Reakcja śródbłonka naczyniowego na hiperglikemię i/lub nadciśnienie tętnicze w późnej ciąży jest zróżnicowana w zależności od przewlekłego lub indukowanego ciążą charakteru zaburzeń

Objectives: We investigated how maternal endothelial function is affected by pregestational (Type 1) diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM) and/or chronic hypertension (chHT) or gestational hypertension (PIH). Methods: We conducted a prospective, observational study involving 78 participants with GDM, PGDM and/or hypertension (PIH-16, GDM + PIH-14, PGDM + chHT-8, PGDM-20, GDM-20) in the third trimester of a singleton viable pregnancy. Twenty healthy women with uncomplicated pregnancies matched for gestational age served as controls. We analysed maternal data, disease history and serum concentrations of E-selectin and Vascular cell adhesion molecule 1 (sVCAM-1). Results: Only the maternal serum concentration of sVCAM-1 differed significantly among the subgroups (p< 0.0001), with the highest levels evident in women with PIH or GDM + PIH and the lowest in women with PGDM alone or PGDM + chHT. Conclusions: Pregestational or pregnancy associated disorders, although sharing similar clinical symptoms, have a different impact on endothelial function in pregnant women.Wstęp: Śródbłonek naczyniowy jest uważany obecnie za narząd docelowy w rozwoju powikłań towarzyszących cukrzycy, jak również nadciśnieniu tętniczemu. Celem badania była analiza wpływu cukrzycy ciążowej lub przedciążowej typu 1(GDM, PGDM) oraz nadciśnienia tętniczego przewlekłego lub indukowanego ciążą (chHT, PIH) na markery funkcji śródbłonka naczyniowego. Materiał i metoda: Prospektywne badanie obserwacyjne na grupie 78 ciężarnych w III trymestrze pojedynczej ciąży (PIH-16, GDM+PIH-14, PGDM+chHT-8, PGDM-20, GDM-20). Grupę kontrolną stanowiło 20 zdrowych ciężarnych w pojedynczej, niepowikłanej ciąży dobranych pod względem wieku ciążowego. W grupie badanej analizowano dane antropometryczne i biochemiczne oraz stężenia rozpuszczalnych frakcji E-Selektyny (sE-Sel) i VCAM-1 (sVCAM-1) w surowicy krwi. Wyniki: Wykazano znamienną różnicę w stężeniach sVCAM-1 między analizowanymi podgrupami (p < 0,0001) przy czym najwyższe stężenia zaobserwowano w podgrupach PIH oraz GDM+PIH, a najniższe stężenia w podgrupach z PGDM z lub bez chHT. Wnioski: W ciążach powikłanych hiperglikemią i/lub nadciśnieniem tętniczym zróżnicowany wpływ chorób matczynych na śródbłonek naczyniowy ciężarnej zależy od przewlekłego lub indukowanego ciążą charakteru zaburzeń

Serum homocysteine and vitamin B12 levels in women with gestational diabetes mellitus

