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Zhang M, Huang X, Lin S, Liu B. Association between maternal blood lipids and neonatal hypoglycaemia in pregnancy with gestational diabetes mellitus: a cohort study. Lipids Health Dis 2024; 23:170. [PMID: 38849832 PMCID: PMC11157930 DOI: 10.1186/s12944-024-02168-z] [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: 01/16/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) prevalence is on the rise globally. Offspring of diabetic mothers face increased risk of neonatal hypoglycaemia (NH), and women with GDM have abnormal lipid profiles. However, there is no consensus on the link between maternal blood lipids and NH in infants from mothers with GDM. This study aimed to explore how maternal blood lipids affect NH. METHODS A retrospective cohort study was conducted at the First Affiliated Hospital of Sun Yat-sen University. Information on participants' baseline characteristics and maternal metabolic profiles of glucose and lipids was collected. Significant variables from the univariate analysis were included in logistic regression, which was used to construct the predictive model for NH. A nomogram was constructed for visualizing the model and assessed using the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS Neonatal capillary blood glucose (CBG) decreased rapidly in the first hour after birth, increased gradually from the first to the second hour, and then remained stable. In the NH group, 86.11% (502/583) of hypoglycaemia cases occurred within the first two hours after birth. Multivariate logistic regression suggested that the lipid indices of maternal apoprotein B/apoprotein A1 (Apo-B/Apo-A1) (odds ratio (OR) = 1.36, 95% confidence intervals (CIs): 1.049-1.764, P = 0.02) and apoprotein E (Apo-E) (OR = 1.014, 95% CIs: 1.004-1.024, P = 0.004) were positively associated with NH in neonates from mothers with GDM. Triglycerides (TGs) (OR = 0.883, 95% CIs: 0.788-0.986, P = 0.028) were inversely associated with NH. Maternal glycated haemoglobin (HbA1c), age, twin pregnancy and caesarean delivery also had predictive value of NH. The AUC of the nomogram derived from these factors for the prediction model of NH was 0.657 (95% CIs: 0.630-0.684). CONCLUSIONS The present study revealed that the Apo-B/Apo-A1 and Apo-E levels were associated with an increased risk of NH. A nomogram was developed to forecast the risk of NH in babies born to mothers with GDM, incorporating maternal blood lipids, HbA1c, age, twin pregnancy, and caesarean section. The trajectory of glycaemia for neonates indicates the need for intensive CBG monitoring within 2 h of birth for neonates from mothers with GDM.
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Affiliation(s)
- Mo Zhang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynaecological Diseases, Guangzhou, China
| | - Xiaoqing Huang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynaecological Diseases, Guangzhou, China
| | - Suiwen Lin
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynaecological Diseases, Guangzhou, China
| | - Bin Liu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynaecological Diseases, Guangzhou, China.
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Monod C, Kotzaeridi G, Linder T, Yerlikaya‐Schatten G, Wegener S, Mosimann B, Henrich W, Tura A, Göbl CS. Maternal overweight and obesity and its association with metabolic changes and fetal overgrowth in the absence of gestational diabetes mellitus: A prospective cohort study. Acta Obstet Gynecol Scand 2024; 103:257-265. [PMID: 38140706 PMCID: PMC10823396 DOI: 10.1111/aogs.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/02/2023] [Accepted: 09/21/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Previous studies indicated an association between fetal overgrowth and maternal obesity independent of gestational diabetes mellitus (GDM). However, the underlying mechanisms beyond this possible association are not completely understood. This study investigates metabolic changes and their association with fetal and neonatal biometry in overweight and obese mothers who remained normal glucose-tolerant during gestation. MATERIAL AND METHODS In this prospective cohort study 893 women who did not develop GDM were categorized according to their pregestational body mass index (BMI): 570 were normal weight, 220 overweight and 103 obese. Study participants received a broad metabolic evaluation before 16 weeks and were followed up until delivery to assess glucose levels during the oral glucose tolerance test (OGTT) at mid-gestation as well as fetal biometry in ultrasound and pregnancy outcome data. RESULTS Increased maternal BMI was associated with an adverse metabolic profile at the beginning of pregnancy, including a lower degree of insulin sensitivity (as assessed by the quantitative insulin sensitivity check index) in overweight (mean difference: -2.4, 95% CI -2.9 to -1.9, p < 0.001) and obese (mean difference: -4.3, 95% CI -5.0 to -3.7, p < 0.001) vs normal weight women. Despite not fulfilling diagnosis criteria for GDM, overweight and obese mothers showed higher glucose levels at fasting and during the OGTT. Finally, we observed increased measures of fetal subcutaneous tissue thickness in ultrasound as well as higher proportions of large-for-gestational-age infants in overweight (18.9%, odds ratio [OR] 1.74, 95% CI 1.08-2.78, p = 0.021) and obese mothers (21.0%, OR 1.99, 95% CI 1.06-3.59, p = 0.027) vs normal weight controls (11.8%). The risk for large for gestational age was further determined by OGTT glucose (60 min: OR 1.11, 95% CI 1.02-1.21, p = 0.013; 120 min: OR 1.13, 95% CI 1.02-1.27, P = 0.025, for the increase of 10 mg/dL) and maternal triglyceride concentrations (OR 1.11, 95% CI 1.01-1.22, p = 0.036, for the increase of 20 mg/dL). CONCLUSIONS Mothers affected by overweight or obesity but not GDM had a higher risk for fetal overgrowth. An impaired metabolic milieu related to increased maternal BMI as well as higher glucose levels at mid-gestation may impact fetal overgrowth in women still in the range of normal glucose tolerance.
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Affiliation(s)
- Cécile Monod
- Department of Obstetrics and GynecologyUniversity Hospital BaselBaselSwitzerland
- Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Grammata Kotzaeridi
- Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Tina Linder
- Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | | | - Silke Wegener
- Clinic of ObstetricsCharité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Beatrice Mosimann
- Department of Obstetrics and GynecologyUniversity Hospital BaselBaselSwitzerland
| | - Wolfgang Henrich
- Clinic of ObstetricsCharité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | | | - Christian S. Göbl
- Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
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Raets L, Ingelbrecht A, Benhalima K. Management of type 2 diabetes in pregnancy: a narrative review. Front Endocrinol (Lausanne) 2023; 14:1193271. [PMID: 37547311 PMCID: PMC10402739 DOI: 10.3389/fendo.2023.1193271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
The prevalence of type 2 diabetes (T2DM) at reproductive age is rising. Women with T2DM have a similarly high risk for pregnancy complications as pregnant women with type 1 diabetes. To reduce adverse pregnancy and neonatal outcomes, such as preeclampsia and preterm delivery, a multi-target approach is necessary. Tight glycemic control together with appropriate gestational weight gain, lifestyle measures, and if necessary, antihypertensive treatment and low-dose aspirin is advised. This narrative review discusses the latest evidence on preconception care, management of diabetes-related complications, lifestyle counselling, recommendations on gestational weight gain, pharmacologic treatment and early postpartum management of T2DM.
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Affiliation(s)
- Lore Raets
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | | | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Benhalima K, Beunen K, Siegelaar SE, Painter R, Murphy HR, Feig DS, Donovan LE, Polsky S, Buschur E, Levy CJ, Kudva YC, Battelino T, Ringholm L, Mathiesen ER, Mathieu C. Management of type 1 diabetes in pregnancy: update on lifestyle, pharmacological treatment, and novel technologies for achieving glycaemic targets. Lancet Diabetes Endocrinol 2023; 11:490-508. [PMID: 37290466 DOI: 10.1016/s2213-8587(23)00116-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 06/10/2023]
Abstract
Glucose concentrations within target, appropriate gestational weight gain, adequate lifestyle, and, if necessary, antihypertensive treatment and low-dose aspirin reduces the risk of pre-eclampsia, preterm delivery, and other adverse pregnancy and neonatal outcomes in pregnancies complicated by type 1 diabetes. Despite the increasing use of diabetes technology (ie, continuous glucose monitoring and insulin pumps), the target of more than 70% time in range in pregnancy (TIRp 3·5-7·8 mmol/L) is often reached only in the final weeks of pregnancy, which is too late for beneficial effects on pregnancy outcomes. Hybrid closed-loop (HCL) insulin delivery systems are emerging as promising treatment options in pregnancy. In this Review, we discuss the latest evidence on pre-pregnancy care, management of diabetes-related complications, lifestyle recommendations, gestational weight gain, antihypertensive treatment, aspirin prophylaxis, and the use of novel technologies for achieving and maintaining glycaemic targets during pregnancy in women with type 1 diabetes. In addition, the importance of effective clinical and psychosocial support for pregnant women with type 1 diabetes is also highlighted. We also discuss the contemporary studies examining HCL systems in type 1 diabetes during pregnancies.
