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The role of plasminogen activator inhibitor-1 in gynecological and obstetrical diseases: an update review. J Reprod Immunol 2022; 150:103490. [DOI: 10.1016/j.jri.2022.103490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/21/2022]
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Retnakaran R. Hyperglycemia in pregnancy and its implications for a woman's future risk of cardiovascular disease. Diabetes Res Clin Pract 2018; 145:193-199. [PMID: 29679623 DOI: 10.1016/j.diabres.2018.04.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/04/2018] [Indexed: 01/13/2023]
Abstract
It is well established that gestational diabetes mellitus (GDM) identifies a population of women who are at risk of ultimately developing type 2 diabetes (T2DM) later in life. Moreover, this relationship extends across the full spectrum of hyperglycemia in pregnancy, with lesser degrees of gestational dysglycemia identifying a proportionate gradient of future risk of T2DM. Importantly, a growing body of evidence suggests that an analogous relationship exists between hyperglycemia in pregnancy and a woman's long-term risk of cardiovascular disease (CVD), as well. Indeed, as compared to their peers, woman who had GDM have a higher risk of major cardiovascular events, which first manifests within the first decade after the index pregnancy. Although the absolute incidence of such events remains low in young women of child-bearing age, the identification of future risk of CVD at this early point in its natural history may provide the unique opportunity for timely intervention and ideally disease prevention. Thus, in this review, we discuss the emerging concept of hyperglycemia in pregnancy as an indicator of the future risk of CVD in young women and its implications for research and clinical practice.
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Affiliation(s)
- Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada; Division of Endocrinology, University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
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Ye Y, Vattai A, Zhang X, Zhu J, Thaler CJ, Mahner S, Jeschke U, von Schönfeldt V. Role of Plasminogen Activator Inhibitor Type 1 in Pathologies of Female Reproductive Diseases. Int J Mol Sci 2017; 18:ijms18081651. [PMID: 28758928 PMCID: PMC5578041 DOI: 10.3390/ijms18081651] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 01/13/2023] Open
Abstract
Normal pregnancy is a state of hypercoagulability with diminishing fibrinolytic activity, which is mainly caused by an increase of plasminogen activator inhibitor type 1 (PAI-1). PAI-1 is the main inhibitor of plasminogen activators, including tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA). In human placentas, PAI-1 is expressed in extravillous interstitial trophoblasts and vascular trophoblasts. During implantation and placentation, PAI-1 is responsible for inhibiting extra cellular matrix (ECM) degradation, thereby causing an inhibition of trophoblasts invasion. In the present study, we have reviewed the literature of various reproductive diseases where PAI-1 plays a role. PAI-1 levels are increased in patients with recurrent pregnancy losses (RPL), preeclampsia, intrauterine growth restriction (IUGR), gestational diabetes mellitus (GDM) in the previous pregnancy, endometriosis and polycystic ovary syndrome (PCOS). In general, an increased expression of PAI-1 in the blood is associated with an increased risk for infertility and a worse pregnancy outcome. GDM and PCOS are related to the genetic role of the 4G/5G polymorphism of PAI-1. This review provides an overview of the current knowledge of the role of PAI-1 in reproductive diseases. PAI-1 represents a promising monitoring biomarker for reproductive diseases and may be a treatment target in the near future.
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Affiliation(s)
- Yao Ye
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians University of Munich, Campus Großhadern: Marchioninistr. 15, 81377 Munich and Campus Innenstadt: Maistr. 11, 80337 Munich, Germany.
| | - Aurelia Vattai
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians University of Munich, Campus Großhadern: Marchioninistr. 15, 81377 Munich and Campus Innenstadt: Maistr. 11, 80337 Munich, Germany.
| | - Xi Zhang
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians University of Munich, Campus Großhadern: Marchioninistr. 15, 81377 Munich and Campus Innenstadt: Maistr. 11, 80337 Munich, Germany.
| | - Junyan Zhu
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians University of Munich, Campus Großhadern: Marchioninistr. 15, 81377 Munich and Campus Innenstadt: Maistr. 11, 80337 Munich, Germany.
| | - Christian J Thaler
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians University of Munich, Campus Großhadern: Marchioninistr. 15, 81377 Munich and Campus Innenstadt: Maistr. 11, 80337 Munich, Germany.
| | - Sven Mahner
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians University of Munich, Campus Großhadern: Marchioninistr. 15, 81377 Munich and Campus Innenstadt: Maistr. 11, 80337 Munich, Germany.
| | - Udo Jeschke
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians University of Munich, Campus Großhadern: Marchioninistr. 15, 81377 Munich and Campus Innenstadt: Maistr. 11, 80337 Munich, Germany.
| | - Viktoria von Schönfeldt
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians University of Munich, Campus Großhadern: Marchioninistr. 15, 81377 Munich and Campus Innenstadt: Maistr. 11, 80337 Munich, Germany.
