Preeclampsia: A risk factor for gestational diabetes mellitus in subsequent pregnancy

Lee, Joohyun; Ouh, Yung Taek; Ahn, Ki Hoon; Hong, Soon Cheol; Oh, Min Jeong; Kim, Hai Joong; Cho, Geum Joon

doi:10.1371/journal.pone.0178150

Cited by 44 publications

(31 citation statements)

References 41 publications

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“…Gestational diabetes is also significantly associated with preeclampsia (p-value = 0.013, confirming previous reports that gestational diabetes is a risk factor of preeclampsia (Schneider et al 2012; J. Lee et al 2017). In addition, parity is also associated with the preeclampsia group (p-value = 0.017), significantly more samples have a larger parity, as expected.…”

Section: Resultssupporting

confidence: 88%

Maternal blood lipidomics analyses link critical metabolic pathways associated with severe preeclampsia

Liu

Maurya

et al. 2020

Preprint

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Preeclampsia is a pregnancy specific syndrome characterized by hypertension and proteinuria after 20 weeks of gestation. To reveal the relationship between lipids and preeclampsia, we conduct lipidomic profiling of maternal serums of 44 severe preeclamptic and 20 healthy pregnancies from a multi-ethnic cohort in Hawaii. Correlation network analysis shows that oxidized phospholipids (OxPLs) have increased inter-correlations and connections in preeclampsia, while other lipids, including triacylglycerols (TAGs), have reduced network correlations and connections. Thirty-one lipid species from various lipid classes demonstrate predominantly reductions and causal relationships with preeclampsia. They include phosphatidylglycerol (PG), TAG, diacylglycerol (DAG), phosphatidylcholine (PC), cholesterol esters (CE), phosphatidylethanolamine (PE), sphingomyelin (SM), ceramides (Cer-NS), hexosyl ceramides (HexCer-NS), lysophosphatidylcholine (LPC), lysophosphatidylethanolamine (LPE), and free fatty acid (FFA). Many of these lipids are also selected as important features by a linear discriminant analysis (LDA) classifier with high predictive accuracy (F-1 statistic 0.941 and balanced accuracy 0.88), indicating their potential to serve as biomarkers for severe preeclampsia. Our study supports the hypothesis of a phospholipid (PL) centered, dysregulated lipidomic metabolic atlas. That is, severe preeclampsia may be originated from hypoxia, which induces the accumulation of OxPLs through oxidative stress whereas reduces many other lipids (eg. reduced PCs, TAGs and ceramides). These molecular changes coherently lead to dysregulated biological functions, such as insulin signaling and inflammation/infections. Moreover, the lipid changes may also be responsible for the comorbidity between preeclampsia and gestational diabetes, a clinically known risk factor for preeclampsia.

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Section: Resultssupporting

confidence: 88%

Maternal blood lipidomics analyses link critical metabolic pathways associated with severe preeclampsia

Liu

Maurya

et al. 2020

Preprint

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“…However, both complications have established risk factors which can be identified pre-pregnancy or early in pregnancy and efforts to promote early screening and risk-reduction strategies may significantly improve health outcomes. Some risk factors common to both conditions include maternal obesity, pregestational diabetes, maternal age, previous PE and/or GDM diagnosis, and familial history ( 9 , 20 – 23 ). Due to the increase in obesity levels and Western dietary practices, GDM diagnoses have dramatically increased over the past decade ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of Endothelial Dysfunction in Pre-eclampsia and Gestational Diabetes Mellitus: Windows Into Future Cardiometabolic Health?