Objectives: Gestational diabetes mellitus (GDM) is described as a glucose intolerance of variable severity which begun or was firstly recognized during gravidity. Two major metabolic disorders, insulin resistance and β-cell dysfunction, currently play major role in pathogenesis of GDM. Our intention was to investigate total serum homocysteine and vitamin B12 levels in pregnant women with GDM and non-diabetic gravid women. Material and methods: Serum homocysteine and vitamin B12 levels were prospectively measured in a total of 79 pregnant women, 60 of whom were diagnosed with GDM, and 19 of whom were healthy controls. Serum homocysteine levels were analyzed by ELISA. Vitamin B12 concentrations were determined by chemiluminescent immunoassay, and lipids were determined enzymatically. Results: GDM and control groups did not differ in terms of the serum homocysteine levels (median 7.24 vs 7.97 umol/L, respectively, p = 0.15). Nor did we find any association between serum homocysteine levels and BMI (r = 0.06, p = 0.55, respectively). There was no correlation between serum homocysteine and fasting serum glucose (r = 0.3, p = 0.8, respectively). There was no relationship between serum homocysteine concentrations and glycosylated hemoglobin (HgbA1c) levels (r = 0.06, p = 0.67, respectively). Serum vitamin B12 concentrations did not differ between the GDM and control groups (median 286 vs 262 pg/mL, respectively, p = 0.17). We found that levels of Vitamin B12 correlated inversely with fasting serum glucose concentrations (r = -0.44, p = 0.0009). Vitamin B12 concentrations increased along with LDL (r = 0.27, p = 0.043) and HDL (r = 0.38, p = 0.004) levels, however were inversely correlated with serum triglycerides (r = -0.34, p = 0.009). Conclusions: GDM patients with low Vitamin B12 values tend to have higher fasting serum glucose and altered lipid profiles (high triglycerides, low HDL and LDL). In women with GDM, serum homocysteine levels are not associated with HbA1c level, fasting glycemia, or BMI

An observational study of the risk of neonatal macrosomia, and early gestational diabetes associated with selected candidate genes for type 2 diabetes mellitus polymorphisms in women with gestational diabetes mellitus

Objectives: 1) to analyse the prevalence of selected candidate genes for type 2 diabetes mellitus polymorphisms (IRS1 G972R; ENPP1 K121Q; ADRB3 W64R) among women with gestational diabetes; and 2) to investigate any association between variants of these genes and risk of neonatal macrosomia.Material and methods: We conducted a prospective observational study of a group of women (N = 140) in singleton pregnancies who delivered at term. Characteristics of the study group at enrolment: age: 32.0 ± 4.9 years; GA: 26.6 ± 7.5 weeks; HbA1c: 5.6 ± 0.6%; fasting blood glucose: 102.3 ± 16.3 mg/dL; insulin treatment (G2DM): 65.7%; chronic hypertension: 11.4%; gestational hypertension: 17.9%; preeclampsia: 1.4%; birth weight: 3590 ± 540 g; birth weight ≥ 4000 g (macrosomia): 18.6%; caesarean section: 44.3%; and female newborns: 57.1%.Results: The maternal metabolic characteristics at the time of booking did not differ between polymorphisms. Macrosomia was insignificantly more frequent in females (22.5%) than in males (13.3%) (p = 0.193). Only maternal height and body weight at the time of booking significantly predicted birth weight (R = 0.27, p = 0.007; R = 0.25, p = 0.005, respectively). IRS1 G972R GR and ENPP1 K121Q KQ polymorphisms were associated with an insignificantly increased risk for macrosomia. Carriers of the heterozygotic variant of the IRS 1 gene were significantly more likely to be diagnosed with GDM/DiP in the first trimester: OR 5.2, 95% CI: 1.4; 19.2; p = 0.014.Conclusions: 1) having similar metabolic characteristics, carriers of specific variants of T2DM candidate genes might be at increased risk of delivery of macrosomic newborns; 2) any association between genetic variants and macrosomia in this population might be gender-specific; and 3) allelic variation in the IRS1 gene is associated with early GDM/DiP

Ultrasound measurements of umbilical cord transverse area in normal pregnancies and pregnancies complicated by diabetes mellitus

Objective: A voluminous umbilical cord has been described in diabetic pregnancies. The aim of this study was to see if measurements of cord diameters might be of value in the evaluation of diabetic pregnancies and especially those suspected of a large for gestational age (LGA) fetus. Methods: In an observational, prospective study umbilical cord areas and vessel diameters were measured between gestational age of 22 and 40 weeks in transverse ultrasound images of the central part of the cord in 141 normal and 135 diabetic pregnancies of which 30 were suspected of being LOA. Wharton's jelly area was calculated by subtracting the vessel area from the total transverse cord area. Normal reference curves were constructed for gestational age. Results: Umbilical cord and Wharton's jelly areas increased with gestation. The vessel area leveled out at 32-33 weeks of gestation and the umbilical vein area decreased after 36 weeks of gestation. The umbilical cord parameters in diabetic pregnancies did not differ from controls. Cord areas were enlarged in 1/3 of the LGA fetuses. Conclusion: Umbilical cord area measurements are of limited value for the evaluation of diabetic pregnancies suspected having a LGA-fetus

