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Klemetti MM, Teramo K, Kautiainen H, Wasenius N, Eriksson JG, Laine MK. Late-Pregnancy Fetal Hypoxia Is Associated With Altered Glucose Metabolism and Adiposity in Young Adult Offspring of Women With Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:738570. [PMID: 34777246 PMCID: PMC8578885 DOI: 10.3389/fendo.2021.738570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate associations between exposure to fetal hypoxia and indicators of metabolic health in young adult offspring of women with type 1 diabetes (OT1D). METHODS 156 OT1D born between 7/1995 and 12/2000 at Helsinki University Hospital, Finland, were invited for follow-up between 3/2019 and 11/2019. A control group of 442 adults born from non-diabetic pregnancies, matched for date and place of birth, was obtained from the Finnish Medical Birth Register. In total, 58 OT1D and 86 controls agreed to participate. All OT1D had amniotic fluid (AF) sampled for erythropoietin (EPO) measurement within two days before delivery in order to diagnose fetal hypoxia. In total, 29 OTID had an AF EPO concentration <14.0 mU/l, defined as normal, and were categorized into the low EPO (L-EPO) group. The remaining 29 OT1D had AF EPO ≥14.0 mU/ml, defined as fetal hypoxia, and were categorized into the high EPO (H-EPO) group. At the age of 18-23 years, participants underwent a 2-h 75g oral glucose tolerance test (OGTT) in addition to height, weight, waist circumference, body composition, blood pressure, HbA1c, cholesterol, triglyceride, high-sensitivity CRP and leisure-time physical activity measurements. RESULTS Two OT1D were diagnosed with diabetes and excluded from further analyses. At young adult age, OT1D in the H-EPO group had a higher BMI than those in the L-EPO group. In addition, among female participants, waist circumference and body fat percentage were highest in the H-EPO group. In the OGTTs, the mean (SD) 2-h post-load plasma glucose (mmol/L) was higher in the H-EPO [6.50 (2.11)] than in the L-EPO [5.21 (1.10)] or control [5.67 (1.48)] offspring (p=0.009). AF EPO concentrations correlated positively with 2-h post-load plasma glucose [r=0.35 (95% CI: 0.07 to 0.62)] and serum insulin [r=0.44 (95% CI: 0.14 to 0.69)] concentrations, even after adjusting for maternal BMI, birth weight z-score, gestational age at birth and adult BMI. Control, L-EPO and H-EPO groups did not differ with regards to other assessed parameters. CONCLUSIONS High AF EPO concentrations in late pregnancy, indicating fetal hypoxia, are associated with increased adiposity and elevated post-load glucose and insulin concentrations in young adult OT1D.
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Affiliation(s)
- Miira M. Klemetti
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Medical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
- *Correspondence: Miira M. Klemetti,
| | - Kari Teramo
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | | | - Johan G. Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- National University of Singapore, Yong Loo Lin School of Medicine, Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
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Hashimoto K, Clapp JF. The Effect of Nuchal Cord on Amniotic Fluid and Cord Blood Erythropoietin at Delivery. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1071-55760300139-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kazumasa Hashimoto
- Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan; Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho, Izumi, Osaka 594-1101, Japan
| | - James F. Clapp
- Department of Reproductive Biology, Case Western Reserve University at Metro Health Medical Center, Cleveland, Ohio; Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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Timur H, Tokmak A, Taflan S, Hançerlioğullari N, Laleli B, İnal HA, Moraloğlu Ö, Danişman N. Investigation of maternal and cord blood erythropoietin and copeptin levels in low-risk term deliveries complicated by meconium-stained amniotic fluid. J Matern Fetal Neonatal Med 2016; 30:665-669. [DOI: 10.1080/14767058.2016.1182973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Hakan Timur
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Aytekin Tokmak
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Selen Taflan
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Necati Hançerlioğullari
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Bergen Laleli
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Hasan Ali İnal
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Özlem Moraloğlu
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Nuri Danişman
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
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Gun Eryilmaz O, Tavil B, Turan S, Yumusak O, Doganay M, Uzunlar O, Akar S, Eyi EG. Hepcidin and erythropoietin measurements in the cord blood of neonates with meconium-stained amniotic fluid. J Obstet Gynaecol Res 2012; 39:175-9. [PMID: 22672260 DOI: 10.1111/j.1447-0756.2012.01896.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To compare hepcidin and erythropoietin levels in the cord blood of neonates with meconium-stained amniotic fluid (MSAF) to levels obtained from age-, body mass index- and gravidity-matched neonates with clear amniotic fluid. METHODS A cross-sectional controlled study was conducted in secondary and tertiary care centers. Cord blood samples of 40 neonates following term gestations (≥37 weeks' gestation) with MSAF and 40 maternal age-, body mass index- and gravidity-matched controls with clear amniotic fluid were analyzed in this study. Demographic data, delivery outcomes and laboratory evaluations were recorded. RESULTS Cord blood pH levels were lower in fetuses with MSAF when compared to those with clear amniotic fluid (P=0.0001). Fetuses with MSAF had higher cord blood erythropoietin levels in comparison to those with clear amniotic fluid (P=0.0001). Delivery outcomes and hepcidin measurements were similar in both groups. CONCLUSIONS We demonstrated a significant relationship between erythropoietin levels and meconium passage, but failed to show the existence of a relationship between hepcidin levels and meconium passage.