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Kebapcilar L, Kebapcilar AG, Ilhan TT, Ipekci SH, Baldane S, Pekin A, Kulaksizoglu M, Celik C. Is the Mean Platelet Volume a Predictive Marker of a Low Apgar Score and Insulin Resistance in Gestational Diabetes Mellitus? A Retrospective Case-Control Study. J Clin Diagn Res 2016; 10:OC06-OC10. [PMID: 27891368 DOI: 10.7860/jcdr/2016/20874.8611] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/23/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Gestational diabetes is defined as various degrees of glucose intolerance diagnosed or detected for the first time during pregnancy and is the most common metabolic complication of pregnancy. Early diagnosis and adequate treatment are important to prevent complications. Pre-eclampsia, polyhydramnios, fetalmacrosomia, and operative delivery are some of the complications seen in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM). AIM The present study was designed to determine whether there was an association between Mean Platelet Volume (MPV) in predicting poor fetal outcome, insulin resistance, neonatal Apgar scores and gestational age for women with GDM. MATERIALS AND METHODS In this retrospective study, we enrolled 101 pregnant women with GDM together with a group of 138 healthy controls. MPV, insulin and homeostatic model assessment (HOMA-IR) values were measured at 24-28 weeks of the pregnancy. An independent samples t-test was used to compare MPV values. Multivariate linear regression models were used to establish relations between MPV values, HOMA-IR, insulin levels and Apgar score. RESULTS There was a significant positive correlation between MPV values, HOMA-IR and Insulin levels and a negative correlation with Apgar score at 1 min and 5 min in the GDM group (r=0.227, p=0.02; r=0.206, p=0.03; r=-0.485, p<0.001; and r=-0.399, p<0.001, respectively). In the multivariate logistic regression analysis, a high MPV value was most consistently associated with a low Apgar 1 min score (β=-0.387, p=0.003) in the GDM group. An MPV of >8.0 fL had a sensitivity of 82% and a specificity of 75% for the prediction of GDM. CONCLUSION We investigated the potential of MPV values in predicting low Apgar scores and insulin resistance in women with GDM.
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Affiliation(s)
- Levent Kebapcilar
- Associate Professor, Department of Internal Medicine, Division of Endocrinology and Metabolism, Selcuk University , Konya, Turkey
| | - Ayse Gul Kebapcilar
- Associate Professor, Department of Gynecology and Obstetrics, Selcuk University , Konya, Turkey
| | - Tolgay Tuyan Ilhan
- Assistant Professor, Department of Gynecology and Obstetrics, Selcuk University , Konya, Turkey
| | - Suleyman Hilmi Ipekci
- Associate Professor, Department of Internal Medicine, Division of Endocrinology and Metabolism, Selcuk University , Konya, Turkey
| | - Suleyman Baldane
- Assistant Professor, Department of Internal Medicine, Division of Endocrinology and Metabolism, Selcuk University , Konya, Turkey
| | - Aybike Pekin
- Associate Professor, Department of Gynecology and Obstetrics, Selcuk University , Konya, Turkey
| | - Mustafa Kulaksizoglu
- Associate Professor, Department of Internal Medicine, Division of Endocrinology and Metabolism, Necmettin Erbakan University , Konya, Turkey
| | - Cetin Celik
- Professor, Department of Gynecology and Obstetrics, Selcuk University , Konya, Turkey
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Harreiter J, Dovjak G, Kautzky-Willer A. Gestational diabetes mellitus and cardiovascular risk after pregnancy. ACTA ACUST UNITED AC 2014; 10:91-108. [PMID: 24328601 DOI: 10.2217/whe.13.69] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Gestational diabetes mellitus (GDM) affects many women in pregnancy and is enhanced by epidemic conditions of obesity, increasing age at the time of the first pregnancy, stressful life conditions, a sedentary lifestyle with less physical activity and unhealthy nutrition with highly processed, high-calorie food intake. GDM does not affect the mother and offspring in pregnancy alone, as there is compelling evidence of the long-term effects of the hyperglycemic state in pregnancy postpartum. Type 2 diabetes mellitus, cardiovascular disease and metabolic syndrome are more common in GDM women, and even the offspring of GDM women are reported to have higher obesity rates and a higher risk for noncommunicable diseases. Early prevention of risk factors seems to be key to overcoming the vicious cycle of cardiometabolic disease onset.
