The prevalence of elevated high-sensitivity C-reactive protein in normal pregnancy and gestational diabetes mellitus

Maternal inflammatory, lipid and metabolic markers and associations with birth and breastfeeding outcomes

Background

Conditions in utero influence intrauterine and postnatal infant growth and a few studies indicate that maternal inflammation and insulin resistance might affect birth and breastfeeding outcomes. Furthermore, hormones in human milk (HM) may influence infant appetite-regulation and thereby milk intake, but the associations are less understood.

Objective

(1) To investigate associations between maternal inflammatory, lipid and metabolic markers and birth and breastfeeding outcomes, and (2) to assess predictors of maternal inflammatory, lipid and metabolic markers in pregnancy.

Methods

Seventy-one mother-infant dyads participating in the Mothers, Infants and Lactation Quality (MILQ) study were included in the present study. Fasting blood samples were collected around 28th gestational week, and HM samples at three time points from 1.0 to 8.5 months, where milk intake was assessed using 24-h test weighing. Maternal plasma inflammatory, lipid and metabolic markers included high-sensitive C-reactive protein (hs-CRP), tumor-necrosis factor-α (TNFα), interferon-γ (IFNγ), Interleukin (IL)-6, IL-8, high-, low-, and very-low-density lipoprotein (HDL, LDL, VLDL), total-cholesterol, triglycerides, leptin, adiponectin, insulin, C-peptide, the homeostasis model assessment of insulin resistance (HOMA-IR) and glucose concentration at t = 120 min following an oral glucose tolerance test. Of these, TNFα, IFNγ, IL-6, IL-8, leptin, adiponectin and insulin were also measured in HM samples.

Results

HDL in pregnancy was inversely associated with gestational age (GA) at birth and GA-adjusted birthweight z-score, whereas triglycerides and glucose (t = 120) were positively associated with GA-adjusted birthweight z-score. Higher hs-CRP, VLDL and triglycerides were associated with a higher placental weight. Furthermore, higher HDL, insulin, leptin and HOMA-IR were associated with longer duration of exclusive breastfeeding (EBF). Higher pre-pregnancy BMI was the main predictor of higher levels of hs-CRP, log-TNFα, leptin, insulin, C-peptide, and HOMA-IR.

Conclusion

Maternal lipid and metabolic markers influenced birthweight z-score and placental weight as well as duration of EBF. Furthermore, pre-pregnancy BMI and maternal age predicted levels of several inflammatory and metabolic markers during pregnancy. Our findings indicate that maternal lipid and metabolic profiles in pregnancy may influence fetal growth and breastfeeding, possibly explained by overweight and/or higher placental weight.

Clinical trial registration

https://clinicaltrials.gov/, identifier NCT03254329.

Glycemic control in gestational diabetes and impact on biomarkers in women and infants

BACKGROUND

Gestational diabetes mellitus (GDM) is linked to the dysregulation of inflammatory markers in women with GDM compared to women without. It is unclear whether the intensity of glycemic control influences these biomarkers. We aimed to assess whether different glycemic targets for women with GDM and compliance influence maternal and infant biomarkers.

METHODS

Maternity hospitals caring for women with GDM were randomized in the TARGET Trial to tight or less tight glycemic targets. Maternal blood was collected at study entry, 36 weeks' gestation, and 6 months postpartum, and cord plasma after birth. We assessed compliance to targets and concentrations of maternal serum and infant biomarkers.

RESULTS

Eighty-two women and infants were included in the study. Concentrations of maternal and infant biomarkers did not differ between women assigned to tighter and less tight glycemic targets; however, concentrations were altered in maternal serum leptin and CRP and infant cord C-peptide, leptin, and IGF in women who complied with tighter targets.

CONCLUSIONS

Use of tighter glycemic targets in women with GDM does not change the concentrations of maternal and infant biomarkers compared to less tight targets. However, when compliance is achieved to tighter targets, maternal and infant biomarkers are altered.

IMPACT

The use of tighter glycemic targets in gestational diabetes does not result in changes to maternal or cord plasma biomarkers. However, for women who complied with tighter targets, maternal serum leptin and CRP and infant cord C-peptide, leptin and IGF were altered compared with women who complied with the use of the less tight targets. This article adds to the current evidence base regarding the impact of gestational diabetes on maternal and infant biomarkers. This article highlights the need for further research to assess enablers to meet the tighter target recommendations and to assess the impact on relevant biomarkers.

