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Shimada H, Powell TL, Jansson T. Regulation of placental amino acid transport in health and disease. Acta Physiol (Oxf) 2024; 240:e14157. [PMID: 38711335 PMCID: PMC11162343 DOI: 10.1111/apha.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
Abnormal fetal growth, i.e., intrauterine growth restriction (IUGR) or fetal growth restriction (FGR) and fetal overgrowth, is associated with increased perinatal morbidity and mortality and is strongly linked to the development of metabolic and cardiovascular disease in childhood and later in life. Emerging evidence suggests that changes in placental amino acid transport may contribute to abnormal fetal growth. This review is focused on amino acid transport in the human placenta, however, relevant animal models will be discussed to add mechanistic insights. At least 25 distinct amino acid transporters with different characteristics and substrate preferences have been identified in the human placenta. Of these, System A, transporting neutral nonessential amino acids, and System L, mediating the transport of essential amino acids, have been studied in some detail. Importantly, decreased placental Systems A and L transporter activity is strongly associated with IUGR and increased placental activity of these two amino acid transporters has been linked to fetal overgrowth in human pregnancy. An array of factors in the maternal circulation, including insulin, IGF-1, and adiponectin, and placental signaling pathways such as mTOR, have been identified as key regulators of placental Systems A and L. Studies using trophoblast-specific gene targeting in mice have provided compelling evidence that changes in placental Systems A and L are mechanistically linked to altered fetal growth. It is possible that targeting specific placental amino acid transporters or their upstream regulators represents a novel intervention to alleviate the short- and long-term consequences of abnormal fetal growth in the future.
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Affiliation(s)
- Hiroshi Shimada
- Department of Obstetrics and Gynecology University of Colorado, Anschutz Medical Campus, Aurora, CO, US
- Departments of Obstetrics & Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Theresa L Powell
- Department of Obstetrics and Gynecology University of Colorado, Anschutz Medical Campus, Aurora, CO, US
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO, US
| | - Thomas Jansson
- Department of Obstetrics and Gynecology University of Colorado, Anschutz Medical Campus, Aurora, CO, US
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Ramö Isgren A, Carlhäll S, Dennis Retrato M, Kodikara C, A. Ubhayasekera K, Kjölhede P, Bergquist J, Blomberg M. The association between maternal body mass index and serial plasma oxytocin levels during labor. PLoS One 2023; 18:e0290038. [PMID: 37566578 PMCID: PMC10420366 DOI: 10.1371/journal.pone.0290038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To evaluate the association between maternal body mass index (BMI) and plasma oxytocin (OT) levels at different OT infusion rates in labor. METHODS A prospective observational study analyzing serial plasma samples in laboring women with OT infusion. The women were categorized into three groups, women with non-obesity (BMI 18.5-29.9, n = 12), obesity (BMI 30.0-34.9, n = 13), and morbid obesity (BMI ≥ 35.0, n = 15). Plasma OT was analyzed using tandem mass spectrometry. RESULTS Except for a low positive correlation between OT levels and BMI and significantly increased plasma OT levels in women with morbid obesity at the OT infusion rate of 3.3 mU/min, no significant differences in OT levels between the BMI groups were found. Further, the inter-individual differences in OT levels were large and no dose-dependent increase of OT levels was seen. CONCLUSIONS Other factors than plasma OT levels may be more likely to determine the clinical response of OT infusion in women with obesity. Perhaps the observed clinical need and individual response would be a better predictor of plasma OT levels than a pre-determined OT infusion rate. The OT dosage guidelines for labor augmentation should be individualized according to clinical response rather than generalized. TRIAL REGISTRATION Clinical trial registration: ClinicalTrials.gov ID NCT04093479.
