Biochemical profile and outcome in normal and high risk subjects

High total cholesterol and triglycerides levels increase arginases metabolism, impairing nitric oxide signaling and worsening fetoplacental endothelial dysfunction in gestational diabetes mellitus pregnancies

During human pregnancy, maternal physiological dyslipidemia (MPD) supports fetal development. However, some women develop maternal supraphysiological dyslipidemia (MSPD: increased total cholesterol (TC) and triglycerides (TG) levels). MSPD is present in normal and pregnancies with gestational diabetes mellitus (GDM). Both pathologies associate with fetoplacental endothelial dysfunction, producing alterations in nitric oxide (NO)-L-arginine/arginase metabolism. Nevertheless, the effect of MSPD on GDM, and how this synergy alters fetoplacental endothelial function is unknown, which is the aim of this study. 123 women at term of pregnancy were classified as MPD (n=40), MSPD (n=35), GDM with normal lipids (GDM- MPD, n=23) and with increased lipids (GDM-MSPD, n=25). TC ≥291 mg/dL and TG ≥275 mg/dL were considered as MSPD. Endothelial NO synthase (eNOS), human cationic amino acid transporter 1 (hCat1), and arginase II protein abundance and activity, were assayed in umbilical vein endothelial cells. In MSPD and MSPD-GDM, TC and TG increased respect to MPD and MPD-GDM. eNOS activity was reduced in MSPD and MSPD-GDM, but increased in MPD-GDM compared with MPD. No changes were observed in eNOS protein. However, decreased tetrahydrobiopterin levels were observed in all groups compared with MPD. Increased hCat1 protein and L-arginine transport were observed in both GDM groups compared with MPD. However, the transport was higher in GDM-MSPD compared to GDM-MPD. Higher Arginase II protein and activity were observed in MSPD-GDM compared with MPD. Thus, MSPD in GDM pregnancies alters fetal endothelial function associated with NO metabolism.

Serum vitamin E level and gestational diabetes mellitus: a systematic review and meta-analysis

Purpose

Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy. This systematic review aimed to evaluate the association between vitamin E and GDM.

Methods

Relevant articles from the Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, and EMBASE databases up to December 2019 were searched. The inclusion criteria were observational full-text articles. The fixed and random effect models were used to analyze the pooled data using Review Manager 5.3.

Results

Thirteen studies, including 596 participants, of whom 285 were diagnosed with GDM were included in the meta-analysis. The vitamin E level was significantly lower in women with GDM (MD: - 0.10; 95% CI: [-0.15, - 0.05]). The level of vitamin E was not different between overweight women with GDM and healthy pregnant women (MD: 0.03; 95% CI: [-0.08, 0.013]). The level of vitamin E was significantly lower in the third trimester of pregnancy in GDM women in comparison to the healthy pregnant women(MD: -0.09; 95% CI: [-0.12, -0.06]).

Conclusion

This study showed that the level of vitamin E is significantly lower in GDM women compared to healthy pregnant women.

Effect of nutritional status of pregnant women on birth weight of newborns at Butajira Referral Hospital, Butajira, Ethiopia

Back ground:

Maternal nutritional status influences the developmental environment of the fetus which consequently affects the birth weight of the newborn. However, the association between maternal nutritional factors and birth weight is complex and is not well characterized in Ethiopia.

Objective:

To assess the effect of maternal anthropometry and biochemical profile on birth weight of babies at Butajira Referral Hospital, Butajira, Ethiopia.

Methods and materials:

Laboratory-based cross-sectional study was conducted among 337 pregnant women at the hospital. Socio-demographic and obstetric characteristics were collected using pre-tested questionnaires. Blood sample was collected from each pregnant women for determination of total serum protein, total serum cholesterol and hemoglobin level. However, maternal dietary habits were not assessed in this study.

