Maternal and fetal placental growth hormone and IGF axis in type 1 diabetic pregnancy

Racial differences in the associations between adiposity, placental growth hormone and inflammatory cytokines in pregnant women

BACKGROUND

The prevalence of obesity among women of child-bearing age has contributed to an increased risk of pregnancy complications with a disproportional impact on women of lower socioeconomic status and among certain racial groups. In particular, socio-demographic and historical factors have resulted in higher rates of premature births and small-for-gestational age infants among Black women, which may be associated with placental function during pregnancy. The current study investigated the influence of maternal pre-pregnancy adiposity and race on the associations between inflammatory proteins, placental growth hormone (PGH), and infant birthweight. This information was collected for a subsample of 109 participants (Black, n = 39 vs. White, n = 70) from the Brain and Early Experiences (BEE) study.

METHODS

Serum samples were acquired late in the second trimester to assess PGH levels, C-reactive protein (CRP), interleukin 6 (IL-6), interleukin 8 (IL-8), and interleukin-1 receptor antagonist (IL-1Ra). Participant questionnaire responses provided information on pre-pregnancy BMI, health, race, educational attainment, and infant birthweight. Bivariate correlations and multiple linear regression models were utilized to evaluate associations by race between preconception adiposity, inflammatory markers and PGH.

RESULTS

After controlling for covariates including maternal age and education, gestational age, and fetal sex, regression models indicated that pre-pregnancy BMI was negatively associated with PGH (β=-0.42, p<0.05) and IL-8 was positively associated with PGH (β=0.35, p<0.05) among the Black mothers only; neither were significantly associated with PGH in the White mothers. When extending models to birth outcomes, BMI was positively associated with birthweight corrected for gestational age (BWz) (β=0.24, p<0.05) and educational attainment was negatively associated with BWz (β=0.28, p<0.05) for infants of White women. In contrast, neither variable was predictive of BWz for infants of Black mothers.

CONCLUSION

Future work is needed to investigate racial differences in the association between adiposity and placental functioning, which are likely to contribute to differential effects on pregnancy outcomes and fetal growth.

Fetal growth regulation via insulin-like growth factor axis in normal and diabetic pregnancy

OBJECTIVES

Diabetes mellitus (DM) in pregnancy and gestational diabetes remain a considerable cause of pregnancy complications, and fetal macrosomia is among them. Insulin, insulin-like growth factors (IGFs), and components of their signal-transduction axes belong to the predominant growth regulators and are implicated in glucose homeostasis. This study aimed to evaluate the available evidence on the association between the IGF axis and fetal anthropometric parameters in human diabetic pregnancy.

METHODS

PubMed, Medline, Web of Science, and CNKI databases (1981-2021) were searched.

RESULTS

Maternal and cord serum IGF-I levels are suggested to be positively associated with weight and length of neonates born to mothers with type 1 DM. The results concerning IGF-II and IGFBPs in type 1 DM or any of the IGF axis components in type 2 DM remain controversial. The alterations of maternal serum IGFs concentrations throughout diabetic and non-diabetic pregnancy do not appear to be the same. Maternal 1st trimester IGF-I level is positively associated with fetal birth weight in DM.

CONCLUSIONS

Research on the IGF axis should take gestational age of sampling, presence of DM, and insulin administration into account. Maternal 1st trimester IGF-I level might become a predictor for macrosomia development in diabetic pregnancy.