How mother’s obesity may affect the pregnancy and offspring

One of the main reasons for the epidemic of obesity, which has already influenced the economic condition of health systemworldwide, is our modern lifestyle having an unbalanced calorie intake and insufficient physical activity. Maternal-fetal nourishmentand metabolism are the mechanisms of fetal programming of obesity-adiposity and non-communicable diseasesthat have been most extensively investigated. A mother’s obesity is related to adverse outcomes for both mother and baby.Maternal overnutrition is also associated with a higher risk of gestational diabetes, preterm birth, large-for-gestational-agebabies, fetal defects, congenital anomalies, and perinatal death. Women with obesity should be encouraged to reduce theirbody mass index (BMI) prior to pregnancy, and to limit weight gain during pregnancy. Obstetric ultrasound imaging inpregnant women is negatively affected by abdominal adipose tissue, having an adverse influence on congenital anomalydetection rates and the estimation of fetal weight

Placental Doppler velocimetry in gestational diabetes mellitus

Objective: To evaluate if maternal glucose level and growth of the fetus were related to placental vascular impedance in pregnancy complicated by gestational diabetes mellitus. Material and methods: A retrospective study of 146 gestational diabetic women of which 117 needed insulin therapy. Glycosylated hemoglobin (HbA(1c)) was evaluated as well as umbilical and uterine artery Doppler velocimetry. The results were related to adverse outcome of pregnancy including newborn birthweight. Results: Abnormal umbilical artery blood flow velocity was seen in 5% of the cases and abnormal uterine artery flow in 16%. Uterine and umbilical artery vascular impedance was significantly lower in macrosomic newborns. There was a poor correlation between HbA(1c), vascular impedance and birthweight. There were 11 cases that developed preeclampsia, all having abnormal uterine artery Doppler and two abnormal umbilical artery Doppler. Conclusion: Uterine and umbilical artery vascular impedance in pregnancies complicated by gestatinal diabetes is related to birthweight and placental weight, but not to maternal HbA(1c) levels. Placental Doppler ultrasound does not seem to be of clinical value for fetal surveillance in these pregnancies unless the pregnancy is complicated by preeclampsia and/or intrauterine fetal growth restriction

Abnormal uterine Doppler is related to vasculopathy in pregestational diabetes mellitus

Background - The aim of the study was to evaluate the relation between maternal placental Doppler velocimetry, levels of the maternal glucose, and clinical signs of vasculopathy in pregnancy complicated by pregestational diabetes mellitus. Methods and Results - A retrospective study of 155 pregestational diabetic women between the 22nd and 40th weeks of pregnancy, categorized in White classification as B, 49; C, 40; D, 22; R, 20; F, 5; and RIF, 19. Cases in classes R, F, and R/F were defined as having vasculopathy. Doppler velocimetry of umbilical and uterine arteries was evaluated for vascular impedance, both in terms of pulsatility index ( PI) for both arteries and a notch in early diastole in the uterine arteries. The last examination before delivery was used for analysis. Increased umbilical artery PI was seen in 19 and a uterine artery abnormality in 45 cases. There was a correlation between levels of HbA(1c) and increased vascular impedance in the uterine and umbilical arteries. Signs of increased uterine artery vascular impedances were significantly related to pregestational vasculopathy. In cases of small-for-gestational-age newborn infants, PI was significantly increased in uterine and umbilical arteries. Furthermore, PI in macrosomic fetuses was significantly lower than in normal infants. Abnormal uterine artery Doppler was also strongly related to adverse outcome. Conclusions - Abnormal uterine artery Doppler is related to pregestational vasculopathy and adverse outcome of pregnancy. The results suggest that the uterine arteries are affected in women with clinical signs of pregestational vasculopathy. This may influence placental perfusion and fetal well-being

Evaluation of third trimester uterine artery flow velocity indices in relationship to perinatal complications.

