The role of new adipokines in gestational diabetes mellitus pathogenesis

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition dur­ing pregnancy. Explanation of the GDM pathogenesis is important due to preventing gestational complications. During pregnancy there are significant changes in maternal metabolism. Many of these changes are influenced by different adi­pokines produced in the placenta and adipose tissue. The exact role of adipokines in the pathogenesis of GDM remains still unknown. Several adipokines have been analysed throughout gestation and their levels have been suggested as biomarkers of maternal–perinatal outcomes. Some of them have been postulated as significant in the pathogenesis of pregnancy complications like GDM. This report aims to review some of the recent topics of adipokine research that may be of particular importance in patho­physiology and diagnosis of gestational diabetes mellitus. Because of manuscript length limitations, after thorough literature review and in view of the recent evidence, we focus on the one of the most well-known adipokine: adiponectin, and not so well-studied: nesfatin-1, chemerin, ghrelin, and CTRP 1

Adipokines and C-peptide in overweight and obese pregnant women

Objectives: The aim of the study was to evaluate the levels of adipokines such as adiponectin, resistin, leptin as well as C-peptide in overweight and obese pregnant women. Material and methods: The adipokines and C-peptide concentrations were measured in the group of 38 overweight/obese pregnant women (BMI > 25 kg/m2) and in 42 pregnant women of normal weight (BMI < 25 kg/m2) with ELISA tests between 24th and 34th weeks of gestation. Results: The overweight/obese women compared to lean ones were characterized by significantly higher concentrations of leptin (43.44 ± 31.41 vs. 21.29 ± 12.67 ng/mL, p = 0.0001) and C-peptide (2.77 ± 1.88 vs. 2.25 ± 1.42 ng/mL, p = 0.034). There were no significant differences between groups in resistin (17.39 ± 7.59 vs. 15.76 ± 6.64 ng/mL, NS) and adiponectin (6.93 ± 3.52 vs. 8.07 ± 6.53 μg/mL, NS) levels. In the overweight/obese patients, no relationships between the adipokines, C-peptide and CRP concentrations were found. BMI was negatively correlated with the resistin levels (R = –0.406, p = 0.011). The significant correlation between leptin and C-peptide concentrations was observed in the study group (R = 0.517, p = 0.012). In the control group, the negative correlation between adiponectin concentrations and BMI was shown (R = –0.446, p = 0.003). Conclusions: The higher levels of leptin in the overweight and obese pregnant women seem to reflect the leptin resistance condition and the higher levels of C-peptide in this group is suggestive for hyperinsulinemia. The positive correlation between C-peptide and leptin levels but not with resistin and adiponectin might confirm the role of leptin in the hyperinsulinemia development in overweight and obesity during pregnancy

Farmakoterapia chorób układu ruchu u kobiet w ciąży

Planowanie lub obecność ciąży ogranicza możliwości leczenia kobiet z reumatoidalnym zapaleniem stawów, innymi chorobami układowymi czy ortopedycznymi. Ciąża jest stanem, który należy omówić ze wszystkimi pacjentkami z chorobami układu ruchu, które są w wieku rozrodczym. Większość chorób układowych, które są dobrze kontrolowane przed ciążą, nie pogorszy się w czasie ciąży, pod warunkiem że pacjentka kontynuuje leczenie odpowiednio dobranymi preparatami. Jednak liczne leki powinny być wykluczone mimo swojej skuteczności. Niektóre z nich, takie jak metotreksat, leflunomid, abatacept i rytuksymab, powinny być odstawione w momencie planowania ciąży, inne — jak bisfosfoniany — mogą być stosowane do momentu zapłodnienia. Istnieją również preparaty dopuszczone do stosowania podczas ciąży (środki przeciwmalaryczne, sulfasalazyna, azatiopryna, cyklosporyna, kortykosteroidy, leki przeciwbólowe i antybiotyki), a więc mogą być podawane do czasu porodu. Niesteroidowe leki przeciwzapalne mogą być bezpiecznie podawane do 32. tygodnia ciąży. Najważniejszym czynnikiem przy planowaniu leczenia pacjentek z chorobami układowymi w okresie ciąży jest możliwość indywidualizacji zaleceń. Celem niniejszej pracy jest podsumowanie aktualnej wiedzy na temat możliwości stosowania preparatów wykorzystywanych w leczeniu chorób układu ruchu u kobiet ciężarnych oraz karmiących piersią

Nutrition as Prevention Factor of Gestational Diabetes Mellitus: A Narrative Review

Gestational diabetes mellitus (GDM) is defined as a glucose tolerance disorder with onset or first recognition during pregnancy. GDM is associated with several adverse maternal and neonatal outcomes. Management to reduce the incidence of GDM could decrease the incidence of these complications. Modification of nutrition in the prevention of GDM is postulated. The vital issue in GDM prevention is the implementation of proper dietary patterns, appropriate physical activity, and a combination of diet and lifestyle modifications. However, intervention studies examining the effects of diet and lifestyle on GDM prevention are contradictory. The aim of this study was to review the scientific evidence on nutritional prevention strategies, including diet and supplementation of some substances such as probiotics, micro/macroelements, fiber, myoinositol, and vitamins that may be effective in reducing the risk of GDM. The presented article is a narrative review. This article indicates that certain nutritional factors may have some benefit in preventing GDM. However, further studies in a variety of populations and large groups of patients are needed. At present, no definitive conclusions can be drawn as to the best intervention in the prevention of GDM

Could Vitamin D Be Effective in Prevention of Preeclampsia?

