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Abstract
OBJECTIVE The present study aimed to evaluate the risk factors for gestational diabetes mellitus (GDM) and build and validate an early risk prediction model of GDM by comparing the differences in the indicators of the first trimester of pregnancy between pregnant women with GDM and non-gestational diabetes mellitus (NGDM). Thus, this study provided a theoretical basis for early intervention of GDM. METHODS A total of 6000 pregnant women who underwent a routine prenatal examination in Qinhuangdao Maternal and Child Health Hospital (Qinhuangdao City, Hebei Province, China) from January 2016-2022 were retrospectively selected and randomly divided into a modeling cohort (4200 cases) and validation cohort (1800 cases) at a ratio of 3:7. According to the results of oral glucose tolerance test (OGTT), they were divided into NGDM and GDM groups. The modeling cohort consisted of 2975 NGDM and 1225 GDM cases, while the validation cohort consisted of 1281 NGDM and 519 GDM cases. The differences in general conditions and laboratory indicators between different groups were compared, and logistic regression analysis was further used to establish a risk prediction model for GDM in the first trimester. The receiver operating characteristic curve (ROC) and Hosmer-Lemeshow (HL) tests were used to evaluate the prediction of the model efficacy. RESULTS Age, pre-pregnancy body mass index (BMI), glycosylated hemoglobin (HbA1c), blood uric acid (UA), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) in the first trimester were independent risk factors for GDM (P < 0.05). The model equation was Y = 1/{1 + exp[- (- 18.373 + age × 0.065 + BMI × 0.030 + first-trimester HbA1c × 2.519 + UA × 0.014 + TG × 0.224-HDL-C × 0.635)]}. The area under the ROC curve (AUC) of the model cohort was 0.803 (0.788-0.817), the sensitivity was 72.0%, and the specificity was 73.5%. The AUC of the validation cohort was 0.782 (0.759-0.806), the sensitivity was 68.6%, and the specificity was 73.8%. The P values of the HL test in both the training and validation sets were > 0.05, indicating a satisfactory model fit. CONCLUSION Age, pre-pregnancy BMI, HbA1C in early pregnancy, blood UA, TG, and HDL-C are independent risk factors for GDM. The risk prediction model established by combining age, pre-pregnancy BMI, and laboratory indicators in the first trimester can provide a theoretical basis for early screening, monitoring, and intervention of GDM high-risk pregnant women.
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Affiliation(s)
- Z-R Niu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, 066000, Hebei, China
| | - L-W Bai
- Department of Obstetrics, Qinhuangdao Hospital for Maternal and Child Health, Qinhuangdao, 066000, Hebei, China
| | - Q Lu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, 066000, Hebei, China.
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Han W, Wang J, Yan X, Liu C, Huang J, Zhang L, Zhang Y, Zhao Y, Hou Y, Zheng W, Li G. Butyrate and iso-butyrate: a new perspective on nutrition prevention of gestational diabetes mellitus. Nutr Diabetes 2024; 14:24. [PMID: 38658555 PMCID: PMC11043397 DOI: 10.1038/s41387-024-00276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Dietary imbalance, such as a lower proportion of complex carbohydrates and a higher protein diet, may contribute to gestational diabetes mellitus (GDM) risks through their metabolisms. However, there is a lack of knowledge regarding the association between butyrate, iso-butyrate, and GDM, which are metabolisms of the two primary nutrients above. This study aimed to clarify the association of butyrate and iso-butyrate with GDM. METHODS A nested case-control study was conducted based on the Beijing Birth Cohort Study (BBCS) from 2017 to 2018. Totally, 99 singleton women were involved (GDM: n = 49, control: n = 50). All participants provided blood samples twice (in their first and second trimesters). Gas chromatography-mass spectrometry (GC-MS) was used for butyrate and iso-butyrate detection. Unconditional logistic regression and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. RESULTS The results showed that butyrate in the first trimester was negatively correlated with GDM (odds ratio (OR): 0.00, 95% confidential interval (CI): 0.00-0.21, P = 0.008), and iso-butyrate in the second trimester was positively related to GDM (OR: 627.68, 95% CI: 40.51-9724.56, P < 0.001). The ratio (butyrate/iso-butyrate) was negatively associated with GDM, both in the first trimester (OR: 0.00, 95%CI: 0.00-0.05, P < 0.001) and in the second trimester (OR: 0.52, 95% CI: 0.34-0.80, P = 0.003). The area under the curve (AUC) using the ratio in the first trimester combined with clinical risk factors achieved 0.89 (95% CI: 0.83-0.95). Iso-butyrate in the second trimester combined with clinical risk factors achieved an AUC of 0.97 (95% CI: 0.92-1.00). CONCLUSIONS High iso-butyrate and low butyrate levels may be associated with an increased risk of GDM. As they are produced through dietary nutrient formation by gut microbiota, further studies on the association of dietary intake and butyrate or iso-butyrate concentration in plasma may help find a novel approach to nutritional intervention for GDM.
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Affiliation(s)
- Weiling Han
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jia Wang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xin Yan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Cheng Liu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Junhua Huang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Lirui Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yujie Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yiqing Zhao
- Hyproca Nutrition Co., Ltd, Changsha, Hunan, China
| | - Yanmei Hou
- Hyproca Nutrition Co., Ltd, Changsha, Hunan, China
| | - Wei Zheng
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
- Beijing Maternal and Child Health Care Hospital, Beijing, China.
| | - Guanghui Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
- Beijing Maternal and Child Health Care Hospital, Beijing, China.
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Burdeau JA, Stephenson BJK, Aris IM, Preston EV, Hivert MF, Oken E, Mahalingaiah S, Chavarro JE, Calafat AM, Rifas-Shiman SL, Zota AR, James-Todd T. First trimester plasma PER- AND Polyfluoroalkyl Substances (PFAS) and blood pressure trajectories across the second and third trimesters of pregnanacy. Environ Int 2024; 186:108628. [PMID: 38583297 DOI: 10.1016/j.envint.2024.108628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) increases risk of high blood pressure (BP) during pregnancy. Prior studies did not examine associations with BP trajectory parameters (i.e., overall magnitude and velocity) during pregnancy, which is linked to adverse pregnancy outcomes. OBJECTIVES To estimate associations of multiple plasma PFAS in early pregnancy with BP trajectory parameters across the second and third trimesters. To assess potential effect modification by maternal age and parity. METHODS In 1297 individuals, we quantified six PFAS in plasma collected during early pregnancy (median gestational age: 9.4 weeks). We abstracted from medical records systolic BP (SBP) and diastolic BP (DBP) measurements, recorded from 12 weeks gestation until delivery. BP trajectory parameters were estimated via Super Imposition by Translation and Rotation modeling. Subsequently, Bayesian Kernel Machine Regression (BKMR) was employed to estimate individual and joint associations of PFAS concentrations with trajectory parameters - adjusting for maternal age, race/ethnicity, pre-pregnancy body mass index, income, parity, smoking status, and seafood intake. We evaluated effect modification by age at enrollment and parity. RESULTS We collected a median of 13 BP measurements per participant. In BKMR, higher concentration of perfluorooctane sulfonate (PFOS) was independently associated with higher magnitude of overall SBP and DBP trajectories (i.e., upward shift of trajectories) and faster SBP trajectory velocity, holding all other PFAS at their medians. In stratified BKMR analyses, participants with ≥ 1 live birth had more pronounced positive associations between PFOS and SBP velocity, DBP magnitude, and DBP velocity - compared to nulliparous participants. We did not observe significant associations between concentrations of the overall PFAS mixture and either magnitude or velocity of the BP trajectories. CONCLUSION Early pregnancy plasma PFOS concentrations were associated with altered BP trajectory in pregnancy, which may impact future cardiovascular health of the mother.
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Affiliation(s)
- Jordan A Burdeau
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Briana J K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Emma V Preston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Boston, MA, USA.
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Ami R Zota
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Tamarra James-Todd
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
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Moungmaithong S, Wang X, Lau CSL, Tse AWT, Lee NMW, Leung HHY, Poon LC, Sahota DS. Glycosylated fibronectin improves first-trimester prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2023; 62:512-521. [PMID: 37616523 DOI: 10.1002/uog.27451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To determine whether maternal serum glycosylated fibronectin (GlyFn) level in the first trimester increases the sensitivity of the Fetal Medicine Foundation (FMF) triple test, which incorporates mean arterial pressure, uterine artery pulsatility index and placental growth factor, when screening for pre-eclampsia (PE) in an Asian population. METHODS This was a nested case-control study of Chinese women with a singleton pregnancy who were screened for PE at 11-13 weeks' gestation as part of a non-intervention study between December 2016 and June 2018. GlyFn levels were measured retrospectively in archived serum from 1685 pregnancies, including 101 with PE, using an enzyme-linked immunosorbent assay (ELISA), and from 448 pregnancies, including 101 with PE, using a point-of-care (POC) device. Concordance between ELISA and POC tests was assessed using Lin's correlation coefficient and Passing-Bablok and Bland-Altman analyses. GlyFn was transformed into multiples of the median (MoM) to adjust for maternal and pregnancy characteristics. GlyFn MoM was compared between PE and non-PE pregnancies, and the association between GlyFn MoM and gestational age at delivery with PE was assessed. Risk for developing PE was estimated using the FMF competing-risks model. Screening performance for preterm and any-onset PE using different biomarker combinations was quantified by area under the receiver-operating-characteristics curve (AUC) and detection rate (DR) at a 10% fixed false-positive rate (FPR). Differences in AUC between biomarker combinations were compared using the DeLong test. RESULTS The concordance correlation coefficient between ELISA and POC measurements was 0.86 (95% CI, 0.83-0.88). Passing-Bablok analysis indicated proportional bias (slope, 1.08 (95% CI, 1.04-1.14)), with POC GlyFn being significantly higher compared with ELISA GlyFn. ELISA GlyFn in non-PE pregnancies was independent of gestational age at screening (P = 0.11), but significantly dependent on maternal age (P < 0.003), weight (P < 0.0002), height (P = 0.001), parity (P < 0.02) and smoking status (P = 0.002). Compared with non-PE pregnancies, median GlyFn MoM using ELISA and POC testing was elevated significantly in those with preterm PE (1.23 vs 1.00; P < 0.0001 and 1.18 vs 1.00; P < 0.0001, respectively) and those with term PE (1.26 vs 1.00; P < 0.0001 and 1.22 vs 1.00; P < 0.0001, respectively). GlyFn MoM was not correlated with gestational age at delivery with PE (P = 0.989). Adding GlyFn to the FMF triple test for preterm PE increased significantly the AUC from 0.859 to 0.896 (P = 0.012) and increased the DR at 10% FPR from 64.9% (95% CI, 48.7-81.1%) to 82.9% (95% CI, 66.4-93.4%). The corresponding DRs at 10% FPR for any-onset PE were 52.5% (95% CI, 42.3-62.5%) and 65.4% (95% CI, 55.2-74.5%), respectively. CONCLUSIONS Adding GlyFn to the FMF triple test increased the screening sensitivity for both preterm and any-onset PE in an Asian population. Prospective non-intervention studies are needed to confirm these initial findings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Moungmaithong
- Department of Obstetrics and Gynaecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - X Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - C S L Lau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - A W T Tse
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong, SAR, China
| | - N M W Lee
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - H H Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - D S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Cuckle H. Re: Routine first-trimester combined screening for pre-eclampsia: pregnancy-associated plasma protein-A or placental growth factor? Ultrasound Obstet Gynecol 2022; 59:404. [PMID: 35239220 DOI: 10.1002/uog.24865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- H Cuckle
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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He X, Banker M, Puttabyatappa M, Padmanabhan V, Auchus RJ. Maternal 11-Ketoandrostenedione Rises Through Normal Pregnancy and Is the Dominant 11-Oxygenated Androgen in Cord Blood. J Clin Endocrinol Metab 2022; 107:660-667. [PMID: 34718643 PMCID: PMC8851933 DOI: 10.1210/clinem/dgab793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenal-derived 11-oxygenated androgens (11oAs) are known important contributors to human physiology and disease but have not been studied in pregnancy. OBJECTIVE We characterize 11oAs in normal human pregnancy and neonatal period and assess the ratios between 11oAs and compare with ratios of other steroids that undergo placental metabolism. DESIGN Prospective cohort study, 2010-2018. SETTING Academic institution. PATIENTS Pairs of pregnant women and newborns (n = 120) were studied. Inclusion criteria were maternal age between 18 and 42 years old, spontaneous singleton pregnancies, and intention to deliver at University of Michigan. INTERVENTION Maternal venous blood was collected during first trimester and at term. Neonatal cord blood was collected following delivery. Steroids were measured via liquid chromatography-tandem mass spectrometry. MAIN OUTCOME MEASURES Levels of 11β-hydroxyandrostenedione (11OHA4), 11-ketoandrostenedione (11KA4), 11β-hydroxytestosterone, and 11-ketotestoterone (11KT) in maternal first trimester, maternal term, and neonatal cord blood were compared. 11OHA4-to-11KA4 ratios were correlated with cortisol-to-cortisone ratios. RESULTS Dominant 11oAs in pregnancy and the cord blood are 11OHA4 and 11KA4, compared to 11OHA4 and 11KT in adult men and nonpregnant women. We found a rise in 11oA concentrations, particularly 11KA4, from first to third trimester. In cord blood, the concentration of 11KA4 exceeded those of both 11OHA4 and 11KT, reflecting placental 11β-hydroxysteroid dehydrogenase type 2 (11βHSD2) and 17β-hydroxysteroid dehydrogenase (17βHSD2) activities, respectively. 11OHA4-to-11KA4 ratios are concordant with cortisol-to-cortisone ratios across all maternal and fetal compartments, reflecting placental 11βHSD2 activity. CONCLUSIONS Placental 17βHSD2 activity defends the fetus against the androgen 11KT. Our normative values may be used in future studies of 11oAs in complicated pregnancies.
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Affiliation(s)
- Xin He
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Banker
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | | | - Vasantha Padmanabhan
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Richard J Auchus
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
- LTC Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, MI, USA
- Correspondence: Richard J. Auchus, MD, PhD, 1150 West Medical Center Dr, Room 5560A MSRB II, Ann Arbor MI 48109, USA. E-mail:
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He F, Yang X. The screening of diagnostic biomarker microRNA in first-trimester maternal plasma for Down syndrome: A study protocol. Medicine (Baltimore) 2022; 101:e28495. [PMID: 35060501 PMCID: PMC8772682 DOI: 10.1097/md.0000000000028495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The trisomy of human chromosome 21 causes Down syndrome (DS), sometimes known as congenital folly's syndrome. The survivors show apparent mental impairment, unusual facial traits, growth and development abnormalities, and various deformities, with 60 percent of the infants having miscarriages in the early stages of the fetus. Plasma micRNA (miRNA) is a new diagnostic biomarker for DS; however, its significance in first-trimester maternal plasma is unknown. As a result, the purpose of this study is to assess the diagnostic significance of the biomarker miRNA in first-trimester maternal plasma for DS. MATERIALS AND METHODS From January 2014 until the present, blood samples were obtained from pregnant women who visited our hospital. This study included 20 eligible DS pregnancies and 20 normal pregnant women. We looked at the differential miRNA expression profile in DS maternal plasma from the first and second trimesters using miRNA microarrays. Bioinformatics technology was used to compare the particular miRNA in DS maternal plasma from the first and second trimesters and screen the miRNA co-expressed in DS maternal plasma. Meanwhile, the expression level of chosen miRNAs was verified using quantitative real-time PCR (qRT-PCR). DISCUSSION This study aims to see how useful the diagnostic biomarker miRNA in first-trimester maternal plasma is for diagnosing DS. The findings of this investigation will provide clinical evidence for the discovery of a new diagnostic biomarker miRNA in first-trimester maternal plasma for DS diagnosis. OSF REGRESSION NUMBER DOI 10.17605/OSF.IO/R49FT.