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Affiliation(s)
- Anna Ramö Isgren
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sara Carlhäll
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mark Dennis Retrato
- Department of Chemistry-BMC, Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden
| | - Chamali Kodikara
- Department of Chemistry-BMC, Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden
| | - Kumari A. Ubhayasekera
- Department of Chemistry-BMC, Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden
| | - Preben Kjölhede
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jonas Bergquist
- Department of Chemistry-BMC, Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Abu Shqara R, Or S, Nakhleh Francis Y, Wiener Y, Lowenstein L, Wolf MF. Third trimester re-screening for gestational diabetes in morbidly obese women despite earlier negative test can reveal risks for obstetrical complications. J Obstet Gynaecol Res 2023; 49:852-862. [PMID: 36494818 DOI: 10.1111/jog.15515] [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: 08/24/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
AIM We investigated associations of maternal obesity with late gestational diabetes mellitus (GDM) diagnosis (>34 weeks) in women with previous normal glucose screening, and associations of late GDM with obstetrical outcomes. METHODS This retrospective cohort study assessed obstetrical and neonatal outcomes of 238 women with normal (24-28 week) glucose screening results, who underwent late repeat oral glucose tolerance tests (OGTT) (>34 weeks) due to a suspected LGA fetus (54.6%) or polyhydramnios (45.4%). A sub-analysis was performed of outcomes of women with late versus mid-trimester GDM. RESULTS The GDM rate in repeat OGTT screening was 22.2% for the total sample, and 33% among women with morbid obesity. Among women with late GDM versus without late GDM, rates were higher for macrosomia, large-for-gestational-age fetus induction of labor, neonatal hypoglycemia, jaundice, and the need for phototherapy. Among women with late GDM, a higher pregestational BMI was associated with adverse maternal and perinatal outcomes. Higher risks for macrosomia and CS due to macrosomia were demonstrated in women with late vs. mid-trimester GDM. CONCLUSION Late screening in pregnancy may reveal GDM among women with previous normal glucose screening, particularly among those with late third trimester BMI ≥ 35 kg/m2 , GDM in a previous pregnancy or fasting glucose >95 mg/dl. Women diagnosed with GDM at >34 weeks following normal glucose screening at 24-28 weeks are at higher risk for adverse perinatal outcomes. For women with morbid obesity, or suspected macrosomia or polyhydramnios in the late third trimester, and normal glucose screening in the second trimester, retesting should be considered.
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Affiliation(s)
- Raneen Abu Shqara
- Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Shany Or
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Yifat Wiener
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Zerifin, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Lowenstein
- Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Teodorescu COD, Gorecki GP, Pleș L, Sima RM, Bălălău DO, Filipescu A, Teodorescu A. Profilul metabolic pentru monitorizarea şi managementul diabetului gestaţional. GINECOLOGIA.RO 2023. [DOI: 10.26416/gine.39.1.2023.7781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Srugo SA, Fell DB, Corsi DJ, Fakhraei R, Guo Y, Gaudet LM. Examining the role of pre-pregnancy weight and gestational weight gain in allergic disease development among offspring: A population-based cohort study in Ontario, Canada. Paediatr Perinat Epidemiol 2022; 36:144-155. [PMID: 34396579 PMCID: PMC9275258 DOI: 10.1111/ppe.12806] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Studies suggest maternal weight and weight gain during pregnancy may influence foetal immunological development. However, their role in the aetiology of allergic disease is unclear. OBJECTIVES We sought to examine the impact of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on the incidence of four common paediatric allergic diseases. METHODS We conducted a retrospective, population-based cohort study of all singleton live births in Ontario, Canada between 2012 and 2014, using maternal-newborn records from the provincial birth registry linked with health administrative databases. Neonates were followed up to 7 years for anaphylaxis, asthma, dermatitis and rhinitis, identified through validated algorithms based on healthcare encounters. We multiply imputed missing data and employed Cox proportional-hazards models to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI). To test the robustness of our findings, we also conducted several sensitivity analyses, including probabilistic bias analyses for exposure and outcome misclassification. All methods were prespecified in a published protocol. RESULTS Of the 248,017 infants followed, 52% were born to mothers with a pre-pregnancy BMI in the normal range and only 19% were born to mothers with adequate weight gain during pregnancy. Incidence rates (per 100,000 person-days) for anaphylaxis, asthma, dermatitis and rhinitis were 0.22, 6.80, 12.41 and 1.54, respectively. Compared with normal BMI, maternal obesity was associated with increased hazards of asthma in offspring (aHR 1.08, 95% CI 1.05, 1.11), but decreased hazards of anaphylaxis (aHR 0.83, 95% CI 0.69, 0.99) and dermatitis (aHR 0.97, 95% CI 0.94, 0.99). In contrast, maternal underweight was associated with increased hazards of dermatitis (aHR 1.06, 95% CI 1.02, 1.10). We found no associations between pre-pregnancy BMI and rhinitis or GWG and any allergic outcome, and no evidence of effect measures modification by infant sex. CONCLUSIONS These findings provide support for the involvement of maternal pre-pregnancy BMI in paediatric allergic disease development.
