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Chatzakis C, Eleftheriades M, Demertzidou E, Eleftheriades A, Koletsos N, Lavasidis L, Zikopoulos A, Dinas K, Sotiriadis A. Uterine Arteries Resistance in Pregnant Women with Gestational Diabetes Mellitus, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, and Uncomplicated Pregnancies. Biomedicines 2023; 11:3106. [PMID: 38137327 PMCID: PMC10741004 DOI: 10.3390/biomedicines11123106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The examination of the uterine arteries using Doppler in the first trimester of pregnancy serves as a valuable tool for evaluating the uteroplacental circulation. Diabetes mellitus is associated with altered placental implantation and pregnancy-related pathologies, such as preeclampsia. The aim of this study was to compare the uterine arteries' pulsatility indices (UtA PI) in women with diabetes mellitus type 1 (DM1), diabetes mellitus type 2 (DM2), gestational diabetes mellitus (GDM), and uncomplicated pregnancies. METHODS This was a retrospective case-control trial including pregnant women with DM1, DM2, GDM, and uncomplicated pregnancies, presenting for first-trimester ultrasound screening in two tertiary university hospitals between 2013 and 2023. The first-trimester UtA pulsatility index (PI), expressed in multiples of medians (MoMs), was compared between the four groups. RESULTS Out of 15,638 pregnant women, 58 women with DM1, 67 women with DM2, 65 women with GDM, and 65 women with uncomplicated pregnancies were included. The mean UtA PI were 1.00 ± 0.26 MoMs, 1.04 ± 0.32 MoMs, 1.02 ± 0.31 MoMs, and 1.08 ± 0.33 MoMs in pregnant women with DM1, DM2, GDM, and uncomplicated pregnancies, respectively (p > 0.05). CONCLUSIONS Potential alterations in the implantation of the placenta in pregnant women with diabetes were not displayed in the first-trimester pulsatility indices of the uterine arteries, as there were no changes between the groups.
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Affiliation(s)
- Christos Chatzakis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
| | - Makarios Eleftheriades
- Second Department of Obstetrics and Gynecology, Medical School, National and Capodistrian University of Athens, 115 28 Athens, Greece; (M.E.); (A.E.)
| | - Eleftheria Demertzidou
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
| | - Anna Eleftheriades
- Second Department of Obstetrics and Gynecology, Medical School, National and Capodistrian University of Athens, 115 28 Athens, Greece; (M.E.); (A.E.)
| | - Nikolaos Koletsos
- Department of Rheumatology, University of Ioannina, 451 10 Ioannina, Greece;
| | - Lazaros Lavasidis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
| | | | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
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Pahlavani HA, Laher I, Weiss K, Knechtle B, Zouhal H. Physical exercise for a healthy pregnancy: the role of placentokines and exerkines. J Physiol Sci 2023; 73:30. [PMID: 37964253 PMCID: PMC10718036 DOI: 10.1186/s12576-023-00885-1] [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: 08/14/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023]
Abstract
Complications such as diabetes and preeclampsia can occur during pregnancy. Moderate-intensity exercise can prevent such complications by releasing placentokines and exerkines, such as apelin, adiponectin, leptin, irisin, and chemerin. Exercise and apelin increase thermogenesis and glucose uptake in pregnancy by activating AMPK, PI3K, PGC-1α, AKT1, UCP3, and sarcolipin. Exercise increases apelin levels to reduce preeclampsia symptoms by increasing eNOS, NO, placental growth factor (PlGF), and VEGF and decreasing levels of fms-like tyrosine kinase 1 (sFlt-1), soluble endoglin (sEng), and oxidative stress. A negative relationship has been reported between plasma leptin and VO2peak/kg and VO2peak in women with gestational diabetes. In active women, decreases in leptin levels reduce the risk of preeclampsia by ~ 40%. Higher adiponectin levels are associated with greater physical activity and lead to increased insulin sensitivity. Increased adiponectin levels in preeclampsia and exercise counteract inflammatory and atherogenic activities while also having vascular protective effects. Exercise increases irisin levels that correlate negatively with fasting glucose, insulin concentration, and glycosylated hemoglobin levels. Irisin augments mRNA expression levels of UCP1 and cell death-inducing DNA fragmentation factor-like effector A (cidea) to cause browning of adipose tissue, increased thermogenesis, and increased energy consumption. Irisin concentrations in mothers with preeclampsia in the third trimester negatively correlate with systolic and diastolic blood pressure. Expression levels of chemerin, IL-6, and TNF-α are increased in gestational diabetes, and the increases in chemerin in late pregnancy positively correlate with the ratio of sFlt-1 to PlGF as a marker of preeclampsia. The effects of physical exercise on placentokines and exerkines in women at various stages of pregnancy remain poorly understood.
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Affiliation(s)
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
- Medbase St Gallen Am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland.
| | - Hassane Zouhal
- Movement Sport, Health and Sciences Laboratory (M2S) UFR-STAPS, University of Rennes 2-ENS Cachan, Charles Tillon, France.
- Institut International Des Sciences Du Sport (2IS), Irodouer, France.
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Chatzakis C, Mastorakos G, Demertzidou E, Theodoridou A, Dinas K, Sotiriadis A. The Impact of a Single Supervised Exercise Session in the Third Trimester of Pregnancy on the Physical Activity Levels of Pregnant Women-A Pilot Study. Clin Pract 2023; 13:1227-1235. [PMID: 37887086 PMCID: PMC10605668 DOI: 10.3390/clinpract13050110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/16/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Despite the numerous beneficial effects of physical exercise during pregnancy, the levels of physical activity remain low. The aim of the study is to investigate the impact of a single supervised physical exercise session on the overall physical activity levels of pregnant women. METHODS During the third trimester, pregnant women attending our outpatient clinic were requested to assess their physical activity levels using the International Physical Activity Questionnaire (IPAQ). Additionally, they were invited to participate in a supervised 30 min mild-moderate-intensity aerobic exercise session (stationary bike ergometer) under the guidance of medical personnel. Subsequently, physical activity levels were reevaluated at the time of delivery. RESULTS Prior to the intervention, 3 out of 50 (6%) women engaged in mild-moderate physical activity for 150 min per week, while 20 out of 50 (40%) women participated in mild-moderate activity for 15-30 min, twice a week. Following the intervention, these percentages increased to 10 out of 50 (20%) and 31 out of 50 (62%), respectively (p < 0.05). CONCLUSIONS This pilot study suggests that a single exercise session supervised by medical personnel may significantly improve the low physical activity levels observed in pregnant women.
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Affiliation(s)
- Christos Chatzakis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (C.C.)
| | - George Mastorakos
- Endocrine Unit of Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Eleftheria Demertzidou
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (C.C.)
| | - Anatoli Theodoridou
- Midwifery Department, School of Health Sciences, International Hellenic University, 65404 Thessaloniki, Greece
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (C.C.)
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (C.C.)
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Chatzakis C, Eleftheriades A, Demertzidou E, Dinas K, Vlahos N, Sotiriadis A, Eleftheriades M. Pregnancy outcomes in the different phenotypes of gestational diabetes mellitus based on the oral glucose tolerance test. A systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 204:110913. [PMID: 37742806 DOI: 10.1016/j.diabres.2023.110913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
AIMS To assess the prevalence variation in pregnancy outcomes of the different phenotypes of gestational diabetes mellitus (GDM). MATERIALS Cohort, cross sectional and case control studies grouping together pregnant women with GDM, based on the results of oral glucose tolerance test(OGTT) and reporting pregnancy outcomes in each group, were included. The primary outcomes were (i)large for gestational age and ii)hypertensive disorders of pregnancy (HDP). The secondary outcomes included (i)insulin treatment, ii)admission to neonatal intensive care unit, iii)preterm birth, iv)small for gestational age and v)caesarean section. The pooled proportions of the outcomes of interest were calculated for each phenotype. RESULTS 8 studies (n = 20.928 women with GDM) were included. The pooled prevalence of LGA, HDP and insulin treatment were 20 %, 8 % and 24 % respectively in women with abnormal fasting plasma glucose,10 %, 6 % and 9 % respectively in women with abnormal post-load plasma glucose and 14 %,14 % and 30 % in women with abnormal combined plasma glucose. CONCLUSIONS Pregnant women with abnormal fasting plasma glucose, present with the highest prevalence of LGA, while those with abnormal combined plasma glucose, present with the highest prevalence of HDP. Pregnant women with abnormal post-load plasma glucose present with the lowest need for insulin treatment.
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Affiliation(s)
- Christos Chatzakis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Anna Eleftheriades
- Postgraduate Program "Fetal Maternal Medicine", National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Eleftheria Demertzidou
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Makarios Eleftheriades
- Postgraduate Program "Fetal Maternal Medicine", National and Kapodistrian University of Athens, School of Medicine, Greece; Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece.
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Perkovic-Kepeci S, Cirkovic A, Milic N, Dugalic S, Stanisavljevic D, Milincic M, Kostic K, Milic N, Todorovic J, Markovic K, Aleksic Grozdic N, Gojnic Dugalic M. Doppler Indices of the Uterine, Umbilical and Fetal Middle Cerebral Artery in Diabetic versus Non-Diabetic Pregnancy: Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1502. [PMID: 37629792 PMCID: PMC10456372 DOI: 10.3390/medicina59081502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/20/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The aim of this study was to assess the differences in Doppler indices of the uterine (Ut), umbilical (UA), and middle cerebral artery (MCA) in diabetic versus non-diabetic pregnancies by conducting a comprehensive systematic review of the literature with a meta-analysis. Materials and Methods: PubMed, Web of Science, and SCOPUS were searched for studies that measured the pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio index (S/D ratio) of the umbilical artery, middle cerebral artery, and uterine artery in diabetic versus non-diabetic pregnancies. Two reviewers independently evaluated the eligibility of studies, abstracted data, and performed quality assessments according to standardized protocols. The standardized mean difference (SMD) was used as a measure of effect size. Heterogeneity was assessed using the I2 statistic. Publication bias was evaluated by means of funnel plots. Results: A total of 62 publications were included in the qualitative and 43 in quantitative analysis. The UA-RI, UtA-PI, and UtA-S/D ratios were increased in diabetic compared with non-diabetic pregnancies. Subgroup analysis showed that levels of UtA-PI were significantly higher during the third, but not during the first trimester of pregnancy in diabetic versus non-diabetic pregnancies. No differences were found for the UA-PI, UA-S/D ratio, MCA-PI, MCA-RI, MCA-S/D ratio, or UtA-RI between diabetic and non-diabetic pregnancies. Conclusions: This meta-analysis revealed the presence of hemodynamic changes in uterine and umbilical arteries, but not in the middle cerebral artery in pregnancies complicated by diabetes.
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Affiliation(s)
- Sonja Perkovic-Kepeci
- General Hospital Pancevo, 26000 Pancevo, Serbia;
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Andja Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Stefan Dugalic
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
| | - Milos Milincic
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
| | - Konstantin Kostic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Nikola Milic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Jovana Todorovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Ksenija Markovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Natasa Aleksic Grozdic
- Institute for Process Engineering Environmental Engineering and Technical Life Sciences, Technical University of Vienna, 1180 Vienna, Austria;
| | - Miroslava Gojnic Dugalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
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