Low placental angiotensin-converting enzyme expression is related to fetal small for gestational age but not to metabolic control in type 1 diabetic pregnancies

The maternal renin-angiotensin system is involved in blood pressure control and plays a crucial role in fetoplacental nutrition. Pre-gestational type 1 diabetes (PGDM) leads to serious pregnancy complications. We thus performed a longitudinal study to analyse the association of maternal angiotensin-converting enzyme (ACE) serum levels and placental mRNA expression with fetal newborns gestational weight in type 1 diabetes mellitus (T1DM) women. We recruited 65 singleton pregnant women with T1DM. Placental mRNA ACE gene expression was examined using quantitative real-time PCR. Serum ACE levels were measured in the first, second and third trimesters of pregnancy by ELISA commercial kits. Placental expression of ACE mRNA was significantly lower in small for gestational age (SGA) than appropriate for gestational age (AGA) and large for gestational age (LGA) mothers (0.55±0.06 vs 0.78±0.06 and 0.85±0.07 respectively, p=0.003). In the SGA group, the mRNA expression of ACE positively correlated with maternal body mass index (BMI) in the third trimester (r=0.49; p=0.04). In all study groups maternal ACE level was significantly higher in the third trimester (mean 139.91±SD 69.64) compared to the first and second trimesters of pregnancy (13.57±4.32 and 15.69±15.92 respectively). Our data suggest that lower placental ACE gene mRNA expression may have a vital role in the etiology of SGA babies.

Low placental visfatin expression is related to impaired glycaemic control and fetal macrosmia in pregnancies complicated by type 1 diabetes

Type 1 diabetes mellitus (T1DM) is still related to altered fetal growth and severe maternal complications. We studied the possible role of placental visfatin/nicotinamide phosphoribosyltransferase (NAMPT) in fetal development in T1DM pregnancies, the possible role of placental visfatin in fetal macrosomia. Sixty five pregnant women with T1DM and singleton pregnancy were qualified into the study. Placental visfatin expression was by analysed by RT-PCR. We demonstrated the lowest expression of placental visfatin in women who delivered neonates with birth weight NBW > 4000 g (0.76 ± 0.05, P < 0.055). The highest placental visfatin/nicotinamide phosphoribosyltransferase (NAMPT) expression was found in the women who delivered small for gestational age (SGA) and large for gestational age (LGA) newborns (1.09 ± 0.95 vs. 0.87 ± 0.67, P < 0.05, respectively). There was also significant negative correlation between placental visfatin (NAMPT) expression and metabolic status in the 3^rd trimester of pregnancy in T1DM LGA group, defined as long-term glycaemic control (3^rd trimester HbA1C) - Pearson rank R - 08667654, P < 0.034. We conclude that the low placental visfatin (NAMPT) expression and poor metabolic control in the 3^rd trimester of pregnancy may have a role in stimulating fetal overgrowth in T1DM pregnancy.

Short-term antidiabetic treatment with insulin or metformin has a similar impact on the components of metabolic syndrome in women with gestational diabetes mellitus requiring antidiabetic agents: results of a prospective, randomised study

Gestational diabetes mellitus (GDM) is associated with an increased prevalence of fetal and maternal complications primarily caused by maternal hyperglycemia, which results in abnormal fetal growth. Diet modification is a common first step in the treatment of GDM, followed by antidiabetic pharmacotherapy if this approach fails. Insulin therapy is generally accepted; however, oral hypoglycemic agents have been used in this population. In this prospective, randomised study, we compared maternal metabolic status after treatment with insulin or metformin. Pregnant women (gestational age: ≥ 20 weeks) with GDM requiring medical hypoglycemic treatment were randomly allocated to the Metformin (n = 35) or Insulin (n = 43) Groups. Maternal metabolic status - assessed by glycated hemoglobin (HBA1c) level, glycemic profile, insulin concentration, Homeostatic Model Assessment - Insulin Resistance index, and lipids - was recorded at booking and throughout pregnancy. The characteristics of the study group were: maternal age 33.5 ± 5.9 years, gestational age at baseline 28.5 ± 3.5 weeks, prepregnancy body mass index (BMI) 32.2 ± 3.5 kg/m(2), HbA1c at baseline 5.6 ± 0.6%, and average daily glycemia 5.9 ± 0.6 mmol/dl. Fasting glycemia at term was significantly lower in the Insulin Group but there were no significant differences in mean daily glycemia, HbA1c and BMI at term between the groups. Longitudinally, there was a small but significant increase in BMI and a significant increase in high-density lipoprotein-cholesterol in the Insulin Group and a significant increase in the atherogenic index of plasma (AIP) and a trend towards higher triglycerides in the Metformin Group. Both fasting and average daily glycemia were significantly reduced following treatment in both groups. No such change was evident for HbA1c. In a relative risk analysis, metformin treatment was associated with an insignificant elevated risk of HbA1c, triglycerides and lipid indices falling within the highest quartile at term. The risk of gestational weight gain and total cholesterol falling within the highest quartile at term was insignificantly reduced in the Metformin Group. In conclusion, short-term antidiabetic treatment with insulin or metformin has a similar impact on markers of metabolic syndrome in women with GDM requiring antidiabetic treatment. Secondly, treatment with metformin is associated with increased triglyceride levels and higher AIP in the third trimester in pregnant women with GDM.