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Affiliation(s)
- Sebastian A. Srugo
- School of Epidemiology and Public HealthUniversity of OttawaOttawaONCanada
| | - Deshayne B. Fell
- School of Epidemiology and Public HealthUniversity of OttawaOttawaONCanada,Children’s Hospital of Eastern Ontario Research InstituteOttawaONCanada,ICESOttawaONCanada
| | - Daniel J. Corsi
- School of Epidemiology and Public HealthUniversity of OttawaOttawaONCanada,Children’s Hospital of Eastern Ontario Research InstituteOttawaONCanada,OMNI Research GroupOttawa Hospital Research InstituteUniversity of OttawaOttawaONCanada,Better Outcomes Registry & Network OntarioOttawaONCanada
| | - Romina Fakhraei
- OMNI Research GroupOttawa Hospital Research InstituteUniversity of OttawaOttawaONCanada
| | - Yanfang Guo
- School of Epidemiology and Public HealthUniversity of OttawaOttawaONCanada,Children’s Hospital of Eastern Ontario Research InstituteOttawaONCanada,OMNI Research GroupOttawa Hospital Research InstituteUniversity of OttawaOttawaONCanada,Better Outcomes Registry & Network OntarioOttawaONCanada
| | - Laura M. Gaudet
- School of Epidemiology and Public HealthUniversity of OttawaOttawaONCanada,OMNI Research GroupOttawa Hospital Research InstituteUniversity of OttawaOttawaONCanada,Department of Obstetrics and GynaecologyQueen’s UniversityKingstonONCanada,Department of Obstetrics and GynaecologyKingston Health Sciences CentreKingstonONCanada
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Molin J, Vanky E, Løvvik TS, Dehlin E, Bixo M. Gestational weight gain, appetite regulating hormones, and metformin treatment in polycystic ovary syndrome: A longitudinal, placebo-controlled study. BJOG 2021; 129:1112-1121. [PMID: 34865304 DOI: 10.1111/1471-0528.17042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore mechanisms that modulate gestational weight gain (GWG) in women with polycystic ovary syndrome (PCOS) and healthy controls. DESIGN Sub-sample of randomised controlled trials (PCOS) combined with a prospective cohort (controls). SETTING Eleven Norwegian, Swedish, and Icelandic hospitals. POPULATION Pregnant women with PCOS treated with metformin (PCOS-M, n = 36) or placebo (PCOS-P, n = 37), and healthy pregnant women (HC, n = 15). METHODS Serum levels of the appetite regulating hormones leptin, ghrelin, allopregnanolone, and soluble leptin receptor (sOB-R) were determined in the first and third trimesters. MAIN OUTCOME MEASURES Excessive GWG (eGWG) relative to body mass index according to Institute of Medicine (IOM) guideline. Serum leptin/sOB-R ratio, or free-leptin-index (FLI), as biomarker of leptin sensitivity. Serum ghrelin and allopregnanolone levels. RESULTS The overall prevalence of eGWG was 44% (38/86). Women with eGWG had higher first and third trimester FLI (P < 0.001), and lower third trimester allopregnanolone levels (P = 0.003) versus women with non-eGWG. The prevalence of eGWG was lower in PCOS-M versus PCOS-P (28% versus 62%, odds ratio = 0.4, 95% CI 0.2-0.8, P = 0.005). FLI decreased during pregnancy in PCOS-M (P = 0.01), but remained unaltered in PCOS-P and HC. Ghrelin and allopregnanolone levels were comparable in PCOS-M, PCOS-P and HC throughout pregnancy. CONCLUSION Excessive GWG is associated with enhanced leptin resistance, and attenuated physiological increase in serum allopregnanolone levels during pregnancy. Metformin reduces the risk for eGWG and improves leptin sensitivity in pregnant women with PCOS.
