Diabetogenically beneficial gut microbiota alterations in third trimester of pregnancy

Altered gut microbiota (dysbiosis), inflammation and weight gain are pivotal to the success of normal pregnancy. These are features of metabolic syndrome that ordinarily increase the risk of type 2 diabetes in non-pregnant individuals. Though gut microbiota influences host energy metabolism and homeostasis, the outcome (healthy or unhealthy) varies depending on pregnancy status. In a healthy pregnancy, the gut microbiota is altered to promote metabolic and immunological changes beneficial to the mother and foetus but could connote a disease state in non-pregnant individuals. During the later stages of gestation, metabolic syndrome-like features, that is, obesity-related gut dysbiotic microbiota, increased insulin resistance, and elevated pro-inflammatory cytokines, promote energy storage in adipose tissue for rapid foetal growth and development, and in preparation for energy-consuming processes such as parturition and lactation. The origin of this gestation-associated host–microbial interaction is still elusive. Therefore, this review critically examined the host–microbial interactions in the gastrointestinal tract of pregnant women at late gestation (third trimester) that shift host metabolism in favour of a diabetogenic or metabolic syndrome-like phenotype. Whether the diabetogenic effects of such interactions are indeed beneficial to both mother and foetus was also discussed with plausible mechanistic pathways and associations highlighted. Lay summary In non-pregnant women, increased blood glucose, fat accumulation, and prolonged immune response lead to obesity and diabetes. However, during the later stages of pregnancy, the changes in the body’s metabolism described previously do not lead to disease, instead pregnancy facilitates the storage of sufficient energy in fat cells for rapid growth and development of the foetus. The excess energy stores also prepares the mother for labour and breastfeeding. This review examines the role of the normal bacteria in the digestive tract in this beneficial energy accumulation and transfer between the mother and foetus without leading to obesity, diabetes and hypertension in pregnancy.

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STATUS OF OXIDANT (MDA) ANTIOXIDANT (SOD) IN FIRST AND THIRD TRIMESTER OF NORMAL PREGNANCY IN TERTIARY CENTER OF CENTRAL INDIA

10.36106/gjra/0200598 ◽

2021 ◽

pp. 12-14

Author(s):

Tamrakar Seema ◽

Sachdeva Payasvi ◽

Tripathi Rashmi

Keyword(s):

Oxidative Stress ◽

Pregnant Women ◽

Central India ◽

Normal Pregnancy ◽

Metabolic Demand ◽

Third Trimester ◽

Dynamic Changes ◽

Tertiary Center ◽

Antioxidant Supplements ◽

High Metabolic Demand

INTRODUCTION: Pregnancy is associated with high metabolic demand and increased demand for tissue oxygen. Consequently increased production of reactive oxygen species. This leads in increased oxidative stress and decreases antioxidant status during gestational age of normal pregnant women. Aim: Aim of this study was to evaluate the level of oxidant and antioxidant in 1st and 3rd trimester of normal pregnant women. MATERIAL AND METHODS: The present study included total 150 cases attended ANC Clinic at the department of Gynae LNMC & J K Hospital was screened for the study. Level of MDA was estimated by Jean et al and SOD was Marklund and Marklund. RESULTS: Findings were, that there was signicantly increase in Malondialdehyde levels (p<0.001) and signicantly decrease in superoxide dismutase activities (P<0.001) in 1st and 3rd trimester of normal pregnant women. Conclusion: present study concludes that there was difference in oxidative status due to dynamic changes. During pregnancy oxidative stress is increased and antioxidant decreased that can be fatal to the health of the mother and the fetus. Therefore antioxidant supplements should be prescribed in early pregnancy to prevent the overwhelming of oxidative stress in pregnant females.