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Affiliation(s)
- Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Kaat Beunen
- Endocrinology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sarah E Siegelaar
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, Netherlands
| | - Rebecca Painter
- Department of Gynaecology and Obstetrics, Amsterdam UMC, Vrije Universiteit, Netherlands; Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Helen R Murphy
- Diabetes and Antenatal Care, University of East Anglia, Norwich, UK
| | - Denice S Feig
- Department of Medicine, Obstetrics, and Gynecology and Department of Health Policy, Management, and Evaluation, University of Toronto, Diabetes and Endocrinology in Pregnancy Program, Mt Sinai Hospital, Toronto, ON, Canada
| | - Lois E Donovan
- Division of Endocrinology and Metabolism, Department of Medicine, and Department of Obstetrics and Gynaecology, Cumming School Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarit Polsky
- Medicine and Pediatrics, Barbara Davis Center for Diabetes, Adult Clinic, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Buschur
- Internal Medicine, Endocrinology, Diabetes, and Metabolism, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Carol J Levy
- Department of Medicine, Endocrinology and Obstetrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yogish C Kudva
- Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | | | - Chantal Mathieu
- Endocrinology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
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Berihu G, Mitiku M, Asfaw Beyene S, Gebregziabher L, Gebregiorgis Y, Eyasu M, Teferi M, Wellay T, Tewele A, Tesfay Atsbeha M. A facility-based study of lipids, glucose levels and their correlates among pregnant women in public hospitals of northern Ethiopia. PLoS One 2023; 18:e0279595. [PMID: 37279250 DOI: 10.1371/journal.pone.0279595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/10/2022] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Lipids and glucose concentrations in the blood rise during pregnancy period. Poor control of these analytes results in cardio metabolic dysfunction. Despite this, there are no documented studies which investigate lipids and glucose among pregnant women in Tigrai, northern Ethiopia. OBJECTIVE The objective of this study was to assess lipid and glucose levels and identify their correlates among pregnant women in Tigrai, northern Ethiopia. METHOD We conducted a facility-based cross sectional study comprising of systematically selected 200 pregnant women from July to October 2021. Those who were severely ill were excluded from the study. We used a structured questionnaire to collect socio-demographic and clinical characteristics of pregnant women. Lipids such as triglycerides, low density lipoprotein, cholesterol and blood glucose were also measured using Cobas C311 chemistry machine from plasma samples. The data were analyzed using SPSS version 25. Logistic regression was performed and statistical significance was declared at p-value < 0.05. RESULT Proportion of pregnant women with cholesterol, triglyceride, low density lipoprotein and blood glucose levels above the upper limit of the normal range used for clinical decision were 26.5%, 43%, 44.5% and 21%, respectively. Pregnant women's income > = 10,000 ETB (AOR = 3.35; 95%CI: 1.46-7.66), age (AOR = 3.16; 95%CI: 1.03-9.68), gestational age 29-37 weeks (AOR = 8.02; 95%CI: 2.69-23.90) and having systolic blood pressure greater than 120 mmHg (AOR = 3.99; 95%CI: 1.64-9.75) demonstrated statistically significant association with raised levels of lipids. CONCLUSION AND RECOMMENDATION Proportion of pregnant women with out of normal range values of lipids, particularly triglycerides and low density lipoprotein, is high. Gestational age is a strong predictor of increase in blood levels for both lipids. Provision of life style related health education and dietary intake to pregnant mothers matters. Moreover, monitoring lipid profile and glucose level during antenatal care period is essential.
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Affiliation(s)
- Gebregziabher Berihu
- Department of Health Systems, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mengistu Mitiku
- Department of Health Systems, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Research and Community Engagement Coordination office, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Selamawit Asfaw Beyene
- Department of Public Health Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Letekirstos Gebregziabher
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yohana Gebregiorgis
- Department of Health Systems, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mulu Eyasu
- Department of Environmental Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Molla Teferi
- Department of Reproductive Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tsegay Wellay
- Department of Health Systems, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Alemtsehay Tewele
- Department of Health Systems, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mussie Tesfay Atsbeha
- Department of Anaesthesia, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Polsky S, Foster NC, DuBose SN, Agarwal S, Lyons S, Peters AL, Uwaifo GI, DiMeglio LA, Sherr JL, Levy CJ. Incident diabetes complications among women with type 1 diabetes based on parity. J Matern Fetal Neonatal Med 2022; 35:4629-4634. [PMID: 33280471 DOI: 10.1080/14767058.2020.1858278] [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: 01/29/2020] [Revised: 11/18/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess risk factors and incidence of diabetes complications in women with type 1 diabetes (T1D) based on parity. RESEARCH DESIGN/METHODS Data were collected from women (16-40 years old) in the T1D Exchange completing pregnancy/childbirth questionnaires during 2011-2013 and 2016-2018. Incidence of risk factors and diabetes complications were compared between women with a first pregnancy at/within 1-year of enrollment (n = 28) and never pregnant women by year 5 (n = 469). RESULTS There was a trend for lower HbA1c (adjusted p = .14) and higher rates of overweight/obesity, triglyceride/HDL > 2, log (triglyercide/HDL), and hypertension among parous women compared with nulliparous women. There were no significant differences in rates of advanced nephropathy, albuminuria or cardiovascular disease. CONCLUSIONS Four-5 years after delivery, parous women with T1D tended to have lower HbA1c levels despite higher body mass indices and more frequent adverse lipid profiles and hypertension compared with nulliparous women. Further studies based on these trends are warranted.
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO, USA
| | | | | | | | - Sarah Lyons
- Baylor College of Medicine, Houston, TX, USA
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Carol J Levy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Linder T, Eder A, Monod C, Rosicky I, Eppel D, Redling K, Geissler F, Huhn EA, Hösli I, Göbl CS. Impact Of Prepregnancy Overweight And Obesity On Treatment Modality And Pregnancy Outcome In Women With Gestational Diabetes Mellitus. Front Endocrinol (Lausanne) 2022; 13:799625. [PMID: 35663318 PMCID: PMC9160363 DOI: 10.3389/fendo.2022.799625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We aim to evaluate the impact of prepregnancy overweight on treatment modalities of Gestational Diabetes Mellitus (GDM). We assessed the association of increased pregravid Body Mass Index (BMI) with dosing of basal and rapid acting insulin as well as pregnancy outcome. METHODS We included 509 gestational diabetic women (normal weight: 200, overweight: 157, obese: 152), attending the pregnancy outpatient clinic at the Department of Obstetrics and Gynecology, Medical University of Vienna, in this retrospective study. We used a prospectively compiled database to assess patient characteristics, treatment approaches - particularly maximum doses of basal and rapid acting insulin or metformin - and pregnancy outcome. RESULTS Increased BMI was associated with the need of glucose lowering medication (odds ratio (OR): 1.08 for the increase of 1 kg/m² BMI, 95%CI 1.05-1.11, p<0.001). Mothers with pregestational obesity received the highest amount of insulin. Metformin was more often used in patients with obesity who also required higher daily doses. Maternal BMI was associated with increased risk of cesarean section (OR 1.04, 95%CI 1.01-1.07, p<0.001) and delivering large for gestational age offspring (OR 1.09, 95%CI 1.04-1.13, p<0.001). Birthweight percentiles were highest in patients with obesity who required glucose lowering therapy. CONCLUSIONS Treatment modalities and outcome in GDM pregnancies are closely related to the extent of maternal BMI. Patients with obesity required glucose lowering medication more often and were at higher risk of adverse pregnancy outcomes. It is crucial to further explore the underlying pathophysiologic mechanisms to optimize clinical management and individual treatment approaches.
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Affiliation(s)
- Tina Linder
- Department of Obstetrics and Gynaecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Anna Eder
- Department of Obstetrics and Gynaecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Cécile Monod
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Ingo Rosicky
- Department of Obstetrics and Gynaecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Eppel
- Department of Obstetrics and Gynaecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Redling
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Franziska Geissler
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Evelyn A. Huhn
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Irene Hösli
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Christian S. Göbl
- Department of Obstetrics and Gynaecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
- *Correspondence: Christian S. Göbl,
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Rao C, Ping F. Second-trimester maternal lipid profiles rather than glucose levels predict the occurrence of neonatal macrosomia regardless of glucose tolerance status: A matched cohort study in Beijing. J Diabetes Complications 2021; 35:107948. [PMID: 34024685 DOI: 10.1016/j.jdiacomp.2021.107948] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/18/2021] [Accepted: 05/08/2021] [Indexed: 01/15/2023]
Abstract
AIMS The mechanism underlying fetal overgrowth during pregnancy remains elusive. We aimed to establish a predictive model to identify the high-risk individuals with macrosomia in the second trimester of pregnancy. DESIGN A total of 2577 pregnant women with a routine 75-g oral glucose tolerance test during 24-28 gestational weeks were screened in a prospective cohort. Gestational diabetes mellitus (GDM) cases were 1:1 matching with age (±2 years) in normal glucose tolerance (NGT) ones from the same region. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were performed to determine the index and its inflection point for predicting macrosomia occurrence. RESULTS The data of perinatal outcomes of 565 GDM and 549 NGT who had given birth to single live babies at term were analyzed. Notably, we found serum apolipoprotein B (ApoB) level higher than 4.04 g/L combined with triglycerides (TG)/high-density lipoprotein cholesterol (HDLC) ratio above 1.36 formed the predictive model in both groups. The area under the ROC curve of this predictive model included ApoB and TG/HDL-C reached 0.807 (95% CI: 0.771-0.873) with a sensitivity of 71.9% and a specificity of 78.6%. Mediation analysis revealed that ApoB and TG/HDL-C ratio mediated the harmful effect of FBG on the risk of macrosomia. CONCLUSION Maternal ApoB levels and TG/HDL-C ratio could predict macrosomia occurrence in pregnancy, which might be a new target for early intervention to prevent excess fetal growth.
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Affiliation(s)
- Chong Rao
- Department of Endocrinology, Beijing ChuiYangLiu Hospital, Beijing 100022, China
| | - Fan Ping
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key Laboratory of Endocrinology Assigned by Ministry of Health, Beijing 100730, China.
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Barrett HL, Dekker Nitert M, D’Emden M, Lingwood B, de Jersey S, McIntyre HD, Callaway LK. Capillary Triglycerides in Late Pregnancy-Challenging to Measure, Hard to Interpret: A Cohort Study of Practicality. Nutrients 2021; 13:nu13041266. [PMID: 33924317 PMCID: PMC8070156 DOI: 10.3390/nu13041266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Maternal triglycerides are increasingly recognised as important predictors of infant growth and fat mass. The variability of triglyceride patterns during the day and their relationship to dietary intake in women in late pregnancy have not been explored. This prospective cohort study aimed to examine the utility of monitoring capillary triglycerides in women in late pregnancy. METHODS Twenty-nine women (22 with gestational diabetes (GDM) and 7 without) measured capillary glucose and triglycerides using standard meters at home for four days. On two of those days, they consumed one of two standard isocaloric breakfast meals: a high-fat/low-carbohydrate meal (66% fat) or low fat/high carbohydrate meal (10% fat). Following the standard meals, glucose and triglyceride levels were monitored. RESULTS Median capillary triglycerides were highly variable between women but did not differ between GDM and normoglycaemic women. There was variability in capillary triglycerides over four days of home monitoring and a difference in incremental area under the curve for capillary triglycerides and glucose between the two standard meals. The high-fat standard meal lowered the incremental area under the curve for capillary glucose (p < 0.0001). Fasting (rho 0.66, p = 0.0002) and postpradial capillary triglycerides measured at home correlated with venous triglyceride levels. CONCLUSIONS The lack of differences in response to dietary fat intake and the correlation between capillary and venous triglycerides suggest that monitoring of capillary triglycerides before and after meals in pregnancy is unlikely to be useful in the routine clinical practice management of women with gestational diabetes mellitus.
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Affiliation(s)
- Helen L. Barrett
- Mater Research Institute, The University of Queensland, South Brisbane, QLD 4101, Australia;
- Department of Endocrinology, Mater Health, South Brisbane, QLD 4101, Australia
- Correspondence: ; Tel.: +61-7-31638111
| | - Marloes Dekker Nitert
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia;
| | - Michael D’Emden
- The Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia; (M.D.); (S.d.J.); (L.K.C.)
- School of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Barbara Lingwood
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD 4006, Australia;
| | - Susan de Jersey
- The Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia; (M.D.); (S.d.J.); (L.K.C.)
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD 4006, Australia;
| | - H. David McIntyre
- Mater Research Institute, The University of Queensland, South Brisbane, QLD 4101, Australia;
- School of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Department of Obstetric Medicine, Mater Health, South Brisbane, QLD 4101, Australia
| | - Leonie K. Callaway
- The Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia; (M.D.); (S.d.J.); (L.K.C.)
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Cibickova L, Schovanek J, Karasek D. Changes in serum lipid levels during pregnancy in women with gestational diabetes. A narrative review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:8-12. [PMID: 33500589 DOI: 10.5507/bp.2021.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
We review current knowledge on lipid metabolism changes during pregnancy with special focus on changes in gestational diabetes. In physiological pregnancy, total plasma cholesterol, triglyceride and HDL-cholesterol level rises, the atherogenic index (LDL-cholesterol / HDL-cholesterol remains unchanged. Compared with healthy women, women with GDM show more pronounced signs of mixed dyslipidaemia - increased levels of triglyceride, changes in cholesterol and lipoprotein concentrations with a shift towards greater small dense LDL subtractions, which is typical for insulin resistance states. Dyslipidaemia, particularly hypertriglyceridemia, is thought to be one of the key drivers of foetal macrosomia and that is why measurements of plasma lipids may be valuable in detecting the metabolic abnormality in GDM and in predicting foetal outcome. Dyslipidaemia in GDM is seen as proatherogenic and potentially harmful for the baby and therefore it should be monitored more carefully.
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Affiliation(s)
- Lubica Cibickova
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jan Schovanek
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - David Karasek
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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11
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Rodrigues IC, Grandi C, Simões VMF, Batista RFL, Rodrigues LS, Cardoso VC. Metabolic profile during pregnancy in BRISA birth cohorts of Ribeirão Preto and São Luís, Brazil. ACTA ACUST UNITED AC 2020; 54:e10253. [PMID: 33295536 PMCID: PMC7727101 DOI: 10.1590/1414-431x202010253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
During pregnancy, metabolic changes that develop in women may increase the risk of diseases and conditions that may also harm the life of the growing fetus. The aim of the present study was to identify and compare the metabolic profile (MP) during pregnancy in two birth cohorts in 2010 in the cities of Ribeirão Preto (RP) and São Luís (SL), Brazil. Pregnant women (1393 in RP and 1413 in SL) were studied; information was obtained through questionnaires in addition to anthropometric, biochemical, and blood pressure measurements. Data are presented as means and proportions. To compare the characteristics of pregnant women in both cities, chi-squared and Student's t-tests were applied, with 5% significance level. Ribeirão Preto presented higher mean values than SL for pre-gestational body mass index (24.5 vs 23 kg/m2, P<0.001), systolic (108.4 vs 102.8 mmHg, P<0.001) and diastolic (65.9 vs 61.8 mmHg, P<0.001) blood pressure, total cholesterol (226.3 vs 213.7 mg/dL, P<0.001) and fractions, and glycemia (84.5 vs 80.2 mg/dL, P<0.001), except for triglycerides (P=0.135). Women from RP also showed higher rates of pre-gestational overweight and obesity compared with SL (40.1 vs 25.8%). In the present study, pregnant women in RP had a worse gestational metabolic profile than those in SL, with higher pre-gestational excess weight, indicating that nutritional transition was more advanced in the more developed city.
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Affiliation(s)
- I C Rodrigues
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C Grandi
- Argentine Society of Pediatrics, Buenos Aires, Argentina
| | - V M F Simões
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - R F L Batista
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - L S Rodrigues
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V C Cardoso
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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12
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Association between maternal blood lipids levels during pregnancy and risk of small-for-gestational-age infants. Sci Rep 2020; 10:19865. [PMID: 33199750 PMCID: PMC7669834 DOI: 10.1038/s41598-020-76845-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/27/2020] [Indexed: 12/04/2022] Open
Abstract
Dyslipidemia in pregnancy are associated with risk of adverse outcomes. As an adverse pregnancy outcome, small-for-gestational-age has been extensively studied in Western countries. However, similar studies have rarely been conducted in Asian countries. Data were derived from 5695 pairs of non-diabetic mothers and neonates between 1 Jan 2014 and 31 Dec 2014. 5.6% neonates in our study were SGA. Serum samples were collected during second and third trimesters for evaluation on fasting lipids levels. The present study intended to explore the associations between maternal lipid profile and small-for-gestational-age neonates. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and adjusted via logistic regression analysis. After adjustments for confounders, third-trimester total cholesterol levels were associated with a decreased risk for small-for-gestational-age (aOR = 0.622, 95% CI 0.458–0.848, P = 0.002), and third-trimester high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels were associated with an increased risk for small-for-gestational-age (aOR = 1.955, 95% CI 1.465–2.578, P < 0.001; aOR = 1.403, 95% CI 1.014–1.944, P = 0.041).In the highest gestational weight gain strata, especially the third-trimester, the effect of high-density lipoprotein cholesterol levels on the risk for small-for-gestational-age is larger. High high-density lipoprotein cholesterol level during third trimester could be considered as indicators of a high-risk of small-for-gestational-age, regardless of gestational weight gain.
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13
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Mahindra MP, Sampurna MTA, Mapindra MP, Sutowo Putri AM. Maternal lipid levels in pregnant women without complications in developing risk of large for gestational age newborns: a study of meta-analysis. F1000Res 2020; 9:1213. [PMID: 33628433 PMCID: PMC7883316 DOI: 10.12688/f1000research.26072.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Circulating into foetal circulation across the placental barrier, abnormal maternal serum lipids predispose neonates to metabolic dysfunction and thereafter affect the steroid metabolism and functions of extra-embryonic foetal tissues. Methods: A systematic review was conducted by searching PubMed-MEDLINE and the Cochrane library between January 2010 and January 2020. The included studies were English case control studies that described original data on at least one raw lipid measurement during pregnancy in healthy women who delivered large for gestational age (LGA) newborns and in healthy women with non-LGA newborns. The data extracted from 12 studies were pooled, and the weighted mean difference (WMD) in lipid levels was calculated using random effects models. A meta-analysis was performed to identify sources of heterogeneity and to describe the significant value of the collected studies. Results: Of 649 published articles identified, a total of 12 met the inclusion criteria . Compared with women who had non-LGA newborns, those who had LGA newborns had significantly higher triglyceride (TG) levels (WMD = 0.28, 95% CI -0.02 to 0.54) and lower high density lipoprotein cholestrol (HDL-C) levels (WMD = 0.08, 95% CI -0.13 to -0.03), but not have significantly lower high-density lipoprotein cholesterol (LDL-C) levels. Moreover, the levels of total cholesterol, low-density lipoprotein cholesterol, and very low density lipoprotein cholesterol (VLDL-C) were inconsistent between both groups. Conclusions: High levels of TG and low levels of HDL-C could cause births of LGA newborns whereas maternal serum of TC, LDL-C and VLDL-C cannot be used as predictor of LGA.
