1
|
Jochumsen S, Hegaard HK, Rode L, Jørgensen KJ, Nathan NO. Maternal factors associated with labor dystocia in low-risk nulliparous women. A systematic review and meta-analysis. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100855. [PMID: 37210774 DOI: 10.1016/j.srhc.2023.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/30/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To identify maternal factors associated with labor dystocia in low-risk nulliparous women. METHODS MEDLINE, Embase, ClinicalTrials.gov, Cochrane, and CINAHL were searched for intervention studies and observational studies published from January 2000 to January 2022. Low-risk was defined as nulliparous women with a singleton, cephalic birth in spontaneous labor at term. Labor dystocia was defined by national or international criteria or treatment. Countries were restricted to OECD members. Two authors independently screened 11,374 titles and abstracts, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Results were presented narratively and by meta-analysis when compatible. RESULTS Seven cohort studies were included. Overall, the certainty of the evidence was moderate. Three studies found that higher maternal age was associated with an increased frequency of labor dystocia (relative risk 1.68; 95% CI 1.43-1.98). Further three studies found that higher maternal BMI was associated with increased frequency of labor dystocia (relative risk 1.20; 95% CI 1.01-1.43). Maternal short stature, fear of childbirth, and high caffeine intake were also associated with an increased frequency of labor dystocia, while maternal physical activity was associated with a decreased frequency. CONCLUSION Maternal factors associated with an increased frequency of labor dystocia were mainly maternal age, physical characteristics, and fear of childbirth. Maternal physical activity was associated with a decreased frequency. Intervention studies targeting these maternal factors would need to be initiated before or early in pregnancy to test the causality of the identified factors and labor dystocia.
Collapse
Affiliation(s)
- Sara Jochumsen
- The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Hanne Kristine Hegaard
- The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Line Rode
- Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet Glostrup, Valdemar Hansens Vej 13, 2600 Glostrup, Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Nina Olsén Nathan
- The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| |
Collapse
|
2
|
Avram VF, Merce AP, Hâncu IM, Bătrân AD, Kennedy G, Rosca MG, Muntean DM. Impairment of Mitochondrial Respiration in Metabolic Diseases: An Overview. Int J Mol Sci 2022; 23:ijms23168852. [PMID: 36012137 PMCID: PMC9408127 DOI: 10.3390/ijms23168852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
Mitochondrial dysfunction has emerged as a central pathomechanism in the setting of obesity and diabetes mellitus, linking these intertwined pathologies that share insulin resistance as a common denominator. High-resolution respirometry (HRR) is a state-of-the-art research method currently used to study mitochondrial respiration and its impairment in health and disease. Tissue samples, cells or isolated mitochondria are exposed to various substrate-uncoupler-inhibitor-titration protocols, which allows the measurement and calculation of several parameters of mitochondrial respiration. In this review, we discuss the alterations of mitochondrial bioenergetics in the main dysfunctional organs that contribute to the development of the obese and diabetic phenotypes in both animal models and human subjects. Herein we review data regarding the impairment of oxidative phosphorylation as integrated mitochondrial function assessed by means of HRR. We acknowledge the critical role of this method in determining the alterations in oxidative phosphorylation occurring in the early stages of metabolic pathologies. We conclude that there is a mutual two-way relationship between mitochondrial dysfunction and insulin insensitivity that characterizes these diseases.
Collapse
Affiliation(s)
- Vlad Florian Avram
- Department VII Internal Medicine—Diabetes, Nutrition and Metabolic Diseases, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Center for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Adrian Petru Merce
- Doctoral School Medicine—Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Iasmina Maria Hâncu
- Doctoral School Medicine—Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Alina Doruța Bătrân
- Doctoral School Medicine—Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Gabrielle Kennedy
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mount Pleasant, MI 48858, USA
| | - Mariana Georgeta Rosca
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mount Pleasant, MI 48858, USA
- Correspondence: (M.G.R.); (D.M.M.)
| | - Danina Mirela Muntean
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Department III Functional Sciences—Pathophysiology, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Correspondence: (M.G.R.); (D.M.M.)