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Wang Y, Sun F, Wu P, Huang Y, Ye Y, Yang X, Yuan J, Liu Y, Zeng H, Wen Y, Qi X, Yang CX, Wang Y, Liu G, Chen D, Li L, Pan XF, Pan A. A Prospective Study of Early-pregnancy Thyroid Markers, Lipid Species, and Risk of Gestational Diabetes Mellitus. J Clin Endocrinol Metab 2022; 107:e804-e814. [PMID: 34453541 DOI: 10.1210/clinem/dgab637] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/23/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT While the associations between thyroid markers and gestational diabetes mellitus (GDM) have been extensively studied, the results are inconclusive and the mechanisms remain unclear. OBJECTIVE We aimed to investigate the prospective associations of thyroid markers in early gestation with GDM risk, and examine the mediating effects through lipid species. METHODS This study included 6068 pregnant women from the Tongji-Shuangliu Birth Cohort. Maternal serum thyroid markers (free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone, thyroid peroxidase antibody, and thyroglobulin antibody) were measured before 15 weeks. Deiodinase activity was assessed by fT3/fT4 ratio. Plasma lipidome were quantified in a subset of 883 participants. RESULTS Mean age of the participants was 26.6 ± 3.7 years, and mean gestational age was 10.3 ± 2.0 weeks. Higher levels of fT4 were associated with a decreased risk of GDM (OR = 0.73 comparing the extreme quartiles; 95% CI 0.54, 0.98, Ptrend = .043), while higher fT3/fT4 ratio was associated with an increased risk of GDM (OR = 1.43 comparing the extreme quartiles; 95% CI 1.06, 1.93, Ptrend = .010) after adjusting for potential confounders. Multiple linear regression suggested that fT3/fT4 ratio was positively associated with alkylphosphatidylcholine 36:1, phosphatidylethanolamine plasmalogen 38:6, diacylglyceride 18:0/18:1, sphingomyelin 34:1, and phosphatidylcholine 40:7 (false discovery rate [FDR] adjusted P < .05). Mediation analysis indicated 67.9% of the association between fT3/fT4 ratio and GDM might be mediated through the composite effect of these lipids. CONCLUSION Lower concentration of serum fT4 or higher fT3/fT4 ratio in early pregnancy was associated with an increased risk of GDM. The association of fT3/fT4 ratio with GDM was largely mediated by specific lipid species.
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Affiliation(s)
- Yi Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Fengjiang Sun
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 511436, China
| | - Ping Wu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yichao Huang
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 511436, China
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Yi Ye
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xue Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Jiaying Yuan
- Department of Science and Education, Shuangliu Maternal and Child Health Hospital, Chengdu 610200, China
| | - Yan Liu
- Department of Obstetrics and Gynecology, Shuangliu Maternal and Child Health Hospital, Chengdu 610200, China
| | - Huayan Zeng
- Nutrition Department, Shuangliu Maternal and Child Health Hospital, Chengdu 610200, China
| | - Ying Wen
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, West China Second Hospital, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, China
| | - Chun-Xia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yixin Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Da Chen
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 511436, China
| | - Liangzhong Li
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Légaré C, Clément AA, Desgagné V, Thibeault K, White F, Guay SP, Arsenault BJ, Scott MS, Jacques PÉ, Perron P, Guérin R, Hivert MF, Bouchard L. Human plasma pregnancy-associated miRNAs and their temporal variation within the first trimester of pregnancy. Reprod Biol Endocrinol 2022; 20:14. [PMID: 35031065 PMCID: PMC8759232 DOI: 10.1186/s12958-021-00883-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/20/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND During pregnancy, maternal metabolism undergoes substantial changes to support the developing fetus. Such changes are finely regulated by different mechanisms carried out by effectors such as microRNAs (miRNAs). These small non-coding RNAs regulate numerous biological functions, mostly through post-transcriptional repression of gene expression. miRNAs are also secreted in circulation by numerous organs, such as the placenta. However, the complete plasmatic microtranscriptome of pregnant women has still not been fully described, although some miRNA clusters from the chromosome 14 (C14MC) and the chromosome 19 (C19MC and miR-371-3 cluster) have been proposed as being specific to pregnancy. Our aims were thus to describe the plasma microtranscriptome during the first trimester of pregnancy, by assessing the differences with non-pregnant women, and how it varies between the 4th and the 16th week of pregnancy. METHODS Plasmatic miRNAs from 436 pregnant (gestational week 4 to 16) and 15 non-pregnant women were quantified using Illumina HiSeq next-generation sequencing platform. Differentially abundant miRNAs were identified using DESeq2 package (FDR q-value ≤ 0.05) and their targeted biological pathways were assessed with DIANA-miRpath. RESULTS A total of 2101 miRNAs were detected, of which 191 were differentially abundant (fold change < 0.05 or > 2, FDR q-value ≤ 0.05) between pregnant and non-pregnant women. Of these, 100 miRNAs were less and 91 miRNAs were more abundant in pregnant women. Additionally, the abundance of 57 miRNAs varied according to gestational age at first trimester, of which 47 were positively and 10 were negatively associated with advancing gestational age. miRNAs from the C19MC were positively associated with both pregnancy and gestational age variation during the first trimester. Biological pathway analysis revealed that these 191 (pregnancy-specific) and 57 (gestational age markers) miRNAs targeted genes involved in fatty acid metabolism, ECM-receptor interaction and TGF-beta signaling pathways. CONCLUSION We have identified circulating miRNAs specific to pregnancy and/or that varied with gestational age in first trimester. These miRNAs target biological pathways involved in lipid metabolism as well as placenta and embryo development, suggesting a contribution to the maternal metabolic adaptation to pregnancy and fetal growth.
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Affiliation(s)
- Cécilia Légaré
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences (FMHS), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Andrée-Anne Clément
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences (FMHS), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Véronique Desgagné
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences (FMHS), Université de Sherbrooke, Sherbrooke, QC, Canada
- Clinical Department of Laboratory Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Saguenay-Lac-St-Jean - Hôpital Universitaire de Chicoutimi, Pavillon des Augustines, 305 rue St-Vallier, Saguenay, QC, G7H 5H6, Canada
| | - Kathrine Thibeault
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences (FMHS), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédérique White
- Department of Biology, FMHS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon-Pierre Guay
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences (FMHS), Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada
| | - Benoit J Arsenault
- Centre de Recherche de L'Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Michelle S Scott
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences (FMHS), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pierre-Étienne Jacques
- Department of Biology, FMHS, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), Sherbrooke, QC, Canada
| | - Patrice Perron
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), Sherbrooke, QC, Canada
- Department of Medicine, FMHS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Renée Guérin
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences (FMHS), Université de Sherbrooke, Sherbrooke, QC, Canada
- Clinical Department of Laboratory Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Saguenay-Lac-St-Jean - Hôpital Universitaire de Chicoutimi, Pavillon des Augustines, 305 rue St-Vallier, Saguenay, QC, G7H 5H6, Canada
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, USA
| | - Luigi Bouchard
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences (FMHS), Université de Sherbrooke, Sherbrooke, QC, Canada.
- Clinical Department of Laboratory Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Saguenay-Lac-St-Jean - Hôpital Universitaire de Chicoutimi, Pavillon des Augustines, 305 rue St-Vallier, Saguenay, QC, G7H 5H6, Canada.
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), Sherbrooke, QC, Canada.
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10
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Wang L, Li W, Zhang S, Liu H, Li W, Hu T, Leng J. Association of leukocyte counts in the first trimester with glucose intolerance during pregnancy. J Diabetes Investig 2022; 13:191-200. [PMID: 34288555 PMCID: PMC8756326 DOI: 10.1111/jdi.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION We investigated the association between leukocyte counts and glucose challenge test (GCT) level during pregnancy. MATERIALS AND METHODS We collected prenatal information of women who had their first clinic visit in early pregnancy. Women underwent GCT at 24-28 gestational weeks, and a result of ≥7.8 mmol/L was considered positive. Participants were divided into quartiles of leukocyte counts, and association with GCT results and positive rate were analyzed by logistic regression. RESULTS Among 20,707 pregnant women, the median of leukocyte counts was higher in the positive group than the normal group (8.5 × 109 /L vs 8.2 × 109 /L, P < 0.01). There was a linear trend in GCT results and positive rate with increasing leukocyte quartiles. Compared with the lowest quartile, the highest leukocyte quartile (>9.70 × 109 /L) was significantly associated with positive GCT results (adjusted odds ratio 1.378, 95% confidence interval 1.246-1.524), and the linear relationship between increased risk of positive result and increasing leukocyte quartiles persisted (P for linear trend <0.01). In multivariable analysis, the risk of a positive result increased by 2.2% with each 1-unit increase in leukocyte counts (adjusted odds ratio 1.022, 95% confidence interval 1.011-1.033). CONCLUSIONS Elevated leukocyte counts in early pregnancy were independently and linearly associated with the risk of positive GCT levels, indicating that inflammation might play an important role in the development of gestational diabetes mellitus.
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Affiliation(s)
- Leishen Wang
- Tianjin Women and Children’s Health CenterTianjinChina
| | - Weiqin Li
- Tianjin Women and Children’s Health CenterTianjinChina
| | - Shuang Zhang
- Tianjin Women and Children’s Health CenterTianjinChina
| | - Huikun Liu
- Tianjin Women and Children’s Health CenterTianjinChina
| | - Wei Li
- Tianjin Women and Children’s Health CenterTianjinChina
| | | | - Junhong Leng
- Tianjin Women and Children’s Health CenterTianjinChina
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11
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Huang X, Zha B, Zhang M, Li Y, Wu Y, Zhang R, Sheng L, Xu J, Yu Z, Gao C, Chen Z, Ding H, Ma L, Zhang Y, Zang S, Zhang TN, Liu J. Decreased Monocyte Count Is Associated With Gestational Diabetes Mellitus Development, Macrosomia, and Inflammation. J Clin Endocrinol Metab 2022; 107:192-204. [PMID: 34478541 DOI: 10.1210/clinem/dgab657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT The immune system plays a central role in the pathophysiology of gestational diabetes mellitus (GDM). Monocytes, the main innate immune cells, are especially important in the maintenance of a normal pregnancy. OBJECTIVE Here, we investigated the potential effect of monocytes in GDM. METHODS Monocyte count was monitored throughout pregnancy in 214 women with GDM and 926 women without in a case-control and cohort study. Circulating levels of inflammatory cytokines, placenta-derived macrophages, and their products were measured. RESULTS Throughout pregnancy, monocyte count was significantly decreased in women with GDM, and was closely associated with glucose level, insulin resistance, and newborn weight. First-trimester monocyte count outperformed that of the second and third trimester as a risk factor and diagnostic predictor of GDM and macrosomia both in the case-control and cohort study. In addition, our cohort study showed that as first-trimester monocyte count decreased, GDM and macrosomia incidence, glucose level, and newborn weight increased in a stepwise manner. Risk of GDM started to decrease rapidly when first-trimester monocyte count exceeded 0.48 × 109/L. Notably, CD206 and interleukin 10 (IL-10) were significantly lower, whereas CD80, CD86, tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) were higher both in GDM placental tissue and peripheral blood. First-trimester monocyte count was positively related to IL-10 and CD206, but negatively related to CD80, CD86, TNF-α, and IL-6. CONCLUSION Decreased monocyte count throughout pregnancy was closely associated with the development of GDM, macrosomia, and the chronic inflammatory state of GDM. First-trimester monocyte count has great potential as an early diagnostic marker of GDM.
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Affiliation(s)
- Xinmei Huang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Bingbing Zha
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Manna Zhang
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yue Li
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Yueyue Wu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Rui Zhang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Li Sheng
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Jiong Xu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Zhiyan Yu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Cuijun Gao
- Department of Obstetrics, Wujing Hospital, Shanghai 200241, China
| | - Zaoping Chen
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Heyuan Ding
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Ling Ma
- Department of Obstetrics, Wujing Hospital, Shanghai 200241, China
| | - Yanquan Zhang
- Department of Obstetrics, Wujing Hospital, Shanghai 200241, China
| | - Shufei Zang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Tie-Ning Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jun Liu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
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12
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Lu L, Li C, Deng J, Luo J, Huang C. Maternal serum NGAL in the first trimester of pregnancy is a potential biomarker for the prediction of gestational diabetes mellitus. Front Endocrinol (Lausanne) 2022; 13:977254. [PMID: 36465627 PMCID: PMC9708734 DOI: 10.3389/fendo.2022.977254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) has adverse effects on the health of mothers and their offspring. Currently, no known biomarker has been proven to have sufficient validity for the prediction of GDM in the first trimester of pregnancy. The aim of this study was to investigate the potential relationship between serum neutrophil gelatinase-associated lipocalin (NGAL) levels in the first trimester of pregnancy and later GDM risk and to evaluate the performance of serum NGAL as a biomarker for the prediction of GDM. METHODS The study was conducted by recruiting participants at 8-13 weeks of gestation from The First Affiliated Hospital of Chengdu Medical College between January and June 2021; participants were followed up for oral glucose tolerance test (OGTT) screening at 24-28 gestational weeks. We examined the serum NGAL levels of all subjects in the first trimester who met the inclusion and exclusion criteria. Anthropometric, clinical, and laboratory parameters of the study subjects were obtained during the same study period. A logistic regression model was carried out to investigate the potential relationship between serum NGAL levels in the first trimester of pregnancy and later GDM risk. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the discrimination and calibration of serum NGAL as a biomarker for the prediction of GDM in the first trimester of pregnancy. RESULTS Serum NGAL levels in the first trimester of pregnancy were significantly higher in women who later developed GDM than in those who did not develop GDM. Serum NGAL levels in the first trimester of pregnancy were positively associated with an increased risk of GDM after adjustment for potential confounding factors. The risk prediction model for GDM constructed by using serum NGAL levels in the first trimester of pregnancy achieved excellent performance. CONCLUSIONS Maternal serum NGAL in the first trimester of pregnancy is a potential biomarker for the prediction of GDM, which could help guide the clinical practice of antenatal care.