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Affiliation(s)
- Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology & Metabolism, Department of Medicine III, Medical University Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
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Sokup A, Ruszkowska-Ciastek B, Walentowicz-Sadłecka M, Grabiec M, Rość D. Gestational diabetes mellitus worsens the profile of cardiometabolic risk markers and decrease indexes of beta-cell function independently of insulin resistance in nondiabetic women with a parental history of type 2 diabetes. J Diabetes Res 2014; 2014:743495. [PMID: 25097861 PMCID: PMC4109116 DOI: 10.1155/2014/743495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/14/2014] [Accepted: 05/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Women with a history of both parental type 2 diabetes (pt2DM) and previous gestational diabetes (pGDM) represent a group at high risk of cardiovascular events. We hypothesized that pGDM changes cardiometabolic risk markers levels as well as theirs associations with glucose indices in nondiabetic pt2DM women. METHODS Anthropometric parameters, glucose regulation (OGTT), insulin resistance (HOMA-IR), beta-cell function, lipid levels, parameters of endothelial dysfunction, and inflammation were evaluated in 55 women with pt2DM, 40 with both pt2DM and pGDM 2-24 months postpartum, and 35 controls. RESULTS Prediabetes was diagnosed more frequently in women with both pt2DM and pGDM in comparison with women with only pt2DM (10 versus 8, P = 0.04). The pGDM group had higher LDL-cholesterol, sICAM-1, tPa Ag, fibrinogen, and lower beta-cell function after adjustment for HOMA-IR, in comparison with pt2DM group. In pt2DM group postchallenge glucose correlated independently with hsCRP and in pGDM group fasting glucose with HOMA-IR. CONCLUSIONS pGDM exerts a combined effect on cardiometabolic risk markers in women with pt2DM. In these women higher LDL-cholesterol, fibrinogen, sICAM-1, tPa Ag levels and decreased beta cell function are associated with pGDM independently of HOMA-IR index value. Fasting glucose is an important cardiometabolic risk marker and is independently associated with HOMA-IR.
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Affiliation(s)
- Alina Sokup
- Department of Gastroenterology, Angiology and Internal Diseases, Nicolaus Copernicus University, Dr. J. Biziel University Hospital, Ujejskiego 75, 85-168 Bydgoszcz, Poland
- Department of Endocrinology, Dr. J. Biziel University Hospital, Ujejskiego 75, 85-168 Bydgoszcz, Poland
- *Alina Sokup:
| | - Barbara Ruszkowska-Ciastek
- Department of Pathophysiology, Nicolaus Copernicus University, Dr. A. Jurasz University Hospital, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Małgorzata Walentowicz-Sadłecka
- Department of Obstetrics and Gynecology, Nicolaus Copernicus University, Dr. J. Biziel University Hospital, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Marek Grabiec
- Department of Obstetrics and Gynecology, Nicolaus Copernicus University, Dr. J. Biziel University Hospital, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Danuta Rość
- Department of Pathophysiology, Nicolaus Copernicus University, Dr. A. Jurasz University Hospital, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
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Sak ME, Soydinç HE, Ozler A, Evsen MS, Turgut A, Sak S, Gül T. Platelet profile in patients with gestational diabetes: a retrospective study. J Turk Ger Gynecol Assoc 2012; 13:223-6. [PMID: 24592046 DOI: 10.5152/jtgga.2012.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/04/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and compare alterations in the morphology and function of platelets occurring in gestational diabetes and healthy pregnancies. MATERIAL AND METHODS A retrospective study was performed of 77 pregnant women: 42 cases with gestational diabetes and 35 healthy controls. The two groups were compared in terms of demographics and platelet parameters derived from complete blood counts. RESULTS The mean platelet volume (p=0.001) and HbA1c (p<0.001) were significantly increased in the patients with gestational diabetes. The mean platelet volume was well correlated with the platelet distribution width (rs=0.404, p<0.001) and the platelet count (rs=0.355, p=0.002). CONCLUSION The mean platelet volume and other platelet parameters may significantly aid the identification of diabetic pregnants at risk for vascular complications. The role and possible clinical relevance of these changes during diabetic pregnancy need to be investigated in further studies.