et al. 2020

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Placental insufficiency and adipose tissue dysregulation are postulated to play key roles in the pathophysiology of both pre-eclampsia (PE) and gestational diabetes mellitus (GDM). A dysfunctional release of deleterious signaling motifs can offset an increase in circulating oxidative stressors, pro-inflammatory factors and various cytokines. It has been previously postulated that endothelial dysfunction, instigated by signaling from endocrine organs such as the placenta and adipose tissue, may be a key mediator of the vasculopathy that is evident in both adverse obstetric complications. These signaling pathways also have significant effects on long term maternal cardiometabolic health outcomes, specifically cardiovascular disease, hypertension, and type II diabetes. Recent studies have noted that both PE and GDM are strongly associated with lower maternal flow-mediated dilation, however the exact pathways which link endothelial dysfunction to clinical outcomes in these complications remains in question. The current diagnostic regimen for both PE and GDM lacks specificity and consistency in relation to clinical guidelines. Furthermore, current therapeutic options rely largely on clinical symptom control such as antihypertensives and insulin therapy, rather than that of early intervention or prophylaxis. A better understanding of the pathogenic origin of these obstetric complications will allow for more targeted therapeutic interventions. In this review we will explore the complex signaling relationship between the placenta and adipose tissue in PE and GDM and investigate how these intricate pathways affect maternal endothelial function and, hence, play a role in acute pathophysiology and the development of future chronic maternal health outcomes.

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“…This is especially important given that preeclampsia is associated with long-term adverse maternal health including cardiovascular disease 10,11 and potentially increased risk of gestational diabetes in future pregnancies. 12 The real-world, practical application of these guidelines with respect of large-scale maternal morbidity and neonatal benefit has yet to be evaluated outside of small clinical trials. In 2015, the University of Alabama at Birmingham, a tertiary care institution with high rates of preeclampsia (16-20%), widely adopted this change toward expectant management of severe preeclampsia.…”

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confidence: 99%

Outcomes before and after Adopting Guidelines for Expectant Management of Severe Preeclampsia

et al. 2020

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Objective This study aimed to compare maternal and neonatal outcomes in women with severe preeclampsia before and after implementation of the American College of Obstetricians and Gynecologists (ACOG) taskforce hypertensive guidelines. Study Design Single-center retrospective cohort study of women with severe preeclampsia delivering live nonanomalous singletons 23 to 342/7 weeks from 2013 to 2017. In 2015, the ACOG guidelines for expectant management of severe preeclampsia were implemented at our institution. Based on this, patients were categorized as preguideline (January 2013–December 2015) or postguideline adoption (January 2016–December 2017). Primary outcomes included composite maternal morbidity and composite neonatal morbidity; secondary outcomes included composite components, length of stay, birth weight, and delivery gestational age. Groups were compared with Student's t-test, Chi-square, and Wilcoxon's rank-sum tests; adjusted odds ratios (aOR; 95% confidence intervals [CIs]) were calculated. Yearly composite outcomes were compared using the Cochran–Armitage trend test. We estimated a sample size of 250 per group would provide 80% power at α = 0.05 to detect a 50% reduction in neonatal morbidity from a baseline rate of 21.5%. Results From 2013 to 2017, a total of 543 women with severe preeclampsia were identified: 278 (51%) preguideline and 265 (49%) postguideline. Baseline characteristics were overall similar between groups. There were no significant differences in maternal (aOR = 0.96, 95% CI: 0.6–1.41) or neonatal (aOR = 0.88, 95% CI: 0.61–1.28) composite morbidity between groups. Furthermore, there were no differences in composite maternal or neonatal morbidity over time. Conclusion Perinatal outcomes were similar before and after implementation of severe preeclampsia management guidelines at our institution. Studies to evaluate if benefits are limited to subsets of this population, such as earlier gestational ages, are needed. Key Points

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Preeclampsia: A risk factor for gestational diabetes mellitus in subsequent pregnancy

Cited by 44 publications

References 41 publications

Maternal blood lipidomics analyses link critical metabolic pathways associated with severe preeclampsia

Maternal blood lipidomics analyses link critical metabolic pathways associated with severe preeclampsia

Mechanisms of Endothelial Dysfunction in Pre-eclampsia and Gestational Diabetes Mellitus: Windows Into Future Cardiometabolic Health?

Outcomes before and after Adopting Guidelines for Expectant Management of Severe Preeclampsia

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