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Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review. Int J Mol Sci 2021; 22:2965. [PMID: 33803995 PMCID: PMC7999044 DOI: 10.3390/ijms22062965] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
In spite of the huge progress in the treatment of diabetes mellitus, we are still in the situation that both pregestational (PGDM) and gestational diabetes (GDM) impose an additional risk to the embryo, fetus, and course of pregnancy. PGDM may increase the rate of congenital malformations, especially cardiac, nervous system, musculoskeletal system, and limbs. PGDM may interfere with fetal growth, often causing macrosomia, but in the presence of severe maternal complications, especially nephropathy, it may inhibit fetal growth. PGDM may also induce a variety of perinatal complications such as stillbirth and perinatal death, cardiomyopathy, respiratory morbidity, and perinatal asphyxia. GDM that generally develops in the second half of pregnancy induces similar but generally less severe complications. Their severity is higher with earlier onset of GDM and inversely correlated with the degree of glycemic control. Early initiation of GDM might even cause some increase in the rate of congenital malformations. Both PGDM and GDM may cause various motor and behavioral neurodevelopmental problems, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most complications are reduced in incidence and severity with the improvement in diabetic control. Mechanisms of diabetic-induced damage in pregnancy are related to maternal and fetal hyperglycemia, enhanced oxidative stress, epigenetic changes, and other, less defined, pathogenic mechanisms.
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Affiliation(s)
- Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Maria Becker
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
- Medical Center, Hadassah Hebrew University, Mount Scopus, Jerusalem 91240, Israel
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Jumaah S, Çelekli A, Sucu M. The role of human urotensin-II in patients with hypertrophic cardiomyopathy. J Immunoassay Immunochem 2018; 39:150-162. [PMID: 28686108 DOI: 10.1080/15321819.2017.1344130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Hypertrophic cardiomyopathy (HCM) is a genetic condition with the hallmark feature of left ventricular hypertrophy. Human Urotensin-II (hUT-II) is regarded as a cardiovascular autacoid/hormone, and it has cardiac inotropic and hypertrophic properties. Aims of this study were to elucidate the clinical significance of serum hUT-II levels as a potential new biomarker in patients with HCM. METHODS This study included 40 HCM patients (60% males and 40% females) and were compared to 30 healthy control subjects (47% males and 53% females. All patients underwent extensive clinical, laboratory, and echocardiographic. Blood samples were taken to test for serum hUT-II levels by commercial ELISA Kit. RESULTS Serum hUT-II was significantly higher (p < 0.01) in patients with HCM (15.8 ± 2.1 pmol/L) compared with healthy controls (3.3 ± 1.7 pmol/L). With regard to HCM patient, Serum hUT-II levels were significantly higher in the female with 16.3 ± 1.9 pmol/L than the male with 15.4 ± 2.2 pmol/L (p < 0.05). Among echocardiographic parameters, hUT-II was negatively associated with ejection fraction (r = -0.160, p = 0.324). CONCLUSION Results of the first study indicated that serum hUT-II levels were markedly elevated in patients with HCM. Serum hUT-II is a novel biomarker parameter that has clinical use in patients with the severity of LVH.