Concentrations of endothelial nitric oxide synthase, angiotensin-converting enzyme, vascular endothelial growth factor and placental growth factor in maternal blood and maternal metabolic status in pregnancy complicated by hypertensive disorders

Hypertensive disorders of pregnancy (HDPs) are associated with altered maternal metabolism, impaired perinatal outcome and increased risk for remote maternal complications. The aim of our study was to analyse associations between circulating levels of angiogenic factors and markers of oxidative stress and metabolic status in women with HDP. Forty-six women in singleton pregnancies complicated by HDP and 30 healthy controls were enrolled in a prospective observational study. Serum concentrations of endothelial nitric oxide synthase (eNOS), angiotensin-converting enzyme, vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) were measured in the third trimester and correlated with maternal anthropometrics and metabolic status. We found significantly lower eNOS levels in patients with severe hypertension vs controls, a strong association between eNOS and PlGF in the study group, a significant association between maternal prepregnancy body mass index (BMI) and VEGF levels and an inverse correlation between VEGF and PlGF. Maternal prepregnancy BMI was the only independent predictor for VEGF concentrations. We noted reduced levels of PlGF and eNOS and increased VEGF levels in women with severe hypertension/preeclampsia. First, different forms of HDP are associated with different alteration patterns in concentrations of angiogenic factors and markers of oxidative stress. Second, maternal prepregnancy BMI, but not body weight, is a significant predictor for VEGF levels in late pregnancy.

Placental vascular endothelial growth factor expression in pregnancies complicated by type 1 diabetes

Type 1 diabetes mellitus (T1DM) is still associated with increased risk of severe maternal and foetal complications but their pathomechanism remains unclear.

OBJECTIVES

we investigated the possible role of placental vascular endothelial growth factor (VEGF) and VEGF single nucleotide polymorphisms (SNP) in foetal development in T1DM pregnancies. Sixty seven pregnant women with T1DM and singleton pregnancy were enrolled into the study. Results demonstrated higher expression of placental VEGF in women who delivered neonates with birth weight (NBW)>4000g. No such correlation was found in the overall T1DM group and in women who delivered appropriate for gestational age (AGA) and small for gestational age (SGA) newborns. We also demonstrated a significant correlation between 3(rd) trimester mean blood glucose, HbA1C and placental VEGF. No such correlation was found for the 1(st) and 2(nd) trimesters. Top placental VEGF expression and placental mass were found in women who delivered large for gestational age (LGA) newborns. We also found a statistically significant difference in homozygous and heterozygous frequency variants of VEGF SNPs in study groups. We conclude that the increased placental VEGF together with impaired metabolic control may have a role in stimulating foetal overgrowth in T1DM pregnancy.

Placental leptin and its receptor genes expression in pregnancies complicated by type 1 diabetes

Type 1 diabetes mellitus (T1DM) is still associated with increased risk for severe maternal and fetal complications but their pathomechanism remains unclear. We investigated into possible role of placental leptin (LEP) and its receptor gene (LEPR) in T1DM pregnancies. Fourty nine pregnant women with T1DM and singleton pregnancy were enrolled into the study. Control group consisted of 15 healthy pregnant women in uncomplicated, singleton gestation. We observed higher expression of LEP and LEPR in T1DM placentas in comparison to healthy subjects. We also noticed greater expression of LEP and LEPR in T1DM pregnancies with large for gestational age (LGA) and appropriate for gestational age (AGA) fetuses in comparison to small for gestational age (SGA) diabetic fetuses and controls. We found a significant positive correlation between placental LEP and LEPR expression and neonatal birthweight in overweight T1DM subjects. No such a correlation was found in T1DM subjects with normal weight and controls. We conclude that increased placental LEP and LEPR expression may have a role in stimulating fetal overgrowth in T1DM pregnancy.