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Affiliation(s)
- Muhammet Erdal Sak
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Hatice Ender Soydinç
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Ali Ozler
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Mehmet Sıddık Evsen
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Abdülkadir Turgut
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Sibel Sak
- Diyarbakır Maternity And Children Hospital, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Talip Gül
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
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Alterations of sympathetic nervous system, coagulation and platelet function in gestational diabetes. Blood Coagul Fibrinolysis 2012; 23:508-13. [DOI: 10.1097/mbc.0b013e3283540c2d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bozkurt L, Göbl CS, Tura A, Chmelik M, Prikoszovich T, Kosi L, Wagner O, Roden M, Pacini G, Gastaldelli A, Kautzky-Willer A. Fatty liver index predicts further metabolic deteriorations in women with previous gestational diabetes. PLoS One 2012; 7:e32710. [PMID: 22393439 PMCID: PMC3290578 DOI: 10.1371/journal.pone.0032710] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 02/03/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Determinants of fatty liver (FL) might be predictive for further deterioration in insulin resistance (IR) in women with previous gestational diabetes (pGDM). The aim was to evaluate the association between pGDM, FL and future manifestation of type 2 diabetes (T2DM) by a detailed pathophysiological characterization early after pregnancy. METHODS 68 pGDM and 29 healthy controls were included 3-6 months after delivery and underwent specific metabolic assessments: status of IR was determined via oral- and intravenous-glucose-tolerance-tests with analysis of proinflammatory factors and kinetics of free-fatty-acids (FFA). According to the fatty-liver-index (FLI), pGDMs were categorized into three groups with low (FLI≤20), intermediate (20 RESULTS FL was strongly associated with IR in pGDM. pGDM with FLI≥60 showed significantly increased interleukin-6, plasminogen-activator-inhibitor-1, tissue-plasminogen-activator, fibrinogen and increased ultrasensitive-C-reactive-protein compared to the low risk group (FLI≤20). Analysis of FFA indicated a less pronounced decrease of plasma FFA levels during the oral-glucose-tolerance-test in subjects with FLI≥60. History of GDM plus FLI≥60 conferred a high risk for the manifestation of diabetes over 10 years of observation as compared to pGDMs with FLI≤20 (HR:7.85, Cl:2.02-30.5, p = 0.003). CONCLUSION FL is closely linked to GDM, especially to IR and inflammation. Most interestingly, subjects with the highest FLI values showed significant alterations in FFA kinetics and a higher risk to develop T2DM in future.
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Affiliation(s)
- Latife Bozkurt
- Unit of Gender Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian S. Göbl
- Unit of Gender Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Feto-Maternal Medicine, Department of Gyneacology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Andrea Tura
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy
| | - Marek Chmelik
- High Field Magnetic Resonance Centre of Excellence, Medical University of Vienna, Vienna, Austria
| | - Thomas Prikoszovich
- Unit of Gender Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lana Kosi
- Unit of Gender Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Oswald Wagner
- Chemical Laboratory Diagnostics, Clinical Institute for Medical, Medical University of Vienna, Vienna, Austria
| | - Michael Roden
- Department of Metabolic Diseases, German Diabetes Center, Leibniz Center for Diabetes Research, Institute for Clinical Diabetology, Heinrich-Heine University, Düsseldorf, Germany
| | - Giovanni Pacini
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy
| | - Amalia Gastaldelli
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alexandra Kautzky-Willer
- Unit of Gender Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Vrachnis N, Belitsos P, Sifakis S, Dafopoulos K, Siristatidis C, Pappa KI, Iliodromiti Z. Role of adipokines and other inflammatory mediators in gestational diabetes mellitus and previous gestational diabetes mellitus. Int J Endocrinol 2012; 2012:549748. [PMID: 22550485 PMCID: PMC3328961 DOI: 10.1155/2012/549748] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/26/2012] [Indexed: 12/22/2022] Open
Abstract
Previous Gestational Diabetes Mellitus (pGDM) is a common condition and has been associated with future development of Type 2 Diabetes Mellitus (T2DM) and Metabolic Syndrome (MS) in women affected. The pathogenesis and risk factors implicated in the development of these conditions later in the lives of women with pGDM are not as yet fully understood. Research has recently focused on a group of substances produced mainly by adipose tissue called adipokines, this group including, among others, adiponectin, leptin, Retinol-Binding Protein-4 (RBP-4), and resistin. These substances as well as other inflammatory mediators (CRP, IL-6, PAI-1, TNF-α) seem to play an important role in glucose tolerance and insulin sensitivity dysregulation in women with pGDM. We summarize the data available on the role of these molecules.