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Affiliation(s)
| | | | | | - Jianbo Luo
- *Correspondence: Chaolin Huang, ; Jianbo Luo,
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13
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Gao X, Wang X, Han Y, Wang H, Li J, Hou Y, Yang Y, Wang H, Teng W, Shan Z. Postpartum Thyroid Dysfunction in Women With Known and Newly Diagnosed Hypothyroidism in Early Pregnancy. Front Endocrinol (Lausanne) 2021; 12:746329. [PMID: 34899598 PMCID: PMC8662309 DOI: 10.3389/fendo.2021.746329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Hypothyroidism in the first trimester of pregnancy (T1) has great adverse effects on mothers and foetuses. However, few studies have investigated the influence on postpartum thyroid dysfunction. This study aimed to evaluate their long-term effect on postpartum thyroid function within one year after delivery. Methods In total, 151 women were recruited from 1496 participants and were classified as newly diagnosed subclinical hypothyroidism (SCH) in T1 (ND-SCH, n=50), previously known SCH before pregnancy (PK-SCH, n=51) and previously known overt hypothyroidism (PK-OH, n=50). Their thyroid functions were dynamically monitored from pre-conception to one-year postpartum. Results During pregnancy, the first thyroid functions' test time in T1 were 5-8 gestational weeks. After delivery, the prevalence of postpartum thyroiditis (PPT) was comparable in women with previously known and newly diagnosed hypothyroidism [ND-SCH 62.0% vs PK-SCH 64.7% vs PK-OH 64.0%, P=0.96]. For the ND-SCH group, PPT was significantly related with thyroid-stimulating hormone (TSH) >4.0 mU/L occurring at <8 gestational weeks [OR=8.06, 95% CI, 2.08-31.29] and TSH levels outside 1.0-2.5 mU/L near childbirth [OR=3.73, 95% CI, 1.04-13.41]. For patients with known hypothyroidism before pregnancy (PK-SCH and PK-OH), TSH>2.5 mU/L in T1 [OR=3.55, 95% CI, 1.43-8.81] and TPOAb≥300 μIU/mL [OR=6.58, 95% CI, 2.05-21.12] were associated with PPT. Regardless of whether SCH was diagnosed before pregnancy or in T1, the levothyroxine (LT4) treatment was discontinued at delivery. More than 50% of the patients had to face the hypothyroidism phase of postpartum and restarted LT4 treatment in the first-year follow-up. The logistic regression analysis revealed that TSH elevation occurring at <8 gestational weeks [OR=2.48, 95% CI, 1.09-5.6], TSH levels outside 1.0-2.5 mU/L near childbirth [OR=3.42, 95% CI, 1.45-8.05], and TPOAb≥300 μIU/mL [OR=6.59, 95% CI, 1.79-24.30] were the risk factors. Conclusion TSH elevation at <8 gestational weeks was associated with PPT after delivery in women with known and newly diagnosed hypothyroidism. Especially for SCH patients who stopped LT4 treatment at delivery, unsatisfactory TSH level at <8 gestational weeks and near childbirth, TPOAb≥300 μIU/mL were the risk factors for LT4 retreatment in one-year postpartum.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
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14
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Wang X, Zheng X, Yan J, Xu R, Xu M, Zheng L, Xu L, Lin Z. The Clinical Values of Afamin, Triglyceride and PLR in Predicting Risk of Gestational Diabetes During Early Pregnancy. Front Endocrinol (Lausanne) 2021; 12:723650. [PMID: 34803906 PMCID: PMC8597949 DOI: 10.3389/fendo.2021.723650] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/18/2021] [Indexed: 01/05/2023] Open
Abstract
Objective To establish a model to predict gestational diabetes mellitus (GDM) based on the clinical characteristics, early pregnancy (10-12 weeks gestation) peripheral blood routine, and biochemical indicators, and to explore its predictive efficiencies. Methods Data from 607 pregnant women with GDM were compared to the data from 833 pregnant women without GDM admitted to the Obstetrics Department of Fujian Maternity and Child Health Hospital (affiliated to Fujian Medical University) from May 2018 to December 2018 were retrospectively included. The ages of the pregnant women, paternal ages, number of pregnancies, number of deliveries, pre-pregnancy heights/weights, and the calculated body mass indexes (BMI) were recorded. In all participants, 10-12 weeks of pregnancy, afamin concentration, routine blood work, prenatal aneuploidy screening, and biochemical testing were performed. At weeks 24-28 of gestation, patients underwent oral glucose tolerance test (OGTT) for GDM screening. Results Multivariate logistic regression analysis showed that maternal age, early pregnancy afamin level, triglycerides, and platelet/lymphocyte ratio (PLR) were independent risk factors for gestational diabetes. The formula for predicting GDM probability was as follows: P = 1/1 + exp( - 6.054 + 0.774 × triglycerides + 0.002 × afamin + 0.155 × age - 0.012 × PLR)]. From the established ROC curve, the area under the curve (AUC) was 0.748, indicating that the model has a good degree of discrimination. When the predictive probability cut-off value was set on 0.358, sensitivity, specificity, positive predictive value, and negative predictive value were 69.2%, 68.3%, 42.5%, and 86.2%, respectively, and the accuracy rate was 70.2%. The Hosmer-Lemeshow test results showed that the goodness of the model fit has a good calibration ability (χ2 = 12.269, df=8, P=0.140). Conclusions Maternal age, early pregnancy afamin level, triglycerides, and PLR are independent risk factors for gestational diabetes. When combined, the above indicators are helpful for prediction, early diagnosis, and intervention of gestational diabetes.
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Affiliation(s)
- Xuechun Wang
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiuqiong Zheng
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jianying Yan
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Rongli Xu
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mu Xu
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lin Zheng
- Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liangpu Xu
- Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi Lin
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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15
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Kyozuka H, Yasuda S, Murata T, Fukuda T, Yamaguchi A, Kanno A, Sato A, Ogata Y, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Adverse obstetric outcomes in early-diagnosed gestational diabetes mellitus: The Japan Environment and Children's Study. J Diabetes Investig 2021; 12:2071-2079. [PMID: 33960705 PMCID: PMC8565414 DOI: 10.1111/jdi.13569] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS/INTRODUCTION To examine adverse outcomes in women with early-diagnosed gestational diabetes mellitus using data from a large birth cohort study in Japan. MATERIALS AND METHODS This study analyzed data from singleton pregnancies in the Japan Environment and Children's Study including births during 2011-2014. Mothers with an HbA1c level ≥6.5% in the first trimester, a history of diabetes mellitus, or steroid use during pregnancy were excluded. The participants were divided into three groups: control (without gestational diabetes mellitus), early-diagnosed gestational diabetes mellitus (diagnosed before gestational week 24), and late-diagnosed gestational diabetes mellitus (diagnosed after gestational week 24). Multiple logistic regression analysis was performed to calculate the risk of early-diagnosed and late-diagnosed gestational diabetes mellitus for adverse obstetrics outcomes. RESULTS In total, 100,376 eligible participants were included in this study. The number of individuals in control cases, early-diagnosed gestational diabetes mellitus cases, and late-diagnosed gestational diabetes mellitus cases was 98,090 (97.7%), 751 (0.7%), and 1,535 (1.5%), respectively. When control cases were used as reference, multiple logistic regression analysis revealed that early-diagnosed gestational diabetes mellitus increased the risk of hypertensive disorders of pregnancy (adjusted odds ratio: 2.08, 95% confidence interval: 1.51-2.86), early-onset hypertensive disorders of pregnancy (adjusted odds ratio: 1.91, 95% confidence interval: 1.01-3.65), and late-onset hypertensive disorders of pregnancy (adjusted odds ratio: 1.92, 95% confidence interval: 1.29-2.86). CONCLUSION Early-diagnosed gestational diabetes mellitus is associated with serious obstetric complications. Our findings indicate the necessity of further investigations to validate the benefit of early screening for gestational diabetes mellitus in pregnant women.
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Affiliation(s)
- Hyo Kyozuka
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Shun Yasuda
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Tsuyoshi Murata
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Toma Fukuda
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Akiko Yamaguchi
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Aya Kanno
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
- Department of PediatricsFukushima Medical University School of MedicineFukushimaJapan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
- Department of Public HealthFukushima Medical University School of MedicineFukushimaJapan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
- Department of PediatricsFukushima Medical University School of MedicineFukushimaJapan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
- Fukushima Medical Center for Children and WomenFukushima Medical UniversityFukushimaJapan
| | - Keiya Fujimori
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
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Noël L, Guy GP, Jones S, Forenc K, Buck E, Papageorghiou AT, Thilaganathan B. Routine first-trimester combined screening for pre-eclampsia: pregnancy-associated plasma protein-A or placental growth factor? Ultrasound Obstet Gynecol 2021; 58:540-545. [PMID: 33998078 DOI: 10.1002/uog.23669] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the screening performance of serum pregnancy-associated plasma protein-A (PAPP-A) vs placental growth factor (PlGF) in routine first-trimester combined screening for pre-eclampsia (PE), small-for-gestational age (SGA) at birth and trisomy 21. METHODS This was a retrospective study nested in pregnancy cohorts undergoing first-trimester combined screening for PE and trisomy 21 using The Fetal Medicine Foundation (FMF) algorithm based on maternal characteristics, nuchal translucency thickness, PAPP-A, free beta-human chorionic gonadotropin, blood pressure and uterine artery Doppler. Women at high risk for preterm PE (≥ 1 in 50) received 150 mg of aspirin per day, underwent serial fetal growth scans at 28 and 36 weeks and were offered elective birth from 40 weeks of gestation. PlGF was quantified retrospectively from stored surplus first-trimester serum samples. The performance of combined first-trimester screening for PE and SGA using maternal history, blood pressure, uterine artery pulsatility index and either PAPP-A or PlGF was calculated. Similarly, the performance of combined first-trimester screening for trisomy 21 was calculated using either PAPP-A or PlGF in addition to maternal age, nuchal translucency thickness and free beta-human chorionic gonadotropin. RESULTS Maternal serum PAPP-A was assayed in 1094 women, including 82 with PE, 111 with SGA (birth weight < 10th centile), 53 with both PE and SGA and 94 with fetal trisomy 21. PlGF levels were obtained retrospectively from 1066/1094 women. Median serum PlGF multiples of the median was significantly lower in pregnancies with PE (1.0 (interquartile range (IQR), 0.8-1.4); P < 0.01), SGA (1.0 (IQR, 0.8-1.3); P < 0.001) and trisomy 21 (0.6 (IQR, 0.5-0.9); P < 0.0001) compared to in controls (1.2 (IQR, 0.9-1.5)). There was no significant difference in the performance of first-trimester screening using PAPP-A vs PlGF for either preterm PE (area under the receiver-operating-characteristics curve (AUC), 0.78 vs 0.79; P = 0.55) or term PE (AUC, 0.74 vs 0.74; P = 0.60). These findings persisted even after correction for the effect of targeted aspirin use on the prevalence of PE. Similarly, there were no significant differences in sensitivity and specificity of combined screening for SGA or trisomy 21 when using PAPP-A vs PlGF. CONCLUSIONS Using either PlGF or PAPP-A in routine first-trimester combined screening based on maternal characteristics, blood pressure and uterine artery Doppler does not make a significant clinical difference to the detection of PE or SGA. Depending on the setting, biomarkers should be chosen to achieve a good compromise between performance and measurement requirements. This pragmatic clinical-effectiveness study suggests that combined screening for PE can be implemented successfully in a public healthcare setting without changing current protocols for the assessment of PAPP-A in the first trimester. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Noël
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - G P Guy
- Fetal Medicine Unit, Medway NHS Foundation Trust, Gillingham, UK
| | - S Jones
- Prenatal Screening Unit, King George's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - K Forenc
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - E Buck
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Tommy's National Centre for Maternity Improvement, Royal College of Obstetricians and Gynaecologists, London, UK
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Bandres-Meriz J, Majali-Martinez A, Hoch D, Morante M, Glasner A, van Poppel MNM, Desoye G, Herrera E. Maternal C-Peptide and Insulin Sensitivity, but Not BMI, Associate with Fatty Acids in the First Trimester of Pregnancy. Int J Mol Sci 2021; 22:10422. [PMID: 34638763 PMCID: PMC8508886 DOI: 10.3390/ijms221910422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
Maternal obesity in pregnancy is a pro-inflammatory condition exposing the fetus to an adverse environment. Here, we tested associations of maternal obesity (primary exposures: BMI, leptin) and metabolic parameters (secondary exposures: glucose, C-peptide, and insulin sensitivity) with total serum concentrations of fatty acids in the first trimester of human pregnancy. This cross-sectional study included 123 non-smoking women with singleton pregnancy. In maternal serum, cotinine, leptin, and C-peptide (ELISA), glucose (hexokinase-based test) and fatty acids (gas chromatography) were quantified, and the insulin sensitivity index (ISHOMA) was calculated. Concentrations of fatty acid classes and total fatty acids did not differ between BMI or leptin categories. However, n-3 polyunsaturated fatty acids (PUFA) were decreased in the category with the highest C-peptide concentration (n-3 PUFA: CI -35.82--6.28, p < 0.006) and in the lowest ISHOMA category (n-3 PUFA: CI -36.48--5.61, p < 0.008). In a subcohort, in which fetal sex was determined (RT-qPCR of placental tissue), C-peptide was significantly associated with docosahexaenoic acid (DHA) in mothers bearing a female (n = 46), but not male (n = 37) fetus. In conclusion, pregnant women with high fasting C-peptide and low ISHOMA had decreased n-3 PUFA, and DHA was lower with higher C-peptide only in mothers bearing a female fetus.
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Affiliation(s)
- Julia Bandres-Meriz
- Department of Obstetrics and Gynaecology, Medical University of Graz, 8036 Graz, Austria; (A.M.-M.); (D.H.)
| | - Alejandro Majali-Martinez
- Department of Obstetrics and Gynaecology, Medical University of Graz, 8036 Graz, Austria; (A.M.-M.); (D.H.)
| | - Denise Hoch
- Department of Obstetrics and Gynaecology, Medical University of Graz, 8036 Graz, Austria; (A.M.-M.); (D.H.)
| | - Milagros Morante
- Faculty of Pharmacy, Universidad San Pablo CEU, 28668 Madrid, Spain; (M.M.); (E.H.)
| | | | | | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, 8036 Graz, Austria; (A.M.-M.); (D.H.)
| | - Emilio Herrera
- Faculty of Pharmacy, Universidad San Pablo CEU, 28668 Madrid, Spain; (M.M.); (E.H.)
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18
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Gulecoglu Onem MG, Coker C, Baysal K, Altunyurt S, Keskinoglu P. The effects of pre-pregnancy obesity and gestational weight gain on maternal lipid profiles, fatty acids and insulin resistance. J Perinat Med 2021; 49:873-883. [PMID: 33887128 DOI: 10.1515/jpm-2020-0540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pregnancy is associated with physiological alterations in insulin sensitivity and lipid metabolism. This study investigates the associations between pregestational body mass index (pBMI) and the rate of gestational weight gain (rGWG) in the second trimester with the biomarkers of lipid, fatty acids metabolism and insulin resistance. METHODS Sixty nine pregnant women followed. The body weights of the pregnant women were measured and blood samples were obtained at 11-14th and 24-28th weeks of pregnancy. Glucose, total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, insulin levels and fatty acids were measured. Rate of GWG (kg/week) and The Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) were calculated. The pregnant women were stratified according to their pBMI and the 2nd trimester rGWG. RESULTS The rate of GWG was significantly higher for the group with pBMI<25, compared to the group with pBMI≥25 (p=0.024). Triglyceride, total cholesterol, LDL and HDL cholesterol were significantly increased in the second trimester compared with the first trimester. Palmitic acid, oleic acid, linoleic acid, myristic acid, docosahexaenoic acid (DHA), arachidonic acid (AA), total omega-6 (n - 6) and omega-3 (n - 3) fatty acid levels and n - 6/n - 3 ratio were significantly higher in the second trimester. Glucose was significantly decreased and insulin was increased in the second trimester. In the overweight/obese group; HOMA-IR, insulin, AA, palmitoleic acid and stearic acid were found to be high in comparison to the group with low/normal pBMI. No parameters were associated with rGWG. CONCLUSIONS The changes in lipid parameters, free fatty acids, insulin and HOMA-IR in the second trimester were compatible with the changes in lipid metabolism and the development of insulin resistance. Pregestational BMI was shown to have a stronger influence on lipid profile, insulin resistance, and fatty acids than rGWG.