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Affiliation(s)
| | - Mahendra Tri Arif Sampurna
- Department of Pediatrics, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60115, Indonesia
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14
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Mahindra MP, Sampurna MTA, Mapindra MP, Sutowo Putri AM. Maternal lipid levels in pregnant women without complications in developing risk of large for gestational age newborns: a meta-analysis. F1000Res 2020; 9:1213. [PMID: 33628433 PMCID: PMC7883316 DOI: 10.12688/f1000research.26072.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 09/17/2023] Open
Abstract
Background: Circulating into foetal circulation across the placental barrier, abnormal maternal serum lipids predispose neonates to metabolic dysfunction and thereafter affect the steroid metabolism and functions of extra-embryonic foetal tissues. Methods: A systematic review was conducted by searching PubMed-MEDLINE and the Cochrane library between January 2010 and January 2020. The included studies were English case control studies that described original data on at least one raw lipid measurement during pregnancy in healthy women who delivered large for gestational age (LGA) newborns and in healthy women with non-LGA newborns. The data extracted from 12 studies were pooled, and the weighted mean difference (WMD) in lipid levels was calculated using random effects models. A meta-analysis was performed to identify sources of heterogeneity and to describe the significant value of the collected studies. Results: Of 643 publications identified, a total of 12 met the inclusion criteria . Compared with women who had non-LGA newborns, those who had LGA newborns had significantly higher triglyceride (TG) levels (WMD = 0.28, 95% CI -0.02 to 0.54) and lower high density lipoprotein cholestrol (HDL-C) levels (WMD = 0.08, 95% CI -0.13 to -0.03), but not have significantly lower high-density lipoprotein cholesterol (LDL-C) levels. Moreover, the levels of total cholesterol, low-density lipoprotein cholesterol, and very low density lipoprotein cholesterol (VLDL-C) were inconsistent between both groups. Conclusions: High levels of TG and low levels of HDL-C could cause births of LGA newborns whereas maternal serum of TC, LDL-C and VLDL-C cannot be used as predictor of LGA.
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Affiliation(s)
| | - Mahendra Tri Arif Sampurna
- Department of Pediatrics, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60115, Indonesia
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15
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Adank MC, Benschop L, Kors AW, Peterbroers KR, Smak Gregoor AM, Mulder MT, Schalekamp-Timmermans S, Roeters Van Lennep JE, Steegers EAP. Maternal lipid profile in early pregnancy is associated with foetal growth and the risk of a child born large-for-gestational age: a population-based prospective cohort study : Maternal lipid profile in early pregnancy and foetal growth. BMC Med 2020; 18:276. [PMID: 33004027 PMCID: PMC7532083 DOI: 10.1186/s12916-020-01730-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lipids such as cholesterol and triglycerides play an important role in both maternal and foetal energy metabolism. Little is known about maternal lipid levels in pregnancy and their effect on foetal growth. The aim of this study was to assess maternal lipid levels, foetal growth and the risk of small-for-gestational age (SGA) and large-for-gestational age (LGA). METHODS We included 5702 women from the Generation R Study, a prospective population-based cohort. Maternal lipid levels (total cholesterol, triglycerides and high-density lipoprotein cholesterol [HDL-c]) were measured in early pregnancy (median 13.4 weeks, 90% range [10.5 to 17.2]). Low-density lipoprotein cholesterol (LDL-c), remnant cholesterol and non-HDL-c were calculated. Foetal growth was measured repeatedly by ultrasound. Information on birth anthropometrics was retrieved from medical records. A birth weight below the 10th percentile was defined as SGA and above the 90th percentile as LGA. RESULTS Maternal triglyceride and remnant cholesterol levels were associated with increased foetal head circumference and abdominal circumference growth rates. Triglycerides and remnant cholesterol were positively associated with the risk of LGA (odds ratio [OR] 1.11, 95% confidence interval [CI] [1.01 to 1.22] and OR 1.11, 95% CI [1.01 to 1.23], respectively). These associations were independent of maternal pre-pregnancy body mass index, but not maternal glucose levels. We observed no association between maternal lipids in early pregnancy and SGA. CONCLUSIONS Our study suggests a novel association of early pregnancy triglyceride and remnant cholesterol levels with foetal growth, patterns of foetal growth and the risk of LGA. Future studies are warranted to explore clinical implication possibilities.
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Affiliation(s)
- Maria C Adank
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands. .,Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
| | - Laura Benschop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Alet W Kors
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Kelly R Peterbroers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Anna M Smak Gregoor
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Monique T Mulder
- Department of General Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Sarah Schalekamp-Timmermans
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | | | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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16
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Abdeltawab A, Zaki ME, Abdeldayem Y, Mohamed AA, Zaied SM. Circulating micro RNA-223 and angiopoietin-like protein 8 as biomarkers of gestational diabetes mellitus. Br J Biomed Sci 2020; 78:12-17. [PMID: 32421465 DOI: 10.1080/09674845.2020.1764211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a serious health problem associated with both foetal and maternal complications. New biomarkers that can predict or help in the early diagnosis of GDM are needed to minimize the hazards of hyperglycaemia in pregnant women and their offspring. We hypothesised a link between levels of microRNA-223 (miRNA-223) and Angiopoietin-Like Protein 8 (ANGPTL8) and GDM. MATERIALS AND METHODS The study included 109 patients with confirmed early diagnosed GDM and 103 healthy control pregnant women in their second or third trimester. miRNA-223 and ANGPTL8 blood levels were assessed by real-time RT-PCR and sandwich ELISA, respectively, laboratory markers by standard methods. RESULTS There was a significant increase in mean [SD] miRNA-223 and ANGPTL8 in GDM (0.31 [0.06] relative units) and (692 [199] pg/ml), respectively, in the GDM women compared to healthy pregnant women (0.17[0.05] relative units) and (261 [127] pg/ml), respectively, P < 0.001. miRNA-223 and ANGPTL8 correlated significantly with each other (r = 0.38, P < 0.001) and with fasting, 1-h and 2-h postprandial blood glucose levels (all P ≤ 0.002) HbA1 c (P < 0.025), total cholesterol (P < 0.01), LDL-C and triglycerides (both P ≤ 0.005). The ROC area under curve (AUC) (95%CI) was 0.94 (0.91-0.97) for ANGPTL8, 0.92 (0.88-0.96) for miRNA-223 and 0.97 (0.95 - 0.99) for their combination. CONCLUSIONS These findings support the hypothesis of involvement of both miRNA-223 and ANGPTL8 in the pathogenesis of GDM. The difference between levels in GDM patients and in control pregnant women indicates potential use for early diagnosis or prediction of GDM.
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Affiliation(s)
- A Abdeltawab
- Physiology Department, College of Medicine, Jouf University , Sakaka, Saudi Arabia.,Physiology Department, Faculty of Medicine, Beni-Suef University , Beni-Suef, Egypt
| | - M E Zaki
- Clinical Pathology Department, Faculty of Medicine, Mansoura University , Mansoura, Egypt
| | - Y Abdeldayem
- Obstetric and Gynecology Department, Mansoura University , Mansoura, Egypt
| | - A A Mohamed
- Medical Biochemistry Division, Pathology Department, Jouf University , Sakaka, Saudi Arabia.,Medical Biochemistry Department, Faculty of Medicine, Beni-Suef University , Beni-Suef, Egypt
| | - S M Zaied
- Clinical and Chemical Pathology Department, Faculty of Medicine, Beni-Suef University , Beni-Suef, Egypt
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17
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Lin XH, Wu DD, Li C, Xu YJ, Gao L, Lass G, Zhang J, Tian S, Ivanova D, Tang L, Chen L, Ding R, Liu XM, Han M, Fan JX, Li XF, Sheng JZ, O'Byrne KT, Huang HF. Maternal High Triglyceride Levels During Early Pregnancy and Risk of Preterm Delivery: A Retrospective Cohort Study. J Clin Endocrinol Metab 2019; 104:1249-1258. [PMID: 30321365 DOI: 10.1210/jc.2018-01372] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022]
Abstract
CONTEXT Maternal obesity increases the risk of preterm delivery. Obesity is known to be associated with altered lipid metabolism. OBJECTIVE To investigate the associations between high maternal triglyceride (mTG) levels during early pregnancy and risks of preterm delivery stratified by early pregnancy body mass index (BMI). DESIGN Retrospective cohort study. SETTING University-based maternity center. PATIENTS 49,612 women with singleton pregnancy who underwent fasting serum lipid screening during early pregnancy. MAIN OUTCOME MEASURES Risk of preterm delivery (total, <37 weeks; early, 28 to 33 weeks; and late, 34 to 36 weeks). RESULTS Among women enrolled, 2494 had a preterm delivery, including 438 early preterm and 2056 late preterm delivery. High mTG (>90th percentile, 2.04 mM) was associated with shortened gestation. Risks of total, early, and late preterm deliveries increased with mTG levels, and the high mTG-related risk was highest for early preterm delivery [adjusted odds ratio (AOR) 1.72; 95% CI, 1.30 to 2.29]. After stratification by BMI, high mTG was associated with risk of preterm delivery in both overweight or obese (OWO) women (AOR 1.32; 95% CI, 1.02 to 1.70) and women with normal BMI (AOR 1.36; 95% CI, 1.16 to 1.59). In additional sensitivity analyses, we found that high mTG was related to higher risks of preterm delivery among OWO women and women with normal BMI (AOR, 1.54; 95% CI, 1.07 to 2.22 and 1.62, 1.34 to 1.96, respectively), especially early preterm delivery (AOR 2.47; 95% CI, 1.19 to 5.10, and AOR 2.50; 95% CI, 1.65 to 3.78, respectively). CONCLUSIONS High mTG level during early pregnancy increased the risks of preterm delivery not only in OWO women but also in women with normal BMI.