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Thrombin Generation in Chinese Pregnant Women and the Effect of Insulin Use on Thrombin Generation in Patients with GDM

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619863492 ◽

2019 ◽

Vol 25 ◽

pp. 107602961986349

Author(s):

Feng Dong ◽

Longhao Wang ◽

Chengbin Wang

Keyword(s):

Blood Glucose ◽

Pregnant Women ◽

Thrombin Generation ◽

First Trimester ◽

Normal Pregnancy ◽

Third Trimester ◽

Control Blood Glucose ◽

Normal Ranges ◽

Increased Risk ◽

Significant Difference

Pregnancy is a hypercoagulable state associated with an increased risk of venous thrombosis. Calibrated automated thrombogram (CAT) is a test to monitor the thrombin generation (TG), a laboratory marker of thrombosis risk, and increases during normal pregnancy, but it is still unclear whether TG is related to the use of insulin in pregnant women with gestational diabetes mellitus (GDM). We performed thrombin generation by CAT on 135 normal pregnant women, including 43 in first trimester, 32 in second trimester, 60 in third trimester, respectively; 68 pregnant women with GDM were also enrolled, 19 patients with GDM using insulin to control blood glucose and 49 patients control their blood glucose through diet and exercise with noninsulin treatment. The overall CAT parameters were calculated using descriptive statistics method with mean ± standard deviation. Mean endogenous thrombin potential, peak thrombin generation, and StartTail time increased significantly with the pregnancy. There was no significant difference in TG test parameters except StartTail time( P = .003) in insulin-treated GDM group when compared to those without insulin in the GDM group. The normal ranges for CAT parameters in pregnant women were determined. Thrombin generation increased significantly in first trimester and remains stable in second and third trimester. The use of insulin in patient with GDM did not affect thrombin generation test. Our study helps to establish the reference range of thrombin generation in Chinese normal pregnant population and provide more basis to predict the risk of thrombus complicating during pregnancy.

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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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Superficial Hand Vein Responses to NG-Monomethyl-l-Arginine in Post-Partum and Non-Pregnant Women

Clinical Science ◽

10.1042/cs0900493 ◽

1996 ◽

Vol 90 (6) ◽

pp. 493-497 ◽

Cited By ~ 7

Author(s):

G. A. Ford ◽

S. C. Robson ◽

Z. A. Mahdy

Keyword(s):

Nitric Oxide ◽

Pregnant Women ◽

Post Partum ◽

Normal Pregnancy ◽

Third Trimester ◽

Hand Vein ◽

Vascular Beds ◽

Oxide Synthase ◽

Constrictor Response ◽

Venous Vasculature

1. During human pregnancy marked vasodilatation occurs in arterial and venous vascular beds. The mechanisms responsible for this change remain unclear. The contribution of increased nitric oxide activity to vasodilatation associated with pregnancy was determined by examining superficial hand vein responses to NG-monomethyl-l-arginine, an inhibitor of nitric oxide synthase, in post-partum women 24–48 h after delivery when vasodilatation remains at levels present during the third trimester. 2. Seventeen healthy women, 24–48 h post partum, and 13 healthy non-pregnant women were studied. Eight of the post-partum women underwent repeat studies 12–16 weeks after delivery. 3. NG-monomethyl-l-arginine (100 nmol/min) resulted in venoconstriction in non-constricted veins (baseline, 0%; 5 min, 26 ± 9%; 10 min, 14 ± 8%; 15 min, 8 ± 7%; means ± SEM) and noradrenaline-constricted veins (5 min, 30 ± 7%; 10 min, 24 ± 10%; 15 min, 14 ± 11%). No constrictor response to NG-monomethyl-l-arginine was present in the same women 12 weeks post partum (5 min, 1 ± 4%; 10 min, 0 ± 3%; 15 min, 1 ± 4%) or in the non-pregnant control subjects in non-constricted (5 min, 2 ± 3%; 10 min, 4 ± 3%; 15 min, 2 ± 2%) or noradrenaline-constricted veins (Smin, − 2 ± 7%; 10 min, 1 ± 9%; 15 min, − 5 ± 7%). 4. These findings indicate that nitric oxide activity is increased in the immediate post-partum period in venous vasculature, and support the hypothesis that increased nitric oxide activity may be responsible for the vasodilatation observed during normal pregnancy.