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Affiliation(s)
| | - Canan Coker
- Department of Medical Biochemistry, Medical Faculty Dokuz Eylul University, Izmir, Turkey
| | - Kemal Baysal
- Department of Medical Biochemistry, Medical Faculty Koc University, Istanbul, Turkey
| | - Sabahattin Altunyurt
- Department of Obstetrics and Gynecology, Medical Faculty Dokuz Eylul University, Izmir, Turkey
| | - Pembe Keskinoglu
- Department of Biostatistics and Medical Informatics, Medical Faculty Dokuz Eylul University, Izmir, Turkey
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19
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Abbara A, Al-Memar M, Phylactou M, Kyriacou C, Eng PC, Nadir R, Izzi-Engbeaya C, Clarke SA, Mills EG, Daniels E, Huo L, Pacuszka E, Yang L, Patel B, Tan T, Bech P, Comninos AN, Fourie H, Kelsey TW, Bourne T, Dhillo WS. Performance of plasma kisspeptin as a biomarker for miscarriage improves with gestational age during the first trimester. Fertil Steril 2021; 116:809-819. [PMID: 34053677 PMCID: PMC8445632 DOI: 10.1016/j.fertnstert.2021.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the performance of kisspeptin and beta human chorionic gonadotropin (βhCG), both alone and in combination, as biomarkers for miscarriage throughout the first trimester. DESIGN Prospective, nested case-control study. SETTING Tertiary Centre, Queen Charlotte Hospital, London, United Kingdom. PATIENT(S) Adult women who had miscarriages (n = 95, 173 samples) and women with healthy pregnancies (n = 265, 557 samples). INTERVENTION(S) The participants underwent serial ultrasound scans and blood sampling for measurement of plasma kisspeptin and βhCG levels during the first trimester. MAIN OUTCOME MEASURE(S) The ability of plasma kisspeptin and βhCG levels to distinguish pregnancies complicated by miscarriage from healthy pregnancies unaffected by miscarriage. RESULT(S) Gestation-adjusted levels of circulating kisspeptin and βhCG were lower in samples from women with miscarriages than in women with healthy pregnancies by 79% and 70%, respectively. The area under the receiver-operating characteristic curve for identifying miscarriage during the first trimester was 0.874 (95% confidence interval [CI] 0.844-0.904) for kisspeptin, 0.859 (95% CI 0.820-0.899) for βhCG, and 0.916 (95% CI 0.886-0.946) for the sum of the two markers. The performance of kisspeptin in identifying miscarriage improved with increasing length of gestation, whereas that of βhCG worsened. A decision matrix incorporating kisspeptin, βhCG, and gestational age had 83% to 87% accuracy for the prediction of miscarriage. CONCLUSION(S) Plasma kisspeptin is a promising biomarker for miscarriage and provides additional value to βhCG alone, especially during later gestational weeks of the first trimester.
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Affiliation(s)
- Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Maya Al-Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, United Kingdom
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, United Kingdom
| | - Pei Chia Eng
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Rans Nadir
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Chioma Izzi-Engbeaya
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Sophie A Clarke
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Edouard G Mills
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Elisabeth Daniels
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Lechun Huo
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Ewa Pacuszka
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Lisa Yang
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Bijal Patel
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Paul Bech
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Hanine Fourie
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, United Kingdom
| | - Tom W Kelsey
- School of Computer Science, University of St. Andrews, St. Andrews, United Kingdom
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, United Kingdom; Katholieke Universiteit Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.
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Antony KM, Romezi M, Lindgren K, Mitchell KB, Venable SF, Racusin DA, Suter MA, Aagaard KM. Maternal Metabolic Biomarkers are Associated with Obesity and Excess Gestational Weight Gain. Am J Perinatol 2021; 38:e173-e181. [PMID: 32232816 PMCID: PMC8630982 DOI: 10.1055/s-0040-1708855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the independent contribution of maternal obesity and gestational weight gain (GWG) in excess of the Institute of Medicine's guidelines on levels of maternal serum inflammatory and metabolic measures. STUDY DESIGN Banked maternal serum samples from 120 subjects with documented prepregnancy or first trimester body mass index (BMI) were utilized for analyte analyses. Validated, BMI-specific formulas were utilized to categorize GWG as either insufficient, at goal or excess based on the Institute of Medicine guidelines with gestational age adjustments. Serum was analyzed for known inflammatory or metabolic pathway intermediates using the Luminex xMap system with the MILLIPLEX Human Metabolic Hormone Magnetic Bead Panel. Measured analytes included interleukin-6, monocyte chemoattractant protein-1, and tumor necrosis factor-α and metabolic markers amylin, c-peptide, ghrelin, gastric inhibitory polypeptide, glucagon-like peptide-1, glucagon, insulin, leptin, pancreatic polypeptide, and peptide YY. Kruskal-Wallis ANOVA and Pearson's correlation coefficients were calculated for each marker. RESULTS C-peptide, insulin, and leptin all varied significantly with both obesity and GWG while glucagon-like peptide-1 varied by BMI but not GWG. These analytes covaried with other metabolic analytes, but not with inflammatory analytes. CONCLUSION Maternal metabolic biomarkers at delivery vary significantly with both obesity and GWG. Taken together, these findings suggest that GWG (with and without comorbid obesity) is an important mediator of measurable metabolites in pregnancy but is not necessarily accompanied by inflammatory measures in serum. These findings are consistent with GWG being an independent risk factor for metabolic disturbances during pregnancy.
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Affiliation(s)
- Kathleen M. Antony
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mona Romezi
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Kourtnee Lindgren
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Kristen B. Mitchell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Susan F. Venable
- Department of Immunology and Pathology, Baylor College of Medicine, Houston, Texas
| | - Diana A. Racusin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Melissa A. Suter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Kjersti M. Aagaard
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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21
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Rashidi H, Kalantari K, Shahbazian H, Nouhjah S. The relationship between fasting plasma glucose in the first trimester of pregnancy and the incidence of gestational diabetes in Iran. Diabetes Metab Syndr 2021; 15:102193. [PMID: 34229225 DOI: 10.1016/j.dsx.2021.102193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022]
Abstract
AIMS This study aimed to investigate the relationship between fasting plasma glucose in the first trimester of pregnancy and the incidence of gestational diabetes. METHODS This descriptive-analytical study was conducted using the merging data from two prospective cohort studies that were carried out from 2015 to 2018 in Ahvaz, southwest of Iran. Logistic regression and ROC curves were used to evaluate the predictive power of risk factors. RESULTS Of all 1270 pregnant women studied, 454 (35.75%) had gestational diabetes who were compared with the other 816 (64.25%) healthy women. The area under the curve (AUC) of fasting glucose for the first pregnancy visit was 0.80 (95% CI: 0.76-83), and the optimum fasting glucose cut-off point was 85.5 mg/dL with a sensitivity of 71% and a specificity of 69%. AUC of the combination of fasting glucose at the first visit with body mass index ≥25 kg/m2 and family history of diabetes was calculated to be 0.85 (CI, 0.82-0.88) and 0.84 (CI, 0.79-0.89) respectively. CONCLUSION Fasting plasma glucose in the first trimester of pregnancy is a relatively good predictor of gestational diabetes. If this factor is combined with other risks, its diagnostic value will increase.
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Affiliation(s)
- Homeira Rashidi
- Diabetes Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kamelia Kalantari
- Diabetes Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hajieh Shahbazian
- Diabetes Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sedigheh Nouhjah
- Diabetes Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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22
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Elger T, Akolekar R, Syngelaki A, De Paco Matallana C, Molina FS, Gallardo Arozena M, Chaveeva P, Persico N, Accurti V, Kagan KO, Prodan N, Cruz J, Nicolaides KH. Fetal loss after chorionic villus sampling in twin pregnancy. Ultrasound Obstet Gynecol 2021; 58:48-55. [PMID: 34038977 DOI: 10.1002/uog.23694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To estimate the chorionic villus sampling (CVS)-related risk of fetal loss in twin pregnancy after adjustment for chorionicity, nuchal translucency thickness (NT), intertwin discordance in crown-rump length (CRL), maternal demographic characteristics and serum pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG). METHODS This was a multicenter study from eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. Data were obtained prospectively from women with twin pregnancy undergoing routine ultrasound examination at 11-13 weeks' gestation. Multivariable logistic regression analysis with backward stepwise elimination was used to examine whether CVS provided a significant independent contribution to the prediction of risk of fetal loss after adjusting for maternal and pregnancy characteristics, including maternal age, racial origin and weight, method of conception, smoking status, parity, chorionicity, intertwin discordance in CRL, fetal NT ≥ 95th percentile and free β-hCG and PAPP-A multiples of the median. Similarly, within the CVS group, multivariable logistic regression analysis was used to investigate the effect of the number of intrauterine needle insertions and size of the needle on the risk of fetal loss. RESULTS The study population of 8581 twin pregnancies undergoing ultrasound examination at 11-13 weeks' gestation included 316 dichorionic and 129 monochorionic twins that had CVS. First, in twin pregnancies undergoing CVS, compared to those not undergoing CVS, there was a 2-fold increased risk of fetal loss at < 24 weeks' gestation and of loss at any stage in pregnancy. Second, the factors providing a significant independent contribution to the prediction of miscarriage or fetal loss in twin pregnancy were increased maternal weight, black racial origin, monochorionicity, and more so monoamnionicity, large intertwin discordance in CRL and increased fetal NT, and, in the case of fetal loss at any stage, there was also a contribution from assisted conception and low serum PAPP-A. Third, after adjustment for maternal and pregnancy characteristics, CVS did not provide a significant contribution to the risk of fetal loss. Fourth, in twin pregnancies that had CVS, there was no significant contribution to fetal loss from the number of intrauterine needle insertions or needle size. CONCLUSION The 2-fold increased risk of fetal loss following CVS in twin pregnancy can, to a great extent, be explained by maternal and pregnancy characteristics rather than the invasive procedure itself. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Elger
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - R Akolekar
- Medway Maritime Hospital, Gillingham, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | | | - F S Molina
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - N Persico
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - V Accurti
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - K O Kagan
- University Women's Hospital, Tuebingen, Germany
| | - N Prodan
- University Women's Hospital, Tuebingen, Germany
| | - J Cruz
- Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Hu Z, Zhang M. Establishment of clinical diagnostic models using glucose, lipid, and urinary polypeptides in gestational diabetes mellitus. J Clin Lab Anal 2021; 35:e23833. [PMID: 34042214 PMCID: PMC8274985 DOI: 10.1002/jcla.23833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/08/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has many adverse outcomes that seriously threaten the short-term and long-term health of mothers and infants. This study comprehensively analyzed the clinical diagnostic value of GDM-related clinical indexes and urine polypeptide research results, and established comprehensive index diagnostic models. METHODS In this study, diagnostic values from the clinical indexes of serum triglyceride (TRIG), high-density lipoprotein cholesterol (HDL-C), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), and 7 GDM-related urinary polypeptides were analyzed retrospectively. The multiple logistic regression equation, multilayer perceptron neural network model, radial basis function, and discriminant analysis function models of GDM-related indexes were established using machine language. RESULTS The results showed that HbA1c had the highest diagnostic value for GDM, with an area under the curve (AUC) of 0.769. When the cut-off value was 4.95, the diagnostic sensitivity and specificity were 70.5% and 70.0%, respectively. Among the seven GDM-related urinary polypeptides, human hemopexin (HEMO) had the highest diagnostic value, with an AUC of 0.690. When the cut-off value was 368.5, the sensitivity and specificity were 79.5% and 43.3%, respectively. The AUC of the multilayer perceptron neural network model was 0.942, followed by binary logistic regression (0.938), radial basis function model (0.909), and the discriminant analysis function model (0.908). CONCLUSION The establishment of a GDM diagnostic model combining blood glucose, blood lipid, and urine polypeptide indexes can lay a foundation for exploring machine language and artificial intelligence in diagnostic systems.
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Affiliation(s)
- Zhiying Hu
- Clinical Laboratory MedicineBeijing Shijitan HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Urinary Cellular Molecular DiagnosticsBeijingChina
| | - Man Zhang
- Clinical Laboratory MedicineBeijing Shijitan HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Urinary Cellular Molecular DiagnosticsBeijingChina
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Hua J, Shen J, Zhang J, Zhou Y, Du W, Williams GJ. The association between COVID-19 pandemic and maternal isolated hypothyroxinemia in first and second trimesters. Psychoneuroendocrinology 2021; 128:105210. [PMID: 33866067 PMCID: PMC8021450 DOI: 10.1016/j.psyneuen.2021.105210] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The outbreak of COVID-19 epidemic has induced entire cities in China placed under 'mass quarantine'. The majority of pregnant women have to be confined at home may be more vulnerable to stressors. In our study, we aimed to explore the effects of the epidemic on maternal thyroid function, so as to provide evidence for prevention and intervention of sustained maternal and offspring's health impairment produced by thyroid dysfunction. METHODS The subjects were selected from an ongoing prospective cohort study. we included the pregnant women who receive a thyroid function test during the COVID-19 epidemic and those receiving the test during the corresponding lunar period of 2019. A total of 7148 pregnant women with complete information were included in the final analysis. Multivariate linear and logistic regression models were used for analyzing the association of COVID-19 pandemic with FT4 levels and isolated hypothyroxinemia. RESULTS We found a decreased maternal FT4 level during the period of the COVID-19 pandemic in first and second trimesters (β = -0. 131, 95%CI = -0.257,-0.006,p = 0.040) and in first trimester (β = -0. 0.176, 95%CI = -0.326,-0.026,p = 0.022) when adjusting for 25 (OH) vitamin D, vitamin B12, folate and ferritin and gestational days, maternal socio-demographic characteristics and health conditions. The status of pandemic increased the risks of isolated hypothyroxinemia in first and second trimesters (OR = 1.547, 95%CI = 1.251,1.913, p < 0.001) and first trimester (OR = 1.651, 95%CI = 1.289,2.114, p < 0.001) when adjusting for the covariates. However, these associations disappeared in the women with positive TPOAb (p > 0.05). Additionally, we found associations between daily reported new case of COVID-19 and maternal FT4 for single-day lag1, lag3 and multi-day lag01 and lag04 when adjusting for the covariates (each p < 0.05). CONCLUSIONS Mass confinement as a primary community control strategy may have a significant cost to public health resources. Access to health service systems and adequate medical resources should be improved for pregnant women during the COVID-19 pandemic.
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Affiliation(s)
- Jing Hua
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 2699, Gaoke Road, Pudong District, Shanghai 201204, China.
| | - Jiajin Shen
- KLATASDS-MOE, School of Statistics, East China Normal University, North Zhangshan Road, Shanghai,Pudong District, Shanghai 200062, China.
| | - Jiajia Zhang
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 2699, Gaoke Road, Pudong District, Shanghai 201204, China.
| | - Yingchun Zhou
- KLATASDS-MOE, School of Statistics, East China Normal University, North Zhangshan Road, Shanghai,Pudong District, Shanghai 200062, China.
| | - Wenchong Du
- Department of psychology, Nottingham Trent University, Burton Street, Nottingham NG1 4BU, UK.
| | - Gareth J Williams
- School of Social Sciences, Nottingham Trent University, 3633, Burton Street, Nottingham NG1 4BU, UK.