Metabolic-endocrine disruption due to preterm birth impacts growth, body composition, and neonatal outcome

Despite optimized nutrition, preterm-born infants grow slowly and tend to over-accrete body fat. We hypothesize that the premature dissociation of the maternal-placental-fetal unit disrupts the maintenance of physiological endocrine function in the fetus, which has severe consequences for postnatal development. This review highlights the endocrine interactions of the maternal-placental-fetal unit and the early perinatal period in both preterm and term infants. We report on hormonal levels (including tissue, thyroid, adrenal, pancreatic, pituitary, and placental hormones) and nutritional supply and their impact on infant body composition. The data suggest that the premature dissociation of the maternal-placental-fetal unit leads to a clinical picture similar to panhypopituitarism. Further, we describe how the premature withdrawal of the maternal-placental unit, neonatal morbidities, and perinatal stress can cause differences in the levels of growth-promoting hormones, particularly insulin-like growth factors (IGF). In combination with the endocrine disruption that occurs following dissociation of the maternal-placental-fetal unit, the premature adaptation to the extrauterine environment leads to early and fast accretion of fat mass in an immature body. In addition, we report on interventional studies that have aimed to compensate for hormonal deficiencies in infants born preterm through IGF therapy, resulting in improved neonatal morbidity and growth. IMPACT: Preterm birth prematurely dissociates the maternal-placental-fetal unit and disrupts the metabolic-endocrine maintenance of the immature fetus with serious consequences for growth, body composition, and neonatal outcomes. The preterm metabolic-endocrine disruption induces symptoms resembling anterior pituitary failure (panhypopituitarism) with low levels of IGF-1, excessive postnatal fat mass accretion, poor longitudinal growth, and failure to thrive. Appropriate gestational age-adapted nutrition alone seems insufficient for the achievement of optimal growth of preterm infants. Preliminary results from interventional studies show promising effects of early IGF-1 supplementation on postnatal development and neonatal outcomes.

The Role of HIV Infection in the Pathophysiology of Gestational Diabetes Mellitus and Hypertensive Disorders of Pregnancy

Purpose of the Review: The main objective of this study is to investigate mechanisms associated with gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) in HIV infected pregnant women by looking how placental hormones such as (progesterone and prolactin) and basic haemostatic parameters are regulated in HIV infected pregnancies.

Recent Findings: HIV/AIDS are a major global obstetric health burden that lead to increased rate of morbidity and mortality. HIV/AIDS has been associated with the pathophysiology of GDM and HDP. Increased risk of GDM due to highly active antiretroviral therapy (HAART) usage has been reported in HIV infected pregnancies, which causes insulin resistance in both pregnant and non-pregnant individuals. HAART is a medication used for lowering maternal antepartum viral load and pre-exposure and post-exposure prophylaxis of the infant. In pregnant women, HAART induces diabetogenic effect by causing dysregulation of placental hormones such as (progesterone and prolactin) and predispose HIV infected women to GDM. In addition to HIV/AIDS and GDM, Studies have indicated that HIV infection causes haemostatic abnormalities such as hematological disorder, deregulated haematopoiesis process and the coagulation process which results in HDP.

Summary: This study will help on improving therapeutic management and understanding of the pathophysiology of GDM and HDP in the absence as well as in the presence of HIV infection by reviewing studies reporting on these mechanism.

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

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.

Human placental GLUT1 glucose transporter expression and the fetal insulin-like growth factor axis in pregnancies complicated by diabetes

We have previously described regulation of syncytial GLUT1 glucose transporters by IGF-I. Despite this, it is not clear what signal regulates transplacental glucose transport. In this report we asked whether changes in GLUT1 expression and glucose transport activity in diabetic pregnancies were associated with alterations in the fetal IGF axis. Cord blood samples and paired syncytial microvillous and basal membranes were isolated from normal term pregnancies and pregnancies characterized by gestational diabetes type A2 (GDM A2) and pre-existing insulin-dependent diabetes mellitus (IDDM). Circulating IGF-I, basal membrane GLUT1 expression and glucose transporter activity were correlated with birth weight, but only in control, not diabetic groups. Basal membrane GLUT1 and transporter activity were correlated with IGF-I concentrations in control, but not diabetic groups. IGF binding protein (IGFBP) binding capacity showed a ≥50% reduction in the diabetic groups compared to control; both showed a higher level of free IGF-I. The absence of a correlation between birth weight and factors such as fetal IGF-I or GLUT1 expression in the diabetic groups suggests that IGF-I-stimulated effects may have reached a limiting threshold, such that further increases in IGF-I (or GLUT1) are without effect. These data support that fetal IGF-I acts as a fetal nutritional signal, modulating placental GLUT1 expression and birth weight via altered levels of fetal circulating IGFBPs. Diabetes appears to exert its effects on fetal and placental factors prior to the third trimester and, despite good glycemic control immediately prior to, and in the third trimester, these effects persist to term.

