Plasma Lipoproteins and Preeclampsia in Women with Type 1 Diabetes: A Prospective Study

Basu, Arpita; Alaupovic, Petar; Wu, Mingyuan; Jenkins, Alicia J.; Yu, Yongxin; Nankervis, Alison; Hanssen, Kristian F.; Scholz, Hanne; Henriksen, Tore; Lorentzen, Bjørg; Clausen, Torun; Garg, Satish K.; Menard, M. Kathryn; Hammad, Samar M.; Scardo, James A.; Stanley, John R.; Dashti, Azar; Aston, Christopher E.; Lyons, Timothy J.

doi:10.1210/jc.2011-3255

Cited by 27 publications

(31 citation statements)

References 46 publications

(56 reference statements)

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“…There is also some evidence of an association with maternal lipids. In women with type 1 diabetes, early pregnancy LDL-C was elevated in those who later developed preeclampsia (13). Conversely, in 184 women with GDM, maternal plasma cholesterol, LDL-C, HDL-C, and triglycerides did not differ in those who went on to develop preeclampsia (26).…”

Section: Maternal Obesitymentioning

confidence: 88%

“…Women with well-controlled type 1 diabetes (mean HbA 1c 6.1%, 43 mmol/mol) had lipoprotein levels comparable to women with uncomplicated pregnancy, but those with poor control (HbA 1c 8.3%, 67 mmol/mol) at the time of delivery had higher triglycerides and VLDL and lower HDL 3 levels (12). Women with type 1 diabetes who go on to develop preeclampsia later in pregnancy have higher LDL-C and cholesterol than women with type 1 diabetes who do not develop preeclampsia (13).…”

Section: Preexisting Type 1 Diabetesmentioning

confidence: 93%

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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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Section: Maternal Obesitymentioning

confidence: 88%

Section: Preexisting Type 1 Diabetesmentioning

confidence: 93%

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

et al. 2014

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“…4,5 We have also shown higher plasma cholesterol-rich lipoprotein particles in early pregnancy (first and/or second trimesters) in women with T1DM who subsequently developed PE versus those who remained normotensive. 6 As part of our continuing efforts to identify early markers of PE in women with diabetes, we have explored the serum levels of soluble receptors for advanced glycation end-products (sRAGE) and several measures of advanced glycation end-products (AGE) in the same study cohort.…”

Section: Introductionmentioning

confidence: 99%

Reduced soluble receptor for advanced glycation end‐products (sRAGE) scavenger capacity precedes pre‐eclampsia in Type 1 diabetes

Hanssen

et al. 2012

BJOG

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Objective Increased advanced glycation end-products (AGEs) and their soluble receptors (sRAGE) have been implicated in the pathogenesis of pre-eclampsia (PE). However, this association has not been elucidated in pregnancies complicated by diabetes. We aimed to investigate the serum levels of these factors in pregnant women with Type 1 diabetes mellitus (T1DM), a condition associated with a four-fold increase in PE. Design Prospective study in women with T1DM at 12.2 ± 1.9, 21.6 ± 1.5 and 31.5 ± 1.7 weeks of gestation [mean ± standard deviation (SD); no overlap] before PE onset. Setting Antenatal clinics. Population Pregnant women with T1DM (n = 118; 26 developed PE) and healthy nondiabetic pregnant controls (n = 21). Methods Maternal serum levels of sRAGE (total circulating pool), Nε-(carboxymethyl)lysine (CML), hydroimidazolone (methylglyoxal-modified proteins) and total AGEs were measured by immunoassays. Main outcome measures Serum sRAGE and AGEs in pregnant women with T1DM who subsequently developed PE (DM PE+) versus those who remained normotensive (DM PE–). Results In DM PE+ versus DM PE–, sRAGE was significantly lower in the first and second trimesters, prior to the clinical manifestation of PE (P < 0.05). Further, reflecting the net sRAGE scavenger capacity, sRAGE : hydroimidazolone was significantly lower in the second trimester (P < 0.05) and sRAGE : AGE and sRAGE : CML tended to be lower in the first trimester (P < 0.1) in women with T1DM who subsequently developed PE versus those who did not. These conclusions persisted after adjusting for prandial status, glycated haemoglobin (HbA1c), duration of diabetes, parity and mean arterial pressure as covariates. Conclusions In the early stages of pregnancy, lower circulating sRAGE levels, and the ratio of sRAGE to AGEs, may be associated with the subsequent development of PE in women with T1DM.

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“…22 Basu A et al studied that early in pregnancy increased cholesterol rich lipoproteins were associated with subsequent preeclampsia similar to present study. 23 Bodnar et al shows irrespective of the obstetric score women with preeclampsia had higher BMI during pregnancy compared to normotensive pregnancies. 24 Sattar et al showed that the increased level of cholesterol and TGL in preeclamptic women.…”

Section: Discussionmentioning

confidence: 96%

Association of dyslipidemia in second trimester of pregnancy with preeclampsia

Kanmani¹,

Subramanian²

2018

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONPre-eclampsia is a pregnancy-specific condition with a multifactorial etiology associated with proteinuria and hypertension.1,2 It is one of the common causes of maternal and perinatal morbidity and mortality.Berg and colleagues stated that around 50% of these preeclampsia related deaths are preventable. 3The exact etiology of preeclampsia is not known. But there are risk factors predisposing to development of preeclampsia. Genetic factors include family history of preeclampsia. 4 Obstetric factors include primiparity, previous history of pre-eclampsia, new paternity, multiple pregnancy, hydrops fetalis with large placenta, hydatidiform mole, triploidy. ABSTRACT Background:The study aimed to determine whether dyslipidemia in the second trimester of pregnancy is associated with pre-eclampsia and to investigate and compare the levels of serum lipids among preeclampsia and normal pregnant women. Methods: This prospective cohort study was done between March 2016 to February 2017. Fasting lipid profile was taken for about 200 selected antenatal women between 18-20 weeks of gestation. The patients who developed preeclampsia were grouped as preeclampsia group and the rest of the patients were grouped as normal group. The maternal characteristics compared between two groups were age, parity, BMI and socioeconomic class according to modified Kuppuswamy scale. Results: There is statistical significance among the two groups with respect to BMI and parity whereas no significance with age distribution. Mean total cholesterol in Preeclampsia was 240.24±46.63 mg/dl and normal pregnancy was 186.10±28.02 mg/dl. Mean HDL in preeclampsia was 47.49±4.40mg/dl and normal pregnancy was 52.11±8.918 mg/dl. Mean LDL in preeclampsia was 140.43±36.92 mg/ dl and normal pregnancy was 94.6±24.5 mg/dl. Mean VLDL in preeclampsia was 64.48±15.76mg/dl and in normal pregnancy was 33.54±9.38 mg/dl, Mean Triglycerides in preeclampsia was 291.95±82.33 mg/dl and normal pregnancy was 166.78±48.83 mg/dl. Total cholesterol, Low density lipoprotein, very low-density lipoprotein, triglycerides were increased in preeclampsia when compared to normal pregnancy, which is statistically significant. Conclusions: Detecting dyslipidemia before 20 weeks of gestation helps to recognise pregnancies at high risk for preeclampsia and to detect and treat the disease earlier for a better maternal and perinatal outcome.

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Plasma Lipoproteins and Preeclampsia in Women with Type 1 Diabetes: A Prospective Study

Cited by 27 publications

References 46 publications

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

Reduced soluble receptor for advanced glycation end‐products (sRAGE) scavenger capacity precedes pre‐eclampsia in Type 1 diabetes

Association of dyslipidemia in second trimester of pregnancy with preeclampsia

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