| |
Collapse
|
3
|
Carvajal JA, Oporto JI. The Myometrium in Pregnant Women with Obesity. Curr Vasc Pharmacol 2021; 19:193-200. [PMID: 32484103 DOI: 10.2174/1570161118666200525133530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Obesity is a worldwide public health problem, affecting at least one-third of pregnant women. One of the main problems of obesity during pregnancy is the resulting high rate of cesarean section. The leading cause of this higher frequency of cesarean sections in obese women, compared with that in nonobese women, is an altered myometrial function that leads to lower frequency and potency of contractions. In this article, the disruptions of myometrial myocytes were reviewed in obese women during pregnancy that may explain the dysfunctional labor. The myometrium of obese women exhibited lower expression of connexin43, a lower function of the oxytocin receptor, and higher activity of the potassium channels. Adipokines, such as leptin, visfatin, and apelin, whose concentrations are higher in obese women, decreased myometrial contractility, perhaps by inhibiting the myometrial RhoA/ROCK pathway. The characteristically higher cholesterol levels of obese women alter myometrial myocyte cell membranes, especially the caveolae, inhibiting oxytocin receptor function, and increasing the K+ channel activity. All these changes in the myometrial cells or their environment decrease myometrial contractility, at least partially explaining the higher rate of cesarean of sections in obese women.
Collapse
Affiliation(s)
- Jorge A Carvajal
- Departamento de Obstetricia, Unidad de Medicina Materno Fetal, Mexico City, Mexico
| | - Joaquín I Oporto
- Estudiante de Medicina, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
4
|
Peska E, Balki M, Maxwell C, Ye XY, Downey K, Carvalho JCA. Oxytocin at elective caesarean delivery: a dose-finding study in women with obesity. Anaesthesia 2020; 76:918-923. [PMID: 33227150 DOI: 10.1111/anae.15322] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Prophylactic oxytocin administration at the third stage of labour reduces blood loss and the need for additional uterotonic drugs. Obesity is known to be associated with an increased risk of uterine atony and postpartum haemorrhage. It is unknown whether women with obesity require higher doses of oxytocin in order to achieve adequate uterine tone after delivery. The purpose of this study was to establish the bolus dose of oxytocin required to initiate effective uterine contraction in 90% of women with obesity (the ED90 ) at elective caesarean delivery. We conducted a double-blind dose-finding study using the biased coin up-down design method. Term pregnant women with a BMI ≥ 40 kg.m-2 undergoing elective caesarean delivery under regional anaesthesia were included. Those with conditions predisposing to postpartum haemorrhage were not included. Oxytocin was administered as an intravenous bolus over 1 minute upon delivery of the fetus. With the first woman receiving 0.5 IU, oxytocin doses were administered according to a sequential allocation scheme. The primary outcome measure was satisfactory uterine tone, as assessed by the operating obstetrician 2 minutes after administration of the oxytocin bolus. Secondary outcomes included the need for rescue uterotonic drugs, adverse effects and estimated blood loss. We studied 30 women with a mean (SD) BMI of 52.3 (7.6) kg.m-2 . The ED90 for oxytocin was 0.75 IU (95%CI 0.5-0.93 IU) by isotonic regression and 0.78 IU (95%CI 0.68-0.88 IU) by the Dixon and Mood method. Our results suggest that women with a BMI ≥ 40 kg.m-2 require approximately twice as much oxytocin as those with a BMI < 40 kg.m-2 , in whom an ED90 of 0.35 IU (95%CI 0.15-0.52 IU) has previously been demonstrated.