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Affiliation(s)
- Johanna Molin
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynaecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tone S Løvvik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynaecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eva Dehlin
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Marie Bixo
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
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Obeidat RA, Abdo N, Sakee B, Alghazo S, Jbarah OF, Hazaimeh EA, Albeitawi S. Maternal and fetal serum leptin levels and their association with maternal and fetal variables and labor: A cross-sectional study. Ann Med Surg (Lond) 2021; 72:103050. [PMID: 34815864 PMCID: PMC8591461 DOI: 10.1016/j.amsu.2021.103050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background Leptin is a polypeptide hormone that may be implicated in the pathogenesis of various disorders during pregnancy. We sought to determine serum leptin levels among pregnant women and their fetuses and to investigate their association with fetal and maternal variables. Method 452 pregnant women who attended to labor ward between January 2020 and August 2020 were included in the study. Serum leptin concentrations were measured using enzyme-linked immunosorbent assay method. Mann-Whitney U test and Spearman's correlation test were used for statistical analysis. A multivariate linear regression analysis was then performed. Significance level was considered at alpha <0.05. Results The median maternal and fetal serum leptin levels were 6.42 [4.16-8.51] ng/mL and 2.9 [1.03-5.36] ng/mL respectively. There was no significant correlation between maternal and fetal serum leptin levels (p = 0.064). Maternal serum leptin levels correlated positively with maternal body mass index (BMI) (r = 0.117, p = 0.005). Besides, maternal serum leptin levels were significantly higher in nulliparous women (7.57 [4.45-9.30] ng/mL vs. 6.22 [4.02-8.30] ng/mL, p = 0.037) and in women who were in active labor (6.83 [4.39-8.92] ng/mL vs. 6.25 [4.04-8.30] ng/mL, p = 0.047). Fetal serum leptin levels were significantly higher in large for gestational age (LGA) fetuses (4.81 [2.13-7.22] ng/mL vs. 2.80 [0.96-5.16] ng/mL, p = 0.003) and in fetuses with preterm premature ruptures of membranes (PPROM) (5.23 [2.42-8.07] ng/mL vs. 2.86 [1.00-5.23] ng/mL, p = 0.021). Conclusion Maternal serum leptin levels were influenced by maternal BMI, parity and labor. Fetal serum leptin levels were higher among LGA fetuses and in fetuses with PPROM.
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Affiliation(s)
- Rawan A Obeidat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nour Abdo
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Baraa Sakee
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shahed Alghazo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F Jbarah
- Department of Neuroscience, Neurosurgery Division, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ethar A Hazaimeh
- Department of Neuroscience, Neurology Division, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Soha Albeitawi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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Abstract
Contractions are produced through a complex interplay of hormonal, mechanical, and electrical factors. In labor, contractions are measured using the Montevideo unit. Clinical considerations in labor wherein contraction assessment becomes paramount include the care of women whose labor is complicated by abnormal progress or tachysystole. In an era of obstetrics in which the high cesarean rate is a major issue of concern, there remain many questions as to how to best incorporate contraction monitoring into practice in order to optimize care. Technological advancement has led to the development on new modalities that can be used to study contraction physiology, and there may be an opportunity in the future to apply these methods for use in the clinical setting. This article also makes a case for the need to reevaluate the current measures of uterine contractile activity and the definition of contraction adequacy using updated definitions of normal labor progress.
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Affiliation(s)
- Stephen E Gee
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, 395 W. 12th Ave, 5th floor, 43210 Columbus, OH, United States.
| | - Heather A Frey
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, 395 W. 12th Ave, 5th floor, 43210 Columbus, OH, United States
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Bahri Khomami M, Moran LJ, Kenny L, Grieger JA, Myers J, Poston L, McCowan L, Walker J, Dekker G, Norman R, Roberts CT. Lifestyle and pregnancy complications in polycystic ovary syndrome: The SCOPE cohort study. Clin Endocrinol (Oxf) 2019; 90:814-821. [PMID: 30801750 DOI: 10.1111/cen.13954] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the risk of pregnancy complications in women with and without polycystic ovary syndrome after consideration of lifestyle factors. DESIGN Prospective cohort. PATIENTS AND MEASUREMENTS Participants (n = 5628) were apparently healthy nulliparous women with singleton pregnancies from the Screening for Pregnancy Endpoints study in New Zealand, Australia, United Kingdom and Ireland. Multivariable regression models were performed assessing the association of self-reported polycystic ovary syndrome status with pregnancy complications with consideration of lifestyle factors at the 15th week of gestation. RESULTS Women with polycystic ovary syndrome (n = 354) were older, had a higher socio-economic index and body mass index and were less likely to consume alcohol and smoke but more likely to do vigorous exercise and take multivitamins. In univariable analysis, polycystic ovary syndrome was associated with increased risk of gestational diabetes (OR: 2.2, 95% CI: 1.2, 4.0). In multivariable models, polycystic ovary syndrome was only significantly associated with decreased risk of large for gestational age (OR: 0.62, 95% CI: 0.40, 0.98) with a population attributable risk of 0.22%. None of the other outcomes were attributable to polycystic ovary syndrome status. CONCLUSIONS Polycystic ovary syndrome is associated with a lower risk of large for gestational age infants. In this low-risk population, the risk of pregnancy complications was not increased in women with polycystic ovary syndrome who were following a healthy lifestyle. Further studies are warranted assessing the contribution of lifestyle factors to the risk of pregnancy complications in higher risk groups of women with and without polycystic ovary syndrome.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Center for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa J Moran
