scholarly journals 135: Fetal growth trajectories in gestational diabetes mellitus pregnancies and large for gestational age at birth

2020 ◽  
Vol 222 (1) ◽  
pp. S102
Author(s):  
Eran Ashwal ◽  
Suraya Saied ◽  
Nir Melamed ◽  
Jon Barrett ◽  
Karizma Mawjee ◽  
...  
2021 ◽  
Vol 8 ◽  
Author(s):  
Tai-Ho Hung ◽  
Chung-Pu Wu ◽  
Szu-Fu Chen

Background: Dysregulation of placental mechanistic target of rapamycin (mTOR) activity has been implicated in the pathophysiology of pregnancies complicated by idiopathic fetal growth restriction (FGR) and gestational diabetes mellitus (GDM) with large-for-gestational-age (LGA) infants. However, the underlying mechanisms remain unclear.Methods: We obtained placentas from women with normal pregnancies (n = 11) and pregnancies complicated by FGR (n = 12) or GDM with LGA infants (n = 12) to compare the levels of total and phosphorylated forms of Akt, AMPK, TSC2, and mTOR among the three groups and used primary cytotrophoblast cells isolated from 30 normal term placentas to study the effects of oxygen–glucose deprivation (OGD) and increasing glucose concentrations on the changes of these factors in vitro.Results: Placentas from FGR pregnancies had lower phosphorylated Akt (p-Akt) levels (P < 0.05), higher p-AMPKα levels (P < 0.01), and lower mTOR phosphorylation (P < 0.05) compared to that of normal pregnant women. Conversely, women with GDM and LGA infants had higher p-Akt (P < 0.001), lower p-AMPKα (P < 0.05), and higher p-mTOR levels (P < 0.05) in the placentas than normal pregnant women. Furthermore, primary cytotrophoblast cells subjected to OGD had lower p-Akt and p-mTOR (both P < 0.05) and higher p-AMPKα levels (P < 0.05) than those cultured under standard conditions, but increasing glucose concentrations had opposite effects on the respective levels. Administering compound C, an AMPK inhibitor, did not significantly affect Akt phosphorylation but partially reversed mTOR phosphorylation. Administering LY294002, an Akt inhibitor, decreased p-mTOR levels, but did not change the levels of total and phosphorylated AMPKα.Conclusion: These results suggest that Akt and AMPK are involved in the regulation of trophoblast mTOR activity in the placentas of pregnancies complicated by FGR and GDM with LGA infants.


2021 ◽  
Author(s):  
Catherine Knight-Agarwal ◽  
Jani Rati ◽  
Meisa Al-Foraih ◽  
Dionne Eckley ◽  
Carrie Ka Wai Lui ◽  
...  

Abstract Background: The prevalence of maternal overweight and obesity has been increasing. This research explored the association between maternal body mass index and ethnicity in relation to the adverse outcomes of large for gestational age and gestational diabetes mellitus. Method: A retrospective cohort study was undertaken with 27 814 Australian women of various ethnicities, who gave birth to a singleton infant between 2008 and 2017. Variables were examined using logistic regression. Results: A significantly higher proportion of large for gestational age infants were born to overweight and obese women compared to those who were classified as underweight and healthy weight. Asian-born women with a body mass index of ≥ 40kg/m2 had an adjusted odds ratio of 9.926 (3.859 - 25.535) for birthing a large for gestational age infant whereas Australian-born women had an adjusted odds ratio of 2.661 (2.256 - 3.139) for the same outcome. Women born in Australia were at high risk of birthing a large for gestational age infant in the presence of insulin controlled gestational diabetes mellitus, but this risk was not significant for those with the diet-controlled type. Asian-born women did not present an elevated risk of birthing a large for gestational infant, in either the diet controlled, or insulin controlled gestational diabetes mellitus groups. Conclusion: Large for gestational age and gestational diabetes mellitus are adverse pregnancy outcomes that can lead to significant maternal and neonatal morbidity. Women who are overweight or obese, and considering a pregnancy, are encouraged to seek culturally appropriate nutrition and weight management advice during the periconception period.


2020 ◽  
Vol 66 (2) ◽  
pp. 139-145
Author(s):  
Rodrigo Dias Nunes ◽  
Mayara Eloisa Flôres ◽  
Mayara Seemann ◽  
Eliane Traebert ◽  
Jefferson Traebert

SUMMARY OBJECTIVE To evaluate two different criteria, one or two cut-off values, of oral glucose tolerance test with 75g of glucose for the diagnosis of gestational diabetes mellitus. METHODS A cross-sectional study involving 120 records of pregnant women who received prenatal care at the service of a Brazilian university was carried out. Bivariate analysis of obstetric and perinatal outcomes was performed using the chi-square test. RESULTS Considering criterion I, 12.5% of patients were diagnosed with gestational diabetes mellitus. Patients were 3.57 times more likely to have a large fetus for the gestational age at birth (p=0.038). Using criterion II, gestational diabetes mellitus was diagnosed in 5.8% of patients, macrosomia was 7.73 times more likely to be found in the presence of gestational diabetes mellitus (p=0.004), and a large fetus for the gestational age at birth was 8.17 times more likely (p=0.004). CONCLUSIONS There was a difference in the prevalence of gestational diabetes mellitus between the two criteria analyzed. The new criterion proposed increased prevalence.


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