Autoimmunity in gestational diabetes mellitus in Sardinia: a preliminary case-control report

Murgia, Cinzia; Orrù, Marisa; Portoghese, Elaine; Garau, Nicoletta; Zedda, Pierina; Berria, Rachele; Motzo, Costantino; Sulis, Simonetta; Murenu, Michela; Paoletti, Anna Maria; Melis, Gian Benedetto

doi:10.1186/1477-7827-6-24

Cited by 19 publications

(16 citation statements)

References 31 publications

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“…Women with autoimmune GDM have been earlier shown to have lower BMI, lower waist circumference, less weight gain during pregnancy, and lower fasting insulin levels compared to women with nonautoimmune gestational diabetes. [ 21 22 ] These parameters might help to identify a subset of women with GDM who are likely to progress to T1DM postpartum; however, these findings need to be evaluated by larger prospective studies.…”

Section: Discussionmentioning

confidence: 99%

Postpartum development of type 1 diabetes in Asian Indian women with gestational diabetes

Unnikrishnan

Rani

Anjana

et al. 2016

Indian J Endocr Metab

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Aim:To study the postpartum conversion of gestational diabetes mellitus (GDM) to different types of diabetes among Asian Indian women.Materials and Methods:Using data from electronic medical records, 418 women with GDM seen at a tertiary diabetes care center for diabetes in Chennai in South India between 1991 and 2014 were evaluated for development of diabetes postpartum.Results:Of the 418 GDM women followed up postpartum, 388 progressed to diabetes. Of these 359 (92.5%) developed type 2 diabetes (T2DM) and 29 women (7.5%) developed type 1 diabetes (T1DM). The median time to development of T1DM was 2 years (interquartile range 2 [IQR]) while for T2DM it was 5 years (IQR 6). Women who developed T1DM had significantly lower mean body mass index (BMI) (20.4 ± 2.8 vs. 27.5 ± 4.4 kg/m2, P = 0.001), and higher fasting plasma glucose (222 ± 105 vs. 165 ± 62 mg/dl P = 0.008) and glycated hemoglobin levels (10.2 ± 2.7 vs. 8.5 ± 2.1% P < 0.001) compared to those who developed T2DM. Glutamic acid decarboxylase (GAD) autoantibodies were present in 24/29 (82.7%) of women who developed T1DM.Conclusion:A small but significant proportion of women with GDM progress to T1DM postpartum. Measurement of GAD antibodies in leaner women with more severe diabetes could help to identify women who are likely to develop T1DM and thus prevent their presentation with acute hyperglycemic emergencies after delivery.

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Section: Discussionmentioning

confidence: 99%

Postpartum development of type 1 diabetes in Asian Indian women with gestational diabetes

Unnikrishnan

Rani

Anjana

et al. 2016

Indian J Endocr Metab

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“…About 10% of all GDM women develop T2D after delivery. Though pancreatic autoimmunity does not seem to represent a typical marker of GDM [ 21 ], high prevalence of autoantibodies, such as anti-GAD65 and anti-IA2 antibodies, has been observed in GDM subjects [ 22 ]. Maternal transmission of these autoantibodies did not affect diabetic risk in the offspring.…”

Section: Cell-mediated Immunity In Diabetic Pregnancy and Macrosommentioning

confidence: 99%

Role of T-Cell Polarization and Inflammation and Their Modulation by n-3 Fatty Acids in Gestational Diabetes and Macrosomia

Hichami

Grissa

Mrizak

et al. 2016

Journal of Nutrition and Metabolism

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Th (T helper) cells are differentiated into either Th1 or Th2 phenotype. It is generally considered that Th1 phenotype is proinflammatory, whereas Th2 phenotype exerts anti-inflammatory or protective effects. Gestational diabetes mellitus (GDM) has been associated with a decreased Th1 phenotype, whereas macrosomia is marked with high expression of Th1 cytokines. Besides, these two pathological situations are marked with high concentrations of inflammatory mediators like tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), known to play a pivotal role in insulin resistance. Dietary n-3 polyunsaturated fatty acids (n-3 PUFAs) may exert a beneficial effect by shifting Th1/Th2 balance to a Th2 phenotype and increasing insulin sensitivity. In this paper, we shed light on the role of T-cell malfunction that leads to an inflammatory and pathophysiological state, related to insulin resistance in GDM and macrosomia. We will also discuss the nutritional management of these pathologies by dietary n-3 polyunsaturated fatty acids (PUFAs).

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“…The prevalence of autoantibodies in GDM has been assessed in several small studies. The prevalence of glutamic acid decarboxylase (GAD) varies from 0-11 %, tyrosine-phosphatase-like islet antigen (IA-2) from 0-6 %, islet cell antibodies (ICA) from 1-15 %, and anti-insulin autoantibodies (IAA) from 0-6 % [41][42][43][44]. Antibodies to a zinc transporter (ZnT8) have not yet been reported in GDM.…”

Section: Islet Autoimmunity In Gdm: Prevalence Trajectory and Clinicmentioning

confidence: 99%

“…With regard to future diabetes risk, the presence and number of positive diabetes-related autoantibodies in GDM have been associated with an increased risk of type *Different to Anglo-Celtiĉ Large for gestational age 1 diabetes in populations with a high background risk, such as Finland and Sardinia [43,49]. A study of 385 Swedish women with GDM found that 24 women (6 %) had one antibody positive [42].…”

Section: Islet Autoimmunity In Gdm: Prevalence Trajectory and Clinicmentioning

confidence: 99%

Gestational Diabetes: Seeing Both the Forest and the Trees

Rudland

Wong

Yue

et al. 2012

Curr Obstet Gynecol Rep

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Gestational diabetes is a heterogeneous disorder. Various metabolic etiologies underpin the diagnosis and influence perinatal outcomes as well as an individual's propensity for the subsequent development of diabetes. Recent landmark studies have driven a review of the diagnostic criteria for gestational diabetes, with an emergent category, "overt diabetes during pregnancy," recognizing the increased surveillance required for some women. As we strive for consensus in diagnosis at a global level, consideration for its application to local populations, with different ethnicities, genetics, and immunological make-up, is essential to optimize obstetric care and neonatal outcomes. An individualized approach must remain the mainstay of management.

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Autoimmunity in gestational diabetes mellitus in Sardinia: a preliminary case-control report

Abstract: These results are in contrast with the very low prevalence of all antibodies reported in Italy. If confirmed, they could indicate that a large proportion of GDM patients in Sardinia have an autoimmune origin, in accordance with the high prevalence of Type 1 diabetes.

Cited by 19 publications

References 31 publications

Postpartum development of type 1 diabetes in Asian Indian women with gestational diabetes

Postpartum development of type 1 diabetes in Asian Indian women with gestational diabetes

Role of T-Cell Polarization and Inflammation and Their Modulation by n-3 Fatty Acids in Gestational Diabetes and Macrosomia

Gestational Diabetes: Seeing Both the Forest and the Trees

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