Collapse
Affiliation(s)
- E Peska
- Department of Anaesthesia, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - M Balki
- Department of Anaesthesia, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada.,Department of Anaesthesiology and Pain Medicine and Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada
| | - X Y Ye
- Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - K Downey
- Department of Anaesthesia, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - J C A Carvalho
- Department of Anaesthesia, Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, ON, Canada.,Department of Anaesthesiology and Pain Medicine and Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada
| |
Collapse
|
5
|
Fetal and Placental Weight in Pre-Gestational Maternal Obesity (PGMO) vs. Excessive Gestational Weight Gain (EGWG)-A Preliminary Approach to the Perinatal Outcomes in Diet-Controlled Gestational Diabetes Mellitus. J Clin Med 2020; 9:jcm9113530. [PMID: 33142800 PMCID: PMC7693942 DOI: 10.3390/jcm9113530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Both pre-gestational maternal obesity (PGMO) and excessive gestational weight gain (EGWG) increase the risk of gestational diabetes mellitus (GDM). Here, we conducted a retrospective study to comparatively examine the relation between fetal birth weight (FW) and placental weight (PW) in PGMO (n = 100) compared to EGWG (n = 100) with respect to perinatal outcomes in diet-controlled GDM. The control group was made up of 100 healthy pregnancies. The mean FW and the mean PW in EGWG were correlated with lowered fetal weight/placental weight ratio (FW/PW ratio). The percentage of births completed by cesarean section accounted for 47%, 32%, and 18% of all deliveries (EGWG, PGMO, and controls, respectively), with the predominance of FW-related indications for cesarean section. Extended postpartum hospital stays due to neonate were more frequent in EGWG, especially due to neonatal jaundice (p < 0.05). The results indicate the higher perinatal risk in mothers with EGWG compared to PGMO during GDM-complicated pregnancy. Further in-depth comparative studies involving larger patient pools are needed to validate these findings, the intent of which is to formulate guidelines for GDM patients in respect to management of PGMO and EGWG.
Collapse
|
6
|
Grishchenko O, Mamedova S. PROGNOSTICATION LABOR DYSTOCIA AND CESAREAN SECTION. REPRODUCTIVE MEDICINE 2020. [DOI: 10.37800/rm2020-1-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The article presents the results of the analysis of clinical and anamnestic indicators to create a model for predicting the development of labor dystocia that caused Caesarean section. The most significant prognostic factors included in the prognostic model were fetus-pelvic imbalances, diabetes mellitus, a burdened gynecological history and cardiovascular diseases in the nulliparous women of late reproductive age. Assessment of the totality of risk factors made it possible to achieve an accurate prognosis in 88.6% of cases with a sensitivity of 40.4%, specificity - 92.1%.
Collapse
|
7
|
Carlson NS, Frediani JK, Corwin EJ, Dunlop A, Jones D. Metabolic Pathways Associated With Term Labor Induction Course in African American Women. Biol Res Nurs 2020; 22:157-168. [PMID: 31983215 PMCID: PMC7273804 DOI: 10.1177/1099800419899730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate differences in the metabolic pathways activated in late-pregnancy serum samples among African American women who went on to have term (≥37 weeks) labor induction requiring high total oxytocin doses to complete first-stage labor compared to those in similar women with low-oxytocin labor inductions. STUDY DESIGN Case-control study (N = 27 women with labor induction with successful cervical ripening: 13 requiring the highest total doses of synthetic oxytocin to progress from 4- to 10-cm cervical dilation and 14 requiring the lowest total doses) with groups balanced on parity and gestational age. Serum samples obtained between 24 and 30 weeks' gestation were analyzed using ultra-high-resolution metabolomics. Differentially expressed metabolites between high-oxytocin induction cases and low-oxytocin induction comparison subjects were evaluated using linear regression with xmsPANDA. Metabolic pathways analysis was conducted using Mummichog Version 2.0, with discriminating metabolites annotated using xMSannotator Version 1.3. RESULTS Labor processes were similar by group with the exception that cases received over 6 times more oxytocin between 4- and 10-cm cervical dilation than comparison women. Induction requiring high total doses of synthetic oxytocin was associated with late-pregnancy serum levels of metabolites from the linoleate and fatty acid activation pathways in term, African American women. CONCLUSION Serum levels of several lipid metabolites predicted more complicated labor induction involving higher doses of synthetic oxytocin to complete first-stage labor. Further investigation in larger, more diverse cohorts of women is needed to identify potential targets to prevent failed labor induction.
