Fetal heart and hemodynamics in diabetic pregnancy - Fetal cardiac and placental function in a rat model of maternal hyperglycemia and human type 1 diabetic pregnancies

Maternal type 1 diabetes mellitus affects fetal and offspring health. We aimed to investigate fetal cardiac and placental function in a rat model of maternal pregestational hyperglycemia, and the effect of gestational hyperglycemia on the offspring heart. In human fetuses of diabetic mothers the aim was to investigate, whether maternal insulin therapy will ameliorate fetal cardiac, hemodynamic, and placental abnormalities. Fetal cardiac and placental ultrasonography, histology, and gene expressions were examined in streptozotocin-induced maternal hyperglycemia and control rats. Rat off-spring cardiac genes and histology were analyzed up to two weeks after birth. In diabetic and healthy human pregnancies, fetal ultrasonography and biochemical markers of cardiac function and fetal hypoxemia, and placental morphology and gene expression were collected. In rat fetuses of maternal hyperglycemia, signs of diastolic dysfunction persisted throughout the second half of pregnancy, and transient mid-pregnancy cardiac dysfunction was observed. Increased myocardial cell turnover with cardiac hyperplasia and abnormal myocardial gene expression patterns were found. Increased placental vascular impedance and placental morphologic abnormalities were observed in the rat fetuses of maternal hyperglycemia. In the newborn rats of maternal hyperglycemia, cardiac genes controlling contractility, growth, structure, and metabolism were differently expressed when compared to healthy newborn rats. In human diabetic pregnancies, fetal cardiac output was decreased, pulsatility of the aortic isthmus blood flow velocity waveform, and fetal serum concentrations of natriuretic peptides and troponin T were increased at near term. The rat model shows that maternal hyperglycemia leads to diastolic dysfunction and placental insufficiency. Abnormal expression of genes involved in cardiac contractility, structure, growth, and metabolism were seen in late term fetal and offspring hearts. In human maternal diabetes, fetal cardiac output is decreased with biochemical evindence of myocardial dysfunction.Diabeetikon sikiön verenkierto – Sikiön sydämen ja istukan toiminta äidin hyperglykemian kokeellisessa eläinmallissa ja tyypin 1 diabeetikoiden raskauksissa Tyypin 1 sokeritauti (T1DM) vaikuttaa sikiön ja jälkikasvun hyvinvointiin. Tämän tutkimuksen tarkoituksena oli tutkia kokeellisen eläinmallin avulla emon raskaudenaikaisen hyperglykemian vaikutusta sikiön sydämen ja istukan toimintaan sekä jälkeläisten sydämen kehitykseen. T1DM naisten raskauksissa tavoitteena oli tutkia insuliinihoidon vaikutusta sikiön sydämen, verenkierron ja istukan poikkeavuuksiin. Streptozotosiinilla (STZ) aikaansaatiin emon hyperglykemia. STZ- ja verrokkirottien sikiöiltä tutkittiin sydämen ja istukan verenkiertoa ultraäänitutkimuksella, sekä kudosten histologiaa ja geenien ilmentymistä. Rotanpoikasten sydänten histologia ja geenien ilmentyminen tutkittiin 2 viikkoa syntymän jälkeen. Potilasmallissa sikiön verenkiertoa tutkittiin ultraäänellä, jonka lisäksi sydämen toiminnan ja hapenpuutteen sekä istukan rakenteen ja geenien ilmaisua selvitettiin. Koe-eläinmallissa hyperglykemialle altistuneiden sikiöiden sydämen diastolinen toiminta oli poikkeava ja keskiraskaudessa havaittiin ohimenevä sydämen vajaatoiminta. Sydämen hyperplasia, runsaat mitoottisten ja apoptoottisten solujen määrät ja poikkeava geenien ilmentyminen todettiin hyperglykeemisten emojen sikiöillä. Tämän ryhmän istukan verenkierron impedanssi oli koholla ja rakenteet poikkesivat terveiden verrokkien poikasista. Hyperglykeemisten rottien poikasilla sydämen kontraktiliteettiin, kasvuun, rakenteeseen ja aineenvaihduntaan liittyvien geenien ilmentyminen oli poikkeavaa terveiden emojen poikasiin verrattuna. Potilasmallissa T1DM-äidin sikiön sydämen minuuttitilavuus oli alentunut, ja aortan istmuksen ja alaonttolaskimon verenvirtauksen vastus ja sikiön seerumin natriureettisten peptidien ja troponiini T:n pitoisuudet olivat koholla. Kokeellisessa eläinmallissa totesimme, että emon hyperglykemia johtaa sikiön sydämen diastolisen toiminnan poikkeavuuteen ja istukan vajaatoimintaan. Sydämen kontraktiliteettiin, rakenteeseen, kasvuun ja metaboliaan liittyvien geenien ilmentyminen oli poikkeava sikiöillä ja vastasyntyneillä poikasilla. Äidin nuoruustyypin sokeritauti johtaa sikiön sydämen minuuttitilavuuden laskuun ja biokemiallisiin muutoksiin, jotka liittyvät sydämen toimintahäiriöön.Siirretty Doriast

Fetal cardiovascular hemodynamics in type 1 diabetic pregnancies at near-term gestation

