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Correlation of Blood Glucose and Pancreatic Islet Function with Serum Retinol-Binding Protein 4, Serum Cystatin C, and Human New Satiety Molecule Protein-1 in Pregnant Women with Gestational Diabetes Mellitus. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4247412. [PMID: 35855829 PMCID: PMC9288275 DOI: 10.1155/2022/4247412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/04/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
Objective To investigate the correlation of blood glucose and islet function with serum retinol-binding protein 4, serum cystatin C, and nesfatin-1 levels in women with gestational diabetes mellitus. Methods Between June 2018 and June 2020, 70 patients with gestational diabetes mellitus were included in a study group and 70 healthy pregnant women were recruited into a healthy group. Alterations in fasting blood glucose (FPG), glycated hemoglobin (HbA1c), fasting serum insulin (FINS), homeostatic model assessment for insulin resistance (HOMA-IR), serum retinol-binding protein 4 (RBP4), serum cystatin C (CysC), and nesfatin-1 of all eligible participants were analyzed, and the occurrence of complications was recorded. Correlation analysis of serum RBP4, serum CysC, and nesfatin-1 levels with blood glucose and islet function in women with gestational diabetes mellitus was performed. Results Gestational diabetes mellitus was associated with significantly higher levels of FPG, HbA1c, and HOMA-IR and lower levels of FINS (6.58 ± 1.41, 9.24 ± 1.09, 3.21 ± 2.03, 8.23 ± 2.21) versus a healthy condition (5.23 ± 0.85, 7.61 ± 0.67, 2.42 ± 1.14, 10.54 ± 2.15) (P < 0.05). Women with gestational diabetes mellitus showed significantly higher levels of serum RBP4, serum CysC, and nesfatin-1 (62.45 ± 7.86, 1.95 ± 0.59, 2.65 ± 0.49) versus healthy pregnant women (45.48 ± 6.15, 1.03 ± 0.67, 1.42 ± 0.62) (P < 0.05). With serum RBP4, serum CysC, and nesfatin-1 as dependent variables, univariate correlation analysis showed that serum RBP4, serum CysC, and nesfatin-1 levels were positively correlated with FPG and HbA1c levels and HOMA-IR, and negatively correlated with FINS in women with gestational diabetes mellitus (P < 0.05). Gestational diabetes mellitus resulted in a significantly higher incidence of preterm delivery, cesarean section, excess amniotic fluid, and premature rupture of membranes versus a healthy status (P < 0.05). Conclusion Glucose metabolism and islet function in women with gestational diabetes are significantly correlated with serum RBP4, serum CysC, and nesfatin-1 levels, which shows great potential for the prevention and treatment of gestational diabetes mellitus and perinatal complications.
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Schmitz EM, Langelaan ML, de Groot MJ, Ermens TA, Joosen AM. Trimester-specific reference intervals for cystatin C and neutrophil gelatinase-associated lipocalin during pregnancy. Ann Clin Biochem 2022; 59:199-204. [PMID: 35044277 DOI: 10.1177/00045632221076354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND During normal pregnancy, the glomerular filtration rate (GFR) increases dramatically. Failure to obtain this physiological increase is an important risk factor for morbidity and mortality for both mother and child. The estimated GFR (eGFR) using serum creatinine levels is unsuitable for accurate measurement of renal function during pregnancy. Therefore, new biomarkers have been proposed. Elevated levels of Cystatin C (CysC) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) are associated with renal failure and preeclampsia (PE). In this study, we determined reference intervals for CysC and NGAL during pregnancy. METHODS Healthy pregnant women were recruited and blood samples were collected at 9-13 weeks (T1), 27-29 weeks (T2), and 36-39 weeks (T3) of gestation and at 4-13 weeks postpartum (PP). The samples from women with uncomplicated pregnancy were analyzed to determine median values and upper reference limits (URLs, 97.5 percentiles) of creatinine, CysC, and NGAL. RESULTS A total of 175 women were included. Longitudinal changes and median values of creatinine, CysC, and NGAL were determined using only complete data sets (n=59). URLs were determined using all available data. The URL at T1, T2, T3, and PP were 60, 63, 74, 93 μmol/L for creatinine; 0.93, 1.04, 1.61, 1.23 mg/L for CysC; and 87, 84, 88, 95 ng/mL for NGAL. CONCLUSIONS CysC concentrations are highly dynamic and increase during pregnancy. NGAL concentrations are less dynamic, but well below the URL specified by the manufacturer for non-pregnant women. It is therefore recommended to use trimester-specific reference values for both CysC and NGAL.