Role of C-reactive Protein(CRP) or high-sensitivity CRP in predicting gestational diabetes Mellitus:Systematic review

BACKGROUND AND AIMS

Gestational Diabetes Mellitus (GDM) is the most common disorder during pregnancy in 8-18% of pregnancies. Due to maternal and neonatal morbidity and mortality, early diagnosis and appropriate treatment have always been of interest to researchers. One of the recent cases for early diagnosis of GDM is the size of the C-reactive protein (CRP). The purpose of this review study was to investigate the role of CRP or its high sensitivity type in predicting GDM.

METHODS

Systematic searching of MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, and ProQuest databases between 2009 and 2019 using keywords 'Gestational Diabetes Mellitus','Screening', 'C-reactive protein',' High sensitivity CRP'was performed. The quality of articles was also assessed using the STROBE checklist.

RESULTS

After a thorough search of the mentioned databases, 31 articles with the desired quality were finally selected. Most of studies showed significant relationship between CRP or high-sensitivity CRP(hs-CRP) level with GDMbutthe relationship was not significant in fewstudies.

CONCLUSIONS

Blood levels of CRP or hs-CRP could be used as a potential indicator for GDM, but more studies are needed.

Relationship between dietary inflammatory index, hs-CRP level in the second trimester and neonatal birth weight: a cohort study

The aim of this study was to investigate whether diet plays a role in the effect of inflammation on birth weight. The normal pre-pregnancy body mass index and healthy single pregnant women without classical inflammatory were recruited at 16-20 weeks of pregnancy and provided blood sample to measure plasma high sensitive C-reactive protein (hs-CRP) level. The Dietary Inflammatory Index (DII) score was calculated by a three-day 24 h recall method, and a cohort of 307 eligible pregnant women was established. According to birth weight, the subjects were divided into three groups: normal birth weight (NBW) group, low birth weight (LBW) group, and high birth weight (HBW) group. The hs-CRP level and DII score were significantly different between NBW and LBW groups. The risk of higher hs-CRP in the pro-inflammatory dietary group was 1.89 times than the control group (95% CI: 1.05, 3.42). The risk of LBW with higher hs-CRP was 3.81 times than normal hs-CRP (95% CI: 1.26, 11.56). The risk of LBW in the pro-inflammatory dietary group was 10.44 times than in the anti-inflammatory dietary group (95%CI: 1.29, 84.61). The pro-inflammatory dietary in the second trimester affects the hs-CRP level, showing a positive correlation. And both of two factors increase the risk of LBW.

Assisted conception as a potential prognostic factor predicting insulin therapy in pregnancies complicated by gestational diabetes mellitus

BACKGROUND

Advanced maternal age, family history of diabetes, pre-gestational obesity, increased level of HbA1c, history of gestational diabetes mellitus (GDM), and poor pregnancy consequences are considered risk factors for antenatal insulin requirement in women with GDM. However, the role of assisted reproductive technology (ART) in increasing the risk of insulin therapy in pregnancies complicated with GDM remained elusive. The current study aimed to determine the role of ART in predicting insulin therapy in GDM women and investigate the clinical and biochemical factors predicting the need for insulin therapy in pregnancies complicated with GDM.

METHODS

In this prospective cohort study, 236 Iranian women with GDM were diagnosed by one-step oral glucose tolerance test (OGTT) between October 2014 and June 2017. They were mainly assigned to two groups; the first group (n = 100) was designated as ART which was further subdivided into two subgroups as follows: 60 participants who received medical nutrition therapy (MNT) and 40 participants who received MNT plus insulin therapy (MNT-IT). The second group (n = 136) was labeled as the spontaneous conception (SC), consisting of 102 participants receiving MNT and 34 participants receiving MNT in combination with IT (MNT-IT). The demographic, clinical, and biochemical data were compared between groups. Multivariate logistic regression was performed to estimate prognostic factors for insulin therapy.