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Affiliation(s)
- Saman Jumaah
- a Institute of Natural and Applied Sciences, Department of Biochemistry Science and Technology , Gaziantep University , Gaziantep , Turkey
| | - Abuzer Çelekli
- b Faculty of Arts and Science, Department of Biology , Gaziantep University , Gaziantep , Turkey
| | - Murat Sucu
- c Medical Faculty Cardiology , Gaziantep University , Gaziantep , Turkey
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Zbucka-Kretowska M, Kuzmicki M, Telejko B, Goscik J, Ciborowski M, Lipinska D, Hryniewicka J, Citko A, Lawicki S, Wolczynski S. First-trimester irisin and fetuin-A concentration in predicting macrosomia. J Matern Fetal Neonatal Med 2018; 32:2868-2873. [PMID: 29562796 DOI: 10.1080/14767058.2018.1450859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: We investigated the diagnostic value of first-trimester adipokines and placental markers in predicting macrosomia. Methods: Out of 328 women recruited during the prenatal diagnosis between 11th and 13th week of pregnancy and subjected to follow up until delivery, we selected 26 women who gave birth to macrosomic babies and 34 women who gave birth to normal weight neonates for the evaluation of first trimester serum levels of pregnancy associated plasma protein-A, free β-human chorionic gonadotropin, placental growth factor (PIGF), and selected adipokines. Results: The mothers of macrosomic infants had higher PIGF (p = .049) and irisin concentrations (p = .00003), and lower fetuin-A levels (p = .0002) than had the mothers of normal weight babies. Newborn's weight correlated positively with maternal irisin (R = 0.454, p = .0003) and negatively with fetuin-A concentrations (R = -0.497, p = .00005). Multiple regression analysis showed that only serum irisin concentration was a significant predictor of birth weight (β = 0.329, p = .03), explaining 14% of its variability. The sensitivity and the specificity of irisin concentration in predicting macrosomia were 0.769 and 0.794, respectively (AUC = 0.818 [95%CI: 0.708-0.928], p = .00001) with a proposed cut-off value of 1725.4 ng/ml. Conclusions: Our results suggest that mother's irisin may be an early biomarker of macrosomia.
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Affiliation(s)
- Monika Zbucka-Kretowska
- a Department of Reproduction and Gynecological Endocrinology , Medical University of Bialystok , Bialystok , Poland
| | - Mariusz Kuzmicki
- b Department of Gynaecology and Gynecological Oncology , Medical University of Bialystok , Bialystok , Poland
| | - Beata Telejko
- c Department of Endocrinology, Diabetology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
| | - Joanna Goscik
- d Department of Software Engineering, Faculty of Computer Science , University of Technology Bialystok , Bialystok , Poland
| | - Michal Ciborowski
- e Clinical Research Centre , Medical University of Bialystok , Bialystok , Poland
| | - Danuta Lipinska
- c Department of Endocrinology, Diabetology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
| | - Justyna Hryniewicka
- c Department of Endocrinology, Diabetology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
| | - Anna Citko
- e Clinical Research Centre , Medical University of Bialystok , Bialystok , Poland
| | - Slawomir Lawicki
- f Department of Biochemical Diagnostics , Medical University of Bialystok , Bialystok , Poland
| | - Slawomir Wolczynski
- a Department of Reproduction and Gynecological Endocrinology , Medical University of Bialystok , Bialystok , Poland
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Vernini JM, Moreli JB, Costa RAA, Negrato CA, Rudge MVC, Calderon IMP. Maternal adipokines and insulin as biomarkers of pregnancies complicated by overweight and obesity. Diabetol Metab Syndr 2016; 8:68. [PMID: 27651836 PMCID: PMC5022162 DOI: 10.1186/s13098-016-0184-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/01/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Maternal obesity is associated with several adverse pregnancy outcomes. This study was conducted aiming to evaluate maternal levels of adipokines and insulin in pregnancies complicated by overweight and obesity and its correlations with maternal and fetal outcomes. METHODS This cross-sectional study included 72 mother-newborn pairs. Mothers were classified as having normal weight (n = 23), overweight (n = 18), and obesity (n = 31). Maternal adiponectin, leptin, resistin and insulin levels at the end of pregnancy were compared among groups and correlated with maternal and perinatal outcomes. Data were analyzed by ANOVA and correlation tests, with a p value <0.05 being considered as significant. RESULTS Obese pregnant women showed higher leptin levels (p = 0.0021). Leptin levels were positively correlated with prepregnancy body mass index-BMI (r = 0.57), gestational (37 or 38 weeks of gestation) BMI (r = 0.39), hypertension (r = 0.27), and hyperglycemia (r = 0.30), and negatively associated with newborns' abdominal circumference (r = -0.25). Adiponectin concentrations were negatively correlated with gestational BMI (r = -0.29) and newborns' cephalic circumference (r = -0.27) and positively correlated with birth weight (r = 0.23). Insulin concentrations correlated positively with prepregnancy BMI (r = 0.38), gestational BMI (r = 0.24) and maternal hyperglycemia (r = 0.26). CONCLUSIONS Our findings support the relationship between markers of obesity and maternal-fetal outcomes. Maternal insulin and adipokines levels showed an independent relationship with mother and newborns outcomes, respectively. In this studied population, the results indirectly reinforce the importance of maternal weight control before and during pregnancy to avoid adverse outcomes to mother and their newborns.