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Affiliation(s)
- Ellen Mh Schmitz
- Department of Clinical Chemistry and Hematology, 8185Máxima MC, Veldhoven, The Netherlands
| | - Marloes Lp Langelaan
- Department of Clinical Chemistry and Hematology, 89411Amphia Hospital, Breda, The Netherlands
| | - Monique Jm de Groot
- Department of Clinical Chemistry and Hematology, 7898Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Ton Am Ermens
- Department of Clinical Chemistry and Hematology, 89411Amphia Hospital, Breda, The Netherlands
| | - Annemiek McP Joosen
- Department of Clinical Chemistry and Hematology, 8185Máxima MC, Veldhoven, The Netherlands
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Yuan X, Han X, Jia C, Wang H, Yu B. Association of Maternal Serum Uric Acid and Cystatin C Levels in Late Pregnancy with Adverse Birth Outcomes: An Observational Cohort Study in China. Int J Womens Health 2022; 14:213-223. [PMID: 35210868 PMCID: PMC8860627 DOI: 10.2147/ijwh.s350847] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the associations between serum uric acid (UA) and cystatin C (CysC) levels in late pregnancy with major unfavorable birth outcomes. Methods We retrospectively analyzed the maternal UA and CysC levels during late pregnancy and their relationship with unfavorable birth outcomes in a Chinese population (n = 11,580). Results Women with the highest quartile of UA had higher risks of low birth weight (LBW) and small for gestational age (SGA) babies and a lower risk of preterm birth (PTB) compared to women with the lowest quartile [for LBW, adjusted-odds ratio (OR) = 2.63, 95% CI: 1.76, 3.95; for SGA, adjusted-OR = 2.11, 95% CI: 1.73, 2.57; for PTB, adjusted-OR = 0.55, 95% CI: 0.45, 0.69; all P for trend <0.001]. Compared to women in the lowest quartile of CysC, higher risks of macrosomia and large for gestational age (LGA) and lower risks of PTB and SGA were observed for those in the highest quartile (for macrosomia, adjusted-OR = 2.01, 95% CI: 1.60, 2.51; for LGA, adjusted-OR = 1.97, 95% CI: 1.67, 2.32; for PTB, adjusted-OR = 0.32, 95% CI: 0.26, 0.41; all P for trend <0.001; for SGA, adjusted-OR = 0.78, 95% CI: 0.64, 0.96; P for trend <0.05). Conclusion This study reports the associations of maternal UA and CysC with adverse birth outcomes, and suggests that routine determination of maternal UA and CysC in late pregnancy is beneficial for assessing the risks of these outcomes.