Collapse
Affiliation(s)
- Nicole S. Carlson
- Nell Hodgson Woodruff School of Nursing, Emory University,
Atlanta, GA, USA
| | | | - Elizabeth J. Corwin
- Nell Hodgson Woodruff School of Nursing, Emory University,
Atlanta, GA, USA
- Department of Physiology, School of Medicine, Emory
University, Atlanta, GA, USA
| | - Anne Dunlop
- Nell Hodgson Woodruff School of Nursing, Emory University,
Atlanta, GA, USA
- Department of Family and Preventive Medicine, Emory
University, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Atlanta, GA,
USA
| | - Dean Jones
- Division of Pulmonary, Allergy, and Critical Care, Emory
University, Atlanta, GA, USA
| |
Collapse
|
8
|
The effect of morbid obesity or advanced maternal age on oxytocin-induced myometrial contractions: an in vitro study. Can J Anaesth 2020; 67:836-846. [PMID: 32189217 DOI: 10.1007/s12630-020-01615-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 12/13/2022] Open
|
9
|
Prendergast C. Maternal phenotype: how do age, obesity and diabetes affect myometrial function? CURRENT OPINION IN PHYSIOLOGY 2020. [DOI: 10.1016/j.cophys.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Parkington HC, Siriwardhana ER, Coleman HA. Intracellular organelles; key regulators of myometrial activity. CURRENT OPINION IN PHYSIOLOGY 2020. [DOI: 10.1016/j.cophys.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Carlson NS, Frediani JK, Corwin EJ, Dunlop A, Jones D. Metabolomic Pathways Predicting Labor Dystocia by Maternal Body Mass Index. AJP Rep 2020; 10:e68-e77. [PMID: 32140295 PMCID: PMC7056397 DOI: 10.1055/s-0040-1702928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the metabolic pathways activated in the serum of African-American women during late pregnancy that predicted term labor dystocia. Study Design Matched case-control study ( n = 97; 48 cases of term labor dystocia and 49 normal labor progression controls) with selection based on body mass index (BMI) at hospital admission and maternal age. Late pregnancy serum samples were analyzed using ultra-high-resolution metabolomics. Differentially expressed metabolic features and pathways between cases experiencing term labor dystocia and normal labor controls were evaluated in the total sample, among women who were obese at the time of labor (BMI ≥ 30 kg/m2), and among women who were not obese. Results Labor dystocia was predicted by different metabolic pathways in late pregnancy serum among obese (androgen/estrogen biosynthesis) versus nonobese African-American women (fatty acid activation, steroid hormone biosynthesis, bile acid biosynthesis, glycosphingolipid metabolism). After adjusting for maternal BMI and age in the total sample, labor dystocia was predicted by tryptophan metabolic pathways in addition to C21 steroid hormone, glycosphingolipid, and androgen/estrogen metabolism. Conclusion Metabolic pathways consistent with lipotoxicity, steroid hormone production, and tryptophan metabolism in late pregnancy serum were significantly associated with term labor dystocia in African-American women.