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Du M, Liu J, Han N, Zhao Z, Luo S, Wang H. Exploring the mediating role of serum retinol-binding protein 4 in the relationship between sleep quality and insulin resistance in pregnant women. Diabetes Res Clin Pract 2021; 176:108866. [PMID: 34023339 DOI: 10.1016/j.diabres.2021.108866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/19/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
AIMS We aimed to explore the mediating role of plasma retinol-binding protein 4 (RBP4) in the relationship between sleep quality and insulin resistance (IR) among pregnant women. METHODS We conducted a cross-sectional study including 263 pregnant women in the first trimester. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI). The ELISA and homeostasis model assessment (HOMA) was used to analyze plasma RBP4 and estimate IR. The mediating model was used to analyze the mediating role of RBP4 in the relationship between PSQI score and IR. RESULTS In the multivariable linear regression model, the three terms were positively related with each other, PSQI score was positively associated with IR levels (β = 0.55, p < 0.05). In the mediating model, RBP4 levels mediated completely the relationship between PSQI scores and IR levels (β = 0.29, p < 0.0001). The indirect effect of RBP4 in the relation between sleep quality and IR explained 89.10% of total effect. CONCLUSIONS RPB4 may play a complete mediating role in the relation between sleep quality and insulin resistance in early pregnancy. Improvements in sleep quality in the first trimester may provide a pathway to reduce plasma RBP4, which is beneficial for less IR and GDM prevention.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing 100871, China.
| | - Na Han
- Maternal and Child Health Hospital of Tongzhou District, Beijing 101101, China
| | - Zhiling Zhao
- Maternal and Child Health Hospital of Tongzhou District, Beijing 101101, China
| | - Shusheng Luo
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
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Jamieson EL, Spry EP, Kirke AB, Griffiths E, Porter C, Roxburgh C, Singleton S, Sterry K, Atkinson DN, Marley JV. Prediabetes and pregnancy: Early pregnancy HbA 1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes. Diabetes Res Clin Pract 2021; 176:108868. [PMID: 34023341 DOI: 10.1016/j.diabres.2021.108868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
AIMS To assess whether early pregnancy HbA1c can predict gestational diabetes mellitus (GDM) and adverse birth outcomes in Australian women. METHODS Prospective study of 466 women without diabetes, aged ≥16-years at first antenatal presentation. Recruitment was from 27 primary healthcare sites in rural and remote Australia from 9-January 2015 to 31-May 2018. HbA1c was measured with first antenatal investigations (<20-weeks gestation). Primary outcome measure was predictive value of HbA1c for GDM, by routine 75 g oral glucose tolerance test (OGTT; ≥24-weeks gestation), and for large-for-gestational-age (LGA) newborn. RESULTS Of 396 (129 Aboriginal) women with routine OGTT, 28.8% had GDM (24.0% Aboriginal). HbA1c ≥5.6% (≥38 mmol/mol) was highly predictive (71.4%, 95% CI; 47.8-88.7%) for GDM in Aboriginal women, and in the total cohort increased risk for LGA newborn (RR 2.04, 95% CI; 1.03-4.01, P = 0.040). There were clear differences between Aboriginal and non-Aboriginal women: 16.3% v 5.2% (P < 0.001) had elevated HbA1c whereas 12.4% v 29.6% (P < 0.001) developed hyperglycemia during pregnancy. CONCLUSIONS Early pregnancy HbA1c ≥5.6% (≥38 mmol/mol) identifies Aboriginal women with apparent prediabetes and elevated risk of having an LGA newborn. Universal HbA1c at first antenatal presentation could facilitate earlier management of hyperglycemia and improved perinatal outcome in this high-risk population.
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Affiliation(s)
- Emma L Jamieson
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University, Robertson Drive, PO Box 412, Bunbury, WA 6230, Australia
| | - Erica P Spry
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, WA 6725, Australia
| | - Andrew B Kirke
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University, Robertson Drive, PO Box 412, Bunbury, WA 6230, Australia
| | - Emma Griffiths
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Cynthia Porter
- Geraldton Regional Aboriginal Medical Service, Rifle Range Road, Rangeway, WA 6530, Australia
| | - Carly Roxburgh
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 31 Stirling Terrace, Albany, WA 6330, Australia
| | - Sally Singleton
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Kylie Sterry
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, St Alban's Road (rear Kalgoorlie Hospital), Kalgoorlie, WA 6433, Australia
| | - David N Atkinson
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
| | - Julia V Marley
- The University of Western Australia, Medical School, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, WA 6725, Australia.
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Arogbokun O, Rosen E, Keil AP, Milne GL, Barrett E, Nguyen R, Bush NR, Swan SH, Sathyanarayana S, Ferguson KK. Maternal Oxidative Stress Biomarkers in Pregnancy and Child Growth from Birth to Age 6. J Clin Endocrinol Metab 2021; 106:1427-1436. [PMID: 33524128 PMCID: PMC8171170 DOI: 10.1210/clinem/dgab018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Maternal oxidative stress in pregnancy can arise through a multitude of sources and may have lifelong consequences for the child. Animal studies suggest that prenatal oxidative stress may contribute to metabolic dysfunction and excessive weight gain in the offspring. However, this relationship has been studied minimally in humans. OBJECTIVE Determine the association between prenatal oxidative stress biomarkers and child weight and body mass index (BMI) z-scores from birth to age 6. METHODS Within The Infant Development and the Environment Study (TIDES) prospective pregnancy cohort, we calculated age- and sex-specific Z-scores for child weight and BMI, measured between birth and age 6 (N = 736). Three oxidative stress biomarkers were quantified in third-trimester urine, including 8-iso-prostaglandin F2α (8-iso-PGF2α), its primary metabolite, and prostaglandin F2α (PGF2α). We examined associations between each biomarker and Z-scores using linear regression as well as group-based trajectory modeling. RESULTS Prenatal 8-iso-PGF2α and its metabolite were associated with lower birth weight and higher weight at age 4. For example, an ln-unit increase in 8-iso-PGF2α was associated with 0.17 SD higher weight at age 4 (95% CI 0.01, 0.33). These biomarkers were also associated with higher BMI at age 4. Finally, within 4 unique weight trajectories (low, normal, high, and low-high), children of mothers with higher 8-iso-PGF2α were 2.56 times more likely (95% CI 1.22, 5.41) to be in the low-high trajectory than children in the normal group. CONCLUSION We observed associations between third-trimester oxidative stress and lower birth weight as well as higher early childhood weight and BMI. These findings have important implications for understanding the developmental origins of childhood weight gain and metabolic disease.
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Affiliation(s)
- Olufunmilayo Arogbokun
- Epidemiology Branch, National Institute of Environmental Health
Sciences, Research Triangle Park, NC,
USA
- Department of Epidemiology, The University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Emma Rosen
- Epidemiology Branch, National Institute of Environmental Health
Sciences, Research Triangle Park, NC,
USA
| | - Alexander P Keil
- Epidemiology Branch, National Institute of Environmental Health
Sciences, Research Triangle Park, NC,
USA
- Department of Epidemiology, The University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Ginger L Milne
- Division of Clinical Pharmacology, Vanderbilt University School of
Medicine, Nashville, TN, USA
| | - Emily Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public
Health, Environmental and Occupational Health Institute,
Piscataway, NJ, USA
| | - Ruby Nguyen
- Division of Epidemiology and Community Health, University of
Minnesota, Minneapolis, MN, USA
| | - Nicole R Bush
- Department of Psychiatry and Pediatrics, University of California at
San Francisco, San Francisco, CA, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of
Medicine at Mount Sinai, New York, NY,
USA
| | - Sheela Sathyanarayana
- Department of Pediatrics, Seattle Children’s Research Institute,
University of Washington, Seattle, WA,
USA
- Department of Environmental and Occupational Health Sciences,
University of Washington, Seattle, WA,
USA
| | - Kelly K Ferguson
- Epidemiology Branch, National Institute of Environmental Health
Sciences, Research Triangle Park, NC,
USA
- Correspondence: Kelly K. Ferguson, 111 TW Alexander Drive, Research Triangle Park, North
Carolina, NC, 27709, USA.
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Zeng S, Han M, Jiang M, Liu F, Hu Y, Long Y, Zhu C, Zeng F, Gan Q, Ye W, Fu W, Yang H. Serum complement proteomics reveal biomarkers for hypertension disorder of pregnancy and the potential role of Clusterin. Reprod Biol Endocrinol 2021; 19:56. [PMID: 33874952 PMCID: PMC8054419 DOI: 10.1186/s12958-021-00742-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Hypertension disorder of pregnancy (HDP) is one of the leading causes of maternal and foetal illness. The aim of the current study was to identify and verify novel serum markers for HDP. METHODS A label-free LC-MS/MS method was used to establish the serum proteomic profiles of 12 pre-HDP (before clinical diagnosis of HDP) pregnancies and verify prioritized candidates in the verification set of 48 pre-HDP pregnancies. These biomarkers were revalidated by ELISA in an independent cohort of 88 pre-HDP pregnancies. Subsequently, the candidate biomarkers were histologically analysed by immunohistochemistry, and function was evaluated in TEV-1 cells. RESULTS We identified 33 proteins with significantly increased abundance and 14 with decreased abundance (peptide FDR ≤ 1%, P < 0.05). Complement was one of the top enriched components in the pre-HDP group compared with the control group. Three complement factors (CLU, CFHR5, and CRP) were significantly increased in the three sets, of which CLU was a critical factor for the development of HDP (OR = 1.22, P < 0.001). When these three factors and body weight were combined, the AUC was 0.74, with a sensitivity of 0.67 and specificity of 0.68 for HDP prediction compared with normal pregnancy. In addition, inflammation-induced CLU could inhibit the invasion of TEV-1 cells. CONCLUSIONS Complement proteins may play an essential role in the occurrence of HDP by acting on trophoblast cells. CLU may be a high-risk factor for HDP, and the models combining candidates show reasonable screening efficiency of HDP in the first half of pregnancy.
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Affiliation(s)
- Shanshui Zeng
- Department of Laboratory, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Mengru Han
- Department of Laboratory, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Min Jiang
- Department of Laboratory, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Fei Liu
- Department of Laboratory, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Yanwei Hu
- Department of Laboratory, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Yan Long
- Department of Laboratory, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Chunyan Zhu
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China
| | - Fangling Zeng
- Department of Gynaecology and Obstetrics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qiangsheng Gan
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China
| | - Weitao Ye
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China
| | - Wenjin Fu
- Clinical Laboratory, Houjie Hospital of Guangdong Medical University, HeTian Road, Dongguan, 523945, Guangdong, China.
| | - Hongling Yang
- Department of Laboratory, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, 510623, Guangdong, China.
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Wang C, Wei Y, Yang Y, Su R, Song G, Kong L, Yang H. Evaluation of the value of fasting plasma glucose in the first trimester for the prediction of adverse pregnancy outcomes. Diabetes Res Clin Pract 2021; 174:108736. [PMID: 33705819 DOI: 10.1016/j.diabres.2021.108736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the importance and usefulness of fasting plasma glucose (FPG) in the first trimester in predicting adverse pregnancy outcomes. METHODS A retrospective study of 22,398 singleton pregnancies was conducted. Participants were divided into subgroups according to first-trimester FPG (low FPG, FPG < 5.1 mmol/L; medium FPG, 5.1 mmol/L ≤ FPG < 5.6 mmol/L; high FPG, 5.6 ≤ FPG < 7.0 mmol/L) and oral glucose tolerance test(OGTT) results (normal and abnormal) during pregnancy. Patient characteristics and risk of adverse pregnancy outcomes were compared. Then, the whole population of women with abnormal OGTT served as a reference, and the relative risks of maternal and neonatal complications in normal OGTT women were analyzed by categorical analyses and logistic regression. Subgroup analyses were performed according to pre-pregnancy body mass index (BMI). RESULTS The frequency of adverse pregnancy outcomes increased with increasing FPG levels during the first trimester, regardless of OGTT results. High FPG + Abnormal OGTT had the worst outcome. Compared to the whole population of women with abnormal OGTT, Normal OGTT + Medium FPG showed the same risk of PIH and macrosomia. Normal OGTT + High FPG showed the same risk of PIH, macrosomia as well as LGA and preterm birth. Additionally, Normal OGTT + Medium FPG + BMI ≥ 24 kg/m2 showed significantly higher risk of PIH (OR = 1.867, 1.245-2.800), macrosomia (OR = 1.748, 1.304-2.344) and LGA (OR = 1.274, 1.019-1.593). Furthermore, the OR value for PIH was 3.759 (1.680-8.412) in Normal OGTT + High FPG + BMI ≥ 24 kg/m2 compared to women with abnormal OGTT. CONCLUSIONS First-trimester FPG values can help identify women at increased risk for adverse pregnancy outcomes. Increased attention and management should be given to women with early pregnancy FPG ≥ 5.10 mmol/L despite a normal OGTT, especially if their BMI ≥ 24 kg/m2.
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Affiliation(s)
- Chen Wang
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Yumei Wei
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Yide Yang
- Teaching and Researching Office of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
| | - Rina Su
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Geng Song
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Lingying Kong
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus
| | - Huixia Yang
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus.
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Murillo-Llorente MT, Llorca-Colomer F, Pérez-Bermejo M. Relationship between Thyroid Status during the First Trimester of Pregnancy and Neonatal Well-Being. Nutrients 2021; 13:nu13030872. [PMID: 33799943 PMCID: PMC7999325 DOI: 10.3390/nu13030872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
Iodine is an essential micronutrient for the synthesis of thyroid hormones. The proper functioning of the thyroid axis is essential for the normal development of the nervous system, especially in the first trimester of gestation. The aim of the present study was to analyze the perinatal outcomes, anthropometry, and APGAR test scores of newborns and to relate them to maternal thyroid status. A total of 190 newborns participated in the study. No correlation was found between thyroid stimulating hormone (TSH) and maternal ioduria values in the first trimester of gestation with the weight or length of the newborn, or the APGAR score at one minute after birth. However, we found significant differences between the APGAR scores of children whose mothers had an iodine sufficiency level in the first trimester compared to the children of mothers with iodine deficiency. Similarly, the APGAR scores of children whose mothers had a TSH > 4 have significantly better APGAR scores than the children of mothers with a TSH < 4. Likewise, we found significant differences between the measurements of the newborns depending on whether their mothers smoked. The children of mothers who took iodine supplements or iodized salt obtained the highest APGAR score at one and five minutes after birth. It is essential to focus on recommending adequate consumption of iodine supplements and iodized salt prior to gestation and at least during the first trimester to achieve better fetal well-being.
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Affiliation(s)
- Maria Teresa Murillo-Llorente
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo n° 2, 46001 Valencia, Spain;
| | - Francisco Llorca-Colomer
- School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo n° 2, 46001 Valencia, Spain;
| | - Marcelino Pérez-Bermejo
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo n° 2, 46001 Valencia, Spain;
- Correspondence: ; Tel.: +34-620-984-639
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Kaur L, Puri M, Pal Sachdeva M, Mishra J, Nava Saraswathy K. Maternal one carbon metabolism and interleukin-10 &-17 synergistically influence the mode of delivery in women with Early Onset Pre-Eclampsia. Pregnancy Hypertens 2021; 24:79-89. [PMID: 33765603 DOI: 10.1016/j.preghy.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Studies on One Carbon Metabolism (OCM), Interleukins-10 &-17 (IL-10/-17) & βhCG in pre-eclampsia and its delivery outcome (preterm birth) reveal contradictory results, attributed to clinical heterogeneity (early/late onset pre-eclampsia) or preterm/term birth. Disturbed OCM also influences IL-10 &-17 during pregnancy. We sought to investigate the synergism between OCM and IL-10/-17 mediated immune-regulation through βhCG in Early onset pre-eclampsia (EO-PE) patients, delivering preterm, among North Indian women. STUDY DESIGN Case-control study with a total of 399 pregnant women (EO-PE delivering preterm = 199; Normotensives delivering at term = 200). Maternal genotypes & biochemical estimations along with fetal genotypes on subset (n = 72) pertaining to OCM and IL-10/-17 regulation were assessed. MAIN OUTCOME MEASURES Association of 1) maternal plasma levels with EO-PE 2) maternal and fetal genotypes with EO-PE. 3) Effect of Hyper-homocysteinemia (surrogate of disturbed OCM) on differential immune regulation (IL10,-17, βhCG) in EO-PE and mode of delivery. RESULTS Hyper-homocysteinemia posed an increased risk of three folds for EO-PE. Both, folate and B12 deficiencies were associated with elevated homocysteine in EO-PE. Further, MTHFR 677TT homozygotes was present only in EO-PE indicating its detrimental role. However, maternal IL17-197AA genotype showed decreased risk for EO-PE. Furthermore, elevated maternal plasma IL-17 along with elevated IL-10 & βhCG were observed in EO-PE. Taken together, altered homocysteine metabolism was associated with high IL10 in EO-PE; and was more pronounced in spontaneous vaginal deliveries as compared to induced/caesarean section deliveries. CONCLUSIONS We report homocysteine mediated IL-10 &17 dysregulation and its influence on mode of delivery in EO-PE, possibly through initiation of cervical ripening. Further, these could serve potential biomarkers of EO-PE & its delivery outcome among vulnerable populations with similar nutritional & genetic predispositions.