Relationship between elevated serum level of placental growth factor and status of gestational diabetes mellitus

Objective: As only limited and confusing evidence about serum placental growth factor (PlGF) level in gestational diabetes mellitus (GDM) exist in the known literature, the aim of this study was to evaluate the association of maternal serum PlGF level with GDM status.Methods: The pregnant women attending the Obstetrics Outpatient Unit of Hitit University Hospital were screened at 24 and 28 weeks of gestation for GDM according to the suggestions of the American College of Obstetricians and Gynecologists (ACOG). Concisely, all of the low-risk pregnant women were evaluated with a 50 g glucose challenge test (GCT). Women with serum glucose ≥140 mg/dL at 1 h after GCT were subjected to a 100 g oral glucose tolerance test (OGTT). According to the criteria of Carpenter and Coustan, the GDM diagnosis was confirmed. Consequently, a total of 158 pregnant women eligible for inclusion criteria were categorized into two main groups; 76 of the GDM group, 82 of the control group. The demographic characteristic and biochemical parameters of the study population including age, body mass index (BMI), gestational age were recorded at the second trimester. The assays for glucose, insulin, and PlGF were carried out.Results: The mean maternal age of control and GDM groups were 27.9 and 30.5 years, respectively. The parameters such as age, BMI, and gestational age were statistically similar in both groups (p>.05, for all). As expected, serum insulin level and homeostasis model assessment-insulin resistance (HOMA-IR) value were significantly elevated in women with GDM (p<.001, for both). Moreover, maternal PlGF concentration was found to be higher in the GDM group compared to the control group (p=.029). Pearson's correlation analysis of PlGF with other study parameters revealed that there was a negative moderate and significant correlation in only control group (r= -0.416, p<.05). However, this correlation was not detected in the GDM group (r = 0.099, p>.05). None of the variables including maternal age, BMI, insulin, and HOMA-IR showed significant correlations in GDM and control groups.Conclusion: Our findings revealed that maternal serum PlGF level is increased in pregnant women complicated with GDM. Early identification of pregnant women who subsequently will pose GDM risk could improve the pregnancy outcomes.

Biomarkers for Macrosomia Prediction in Pregnancies Affected by Diabetes

Large birthweight, or macrosomia, is one of the commonest complications for pregnancies affected by diabetes. As macrosomia is associated with an increased risk of a number of adverse outcomes for both the mother and offspring, accurate antenatal prediction of fetal macrosomia could be beneficial in guiding appropriate models of care and interventions that may avoid or reduce these associated risks. However, current prediction strategies which include physical examination and ultrasound assessment, are imprecise. Biomarkers are proving useful in various specialties and may offer a new avenue for improved prediction of macrosomia. Prime biomarker candidates in pregnancies with diabetes include maternal glycaemic markers (glucose, 1,5-anhydroglucitol, glycosylated hemoglobin) and hormones proposed implicated in placental nutrient transfer (adiponectin and insulin-like growth factor-1). There is some support for an association of these biomarkers with birthweight and/or macrosomia, although current evidence in this emerging field is still limited. Thus, although biomarkers hold promise, further investigation is needed to elucidate the potential clinical utility of biomarkers for macrosomia prediction for pregnancies affected by diabetes.

Continuous Glucose Monitoring, Glycemic Variability, and Excessive Fetal Growth in Pregnancies Complicated by Type 1 Diabetes

BACKGROUND

To examine trimester-specific associations among glycemic variability, fetal growth, and birthweight in pregnancies with type 1 diabetes mellitus (Type 1 DM).

