevailed in HPs. Participants with HPs were younger (58.9±8.3 versus 61.9±9.6 years;
P
=0.025) than participants with normotensive pregnancies. Although 49% of all participants had hemodynamically significant coronary artery disease (≥70% stenosis), no differences were observed between groups in the number of stenotic arteries; however, their number increased by 28% and 22% over a 10-year period in HPs and normotensive pregnancies, respectively (
P
=0.034). Multivariate analysis showed that HPs had a nonsignificant risk of having coronary artery disease (odds ratio: 1.21; 95% CI: 0.64 to 2.28), and being a current smoker (odds ratio: 4.13; 95% CI: 1.85 to 9.25), a diabetic (odds ratio: 2.29; 95% CI: 1.85 to 9.25), or having a family history of premature cardiovascular disease (odds ratio: 2.34; 95% CI: 1.17 to 2.39) significantly increased the risk of coronary artery disease. This study demonstrates that women with HPs have earlier coronary disease, probably related to intermediate cardiovascular risks that have a gestational expression.
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Affiliation(s)
- Gloria Valdés
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Felipe Quezada
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Eugenio Marchant
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Astrid von Schultzendorff
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Sergio Morán
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Oslando Padilla
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
| | - Alejandro Martínez
- From the Departamentos de Nefrología (G.V.), Enfermedades Cardiovasculares (E.M., S.M., A.M.), and Salud Pública (O.P.), Escuela Medicina Pontificia Universidad Católica (F.Q., A.v.S.), Sección Cardiología, Hospital Sótero del Río (E.M.), Santiago, Chile
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Dane B, Dane C, Kiray M, Koldas M, Cetin A. A new metabolic scoring system for analyzing the risk of hypertensive disorders of pregnancy. Arch Gynecol Obstet 2009; 280:921-4. [PMID: 19301024 DOI: 10.1007/s00404-009-1029-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 03/02/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between some components of metabolic syndrome (MS) and pregnancy induced hypertension (PIH). STUDY DESIGN Forty-one patients with PIH (gestational hypertension or preeclampsia) after 32 weeks of gestation were compared with 97 normotensive pregnant women. Metabolic scores (0-4) were created using standard deviations in normotensive cases: mean level + 1SD for BMI (>31 kg/m(2)), mean level + 1SD for triglyceride (>287 mg/dl), mean level + 1SD for fasting serum glucose (>90 mg/dl)) and mean level - 1SD for HDL (<48 mg/dl). RESULTS The mean values for BMI (31.6 +/- 5.7 vs. 27.7 +/- 3.6; P < 0.0001), fasting triglyceride (341 +/- 129 vs. 220.7 +/- 67; P < 0.0001) and glucose (87.5 +/- 17.1 vs. 79.6 +/- 10.4; P = 0.0009) were higher in hypertensive group. The proportions of the women with a positive result for each of the components were significantly higher in the group of PIH. The percentage of the cases having 2 (35.2 vs. 8.2%; P = 0.0002) and 3 or more (27 vs. 4.1%; P = 0.0003) components of MS was higher in the hypertensive group and the percentage of the cases with none of these factors was high in the normotensive group (10.8 vs. 56.7%; P < 0.0001). CONCLUSION The presence of multiple components of MS may be a risk factor in the development of PIH. New scoring systems according to the gestational age might be useful in analyzing the risk of PIH.
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Affiliation(s)
- Banu Dane
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey.
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