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Affiliation(s)
- Xian-Hua Lin
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Dan-Dan Wu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Cheng Li
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yi-Jing Xu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ling Gao
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Geffen Lass
- Division of Reproduction and Endocrinology, King's College London, London, United Kingdom
| | - Jian Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shen Tian
- The Key Laboratory of Reproductive Genetics, Ministry of Education (Zhejiang University), Hangzhou, China
| | - Deyana Ivanova
- Division of Reproduction and Endocrinology, King's College London, London, United Kingdom
| | - Lin Tang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Chen
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Ding
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xi-Mei Liu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Mi Han
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jian-Xia Fan
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiao-Feng Li
- Division of Reproduction and Endocrinology, King's College London, London, United Kingdom
| | - Jian-Zhong Sheng
- The Key Laboratory of Reproductive Genetics, Ministry of Education (Zhejiang University), Hangzhou, China
- Department of Pathology and Pathophysiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kevin T O'Byrne
- Division of Reproduction and Endocrinology, King's College London, London, United Kingdom
| | - He-Feng Huang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- The Key Laboratory of Reproductive Genetics, Ministry of Education (Zhejiang University), Hangzhou, China
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18
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McGrath RT, Glastras SJ, Hocking SL, Fulcher GR. Large-for-Gestational-Age Neonates in Type 1 Diabetes and Pregnancy: Contribution of Factors Beyond Hyperglycemia. Diabetes Care 2018; 41:1821-1828. [PMID: 30030258 DOI: 10.2337/dc18-0551] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/07/2018] [Indexed: 02/03/2023]
Abstract
Despite significant reductions in serious adverse perinatal outcomes for women with type 1 diabetes in pregnancy, the opposite effect has been observed for fetal overgrowth and associated complications, such as neonatal hypoglycemia, shoulder dystocia, and admission to the neonatal intensive care unit. In addition, infants born large for gestational age (LGA) have an increased lifetime risk of obesity, diabetes, and chronic disease. Although exposure to hyperglycemia plays an important role, women who seemingly achieve adequate glycemic control in pregnancy continue to experience a greater risk of excess fetal growth, leading to LGA neonates and macrosomia. We review potential contributors to excess fetal growth in pregnancies complicated by type 1 diabetes. In addition to hyperglycemia, we explore the role of glycemic variability, prepregnancy overweight and obesity, gestational weight gain, and maternal lipid levels. Greater understanding of the stimuli that drive excess fetal growth could lead to targeted management strategies in pregnant women with type 1 diabetes, potentially reducing the incidence of LGA neonates and the inherent risk of acute and long-term complications.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia .,Kolling Institute, St Leonards, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.,Kolling Institute, St Leonards, Sydney, New South Wales, Australia
| | - Samantha L Hocking
- Central Clinical School and The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
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19
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Nahavandi S, Seah JM, Shub A, Houlihan C, Ekinci EI. Biomarkers for Macrosomia Prediction in Pregnancies Affected by Diabetes. Front Endocrinol (Lausanne) 2018; 9:407. [PMID: 30108547 PMCID: PMC6079223 DOI: 10.3389/fendo.2018.00407] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/29/2018] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Sofia Nahavandi
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Jas-mine Seah
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Alexis Shub
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Mercy Hospital for Women, Mercy Health, Melbourne, VIC, Australia
| | - Christine Houlihan
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
- Mercy Hospital for Women, Mercy Health, Melbourne, VIC, Australia
| | - Elif I. Ekinci
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
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Geraghty AA, Alberdi G, O'Sullivan EJ, O'Brien EC, Crosbie B, Twomey PJ, McAuliffe FM. Maternal and fetal blood lipid concentrations during pregnancy differ by maternal body mass index: findings from the ROLO study. BMC Pregnancy Childbirth 2017; 17:360. [PMID: 29037224 PMCID: PMC5644148 DOI: 10.1186/s12884-017-1543-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 10/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Pregnancy is a time of altered metabolic functioning and maternal blood lipid profiles change to accommodate the developing fetus. While these changes are physiologically necessary, blood lipids concentrations have been associated with adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and high birth weight. As blood lipids are not routinely measured during pregnancy, there is limited information on what is considered normal during pregnancy and in fetal blood. Methods Data from 327 mother-child pairs from the ROLO longitudinal birth cohort study were analysed. Fasting total cholesterol and triglycerides were measured in early and late pregnancy and fetal cord blood. Intervals were calculated using the 2.5th, 50th and 97.5th centile. Data was stratified based on maternal body mass index (BMI) measured during early pregnancy. Differences in blood lipids between BMI categories were explored using ANOVA and infant outcomes of macrosomia and large-for-gestational-age (LGA) were explored using independent student T-tests and binary logistic regression. Results All maternal blood lipid concentrations increased significantly from early to late pregnancy. In early pregnancy, women with a BMI < 25 kg/m2 had lower concentrations of total cholesterol compared to women with a BMI of 25–29.9 kg/m2 (P = 0.02). With triglycerides, women in the obese category (BMI > 30 kg/m2) had higher concentrations than both women in the normal-weight and overweight category in early and late pregnancy (P < 0.001 and P = 0.03, respectively). In late pregnancy, triglyceride concentrations remained elevated in women in the obese category compared to women in the normal-weight category (P = 0.01). Triglyceride concentrations were also elevated in late pregnancy in mothers that then gave birth to infants with macrosomia and LGA (P = 0.01 and P = 0.03, respectively). Conclusion Blood lipid concentrations increase during pregnancy and differ by maternal BMI. These intervals could help to inform the development of references for blood lipid concentrations during pregnancy. Trial registration ROLO Study - ISRCTN54392969. Date of registration: 22/04/2009.
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Affiliation(s)
- Aisling A Geraghty
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Goiuri Alberdi
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Elizabeth J O'Sullivan
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Eileen C O'Brien
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Brenda Crosbie
- Clinical Chemistry, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Patrick J Twomey
- Clinical Chemistry, St. Vincent's University Hospital, Dublin 4, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
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HDL-cholesterol concentration in pregnant Chinese Han women of late second trimester associated with genetic variants in CETP, ABCA1, APOC3, and GALNT2. Oncotarget 2017; 8:56737-56746. [PMID: 28915626 PMCID: PMC5593597 DOI: 10.18632/oncotarget.18128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/25/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate whether HDL-C level in pregnant Chinese Han women of late second trimester correlated with loci in high-density lipoprotein-cholesterol (HDL-C)-related genes found in genome-wide association studies (GWAS). Methods Seven single-nucleotide polymorphisms (rs3764261 in CETP, rs1532085 in LIPC, rs7241918 in LIPG, rs1883025 in ABCA1, rs4225 in APOC3, rs1059611 in LPL, and rs16851339 in GALNT2) were genotyped using the Sequenom MassArray system for 1,884 pregnant women. Results The following polymorphisms were statistically associated with HDL-C level after adjusting for age, gestational week, pre-pregnancy BMI and state of GDM or HOMAIR: (i) rs3764261 (b = -0.055 mmol/L, 95% CI -0.101 to -0.008, p = 0.021), (ii) rs1883025 (b = -0.054 mmol/L, 95% CI -0.097 to -0.012, p = 0.013), (iii) rs4225 (b = -0.071 mmol/L, 95% CI -0.116 to -0.027, p = 1.79E-3) and (iv) rs16851339 (b = -0.064 mmol/L, 95% CI -0.120 to -0.008, p = 0.025). The more risk alleles the pregnant women have, the lower the plasma HDL-C levels of the subjects are. Conclusions Several risk alleles found to be related to HDL-C in GWAS are also associated with HDL-C levels in pregnant Chinese Han women and these risk loci contribute additively to low HDL-C levels.
