Gestational Diabetes Mellitus Treatment Schemes Modify Maternal Plasma Cholesterol Levels Dependent to Women´s Weight: Possible Impact on Feto-Placental Vascular Function

Abstract

Gestational diabetes mellitus (GDM) associates with fetal endothelial dysfunction (ED), which occurs independently of adequate glycemic control. Scarce information exists about the impact of different GDM therapeutic schemes on maternal dyslipidemia and obesity and their contribution to the development of fetal-ED. The aim of this study was to evaluate the effect of GDM-treatments on lipid levels in nonobese (N) and obese (O) pregnant women and the effect of maternal cholesterol levels in GDM-associated ED in the umbilical vein (UV). O-GDM women treated with diet showed decreased total cholesterol (TC) and low-density lipoproteins (LDL) levels with respect to N-GDM ones. Moreover, O-GDM women treated with diet in addition to insulin showed higher TC and LDL levels than N-GDM women. The maximum relaxation to calcitonin gene-related peptide of the UV rings was lower in the N-GDM group compared to the N one, and increased maternal levels of TC were associated with even lower dilation in the N-GDM group. We conclude that GDM-treatments modulate the TC and LDL levels depending on maternal weight. Additionally, increased TC levels worsen the GDM-associated ED of UV rings. This study suggests that it could be relevant to consider a specific GDM-treatment according to weight in order to prevent fetal-ED, as well as to consider the possible effects of maternal lipids during pregnancy.

The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go?

“…Specific to pregnancy, there is concern that higher dietary fat intake could increase maternal TG and FFA, potentially increasing fetal exposure to maternal lipids secondary to heightened maternal insulin resistance, leading to overgrowth [ 57 ]. Fetal exposure to increased maternal lipids, particularly through high fat diets, has been linked with developmental programming of offspring obesity and fatty liver in animal models and in human cohorts [ 44 , 57 , 58 , 59 , 60 , 61 ].…”

Longitudinal Metabolic Profiling of Maternal Obesity, Gestational Diabetes, and Hypertensive Pregnancy Disorders

“…Also, reduced activity of lipoprotein lipase results in higher levels of circulating VLDL lipoproteins and triglycerides ( 37 ). Excess VLDL may provoke endothelial and placental dysfunction, which have been suggested to explain the associations between maternal hyperlipidemia, obesity, PE, and GDM ( 38 ). The high MUFA levels in obesity and pregnancy disorders are probably a consequence of increased lipolysis, lack of fatty acid oxidation, and increased de novo lipogenesis ( 39 ).…”

C1q/TNF-Related Protein-3 (CTRP-3) and Pigment Epithelium-Derived Factor (PEDF) Concentrations in Patients with Gestational Diabetes Mellitus: A Case-Control Study

“…The prevalence ranges from less than 2% in Sweden to 20.6% in United Arab Emirates [30]. GDM is a worldwide metabolic disorder that has negative maternal and neonatal effects with long-term consequences [31,32]. It is associated with adverse maternal health outcomes such as gestational hypertension, pre-eclampsia, caesarean section, and neonatal outcomes including hyperinsulinemia, macrosomia (usually defined as a neonate weighing over 4 kg), shoulder dystocia, and hypoglycemia.…”