Collapse
Affiliation(s)
- Nicole S. Carlson
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | | | - Elizabeth J. Corwin
- Department of Physiology, Columbia University School of Nursing, New York, New York
| | - Anne Dunlop
- Departments of Family and Preventive Medicine, Epidemiology, and Nursing, Emory University, Atlanta, Georgia
| | - Dean Jones
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Emory University, Atlanta, Georgia
| |
Collapse
|
12
|
The Myometrium: From Excitation to Contractions and Labour. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1124:233-263. [PMID: 31183830 DOI: 10.1007/978-981-13-5895-1_10] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
Abstract
We start by describing the functions of the uterus, its structure, both gross and fine, innervation and blood supply. It is interesting to note the diversity of the female's reproductive tract between species and to remember it when working with different animal models. Myocytes are the overwhelming cell type of the uterus (>95%) and our focus. Their function is to contract, and they have an intrinsic pacemaker and rhythmicity, which is modified by hormones, stretch, paracrine factors and the extracellular environment. We discuss evidence or not for pacemaker cells in the uterus. We also describe the sarcoplasmic reticulum (SR) in some detail, as it is relevant to calcium signalling and excitability. Ion channels, including store-operated ones, their contributions to excitability and action potentials, are covered. The main pathway to excitation is from depolarisation opening voltage-gated Ca2+ channels. Much of what happens downstream of excitability is common to other smooth muscles, with force depending upon the balance of myosin light kinase and phosphatase. Mechanisms of maintaining Ca2+ balance within the myocytes are discussed. Metabolism, and how it is intertwined with activity, blood flow and pH, is covered. Growth of the myometrium and changes in contractile proteins with pregnancy and parturition are also detailed. We finish with a description of uterine activity and why it is important, covering progression to labour as well as preterm and dysfunctional labours. We conclude by highlighting progress made and where further efforts are required.
Collapse
|
13
|
Gam CMBF, Mortensen OH, Larsen LH, Poulsen SS, Qvortrup K, Mathiesen ER, Damm P, Quistorff B. Diabetes, myometrium, and mitochondria in pregnant women at term. Acta Diabetol 2018; 55:999-1010. [PMID: 29931421 DOI: 10.1007/s00592-018-1171-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/28/2018] [Indexed: 12/25/2022]
Abstract
AIMS Poor myometrial contractility has been demonstrated in women at term with diabetes and decreased muscular mitochondrial content and/or function has been extensively implicated in the progression of type 2 diabetes. Alterations of the uterine mitochondrial phenotype in pregnant women with diabetes have yet to be investigated as a causal link to decreased myometrial contractility. METHODS Observational study of 18 women with diabetes (type 2 and gestational) scheduled for an elective Caesarean section at term with matching controls. A uterine biopsy and fasting blood samples were taken on the day of delivery. RESULTS Respiration rates in isolated mitochondria and myometrial mRNA levels of genes related to mitochondrial biogenesis were unaffected by diabetes. Mitochondrial quantity examined by quantification of the complexes of the respiratory chain and histology did not indicate alterations in mitochondrial quantity. Citrate syntase activity was higher (0.31 ± 0.02 vs. 0.24 ± 0.02 U/mg protein, P = 0.008), whereas protein content was lower in women with diabetes compared with the control group (94.6 ± 6.9 vs. 118.6 ± 7.4 mg/g wet wt, P = 0.027). Histological examinations did not support any structural alterations in the myometrium or its mitochondria. CONCLUSION No indication of decreased mitochondrial function, content, morphology, or localization in the myometrium at term in women with diabetes compared with controls was observed. The increase in citrate syntase activity in the myometrium could be explained by the lower protein content in the myometrium, which we suggest is due to alterations in tissue or cellular composition.
Collapse
Affiliation(s)
- Christiane Marie Bourgin Folke Gam
- Cellular and Metabolic Research Section, Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Blegdamsvej 3, Bygning 6.5, 2200, Copenhagen N, Denmark.
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen N, Denmark.
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark.
| | - Ole Hartvig Mortensen
- Cellular and Metabolic Research Section, Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Blegdamsvej 3, Bygning 6.5, 2200, Copenhagen N, Denmark
| | - Lea Hüche Larsen
- Cellular and Metabolic Research Section, Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Blegdamsvej 3, Bygning 6.5, 2200, Copenhagen N, Denmark
| | - Steen Seier Poulsen
- Endocrinology Research Section, University of Copenhagen, Copenhagen N, Denmark
| | - Klaus Qvortrup
- Core Facility for Integrated Microscopy, Department of Biomedical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Elisabeth Reinhart Mathiesen
- Departement of Endocrinology, Rigshospitalet, Copenhagen N, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen N, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen N, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen N, Denmark
| | - Bjørn Quistorff
- Cellular and Metabolic Research Section, Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Blegdamsvej 3, Bygning 6.5, 2200, Copenhagen N, Denmark
| |
Collapse
|