Results:

A total of 337 pregnant women were involved in the study. The mean (standard deviation) birth weight of the newborns was 3.14 ± 0.46 kg. After adjusting for different maternal factors, parity (p = 0.013), hemoglobin level (p = 0.046), pre-pregnancy body mass index (p < 0.001) and weight gain during pregnancy (p < 0.001) were positively associated with birth weight of the newborns, while the associations with total protein (p = 0.822) and total cholesterol (p = 0.423) were not significant.

Conclusion:

This study has shown that nutritional status of pregnant women as indicated by maternal anthropometry and hemoglobin level was associated with birth weight of the baby. Therefore, nutritional status of the pregnant women should be improved to reduce the risk of low birth weight.

Complex and irregular heart rate dynamics in fetuses compromised by maternal anemia as a high-risk pregnancy

AIM

To examine how complex and irregular fetal heart rate (FHR) dynamics differ between fetuses of normal pregnancies and those of pregnancies complicated by maternal anemia (MA), and to place this in the context of high-risk pregnancies.

METHODS

Our study population consisted of 97 pregnant women affected by MA, 118 affected by pregnancy-induced hypertension (PIH), 88 affected by gestational diabetes mellitus (GDM), 53 with preterm premature rupture of membranes (pPROM), and 356 normal pregnancies as controls. We calculated approximate entropy (ApEn), sample entropy (SampEn), and correlation dimension (CD) to quantify irregularity and the chaotic dynamics of each FHR time series.

RESULTS

The ApEn in the fetuses of the MA and PIH groups was significantly lower than that of the normal controls (P<0.05). The SampEn was significantly lower in the high-risk groups, except for the pPROM group, than in the normal controls (P<0.05). The CD in the PIH and severe MA groups was significantly lower than that of the normal controls (P<0.05, respectively). In the MA group, the dynamic indices showed a highly significant positive correlation with hemoglobin (Hb) levels (P<0.0001).

CONCLUSION

The decreased complexity and/or irregularity in the FHR from pregnancies with MA may reflect abnormalities in the complex, integrated cardiovascular control. The irregularity and complexity of the FHR increased together with Hb levels in pregnancies with MA. Our data suggest that the integrity of the nervous system in the fetuses compromised by severe MA might result directly in adverse outcomes.

Effects of lifestyle factors on urinary oxidative stress and serum antioxidant markers in pregnant Japanese women: A cohort study

Oxidative stress plays a major pathological role in pregnancy-related complications. Although oxidative stress is induced by exogenous toxins in association with a poor lifestyle in normal subjects, there is little information on the factors altering oxidative stress and antioxidant levels during pregnancy. The purpose of this study was to determine the relationship between lifestyle factors and oxidative stress/antioxidant levels during each trimester and 1-month postpartum. This prospective cohort study followed 54 healthy women through pregnancy; first, second, and third trimester and 1-month postpartum. Participants were administered a questionnaire on characteristics and lifestyle factors. Morning blood and urine samples were obtained to measure urinary biopyrrins and serum coenzyme Q10 (CoQ10) levels. The levels of urinary biopyrrins and serum CoQ10 increased significantly throughout pregnancy, with peak values registered during the third trimester. Higher biopyrrin levels were significantly associated with non-consumption of morning meal during the first trimester, smoking during the third trimester and 1-month postpartum, alcohol consumption during the third trimester, high food-based polyunsaturated fatty acid intake during the third trimester, and poor mental health scores during the first and third trimesters. Higher CoQ10 levels were significantly associated with no smoking during pregnancy and at 1-month postpartum, and with a high frequency of exercise during the third trimester and 1-month postpartum. Thus, pregnancy represents a state of oxidative stress, which can be counterbalanced by increased levels of antioxidants, such as CoQ10. We speculate that certain lifestyle choices such as avoiding smoking can reduce oxidative stress and increase antioxidant levels during pregnancy.

Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis

BACKGROUND

Lipid levels during pregnancy in women with gestational diabetes mellitus (GDM) have been extensively studied; however, it remains unclear whether dyslipidaemia is a potential marker of preexisting insulin resistance.