RESULTS

A higher rate of insulin therapy was observed in the ART group as compared with the SC group (40% vs. 25%; P < 0.001). Multivariate logistic regression demonstrated that maternal age ≥ 35 years [OR: 2.91, 95% CI: (1.28-6.62)], high serum FBS [1.10: (1.04-1.16)], HbA1c [1.91 (1.09-3.34)], and ART treatment [2.94: (1.24-6.96)] were independent risk factors for insulin therapy in GDM women.

CONCLUSIONS

Apart from risk factors mentioned earlier, ART may be a possible prognostic factor for insulin therapy in pregnancies complicated with GDM.

Early pregnancy biochemical markers of placentation for screening of gestational diabetes mellitus (GDM)

For the effective management and screening of patients with diabetes, lipid profile has been a useful mean. Here, we hypothesized that biochemical analyses of blood serum in pregnant women with GDM will develop an insight on the pathogenesis of the disease and possibly uncover new biomarkers. In order to test our hypothesis, antenatal pregnant women (n = 300) were selected for blood samples including 176 with positive clinical/family history and 124 with negative clinical/family history of GDM during the early second trimester (14-18 weeks of gestation). All the subjects were followed up to the early third trimester (24-28 weeks of gestation) for second sampling until the onset of GDM. Lipid profile data shows that mean values of triglycerides, total cholesterol, low density lipids and very low density lipids were significantly higher (p < 0.05) and mean HDL was significantly lower in early second trimester in those patients who subsequently developed GDM during late third trimester when compared with those who didn't develop GDM. Inflammatory biomarker such as High-sensitivity C-reactive protein (hs-CRP) levels were also found to be significantly higher by 69% increase in patients who developed GDM later in third trimester in comparison with those who didn't develop. About 32% patients who finally developed GDM belonged to positive clinical/family history group. The results of our study indicate that abnormal serum cholesterol; triglycerides, HDL, LDL, VLDL and hs-CRP play a vital in pathophysiology of gestational diabetes. Early diagnosis of GDM based on these biochemical markers will help decrease adverse neonatal and maternal outcomes.

The effects of magnesium-zinc-calcium-vitamin D co-supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes

BACKGROUND

Diabetes is the most common medical condition in pregnant women and its complications affect both mother and fetus. The beneficial effects of vitamin D on gestational diabetes have been shown, though data on the effects of co-administration of vitamin D with other nutrients on pregnancy outcomes in gestational diabetes (GDM) are scarce. This study was aimed to determine the effects of magnesium-zinc-calcium-vitamin D co-supplementation on parameters of inflammation and oxidative stress, and pregnancy outcomes among women with GDM.

METHODS

This randomized, double-blinded, placebo-controlled trial was conducted on 60 women with GDM not taking oral hypoglycemic agents. Patients were randomly assigned to take magnesium-zinc-calcium-vitamin D supplements (n = 30) or placebo (n = 30) for 6 weeks. Fasting blood samples were collected from participants at baseline and after the 6-week intervention to measure related biomarkers.

RESULTS

Magnesium-zinc-calcium-vitamin D co-supplementation resulted in a significant reduction in serum high-sensitivity C-reactive protein (- 1.2 ± 3.5 vs. + 0.8 ± 2.0 mg/L, P = 0.01) and plasma malondialdehyde concentrations (- 0.3 ± 0.3 vs. + 0.3 ± 1.1 μmol/L, P = 0.003), as well as a significant increase in total antioxidant capacity levels (+ 38.2 ± 76.5 vs. -16.3 ± 93.5 mmol/L, P = 0.01), compared to placebo. We found a decreasing trend in newborns' weight (3089.8 ± 519.9 vs. 3346.3 ± 411.1 g, P = 0.05) and the rate of macrosomia (3.3% vs. 16.7%, P = 0.08) in the magnesium-zinc-calcium-vitamin D supplemented women.

CONCLUSIONS

Overall, the findings of this study have demonstrated that magnesium-zinc-calcium-vitamin D co-supplementation for 6 weeks to women with GDM may reduce biomarkers of inflammation and oxidative stress. This study was retrospectively registered on 25 April 2017 in the Iranian website ( www.irct.ir ) for clinical trials registration ( http://www.irct.ir : IRCT201704225623N109).