Antidiabetic Therapy during Pregnancy: The Prescription Pattern in Italy

Pregestational and gestational diabetes mellitus are relevant complications of pregnancy, and antidiabetic drugs are prescribed to obtain glycemic control and improve perinatal outcomes. The objective of this study was to describe the prescription pattern of antidiabetics before, during and after pregnancy in Italy and to evaluate its concordance with the Italian guideline on treatment of diabetes mellitus. A multi-database cross-sectional population study using a Common Data Model was performed. In a cohort of about 450,000 women, the prescribing profile of antidiabetics seemed to be in line with the Italian guideline, which currently does not recommend the use of oral antidiabetics and non-insulin injection, even if practice is still heterogeneous (up to 3.8% in the third trimester used oral antidiabetics). A substantial variability in the prescription pattern was observed among the Italian regions considered: the highest increase was registered in Tuscany (4.2%) while the lowest was in Lombardy (1.5%). Women with multiple births had a higher proportion of antidiabetic prescriptions than women with singleton births both in the preconception period and during pregnancy (1.3% vs. 0.7%; 3.4% vs. 2.6%) and used metformin more frequently. The consumption of antidiabetics in foreign women was higher than Italians (second trimester: 1.8% vs. 0.9%, third trimester: 3.6% vs. 1.8%).

sFlt-1 Levels as a Predicting Tool in Placental Dysfunction Complications in Multiple Pregnancies

BACKGROUND

several studies have demonstrated that angiogenic markers can improve the clinical management of hypertensive disorders (HDs) and fetal growth restriction (FGR) in singleton pregnancies, but few studies have evaluated the performance of these tests in multiple pregnancies. Our aim was to investigate the role of soluble fms-like tyrosine kinase 1 (sFlt-1) in predicting adverse obstetric outcomes in hospitalized multiple pregnancies with HD (preeclampsia/gestational hypertension/uncontrolled chronic hypertension) and/or FGR in one or more fetuses.

METHODS

A retrospective analysis of multiple pregnancies with HD/FGR occurring after the 20th gestational week. Pregnant women were divided into two groups: women with high levels of sFlt-1 and those with low levels of sFlt-1. A value of sFlt-1 greater than or equal to 15,802 pg/mL was considered arbitrarily high, as it is equivalent to two times the 90th percentile expected in an uncomplicated full-term singleton pregnancy based on data from a prospective multicenter study (7901 pg/mL).

RESULTS

The cohort included 39 multiple pregnancies. There were no cases of birth <34 weeks, HELLP syndrome, ICU admission, and urgent cesarean sections for HD/FGR complications reported among women with low levels of sFlt-1.

CONCLUSIONS

A cut-off value of sFlt-1 ≥ 15,802 pg/mL could represent a valuable tool for predicting adverse obstetric outcomes in multiple pregnancies hospitalized for HD/FGR disorders, regardless of gestational age and chorionicity.

Fluorescence excimer formation imaging: a new technique to investigate association to cells and membrane behavior of glycolipids

A new fluorescence ratio imaging technique aiming to monitor the lateral distribution of pyrene-labeled lipids in the membranes through visualization of the excimer/monomer (E/M) intensity ratio, has been set up, studying the association of a fluorescent derivative of GM1 ganglioside (pyreneGM1) to rat cerebellar granule cells in culture. The imaging results show that the mean E/M ratio value, under experimental conditions leading to the association of pyreneGM1 with the plasma membrane, is significantly higher in neuritic processes than in cell bodies and, moreover, locally distributed in patches. Fluorescence antisotropy imaging of the fluorescent probe TMA-DPH (trimethylaminodiphenylhexatriene) shows the presence of domains having different fluidity and that the average fluidity is higher in cell bodies than in neuritic processes. Additional experiments using TMA-DPH as a marker of fluid-phase pinocytosis, suggest that the rate of endocytosis is comparable in the two regions of the cell. Taken together, on the one hand these data indicate that the fluorescent ganglioside is present in a more clustered state at the level of neuritic processes than in cell bodies and locally distributed in patches of different size and enrichment. On the other hand, they point out the potentiality of the excimer formation imaging technique to study membrane behavior and dynamics of pyrene-labeled lipids, with a particular insight into their aggregative properties.

Protective effect of some exogenous glycolipids on human cultured keratinocytes against lipid peroxidation

Cultured human keratinocytes were incubated in the presence of glycolipids (GM1, asialoGM1, glucosylceramide and galactosylceramide) added to the medium at a concentration of 10(-5) M. All of them became associated with the cells, but in different amounts depending on the type of glycolipid and on the time in culture. GM1- and asialoGM1-treated keratinocytes developed a resistance to peroxidative stress induced by FeSO4/H2O2 treatment. These results suggest that these exogenously added glycolipids could play a role as eutrophic, repairing and protective agents for the epidermis.

Interaction of glycosphingolipids and glycoproteins: thermotropic properties of model membranes containing GM1 ganglioside and glycophorin

High-sensitivity differential scanning calorimetry (DSC) was used to study the mutual interactions between a glycoprotein (human glycophorin, GPA) and a glycosphingolipid (GM1 ganglioside) embedded in large unilamellar vesicles composed of dimyristoylphosphatidylcholine (DMPC). The DSC thermograms exhibited by DMPC/GM1 vesicles, either in the presence or in the absence of GPA, are resolvable into two components. The relative contribution of the minor component, centered at higher temperature, to the total enthalpy and its transition temperature increase with the concentration of the glycolipid embedded in the vesicles. This minor peak, undetectable in the absence of ganglioside, is indicative of the occurrence of lateral phase separation and suggests that GM1 ganglioside-enriched domains are present within the bilayer. At a given concentration of GM1 embedded in the vesicles, the proportion of the phase-separated peak is higher in the presence of GPA, suggesting that the glycoprotein enhances the tendency of GM1 to segregate. Experiments investigating the thermotropic behavior of GPA show that the temperature of irreversible thermal unfolding of the glycoprotein inserted in DMPC vesicles, centered at 65.9 degrees C in the absence of GM1, is shifted to 57.6 degrees C when GM1 is present in the bilayer. These results indicate that, at least in this experimental system, on the one hand, GPA enhances the tendency of the glycolipid to segregate within the membrane, and on the other hand, the glycolipid clusters affect the protein conformation and oligomerization in the membrane.