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Affiliation(s)
- Ozlem Gun Eryilmaz
- Department of Perinatology, Zekai Tahir Burak Women's Education and Research Hospital Department of Hematology, Ankara Children's Hospital Department of Biochemistry, Ankara Numune Hospital, Ankara, Turkey
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Abstract
Tissue hypoxia is the major stimulus of erythropoietin (EPO) synthesis in fetuses and adults. Since EPO does not cross the placenta and is not stored, fetal plasma and amniotic fluid levels indicate EPO synthesis and elimination. Acutely, the rate and magnitude of the increase in plasma EPO levels correlate with the intensity of hypoxia. Amniotic fluid EPO levels correlate with cord plasma levels in normal and abnormal pregnancies, with fetal plasma EPO levels in humans averaging 2.6 times higher than the corresponding amniotic fluid EPO levels. Recent experimental and clinical studies demonstrate that EPO has neuroprotective effects related to its anti-apoptotic and vascular growth-promoting properties. Although under basal conditions the fetal kidneys are the main site of EPO production, during hypoxia recent experimental data indicate an important role of the placenta. Amniotic fluid EPO levels have been shown to increase exponentially during fetal hypoxia in preeclamptic, diabetic and Rh-immunized pregnancies, to correlate inversely with cord blood pH, pO(2) and base excess and to predict neonatal morbidities and NICU admission. As an indicator of chronic intrauterine hypoxia, fetal EPO measurements have increased our knowledge about the pathogenesis and importance of intrauterine growth restriction, macrosomia, diabetic pregnancy, prolonged pregnancy, meconium staining, fetal hemorrhage, fetal anemia, maternal smoking and alcohol consumption, abnormal fetal heart rate and abnormal Doppler flow patterns. While the clinical utility of fetal amniotic fluid and plasma EPO measurements in the management of high-risk pregnancies and their offspring is promising, adequately powered clinical trials are urgently needed.
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Affiliation(s)
- Kari A Teramo
- Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland.
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Jain V, Lim M, Longo M, Fisk NM. Inhibitory effect of erythropoietin on contractility of human chorionic plate vessels. Am J Obstet Gynecol 2006; 194:246. [PMID: 16389039 DOI: 10.1016/j.ajog.2005.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Revised: 04/07/2005] [Accepted: 05/06/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Placenta is a major source of erythropoietin production in the fetus; hypoxia is associated with elevated erythropoietin levels in the fetal circulation. We investigated fetoplacental vascular reactivity after exposure to erythropoietin in vitro. STUDY DESIGN Third-order chorionic plate arteries from human term placentae were incubated in culture medium with or without erythropoietin (3 U/mL) for 24 hours. Vessels were mounted in a myograph for isometric tension recording, and their responses to vasopressors and vasorelaxants were studied. RESULTS Contractile responses to endothelin-1 and the thromboxane analogue U46619 were decreased in erythropoietin-exposed vessels compared with controls. Relaxant responses to the nitric oxide donor sodium nitroprusside and the phosphodiesterase inhibitor papaverine were not influenced by erythropoietin. CONCLUSION Exposure to elevated levels of erythropoietin has an inhibitory effect on contractile responses in human placental chorionic plate arteries. We speculate that this may improve fetoplacental perfusion in hypoxic fetuses with elevated erythropoietin production.
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Affiliation(s)
- Venu Jain
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.