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Affiliation(s)
- Xiaosong Yuan
- Department of Medical Genetics, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou City, Jiangsu Province, People's Republic of China
| | - Xiaoya Han
- Department of Medical Genetics, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou City, Jiangsu Province, People's Republic of China
| | - Chenbo Jia
- Department of Medical Genetics, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou City, Jiangsu Province, People's Republic of China
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou City, Jiangsu Province, People's Republic of China
| | - Bin Yu
- Department of Medical Genetics, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou City, Jiangsu Province, People's Republic of China
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Di Filippo D, Wanniarachchi T, Wei D, Yang JJ, Mc Sweeney A, Havard A, Henry A, Welsh A. The diagnostic indicators of gestational diabetes mellitus from second trimester to birth: a systematic review. Clin Diabetes Endocrinol 2021; 7:19. [PMID: 34635186 PMCID: PMC8504031 DOI: 10.1186/s40842-021-00126-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is glucose intolerance first recognised during pregnancy. Both modalities and thresholds of the GDM diagnostic test, the Oral Glucose Tolerance Test (OGTT), have varied widely over time and among countries. Additionally, OGTT limitations include inconsistency, poor patient tolerability, and questionable diagnostic reliability. Many biological parameters have been reported to be modified by GDM and could potentially be used as diagnostic indicators. This study aimed to 1) systematically explore biomarkers reported in the literature as differentiating GDM from healthy pregnancies 2) screen those indicators assessed against OGTT to propose OGTT alternatives. MAIN BODY A systematic review of GDM diagnostic indicators was performed according to PRISMA guidelines (PROSPERO registration CRD42020145499). Inclusion criteria were full-text, comprehensible English-language articles published January 2009-January 2021, where a biomarker (from blood, ultrasound, amniotic fluid, placenta) was compared between GDM and normal glucose tolerance (NGT) women from the second trimester onward to immediately postpartum. GDM diagnostic method had to be clearly specified, and the number of patients per study higher than 30 in total or 15 per group. Results were synthesised by biomarkers. RESULTS Of 13,133 studies identified in initial screening, 174 studies (135,801 participants) were included. One hundred and twenty-nine studies described blood analytes, one amniotic fluid analytes, 27 ultrasound features, 17 post-natal features. Among the biomarkers evaluated in exploratory studies, Adiponectin, AFABP, Betatrophin, CRP, Cystatin-C, Delta-Neutrophil Index, GGT, TNF-A were those demonstrating statistically and clinically significant differences in substantial cohorts of patients (> 500). Regarding biomarkers assessed versus OGTT (i.e. potential OGTT alternatives) most promising were Leptin > 48.5 ng/ml, Ficolin3/adiponectin ratio ≥ 1.06, Chemerin/FABP > 0.71, and Ultrasound Gestational Diabetes Score > 4. These all demonstrated sensitivity and specificity > 80% in adequate sample sizes (> / = 100). CONCLUSIONS Numerous biomarkers may differentiate GDM from normoglycaemic pregnancy. Given the limitations of the OGTT and the lack of a gold standard for GDM diagnosis, advanced phase studies are needed to triangulate the most promising biomarkers. Further studies are also recommended to assess the sensitivity and specificity of promising biomarkers not yet assessed against OGTT. TRIAL REGISTRATION PROSPERO registration number CRD42020145499.
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Affiliation(s)
- Daria Di Filippo
- School, of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Daniel Wei
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jennifer J Yang
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Aoife Mc Sweeney
- Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia
| | - Alys Havard
- National Drug and Alcohol Research Centre - Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Centre for Big Data Research in Health - Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amanda Henry
- School, of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia
| | - Alec Welsh
- School, of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW, 2031, Australia.