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Affiliation(s)
- Lovejeet Kaur
- Translational Health Science and Technology Institute, Faridabad, Haryana, India.
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Delhi, India
| | | | - Jyoti Mishra
- Department of Anthropology, University of Delhi, Delhi, India
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Papastefanou I, Wright D, Lolos M, Anampousi K, Mamalis M, Nicolaides KH. Competing-risks model for prediction of small-for-gestational-age neonate from maternal characteristics, serum pregnancy-associated plasma protein-A and placental growth factor at 11-13 weeks' gestation. Ultrasound Obstet Gynecol 2021; 57:392-400. [PMID: 32936500 DOI: 10.1002/uog.23118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To expand a new competing-risks model for prediction of a small-for-gestational-age (SGA) neonate, by the addition of pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF), and to evaluate and compare PAPP-A and PlGF in predicting SGA. METHODS This was a prospective observational study of 60 875 women with singleton pregnancy undergoing routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation. We fitted a folded-plane regression model for the PAPP-A and PlGF likelihoods. A previously developed maternal history model and the likelihood models were combined, according to Bayes' theorem, to obtain individualized distributions for gestational age (GA) at delivery and birth-weight Z-score. We assessed the discrimination and calibration of the model. McNemar's test was used to compare the detection rates for SGA with, without or independently of pre-eclampsia (PE) occurrence, of different combinations of maternal history, PAPP-A and PlGF, for a fixed false-positive rate. RESULTS The distributions of PAPP-A and PlGF depend on both GA at delivery and birth-weight Z-score, in the same continuous likelihood, according to a folded-plane regression model. The new approach offers the capability for risk computation for any desired birth-weight Z-score and GA at delivery cut-off. PlGF was consistently and significantly better than PAPP-A in predicting SGA delivered before 37 weeks, especially in cases with co-existence of PE. PAPP-A had similar performance to PlGF for the prediction of SGA without PE. At a fixed false-positive rate of 10%, the combination of maternal history, PlGF and PAPP-A predicted 33.8%, 43.8% and 48.4% of all cases of a SGA neonate with birth weight < 10th percentile delivered at ≥ 37, < 37 and < 32 weeks' gestation, respectively. The respective values for birth weight < 3rd percentile were 38.6%, 48.7% and 51.0%. The new model performed well in terms of risk calibration. CONCLUSIONS The combination of PAPP-A and PlGF values with maternal characteristics, according to Bayes' theorem, improves prediction of SGA. PlGF is a better predictor of SGA than PAPP-A, especially when PE is present. The new competing-risks model for SGA can be tailored to each pregnancy and to the relevant clinical requirements. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Papastefanou
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - D Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - M Lolos
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K Anampousi
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Mamalis
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Harville EW, Li YY, Pan K, McRitchie S, Pathmasiri W, Sumner S. Untargeted analysis of first trimester serum to reveal biomarkers of pregnancy complications: a case-control discovery phase study. Sci Rep 2021; 11:3468. [PMID: 33568690 PMCID: PMC7876105 DOI: 10.1038/s41598-021-82804-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
Understanding of causal biology and predictive biomarkers are lacking for hypertensive disorders of pregnancy (HDP) and preterm birth (PTB). First-trimester serum specimens from 51 cases of HDP, including 18 cases of pre-eclampsia (PE) and 33 cases of gestational hypertension (GH); 53 cases of PTB; and 109 controls were obtained from the Global Alliance to Prevent Prematurity and Stillbirth repository. Metabotyping was conducted using liquid chromatography high resolution mass spectroscopy and nuclear magnetic resonance spectroscopy. Multivariable logistic regression was used to identify signals that differed between groups after controlling for confounders. Signals important to predicting HDP and PTB were matched to an in-house physical standards library and public databases. Pathway analysis was conducted using GeneGo MetaCore. Over 400 signals for endogenous and exogenous metabolites that differentiated cases and controls were identified or annotated, and models that included these signals produced substantial improvements in predictive power beyond models that only included known risk factors. Perturbations of the aminoacyl-tRNA biosynthesis, L-threonine, and renal secretion of organic electrolytes pathways were associated with both HDP and PTB, while pathways related to cholesterol transport and metabolism were associated with HDP. This untargeted metabolomics analysis identified signals and common pathways associated with pregnancy complications.
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Affiliation(s)
- E W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Epidemiology #8318, 1440 Canal St. Ste. 2001, New Orleans, LA, 70112, USA.
| | - Y-Y Li
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, CB#74612, Chapel Hill, NC, 27599-7461, USA
| | - K Pan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Epidemiology #8318, 1440 Canal St. Ste. 2001, New Orleans, LA, 70112, USA
| | - S McRitchie
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, CB#74612, Chapel Hill, NC, 27599-7461, USA
| | - W Pathmasiri
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, CB#74612, Chapel Hill, NC, 27599-7461, USA
| | - S Sumner
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, CB#74612, Chapel Hill, NC, 27599-7461, USA.
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Amaral LM, Sandrim VC, Kutcher ME, Spradley FT, Cavalli RC, Tanus-Santos JE, Palei AC. Circulating Total Cell-Free DNA Levels Are Increased in Hypertensive Disorders of Pregnancy and Associated with Prohypertensive Factors and Adverse Clinical Outcomes. Int J Mol Sci 2021; 22:E564. [PMID: 33429954 PMCID: PMC7826953 DOI: 10.3390/ijms22020564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Previous studies have described increased circulating cell-free DNA (cfDNA) in hypertensive disorders of pregnancy (HDP). Here, we aimed first to confirm this information using a simple, but sensible fluorescent assay, and second to investigate whether total cfDNA is associated with circulating factors known to be linked to the pathophysiology of HDP as well as with poor maternal-fetal outcomes. We studied 98 women with healthy pregnancies (HP), 88 with gestational hypertension (GH), and 91 with preeclampsia (PE). Total DNA was extracted from plasma using the QIAamp DNA blood mini kit and quantified using Quant-iT™ PicoGreen® dsDNA fluorescent detection kit. We found higher total cfDNA levels in GH and PE (197.0 and 174.2 ng/mL, respectively) than in HP (140.5 ng/mL; both p < 0.0001). Interestingly, total cfDNA levels were elevated in both male and female-bearing pregnancies diagnosed with either HDP, and in more severe versus less severe HDP cases, as classified according to responsiveness to antihypertensive therapy. In addition, total cfDNA was independently associated with HDP, and a cutoff concentration of 160 ng/mL provided appropriate sensitivity and specificity values for diagnosing GH and PE compared to HP (70-85%, both p < 0.0001). Moreover, high total cfDNA was associated with adverse clinical outcomes (high blood pressure, low platelet count, preterm delivery, fetal growth restriction) and high prohypertensive factors (sFLT-1, sEndoglin, MMP-2). These findings represent a step towards to the establishment of cfDNA as a diagnostic tool and the need to understand its role in HDP.
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Affiliation(s)
- Lorena M. Amaral
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4500, USA;
| | - Valeria C. Sandrim
- Department of Biophysics and Pharmacology, Institute of Biosciences, Universidade Estadual Paulista, Botucatu, SP 18618-689, Brazil;
| | - Matthew E. Kutcher
- Department of Surgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4500, USA; (M.E.K.); (F.T.S.)
| | - Frank T. Spradley
- Department of Surgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4500, USA; (M.E.K.); (F.T.S.)
| | - Ricardo C. Cavalli
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil;
| | - Jose E. Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil;
| | - Ana C. Palei
- Department of Surgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4500, USA; (M.E.K.); (F.T.S.)
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Lin S, Li R, Wang Y, Li M, Wang L, Zhen X, Liu P. Increased maternal serum hCG concentrations in the presence of a female fetus as early as 2 weeks after IVF-ET. J Gynecol Obstet Hum Reprod 2021; 50:102053. [PMID: 33401030 DOI: 10.1016/j.jogoh.2020.102053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/28/2020] [Accepted: 12/29/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maternal serum human chorionic gonadotropin (hCG) is produced in trophoblast cells during pregnancy. Whether there are sex-related growth differences of hCG concentrations in early pregnancy is still controversial. OBJECTIVE To explore the association between hCG concentrations and fetal sex as early as 2 weeks after in vitro fertilization and embryo transfer (IVF-ET). METHODS This study involved 6669 women ≤ 38 years of age. These 6669 patients all delivered singletons; 3531 had a male fetus and 3138 had a female fetus. The maternal serum hCG concentrations on Day 14 and Day 21 were determined using a Beckman DxI800 immunoassay system. RESULTS Among the 6669 patients who delivered singletons, 3531 had a male fetus and 3138 had a female fetus. The hCG concentrations on day 14 of gestation were 516.12 (342.12-757.34) IU/L in the group of male fetuses and 552.69 (359.35-772.83) IU/L in group of female fetuses. The hCG concentration on day 21 was 8839.60 (5975.00-12615.00) IU/L in male fetuses and 9289.10 (6162.00-13146.00) IU/L in female fetuses. Maternal serum hCG levels were significantly higher in those with female fetuses than those with male fetuses. After adjusting for confounding factors, the hCG levels were significantly associated with fetal sex. CONCLUSIONS Our results showed pregnant women with female fetuses have significantly higher hCG levels than those bearing male fetuses.
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Affiliation(s)
- Shengli Lin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yapeng Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Ming Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Lina Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Xiumei Zhen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Ping Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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Tian M, Ma S, You Y, Long S, Zhang J, Guo C, Wang X, Tan H. Serum Metabolites as an Indicator of Developing Gestational Diabetes Mellitus Later in the Pregnancy: A Prospective Cohort of a Chinese Population. J Diabetes Res 2021; 2021:8885954. [PMID: 33628838 PMCID: PMC7884125 DOI: 10.1155/2021/8885954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/23/2020] [Accepted: 01/20/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a common metabolic disorder with onset during pregnancy. However, the etiology and pathogenesis of GDM have not been fully elucidated. In this study, we used a metabolomics approach to investigate the relationship between maternal serum metabolites and GDM in early pregnancy. METHODS A nested case-control study was performed. To establish an early pregnancy cohort, pregnant women in early pregnancy (10-13+6 weeks) were recruited. In total, 51 patients with GDM and 51 healthy controls were included. Serum samples were analyzed using an untargeted high-performance liquid chromatography mass spectrometry metabolomics approach. The relationships between metabolites and GDM were analyzed by an orthogonal partial least-squares discriminant analysis. Differential metabolites were evaluated using a KEGG pathway analysis. RESULTS A total of 44 differential metabolites were identified between GDM cases and healthy controls during early pregnancy. Of these, 26 significant metabolites were obtained in early pregnancy after false discovery rate (FDR < 0.1) correction. In the GDM group, the levels of L-pyroglutamic acid, L-glutamic acid, phenylacetic acid, pantothenic acid, and xanthine were significantly higher and the levels of 1,5-anhydro-D-glucitol, calcitriol, and 4-oxoproline were significantly lower than those in the control group. These metabolites were involved in multiple metabolic pathways, including those for amino acid, carbohydrate, lipid, energy, nucleotide, cofactor, and vitamin metabolism. CONCLUSIONS We identified significant differentially expressed metabolites associated with the risk of GDM, providing insight into the mechanisms underlying GDM in early pregnancy and candidate predictive markers.
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Affiliation(s)
- Mengyuan Tian
- Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Shujuan Ma
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Yiping You
- Department of Obstetrics, Hunan Provincial Maternal and Child Health Hospital, Changsha, China
| | - Sisi Long
- Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Jiayue Zhang
- Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Chuhao Guo
- Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Xiaolei Wang
- Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Hongzhuan Tan
- Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Key Laboratory of Clinical Epidemiology, Changsha, China
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Sun J, Chai S, Zhao X, Yuan N, Du J, Liu Y, Li Z, Zhang X. Predictive Value of First-Trimester Glycosylated Hemoglobin Levels in Gestational Diabetes Mellitus: A Chinese Population Cohort Study. J Diabetes Res 2021; 2021:5537110. [PMID: 33928166 PMCID: PMC8053049 DOI: 10.1155/2021/5537110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022] Open
Abstract
This study was aimed at exploring the predictive value of first-trimester glycosylated hemoglobin (HbA1c) levels in the diagnosis of gestational diabetes mellitus (GDM). A total of 744 pregnant women registered at the Peking University International Hospital between March 2017 and March 2019 were included in this study. Data on personal characteristics and biochemical indicators of the pregnant women were collected during the first trimester. The International Association of Diabetes and Pregnancy Study Groups has adopted specific diagnostic criteria as the gold standard for the diagnosis of GDM. Receiver operating characteristic (ROC) curve statistics were used to assess the predictive value of first-trimester HbA1c levels in the diagnosis of GDM. HbA1c levels in the first trimester were significantly higher in the GDM group than in the non-GDM group (5.23% ± 0.29% vs. 5.06 ± 0.28%, P < 0.05). The first-trimester HbA1c level was an independent risk factor for gestational diabetes. The area under the ROC curve (AUC) of HbA1c for GDM was 0.655 (95% confidence interval 0.620-0.689, P < 0.001). The positive likelihood ratio was the highest at HbA1c = 5.9%, sensitivity was 2.78, and specificity was 99.83%. There was no statistical difference in AUC between fasting blood glucose and HbA1c (P = 0.407). First-trimester HbA1c levels can be used to predict GDM. The risk of GDM was significantly increased in pregnant women with first-trimester HbA1c levels > 5.9%. There was no statistical difference between first-trimester HbA1c and fasting blood glucose levels in predicting GDM.
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Affiliation(s)
- Jianbin Sun
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Sanbao Chai
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Xin Zhao
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Ning Yuan
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Jing Du
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Yufang Liu
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Zhi Li
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing 102206, China
| | - Xiaomei Zhang
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
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Liu C, Wang Y, Zheng W, Wang J, Zhang Y, Song W, Wang A, Ma X, Li G. Putrescine as a Novel Biomarker of Maternal Serum in First Trimester for the Prediction of Gestational Diabetes Mellitus: A Nested Case-Control Study. Front Endocrinol (Lausanne) 2021; 12:759893. [PMID: 34970221 PMCID: PMC8712719 DOI: 10.3389/fendo.2021.759893] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
AIMS Early identification of gestational diabetes mellitus (GDM) aims to reduce the risk of adverse maternal and perinatal outcomes. Currently, no acknowledged biomarker has proven clinically useful for the accurate prediction of GDM. In this study, we tested whether serum putrescine level changed in the first trimester and could improve the prediction of GDM. METHODS This study is a nested case-control study conducted in Beijing Obstetrics and Gynecology Hospital. We examined serum putrescine at 8-12 weeks pregnancy in 47 women with GDM and 47 age- and body mass index (BMI)-matched normoglycaemic women. Anthropometric, clinical and laboratory variables were obtained during the same period. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the discrimination and calibration of the prediction models. RESULTS Serum putrescine in the first trimester was significantly higher in women who later developed GDM. When using putrescine alone to predict the risk of GDM, the AUC of the nomogram was 0.904 (sensitivity of 100% and specificity of 83%, 95% CI=0.832-0.976, P<0.001). When combined with traditional risk factors (prepregnant BMI and fasting blood glucose), the AUC was 0.951 (sensitivity of 89.4% and specificity of 91.5%, 95% CI=0.906-0.995, P<0.001). CONCLUSION This study revealed that GDM women had an elevated level of serum putrescine in the first trimester. Circulating putrescine may serve as a valuable predictive biomarker for GDM.