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Morley R, Moore VM, Dwyer T, Owens JA, Umstad MP, Carlin JB. Association between erythropoietin in cord blood of twins and size at birth: does it relate to gestational factors or to factors during labor or delivery? Pediatr Res 2005; 57:680-4. [PMID: 15718359 DOI: 10.1203/01.pdr.0000156505.12614.ff] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We hypothesized that cord blood erythropoietin (EPO), a marker of fetal hypoxia, relates to gestational factors and not solely those associated with delivery. We investigated the association between birth weight SD score (SDS) and cord blood EPO in 290 twins (145 pairs), assessing the influence of gestational versus perinatal factors by comparing the association in those who were delivered by elective cesarean (CS) with that in other delivery modes. Blood EPO values were skewed, so geometric means are presented and log EPO values were used in statistical models. The birth size-EPO association was estimated in mixed-effects models that included terms that represented difference in log EPO and mean log EPO for each twin pair. Within-pair estimates of the association were unconfounded by maternal factors (because these were perfectly controlled). Geometric mean EPO was higher in boys versus girls (24.4 versus 17.0 IU/L; p = 0.0001) and increased with gestational age (p = 0.0003) but was similar after elective CS versus other delivery modes. The negative birth size-EPO association was stronger in infants who were delivered by elective CS than by other delivery modes [beta for log(2) EPO: -0.56 (95% CI, -0.77 to -0.36) versus -0.27 (-0.42 to -0.12), respectively; p = 0.02 for interaction). Because the association was seen after elective CS delivery, cord blood EPO must relate to factors during gestation, not just perinatal factors. There was no evidence of an association between birth weight SDS and pair mean log EPO, indicating that the association is entirely due to fetus-specific rather than pair-specific factors.
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Affiliation(s)
- Ruth Morley
- Department of Pediatrics, University of Melbourne, and Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria 3052, Australia.
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Teramo KA, Hiilesmaa VK, Schwartz R, Clemons GK, Widness JA. Amniotic fluid and cord plasma erythropoietin levels in pregnancies complicated by preeclampsia, pregnancy-induced hypertension and chronic hypertension. J Perinat Med 2004; 32:240-7. [PMID: 15188798 DOI: 10.1515/jpm.2004.045] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The purpose of the present study was to compare fetal and neonatal outcomes with amniotic fluid erythropoietin (EPO) levels obtained in the antepartum period in pregnancies complicated by preeclampsia, pregnancy-induced hypertension or chronic hypertension. METHODS Erythropoietin concentrations were measured in amniotic fluid within 2 days before delivery and in cord blood at birth in 75 hypertensive women and in 23 healthy controls delivered by cesarean section before labor contractions. Erythropoietin levels did not influence clinical decisions. RESULTS Amniotic fluid erythropoietin levels correlated highly significantly with cord plasma EPO levels and were significantly higher in pregnancies complicated by hypertension than in control pregnancies. Umbilical arterial pH, acid-base and blood gas values at birth were not different from controls. Both cord plasma and amniotic fluid erythropoietin levels correlated with cord blood pH, acid-base and blood gas values at birth in the study group. Newborn infants admitted to the newborn intensive care unit had significantly higher fetal erythropoietin levels and were more acidotic, hypoxemic and hypoglycemic than infants admitted to the normal care nursery. CONCLUSIONS Our findings suggest that elevated amniotic fluid erythropoietin levels are markers of chronic or subchronic fetal hypoxia and are associated with neonatal morbidity in pregnancies complicated by hypertension.
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Affiliation(s)
- Kari A Teramo
- Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland.
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Clapp JF, Little KD, Widness JA. Effect of maternal exercise and fetoplacental growth rate on serum erythropoietin concentrations. Am J Obstet Gynecol 2003; 188:1021-5. [PMID: 12712104 DOI: 10.1067/mob.2003.232] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study was undertaken to test the null hypotheses that neither weight-bearing exercise nor fetoplacental growth has a short- or long-term effect on the maternal serum erythropoietin level. STUDY DESIGN Serial blood samples were obtained before and after exercise from seven women who exercised regularly and seven physically active controls before pregnancy and at 8, 16, 24, 32, and 38 weeks' gestation. Fetoplacental growth was assessed both in midpregnancy (ultrasound) and at birth (morphometry). RESULTS Maternal serum erythropoietin levels rose with advancing gestation in both groups. Individual patterns, however, were quite variable and not related to differences in fetoplacental growth. There were no significant between-group differences at any time point, but levels rose after exercise in mid and late pregnancy. CONCLUSION The highly variable, pregnancy-associated changes in maternal serum erythropoietin were unrelated to variability in fetoplacental growth or maternal hematocrit. Absolute levels of erythropoietin are not influenced by regular exercise before or during pregnancy, but small acute elevations are seen after exercise in mid and late pregnancy.
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Affiliation(s)
- James F Clapp
- Department of Reproductive Biology, Schwartz Center for Metabolism and Nutrition, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA.
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