Prevention of preeclampsia (PE) remains one of the most significant problems in perinatal medicine. Due to the possible unpredictable course of hypertension in pregnancy, primarily PE and the high complication rate for the mother and fetus/newborn, it is urgent to offer pregnant women in high-risk groups effective methods of preventing the PE development or delaying its appearance. In addition, due to the association of PE with an increased risk of developing cardiovascular diseases (CVD) in later life, effective preeclampsia prevention could also be important in reducing their incidence. Ideal PE prophylaxis should target the pathogenetic changes leading to the development of PE and be safe for the mother and fetus, inexpensive and freely available. Currently, the only recognized method of PE prevention recommended by many institutions around the world is the use of a small dose of acetylsalicylic acid in pregnant women with risk factors. Unfortunately, some cases of PE are diagnosed in women without recognized risk factors and in those in whom prophylaxis with acetylsalicylic acid is not adequate. Hence, new drugs which would target pathogenetic elements in the development of preeclampsia are studied. Vitamin D (Vit D) seems to be a promising agent due to its beneficial effect on placental implantation, the immune system, and angiogenic factors. Studies published so far emphasize the relationship of its deficiency with the development of PE, but the data on the benefits of its supplementation to reduce the risk of PE are inconclusive. In the light of current research, the key issue is determining the protective concentration of Vit D in a pregnant woman. The study aims to present the possibility of using Vit D to prevent PE, emphasizing its impact on the pathogenetic elements of preeclampsia development

Preeclampsia and Obesity—The Preventive Role of Exercise

Obesity is now recognized as a worldwide epidemic. An inadequate diet and reduced physical activity are acknowledged as the leading causes of excess body weight. Despite growing evidence that obesity is a risk factor for unsuccessful pregnancies, almost half of all women who become pregnant today are overweight or obese. Common complications of pregnancy in this group of women are preeclampsia and gestational hypertension. These conditions are also observed more frequently in women with excessive weight gain during pregnancy. Preeclampsia is one of the most serious pregnancy complications with an unpredictable course, which in its most severe forms, threatens the life and health of the mother and her baby. The early identification of the risk factors for preeclampsia development, including obesity, allows for the implementation of prophylaxis and a reduction in maternal and fetal complications risk. Additionally, preeclampsia and obesity are the recognized risk factors for developing cardiovascular disease in later life, so prophylaxis and treating obesity are paramount for their prevention. Thus, a proper diet and physical activity might play an essential role in the prophylaxis of preeclampsia in this group of women. Limiting weight gain during pregnancy and modifying the metabolic risk factors with regular physical exercise creates favorable metabolic conditions for pregnancy development and benefits the elements of the pathogenetic sequence for preeclampsia development. In addition, it is inexpensive, readily available and, in the absence of contraindications to its performance, safe for the mother and fetus. However, for this form of prevention to be effective, it should be applied early in pregnancy and, for overweight and obese women, proposed as an essential part of planning pregnancy. This paper aims to present the mechanisms of the development of hypertension in pregnancy in obese women and the importance of exercise in its prevention

Zespół HELLP – patogeneza i postępowanie kliniczne

The HELLP syndrome is a serious complication of pregnancy characterized by haemolysis, elevated liverenzymes and low platelet count. In the past it was thought to be related to severe preeclampsia, nowadays itis believed to be a separate disease. Its pathogenesis remains to be elucidated – the importance of genetic andimmunological origins is highlighted. This review presents pathogenesis, diagnosis and management in patientswith the HELLP syndrome. About 70% of the cases develop before delivery, the majority between the 24th and37th gestational weeks; the remainder (rest) within 48 hours after delivery. The HELLP syndrome may be completeor incomplete. In the Tennessee Classification System, diagnostic criteria for HELLP are haemolysis with increasedLDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100 000/mm3. The Mississippi Triple-class HELLP Systemfurther classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and seriouscomplications are frequent. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week orthe foetal and/or maternal conditions (status) deteriorate. Conservative treatment (≥ 48 hours) is controversialbut may be considered in selected cases before 34 weeks' gestation. Most authors prefer a single course ofcorticosteroid therapy for RDS prophylaxis between 24th and 34th week of pregnancy. Standard corticosteroidtreatment is still of uncertain clinical value in the management of the maternal HELLP syndrome, but justifiedin some cases, mainly with severe thrombocytopenia. Blood pressure should be kept below 155/105 mm Hgas well as the therapy with MgSO4 should be offered to all patients with the HELLP syndrome

Nutrition as Prevention Factor of Gestational Diabetes Mellitus: A Narrative Review

Gestational diabetes mellitus (GDM) is defined as a glucose tolerance disorder with onset or first recognition during pregnancy. GDM is associated with several adverse maternal and neonatal outcomes. Management to reduce the incidence of GDM could decrease the incidence of these complications. Modification of nutrition in the prevention of GDM is postulated. The vital issue in GDM prevention is the implementation of proper dietary patterns, appropriate physical activity, and a combination of diet and lifestyle modifications. However, intervention studies examining the effects of diet and lifestyle on GDM prevention are contradictory. The aim of this study was to review the scientific evidence on nutritional prevention strategies, including diet and supplementation of some substances such as probiotics, micro/macroelements, fiber, myoinositol, and vitamins that may be effective in reducing the risk of GDM. The presented article is a narrative review. This article indicates that certain nutritional factors may have some benefit in preventing GDM. However, further studies in a variety of populations and large groups of patients are needed. At present, no definitive conclusions can be drawn as to the best intervention in the prevention of GDM

Ovarian Cancer and Pregnancy—A Current Problem in Perinatal Medicine: A Comprehensive Review

The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15&ndash;5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords &ldquo;ovarian cancer&rdquo;, &ldquo;ovarian malignancy&rdquo;, &ldquo;adnexal masses&rdquo;, &ldquo;ovarian tumor&rdquo; and &ldquo;pregnancy&rdquo; was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother&rsquo;s decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes