Factors predisposing to pre-eclampsia in women with gestational diabetes

Barden, Anne; Singh, Ravinder; Walters, Barry N J; Ritchie, Jackie; Roberman, Brian; Beilin, Lawrence J.

doi:10.1097/00004872-200412000-00020

Cited by 67 publications

(96 citation statements)

References 34 publications

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“…In women with type 1 diabetes, early pregnancy LDL-C was elevated in those who later developed preeclampsia (13). Conversely, in 184 women with GDM, maternal plasma cholesterol, LDL-C, HDL-C, and triglycerides did not differ in those who went on to develop preeclampsia (26). There are no studies examining the relationship between lipids and preeclampsia in women with type 2 diabetes.…”

Section: Maternal Obesitymentioning

confidence: 98%

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

et al. 2014

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Outcomes in pregnancies complicated by preexisting diabetes (type 1 and type 2) and gestational diabetes mellitus have improved, but there is still excess morbidity compared with normal pregnancy. Management strategies appropriately focus on maternal glycemia, which demonstrably improves pregnancy outcomes for mother and infant. However, we may be reaching the boundaries of obtainable glycemic control for many women. It has been acknowledged that maternal lipids are important in pregnancies complicated by diabetes. Elevated maternal lipids are associated with preeclampsia, preterm delivery, and large-forgestational-age infants. Despite this understanding, assessment of management strategies targeting maternal lipids has been neglected to date. Consideration needs to be given to whether normalizing maternal lipids would further improve pregnancy outcomes. This review examines the dyslipidemia associated with pregnancy complicated by diabetes, reviews possible therapies, and considers whether it is time to start actively managing this aspect of maternal metabolism.Although rates of adverse outcomes in pregnancies complicated by preexisting diabetes (type 1 and type 2) and gestational diabetes mellitus (GDM) have improved, there is still excess maternal and fetal morbidity compared with normal pregnancy. Current management strategies focus on maternal glycemic control, which demonstrably improves pregnancy outcomes for mother and infant. Truly "normal" glucose levels in pregnancy appear lower than previously thought (1) and achieving currently recommended glucose targets in pregnancy carries a risk of hypoglycemia (2). The challenges in reaching glycemic targets before and after conception raise the question of whether other aspects of maternal metabolism could potentially be addressed to provide benefit to mother and infant.Multiple maternal metabolic, hormonal, and inflammatory factors other than maternal glucose are associated with maternal and fetal outcomes and are altered in pregnancies complicated by prepregnancy diabetes and GDM. These include maternal amino acids, glycerol, ketones, and lipids (3). Lipid management in diabetes is acknowledged as a key therapeutic target in the nonpregnant setting. However, it has not been accorded the same attention in pregnancy. Abnormal maternal lipids in pregnancy have been associated with preeclampsia (4,5), preterm delivery (6), and large-forgestational-age (LGA) infants (7). This review examines the dyslipidemia associated with pregnancy complicated by diabetes, reviews possible therapies, and considers whether there is sufficient evidence to start actively managing lipids in pregnancy. LIPID METABOLISM IN PREGNANCYMaternal metabolism is designed to provide adequate nutrition for fetal growth, in the form of glucose, ketones, lipids, and other fuels. In early pregnancy, maternal

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Section: Maternal Obesitymentioning

confidence: 98%

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

et al. 2014

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“…Both pre-gestational diabetes and gestational diabetes mellitus (GDM) are associated with a two to fourfold increased risk of developing preeclampsia in pregnancy (113)(114)(115), named superimposed preeclampsia. In this context, this includes women with diabetes mellitus (pre-existing or gestationally induced) with development of preeclampsia in the present pregnancy.…”

Section: Diabetes Mellitus and Superimposed Preeclampsiamentioning

confidence: 99%

The decidual suction method: a new way of collecting decidual tissue for functional and morphological studies

Harsem¹,

Staff²,

et al. 2004

Acta Obstet Gynecol Scand

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Background. Studies of extravillous trophoblasts and placental bed spiral arteries are essential for a better understanding of pathological pregnancies such as preeclampsia, intrauterine growth restriction and diabetes mellitus. A major challenge is to obtain representative and sufficient tissue for morphological and functional investigations. Currently, tissue material is mostly harvested by placental bed biopsy (PBB). We describe a new suction method to obtain a larger volume of decidual tissue from the placental bed. Methods. Tissue was harvested in 51 cesarean sections by vacuum suction of the placental bed. Sections from formalin‐fixed, paraffin‐embedded tissue were routinely stained with hematoxylin and eosin (H&E), immunostained with a panel of antibodies and morphologically examined for the presence of trophoblasts and spiral arteries. The results were compared with those from archive material from PBBs and placental basal plate sections (BPSs). Short‐term adverse events were registered for the study patients. Long‐term complications were registered from medical charts of 151 women having undergone the decidual suction method (DSM), with a follow‐up of 38–60 months. Results. In 86% (n = 44), one random section from the decidual suction material demonstrated at least one spiral artery. In 37% (n = 19), six or more spiral arteries were present. All sections revealed extravillous trophoblasts. No short‐ or long‐term morbidity was recorded. Conclusions. The decidual suction method represents an important improvement in the work to obtain sufficient decidual tissue for morphological and functional studies of extravillous trophoblast function and spiral artery adaptation. The method is safe, as no short‐ or long‐term complications were registered.

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“…The positive association of maternal triglycerides and PE we found in our analyses is in keeping with these studies. This finding is not universal, with one study examining 184 women with GDM, and using metabolic measures taken at ~28 weeks gestation and prior to therapy for GDM, found no difference in maternal lipids (including triglycerides and HDL-C) and no association with the development of PE [30]. The negative association of HDL-C and PE we demonstrate has been reported previously [25,26], but the size of the effect does need to be interpreted with some caution since fewer women in our study had HDL-C measured.…”

Section: Discussionmentioning

confidence: 99%