- Monash Center for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Louise Kenny
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
| | - Jenny Myers
- The Maternal and Fetal Health Research Center, University of Manchester, Manchester, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College, London, UK
| | - Lesley McCowan
- Department of Obstetrics and Gynecology, University of Auckland, Auckland, New Zealand
| | - James Walker
- Department of Obstetrics and Gynecology, University of Leeds, Leeds, UK
| | - Gustaaf Dekker
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
- Women and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Norman
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Fertility SA, Adelaide, South Australia, Australia
| | - Claire T Roberts
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
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Tavares BB, Tresso BD. Índice de masa corporal asociado a las características de las puérperas y de los neonatos. REVISTA CUIDARTE 2019. [DOI: 10.15649/cuidarte.v10i2.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Un Índice de Masa Corporal (IMC) pregestacional inadecuado conlleva riesgos maternos/fetales. Objetivos: Identificar el IMC pregestacional y vincularlo a los datos sociodemográficos y obstétricos de las puérperas; e identificar el IMC pregestacional y el aumento de peso durante el embarazo relacionados con las características de los neonatos. Materiales y Métodos: Estudio cuantitativo, descriptivo, desarrollado en un hospital de referencia, con 187 binomios. Los datos fueron recolectados a partir de la libreta prenatal y de la Declaración de Nacido Vivo. Debido a la ausencia de distribución gaussiana, se compararon las variables continuas, utilizando pruebas no paramétricas (Mann-Whitney o Kruskal-Wallis). Las muestras pareadas fueron comparadas utilizando la prueba de Wilcoxon para datos pareados. Para comparar las variables categóricas, se utilizó la prueba exacta de Fisher o la prueba chi-cuadrado de Pearson. Resultados: El IMC pre-gestacional varió de 16 a 53kg/m², promedio 25,0 ±5,9kg/m²; 41,2% con sobrepeso y mujeres obesas; el promedio de aumento del peso gestacional fue de 11Kg ±30Kg; el promedio de edad fue de 26 años. Se observó un aumento progresivo del peso de acuerdo con el aumento de la edad (P=0,009); las mujeres obesas más propensas a ser hospitalizadas por Síndrome Hiperintensiva Gestacional (P=0,003) y por hipertensión arterial crónica (P=0,026); entre las mujeres con IMC elevado 24,0% eran primíparas y 23,5% multíparas; el promedio de peso de los neonatos fue de 3146,8g ±559,7g. El peso de los neonatos de las obesas fue superior (P=0,034). Se observó una correlación positiva entre el IMC materno pre-gestacional y el peso del RN al nacer (rho–0,219; P=0,003). Discusión: Los resultados demostraron un aumento de peso en las madres gestantes, lo que corrobora las investigaciones de la literatura. Conclusiones: La evaluación del estado nutricional se debe realizar en la fase de planeación de la gestación con el fin de evitar complicaciones futuras.
Como citar este artigo: Tresso BD, Tavares BB. Índice de massa corporal associado às caractéristicas das puérperas e dos neonatos. Rev Cuid. 2019; 10(2): e678. http://dx.doi.org/10.15649/cuidarte.v10i2.678
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Ostafiichuk SO. Genetic aspects of metabolic disorders in pregnant women with pathological weight gain. REGULATORY MECHANISMS IN BIOSYSTEMS 2019. [DOI: 10.15421/021941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Polymorphism of the leptin receptor gene (LEPR) has been shown to be linked to obesity-related metabolic markers and phenotype. Therefore, we hypothesized that the Gln233Arg LEPR polymorphism is related to metabolic changes in pregnancy and the risk of excessive gestational weight gain (GWG). A total of 97 pregnant women with a singleton gestation were enrolled from April 2016 until December 2018. Genetic variants of LEPR were analyzed by real-time polymerase chain reaction, leptin by enzyme-linked immunosorbent assay, lipid profile, and carbohydrate status were assessed in the first, and third trimesters of pregnancy. The recommended GWG was diagnosed in 34.0%, insufficient in 19.6%, and excessive in 46.4% patients. Statistical analysis revealed that 20.6% patients were with AA genotype, 50.5% – AG genotype, and 28.9% – GG genotype. The frequency of GG-alleles carriers of the LEPR Gln233Arg gene in the group of excessive GWG patients was 3 times higher compared to recommended GWG patients. Thus, the inheritance of pathological G-homozygotes increases the risk of excessive weight gain by 7 times, compared to carriers of the AA genotype. LEPR GG polymorphism was significantly associated with high levels of triglycerides, total cholesterol, lipoprotein low and very low density, and leptin compared to homozygous А-carriers in the third trimester of pregnancy. In pregnant women with GG polymorphism, the glucose level, insulin level, and HOMO-IR index were significantly increased compared to women with AA genotype in late pregnancy. In the group with excessive GWG, the presence of GG-alleles of the LEPR gene was accompanied by a higher level of hyperleptinemia, compared to carriers of AA-genotype. Inheritance of pathological G-homozygotes was associated with hyperlipidemia, leptin resistance with high leptin serum levels, and increased insulin resistance, which was especially manifested in excessive GWG. In our opinion, excessive GWG can be seen as a marker of the mother's genotype and genetic predisposition to the development of metabolic diseases after delivery.