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Affiliation(s)
- Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, 11528 Athens, Greece
- *Nikolaos Vrachnis:
| | - Panagiotis Belitsos
- Department of Obstetrics and Gynaecology, General Hospital of Chalkida, Evia, Chalkida 34100, Greece
| | - Stavros Sifakis
- Department of Obstetrics and Gynaecology, University Hospital of Heraklion, 71110 Heraklio, Crete, Greece
| | - Konstantinos Dafopoulos
- Department of Obstetrics and Gynaecology, Medical School, University of Thessaly, 41334 Larissa, Greece
| | | | - Kalliopi I. Pappa
- 1st Department of Obstetrics and Gynecology, University of Athens, School of Medicine, Athens, Greece
| | - Zoe Iliodromiti
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, 11528 Athens, Greece
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Vrachnis N, Augoulea A, Iliodromiti Z, Lambrinoudaki I, Sifakis S, Creatsas G. Previous gestational diabetes mellitus and markers of cardiovascular risk. Int J Endocrinol 2012; 2012:458610. [PMID: 22518122 PMCID: PMC3317164 DOI: 10.1155/2012/458610] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/06/2012] [Accepted: 01/10/2012] [Indexed: 11/17/2022] Open
Abstract
The prevalence of gestational diabetes mellitus (GDM) in the developed world has increased at an alarming rate over the last few decades. GDM has been shown to be associated with postpartum diabetes, insulin resistance, hypertension, and dyslipidemia. A history of previous GDM (pGDM), associated or not with any of these metabolic abnormalities, can increase the risk of developing not only type 2 diabetes mellitus but also cardiovascular disease (CVD) independent of a diagnosis of type 2 diabetes later in life. In this paper we discuss the relationship among inflammatory markers, metabolic abnormalities, and vascular dysfunction in women with pGDM. We also review the current knowledge on metabolic modifications occurring in normal pregnancy and the link between alterations of a normal metabolic state with the long-term maternal complications that may result in increased CVD risk. Our review of studies on pGDM prompts us to recommend that these women be considered a population at risk for later CVD events, which however could be avoided via the use of specially designed follow-up programs in the future.
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Affiliation(s)
- Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, 11526 Athens, Greece
- Obstetric and Gynecological Unit and Research Center, Evgenideio Hospital, University of Athens, 11526 Athens, Greece
- *Nikolaos Vrachnis:
| | - Areti Augoulea
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, 11526 Athens, Greece
- Obstetric and Gynecological Unit and Research Center, Evgenideio Hospital, University of Athens, 11526 Athens, Greece
| | - Zoe Iliodromiti
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, 11526 Athens, Greece
| | - Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, 11526 Athens, Greece
| | - Stavros Sifakis
- Department of Obstetrics and Gynaecology, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - George Creatsas
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, 11526 Athens, Greece
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Farhan S, Jarai R, Tentzeris I, Freynhofer MK, Brozovic I, Vogel B, Kautzky-Willer A, Wascher T, Wojta J, Huber K. Admission proinsulin is associated with mortality in patients with admission hyperglycemia during acute coronary syndrome: results from a pilot observational study. Clin Chem 2011; 57:1456-60. [PMID: 21784763 DOI: 10.1373/clinchem.2011.165126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute hyperglycemia (AHG) is associated with mortality in patients with acute coronary syndrome (ACS). The extent to which hyperproinsulinemia contributes to worse clinical outcomes for this specific patient population is unknown. METHODS We included 308 consecutive ACS patients who underwent coronary angioplasty in this pilot observational study. Patients were separated into 3 groups: patients with proven diabetes mellitus (DM group) (n =55), nondiabetic patients with a normal glucose concentration at admission (NAG group) (n =175), and nondiabetic patients with AHG at presentation (AHG group) (n =78). Blood samples for glucose, insulin, and proinsulin measurements were obtained at admission. The primary end point of the study was all-cause mortality, which was assessed at a mean follow-up of 19 months (interquartile range, 12-28 months). RESULTS Patients in the AHG and DM groups had significantly (P =0.048) higher all-cause mortality compared with the NAG group. A univariate Cox regression analysis revealed that the proinsulin concentration was significantly associated with all-cause mortality for all study participants (hazard ratio, 1.013; 95% CI, 1.002-1.024; P =0.023). AHG patients with increased proinsulin concentrations showed a mortality rate similar to that of DM patients but had a significantly higher mortality rate than patients with AHG and a low proinsulin concentration (χ² =7.57; P =0.006) and patients with NAG (with or without increased proinsulin) [χ² =7.66 (P =0.006) and 13.98 (P < 0.001), respectively]. A multivariate regression analysis revealed that the concentrations of glucose and proinsulin at admission were significant (P =0.002) predictors of all-cause mortality. CONCLUSIONS An increased proinsulin concentration may be a marker for mortality in ACS patients with hyperglycemia at admission and without known diabetes. Further studies are needed to evaluate the role of metabolic parameters such as proinsulin.
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Affiliation(s)
- Serdar Farhan
- Third Department of Medicine, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria.
