Intermediate metabolism in association with the amino acid profile during the third trimester of normal pregnancy and diet-controlled gestational diabetes

Abstract Background: Gestational diabetes mellitus (GDM), one of the most common pregnancy complications, can lead to morbidity and mortality in both the mother and the infant. Metabolomics has provided new insights into the pathology of GDM and systemic analysis of GDM with metabolites is required for providing more clues for GDM diagnosis and mechanism research. This study aims to reveal metabolic differences between normal pregnant women and GDM patients in the second- and third-trimester stages and to confirm the clinical relevance of these new findings.Methods: Metabolites were quantitated with the serum samples of 200 healthy pregnant women and 200 GDM women in the second trimester, 199 normal controls, and 199 GDM patients in the third trimester. Both function and pathway analyses were applied to explore biological roles involved in the two sets of metabolites. Then the trimester stage-specific GDM metabolite biomarkers were identified by combining machine learning approaches, and the logistic regression models were constructed to evaluate predictive efficiency. Finally, the weighted gene co-expression network analysis method was used to further capture the associations between metabolite modules with biomarkers and clinical indices. Results: This study revealed that 57 differentially expressed metabolites (DEMs) were discovered in the second-trimester group, among which the most significant one was 3-methyl-2-oxovaleric acid. Similarly, 72 DEMs were found in the third-trimester group, and the most significant metabolites were ketoleucine and alpha-ketoisovaleric acid. These DEMs were mainly involved in the metabolism pathway of amino acids, fatty acids and bile acids. The logistic regression models for selected metabolite biomarkers achieved the area under the curve values of 0.807 and 0.81 for the second- and third-trimester groups. Furthermore, significant associations were found between DEMs/biomarkers and GDM-related indices. Conclusions: Metabolic differences between healthy pregnant women and GDM patients were found. Associations between biomarkers and clinical indices were also investigated, which may provide insights into pathology of GDM.

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Alterations of serum resistin in normal pregnancy and pre-eclampsia

Clinical Science ◽

10.1042/cs20040225 ◽

2004 ◽

Vol 108 (1) ◽

pp. 81-84 ◽

Cited By ~ 59

Author(s):

Danqing CHEN ◽

Minyue DONG ◽

Qin FANG ◽

Jing HE ◽

Zhengping WANG ◽

...

Keyword(s):

Pregnant Women ◽

Normal Pregnancy ◽

Third Trimester ◽

Resistin Level ◽

Blood Samples ◽

The Third ◽

Maternal Adaptation ◽

Serum Resistin Level ◽

One Way Anova ◽

Insight Into

Resistin is expressed in human placenta and has been postulated to play a role in regulating energy metabolism in pregnancy. However, changes in serum resistin levels in normal pregnancy and in the setting of pre-eclampsia are far from understood. The purpose of the present study was to clarify the alterations in serum resistin level in normal pregnancy and pre-eclampsia. Blood samples were taken from 28 healthy non-pregnant women, 27 women in the first, 26 in the second and 26 in the third trimesters of normal pregnancy and 25 women with pre-eclampsia. Serum resistin concentrations were determined by using an ELISA, and mean serum resistin levels were compared with one-way ANOVA. Serum resistin levels were not significantly different among non-pregnant women and women in the first and second trimesters of pregnancy (P>0.05 for all). Serum resistin was significantly elevated in the third trimester of normal pregnancy compared with non-pregnant women (P<0.01) and women in the first (P<0.001) and second (P<0.001) trimesters of pregnancy. Serum resistin level was significantly lower in women with pre-eclampsia than women in the third trimester of normal pregnancy (P<0.001), but was comparable with those of non-pregnant women and women in the first and second trimesters of pregnancy (P>0.05 for all). In conclusion, we found an increase in serum resistin in the third trimester of normal pregnancy, but this increase was not present in pre-eclampsia. We postulate that these associations may offer insight into the mechanisms of maternal adaptation to pregnancy and the pathogenesis of pre-eclampsia.

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Stroke Volume Recruitability during the Third Trimester of Pregnancy

American Journal of Perinatology ◽

10.1055/s-0037-1615788 ◽

2017 ◽

Vol 35 (08) ◽

pp. 737-740 ◽

Cited By ~ 1

Author(s):

Sandra Herrera ◽

Maggie Kuhlmann-Capek ◽

Sarah Rogan ◽

Antonio Saad ◽

George Saade ◽

...

