Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women

Montelongo, Adela; Lasuncion, M. A.; Pallardo, L. F.; Herrera, Emilio

doi:10.2337/diabetes.41.12.1651

Cited by 58 publications

(27 citation statements)

References 29 publications

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“…In keeping with other reports, total cholesterol and LDL cholesterol levels were similar among the three groups (26). Moreover, there was no relationship between these lipids and the percentage increase in flow-mediated vasodilatation.…”

Section: Conclusion -supporting

confidence: 90%

“…Therefore, it is highly unlikely that these lipid parameters could account for the differences in endothelial function observed between our study groups. As previously reported, NEFA levels were higher in both groups of pregnancies complicated by carbohydrate abnormality than in control subjects (26). In addition, NEFA values did correlate with FMD.…”

Section: Conclusion -supporting

confidence: 84%

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Abnormal Carbohydrate Metabolism During Pregnancy

et al. 2002

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OBJECTIVE -To evaluate whether abnormal endothelial function, a common finding in premenopausal women with type 2 diabetes, is present in early states of diabetes during pregnancy, such as impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -Brachial artery flow-mediated dilatation (FMD) (endothelium-dependent) and nitrate-induced dilatation (NID) (endotheliumindependent) were measured in 23 pregnant subjects with carbohydrate abnormalities (10 IGT, 13 GDM) and in 15 pregnant control subjects during the third trimester of gestation. Highresolution vascular ultrasonography was used to perform these investigations. A fasting lipid panel was obtained, and glucose and insulin values in response to a 100-g oral glucose load were also measured.RESULTS -FMD was significantly reduced in both groups of women with abnormal carbohydrate metabolism compared with control subjects (7.6 Ϯ 1.1% in the IGT group and 4.1 Ϯ 0.9% in the GDM group vs. 10.9 Ϯ 1.1% in control subjects, P Ͻ 0.04 and P Ͻ 0.0001, respectively). Significant difference in FMD was also observed between IGT and GDM groups (P Ͻ 0.04). NID was comparable in the three groups. Among all subjects, FMD showed a strong independent negative correlation with glycemic area (r ϭ -0.60, P Ͻ 0.0001).CONCLUSIONS -Endothelial dysfunction, an early marker of macrovascular disease, is present in pregnancies complicated by IGT and GDM. This alteration, which seems to be directly related to glycemic levels, could explain, at least in part, the increased risk for concurrent hypertensive disorders during pregnancy in these women. Diabetes Care 25:560 -564, 2002A bnormal carbohydrate metabolism during pregnancy, such as impaired glucose tolerance (IGT) and gestational diabetes (GDM), is a relatively frequent disease affecting ϳ2-5% of all pregnancies (1). In common with other maternal disorders associated with macrovascular dysfunction, abnormal carbohydrate metabolism is associated with augmented maternal and fetal-neonatal morbidity (1,2). It has been shown that women with GDM have an increased incidence of preeclampsia (3). Furthermore, these patients are more prone to development of type 2 diabetes, a known condition that leads to an increased risk for cardiovascular disease (1), later in life. Recently, several lines of evidence seem to indicate that vascular endothelial dysfunction has a role in the etiopathogenesis of vascular abnormality associated with preeclampsia and with type 2 diabetes (4 -6). In addition, impaired endothelium-dependent vasodilation has been shown in euglycemic women with a history of GDM, thus supporting the assumption that glucose metabolism derangement is closely related to vascular dysfunction (7). On the basis of these findings, it could be argued that impaired endothelial function may be a factor occurring in pregnant women with abnormal carbohydrate metabolism. To verify this hypothesis, we evaluated endothelial function, along with carbohydrate and lipid metabolism, in women with impaired gluco...

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Section: Conclusion -supporting

confidence: 90%

Section: Conclusion -supporting

confidence: 84%

Abnormal Carbohydrate Metabolism During Pregnancy

et al. 2002

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“…Similarly, maternal cholesterol has been reported as increased (17) or unchanged (14,18,19) across gestation. Studies in women with GDM have shown no difference (18) or a decline in LDL-C concentration (20) but with increased levels of small, dense LDL (18,20) and increased LDL oxidation (17).…”

Section: Gdmmentioning

confidence: 94%

“…Studies have shown higher free fatty acid levels compared with normal pregnancy (14) and higher triglyceride and lower HDL-C levels in the first trimester when compared with women with type 1 diabetes in pregnancy (15), or no difference in any lipoprotein compared with either type 1 diabetes or GDM (16). However, ,80 women with type 2 diabetes were included in these reports.…”

Section: Preexisting Type 2 Diabetesmentioning

confidence: 95%

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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“…Plasma levels of triglycerides, cholesterol and free fatty acids rise, and there is a greater tendency to ketosis (Campbell & Lees, 2000). Some studies showed that total triglycerides increase with gestational time in pre-gestational diabetic women, GDM women and healthy control women (Montelongo et al, 1992). Every aspect of lipid metabolism is affected by pregnancy.…”

Section: Discussionmentioning

confidence: 99%