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Krstevska B, Jovanovska SM, Krstevska SS, Nakova VV, Serafimoski V. Maternal Lipids May Predict Fetal Growth in Type 2 Diabetes Mellitus and Gestational Diabetes Mellitus Pregnancies. ACTA ACUST UNITED AC 2017; 37:99-105. [PMID: 27883318 DOI: 10.1515/prilozi-2016-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM During diabetic pregnancy, complex metabolic changes occur in the lipid profile. The aim of the study was to determine the predictive values of maternal serum lipid levels on large-for-gestational age newborns during the third trimester in pregnancies of women with type 2 diabetes mellitus (DM2) and gestational diabetes mellitus (GDM). MATERIAL AND METHODS Data of forty three pregnancies of women with DM2 and two hundred women with GDM were analyzed. The analysis encompassed the following parameters: age, body mass index (BMI), lipid parameters, HbA1c in first, second and third trimester of pregnancy, preeclampsia and baby birth weight. RESULTS DM2 and GDM groups showed statistically significant differences in the following variables: total lipids, triglycerides, total cholesterol, BMI, age, baby birth weight, incidence of SGA and preterm delivery (9.4 ± 2.3 vs. 11.0 ± 2.3 mmol/L, 2.4 ± 1.4 vs. 3.4 ± 1.6 mmol/L, 5.5 ± 1.2 vs. 6.4 ± 1.4 mmol/L, 30.6 ± 5.4 vs. 26.9 ± 5.2 kg/m2, 34 ± 7.8 vs. 31.5 ± 5.6 years, 3183 ± 972 vs. 3533 ± 699 g., 20% vs. 7.5%, 27.9 vs. 14%, respectively, p < 0.05). Linear multiple regression analysis demonstrated that triglycerides, LDL-C and total cholesterol were independent predictors of LGA (p < 0.05). CONCLUSION Triglycerides and LDL-C in the third trimester of pregnancy are independent predictors for fetal macrosomia in DM2 and GDM pregnancies. Thus, the maternal serum triglycerides and LDL-C levels determined in the maternal blood taken in the third trimester of pregnancy may indentify women who will give birth to LGA newborns.
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Gutaj P, Wender-Ożegowska E, Brązert J. Maternal lipids associated with large-for-gestational-age birth weight in women with type 1 diabetes: results from a prospective single-center study. Arch Med Sci 2017; 13:753-759. [PMID: 28721142 PMCID: PMC5510499 DOI: 10.5114/aoms.2016.58619] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite improvement in diabetes care over the years, the incidence of macrosomia in type 1 diabetic mothers is still very high and even shows an increasing tendency. It is suggested that other factors that maternal hyperglycemia might be associated with excessive fetal growth in diabetic mothers. The aim of this study was to determine whether maternal lipids might contribute to high rates of large-for-gestational-age (LGA) newborns in women with type 1 diabetes (T1DM). MATERIAL AND METHODS This prospective, single-center study was performed in a population of women with T1DM admitted to the perinatal center for women with diabetes. Data were collected in the first trimester (< 12th week), in mid-pregnancy (20th-24th weeks), and before delivery (34th-39th weeks). RESULTS Among 114 women included in the analysis, 30 (26.3%) delivered LGA newborns. The remaining 84 (73.7%) newborns were appropriate for gestational age (AGA). Lower high-density lipoprotein (HDL) HDL concentration in the first trimester was significantly associated with LGA (p = 0.01). Similar associations were observed for the HDL concentrations in mid-pregnancy (p = 0.04) and before delivery (p = 0.03). Higher triglyceride concentrations in the first trimester (p = 0.02) and before delivery (p = 0.008) were associated with LGA. Higher glycated haemoglobin (HbA1c) levels in mid-pregnancy and before delivery were associated with LGA. The associations between maternal lipids and LGA were independent of maternal body mass index at onset of the study, gestational weight gain and HbA1c concentrations. CONCLUSIONS Decreased HDL and increased triglycerides during pregnancy might contribute to the development of LGA in women with type 1 diabetes.
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Affiliation(s)
- Paweł Gutaj
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Wender-Ożegowska
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Brązert
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
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The impact of preconceptional obesity on trajectories of maternal lipids during gestation. Sci Rep 2016; 6:29971. [PMID: 27436227 PMCID: PMC4951687 DOI: 10.1038/srep29971] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/28/2016] [Indexed: 11/27/2022] Open
Abstract
Growing challenges of maternal obesity necessitate to focus metabolic management on alternative factors than glycaemia. The objective is to assess longitudinal changes in lipids and inflammatory parameters during pregnancies stratified by pregestational BMI. Therefore, 222 pregnant women (normal-weight BMI < 25: n = 91 (41%), overweight BMI 25–29.9: n = 69 (31%), obese BMI ≥ 30: n = 62 (28%)) underwent a detailed metabolic characterization including fasting lipids and glucometabolic parameters at <21st gestational week (GW) with follow-up assessments at further three visits (24–28th GW, 32–34th GW, >36th GW). Overweight and obesity was related to dyslipidemia already at baseline, i.e. elevated triglycerides (TG, p < 0.001), decreased high-density-lipoprotein-C (p = 0.009) and increased ultrasensitive-c-reactive-protein (usCRP, p < 0.001) independent of gestational diabetes prevalence. Trajectories of lipids during pregnancy progress revealed an unexpected less pronounced increase in TG, low-density-lipoprotein-C and total-cholesterol in overweight/obese women. usCRP remained associated with higher BMI throughout pregnancy showing no time-dependent longitudinal changes. Newborns of obese/overweight women were affected by higher birth-weight percentiles. Regarding lipids only maternal TG showed tendency for relation to prevalence of large-for-gestational-age offspring, particularly at the end of pregnancy (p = 0.048). Overweight and obese women show significant differences in trajectories of lipids during pregnancy that distinguish them from normal-weight women. Further studies should evaluate if targeting lipid metabolism could improve clinical management of maternal obesity.
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Savona-Ventura C, Vassallo J, Craus J, Anastasiou E, Jotic A, Lalic NM, Slama CB, Loscos AR, Napoli A, Roma G. Biological and biochemical characteristics of a Mediterranean population with Gestational Diabetes Mellitus. J Perinat Med 2016; 44:377-82. [PMID: 26021548 DOI: 10.1515/jpm-2015-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/20/2015] [Indexed: 11/15/2022]
Abstract
The interplay of various nutrients provided to the developing foetus determines the growth potential of the conceptus. This study assessed the inter-relationship between these nutrients in a Mediterranean population including 1062 pregnant, previously non-diabetic women. These underwent an oral glucose tolerance test (oGTT) and were accordingly classified into gestational hyperglycaemic and normoglycaemic groups. Fasting insulin, HbA1c, and lipid profiles were further assessed, and the anthropomorphic characteristics of the mother and child at birth were measured. Lipid profiles were compared between the two groups and related to the biological characteristics of the mother and child at birth. Gestational hyperglycaemia was significantly associated with elevated triglycerides (P<0.0001) and decreased low density lipoprotein cholesterol (LDL-C) (P=0.02). There were no significant changes in total cholesterol and high density lipoprotein cholesterol (HDL-C) levels. Maternal BMI correlated positively with the various glycaemic indices (P<0.0001) and triglycerides (P<0.0001), but inversely with cholesterol (P<0.0001), HDL-C (P<0.0001) and LDL-C (P<0.0001). The infant birth weight correlated positively with maternal body weight (P<0.0001), LDL-C (P<0.0001) and the glycaemic indices (P<0.0001), but negatively with cholesterol (P<0.0001), triglycerides (P<0.0001), HDL-C (P<0.0001) and FBG (P<0.0001). This study confirms that the maternal body mass index (BMI), insulin resistance, and LDL-C levels positively contribute towards foetal growth, whereas a negative correlation was noted with cholesterol, triglycerides, and HDL-C.