Metabolic syndrome in type 1 diabetes mellitus. Does it have any impact on the course of pregnancy?

To determine whether the symptoms of metabolic syndrome (MS), if accompanied by oxidative stress (OS), in type 1 diabetes mellitus (DM) patients could affect the course of pregnancy and the perinatal outcome. Oxidized low density lipoproteins (ox-LDL) and total lipid peroxides (TLP) were studied in 98 pregnant women with type 1 DM in the I(st) and III(rd) trimesters. 24% of the participants met the criteria of MS. Vascular complications were significantly more frequent in the MS-group (41.9% vs. 17.4% in the non-MS group, p<0.05). No differences in the markers of OS between the MS and the non-MS groups were noted in either the I(st) or the III(rd) trimester. A significant gestational rise in Per-Ox was found in both groups. Chronic hypertension was associated with significant differences in ox-LDL levels in both the I(st) and III(rd) trimester. No differences in perinatal outcome, as measured by abnormal birth weight or poor neonatal status (Apgar score<6, umbilical venous and/or arterial pH<7.20), were found.

CONCLUSIONS

1) MS in type 1 DM is associated with some changes in markers of oxidative stress, but it poses no additional risk to the course of pregnancy and perinatal outcome in properly controlled and treated pregnant women with type 1 DM. 2) Maternal hypertension is the only component of MS in diabetic pregnancy that is associated with significant changes in markers of oxidative stress. 3) MS is significantly more frequent in diabetic pregnant women with co-existing vascular complications and obesity.

Leptin gene, leptin gene polymorphisms and body weight in pregnant women with diabetes mellitus type I

There have been several genetic causes of obesity discussed by past authors, among others leptin, that have provided information regarding signaling pathways in energy expenditure in humans. Genetic variants of the leptin gene and its receptor may influence body weight.

AIM

To investigate the role of the leptin gene's polymorphism promotion region (2548 G/A) and the leptin gene receptor polymorphism (668 A/G) and its associations with body weight in pregnant women with type 1 diabetes (PGDM-1).

METHODS

78 PGDM-1 were qualified to the study group (SG) which was divided into normal and over-weight individuals according to BMI criteria. The control group (CG) consisted of first trimester healthy pregnant women with normal body weight. Genetic variants of the leptin gene and its receptor were analyzed using PCR-RFLP assays. Within the SG, the following metabolic parameters were estimated: MBG, HbA1C, insulin dose, LDL, HDL, T-CHOL, creatinine, creatinine clearance and blood pressure.

RESULTS

There was a trend found among the majority of homozygous A and G variants in LEP -2548 G/A and LEPR 668 A/G in over-weight and obese individuals in comparison to normal-weight subjects (CG). There were no specific differences found in selected first trimester metabolic parameters in relation to patients' genotypes.

Components of metabolic syndrome and their impact on fetal growth in women with gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is associated with increased maternal insulin resistance. Maternal hyperglycemia is a well known risk factor for fetal overgrowth. However, despite improved glycemia control, macrosomia complicates a significant proportion of diabetic pregnancies, resulting in increased perinatal risk. The aim of our retrospective study was to investigate the association between fetal growth and different maternal metabolic characteristics in women with GDM. The study group included 357 women (singleton pregnancy, and GDM diagnosed following WHO criteria). The following parameters were studied: maternal pre-pregnancy BMI, 75 g OGTT results, HbA(1c), triglycerides (TAG), total, HDL- and LDL-cholesterol levels at admission. Neonatal birth weight and the prevalence of being large for gestational age birth weight (LGA) was an end-point. We found a significant association between birth weight and HbA(1c), TAG, fasting OGTT glycemia, BMI and a birth weight of a large child born previously. BMI and birth weight of a large child was the strongest independent predictors for LGA. A significant increase in birth weight and the prevalence of LGA (from 10.5% to 83.3%) was related to a number of altered maternal metabolic features.

CONCLUSIONS

Fetal growth in a diabetic pregnancy is a complex process and maternal metabolic parameters other than glucose levels should be addressed to reduce the risk of macrosomia in these groups of patients.

Plasma anhydro-D-glucitol (1,5-AG) as an indicator of hyperglycaemic excursions in pregnant women with diabetes

AIMS

To evaluate the use of the plasma 1,5-anhydro-d-glucitol (1,5-AG) level as a possible marker for glucose excursions in pregnant women with diabetes.