Introduction Poor glycemic control in maternal type 1 diabetes mellitus during pregnancy can affect fetal cardiac and placental function. However, studies concerning fetal central hemodynamics have revealed conflicting results. We hypothesized that in pregnancies complicated by maternal type 1 diabetes, fetal cardiovascular and placental hemodynamics are comparable to the control fetuses at near-term gestation. In addition, we investigated the relationship between newborn serum biomarkers of cardiac function and fetal cardiovascular and placental hemodynamics. Furthermore, we studied whether maternal diabetes is associated with placental inflammation. Material and methods In this prospective case-control study, fetal central and peripheral hemodynamics were assessed by ultrasonography in 33 women with type 1 diabetes and in 67 controls with singleton pregnancies between 34(+2)and 40(+2)gestational weeks. Newborn umbilical cord serum was collected to analyze cardiac natriuretic peptides (atrial and B-type natriuretic peptides) and troponin T concentrations. Placental tissue samples were obtained for cytokine analyses. Results Fetal ventricular wall thicknesses were greater and weight-adjusted stroke volumes and cardiac outputs were lower in the type 1 diabetes group than in the control group. Pulsatility in the aortic isthmus and inferior vena cava blood flow velocity waveforms was greater in the type 1 diabetes group fetuses than in the controls. A positive correlation was found between branch pulmonary artery and aortic isthmus pulsatility index values. Umbilical artery pulsatility indices were comparable between the groups. Umbilical cord serum natriuretic peptide and troponin T concentrations were elevated in the type 1 diabetes fetuses. These cardiac biomarkers correlated significantly with cardiovascular hemodynamics. Placental cytokine levels were not different between the groups. Conclusions In maternal type 1 diabetes pregnancies, fetal cardiovascular hemodynamics is impaired. Maternal type 1 diabetes does not seem to alter placental vascular impedance or induce placental inflammation.</p

Lipoproteiini (a) - valtimotaudin salakavala riskitekijä

Pääkirjoitu

Potentially traumatic experiences pre-migration and adverse pregnancy and childbirth outcomes among women of Somali- and Kurdish-origin in Finland

Abstract Background Women in precarious conditions in their countries of origin, especially those who have left the country as refugees, may have been victims of serious mental and physical violence. These potentially traumatic experiences may threaten women’s reproductive health. This study examines the prevalence of potentially traumatic experiences pre-migration and female genital mutilation/cutting (FGM/C) and their associations with adverse reproductive outcomes among migrant women of Somali- and Kurdish-origin who have been pregnant in Finland. Methods Survey and register data of the participants of the Finnish Migrant Health and Wellbeing Study (Maamu), conducted in 2010–2012, were used. Women of 18 to 64 years of age, 185 Somali- and 230 Kurdish-origin, who had at least one pregnancy or birth in Finland were included in the analysis. The survey data were linked to the Finnish Medical Birth Register, the Register of Induced Abortions, and the Care Register for Health Care until 2018. For each outcome, logistic regression was used and adjusted for age, body mass index, time lived in Finland, and the number of births. Results A total of 67% of Somali-origin and 71% of Kurdish-origin women had experienced potentially traumatic experiences pre-migration and 64% of Somali- and 32% of Kurdish-origin women had also undergone FGM/C. In Kurdish-origin women, complications during pregnancy (e.g. bleeding in the first trimester, known or suspected fetal abnormality, signs of fetal hypoxia, death of the fetus and other problems) were significantly more common among women without potentially traumatic experiences (70%) than among women with potentially traumatic experiences (48%) (p-value 0.005). No associations between potentially traumatic experiences or FGM/C and other adverse reproductive outcomes were observed among Somali- or Kurdish-origin women. Conclusion Past trauma is common among Somali- and Kurdish-origin women and this needs to be evaluated in maternity care. However, we found no association between potentially traumatic experiences pre-migration and adverse reproductive outcomes

Fetal cardiovascular hemodynamics in type 1 diabetic pregnancies at near‐term gestation

Abstract Introduction: Poor glycemic control in maternal type 1 diabetes mellitus during pregnancy can affect fetal cardiac and placental function. However, studies concerning fetal central hemodynamics have revealed conflicting results. We hypothesized that in pregnancies complicated by maternal type 1 diabetes, fetal cardiovascular and placental hemodynamics are comparable to the control fetuses at near‐term gestation. In addition, we investigated the relation between newborn serum biomarkers of cardiac function and fetal cardiovascular and placental hemodynamics. Furthermore, we studied whether maternal diabetes is associated with placental inflammation. Material and methods: In this prospective case‐control study, fetal central and peripheral hemodynamics were assessed by ultrasonography in 33 women with type 1 diabetes and in 67 controls with singleton pregnancies between 34+2 and 40+2 gestational weeks. Newborn umbilical cord serum was collected to analyze cardiac natriuretic peptides (atrial and B‐type natriuretic peptides) and troponin T concentrations. Placental tissue samples were obtained for cytokine analyses. Results: Fetal ventricular wall thicknesses were greater and weight‐adjusted stroke volumes and cardiac outputs were lower in the type 1 diabetes group than in the control group. Pulsatility in the aortic isthmus and inferior vena cava blood flow velocity waveforms was greater in the type 1 diabetes group fetuses than in the controls. A positive correlation was found between branch pulmonary artery and aortic isthmus pulsatility index values. Umbilical artery pulsatility indices were comparable between the groups. Umbilical cord serum natriuretic peptide and troponin T concentrations were elevated in the type 1 diabetes fetuses. These cardiac biomarkers correlated significantly with cardiovascular hemodynamics. Placental cytokine levels were not different between the groups. Conclusions: In maternal type 1 diabetes pregnancies, fetal cardiovascular hemodynamics is impaired. Maternal type 1 diabetes does not seem to alter placental vascular impedance or induce placental inflammation