Trace elements as predictors of preeclampsia in type 1 diabetic pregnancy

Abstract

Preeclampsia (PE) affects approximately 5% of all pregnancies, but is increased several-fold in women with pre-gestational type 1 diabetes mellitus (T1DM). Increased oxidative stress and altered maternal plasma trace elements that modulate the antioxidant system have been implicated in PE. In non-diabetic women, increased plasma copper and iron, and decreased manganese, selenium, and zinc have been associated with PE in cross-sectional studies. In a longitudinal study, we hypothesized that plasma levels of trace elements differ between T1DM women with vs. without subsequent PE. Samples were collected during the first (gestation 12.2 ± 1.9 weeks, (mean ± SD)), second (21.6 ± 1.5 weeks), and third (31.5 ± 1.7 weeks) trimesters of pregnancy, all before the onset of PE. We compared 23 T1DM women who subsequently developed PE with 24 T1DM women who remained normotensive; and we included 19 non-diabetic (non-DM) normotensive pregnant women as reference controls. Trace elements were measured using inductively coupled plasma mass spectroscopy (ICP-MS). In T1DM women with subsequent PE vs. normotensive, only plasma zinc was significantly higher at the first trimester, while copper:zinc and copper:HDL-cholesterol ratios were higher throughout gestation (all p<0.05). These findings persisted after adjustment for covariates. Higher copper:zinc ratios may contribute to oxidative stress in T1DM women who develop PE. Ratio of pro-to anti-oxidant factors may predict risk for PE in diabetic pregnancies more effectively than individual trace element levels.

First Trimester Microelements and Their Relationships with Pregnancy Outcomes and Complications

“…Among prospective studies, the development of preeclampsia was associated with lower Se levels in a study by Ghaemi et al [22] and Rayman et al [22,23]. The prospective role of lower Cu levels in predicting preeclampsia were found by Basu et al and Ugwuja et al [27,34]. In the very small pilot prospective study, Tande et al found statistically lower maternal first trimester serum iron (Fe) levels in the women who subsequently developed gestational hypertension, compared to controls [35].…”

“…In the literature, links between lower concentrations of selenium in early pregnancy, and a higher risk of preeclampsia [22,23], preterm birth [5], or birth to infants <10th percentile [24][25][26] have been also found. However, the results of other prospective studies are divergent and the research methodologies differ [1,24,27], e.g., Basu et al examined serum microelements in a small cohort of 151 pregnant women with preexisting diabetes mellitus, including 23 cases of preeclampsia [27]; and Mistry et al examined a group of 126 adolescents, including 19 women giving birth to infants <10th percentile [24]. However, only one pregnancy complication has been evaluated in these studies.…”

A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy

“…In particular, dietary management before and during pregnancy should be offered to overweight and underweight patients, and all patients should be timely screened for vitamin deficits, in particular on the vitamin D axis, potentially related to PE incidence [83][84][85][86][87][88][89].…”

Circulating adipokines are associated with pre-eclampsia in women with type 1 diabetes

“…Using samples from a prospective study of pregnancy in women with type 1 diabetes [36,37], we measured these adipokines (and ratios of those mediating insulin resistance vs sensitivity) in the first, second and early third trimesters, comparing women who did with those who did not develop pre-eclampsia (primary analysis). We also included a group of normotensive, non-diabetic women to provide reference values, and compared normotensive women with and without type 1 diabetes (secondary analysis).…”