METHODS

The study group consisted of 55 pregnant women with diabetes (gestational diabetes mellitus-GDM, n = 28 or pre-gestational diabetes mellitus -PGDM, n = 27), without hepatic or renal insufficiency, gestational age range 5-38 weeks. In each patient, 24-h glucose profile, glycated haemoglobin and 1,5-AG plasma levels were measured. Mean blood glucose (MBG) and M-value (by Schlichtkrull) were calculated. MBG, M-value and maximal daily glycaemia (MxG) were used as indexes of daily glycaemic excursions.

RESULTS

A significant correlation was found between the 1,5-AG plasma level and MxG [r = (-0.3)] and between the 1,5-AG level and M-value [r = (-0.36)]. There was no association between the 1,5-AG level and gestational age. Multivariate regression analysis, with 24-h glucose profile, gestational age and MxG as independent variables, showed that MxG was the main parameter determining the 1,5-AG plasma level [beta = (-0.68)]. The M-value, the coefficient of glucose fluctuations, also determined the 1,5-AG level but with lower statistical power [beta = (0.41)]. No statistical differences were found in the group with HbA(1c) < 6% or > 6% for 1,5-AG and M-value, while MBG was higher in poorly controlled patients (HbA(1c) > 6%).

CONCLUSIONS

The plasma 1,5-AG level may be a useful marker of daily glucose excursion in pregnant women with diabetes, as an adjunct to HbA(1c) monitoring.

[Qualitative blood flow parameters in the spiral artery and progesterone concentration in pregnancy complicated by threatened abortion]

OBJECTIVES

The aim of the study was to determine the values of i.e. resistance index (RI) and pulsatility index (PI) in the spiral arteries and to evaluate the maternal serum concentration of progesterone trying to find correlation between these parameters in the group of patients in early pregnancy complicated by threatened abortion.

STUDY METHODS

We have analysed 30 pregnant women between 5th and 12th weeks of pregnancy with the symptoms of vaginal bleeding & lower abdominal pains diagnosed as threatened abortion. In all patients transvaginal ultrasound examination with pulse color Doppler was performed. The RI and PI values were calculated for blood flow velocity waveforms obtained from the spiral arteries. The concentration of progesterone in maternal serum was evaluated by Microparticle Enzyme Immunoassay. The correlation between analysed parameters and pregnancy duration was examined with use of linear correlation by Pearson. The correlation between Doppler and biochemical parameters were analysed with use of rang correlation method by Spearman.

RESULTS

Thirty flow velocity waveforms from spiral arteries were analysed and blood flow indices were calculated. We have found statistically significant negative correlation between the values of both blood flow parameters (RI & PI) and successive weeks of pregnancy (p < 0.001) and statistically significant positive correlation between maternal serum concentration of progesterone and pregnancy duration (p < 0.05). In the tested group in 40% of patients the level of progesterone was abnormal. We have not find any correlation between serum progesterone concentration and doppler parameters in our study.

CONCLUSIONS

There is observed the characteristic drop of resistance to the blood flow in the vessels of the uteroplacental circulation in the successive weeks of early pregnancy in patients with threatened abortion similar to normal early pregnancies. Lack of correlation between maternal serum concentration of progesterone and blood flow parameters indicates that other hormonal factors play major role in the regulation of the blood flow in these vessels in early pregnancy. Only the combination of Doppler blood flow analysis in spiral arteries and progesterone evaluation in the maternal serum performed in first trimester may be useful for the intensive fetal monitoring of high risk pregnancies.

[Diagnostic value of transvaginal ultrasound in the detection of ovarian endometriosis]

The aim of the study was to estimate of efficiency of endovaginal ultrasonography in diagnosis of ovarian endometriosis. The study was performed in 59 women with ovarian tumors. Ultrasound examinations were performed with Aloka 2000 using 5.0 MHz transducers. The endovaginal ultrasonography is very useful in diagnosis of ovarian endometriosis, showing sensitivity--90%, specificity--68%, positive predictive value--75%, negative predictive value--86%. Ultrasound examination is an important tool in noninvasive diagnostic procedure of adnexal pathology.

[Biomarkers in primary ovarian cancers and after chemotherapy]

The authors analyzed the expression of oncogen and antioncogen proteins using immunoperoxidase technique with monoclonal antibodies in 49 primary ovarian carcinomas and 38 cancers after chemotherapy (second look) There was not found independent prognostic marker. But some results suggest, that in the individual cases estimate proliferative activity and overexpression P53 may give some information about intensitivity and quality of chemotherapy.