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Prevalence of components of metabolic syndrome in pregnant women with obstructive sleep apnoea hypopnoea syndrome

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20172267 ◽

2017 ◽

Vol 4 (3) ◽

pp. 755

Author(s):

Sisira M. ◽

Sunny George ◽

James P. T.

Keyword(s):

Metabolic Syndrome ◽

Pregnant Women ◽

Blood Sugar ◽

Obstructive Sleep Apnoea ◽

Complete Blood Count ◽

Sleep Apnoea ◽

Third Trimester ◽

Biochemical Tests ◽

Obstructive Sleep ◽

The Government

Background: Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) related cardiovascular and metabolic risk factors such as hypertension, diabetes mellitus and dyslipidaemia which together are commonly known as metabolic syndrome (MS) is often overlooked in pregnancy. OSAHS is known to cause higher maternal morbidity and bad foetal outcome. Aim was to study the prevalence of components of MS among third trimester pregnant women with OSAHS.Methods: A total of 100 cases and 100 controls each amongst third trimester pregnant females admitted in the Department of Obstetrics and Gynecology at the Government Medical College, Kozhikode, Kerala, India were enrolled in the study. All subjects underwent a thorough clinical, anthropometric, obstetrical examination and biochemical tests such as complete blood count, blood sugar and lipid profile. The parameters were compared between cases and controls.Results: OSAHS positive pregnant women had a higher prevalence of elevated systolic (P=0.01) and diastolic (P=0.002) blood pressure, abnormal fasting (P<0.0001) and post prandial (P=0.02) blood sugar, abnormal cholesterol (P=0.006) and triglyceride levels (P<0.001), and abnormally low HDL levels (P<0.001).Conclusions: This study showed that metabolic syndrome was highly prevalent among OSAHS positive third trimester pregnancy (52%) versus OSAHS negative (8%) pregnant women.

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Glycaemic profile in the second and third trimesters of normal pregnancy compared to non-pregnant adult females

Obstetric Medicine ◽

10.1177/1753495x18807549 ◽

2019 ◽

Vol 13 (1) ◽

pp. 30-36 ◽

Cited By ~ 1

Author(s):

Aruna Nigam ◽

Neha Varun ◽

Sumedha Sharma ◽

YP Munjal ◽

Anupam Prakash

Keyword(s):

Blood Glucose ◽

Pregnant Women ◽

Normal Pregnancy ◽

Postprandial Blood Glucose ◽

Second Trimester ◽

Third Trimester ◽

Glycaemic Variability ◽

The Third ◽

Data Points ◽

Mean Blood Glucose

Aim To assess the glycaemic profile and glycaemic variation in the second and third trimesters of normal pregnancies. Methodology Healthy pregnant women aged 19–35 years between 24 and 36 weeks of gestation were recruited for ambulatory glucose profile monitoring. A total of 18 women in the second trimester, 15 women in the third trimester and 9 healthy non-pregnant women were recruited providing, respectively, 205 days (19,680 data points), 147 days (14,112 data points) and 100 days (9,600 data points) for analysis. Results Mean blood glucose level was 20.2% lower in the second trimester and 10.6% lower in the third trimester than non-pregnant women (p < 0.001). In pregnancy, it took 15 to 20 minutes more to reach peak postprandial blood glucose levels compared to non-pregnant women (p = 0.003). Glycaemic variability was more in the third trimester (p < 0.001). Conclusion There is tight blood sugar control along with lower mean blood glucose in healthy pregnant women compared to non-pregnant women. Despite this tight glycaemic control, glycaemic variability is higher during pregnancy.