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Tang X, Ju H, Yang L, Liu C. Relationship between serum cystatin C level and pregnancy complications and abnormal glucose tolerance at 6-week postpartum in patients with gestational diabetes mellitus. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00839-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kreepala C, Srila-On A, Kitporntheranunt M, Anakkamatee W, Lawtongkum P, Wattanavaekin K. The Association Between GFR Evaluated by Serum Cystatin C and Proteinuria During Pregnancy. Kidney Int Rep 2019; 4:854-863. [PMID: 31194092 PMCID: PMC6551540 DOI: 10.1016/j.ekir.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Physiological changes in pregnancy result in increased cardiac output and renal blood flow, with a consequential increase in proteinuria. Data from studies of the relationship between proteinuria caused by isolated proteinuria and glomerular filtration rate (GFR) are still limited. The objective of this study was to investigate the effects of isolated proteinuria on the cystatin C–based GFR in the third trimester of pregnancy. Methods Data were collected from pregnant women in their third trimester whose serum creatinine levels were normal. The GFR of each participant was measured using serum cystatin C levels, and proteinuria was measured using urine protein–creatinine ratios. The participants were divided into 3 groups according to their level of proteinuria: normal (<150 mg/d), physiological (150–300 mg/d), and gestational (>300 mg/d). Changes in GFR were recorded for each group. Results The study included 89 participants, of whom 66.3% had levels of proteinuria that did not differ from that of the normal population (<150 mg/d). The incidence of physiological and gestational proteinuria was 21.4% and 12.4%, respectively. The results demonstrate that proteinuria >101.50 mg/d was significantly associated with declined estimated glomerular filtration rate (eGFR) (r = –0.34, P = 0.01). The analysis found that proteinuria >491.27 mg/d led to a risk of GFR <90 ml/min with an odds ratio of 12.69, P = 0.02 when adjusted for systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index. Conclusion This study suggests that the term “physiological proteinuria” is a misnomer. When used in the traditional manner, creatinine level has inadequate sensitivity to estimate GFR in pregnant women. We found that there is a significant decline in GFR when urine protein > 101.5 mg/d, which could be an early biomarker for renal pathology rather than pregnancy physiology, suggesting that further workup and precaution is required.
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Affiliation(s)
- Chatchai Kreepala
- Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand
| | - Atitaya Srila-On
- Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand
| | - Maethaphan Kitporntheranunt
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand
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Hou W, Meng X, Zhao A, Zhao W, Pan J, Tang J, Huang Y, Li H, Jia W, Liu F, Jia W. Development of Multimarker Diagnostic Models from Metabolomics Analysis for Gestational Diabetes Mellitus (GDM). Mol Cell Proteomics 2017; 17:431-441. [PMID: 29282297 DOI: 10.1074/mcp.ra117.000121] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 12/06/2017] [Indexed: 12/12/2022] Open
Abstract
Although metabolomics are desirable to understand the pathophysiology of gestational diabetes mellitus (GDM), comprehensive metabolomic studies of GDM are rare. We aimed to offer a holistic view of metabolites alteration in GDM patients and investigate the possible multimarker models for GDM diagnosis. Biochemical parameters and perinatal data of 131 GDM cases and 138 controls were collected. Fasting serum samples at 75 g oral glucose tolerance test were used for metabolites by ultra performance liquid chromatography-quadrupole-time of flight-mass spectrometry, ultra performance liquid chromatography-triple triple-quadrupole-mass spectrometry and gas chromatography- time-of- flight mass spectrometry platforms. Significant changes were observed in free fatty acids, bile acids, branched chain amino acids, organic acids, lipids and organooxygen compounds between two groups. In receiver operating characteristic (ROC) analysis, different combinations of candidate biomarkers and metabolites in multimarker models achieved satisfactory discriminative abilities for GDM, with the values of area under the curve (AUC) ranging from 0.721 to 0.751. Model consisting of body mass index (BMI), retinol binding protein 4 (RBP4), n-acetylaspartic acid and C16:1 (cis-7) manifested the best discrimination [AUC 0.751 (95% CI: 0.693-0.809), p < 0.001], followed by model consisting of BMI, Cystatin C, acetylaspartic acid and 6,7-diketoLCA [AUC 0.749 (95% CI: 0.691-0.808), p < 0.001]. Metabolites alteration reflected disorders of glucose metabolism, lipid metabolism, amino acid metabolism, bile acid metabolism as well as intestinal flora metabolism in GDM state. Multivariate models combining clinical markers and metabolites have the potential to differentiate GDM subjects from healthy controls.
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Affiliation(s)
- Wolin Hou
- From the ‡Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Xiyan Meng
- §Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Aihua Zhao
- ¶Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weijing Zhao
- From the ‡Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Jiemin Pan
- From the ‡Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Junling Tang
- From the ‡Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Yajuan Huang
- §Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Huaping Li
- §Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Jia
- ¶Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Liu
- From the ‡Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China;
| | - Weiping Jia
- From the ‡Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
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