Changes in plasma lipids and increased low-density lipoprotein susceptibility to oxidation in pregnancies complicated by gestational diabetes: consequences of obesity

Sánchez-Vera, Isabel; Bonet, Bartolomé; Viana, Marta; Quintanar, Amalia; Martín, María Nieves Cabrera; Blanco, Pilar; Donnay, Sergio; Albi, Manuel

doi:10.1016/j.metabol.2007.06.020

Cited by 99 publications

(87 citation statements)

References 33 publications

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“…These results contrast previous reports of accentuated dyslipidemia in women with GDM [25]. The only plausible explanation for this disparity could be the good glycemic control of diabetes in our study population.…”

Section: Discussioncontrasting

confidence: 99%

Effect of Gestational Diabetes on Circulating Levels of Maternal and Neonatal Carnitine

Agakidou¹,

Diamanti²,

Papoulidis³

et al. 2013

J Diabetes Metab

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Objectives: Free carnitine is reported to decrease in normal pregnancies whereas data on the effect of gestational diabetes mellitus (GDM) on maternal and offspring carnitine status are lacking. This study aimed to assess changes in carnitine status in mothers with GDM and the offspring. Subjects/methods:Prospective case-control study of 54 pairs of mothers -neonates (27 with GDM and 27 with normal pregnancies) and 26 non-pregnant controls. Serum glucose, lipids, and total fatty acids, blood β-hydroxybutyric acid, and whole blood carnitine were assessed in mothers before labor and neonates at birth. Carnitine was assessed in dried blood-spots on Guthrie paper using Tandem Mass Spectrometry.Results: Compared to the controls, both groups of mothers had lower free carnitine and acylcarnitine and higher triglyceride and fatty acid levels. Compared to their respective maternal group, both groups of neonates had significantly higher free carnitine and acylcarnitine and lower triglyceride and fatty acid levels. Free carnitine and acylcarnitine, were comparable between the two maternal groups, whereas they were significantly higher in neonates of GDM mothers versus healthy neonates. Conclusions:Well controlled GDM does not exacerbate changes in free carnitine, acylcarnitine, and fatty acid levels in pregnant women, albeit it is associated with increased carnitine in the newborn indicating enhanced fatty acid oxidation. The potential association of carnitine changes with macrosomia and long-term consequences in the offspring of GDM needs further investigation. increased in neonates born to mothers with uncomplicated pregnancies [6,11], whereas there are no published data on the effect of GDM on the neonatal carnitine levels. The primary aim of this study was to assess the effect of GDM on maternal and offspring's carnitine levels. In addition, we investigated the possible association between circulating carnitine levels and FA changes in the mothers and their neonates. Effect of Gestational Diabetes on Circulating Levels of Maternal and Subjects and MethodsThis is a prospective case-control study. Participants were recruited among pregnant women who attended the antenatal clinic of the 2 nd Department of Obstetrics and Gynecology of the Aristotle University of Thessaloniki, at the Hippokration General Hospital, during a twoyear period. Eligible for the study were all pregnant women with single pregnancies who had an abnormal glucose tolerance test at 26-28 weeks of gestation and no history of pre-gestational diabetes. An

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Section: Discussioncontrasting

confidence: 99%

Effect of Gestational Diabetes on Circulating Levels of Maternal and Neonatal Carnitine

Agakidou¹,

Diamanti²,

Papoulidis³

et al. 2013

J Diabetes Metab

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“…In women with GDM, maternal triglycerides have been reported to be increased in all trimesters of pregnancy (17), although this is not a universal finding. Similarly, maternal cholesterol has been reported as increased (17) or unchanged (14,18,19) across gestation.…”

Section: Gdmmentioning

confidence: 94%

“…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: 95%

“…Disentangling the effect of maternal obesity per se from that of maternal diabetes on maternal metabolism and pregnancy outcomes in the women with obesity and diabetes in pregnancy is almost impossible without very large cohorts with refined metabolic measures. In observational studies and larger population cohort studies in normal pregnancy, increasing maternal triglycerides in early pregnancy have been associated with increased rates of preeclampsia (4,5), future diagnosis of GDM (17,23), induced preterm delivery (5), and LGA infants (5). Low maternal HDL-C in early pregnancy has also been associated with increased risk of later GDM (23), and elevated HDL-C has been associated with lower rates of preterm birth (24).…”

Section: Maternal Obesitymentioning

confidence: 99%

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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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“…tocopherol (vitamin E), ascorbate (vitamin C), and carotenoids (vitamin A), in GDM are both contradictory and confusing [44,50,54,55,[63][64][65][66][67][68][69].…”

Section: Endogenous Antioxidantsmentioning

confidence: 99%