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Plasma endothelin-1 and big endothelin-1 levels in women with pre-eclampsia

Acta Endocrinologica ◽

10.1530/acta.0.1290114 ◽

1993 ◽

Vol 129 (2) ◽

pp. 114-120 ◽

Cited By ~ 31

Author(s):

Norihito Sudo ◽

Kyuzi Kamoi ◽

Miyuki Ishibashi ◽

Tohru Yamaji

Keyword(s):

Pregnant Women ◽

Vascular Endothelial Cells ◽

Plasma Concentrations ◽

Regulatory System ◽

Normal Pregnancy ◽

Molar Ratio ◽

Chronic Hypertension ◽

Third Trimester ◽

Endothelin 1 ◽

The Third

To examine a possible role for endothelin-1 (ET-1) and conversion of big ET-1 to ET-1 in the pathophysiology of pre-eclampsia, we measured plasma levels of ET-1 and big ET-1 in 16 women with pre-eclampsia in the third trimester and compared them with those in 11 age-matched normotensive pregnant women and in 10 age-matched pregnant women with chronic hypertension in the third trimester. The plasma concentrations of ET-1 and big ET-1 in the normotensive pregnant women were significantly lower than those in 16 non-pregnant women with a higher molar ratio of big ET-1 to ET-1 in the former group. The plasma concentrations of ET-1 and big ET-1 in the women with pre-eclampsia, on the other hand, were significantly higher than those in the normotensive pregnant women and the molar ratio of big ET-1 to ET-1 in the former group was less than that in the latter group. In sharp contrast, plasma ET-1 and big ET-1 levels in the pregnant women with chronic hypertension were not significantly different from those in the normotensive pregnant women. When examined after delivery, elevated plasma ET-1 and big ET-1 in the women with pre-eclampsia declined, with restoration of normal blood pressure, to the levels in the normotensive women after parturition. There were no significant differences of the levels of ET-1 and big ET-1 in umbilical venous plasma and simultaneously drawn maternal plasma at cesarean section between normotensive pregnant women and women with pre-eclampsia, respectively. These results suggest that normal pregnancy is associated with decreased plasma concentrations of ET-1 with reduced conversion of big ET-1 to ET-1 in maternal vascular endothelial cells, and the derangement of this regulatory system plays an important role in the pathophysiology of pre-eclampsia.

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Midwifery Care with Frequent Urination on Pregnant Women at BPM Nuril Masrukah Candi Sidoarjo

Academia Open ◽

10.21070/acopen.5.2021.1908 ◽

2021 ◽

Vol 5 ◽

Author(s):

Okky Elvira Novianti ◽

Evi Rinata ◽

Rafhani Rosyidah

Keyword(s):

Data Collection ◽

Pregnant Women ◽

Continuity Of Care ◽

Normal Pregnancy ◽

Case Study Method ◽

Third Trimester ◽

Midwifery Care ◽

Psychological Condition ◽

The Third

Pregnancy is the fertilization or fusion of spermatozoa and ovum which is followed by bullying. Normal pregnancy lasts in 9 to 10 months. Complaints and discomfort can arise from the beginning of pregnancy to the end of pregnancy which can affect the physical and psychological condition of the mother. Pregnant women often complain in the third trimester and 96.7% experience complaints of frequent urination. The case study method used is observational (COC) Continuity of Care. From data collection and inspection there were no gaps and problem found, so no further special handling was needed.

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Severe Reduction of Free ADAMTS13, Unbound to Von Willebrand Factor, in Plasma Milieu Is a Unique Feature of HELLP Syndrome

Blood ◽

10.1182/blood.v128.22.134.134 ◽

2016 ◽

Vol 128 (22) ◽

pp. 134-134

Author(s):

Yoko Yoshida ◽

Ayami Isonishi ◽

Toshiyuki Sado ◽

Masaki Hayakawa ◽

Hideo Yagi ◽

...

Keyword(s):