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Affiliation(s)
- Cheng Liu
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Wei Zheng
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jia Wang
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Wei Song
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Aili Wang
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- *Correspondence: Guanghui Li, ; Xu Ma,
| | - Guanghui Li
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
- *Correspondence: Guanghui Li, ; Xu Ma,
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Bakleicheva M, Bespalova O, Kovaleva I. Features of the 1st trimester of pregnancy course with severe deficiency of 25(OH)D. Gynecol Endocrinol 2021; 37:49-53. [PMID: 34937507 DOI: 10.1080/09513590.2021.2006527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The course of physiological pregnancy is provided by many complementary factors. Thus, a deficiency in one of the links of the metabolic network contributes to the development of an imbalance in the work of the whole organism, which ensures the growth and development of the embryo from the first days of gestation. It has been demonstrated that vitamin D can act as an immune regulator during implantation, providing a protective effect in the entire period of pregnancy. OBJECTIVE The aim of this study is to assess the features of the course of pregnancy in patients with different levels of vitamin D in the blood in the first trimester. MATERIALS AND METHODS A prospective multicenter randomized study was conducted in the North-West region of the Russian Federation among 88 pregnant women in the first trimester of gestation (up to 13 weeks). All patients were divided into 3 groups depending on the initial level of vitamin D (group 1-14 women with a 25(OH)D < 10 ng/ml, group 2-62 pregnant women from 10 to 30 ng/ml, group 3-12 pregnant women with a vitamin D content >30 ng/ml). INTERVENTIONS Criteria of inclusion: pregnant women from 20 to 44 years of the first trimester of gestation (up to 13 weeks) with the studied level of vitamin D in the blood serum; singleton pregnancy; BMI ≤30 kg/m2; signing by the patient of informed consent for inclusion in the study group. MAIN OUTCOME MEASURES AND RESULTS In group 1, 86% of patients with severe vitamin D deficiency were diagnosed with threatened miscarriage, which is significantly higher than in group 3 (85.7% and 33.3%, χ2 = 7.490, p = .007). At the same time, retrochorial hematoma in group 1 occurred 3.5 times more often than in group 3 (57.1% and 16.67%, respectively, χ2 = 4.473, p = .035). Subsequently, every 4th woman from the group with vitamin D deficiency gave birth earlier than expected, which was not observed among patients from group 3 (25%, 0%, χ2 = 1.231, p = .268). CONCLUSION Prescribing cholecalciferol vitamin replacement therapy as part of complex preserving therapy for threatening miscarriage, followed by monitoring its blood level and deviating from normal parameters, contributing to a favorable course of pregnancy and improving perinatal outcomes.
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Affiliation(s)
- M Bakleicheva
- "The Research Institute of Obstetrics, Gynecology and Reproductology Named After D.O.Ott", Saint-Petersburg, Russia
| | - O Bespalova
- "The Research Institute of Obstetrics, Gynecology and Reproductology Named After D.O.Ott", Saint-Petersburg, Russia
| | - I Kovaleva
- OOO "AVA-PETER", Saint-Petersburg, Russia
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Hassan B, Rayis DA, Musa IR, Eltayeb R, ALhabardi N, Adam I. Blood Groups and Hematological Parameters Do Not Associate with First Trimester Gestational Diabetes Mellitus (Institutional Experience). Ann Clin Lab Sci 2021; 51:97-101. [PMID: 33653786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There are few published researches on blood groups, hematological parameters [hemoglobin, red cell distribution width (RDW), white blood cells (WBCs), mean platelets volume (MPV)] and gestational diabetes mellitus (GDM). The aim of this study was to investigate the association of haematological indices with GDM in early pregnancy. METHODS The study was carried out at Saad Abuelela Hospital (Khartoum, Sudan) during March-November of 2018. Pregnant Sudanese women in early pregnancy (gestational age <14 weeks) were enrolled in the study. The details of the medical and obstetrics history were recorded. The women were then followed up until 24-28 weeks of gestation when a 75-gram oral glucose tolerance test was performed. RESULTS Two hundred and fifty-three women at 10.2 week of gestational age completed the follow-up. The mean (SD) of the age and gravidity at the initial antenatal visit were 28.03 (5.6) years, 2.32 (2.41). The mean (SD) of body mass index (BMI) was 27.28 (24.41-30.80) kg/m2. Fifty women (19.8%) had GDM. Age, parity, BMI, place of residence, employment and education were not significantly different between the two groups. Moreover, there was no significant difference in the blood groups and hematological parameters between women with and without GDM. CONCLUSION In this study, the blood groups and other hematological parameters were not different between women with and without GDM.
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Affiliation(s)
- Bahaeldin Hassan
- Department of Obstetrics and Gynaecology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Duria A Rayis
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan, Kingdom of Saudi Arabia
| | - Imad R Musa
- Royal Commission Hospital in Al Jubail Industrial City. Kingdom of Saudi Arabia
| | - Reem Eltayeb
- Department of Clinical Laboratory Science, College of Applied Medical Science, University of Hail, Hail, Saudi Arabia
| | - Nadiah ALhabardi
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
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Yang X, Yu Y, Zhang C, Zhang Y, Chen Z, Dubois L, Huang HF, Fraser WD, Fan J. The Association Between Isolated Maternal Hypothyroxinemia in Early Pregnancy and Preterm Birth. Thyroid 2020; 30:1724-1731. [PMID: 32434441 DOI: 10.1089/thy.2019.0818] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: The association between isolated maternal hypothyroxinemia (IMH) during pregnancy and preterm birth (PTB), especially for subtypes of PTB, is unclear. This study aimed at determining the association between IMH diagnosed in early pregnancy and PTB, with further investigation into various subtypes of PTB. Methods: This study included 41,911 pregnant women (963 with IMH and 40,948 euthyroid women) who underwent first-trimester prenatal screening at the International Peace Maternity and Child Health Hospital (IPMCH) in Shanghai, China between January 2013 and December 2016. PTB was defined as birth before 37 weeks of gestation. PTB was further classified into three clinically relevant groups to investigate the clinical heterogeneity of PTB: (a) preterm birth with premature rupture of membranes (PROM-PTB); (b) spontaneous preterm birth with intact membranes (S-PTB); and (c) medically-induced preterm birth (MI-PTB). The overall and sex-specific effect of IMH on PTB and various subtypes of PTB were estimated by using logistic regression in crude and adjusted models. Results: Pregnant women with IMH had an increased risk of PTB (odds ratio [OR]: 1.32 [95% confidence interval; CI: 1.02-1.70], p = 0.03) compared with women with euthyroid function. The increased risk of PTB is mainly driven by S-PTB (OR: 1.57 [CI: 1.11-2.24], p = 0.01), while women with early pregnancy IMH had no statistically significant increased risk of PROM-PTB and MI-PTB. The effect of IMH on PTB was modified by fetal sex (p-values for interaction = 0.04). More prominent effects were observed in women carrying a female fetus, while no statistically significant effects were found in women carrying a male fetus. Conclusions: This study revealed that pregnant women with IMH in early pregnancy have a higher risk of PTB compared with euthyroid women. The effect of IMH on PTB is mainly driven by S-PTB and is modified by fetal sex.
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Affiliation(s)
- Xi Yang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yamei Yu
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Chen Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yong Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Zhirou Chen
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lise Dubois
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - He-Feng Huang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - William D Fraser
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Centre de Recherche du Centre hospitalier Univeritaire de Sherbrooke (CRCHUS), Sherbrooke, Canada
| | - Jianxia Fan
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
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Andræ F, Abbott D, Stridsklev S, Schmedes AV, Odsæter IH, Vanky E, Salvesen Ø. Sustained Maternal Hyperandrogenism During PCOS Pregnancy Reduced by Metformin in Non-obese Women Carrying a Male Fetus. J Clin Endocrinol Metab 2020; 105:5899825. [PMID: 32866967 PMCID: PMC7538101 DOI: 10.1210/clinem/dgaa605] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Large, longitudinal studies on androgen levels in pregnant women with polycystic ovary syndrome (PCOS) are lacking. While metformin has a mild androgen-lowering effect in non-pregnant women with PCOS, its effects on maternal androgen levels in pregnancy are less well understood. OBJECTIVE To describe androgen patterns in pregnant women with PCOS and in healthy control women, and to explore the potential effects of metformin on maternal androgen levels in PCOS. DESIGN AND SETTING A post hoc analysis from a randomized, placebo-controlled, multicenter study carried out at 11 secondary care centers and a longitudinal single-center study on healthy pregnant women in Norway. PARTICIPANTS A total of 262 women with PCOS and 119 controls. INTERVENTION The participants with PCOS were randomly assigned to metformin (2 g daily) or placebo, from first trimester to delivery. MAIN OUTCOME MEASURES Androstenedione (A4), testosterone (T), sex-hormone binding globulin (SHBG), and free testosterone index (FTI) at 4 time points in pregnancy. RESULTS Women with PCOS versus healthy controls had higher A4, T, and FTI, and lower SHBG at all measured time points in pregnancy. In the overall cohort of women with PCOS, metformin had no effect on A4, T, SHBG, and FTI. In subgroup analyses, metformin reduced A4 (P = 0.019) in nonobese women. Metformin also reduced A4 (P = 0.036), T (P = 0.023), and SHBG (P = 0.010) levels through pregnancy in mothers with a male fetus. CONCLUSION Metformin had no effect on maternal androgens in PCOS pregnancies. In subgroup analyses, a modest androgen-lowering effect was observed in nonobese women with PCOS. In PCOS women carrying a male fetus, metformin exhibited an androgen-lowering effect.
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Affiliation(s)
- Frida Andræ
- Department of Obstetrics and Gynecology, Nordlandssykehuset, Bodø, Norway
- Correspondence and Reprint Requests: Frida Andræ, Kvinneklinikken i Bodø, Nordlandssykehuset HF Postboks 1480, NO-8092 Bodø, Norway. E-mail:
| | - David Abbott
- Wisconsin National Primate Research Centre, University of Wisconsin, Madison, WI
| | - Solhild Stridsklev
- Department of Obstetrics and Gynecology, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Ingrid Hov Odsæter
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical Chemistry, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eszter Vanky
- Department of Obstetrics and Gynecology, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Schuitemaker JHN, Beernink RHJ, Franx A, Cremers TIFH, Koster MPH. First trimester secreted Frizzled-Related Protein 4 and other adipokine serum concentrations in women developing gestational diabetes mellitus. PLoS One 2020; 15:e0242423. [PMID: 33206702 PMCID: PMC7673552 DOI: 10.1371/journal.pone.0242423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/02/2020] [Indexed: 01/03/2023] Open
Abstract
Background The aim of this study was to evaluate whether soluble frizzled-related protein 4 (sFRP4) concentration in the first trimester of pregnancy is individually, or in combination with Leptin, Chemerin and/or Adiponectin, associated with the development of gestational diabetes (GDM). Methods In a nested case-control study, 50 women with GDM who spontaneously conceived and delivered a live-born infant were matched with a total of 100 uncomplicated singleton control pregnancies based on body mass index (± 2 kg/m2), gestational age at sampling (exact day) and maternal age (± 2 years). In serum samples, obtained between 70–90 days gestational age, sFRP4, Chemerin, Leptin and Adiponectin concentrations were determined by ELISA. Statistical comparisons were performed using univariate and multi-variate logistic regression analysis after logarithmic transformation of the concentrations. Discrimination of the models was assessed by the area under the curve (AUC). Results First trimester sFRP4 concentrations were significantly increased in GDM cases (2.04 vs 1.93 ng/ml; p<0.05), just as Chemerin (3.19 vs 3.15 ng/ml; p<0.05) and Leptin (1.44 vs 1.32 ng/ml; p<0.01). Adiponectin concentrations were significantly decreased (2.83 vs 2.94 ng/ml; p<0.01) in GDM cases. Further analysis only showed a weak, though significant, correlation of sFRP4 with Chemerin (R2 = 0.124; p<0.001) and Leptin (R2 = 0.145; p<0.001), and Chemerin with Leptin (R2 = 0.282; p<0.001) in the control group. In a multivariate logistic regression model of these four markers, only Adiponectin showed to be significantly associated with GDM (odds ratio 0.12, 95%CI 0.02–0.68). The AUC of this model was 0.699 (95%CI 0.605–0.793). Conclusion In the first trimester of pregnancy, a multi-marker model with sFRP4, Leptin, Chemerin and Adiponectin is associated with the development of GDM. Therefore, this panel seems to be an interesting candidate to further evaluate for prediction of GDM in a prospective study.
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Affiliation(s)
- Joost H. N. Schuitemaker
- Division of Medical Biology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research & Development, IQ Products BV, Groningen, The Netherlands
| | - Rik H. J. Beernink
- Research & Development, IQ Products BV, Groningen, The Netherlands
- Department of Analytical Biochemistry, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thomas I. F. H. Cremers
- Department of Analytical Biochemistry, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Maria P. H. Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Wiegel RE, Jan Danser AH, Steegers-Theunissen RPM, Laven JSE, Willemsen SP, Baker VL, Steegers EAP, von Versen-Höynck F. Determinants of Maternal Renin-Angiotensin-Aldosterone-System Activation in Early Pregnancy: Insights From 2 Cohorts. J Clin Endocrinol Metab 2020; 105:5898239. [PMID: 32853347 PMCID: PMC7494245 DOI: 10.1210/clinem/dgaa582] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/26/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT The corpus luteum (CL) secretes prorenin, renin's inactive precursor. It may thus contribute to the renin-angiotensin-aldosterone-system (RAAS) activation that is required for maternal adaptation in pregnancy. Whether this activation is disturbed in pregnancies lacking a CL is unknown. OBJECTIVE The objective of this work is to investigate maternal RAAS determinants in early pregnancy. DESIGN AND SETTING Two observational prospective cohort studies. TOOK PLACE AT 2 tertiary referral hospitals. PATIENTS AND INTERVENTION(S) Pregnancies (n = 277) were stratified by CL number and in vitro fertilization (IVF) protocol: 0 CL (programmed cycle frozen embryo transfer [FET], n = 28), 1 CL (natural cycle FET, n = 41 and spontaneous conceptions, n = 139), and more than 1 CL (ovarian stimulation and fresh embryo transfer, n = 69). METHODS Quantification was performed for maternal prorenin, renin, and aldosterone blood levels at 5, 9, and 11 weeks of gestation. RESULTS Prorenin and renin were lower in the absence of a CL at all time points when compared to 1 CL, whereas prorenin, renin, and aldosterone were higher in the presence of more than 1 CL vs 1 CL (P < .05). Ovarian stimulation with menopausal gonadotropin resulted in higher prorenin, renin, and aldosterone concentrations during the late first trimester than recombinant follicle-stimulating hormone (P < .05). Prorenin, and to a lesser degree renin, correlated positively with serum progesterone and relaxin, but not serum estradiol. Total follicle diameter, body mass index (BMI), polycystic ovary syndrome (PCOS), and antimüllerian hormone (AMH) were additional determinants of circulating prorenin. Finally, pregnancies conceived in the absence of a CL were more disposed to develop preeclampsia. CONCLUSIONS CL number, IVF protocol, BMI, PCOS, and AMH affect maternal RAAS activation in early pregnancy, and may thus contribute to pregnancy complications.
