Early second trimester retinol-binding protein-4 values in cases with or without gestational diabetes mellitus risk factors: a cross-sectional study

Adipokines in Pregnancy: A Systematic Review of Clinical Data

Adipokines are signaling proteins involved in metabolic, endocrinological, vascular and immunogenic processes. Associations of various adipokines with not only insulin resistance but also with increased insulin sensitivity, increased systolic blood pressure, and atherosclerosis highlight the significance of adipokines in several components of metabolic syndrome and metabolic diseases in general. As pregnancy presents a unique metabolic state, the role of adipokines in pregnancy, and even in various pregnancy complications, appears to be key to elucidating these metabolic processes. Many studies in recent years have attempted to clarify the role of adipokines in pregnancy and gestational pathologies. In this review, we aim to investigate the changes in maternal adipokine levels in physiological gestation, as well as the association of adipokines with pregnancy pathologies, such as gestational diabetes mellitus (GDM) and preeclampsia (PE). Furthermore, we will analyze the association of adipokines in both maternal serum and cord blood with parameters of intrauterine growth and various pregnancy outcomes.

Association between retinol-binding protein 4 concentrations and gestational diabetes mellitus (A1GDM and A2GDM) in different pregnancy and postpartum periods

Background

Gestational diabetes mellitus (GDM) can cause severe adverse effects on fetal and neonatal outcomes. The following study investigates the relationship between retinol-binding protein 4 (RBP4) and GDM in pregnant women with different grades (A1 and A2) and different gestational weeks.

Methods

In this retrospective study, 194 GDM patients (GDM group) and 67 normal glucose tolerance pregnant women (control group) were enrolled from 2014 to 2017. Elbow venous blood samples were collected from all subjects. Enzyme electrode method and enzyme linked immunosorbent assay (ELISA) were used for fasting plasma glucose (FPG) and RBP4/insulin levels (FINS) analysis, respectively.

Results

At middle pregnancy and late stage, FINS, insulin resistance index (HOMA-IR) and RBP4 were all significantly higher in the GDM group compared to control group (P<0.05). Higher HOMA-IR and RBP4 levels, and lower levels of FPG were observed at late stage than those middle pregnancy in the GDM group (P<0.05). Moreover, FINS and RBP4 gradually decreased from middle pregnancy and late stage after delivery in the GDM group. Levels of FINS and RBP4 in postpartum GDM group were higher than those in normal control group (P<0.05). The optimal cut-off value of RBP4 at middle pregnancy diagnostic GDM was 34.84 µg/mL with sensitivity of 79.4% and specificity of 79.1%. The OGTT0h, 2h in A2GDM group was higher than that in A1GDM group, but there was no difference in OGTT1h, age and FINS, RBP4 in both A1GDM and A2GDM group.

Conclusions

RBP4 is closely related to GDM, and its levels increases with the increase of gestational weeks, which may reflect the development of insulin resistance in GDM. RBP4 suggests that the impaired insulin function of GDM in pregnant women is still difficult to recover in the short term after delivery. Compared with OGTT1h, the increase in OGTT0h and 2h levels during middle pregnancy is more helpful for predicting the risk of developing A2GDM at late stage.

Diagnostic value of urinary RBP, ALB and AQP2 in neonatal hydronephrosis and the relationship with expression of MCP-1 in the prenatal maternal peripheral blood

Diagnostic value of urinary retinol binding protein (RBP), albumin (ALB) and aquaporin-2 (AQP2) in neonatal hydronephrosis and their relationship with the expression of monocyte chemoattractant protein 1 (MCP-1) in the prenatal maternal peripheral blood was investigated. Forty-six child patients with hydronephrosis admitted to Hongqi Hospital Affiliated to Mudanjiang Medical College from December 2016 to November 2017 were selected as the observation group and the control included 46 normal newborn infants. The urinary RBP, ALB, AQP2 and the expression of MCP-1 in the prenatal maternal peripheral blood in the two groups were compared. The diagnostic value of the combination of urinary RBP, ALB and AQP2 for the neonatal hydronephrosis was accessed through the area under curve (AUC). The changes of urinary RBP, ALB and AQP2 of child patients were observed and the correlations between RBP, ALB, AQP2 and MCP-1 were analyzed. The concentrations of RBP and ALB in the observation group were obviously increased compared to those in the control group. The AQP2 concentration in the observation group was lower than that in the control group. In the observation group, the MCP-1 level in the prenatal maternal blood was significantly higher than that in the control group (P<0.05). After treatment, the concentration of RBP and ALB in the child patients were significantly decreased and AQP2 concentration was increased compared with that before treatment (P<0.05). The AUC of the diagnosis combining with RBP, ALB and AQP2 was 0.913. RBP and ALB were positively correlated to MCP-1 in the prenatal maternal peripheral blood and there was a negative correlation between AQP2 and MCP-1 (P<0.05). In conclusion, urinary RBP, ALB and AQP2 can be regarded as markers for the diagnosis of the neonatal hydronephrosis and they are also closely related to the MCP-1 level in the prenatal maternal peripheral blood.

Early Pregnancy Biochemical Predictors of Gestational Diabetes Mellitus

PURPOSE OF REVIEW

Universal oral glucose tolerance-based screening is employed to identify pregnant women with gestational diabetes mellitus (GDM), as treatment of this condition decreases the risk of associated complications. A simple and accurate blood test which identifies women at low or high risk for GDM in the first trimester would have the potential to decrease costs and improve outcomes through prevention or treatment. This review summarizes published data on early pregnancy biomarkers which have been tested as predictors of GDM.

RECENT FINDINGS

A large number of first-trimester biochemical predictors of GDM have been reported, mostly in small case-control studies. These include glycemic markers (fasting glucose, post-load glucose, hemoglobin A1C), inflammatory markers (C-reactive protein, tumor necrosis factor-alpha), insulin resistance markers (fasting insulin, sex hormone-binding globulin), adipocyte-derived markers (adiponectin, leptin), placenta-derived markers (follistatin-like-3, placental growth factor, placental exosomes), and others (e.g., glycosylated fibronectin, soluble (pro)renin receptor, alanine aminotransferase, ferritin). A few large studies suggest that first-trimester fasting glucose or hemoglobin A1C may be useful for identifying women who would benefit from early GDM treatment. To translate the findings from observational studies of first-trimester biomarkers for GDM to clinical practice, trials or cost-effectiveness analyses of screening and treatment strategies based on these novel biomarkers are needed.