Objective. Uterine artery Doppler is becoming a routine part of pregnancy surveillance in high-risk pregnancies. Which blood flow velocity waveform index to measure is debated and the 'notch' in early diastole is not widely accepted, as it is a subjective measure. The aim of the present study was to evaluate the different indices in the prediction of adverse outcome of pregnancies suspected for intrauterine fetal growth restriction (IUGR). Methods. Uterine artery blood flow was recorded in 217 pregnancies admitted for Doppler ultrasound surveillance due to suspected IUGR. The median gestational age at examination was 38 weeks (range 25-42 weeks). Only cases having bilateral uterine artery notching were included in the evaluation. The uterine artery Doppler spectrum was analyzed for different indices, including evaluation of notch and end-diastolic velocities. Umbilical artery Doppler velocimetry was also performed. The outcome variables chosen were: a small-for-gestational-age (SGA) newborn, preterm birth, and abdominal delivery. ROC-curve calculations were used to compare the different indices. Results. The uterine artery blood velocity pulsatility index (PI) and resistance indices (RI) were the best predictors of adverse outcome of pregnancy. Apart from premature birth, the systolic/end-diastolic ratio was less predictive of adverse outcome. The indices including only diastolic blood velocities were the least predictive of adverse outcome. The group with notch velocity above end-diastolic velocity was compared with those having notch velocity below the end-diastolic velocity. No difference in outcome was seen between the two groups. Conclusions. RI and PI as measures of third trimester utero-placental vascular impedance are the best predictors of adverse outcome of IUGR-suspected pregnancies

Can redox imbalance predict abnormal foetal development?

Objectives: Based on the current state of knowledge, elevated levels of oxidative stress markers may be considered as risk factors for pregnancy complications. The aim of the research was to assess the correlation between selected oxidative stress biomarkers with the occurrence of foetal chromosomal aberration and congenital malformations. Material and methods: This retrospective research lasted for two years. The purpose was to determine serum levels of selected oxidative stress markers, including total protein (TP), glutathione (GSH), S-nitrosothiols (RSNO), nitric oxide (NO), trolox equivalent antioxidant capacity (TEAC) and glutathione S-transferase (GST) at 11–13 + 6 gestational weeks in 38 women with confirmed foetal developmental abnormalities and in 34 healthy pregnancies in order to assess their utility as predictors of abnormal foetal development. Results: Serum concentrations of TP (56.90 ± 5.30 vs 69.1 ± 15.30 mg/mL), TEAC (4.93 ± 0.82 vs 5.64 ± 0.74 μM/mL) and GST (15.94 ± 4.52 vs 21.72 ± 6.81 nM/min/mg) were statistically significantly (p < 0.05) lower in the group of patients with developmental abnormalities in the fetus, whereas GSH levels (6.43 ± 1.24 vs 4.98 ± 1.88 nM/mg) were significantly higher, compared to the group of healthy fetuses. There were no differences in the concentration of these markers between chromosomal aberrations and fetal dysmorphia in subjects. A significant difference in odds ratio obtained for GSH (OR = 0.57, 95% CL: 0.40–0.80) indicates that its higher concentration can relate to reduced risk of developmental abnormalities, whereas odds ratio for TP (OR=1.11, 95% CL: 1.04–1.17), TEAC (OR = 3.54, 95% CL: 1.56–8.05) and GST (OR = 1.18, 95% CL: 1.03–1.17) indicate that their elevation may increase the risk of developmental abnormalities Conclusions: Elevated levels of TP, GST, TEAC and low GSH level may be relevant to predict congenital defects