The combination of symphysis-fundal height and abdominal circumference as a novel predictor of macrosomia in GDM and normal pregnancy

Overexpression of IGF2 affects mouse weight and glycolipid metabolism and IGF2 is positively related to macrosomia

Objective

To investigate the effects of insulin-like growth factor 2 (IGF2) on growth and glycolipid metabolism, as well as the underlying mechanism.

Methods

A mouse model of IGF2 overexpression was constructed to measure weight gain before adulthood, to obtain the values of adult glycolipid metabolism indicators in the peripheral blood and to detect the expression of genes in the IGF2 signaling pathway in different mouse tissues. The present study also explored the independent association between the IGF2 gene and macrosomia by detecting and comparing the expression levels of IGF2 mRNA/H19 RNA in maternal peripheral blood and fetal cord blood of 26 human pregnancies.

Results

In the mouse model, weights of the IGF2-overexpressing mice were significantly higher than those of the control mice at the age of 5-10 weeks. The glucose concentration, total cholesterol and high-density lipoprotein cholesterol (HDL-C) levels of IGF2-overexpressing mice were significantly lower than those of wild-type (WT) mice. Compared with the WT mice, the expression of H19 was significantly decreased in the pancreas and IGF1R was significantly decreased in the muscle of mice with IGF2 overexpression. The expression levels of STAT3 and AKT2 showed significant decrease in liver, muscle and increase in muscle of IGF2-overexpressing mice, respectively. GLUT2 expression showed significant increase in liver, kidney, muscle and decrease in pancreas of mice with IGF2 overexpression. This study also found that in normal mothers with the similar clinical characteristics, IGF2 expression in the maternal peripheral blood and fetal cord blood is an independent factor influencing macrosomia.

Conclusion

IGF2 expression was independently correlated with the occurrence of macrosomia, and overexpression of IGF2 significantly increased the weights of mice at the age of 5-10 weeks and significantly affected the values of adult glycolipid metabolism indicators, which might be the result of changes in the IGF2-IGF1R-STAT3/AKT2-GLUT2/GLUT4 pathway. These findings might suggest that IGF2 plays an important role in growth and glycolipid metabolism during both pregnancy and postnatal development.

Risk Factors for Macrosomia in Multipara: A Multi-Center Retrospective Study

The increased incidence of macrosomia has caused an enormous burden after the transition from the almost 40-year one-child policy to the universal two-child policy in 2015 and further to the three-child policy in 2021 in China. However, studies on risk factors of macrosomia in multipara under the new fertility policy in China are limited. We aim to explore the incidence and risk factors for macrosomia in multipara to provide the scientific basis for preventing macrosomia in multipara. A multi-center retrospective study was conducted among 6200 women who had two consecutive deliveries in the same hospital and their second newborn was delivered from January to October 2018 at one of 18 hospitals in 12 provinces in China. Macrosomia was defined as birth weight ≥ 4000 g. Logistic regression models were performed to analyze risk factors for macrosomia in multipara. The incidence of macrosomia in multipara was 7.6% (470/6200) and the recurrence rate of macrosomia in multipara was 27.2% (121/445). After adjusting for potential confounders, a higher prepregnancy BMI, higher gestational weight gain, history of macrosomia, a longer gestation in the subsequent pregnancy were independent risk factors of macrosomia in multipara (p < 0.05). Healthcare education and preconception consultation should be conducted for multipara patients with a history of macrosomia to promote maintaining optimal prepregnancy BMI and avoid excessive gestational weight gain to prevent macrosomia.

The Role of Slit-2 in Gestational Diabetes Mellitus and Its Effect on Pregnancy Outcome

BACKGROUND

Slit guidance ligand 2 (Slit-2), as a member of the Slit family, can regulate the inflammatory response and glucose metabolism. The purpose of this study was to explore the expression of Slit-2 in maternal peripheral blood and neonatal cord blood of gestational diabetes mellitus (GDM) patients and its potential importance in disease progression.

METHODS

This study included 57 healthy pregnant women and 61 GDM patients. The levels of Slit-2, C-reactive protein (CRP), monocyte chemoattractant protein-1 (MCP-1), C-peptide (C-P), galectin-3(Gal-3), HbA1c, fasting blood glucose (FBG) and fasting insulin (FINS) in maternal peripheral blood and neonatal cord blood were detected by ELISA. Spearman's rank correlation test was used to assess the association between peripheral Slit-2 and inflammatory indicators, insulin resistance, and pregnancy outcomes. Logistic regression analysis was used to analyze the risk factors of GDM.

RESULTS

Slit-2 levels in maternal peripheral blood and neonatal cord blood of the GDM patients were higher than those of the HC. Slit-2 levels in maternal peripheral blood and neonatal cord blood of the GDM patients were positively correlated with inflammatory factors CRP and MCP-1 levels. The level of Slit-2 in the maternal peripheral blood of the GDM patients was positively correlated with the level of homeostasis model assessment insulin resistance (HOMA-IR) and HbA1c in maternal peripheral blood, but was negatively correlated with the level of homeostasis model assessment -β (HOMA-β). We also found that the Slit-2 level in the maternal peripheral blood of the GDM patients was negatively correlated with neonatal blood glucose, positively correlated with neonatal weight and independent of neonatal total bilirubin.

CONCLUSION

Our study suggests that the abnormal increase in Slit-2 in GDM may be related to its pathogenesis, and it was correlated with neonatal blood glucose and weight in patients with GDM, suggesting that Slit-2 may be a potential biomarker of GDM.