Keyword(s):

Stroke Volume ◽

Pregnant Women ◽

Vena Cava ◽

Normal Pregnancy ◽

Gravid Uterus ◽

Third Trimester ◽

Fluid Bolus ◽

The Third ◽

Hemodynamic Variables ◽

Flat Portion

Objective It is unknown whether the heart operates in the ascending or flat portion of the Starling curve during normal pregnancy. Pregnant women do not respond to the passive leg-raising maneuver secondary to mechanical obstruction of the inferior vena cava by the gravid uterus. Our objective was to evaluate if administration of a fluid bolus increases baseline stroke volume (SV) among healthy pregnant patients during the third trimester. Study Design Healthy pregnant women who underwent elective term cesarean sections were included. A noninvasive cardiac output monitor was used to measure hemodynamic variables at baseline and after administration of a 500-mL crystalloid bolus. Results Forty-five women were included in the study. Fluid administration was associated with a statistically significant increase in SV from a baseline value of 71 ± 11 to 90 ± 19 mL (95% confidence interval [CI]: 13.67–21.49; p < 0.01) and a significant decrease in maternal heart rate from a baseline of 87 ± 9 beats per minute to 83 ± 8 after the fluid bolus (95% CI: −6.81 to −2.78; p = 0.03). No changes in peripheral vascular resistances or any other measured hemodynamic parameters were noted with volume expansion. Conclusion In healthy term pregnancy, the heart operates in the ascending portion of the Starling's curve, rendering it fluid responsive.

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Transvaginal sonographic assessment of cervical dynamics during the third trimester of normal pregnancy

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.3109/00016349709050065 ◽

1997 ◽

Vol 76 (2) ◽

pp. 118-122 ◽

Cited By ~ 30

Author(s):

Geoffrey M. Brieger ◽

Xie Hong Ning ◽

Robert R. Dawkins ◽

Kong Qiu Ying ◽

Cai Weng ◽

...

Keyword(s):

Normal Pregnancy ◽

Third Trimester ◽

The Third ◽

Sonographic Assessment

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The radioimmunoassay of placental protein 5 and circulating levels in maternal blood in the third trimester of normal pregnancy

Clinica Chimica Acta ◽

10.1016/0009-8981(79)90203-1 ◽

1979 ◽

Vol 95 (3) ◽

pp. 509-516 ◽

Cited By ~ 54

Author(s):

B. Obiekwe ◽

Diana J. Pendlebury ◽

Y.B. Gordon ◽

J.G. Grudzinskas ◽

T. Chard ◽

...

Keyword(s):

Normal Pregnancy ◽

Maternal Blood ◽

Third Trimester ◽

The Third ◽

Placental Protein ◽

Circulating Levels

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Perturbed (procoagulant) endothelium and deviations within the fibrinolytic system during the third trimester of normal pregnancy: A possible link to placental function

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.3109/00016349509024445 ◽

1995 ◽

Vol 74 (4) ◽

pp. 257-261 ◽

Cited By ~ 16

Author(s):

Jannie Dalby Sørensen ◽

Niels Jørgen Secher ◽

Jørgen Jespersen

Keyword(s):

Normal Pregnancy ◽

Fibrinolytic System ◽

Third Trimester ◽

Placental Function ◽

The Third

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Fetal movement in the third trimester of normal pregnancy

International Journal of Gynecology & Obstetrics ◽

10.1016/0020-7292(87)90101-9 ◽

1987 ◽

Vol 25 (6) ◽

pp. 490-490

Author(s):

L Valentin ◽

K Marsal

Keyword(s):

Normal Pregnancy ◽

Fetal Movement ◽

Third Trimester ◽

The Third

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D-Dimer Concentrations in Normal Pregnancy: New Diagnostic Thresholds Are Needed

Clinical Chemistry ◽

10.1373/clinchem.2004.044883 ◽

2005 ◽

Vol 51 (5) ◽

pp. 825-829 ◽

Cited By ~ 130

Author(s):

Jeffrey A Kline ◽

Ginger W Williams ◽

Jackeline Hernandez-Nino

Keyword(s):

Fetal Loss ◽

Pregnant Patient ◽

Normal Pregnancy ◽

Progressive Increase ◽

Third Trimester ◽

The Third ◽

Diagnostic Thresholds ◽

Turbidimetric Assay ◽

D Dimer ◽

Rule Out

Abstract Background: Pregnancy is known to increase the D-dimer concentration above the conventional normal threshold of 0.50 mg/L, leading to an increased false-positive D-dimer test when venous thromboembolism (VTE) is clinically suspected in a pregnant patient. Our aim was to determine the effect of normal pregnancy on the D-dimer concentration. Methods: Healthy women who were seeking to become pregnant and had no preexisting condition known to increase the D-dimer concentration were identified. Quantitative D-dimer measurements (MDA turbidimetric assay) and fibrinogen assays were performed before conception, at each trimester, and at 4 weeks postpartum. Patients were excluded for fetal loss or preeclampsia. Results: A total of 50 women were enrolled in the study, and blood samples were obtained at preconception and all trimesters from 23 women. The mean (SD) preconception D-dimer concentration was 0.43 (0.49) mg/L, and 79% of women had a D-dimer concentration <0.50 mg/L. D-Dimer increased with each trimester such that only 22% of women in the second trimester and none (of 23) in the third trimester (95% confidence interval, 0–14%) had a D-dimer concentration <0.50 mg/L. We found no correlation between either the D-dimer and fibrinogen concentrations or between the increases in D-dimer and fibrinogen with pregnancy. Conclusions: Normal pregnancy causes a progressive increase in circulating D-dimer. The D-dimer test has no use in ruling out VTE in the third trimester if a cutoff of 0.50 mg/L is used. A large management study is needed to establish new thresholds for the D-dimer to rule out VTE in each trimester.

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