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Jin WY, Lin SL, Hou RL, Chen XY, Han T, Jin Y, Tang L, Zhu ZW, Zhao ZY. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth 2016; 16:60. [PMID: 27000102 PMCID: PMC4802610 DOI: 10.1186/s12884-016-0852-9] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 03/17/2016] [Indexed: 02/07/2023] Open
Abstract
Background Dyslipidemia in pregnancy are associated with gestational diabetes mellitus (GDM), preeclampsia, preterm birth and other adverse outcomes, which has been extensively studied in western countries. However, similar studies have rarely been conducted in Asian countries. Our study was aimed at investigating the associations between maternal dyslipidemia and adverse pregnancy outcomes among Chinese population. Methods Data were derived from 934 pairs of non-diabetic mothers and neonates between 2010 and 2011. Serum blood samples were assayed for fasting total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) concentrations during the first, second and third trimesters. The present study explored the associations between maternal lipid profile and pregnancy complications and perinatal outcomes. The pregnancy complications included GDM, preeclampsia and intrahepatic cholestasis of pregnancy (ICP); the perinatal outcomes included preterm birth, small/large for gestational age (SGA/LGA) infants and macrosomia. Odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were calculated and adjusted via stepwise logistic regression analysis. Optimal cut-off points were determined by ROC curve analysis. Results After adjustments for confounders, every unit elevation in third-trimester TG concentration was associated with increased risk for GDM (OR = 1.37, 95 % CI: 1.18-1.58), preeclampsia (OR = 1.50, 95 % CI: 1.16-1.93), ICP (OR = 1.28, 95 % CI: 1.09-1.51), LGA (OR = 1.13, 95 % CI: 1.02-1.26), macrosomia (OR = 1.19, 95 % CI: 1.02-1.39) and decreased risk for SGA (OR = 0.63, 95 % CI: 0.40-0.99); every unit increase in HDL-C concentration was associated with decreased risk for GDM and macrosomia, especially during the second trimester (GDM: OR = 0.10, 95 % CI: 0.03-0.31; macrosomia: OR = 0.25, 95 % CI: 0.09-0.73). The optimal cut-off points for third-trimester TG predicting GDM, preeclampsia, ICP, LGA and SGA were separately ≥3.871, 3.528, 3.177, 3.534 and ≤2.530 mmol/L. The optimal cut-off points for third-trimester HDL-C identifying GDM, macrosomia and SGA were respectively ≤1.712, 1.817 and ≥2.238 mmol/L. Conclusions Among Chinese population, maternal high TG in late pregnancy was independently associated with increased risk of GDM, preeclampsia, ICP, LGA, macrosomia and decreased risk of SGA. Relative low maternal HDL-C during pregnancy was significantly associated with increased risk of GDM and macrosomia; whereas relative high HDL-C was a protective factor for both of them.
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Affiliation(s)
- Wen-Yuan Jin
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Sheng-Liang Lin
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Ruo-Lin Hou
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Xiao-Yang Chen
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Ting Han
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yan Jin
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Li Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, WA6845, Australia
| | - Zhi-Wei Zhu
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Zheng-Yan Zhao
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Shablinskiĭ MA, Milent'ev AY, Lotosh NY, Selishcheva AA, Badyshtov BA, Besova NV, Savel'ev SV. [Non-esterified fatty acids of blood serum in type 1 diabetic women during late pregnancy]. BIOMEDIT︠S︡INSKAI︠A︡ KHIMII︠A︡ 2015; 60:689-94. [PMID: 25552510 DOI: 10.18097/pbmc20146006689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Using gas chromatography a comparative study of the range and content of individual non-esterified fatty acids in serum of patients with diabetes mellitus type 1 in the third trimester of pregnancy, and healthy pregnant and non-pregnant women has been carried out. In groups of pregnant women there was activation of lipid metabolism, confirmed by corresponding changes in serum biochemical parameters, as well as in the content of non-esterified fatty acids. Intergroup differences in the non-esterified fatty acids were not found. However, there were significant differences between the examined groups in the quantitative content of non-esterified fatty acids.
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Affiliation(s)
- M A Shablinskiĭ
- Institute of Biomedical Problems, Moscow, Russia;Lomonosov Moscow State University, Department of Biology
| | | | - N Yu Lotosh
- Institute of Biomedical Problems, Moscow, Russia
| | - A A Selishcheva
- Institute of Biomedical Problems, Moscow, Russia;Lomonosov Moscow State University, Department of Biology
| | - B A Badyshtov
- Central Clinical Hospital of Civil Aviation, Moscow, Russia
| | - N V Besova
- Institute of Biomedical Problems, Moscow, Russia
| | - S V Savel'ev
- Institute of Biomedical Problems, Moscow, Russia; Institute of Human Morphology, Moscow, Russia
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Hou RL, Zhou HH, Chen XY, Wang XM, Shao J, Zhao ZY. Effect of maternal lipid profile, C-peptide, insulin, and HBA1c levels during late pregnancy on large-for-gestational age newborns. World J Pediatr 2014; 10:175-81. [PMID: 24801236 DOI: 10.1007/s12519-014-0488-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Large-for-gestational age (LGA) newborns can increase the risk of metabolic syndrome. Previous studies have shown that the levels of maternal blood lipids, connecting peptide (C-peptide), insulin and glycosylated hemoglobin (HbA1c) were significantly different between LGA and appropriate-for-gestational age (AGA) newborns. This study aimed to determine the effect of the levels of maternal lipids, C-peptide, insulin, and HbA1c during late pregnancy on LGA newborns. METHODS This study comprised 2790 non-diabetic women in late pregnancy. Among their newborns, 2236 (80.1%) newborns were AGA, and 554 (19.9%) newborns were LGA. Maternal and neonatal characteristics were obtained from questionnaires and their case records. The levels of maternal fasting serum apolipoprotein A1 (ApoA1), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-peptide, insulin and blood HbA1c were measured. The chi-square and Mann-Whitney U test were used to analyze categorical variables and continuous variables between the AGA and LGA groups, respectively. Binary logistic regression analysis was made to determine the independent risk factors for LGA newborns. RESULTS Maternal TG, C-peptide, insulin and HbA1c levels were significantly higher in the LGA group than in the AGA group (P<0.05). The LGA group had significantly lower levels of maternal TC, HDL-C and LDL-C than the AGA group (P<0.05). After adjustment for confounding variables, including maternal age, pre-pregnancy body mass index, education, smoking, annual household income, amniotic fluid volume, gestational hypertension, newborn gender and gestational age at blood collection, high maternal TG levels remained significantly associated with LGA newborns (P<0.05). CONCLUSION High maternal TG level during late pregnancy is significantly associated with LGA newborns.
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Affiliation(s)
- Ruo-Lin Hou
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
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Visiedo F, Bugatto F, Sánchez V, Cózar-Castellano I, Bartha JL, Perdomo G. High glucose levels reduce fatty acid oxidation and increase triglyceride accumulation in human placenta. Am J Physiol Endocrinol Metab 2013; 305:E205-12. [PMID: 23673156 DOI: 10.1152/ajpendo.00032.2013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Placentas of women with gestational diabetes mellitus (GDM) exhibit an altered lipid metabolism. The mechanism by which GDM is linked to alterations in placental lipid metabolism remains obscure. We hypothesized that high glucose levels reduce mitochondrial fatty acid oxidation (FAO) and increase triglyceride accumulation in human placenta. To test this hypothesis, we measured FAO, fatty acid esterification, de novo fatty acid synthesis, triglyceride levels, and carnitine palmitoyltransferase activities (CPT) in placental explants of women with GDM or no pregnancy complication. In women with GDM, FAO was reduced by ~30% without change in mitochondrial content, and triglyceride content was threefold higher than in the control group. Likewise, in placental explants of women with no complications, high glucose levels reduced FAO by ~20%, and esterification increased linearly with increasing fatty acid concentrations. However, de novo fatty acid synthesis remained unchanged between high and low glucose levels. In addition, high glucose levels increased triglyceride content approximately twofold compared with low glucose levels. Furthermore, etomoxir-mediated inhibition of FAO enhanced esterification capacity by ~40% and elevated triglyceride content 1.5-fold in placental explants of women, with no complications. Finally, high glucose levels reduced CPT I activity by ~70% and phosphorylation levels of acetyl-CoA carboxylase by ~25% in placental explants of women, with no complications. We reveal an unrecognized regulatory mechanism on placental fatty acid metabolism by which high glucose levels reduce mitochondrial FAO through inhibition of CPT I, shifting flux of fatty acids away from oxidation toward the esterification pathway, leading to accumulation of placental triglycerides.
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Barrett HL, Dekker Nitert M, Jones L, O'Rourke P, Lust K, Gatford KL, De Blasio MJ, Coat S, Owens JA, Hague WM, McIntyre HD, Callaway L, Rowan J. Determinants of maternal triglycerides in women with gestational diabetes mellitus in the Metformin in Gestational Diabetes (MiG) study. Diabetes Care 2013; 36:1941-6. [PMID: 23393209 PMCID: PMC3687298 DOI: 10.2337/dc12-2132] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Factors associated with increasing maternal triglyceride concentrations in late pregnancy include gestational age, obesity, preeclampsia, and altered glucose metabolism. In a subgroup of women in the Metformin in Gestational Diabetes (MiG) trial, maternal plasma triglycerides increased more between enrollment (30 weeks) and 36 weeks in those treated with metformin compared with insulin. The aim of this study was to explain this finding by examining factors potentially related to triglycerides in these women. RESEARCH DESIGN AND METHODS Of the 733 women randomized to metformin or insulin in the MiG trial, 432 (219 metformin and 213 insulin) had fasting plasma triglycerides measured at enrollment and at 36 weeks. Factors associated with maternal triglycerides were assessed using general linear modeling. RESULTS Mean plasma triglyceride concentrations were 2.43 (95% CI 2.35-2.51) mmol/L at enrollment. Triglycerides were higher at 36 weeks in women randomized to metformin (2.94 [2.80-3.08] mmol/L; +23.13% [18.72-27.53%]) than insulin (2.65 [2.54-2.77] mmol/L, P = 0.002; +14.36% [10.91-17.82%], P = 0.002). At 36 weeks, triglycerides were associated with HbA1c (P = 0.03), ethnicity (P = 0.001), and treatment allocation (P = 0.005). In insulin-treated women, 36-week triglycerides were associated with 36-week HbA1c (P = 0.02), and in metformin-treated women, they were related to ethnicity. CONCLUSIONS At 36 weeks, maternal triglycerides were related to glucose control in women treated with insulin and ethnicity in women treated with metformin. Whether there are ethnicity-related dietary changes or differences in metformin response that alter the relationship between glucose control and triglycerides requires further study.