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Carlhäll S, Källén K, Thorsell A, Blomberg M. Maternal plasma leptin levels in relation to the duration of the active phase of labor. Acta Obstet Gynecol Scand 2018; 97:1248-1256. [PMID: 29772056 DOI: 10.1111/aogs.13380] [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] [Received: 01/16/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Obese women have increased leptin levels and longer duration of labor compared with normal-weight women. Leptin has an inhibitory effect on myometrial contractility in vitro. Our purpose was to examine whether maternal leptin levels in active labor were associated with the duration of the active phase of labor. MATERIAL AND METHODS This prospective cohort study included 914 women. Maternal blood samples were collected in active labor. The plasma-leptin concentration was obtained using a direct sandwich-based ELISA. Bivariate and multiple linear regression analyses were used to study the association between leptin levels and the duration of labor. RESULTS A 1 ng/mL increase in maternal plasma leptin was associated with a 0.015 hour increase in duration of labor (P < .007). This association was not statistically significant in the adjusted analyses nor when analyzing nulliparous and multiparous women separately. In women with spontaneous labor (n = 766) leptin levels were not associated with an increase in duration of labor in the adjusted analyses. CONCLUSIONS There was no significant association between leptin levels and duration of the active phase of labor. Leptin in vivo might display a similar dose-response effect on myometrial contractility as demonstrated in in vitro studies. Future studies need to explore the association between leptin levels and time in labor in obese women with high leptin levels to evaluate a possible dose-response effect.
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Affiliation(s)
- Sara Carlhäll
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Karin Källén
- Institution of Clinical Sciences Lund, Center for Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
| | - Annika Thorsell
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Solis-Paredes M, Estrada-Gutierrez G, Perichart-Perera O, Montoya-Estrada A, Guzmán-Huerta M, Borboa-Olivares H, Bravo-Flores E, Cardona-Pérez A, Zaga-Clavellina V, Garcia-Latorre E, Gonzalez-Perez G, Hernández-Pérez JA, Irles C. Key Clinical Factors Predicting Adipokine and Oxidative Stress Marker Concentrations among Normal, Overweight and Obese Pregnant Women Using Artificial Neural Networks. Int J Mol Sci 2017; 19:ijms19010086. [PMID: 29283404 PMCID: PMC5796036 DOI: 10.3390/ijms19010086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Maternal obesity has been related to adverse neonatal outcomes and fetal programming. Oxidative stress and adipokines are potential biomarkers in such pregnancies; thus, the measurement of these molecules has been considered critical. Therefore, we developed artificial neural network (ANN) models based on maternal weight status and clinical data to predict reliable maternal blood concentrations of these biomarkers at the end of pregnancy. Adipokines (adiponectin, leptin, and resistin), and DNA, lipid and protein oxidative markers (8-oxo-2′-deoxyguanosine, malondialdehyde and carbonylated proteins, respectively) were assessed in blood of normal weight, overweight and obese women in the third trimester of pregnancy. A Back-propagation algorithm was used to train ANN models with four input variables (age, pre-gestational body mass index (p-BMI), weight status and gestational age). ANN models were able to accurately predict all biomarkers with regression coefficients greater than R2 = 0.945. P-BMI was the most significant variable for estimating adiponectin and carbonylated proteins concentrations (37%), while gestational age was the most relevant variable to predict resistin and malondialdehyde (34%). Age, gestational age and p-BMI had the same significance for leptin values. Finally, for 8-oxo-2′-deoxyguanosine prediction, the most significant variable was age (37%). These models become relevant to improve clinical and nutrition interventions in prenatal care.