METHODS

In this retrospective cohort study of 41 pregnant women with Type 1 DM, we used continuous glucose monitoring (CGM) data to calculate glycemic variability (coefficient of variation of glucose) over a 7-day interval in each trimester. Clinical data, including fetal biometry, birthweight, and perinatal complications, were extracted from medical records.

RESULTS

Women maintained good glycemic control during pregnancy, with mean HbA1c in the first, second, and third trimester 6.5%, 6.1%, and 6.4%, respectively. Sixty-three percent of infants were large for gestational age (LGA). Estimated fetal weight percentile (EFW%ile) and abdominal circumference percentile (AC%ile) increased during pregnancy, consistent with accelerated prenatal growth. Correlations between trimester-specific glycemic variability and EFW, AC, and birthweight were not statistically significant. After maternal age adjustment, glycemic variability was not associated with birthweight for any trimester (adj. β for first trimester: -38.46, 95% CI: -98.58 to 21.66; adj. β for second trimester: -12.20, 95% CI: -51.47 to 27.06; adj. β for third trimester: -26.26, 95% CI: -79.52 to 27.00).

CONCLUSIONS

The occurrence of LGA remains very high in contemporary U.S. women with Type 1 DM, despite the use of CGM and overall good glycemic control. Neither HbA1c nor glycemic variability predicted fetal overgrowth or birthweight. Since LGA is a key driver of maternal and newborn complications in pregnancies with Type 1 DM, our data emphasize the importance of investigating both glucose-dependent and glucose-independent underlying mechanisms.

Temporal relationships of GH, IGF-I and fructosamine concentrations in pregnant Spanish Purebred mares: A substantial contribution from the hormonal standpoint

Growth hormone (GH) and insulin-like growth factor (IGF-I) exert essential functions to maintain an adequate metabolic activity for correct placental and fetal development. Although fructosamine (FRUCT) is used in clinical evaluation to assess the glycaemic state, the relationships between GH, IGF-I and FRUCT remain unknown in the mare. Therefore, the objectives of this study were to evaluate the relationships among these parameters in pregnant mares. A total of 30 healthy Spanish Purebred mares, with an age range of 9.33 ± 3.31 years, were studied during the 11 months of gestation. Serum concentrations of GH, IGF-I and FRUCT were analyzed by EIA, competition ELISA and spectrophotometry, respectively. GH showed a biphasic pattern, the first occurred during 4th and 5th month and the second which was higher than the 1st one during the 7th, 8th and 9th month (P < 0.05). Compared to the 1st month, the IGF-I concentrations increased in the 2nd month (P < 0.05), decreased in the 3rd and 4th month and increased to reach the maximum average value in the 5th month (P < 0.05); after slight oscillations between the 6th and 8th month, IGF-I concentrations increased in the 9th month (P < 0.05), decreasing until the end of gestation. FRUCT increased progressively and significantly from the 6th month of gestation, reaching the maximum values in the last month of gestation (P < 0.05). These results suggest that alternative mechanisms other than GH and IGF-I could be involved in the regulation of glycaemic metabolism in pregnant mare.

Human Placental Growth Hormone Variant in Pathological Pregnancies

Growth hormone (GH), an endocrine hormone, primarily secreted from the anterior pituitary, stimulates growth, cell reproduction, and regeneration and is a major regulator of postnatal growth. Humans have two GH genes that encode two versions of GH proteins: a pituitary version (GH-N/GH1) and a placental GH-variant (GH-V/GH2), which are expressed in the syncytiotrophoblast and extravillous trophoblast cells of the placenta. During pregnancy, GH-V replaces GH-N in the maternal circulation at mid-late gestation as the major circulating form of GH. This remarkable change in spatial and temporal GH secretion patterns is proposed to play a role in mediating maternal adaptations to pregnancy. GH-V is associated with fetal growth, and its circulating concentrations have been investigated across a range of pregnancy complications. However, progress in this area has been hindered by a lack of readily accessible and reliable assays for measurement of GH-V. This review will discuss the potential roles of GH-V in normal and pathological pregnancies and will touch on the assays used to quantify this hormone.