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Affiliation(s)
- Joice Monaliza Vernini
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo Brazil
| | - Jusciéle Brogin Moreli
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo Brazil
| | - Roberto Antônio Araújo Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo Brazil
| | - Carlos Antonio Negrato
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo Brazil
- Bauru’s Diabetics Association, Internal Medicine, Bauru, São Paulo Brazil
- Faculty of Medicine of Botucatu, Universidade Estadual Paulista-UNESP, District Rubião Jr. s / n, Botucatu, São Paulo, CEP 18618-000 Brazil
| | - Marilza Vieira Cunha Rudge
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo Brazil
| | - Iracema Mattos Paranhos Calderon
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo Brazil
- Faculty of Medicine of Botucatu, Universidade Estadual Paulista-UNESP, District Rubião Jr. s / n, Botucatu, São Paulo, CEP 18618-000 Brazil
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França-Silva N, Oliveira NDG, Balbi APC. Morphofunctional renal alterations in rats induced by intrauterine hyperglycemic environment. Arch Med Sci 2016; 12:243-51. [PMID: 27186167 PMCID: PMC4848350 DOI: 10.5114/aoms.2015.48220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/28/2014] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The renal development of rats begins in intrauterine life, finishing by 15 days after birth. Diabetes and other diseases during pregnancy can cause systemic changes in the offspring. We evaluated the structural and functional renal alterations of the offspring from diabetic mothers. MATERIAL AND METHODS Pregnant rats were separated and 1, 7, 30 and 90 days-old (DO) pups were divided into groups according to the treatment that the mothers received: G1: control, G2: untreated diabetic and G3: insulin-treated diabetic. The kidneys from offspring at 1, 7 and 30 DO were removed for immunohistochemical and histological studies. Furthermore, blood and urine samples were collected from animals at 30 DO to determine the glomerular filtration rate (GFR) by creatinine clearance, and the animals at 90 DO were subjected to blood pressure measurement by plethysmography. RESULTS Our results show an increase of PCNA(+) glomerular cells at 7 DO and a reduction in 30 DO animals as well as increased α-smooth muscle actin (α-SMA) tubulointerstitial expression at 1 and 7 DO in animals from G2, when compared with controls. The adult offspring from G2 showed reduced GFR and increased blood pressure. CONCLUSIONS Maternal diabetes may have induced programming of renal damage in offspring of hyperglycemic mothers, which may have contributed to the impairment of renal function.
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Affiliation(s)
- Nathane França-Silva
- Department of Physiological Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Ana Paula Coelho Balbi
- Department of Physiological Sciences, Federal University of Uberlândia, Uberlândia, Brazil
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Scott-Finley M, Woo JG, Habli M, Ramos-Gonzales O, Cnota JF, Wang Y, Kamath-Rayne BD, Hinton AC, Polzin WJ, Crombleholme TM, Hinton RB. Standardization of amniotic fluid leptin levels and utility in maternal overweight and fetal undergrowth. J Perinatol 2015; 35:547-52. [PMID: 25927274 DOI: 10.1038/jp.2015.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Leptin is an adipokine that regulates energy homeostasis. The objective of this study was to establish a gestational age-specific standard for amniotic fluid leptin (AFL) levels and examine the relationship between AFL, maternal overweight and fetal growth restriction. STUDY DESIGN Amniotic fluid was obtained at mid-gestation from singleton gravidas, and leptin was quantified using enzyme-linked immunosorbent assay. Amniotic fluid samples from 321 term pregnancies were analyzed. Clinical data, including fetal ultrasound measurements and maternal and infant characteristics, were available for a subset of patients (n=45). RESULTS The median interquartile range AFL level was significantly higher at 14 weeks' gestation (2133 pg ml(-1) (1703 to 4347)) than after 33 weeks' gestation (519 pg ml(-1) (380 to 761), P trend<0.0001), an average difference of 102 pg ml(-1) per week. AFL levels were positively correlated with maternal pre-pregnancy body mass index (BMI) (r=0.36, P=0.03) adjusting for gestational age at measurement, but were not associated with fetal growth. CONCLUSIONS AFL levels are higher at mid-gestation than at late gestation, and are associated with maternal pre-pregnancy BMI.