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Akinci B, Celtik A, Yener S, Genc S, Tunali S, Yuksel F, Ozcan MA, Secil M, Yesil S. Plasma thrombin-activatable fibrinolysis inhibitor levels are not associated with glucose intolerance and subclinical atherosclerosis in women with previous gestational diabetes. Clin Appl Thromb Hemost 2011; 17:E224-30. [PMID: 21406417 DOI: 10.1177/1076029610397753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We aimed to determine plasma thrombin-activatable fibrinolysis inhibitor (TAFI) antigen levels in women with previous gestational diabetes mellitus (GDM) and to evaluate the possible association of plasma TAFI with glucose intolerance and markers of subclinical atherosclerosis. This cross-sectional study was performed in 111 women with previous GDM and 60 controls. Glucose intolerance was evaluated. Homeostasis model assessment score was calculated. Circulating lipids, interleukin-6, matrix metalloproteinase-1, fibrinogen, plasminogen activator inhibitor-1, and TAFI antigen levels were assayed. Carotid intima media thickness (IMT) was measured. Women with previous GDM had increased levels of atherosclerosis markers and carotid IMT. On the other hand, plasma TAFI antigen levels were similar (P = .395). Thrombin-activatable fibrinolysis inhibitor was not associated with the indices of insulin resistance, glucose intolerance, markers of atherosclerosis, and carotid IMT. Our data demonstrated that plasma TAFI was not altered in women with previous GDM. TAFI was not associated with glucose intolerance and subclinical atherosclerosis.
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Affiliation(s)
- Baris Akinci
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey.
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Lowe LP, Metzger BE, Lowe WL, Dyer AR, McDade TW, McIntyre HD. Inflammatory mediators and glucose in pregnancy: results from a subset of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. J Clin Endocrinol Metab 2010; 95:5427-34. [PMID: 20843942 PMCID: PMC2999969 DOI: 10.1210/jc.2010-1662] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 08/18/2010] [Indexed: 12/18/2022]
Abstract
CONTEXT Inflammatory mediators are associated with type 2 and gestational diabetes. It is unknown whether there are associations with glucose in pregnant women with lesser degrees of hyperglycemia. OBJECTIVE The objective of the study was to examine associations of inflammatory mediators with maternal glucose levels and neonatal size in a subset of participants in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. DESIGN Eligible pregnant women underwent a 75-g oral glucose tolerance test between 24 and 32 wk gestation, and levels of C-peptide, adiponectin, plasminogen activator inhibitor type 1 (PAI-1), C-reactive protein (CRP), and resistin were measured in fasting serum samples. Associations of inflammatory mediators with maternal glucose and with birth size were assessed using multiple linear regression analyses, adjusting for maternal body mass index (BMI), fasting C-peptide, and other potential confounders. RESULTS Mean levels of adiponectin declined, and PAI-1 and CRP increased across increasing levels of maternal glucose, BMI, and C-peptide. For example, for fasting plasma glucose less than 75 mg/dl and fasting plasma glucose of 90 mg/dl or greater, adiponectin was 22.5 and 17.4 μg/ml and PAI-1 was 30.9 and 34.2 ng/ml, respectively. Associations with 1- and 2-h plasma glucose remained significant for adiponectin (P<0.001), PAI-1 (P<0.05), and CRP (P<0.01) after adjustment for BMI and C-peptide. Adiponectin and CRP were inversely associated with birth weight, sum of skinfolds and percent body fat, and PAI-1 with sum of skinfolds (all P<0.05) after adjustment for confounders. Resistin was not associated with 1- or 2-h glucose or birth size. CONCLUSION Levels of inflammatory mediators are associated with levels of maternal glucose in pregnant women without overt diabetes.
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Affiliation(s)
- Lynn P Lowe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, Illinois 60611, USA.
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Farhan S, Höchtl T, Kautzky-Willer A, Wojta J, Huber K. Antithrombotic therapy in patients with coronary artery disease and with type 2 diabetes mellitus. Wien Med Wochenschr 2010; 160:30-8. [PMID: 20229159 DOI: 10.1007/s10354-010-0747-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/16/2009] [Indexed: 10/19/2022]
Abstract
Diabetes mellitus (DM) is a life-threatening disease. Patients with DM have a 2- to 4-fold higher risk of developing cardiovascular disease compared to their non-diabetic counterparts. Several drugs are available for the treatment of stable coronary artery disease (CAD) and acute coronary syndrome (ACS). Among oral antiplatelet agents (acetylsalicylic acid, ticlopidine, clopidogrel, and prasugrel), prasugrel has shown the highest efficacy in patients with DM and ACS. The use of glycoprotein IIb-IIIa receptor inhibitors in diabetic subjects with ACS undergoing percutaneous coronary intervention (PCI) reduces adverse clinical events in a greater extent than in non-diabetics. Several direct and indirect antithrombins are recommended for the treatment of ACS such as unfractionated heparin (UFH), enoxaparin, fondaparinux, and bivalirudin. Enoxaparin and bivalirudin have been shown to be superior to UFH among patients with ST-elevation MI (STEMI) and non-ST elevation MI (NSTEMI) also in diabetic subgroup analyses.