OBJECTIVE

To evaluate the relationship between lipid measures throughout pregnancy and GDM.

SEARCH STRATEGY

We searched PubMed-MedLine and SCOPUS (inception until January 2014) and reference lists of relevant studies.

SELECTION CRITERIA

Publications describing original data with at least one raw lipid (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], or triglyceride) measurement during pregnancy in women with GDM and healthy pregnant controls were retained.

DATA COLLECTION AND ANALYSIS

Data extracted from 60 studies were pooled and weighted mean difference (WMD) in lipid levels was calculated using random effects models. Meta-regression was also performed to identify sources of heterogeneity.

MAIN RESULTS

Triglyceride levels were significantly elevated in women with GDM compared with those without GDM (WMD 30.9, 95% confidence interval [95% CI] 25.4-36.4). This finding was consistent in the first, second and third trimesters of pregnancy. HDL-C levels were significantly lower in women with GDM compared with those without GDM in the second (WMD -4.6, 95% CI -6.2 to -3.1) and third (WMD -4.1, 95% CI -6.5 to -1.7) trimesters of pregnancy. There were no differences in aggregate total cholesterol or LDL-C levels between women with GDM and those without insulin resistance.

AUTHOR'S CONCLUSIONS

Our meta-analysis shows that triglycerides are significantly elevated among women with GDM compared with women without insulin resistance and this finding persists across all three trimesters of pregnancy.

Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis

OBJECTIVES

To summarise evidence on the associations of maternal anaemia and prenatal iron use with maternal haematological and adverse pregnancy outcomes; and to evaluate potential exposure-response relations of dose of iron, duration of use, and haemoglobin concentration in prenatal period with pregnancy outcomes.

DESIGN

Systematic review and meta-analysis

DATA SOURCES

Searches of PubMed and Embase for studies published up to May 2012 and references of review articles.

STUDY SELECTION CRITERIA

Randomised trials of prenatal iron use and prospective cohort studies of prenatal anaemia; cross sectional and case-control studies were excluded.

RESULTS

48 randomised trials (17 793 women) and 44 cohort studies (1 851 682 women) were included. Iron use increased maternal mean haemoglobin concentration by 4.59 (95% confidence interval 3.72 to 5.46) g/L compared with controls and significantly reduced the risk of anaemia (relative risk 0.50, 0.42 to 0.59), iron deficiency (0.59, 0.46 to 0.79), iron deficiency anaemia (0.40, 0.26 to 0.60), and low birth weight (0.81, 0.71 to 0.93). The effect of iron on preterm birth was not significant (relative risk 0.84, 0.68 to 1.03). Analysis of cohort studies showed a significantly higher risk of low birth weight (adjusted odds ratio 1.29, 1.09 to 1.53) and preterm birth (1.21, 1.13 to 1.30) with anaemia in the first or second trimester. Exposure-response analysis indicated that for every 10 mg increase in iron dose/day, up to 66 mg/day, the relative risk of maternal anaemia was 0.88 (0.84 to 0.92) (P for linear trend<0.001). Birth weight increased by 15.1 (6.0 to 24.2) g (P for linear trend=0.005) and risk of low birth weight decreased by 3% (relative risk 0.97, 0.95 to 0.98) for every 10 mg increase in dose/day (P for linear trend<0.001). Duration of use was not significantly associated with the outcomes after adjustment for dose. Furthermore, for each 1 g/L increase in mean haemoglobin, birth weight increased by 14.0 (6.8 to 21.8) g (P for linear trend=0.002); however, mean haemoglobin was not associated with the risk of low birth weight and preterm birth. No evidence of a significant effect on duration of gestation, small for gestational age births, and birth length was noted.

CONCLUSIONS

Daily prenatal use of iron substantially improved birth weight in a linear dose-response fashion, probably leading to a reduction in risk of low birth weight. An improvement in prenatal mean haemoglobin concentration linearly increased birth weight.