Insulin-Like Growth Factor Binding Proteins in Autoimmune Diseases

Insulin-like growth factor binding proteins (IGFBPs) are a family of proteins binding to Insulin-like growth factors (IGFs), generally including IGFBP1, IGFBP2, IGFBP3, IGFBP4, IGFBP5, and IGFBP6. The biological functions of IGFBPs can be classified as IGFs-dependent actions and IGFs-independent effects. In this review, we will discuss the structure and function of various IGFBPs, particularly IGFBPs as potential emerging biomarkers and therapeutic targets in various autoimmune diseases, and the possible mechanisms by which IGFBPs act on the pathogenesis of autoimmune diseases.

Human placental growth hormone in normal and abnormal fetal growth

Human placental growth hormone (PGH), encoded by the growth hormone (GH) variant gene on chromosome 17, is expressed in the syncytiotrophoblast and extravillous cytotrophoblast layers of the human placenta. Its maternal serum levels increase throughout pregnancy, and gradually replaces the pulsatile secreted pituitary GH. PGH is also detectable in cord blood and in the amniotic fluid. This placental-origin hormone stimulates glyconeogenesis, lipolysis and anabolism in maternal organs, and influences fetal growth, placental development and maternal adaptation to pregnancy. The majority of these actions are performed indirectly by regulating maternal insulin-like growth factor-I levels, while the extravillous trophoblast involvement indicates a direct effect on placental development, as it stimulates trophoblast invasiveness and function via a potential combination of autocrine and paracrine mechanisms. The current review focuses on the role of PGH in fetal growth. In addition, the association of PGH alterations in maternal circulation and placental expression in pregnancy complications associated with abnormal fetal growth is briefly reviewed.

Nutrition, infection and stunting: the roles of deficiencies of individual nutrients and foods, and of inflammation, as determinants of reduced linear growth of children

The regulation of linear growth by nutritional and inflammatory influences is examined in terms of growth-plate endochondral ossification, in order to better understand stunted growth in children. Linear growth is controlled by complex genetic, physiological, and nutrient-sensitive endocrine/paracrine/autocrine mediated molecular signalling mechanisms, possibly including sleep adequacy through its influence on growth hormone secretion. Inflammation, which accompanies most infections and environmental enteric dysfunction, inhibits endochondral ossification through the action of mediators including proinflammatory cytokines, the activin A-follistatin system, glucocorticoids and fibroblast growth factor 21 (FGF21). In animal models linear growth is particularly sensitive to dietary protein as well as Zn intake, which act through insulin, insulin-like growth factor-1 (IGF-1) and its binding proteins, triiodothyronine, amino acids and Zn2+ to stimulate growth-plate protein and proteoglycan synthesis and cell cycle progression, actions which are blocked by corticosteroids and inflammatory cytokines. Observational human studies indicate stunting to be associated with nutritionally poor, mainly plant-based diets. Intervention studies provide some support for deficiencies of energy, protein, Zn and iodine and for multiple micronutrient deficiencies, at least during pregnancy. Of the animal-source foods, only milk has been specifically and repeatedly shown to exert an important influence on linear growth in both undernourished and well-nourished children. However, inflammation, caused by infections, environmental enteric dysfunction, which may be widespread in the absence of clean water, adequate sanitation and hygiene (WASH), and endogenous inflammation associated with excess adiposity, in each case contributes to stunting, and may explain why nutritional interventions are often unsuccessful. Current interventions to reduce stunting are targeting WASH as well as nutrition.

Investigating the Relationship between Insulin-like Growth Factor-1 (IGF-1) in diabetic mother's breast milk and the blood serum of their babies

Introduction

Since research investigating IGF-1 levels in breast milk are few, the goal of this study was to analyze the IGF-1 levels in the breast milk of diabetic mothers as well as in the serum of their newborn babies and to identify what relationship exists between blood serum and IGF-1 milk levels through patient measurement of mothers and their babies.

Methods

This case control study was undertaken under the auspices of the Clinic of Neonatology at Al Minia University Pediatric Hospital over May 2012 through May 2013. With a total of 30 diabetic mothers and their babies forming the experimental group and the control group consisting of 15 non-diabetic mothers and their babies. A detailed medical history, anthropometric assessments, as well as the measurement of the baby’s serum IGF-1 and their mother’s breast milk IGF-1 levels were taken from all participants using ELSIA. The resulting data were analyzed via Statistical Package for the Social Sciences (SPSS) version 16 and measurements of descriptive statistics, t-test, Chi-square test, as well as the Pearson Correlation Coefficient.

Results

The Infants born to Diabetic Mothers (IDMs) demonstrated significantly greater anthropometric measurement. Both the serum levels and the milk IGF-1 levels as well as all of the physical measurements taken were found to have a positive correlation between the level of IGF-1 in mother’s milk and all of the anthropometric measurements studied with the exception of delivered baby’s length.

Conclusion

Higher levels of IGF-1 are present in the milk of diabetic mothers and the blood serum of their babies and this characteristic could be used as a prenatal biomarker for macrosomia.

Incorporation of human growth hormone-2 into proteoliposome enhances tissue regeneration with anti-oxidant and anti-senescence activities

Human growth hormone-2 (GH-2) is a 191-amino-acid protein also known as human placental hormone. During pregnancy, continuous secretion of GH-2 appears to have important implications for physiological adjustment to gestation, especially in controlling levels of maternal insulin-like growth factor 1. To compare the physiological activity of GH-2 between lipid-free and lipid-bound states, GH-2 was expressed and incorporated into proteoliposome. GH-2 was expressed and purified using a pET28(a)-GH-2 vector in an Escherichia coli system. Purified GH-2 was then characterized and synthesized into reconstituted high-density lipoprotein (rHDL). The expression yield of GH-2 was 20-30 mg by BL21 (DE3) cells in 1 liter of Luria-Bertani broth. Purified GH-2 of at least 98% purity (23 kDa) was incorporated into rHDL with human apolipoprotein A-I (ApoA-I) and palmitoyloleoyl phosphatidylcholine (POPC) at a 1:1:95 (GH-2:ApoA-I:POPC) molar ratio. Structural analysis revealed that GH-2 had a 44% α-helix content and a wavelength maximum fluorescence (WMF) of 349 nm in a lipid-free state. In a lipid-bound state, the WMF of GH-2 was ∼4 nm blue-shifted (345 nm), with 50% of α-helix content. The lipid-bound GH-2 showed enhanced anti-atherosclerotic activity and anti-senescence activity with inhibition of fructose-mediated glycation. A fin regeneration experiment using zebrafish (17 weeks old, n=9) showed that lipid-bound GH-2 enhanced regeneration efficiency by 44% compared to native GH-2 (in the lipid-free state) without any notable side effects. GH-2 has anti-oxidant activity to enhance tissue regeneration as well as to exert anti-diabetic activity. Incorporation of GH-2 into rHDL can enhance structural stability and tissue regeneration efficiency in vertebrate models, indicating a synergetic effect between GH-2 and ApoA-I in rHDL.

Lower levels of placental growth hormone in early pregnancy in women with type 1 diabetes and large for gestational age infants

OBJECTIVE

To evaluate whether levels of placental growth hormone (GH) and Insulin-like Growth Factor-I (IGF-I) are associated with development of LGA infants in pregnant women with type 1 diabetes.

DESIGN

Observational study of 103 consecutive pregnant women with long-term type 1 diabetes and median HbA1c 6.6% (range 4.9-10.5) (49 mmol/mol (30-91)) in early pregnancy. At 8, 14, 21, 27 and 33 weeks weight was recorded and blood was sampled for measurements of placental GH, IGF-I and HbA1c. LGA was defined as birth weight >90th percentile after adjustment for gender and gestational age.

RESULTS

Throughout pregnancy placental GH levels were similar in 51 (50%) women delivering LGA infants compared with the remaining women except at 8 weeks where placental GH levels were lower in women with LGA infants (1.1 ng/ml (0.1-4.3) vs. 1.7 (0.3-11.7), p = 0.04). IGF-I levels were similar in women with and without LGA infants (p=0.97). Gestational age at first blood sampling was similar in women with and without LGA infants (60 days (37-89) vs. 61.5 (42-94), p = 0.42). Placental GH levels at 14 weeks correlated negatively with weight gain in early pregnancy (r=-0.32, p=0.002). As predictors of LGA infants,multivariate logistic regression analysis identified placental GH levels at 8 weeks (OR 0.4 (95% CI: 0.2-0.9), p = 0.02), HbA1c at 33 weeks (3.6 (1.3-9.9), p = 0.01) and parity ≥1 (3.1 (1.3-7.5), p = 0.01) after adjustment for pre-pregnancy BMI.

CONCLUSIONS

Women delivering LGA infants had lower placental GH levels in early pregnancy. Growth factors and maternal weight gain in early pregnancy may be important for healthy fetal growth.

Novel placental ultrasound assessment: potential role in pre-gestational diabetic pregnancy

OBJECTIVES

Management of women with pre-gestational diabetes continues to be challenging for clinicians. This study aims to determine if 3D power Doppler (3DPD) analysis of placental volume and flow, and calculation of placental calcification using a novel software method, differ between pregnancies with type 1 or type 2 diabetes and normal controls, and if there is a relationship between these ultrasound placental parameters and clinical measures in diabetics.

METHODS

This was a prospective cohort study of 50 women with diabetes and 250 controls (12-40 weeks gestation). 3DPD ultrasound was used to evaluate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Placental calcification was calculated by computer analysis. Results in diabetics were compared with control values, and correlated with early pregnancy HbA1c, Doppler results and placental histology.

RESULTS

Placental calcification and volume increased with advancing gestation in pre-gestational diabetic placentae. Volume was also found to be significantly higher than in normal placentae. VI and VFI were significantly lower in diabetic pregnancies between 35 and 40 weeks gestation. A strong relationship was seen between a larger placental volume and both increasing umbilical artery pulsatility index and decreasing middle cerebral artery pulsatility index. FI was significantly lower in cases which had a booking HbA1c level ≥6.5%. Ultrasound assessed placental calcification was reduced with a histology finding of delayed villous maturation. No other correlation with placental histology was found.

CONCLUSIONS

This study shows a potential role for 3D placental evaluation, and computer analysis of calcification, in monitoring pre-gestational diabetic pregnancies.

Placental growth factor as a new marker for predicting abnormal glucose challenge test results

BACKGROUND

To differentiate placental growth factor (PlGF) levels in pregnancies with normal and abnormal glucose challenge test (GCT) results.

METHODS

A total of 94 pregnant women underwent a 50 -g GCT as part of our routine antenatal screening protocol from September 2011 to January 2012. The patients were divided into three groups: (i) normal GCT, (ii) abnormal GCT and (iii) gestational diabetes mellitus (GDM) based on the screening results for gestational diabetes. The main outcome measure of the study was the relationship between PlGF and GCT results in non-diabetic pregnancies. The Kolmogorov-Smirnov test was used to check the normality of the variables' distributions. The Kruskal-Wallis and analysis of variance tests (Tukey's test) were used to analyze the qualitative parameters.

RESULTS

There were 53 (56.4%), 22 (23.4%) and 19 (20.2%) patients in the normal GCT, abnormal GCT and GDM groups, respectively. The PlGF level in the abnormal GCT group was 518 ± 307.6 pg/mL, which was the highest level in the study population, and there was a statistically significant difference compared with the other groups (p = 0.006). There were no statistically significant differences with respect to fetal birth weight among the three groups in our study.

CONCLUSION

PlGF can be used as a laboratory marker to predict which patients will have abnormal GCT results.