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Affiliation(s)
- Serdar Farhan
- Third Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria.
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Abstract
BACKGROUND Clinicians and health professionals are increasingly challenged to understand and consider the different health needs of women and men. The increase of gender awareness and the expanding science of gender medicine will affect more and more clinical practice. This review addresses gender-specific aspects in metabolic disorders and related complications, which represent an increasing burden of this century and a great challenge to public health. DESIGN There is increasing evidence of gender-related differences in risk factors, clinical manifestation and sequelae of obesity and diabetes and increasing knowledge that prevention, detection and therapy of illness affect men and women differently. RESULTS Some gender-specific aspects, especially regarding cardiovascular disease, have been studied in more detail, but for many complications sex-related analyses of the results of both clinical trials and basic science are still missing or disregarded. Impaired glucose and lipid metabolism as well as dysregulation of energy balance and body fat distribution have a great impact on overall health via neuroendocrine changes and inflammatory pathways and deteriorate the course of many diseases with particular harm for women. Metabolic diseases dramatically affect life of men and women from infancy up to old age and are a major challenge for women during pregnancy. Great impact is attached to the intrauterine period and the lifelong implications of fetal programming. CONCLUSIONS Initiation of prospective studies on the impact of gender as primary outcome and investigation of gender-related pathophysiological mechanisms of chronic diseases will help to improve patient care and to implement evidence-based gender-specific prevention programs and clinical recommendations in future.
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Affiliation(s)
- A Kautzky-Willer
- Department of Internal Medicine III, Division of Endocrinology & Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
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Akinci B, Demir T, Celtik A, Baris M, Yener S, Ozcan MA, Yuksel F, Secil M, Yesil S. Serum osteoprotegerin is associated with carotid intima media thickness in women with previous gestational diabetes. Diabetes Res Clin Pract 2008; 82:172-8. [PMID: 18722030 DOI: 10.1016/j.diabres.2008.07.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 07/02/2008] [Accepted: 07/11/2008] [Indexed: 12/11/2022]
Abstract
Circulating levels of osteoprotegerin (OPG) have been shown to be increased in patients with cardiovascular disorders and diabetes. The aim of this study was to determine serum OPG levels in women with previous gestational diabetes (GDM), and to investigate the relationship between OPG and carotid intima media thickness (IMT) and circulating cardiovascular risk factors. Serum OPG was measured in 46 women with previous GDM and 30 age-matched healthy controls. Carotid IMT was evaluated. Serum lipid, insulin and hsCRP levels, plasma fibrinogen, vWF and PAI-1 levels were measured. Serum OPG levels tended to be increased in women with previous GDM (p=0.058). Carotid IMT was increased in the study group. Women with previous GDM had elevated levels of hsCRP and PAI-1. OPG levels were positively correlated with age, fasting and post-load glucose levels, hsCRP, and carotid IMT. Multiple regression analysis showed that serum OPG was a statistically significant predictor for elevated carotid IMT. Our results revealed that OPG levels tended to be elevated in women with previous GDM. Significant association of OPG with carotid IMT suggested that OPG might play a role in the pathogenesis of endothelial dysfunction in women with previous GDM.
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Affiliation(s)
- Baris Akinci
- Dokuz Eylul University Medical School, Department of Internal Medicine, Division of Endocrinology and Metabolism, Turkey.