[Transvaginal color Doppler study of the uteroplacental circulation in early pregnancy]

OBJECTIVE

To compare resistance index (RI) and pulsatility index (PI) values of blood flow in arteries of uteroplacental circulation in normal and threatened abortion first trimester pregnancies.

STUDY DESIGN

We have analysed 36 pregnant woman between 5th and 12th weeks of pregnancy--17 patients with threatened abortion as a test group and 19 patients with normal intrauterine pregnancy taken as controls. In all patients transvaginal ultrasonography with pulse color Doppler was performed. The RI and PI values were calculated for blood flow velocity waveforms obtained from uterine artery and its branches--arcuate, radial and spiral arteries.

RESULTS

In the test group we have analysed 17 flow velocity waveforms from uterine artery (mean RI 0.852; SD 0.080, mean PI 2.324; SD 0.693), 16 from arcuate artery (mean RI 0.638; SD 0.049, mean PI 1.315; SD 0.064,), 17 from radial artery (mean RI 0.638; SD 0.049, mean PI 1.009; SD 0.177) and 15 from spiral artery (mean RI 0.548; SD 0.068, mean PI 0.804; SD 0.160); in controls we have analysed 16 flow velocity waveforms from uterine artery (mean RI 0.866; SD 0.066, mean PI 2.469; SD 0.618), 17 from arcuate artery (mean RI 0.728; SD 0.123, mean PI 1.352; SD 0.362), 19 from radial artery (mean RI 0.630; SD 0.092, mean PI 1.017; SD 0.261) and 16 from spiral artery (mean RI 0.511; SD 0.100, mean PI 0.760; SD 0.202).

CONCLUSION

There was no significant difference in mean RI and PI values between normal and abnormal pregnancies. A gradual statistically significant decrease of RI and PI values during time of pregnancy we have observed only in radial arteries in both groups. For other vessels in the control group the RI and PI values tended to decrease during the time of pregnancy while in the test group some even rose up.

[The evaluation of the efficiency of treatment in ectopic pregnancy with the application of various surgical procedures]

In our study we analyzed 54 women with confirmed diagnosis of ectopic pregnancy, in whom two different surgical approaches were performed. There were 40 salpingotomies and 14 salpingectomies. The dynamics of the decrease of beta hCG serum level were assessed. The beta hCG levels not greater than 5 mIU/ml (2nd IS) were the markers of the recovery. Similar therapeutic effect was obtained in both testing group. The normalisation of the beta hCG serum level was observed after 19th and 21st days after salpingectomy and salpingotomy, respectively.

[Ultrasonographic evaluation of yolk sac in early pregnancy]

Ultrasound diagnosis of yolk sac in early pregnancy. In cross-sectional study pregnant patients were analyzed by means of endovaginal ultrasound. Yolk sac diameter was analyzed to assess its growth in early pregnancy. Linear growth of sac diameter was observed (at 31 day of the cycle 0.4 mm at 72nd day of the cycle 4.8 mm).

[Transvaginal ultrasound in evaluation of the uterine cervix during pregnancy]

127 pregnant patients between 20 and 37 week of gestation were studied. Cervical estimation was done by using transvaginal ultrasonography. An accurate estimation was possible in all investigation patients. Statistically significant distinctions in uterine cervical length during pregnancy progress were noticed (p < 0.05). However, differences in cervical with were not perceived (p = 0.3). Interdependence of the duration of pregnancy upon the cervical length and width were calculated. Obtained findings could be applicable in preterm labor prognosis.

[Doppler ultrasound evaluation of fetal renal arteries in normal pregnancy]

Normal values of the pulsatility index in the fetal renal arteries in a group of 65 uncomplicated pregnancies were established. The measurements were obtained between 28 and 40 weeks of gestation. The values of pulsatility index may be used as a reference for further investigation of pathologic pregnancies.

[Use of the "color doppler" technique in diagnosing ovulation]

Graafian follicle growth and development and Doppler flow analysis of blood vessels in the wall of the follicle, was analyzed. Twelve patients with primary infertility were observed between days 12 to 15 of the cycle. Analysis of resistance index (RI) and pulsatility index (PI) of the wall vessels was performed. Statistically significant difference in RI and PI indices in preovulatory and post-ovulatory period was observed.