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Affiliation(s)
- Mario Solis-Paredes
- Department of Human Genetics and Genomics, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico;
- Posgrado en Ciencias Químico-Biológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico;
| | - Guadalupe Estrada-Gutierrez
- Research Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (G.E.-G.); (M.G.-H.); (A.C.-P.)
| | - Otilia Perichart-Perera
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (O.P.-P.); (H.B.-O.)
| | - Araceli Montoya-Estrada
- Department of Inmunobiochemistry, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (A.M.-E.); (E.B.-F.); (V.Z.-C.)
| | - Mario Guzmán-Huerta
- Research Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (G.E.-G.); (M.G.-H.); (A.C.-P.)
| | - Héctor Borboa-Olivares
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (O.P.-P.); (H.B.-O.)
| | - Eyerahi Bravo-Flores
- Department of Inmunobiochemistry, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (A.M.-E.); (E.B.-F.); (V.Z.-C.)
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de Mexico, Mexico City 04510, Mexico
| | - Arturo Cardona-Pérez
- Research Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (G.E.-G.); (M.G.-H.); (A.C.-P.)
| | - Veronica Zaga-Clavellina
- Department of Inmunobiochemistry, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (A.M.-E.); (E.B.-F.); (V.Z.-C.)
| | - Ethel Garcia-Latorre
- Posgrado en Ciencias Químico-Biológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico;
| | - Gabriela Gonzalez-Perez
- Department of Physiology and Cellular Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico;
| | - José Alfredo Hernández-Pérez
- Centro de Investigación en Ingeniería y Ciencias Aplicadas-Instituto de Investigación en Ciencias Básicas y Aplicadas (CIICAp-IICBA), Universidad Autónoma de Morelos, Cuernavaca 62209, Mexico;
| | - Claudine Irles
- Department of Physiology and Cellular Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico;
- Correspondence: or ; Tel.: +52-55-5520-9900
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Sámano R, Martínez-Rojano H, Chico-Barba G, Godínez-Martínez E, Sánchez-Jiménez B, Montiel-Ojeda D, Tolentino M. Serum Concentration of Leptin in Pregnant Adolescents Correlated with Gestational Weight Gain, Postpartum Weight Retention and Newborn Weight/Length. Nutrients 2017; 9:nu9101067. [PMID: 28953229 PMCID: PMC5691684 DOI: 10.3390/nu9101067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction: Gestational weight gain is an important modifiable factor known to influence fetal outcomes including birth weight and adiposity. Leptin is normally correlated with adiposity and is also known to increase throughout pregnancy, as the placenta becomes a source of leptin synthesis. Several studies have reported positive correlations between cord blood leptin level and either birthweight or size for gestational age, as well as body mass index (BMI). Objective: To determine the correlation of prenatal leptin concentration in pregnant adolescents with their gestational weight gain, postpartum weight retention, and weight/length of their newborn. Methods: A cohort study was conducted on pregnant Mexican adolescents from Gestational Week 26–28 to three months postpartum (n = 168 mother–child dyads). An anthropometric assessment was made of each pregnant adolescent, and the serum level of leptin and the intake of energy were determined. The newborn was evaluated each month during postpartum. Clinical records were reviewed to obtain sociodemographic data. Bivariate correlations, tests for repeating measurements and logistic regression models were performed. Results: Leptin concentration gradually increased during the third trimester of pregnancy. At Gestation Week 36, leptin level correlated with gestational weight gain. When comparing adolescents that had the lowest and highest concentration of leptin, the former presented a mean of 6 kg less in gestational weight gain (inter-subject leptin concentration, p = 0.001; inter-subject energy intake, p = 0.497). Leptin concentration and gestational weight gain exerted an effect on the weight of the newborn (inter-subject leptin concentration for Week 32, p = 0.024; inter-subject gestational weight gain, p = 0.011). Newborn length was associated with leptin concentration at Week 28 (leptin effect, p = 0.003; effect of gestational weight gain, p = 0.722). Conclusions: Pregnant adolescents with leptin concentration over 20 ng/mL showed a greater gestational weight gain. Leptin concentration correlated with length and weight of the newborn.
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Affiliation(s)
- Reyna Sámano
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, 11000 Ciudad de México, Mexico.
| | - Hugo Martínez-Rojano
- Sección de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, 11340 Ciudad de México, Mexico.