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Morimitsu LK, Fusaro AS, Sanchez VH, Hagemann CCF, Bertini AM, Dib SA. Fibrinolytic dysfunction after gestation is associated to components of insulin resistance and early type 2 diabetes in latino women with previous gestational diabetes. Diabetes Res Clin Pract 2007; 78:340-8. [PMID: 17544539 DOI: 10.1016/j.diabres.2007.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Accepted: 04/25/2007] [Indexed: 12/19/2022]
Abstract
Among patients with metabolic syndrome (MS), atherosclerosis and abnormal fibrinolytic function are frequently present, mostly owing to an increase in plasminogen activator inhibitor-1(PAI-1). We analyze PAI-1 in pregnant women, both normal and with gestational diabetes (GDM) and postpartum regarding its correlation to MS surrogates. Clinical characteristics, glucose tolerance (100g-OGTT), lipids, PAI-1 antigen, insulin sensitivity (HOMA-S), and pancreatic beta-cell function (HOMA-B) were investigated in 34 women. Eleven had normal glucose tolerance (NGT) during pregnancy and 23 had GDM (all GAD antibodies-negative). All patients were studied at 28-34 weeks of gestation and 16-24 weeks after delivery (75 g-OGTT). Parameters of interest were determined using commercial test systems. During pregnancy, PAI-1 was not statistically different between NGT and GDM (47+/-25 ng/ml versus 47+/-28 ng/ml, p=0.9). After gestation, 19 (56%) women had NGT (11 of them from previous NGT group) and 15 (44%) had impaired glucose tolerance (IGT) or DM. The IGT (IGT+DM) group had higher PAI-1 (p=0.01), which did not decreased after delivery NGT-NGT before and after delivery (47+/-25 ng/ml versus 6+/-5 ng/ml; p<0.001), GDM-NGT (62+/-36 ng/ml versus 14+/-15 ng/ml; p=0.001) and GDM-IGT (39+/-20 ng/ml versus 27+/-23 ng/ml; p=0.15). PAI-1 levels were positively correlated (p<0.05) to total cholesterol (r(s)=0.37), triglycerides (r(s)=0.48), fasting plasma glucose (r(s)=0.52), 2-h plasma glucose in the OGTT (r(s)=0.58) and were negatively correlated (p<0.05) with HOMA-S (r(s)=-0.42) and HOMA-B (r(s)=-0.38). Fibrinolytic dysfunction is still present in GDM women and is associated with early development of IGT or T2DM. PAI correlated with surrogate markers of MS levels and may identify a group of women at risk for macroangiopathy.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas II. Curr Opin Endocrinol Diabetes Obes 2007; 14:329-57. [PMID: 17940461 DOI: 10.1097/med.0b013e3282c3a898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kitzmiller JL, Dang-Kilduff L, Taslimi MM. Gestational diabetes after delivery. Short-term management and long-term risks. Diabetes Care 2007; 30 Suppl 2:S225-35. [PMID: 17596477 DOI: 10.2337/dc07-s221] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- John L Kitzmiller
- Division of Maternal-Fetal Medicine, Santa Clara County Health System, San Jose, California, USA.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2007; 14:170-96. [PMID: 17940437 DOI: 10.1097/med.0b013e3280d5f7e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gasic S, Winzer C, Bayerle-Eder M, Roden A, Pacini G, Kautzky-Willer A. Impaired cardiac autonomic function in women with prior gestational diabetes mellitus. Eur J Clin Invest 2007; 37:42-7. [PMID: 17181566 DOI: 10.1111/j.1365-2362.2007.01752.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac autonomic neuropathy is a common dysfunction in manifest diabetes mellitus and is associated with duration of diabetes and/or an inadequate glycaemic control. Heart rate variability (HRV) reflects autonomic heart function. The aim of the present study was to investigate whether in women with prior gestational diabetes (GD; pre-type 2 diabetes) alterations of cardiac autonomic function can be observed after delivery in relation to insulin sensitivity and glycaemic control. MATERIALS AND METHODS Forty-eight healthy women with prior GD were consecutively admitted to the study. HRV was analysed by both time, as well as frequency, domain methods using 24-h Holter monitoring. In addition, 20 women with normal glucose tolerance during and after pregnancy were investigated as control subjects. All women underwent a frequently sampled intravenous glucose tolerance test (FSIGT) for measurement of insulin sensitivity. RESULTS Time domain analysis (standard deviation of normal RR intervals; SDNN) showed a reduced HRV in 25 out of the 48 (52%) women with prior GD. Frequency domain analysis revealed that in these 25 subjects both low and high frequency components of power spectral density (reflecting mainly sympathetic respectively parasympathetic activity) were reduced, indicating that sympathetic as well as parasympathetic functional impairment may be assumed. However, a relative predominance of the sympathetic over parasympathetic cardiac function was observed. The impairment of cardiac autonomic function (reduced SDNN) was correlated with HbA1c values and the 2-h blood glucose concentration (oral glucose tolerance test) but not with insulin sensitivity. CONCLUSION The present results demonstrate that in 52% of the women examined who had prior GD, an impairment of cardiac sympathetic as well as parasympathetic function was present, which related to glycaemic control, but not to insulin sensitivity. This infers that functional autonomic changes could be an early prognostic indicator in pre-type 2 diabetes.
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Affiliation(s)
- S Gasic
- Department of Internal Medicine III, Medical University of Vienna, Austria
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Metabolic syndrome and higher risk of maternal placental syndromes and cardiovascular disease. Drug Dev Res 2006. [DOI: 10.1002/ddr.20134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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