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Affiliation(s)
- M Scott-Finley
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA
| | - J G Woo
- 1] Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA [2] Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M Habli
- 1] Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA [2] Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - O Ramos-Gonzales
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J F Cnota
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Y Wang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - B D Kamath-Rayne
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A C Hinton
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA
| | - W J Polzin
- 1] Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA [2] Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - T M Crombleholme
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - R B Hinton
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Coleman A, Habli M, Hinton RB, Polzin W, Lim FY. Altered amniotic fluid leptin levels in twin-twin transfusion syndrome with concurrent placental insufficiency. J Matern Fetal Neonatal Med 2014; 28:1647-52. [PMID: 25248665 DOI: 10.3109/14767058.2014.968122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To measure amniotic fluid leptin levels in fetuses with twin-twin transfusion syndrome (TTTS) with and without placental insufficiency (PI) and determine its usefulness as a biomarker of PI. STUDY DESIGN A retrospective case control study of TTTS stage III patients from 2009 to 2011 was conducted. Cases were pregnancies with PI (TTTS-PI, n = 18) matched by stage, gestational age, and degree of cardiomyopathy to controls without PI (TTTS, n = 26). PI was strictly defined using biometric parameters. Amniotic fluid from recipient twins (RT) was taken during second trimester fetoscopic laser therapy. Leptin concentrations were determined and compared to growth parameters and birth weight. RESULTS RT-adjusted leptin was 66% higher in TTTS-PI (p = 0.016) compared to TTTS controls. Cases had significantly higher growth discordance (p = 0.004) and lower RT birth weight (p = 0.041) compared to controls. Significantly higher adjusted leptin levels were observed at birth in the TTTS-PI group when comparing those with SGA donor twins to those of normal weight (p = 0.016). CONCLUSION These data suggest a role for leptin in pregnancies complicated by TTTS with placental insufficiency. However, further studies are needed to define its mechanism and potential role as a biomarker in amniotic fluid for placental pathophysiology.
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Affiliation(s)
- Alan Coleman
- a Cincinnati Fetal Center, Center for Fetal Cellular and Molecular Therapy, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA and
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Streptozotocin-induced diabetes models: pathophysiological mechanisms and fetal outcomes. BIOMED RESEARCH INTERNATIONAL 2014; 2014:819065. [PMID: 24977161 PMCID: PMC4058231 DOI: 10.1155/2014/819065] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/30/2014] [Accepted: 05/14/2014] [Indexed: 12/26/2022]
Abstract
Glucose homeostasis is controlled by endocrine pancreatic cells, and any pancreatic disturbance can result in diabetes. Because 8% to 12% of diabetic pregnant women present with malformed fetuses, there is great interest in understanding the etiology, pathophysiological mechanisms, and treatment of gestational diabetes. Hyperglycemia enhances the production of reactive oxygen species, leading to oxidative stress, which is involved in diabetic teratogenesis. It has also been suggested that maternal diabetes alters embryonic gene expression, which might cause malformations. Due to ethical issues involving human studies that sometimes have invasive aspects and the multiplicity of uncontrolled variables that can alter the uterine environment during clinical studies, it is necessary to use animal models to better understand diabetic pathophysiology. This review aimed to gather information about pathophysiological mechanisms and fetal outcomes in streptozotocin-induced diabetic rats. To understand the pathophysiological mechanisms and factors involved in diabetes, the use of pancreatic regeneration studies is increasing in an attempt to understand the behavior of pancreatic beta cells. In addition, these studies suggest a new preventive concept as a treatment basis for diabetes, introducing therapeutic efforts to minimize or prevent diabetes-induced oxidative stress, DNA damage, and teratogenesis.
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