- Coordinación de Medicina Laboral, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) "Dr. Manuel Martínez Báez", Secretaría de Salud, 01480 Ciudad de México, Mexico.
| | - Gabriela Chico-Barba
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, 11000 Ciudad de México, Mexico.
| | - Estela Godínez-Martínez
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, 11000 Ciudad de México, Mexico.
| | - Bernarda Sánchez-Jiménez
- Subdirección de Investigación en Intervenciones Comunitarias del Instituto Nacional de Perinatología, Secretaría de Salud, 11000 Ciudad de México, Mexico.
| | - Diana Montiel-Ojeda
- Universidad del Valle de México, Chapultepec, 11810 Ciudad de México, Mexico.
| | - Maricruz Tolentino
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, 11000 Ciudad de México, Mexico.
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Moran LJ, Fraser LM, Sundernathan T, Deussen AR, Louise J, Yelland LN, Grivell RM, Macpherson A, Gillman MW, Robinson JS, Owens JA, Dodd JM. The effect of an antenatal lifestyle intervention in overweight and obese women on circulating cardiometabolic and inflammatory biomarkers: secondary analyses from the LIMIT randomised trial. BMC Med 2017; 15:32. [PMID: 28193219 PMCID: PMC5307888 DOI: 10.1186/s12916-017-0790-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/11/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Maternal overweight and obesity during pregnancy is associated with insulin resistance, hyperglycaemia, hyperlipidaemia and a low-grade state of chronic inflammation. The aim of this pre-specified analysis of secondary outcome measures was to evaluate the effect of providing antenatal dietary and lifestyle advice on cardiometabolic and inflammatory biomarkers. METHODS We conducted a multicentre trial in which pregnant women who were overweight or obese were randomised to receive either Lifestyle Advice or Standard Care. We report a range of pre-specified secondary maternal and newborn cardiometabolic and inflammatory biomarker outcomes. Maternal whole venous blood was collected at trial entry (mean 14 weeks gestation; non-fasting), at 28 weeks gestation (fasting), and at 36 weeks gestation (non-fasting). Cord blood was collected after birth and prior to the delivery of the placenta. A range of cardiometabolic and inflammatory markers were analysed (total cholesterol, triglycerides, non-esterified fatty acids, high-density lipoprotein cholesterol, insulin, glucose, leptin, adiponectin, C-reactive protein, granulocyte macrophage-colony stimulating factor, interferon gamma, TNF-α, and interleukins 1β, 2, 4, 5, 6, 8, and 10). Participants were analysed in the groups to which they were randomised, and were included in the analyses if they had a measure at any time point. RESULTS One or more biological specimens were available from 1951 women (989 Lifestyle Advice and 962 Standard Care), with cord blood from 1174 infants (596 Lifestyle Advice and 578 Standard Care). There were no statistically significant differences in mean cardiometabolic and inflammatory marker concentrations across pregnancy and in infant cord blood between treatment groups. Estimated treatment group differences were close to zero, with 95% confidence intervals spanning a range of differences that were short of clinical relevance. There was no evidence to suggest that the intervention effect was modified by maternal BMI category. CONCLUSIONS Despite our findings, it will be worth considering potential relationships between cardiometabolic and inflammatory markers and clinical outcomes, including longer-term infant health and adiposity. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426 ; Date Registered 09/03/2007).
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Affiliation(s)
- Lisa J. Moran
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
- Monash University, Monash Centre for Health Research Implementation, Clayton, Victoria Australia
| | - Louise M. Fraser
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
| | - Tulika Sundernathan
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
| | - Andrea R. Deussen
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
| | - Jennie Louise
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
- The University of Adelaide, School of Population Health, Adelaide, South Australia Australia
| | - Lisa N. Yelland
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
- The University of Adelaide, School of Population Health, Adelaide, South Australia Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia Australia
| | - Rosalie M. Grivell
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
- Flinders University, Department of Obstetrics & Gynaecology, Bedford Park, South Australia Australia
| | - Anne Macpherson
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
| | - Matthew W. Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts USA
- Environmental Influences on Child Health Outcomes (ECHO) Program, National Institutes of Health, Rockville, Maryland USA
| | - Jeffrey S. Robinson
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
| | - Julie A. Owens
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
| | - Jodie M. Dodd
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia Australia
- The Women’s and Children’s Hospital, Women’s and Babies Division, Department of Perinatal Medicine, Adelaide, South Australia Australia
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