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Affiliation(s)
- Rosalieke E Wiegel
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | - A H Jan Danser
- Department of Internal Medicine, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
- Correspondence and Reprint Requests: R.P.M. Steegers-Theunissen, MD, PhD, Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Room EE-2271a, PO Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail:
| | - Joop S E Laven
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | - Valerie L Baker
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Lutherville, Maryland, USA
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
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Bandres-Meriz J, Dieberger AM, Hoch D, Pöchlauer C, Bachbauer M, Glasner A, Niedrist T, van Poppel MNM, Desoye G. Maternal Obesity Affects the Glucose-Insulin Axis During the First Trimester of Human Pregnancy. Front Endocrinol (Lausanne) 2020; 11:566673. [PMID: 33154737 PMCID: PMC7586307 DOI: 10.3389/fendo.2020.566673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022] Open
Abstract
Background and objective: The maternal glucose-insulin axis is central for metabolic adaptations required for a healthy pregnancy. Metabolic changes in obese mothers in early pregnancy have been scantly described. Here we characterized the glucose-insulin axis in the first trimester of human pregnancy and assessed the effect of maternal obesity and fat mass. Methods: In this cross-sectional study, maternal blood samples (N = 323) were collected during voluntary pregnancy termination (gestational age 4+0-11+6 weeks) after overnight fasting. Smokers (N = 198) were identified by self-report and serum cotinine levels (ELISA). Maternal BMI (kg/m2) and serum leptin (ELISA) were used as proxy measures of obesity and maternal fat mass, respectively. BMI was categorized into under-/normal weight (BMI < 25.0 kg/m2), overweight (BMI 25.0-29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2), and leptin in tertiles (1st tertile: leptin < 6.80 ng/ml, 2nd tertile: leptin 6.80-12.89 ng/ml, 3rd tertile: leptin > 12.89 ng/ml). ISHOMA insulin sensitivity index was calculated from glucose and C-peptide (ELISA) serum concentrations. Analyses of covariance including multiple confounders were performed to test for differences in glucose, C-peptide and ISHOMA between gestational age periods, BMI and leptin groups. C-peptide and ISHOMA were log-transformed before analyses. Results: At weeks 7-9, fasting glucose and C-peptide levels were lower (P < 0.01 and P < 0.001, respectively) and insulin sensitivity higher (P < 0.001) than at weeks 4-6. Glucose levels were not significantly different between BMI or leptin categories. In contrast, C-peptide increased by 19% (P < 0.01) between the normal weight and the overweight group and by 39% (P < 0.001) between the overweight and obese group. In the leptin groups, C-peptide increased by 25% (P < 0.001) between the 1st and 2nd leptin tertile and by 15% (P < 0.05) between the 2nd and 3rd leptin tertile. ISHOMA decreased with higher BMI and fat mass. ISHOMA decreased by 18% (P < 0.01) between the normal weight and the overweight group and by 30% (P < 0.01) between the overweight and the obese group. In the leptin groups, ISHOMA decreased by 22% (P < 0.001) between the 1st and 2nd leptin tertile and by 14% (P < 0.05) between the 2nd and 3rd leptin tertile. Conclusions: At the group level, fasting glucose, C-peptide and insulin sensitivity dynamically change in the first trimester of human pregnancy. Maternal obesity is associated with higher C-peptide and lower insulin sensitivity at all periods in the first trimester of human pregnancy, while glucose is unaltered. These findings have implications for the timing of early gestational diabetes mellitus risk screening.
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Affiliation(s)
- Julia Bandres-Meriz
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Anna M. Dieberger
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Denise Hoch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Caroline Pöchlauer
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Martina Bachbauer
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | | | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Papastefanou I, Wright D, Syngelaki A, Lolos M, Anampousi K, Nicolaides KH. Competing-risks model for prediction of small-for-gestational-age neonate from maternal characteristics and serum pregnancy-associated plasma protein-A at 11-13 weeks' gestation. Ultrasound Obstet Gynecol 2020; 56:541-548. [PMID: 32770776 DOI: 10.1002/uog.22175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To develop a continuous likelihood model for pregnancy-associated plasma protein-A (PAPP-A), in the context of a new competing-risks model for prediction of a small-for-gestational-age (SGA) neonate, and to compare the predictive performance of the new model for SGA to that of previous methods. METHODS This was a prospective observational study of 60 875 women with singleton pregnancy undergoing routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation. The dataset was divided randomly into a training dataset and a test dataset. The training dataset was used for PAPP-A likelihood model development. We used Bayes' theorem to combine the previously developed prior model for the joint Gaussian distribution of gestational age (GA) at delivery and birth-weight Z-score with the PAPP-A likelihood to obtain a posterior distribution. This patient-specific posterior joint Gaussian distribution of GA at delivery and birth-weight Z-score allows risk calculation for SGA defined in terms of different birth-weight percentiles and GA. The new model was validated internally in the test dataset and we compared its predictive performance to that of the risk-scoring system of the UK National Institute for Health and Care Excellence (NICE) and that of logistic regression models for different SGA definitions. RESULTS PAPP-A has a continuous association with both birth-weight Z-score and GA at delivery according to a folded-plane regression. The new model, with the addition of PAPP-A, was equal or superior to several logistic regression models. The new model performed well in terms of risk calibration and consistency across different GAs and birth-weight percentiles. In the test dataset, at a false-positive rate of about 30% using the criteria defined by NICE, the new model predicted 62.7%, 66.5%, 68.1% and 75.3% of cases of a SGA neonate with birth weight < 10th percentile delivered at < 42, < 37, < 34 and < 30 weeks' gestation, respectively, which were significantly higher than the respective values of 46.7%, 55.0%, 55.9% and 52.8% achieved by application of the NICE guidelines. CONCLUSIONS Using Bayes' theorem to combine PAPP-A measurement data with maternal characteristics improves the prediction of SGA and performs better than logistic regression or NICE guidelines, in the context of a new competing-risks model for the joint distribution of birth-weight Z-score and GA at delivery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Papastefanou
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - D Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Lolos
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K Anampousi
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Lumley SF, Eyre DW, McNaughton AL, Howarth A, Hoosdally S, Hatch SB, Kavanagh J, Chau KK, Downs LO, Cox S, Dunn L, Justice A, Wareing S, Dingle K, Rudkin J, Auckland K, Fyfe A, Bolton J, Paton R, Mentzer AJ, Jeffery K, Andersson MI, James T, Peto TEA, Marsden BD, Screaton G, Cornall RJ, Klenerman P, Ebner D, Stuart DI, Crook DW, Stoesser N, Kennedy SH, Thompson C, Gupta S, Matthews PC. SARS-CoV-2 antibody prevalence, titres and neutralising activity in an antenatal cohort, United Kingdom, 14 April to 15 June 2020. Euro Surveill 2020; 25:2001721. [PMID: 33094717 PMCID: PMC7651878 DOI: 10.2807/1560-7917.es.2020.25.41.2001721] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 12/29/2022] Open
Abstract
SARS-CoV-2 IgG screening of 1,000 antenatal serum samples in the Oxford area, United Kingdom, between 14 April and 15 June 2020, yielded a 5.3% seroprevalence, mirroring contemporaneous regional data. Among the 53 positive samples, 39 showed in vitro neutralisation activity, correlating with IgG titre (Pearson's correlation p<0.0001). While SARS-CoV-2 seroprevalence in pregnancy cohorts could potentially inform population surveillance, clinical correlates of infection and immunity in pregnancy, and antenatal epidemiology evolution over time need further study.
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Affiliation(s)
- Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
| | - David W Eyre
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- These authors contributed equally to this work
| | - Alison Howarth
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sarah Hoosdally
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stephanie B Hatch
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - James Kavanagh
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kevin K Chau
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Louise O Downs
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stuart Cox
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Laura Dunn
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Anita Justice
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Susan Wareing
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kate Dingle
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Justine Rudkin
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Kathryn Auckland
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alexander Fyfe
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Jai Bolton
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Robert Paton
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Alexander J Mentzer
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Katie Jeffery
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Monique I Andersson
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tim James
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tim E A Peto
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Brian D Marsden
- Structural Genomics Consortium, Nuffield Department of Medicine, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Headington, Oxford, United Kingdom
- The Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building, Roosevelt Dr, Headington, Oxford, United Kingdom
- Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Gavin Screaton
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Richard J Cornall
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Daniel Ebner
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - David I Stuart
- Structural Genomics Consortium, Nuffield Department of Medicine, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Headington, Oxford, United Kingdom
- The Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building, Roosevelt Dr, Headington, Oxford, United Kingdom
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Derrick W Crook
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nicole Stoesser
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Craig Thompson
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Sunetra Gupta
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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Dreyer AF, Jensen RC, Glintborg D, Schmedes AV, Brandslund I, Nielsen F, Kyhl HB, Jensen TK, Andersen MS. Perfluoroalkyl Substance Exposure Early In Pregnancy Was Negatively Associated With Late Pregnancy Cortisone Levels. J Clin Endocrinol Metab 2020; 105:5841634. [PMID: 32436946 DOI: 10.1210/clinem/dgaa292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/18/2020] [Indexed: 02/13/2023]
Abstract
INTRODUCTION During pregnancy, maternal cortisol levels are increased 3-fold by the third trimester. The enzyme 11β-hydroxysteroid dehydrogenase (11β-HSD, isoforms 1 and 2) regulates the balance between cortisol and cortisone levels. Perfluoroalkyl substances (PFAS) have been reported to inhibit 11β-HSD1 and more potently 11β-HSD2, which could lead to reduced levels of cortisol and more extensively cortisone. AIM The aim of this work is to investigate a possible effect of early pregnancy PFAS exposure on late pregnancy activity of 11β-HSD1 and 11β-HSD2 assessed by cortisol and cortisone levels in diurnal urine (dU) and blood samples. METHODS This study is part of the prospective cohort study, Odense Child Cohort (OCC). A total of 1628 pregnant women had serum (S) concentrations of 5 PFAS (perfluorooctanoic acid [PFOA], perfluorooctane sulfonic acid [PFOS], perfluorohexane sulfonic acid [PFHxS], perfluorononanoic acid [PFNA], and perfluorodecanoic acid (PFDA)) measured in the first trimester (median gestational week, GW 11). dU cortisol and cortisone (n = 344) and S-cortisol (n = 1048) were measured in the third trimester (median GW 27). RESULTS In multiple regression analyses, a 2-fold increase in S-PFOS was significantly associated with lower dU-cortisone (β = -9.1%, P < .05) and higher dU-cortisol/dU-cortisone (dU-C/C) (β = 9.3%, P < .05). In crude models, a doubling in PFOS, PFOA, PFHxS, and PFNA concentrations were associated with a significant increase in S-cortisol; however, these associations became insignificant after adjustment. CONCLUSION Early pregnancy maternal S-PFAS were inversely associated with late pregnancy dU-cortisone, indicating reduced activity of 11β-HSD2.
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Affiliation(s)
- Anja Fenger Dreyer
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Richard Christian Jensen
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - Ivan Brandslund
- Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Flemming Nielsen
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Henriette Boye Kyhl
- Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Tina Kold Jensen
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Preston EV, Rifas-Shiman SL, Hivert MF, Zota AR, Sagiv SK, Calafat AM, Oken E, James-Todd T. Associations of Per- and Polyfluoroalkyl Substances (PFAS) With Glucose Tolerance During Pregnancy in Project Viva. J Clin Endocrinol Metab 2020; 105:5849987. [PMID: 32480407 PMCID: PMC7320827 DOI: 10.1210/clinem/dgaa328] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Per- and polyfluoroalkyl substances (PFAS) exposure may alter glucose homeostasis. Research on PFAS exposure and glucose tolerance during pregnancy is limited. OBJECTIVE The objective of this work is to estimate associations between first-trimester plasma PFAS concentrations and glucose tolerance assessed in late second pregnancy trimester. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES Pregnant women (n = 1540) enrolled in Project Viva in 1999 to 2002 provided first-trimester plasma samples analyzed for 8 PFAS. At approximately 28 weeks' gestation, women completed 1-hour nonfasting, 50-g oral glucose challenge tests (GCTs); if abnormal, women completed subsequent 3-hour oral glucose tolerance tests (OGTTs) to screen for gestational diabetes mellitus (GDM). We assessed both continuous GCT glucose levels and 4 categories of glucose tolerance (normal glycemia [reference], isolated hyperglycemia, impaired glucose tolerance, GDM). We used multinomial logistic regression to estimate associations of PFAS with glucose tolerance categories. We used multivariable linear regression and Bayesian kernel machine regression (BKMR) to assess individual and joint effects of PFAS on continuous GCT glucose levels, respectively. We evaluated effect modification by maternal age and race/ethnicity. RESULTS PFAS were not associated with glucose tolerance categories. In BKMR analyses, we observed a positive association between ln-perfluorooctane sulfonate (PFOS) and glucose levels (Δ25th to 75th percentile: 6.2 mg/dL, 95% CI, 1.1-11.3) and an inverse-U shaped association between 2-(N-perfluorooctane sulfonamide) acetate and glucose levels. Individual linear regression results were similar. We found suggestive evidence that associations varied by age and racial/ethnic group. CONCLUSION Certain PFAS may alter glucose homeostasis during pregnancy, but may not be associated with overt GDM.
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Affiliation(s)
- Emma V Preston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Correspondence and Reprint Requests: Emma V. Preston, PhD, Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Building 1, Boston, MA 02115. E-mail:
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Ami R Zota
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sharon K Sagiv
- Center for Environmental Research and Children’s Health, School of Public Health, University of California at Berkeley, Berkeley, California
| | | | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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50
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Jiang R, Wu S, Fang C, Wang C, Yang Y, Liu C, Hu J, Huang Y. Amino acids levels in early pregnancy predict subsequent gestational diabetes. J Diabetes 2020; 12:503-511. [PMID: 31883199 DOI: 10.1111/1753-0407.13018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aimed to estimate the performance of amino acids levels in predicting the risk of subsequent gestational diabetes mellitus (GDM). METHODS A total of 431 women at 12 to 16 weeks of gestation in the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Soochow University were recruited. High-performance liquid chromatography electrospray tandem mass spectrometry was used to measure amino acids levels in maternal blood at 12 to 16 weeks of gestation. At 24 to 28 weeks of gestation, all participants were administered 75-g oral glucose tolerance tests for the diagnosis of GDM. RESULTS Alanine, isoleucine, and tyrosine levels in early pregnancy were significantly different between women who developed GDM and those who remained normal glucose tolerant. Logistic regressions showed that after adjustments for age, parity, body mass index, family history of diabetes, γ-glutamyltranspeptidase, triglycerides, fasting glucose and fasting insulin levels, alanine (odds ratio [OR], 1.46; 95% CI, 1.05-2.04; P = .027), isoleucine (OR, 1.48; 95% CI, 1.12-1.96; P = .0062), and tyrosine (OR, 1.46; 95% CI, 1.07-2.03; P = .020) levels in early pregnancy were independently associated with subsequent GDM. The addition of isoleucine and tyrosine into the conventional model improved the area under curve from 0.692 to 0.737 (P = .036) and significantly increased the net reclassification improvement (+13.7%, P = .0025). CONCLUSIONS The present study suggests that elevated isoleucine, tyrosine, and alanine levels are independently and significantly associated with subsequent incidence of GDM. New models including conventional risk factors, isoleucine and tyrosine levels in early pregnancy might help physicians identify high-risk population of GDM.
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Affiliation(s)
- Rong Jiang
- The Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shuhua Wu
- The Department of Geriatrics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chen Fang
- The Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Wang
- School of Radiation Medicine and Protection, Jiangsu Provincial Key Laboratory of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Ya Yang
- Institute of Forensic Sciences, Soochow University, Suzhou, China
| | - Chao Liu
- Institute of Forensic Sciences, Soochow University, Suzhou, China
| | - Ji Hu
- The Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Huang
- The Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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