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Affiliation(s)
- Helen L Barrett
- UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia.
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Göbl CS, Bozkurt L, Rivic P, Schernthaner G, Weitgasser R, Pacini G, Mittlböck M, Bancher-Todesca D, Lechleitner M, Kautzky-Willer A. A two-step screening algorithm including fasting plasma glucose measurement and a risk estimation model is an accurate strategy for detecting gestational diabetes mellitus. Diabetologia 2012; 55:3173-81. [PMID: 23001377 DOI: 10.1007/s00125-012-2726-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
Abstract
AIMS/HYPOTHESIS It is currently not clear how to construct a time- and cost-effective screening strategy for gestational diabetes mellitus (GDM). Thus, we elaborated a simple screening algorithm combining (1) fasting plasma glucose (FPG) measurement; and (2) a multivariable risk estimation model focused on individuals with normal FPG levels to decide if a further OGTT is indicated. METHODS A total of 1,336 women were prospectively screened for several risk factors for GDM within a multicentre study conducted in Austria. Of 714 women (53.4%) who developed GDM using recent diagnostic guidelines, 461 were sufficiently screened with FPG. A risk prediction score was finally developed using data from the remaining 253 women with GDM and 622 healthy women. The screening algorithm was validated with a further 258 pregnant women. RESULTS A risk estimation model including history of GDM, glycosuria, family history of diabetes, age, preconception dyslipidaemia and ethnic origin, in addition to FPG, was accurate for detecting GDM in participants with normal FPG. Including an FPG pretest, the receiver operating characteristic AUC of the screening algorithm was 0.90 (95% CI 0.88, 0.91). A cut-off value of 0.20 was able to differentiate between low and intermediate risk for GDM with a high sensitivity. Comparable results were seen with the validation cohort. Moreover, we demonstrated an independent association between values derived from the risk estimation and macrosomia in offspring (OR 3.03, 95% CI 1.79, 5.19, p < 0.001). CONCLUSIONS/INTERPRETATION This study demonstrates a new concept for accurate but cheap GDM screening. This approach should be further evaluated in different populations to ensure an optimised diagnostic algorithm.
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Affiliation(s)
- C S Göbl
- Department of Gynecology and Obstetrics, Division of Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
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Basu A, Alaupovic P, Wu M, Jenkins AJ, Yu Y, Nankervis AJ, Hanssen KF, Scholz H, Henriksen T, Lorentzen B, Clausen T, Garg SK, Menard MK, Hammad SM, Scardo JA, Stanley JR, Dashti A, Aston CE, Lyons TJ. Plasma lipoproteins and preeclampsia in women with type 1 diabetes: a prospective study. J Clin Endocrinol Metab 2012; 97:1752-62. [PMID: 22438226 PMCID: PMC3339882 DOI: 10.1210/jc.2011-3255] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In nondiabetic pregnancy, cross-sectional studies have shown associations between maternal dyslipidemia and preeclampsia (PE). In type 1 diabetes mellitus (T1DM), the prevalence of PE is increased 4-fold, but prospective associations with plasma lipoproteins are unknown. OBJECTIVES The aim of this study was to define lipoprotein-related markers and potential mechanisms for PE in T1DM. DESIGN AND SETTINGS We conducted a multicenter prospective study in T1DM pregnancy. PATIENTS We studied 118 T1DM women (26 developed PE, 92 remained normotensive). Subjects were studied at three visits before PE onset [12.2 ± 1.9, 21.6 ± 1.5, and 31.5 ± 1.7 wk gestation (means ± SD)] and at term (37.6 ± 2.0 wk). Nondiabetic normotensive pregnant women (n = 21) were included for reference. MAIN OUTCOME MEASURES Conventional lipid profiles, lipoprotein subclasses [defined by size (nuclear magnetic resonance) and by apolipoprotein content], serum apolipoproteins (ApoAI, ApoB, and ApoCIII), and lipolysis (ApoCIII ratio) were measured in T1DM women with and without subsequent PE. RESULTS In women with vs. without subsequent PE, at the first and/or second study visits: low-density lipoprotein (LDL)-cholesterol, particle concentrations of total LDL and large (but not small) LDL, serum ApoB, and ApoB:ApoAI ratio were all increased (P < 0.05); peripheral lipoprotein lipolysis was decreased (P < 0.01). These early differences remained significant in covariate analysis (glycated hemoglobin, actual prandial status, gravidity, body mass index, and diabetes duration) but were not present at the third study visit. High-density lipoprotein and very low-density lipoprotein subclasses did not differ between groups before PE onset. CONCLUSIONS Early in pregnancy, increased cholesterol-rich lipoproteins and an index suggesting decreased peripheral lipolysis were associated with subsequent PE in T1DM women. Background maternal lipoprotein characteristics, perhaps masked by effects of late pregnancy, may influence PE risk.
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Affiliation(s)
- Arpita Basu
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma 74078, USA
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Abstract
During pregnancy, complex changes occur in lipid profiles. From the 12th week of gestation, phospholipids, cholesterol (total, LDL, HDL), and triglycerides (TG) increase in response to estrogen stimulation and insulin resistance. Transition to a catabolic state favors maternal tissue lipid use as energy sources, thus sparing glucose and amino acids for the fetus. In addition, maternal lipids, that is, cholesterol, are available for fetal use in building cell membranes and as precursor of bile acids and steroid hormones. It is also required for cell proliferation and development of the growing body. Free-fatty acids (FFA), oxidized in the maternal liver as ketone-bodies, represent an alternative fuel for the fetus. Maternal hypertriglyceridemia (vs. other lipids) has many positive effects such as contributing to fetal growth and development and serving as an energy depot for maternal dietary fatty acids. However, increased TG during pregnancy appears to increase risk of preeclampsia and preterm birth. Some have suggested that maternal hypertriglyceridemia has a role in increasing cardiovascular risk later in life. This chapter reviews lipid metabolism during pregnancy to elucidate its effect on fetal growth and its potential role in pregnancy-associated complications and future cardiovascular risk.
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Affiliation(s)
- Alessandra Ghio
- Department of Endocrinology and Metabolism, Section of Metabolic Diseases and Diabetes, AOUP, University of Pisa, Pisa, Italy.
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Abstract
OBJECTIVE To assess a cluster of risk factors, including parameters of the metabolic syndrome, in women with gestational diabetes mellitus (GDM) early after delivery, that features the best prediction for developing diabetes. METHODS Women with GDM 3-6 months after delivery received a complete metabolic characterization at baseline as well as annually for up to 10 years of follow-up (N=110). We used parameters characterizing the metabolic syndrome as well as demographic variables at baseline to predict diabetes manifestation. RESULTS Metabolic disturbances and insulin treatment during pregnancy were significantly associated with overt diabetes. Waist circumference of 80 cm or higher failed to show a significant effect on later development of the disease; however, it was significant when 88 cm or more was used as a cutoff value. We identified impaired glucose tolerance (13 [56.5%]; hazard ratio 6.77, confidence interval [CI] 2.96-15.45, P<.001) as well as high-density lipoprotein (HDL) cholesterol less than 50 mg/dL (14 [60.9%]; hazard ratio 2.88, CI 1.24-6.67, P=.010) and age older than 35 years (12 [52.2%]; hazard ratio 3.06, CI 1.32-7.12, P=.006) as the best predictors with additive effects. Women with at least two risk factors had a higher risk to develop the disease as compared with those women who showed only one risk factor (hazard ratio 3.2, CI 1.4-7.7, P=.008). CONCLUSION Impaired glucose tolerance, HDL cholesterol less than 50 mg/dL, and age older than 35 years were identified as the best predictors of developing diabetes after GDM.
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Abel T, Blázovics A, Kemény M, Lengyel G. [Hyperlipoproteinemia in pregnancy]. Orv Hetil 2011; 152:753-7. [PMID: 21498165 DOI: 10.1556/oh.2011.29108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Physiological changes in lipoprotein levels occur in normal pregnancy. Women with hyperlipoproteinemia are advised to discontinue statins, fibrates already when they consider pregnancy up to and including breast-feeding the newborn, because of the fear for teratogenic effects. Hypertriglyceridemia in pregnancy can rarely lead to acute pancreatitis. Management of acute pancreatitis in pregnant women is similar to that used in non-pregnant patients. Further large cohort studies are needed to estimate the consequence of supraphysiologic hyperlipoproteinemia or extreme hyperlipoproteinemia in pregnancy on the risk for cardiovascular disease later in life.
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Affiliation(s)
- Tatjána Abel
- Állami Egészségügyi Központ Szakrendelő Intézet Budapest Róbert Károly krt. 44. 1134.
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