Shear Stress ◽

Pregnant Women ◽

Hellp Syndrome ◽

First Trimester ◽

Normal Pregnancy ◽

High Shear ◽

High Shear Stress ◽

Third Trimester ◽

Severe Reduction ◽

Mild Reduction

Abstract Introduction Plasma ADAMTS13 exists at least two forms, bound and unbound to vonWillebrandfactor (VWF), of which the former was assumed to be 3% of the total by the immunoprecipitation method (Feyset al., JTH 2009). We have shown that plasma ADAMTS13 consists of 3 group bands, by means of isoelectric focusing (IEF) analysis (Hori et al, Transfusion 2013). Band I (pI4.9-5.6) was assumed to be free ADAMTS13, unbound to VWF, and Band III (pI7.0-7.5) was a complex with high-molecular-weight VWFmultimers(HMW-VWFM). However, the feature of Band II (pI5.8-6.7) was undetermined. HELLP (hemolysis, elevated liver enzymes and low platelet counts) syndrome is a life-threatening thromboembolic complication during pregnancy, and its pathogenesis is not determined. The curative therapy of HELLP syndrome is a termination of pregnancy. It was reported that plasma VWF antigen (VWF: Ag) was remarkably increased (215-422% of the normal) with a mild reduction of ADAMTS13 activity (ADAMTS13: AC) (12-43 % of the normal), but without qualitative analysis of ADAMTS13 antigen (Lattuadaet al.,Haematologica2003). We here analyzed plasma ADAMTS13 antigen in 9 patients with HELLP syndrome using the IEF gel, and revealed a unique picture of severe reduction of Band I (free ADAMTS13), unbound to VWF, that was not seen in plasmas from normal pregnancy. Patients and Methods One hundred twenty-nine normal pregnant women and 9 patients with HELLP syndrome were analyzed under approval by the ethics committees of Nara Medical University. All individuals gave written informed consent to the study. Diagnosis of HELLP syndrome was made by all the following laboratory abnormalities: characteristics peripheral blood smear, serum LDH >600 IU/L (or total bilirubin >1.2 mg/dL), AST >70 IU/L, and platelet counts < 100,000/mm3 (Sibai et al., Am JObstetGynecol 1993). Plasma level of ADAMTS13: AC was determined by chromogenic ADAMTS13-act-ELISA, and VWF: Ag was measured by a sandwich ELISA using a rabbit polyclonal anti-human VWF antibody. As reported previously (Hori et al., Transfusion 2013), the IEF was performed using a large-pore agarose-acrylamide composing gel followed by detection with anti-ADAMTS13 monoclonal antibody. Results In normal women, plasma levels of VWF: Agweremarkedly increased during pregnancy, and the values of third trimester (median 223%) were almost two times higher than those of first trimester (119%). Contrarily,plasma levels ofADAMTS13: AC were significantly decreased in second (68.4%) and third (66.2%) trimester compared with first trimester (84.3%, p<0.01 and p<0.001, respectively). Of note, a reduction in ADAMTS13: AC was significantly prolonged in postpartum period (50.2%, p<0.001), while increased VWF: Ag was rapidly recovered after delivery. Further, the IEF analysis of normal pregnant women showed that Band I was slightly decreased in accord with progression of pregnancy. In puerperium, there was no difference in ADAMTS13: AC between normal pregnant women and patients with HELLP syndrome. However, the values of VWF: Ag of patients with HELLP syndrome (352%) were significantly higher than those of normal pregnant women (178%, p<0.001), in agreement with a previous report. Interestingly, however, here we have shown that 7 out of 9 patients with HELLP syndrome showed severe reduction of Band I in puerperium period by the IEF analysis of ADAMTS13 (Figure). Discussion In normal pregnant women, the decreased ADAMTS13:AC was assumed to reflect a consumption of the enzyme for cleavage of increased VWF. Interestingly, both Band II and III were almost unchanged during normal pregnancy, but Band I slightly decreased in third trimester, concomitantly with a mild reduction of ADAMTS13:AC. In contrast, Band I was severely reduced during the acute phase of HELLP syndrome in 7 out of 9 patients. Our previous report indicated that under high-shear-stress Band I inhibited the VWF-dependent platelet aggregation in a dose-response manner from the initial phase, whereas Band III (+II) worked from the later phase. This result indicates that ADAMTS13 lacking Band I neither readily binds to VWF nor efficiently blocks the heightened high-shear-stress induced platelet aggregation generated by newly produced HMW-VWFM. Our data suggest that ADAMTS13 preparation might be used as a therapeutic option for the treatment of HELLP syndrome, before termination of pregnancy. Disclosures No relevant conflicts of interest to declare.

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