Altered maternal metabolism during mild gestational hyperglycemia as a predictor of adverse perinatal outcomes: A comprehensive analysis

BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR BASIS OF DISEASE

卷:1866

Article

Cunha Rudge, Marilza Vieira^1,2  Pascon Barbosa, Angelica Mercia^2,3  Sobrevia, Luis^2,4,5,6  Gelaleti, Rafael Bottaro²  Shetty Hallur, Raghavendra Lakshmana²  Castro Marcondes, Joao Paulo²  Favero Salvadori, Daisy Maria⁷  Prudencio, Caroline Baldini²  Magalhaes, Claudia Garcia¹  Costa, Roberto¹  Abbade, Joelcio Francisco¹  Corrente, Jose Eduardo⁸  Paranhos Calderon, Iracema de Mattos^1,2 

[1] Sao Paulo State Univ, Botucatu Med Sch FMB, Dept Gynecol & Obstet, UNESP, BR-18618687 Botucatu, SP, Brazil

[2] Sao Paulo State Univ, Botucatu Med Sch FMB, Grad Program Gynecol Obstet & Mastol, UNESP, Sao Paulo, Brazil

[3] Sao Paulo State Univ, Sch Philosophy & Sci, Dept Physiotherapy & Occupat Therapy, UNESP, Marilia, SP, Brazil

[4] Pontificia Univ Catolica Chile, Fac Med, Sch Med, Dept Obstet,Div Obstet & Gynaecol,CMPL, Santiago 8330024, Chile

[5] Univ Seville, Fac Pharm, Dept Physiol, E-41012 Seville, Spain

[6] Univ Queensland, UQCCR, Fac Med & Biomed Sci, Herston, Qld 4029, Australia

[7] Sao Paulo State Univ, Botucatu Med Sch FMB, Dept Pathol, UNESP, Sao Paulo, Brazil

[8] Sao Paulo State Univ, Biosci Inst, Biostat Dept, UNESP, Sao Paulo, Brazil

关键词: Mild gestational hyperglycemia;    Gestational diabetes mellitus;    Large for gestational age;    Insulin resistance;    Placenta;    Cytokines;    Apoptosis;    Natural killer cells;    Inflammatory mediators;    IRS-1 gene;    Gene expression;    Moderator analysis;   

DOI  :  10.1016/j.bbadis.2019.05.014

来源: Elsevier

【 摘 要 】

Mild gestational hyperglycemia (MGH), as assessed using the normal oral glucose tolerance test (OGTT) and detection of an altered glycemic profile, is associated with adverse perinatal outcome. This study described the results of 40 years of research conducted at the Perinatal Diabetes Research Centre at Sao Paulo State University (UNESP), Brazil, on the maternal MGH environment and placental markers. This study also described the unidirectional relationship between MGH and excessive fetal growth, also supplying moderator analysis. In addition to hyperglycemia, MGH is associated with an increased incidence of hypertension, metabolic syndrome, persistent insulin resistance after pregnancy, and high risk of developing type 2 diabetes mellitus (T2DM) after pregnancy. Structural changes and functional abnormalities resulting from MGH were observed in placenta. The fully adjusted model concluded that the predictor variable (MGH), which creates a complex environment for the fetus, has a direct effect on excessive birth weight and produces a z-score for ratios of birth weight to gestational age of >= 2. Maternal age, pre-pregnancy BMI, number of previous pregnancies, numbers of prenatal visits, and 1 h OGTT are moderator variables that impact MGH and excessive fetal growth. These results show that maternal MGH has some characteristics associated with similar long-term T2DM development and similar adverse perinatal results to those of gestational diabetes mellitus (GDM) mothers, making it an intermediate maternal and placental marker between normoglycemic and GDM mothers.

【 授权许可】

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