Overweight and obesity are associated with clustering of metabolic risk factors in early pregnancy and the risk of GDM


Autoři: I-Weng Yen aff001;  Chien-Nan Lee aff002;  Ming-Wei Lin aff002;  Kang-Chih Fan aff001;  Jung-Nan Wei aff003;  Kuan-Yu Chen aff004;  Szu-Chi Chen aff005;  Yi-Yun Tai aff002;  Chun-Heng Kuo aff006;  Chia-Hung Lin aff001;  Chih-Yao Hsu aff001;  Lee-Ming Chuang aff007;  Shin-Yu Lin aff002;  Hung-Yuan Li aff007
Působiště autorů: Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan aff001;  Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan aff002;  Chia Nan University of Pharmacy and Science, Tainan, Taiwan aff003;  Ansn Clinic, Hsin-Chu, Taiwan aff004;  Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan aff005;  Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan aff006;  Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan aff007
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0225978

Souhrn

Aim

Overweight and obesity are important risk factors of gestational diabetes mellitus (GDM). Clustering of metabolic risk factors in early pregnancy may be a potential pathogenesis between the link of overweight/obesity and GDM. Since it remains unexplored, we investigated if overweight and obesity are associated with clustering of metabolic risk factors in early pregnancy and the risk of GDM in this cohort study.

Methods

Total 527 women who visited National Taiwan University Hospital for prenatal care in between November 2013 to April 2018 were enrolled. Risk factors of GDM in the first prenatal visit (FPV) were recorded. Overweight/obesity was defined if body mass index ≥24 kg/m2. GDM was diagnosed from the result of a 75g oral glucose tolerance test in 24–28 gestational weeks.

Results

Overweight/obesity was associated with clustering of metabolic risk factors of GDM, including high fasting plasma glucose, high HbA1c, insulin resistance, high plasma triglyceride and elevated blood pressure in FPV (p<0.05). There was a positive relationship between the number of metabolic risk factors and the incidence of GDM (p <0.05). The odds ratios of HbA1c and diastolic blood pressure were higher in overweight/obese women, compared with those in normal-weight women.

Conclusions

Overweight/obesity is associated with clustering of metabolic risk factors in early pregnancy, which is correlated with higher risk of GDM. Our findings suggest that metabolic risk factors during early pregnancy should be evaluated in overweight/obese women.

Klíčová slova:

Blood plasma – Blood pressure – Medical risk factors – Obesity – Pregnancy


Zdroje

1. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstetrics and gynecology. 2013;122(2 Pt 1):406–16.

2. IDF Diabetes Atlas, 8th edn. Brussels, Belgium. International Diabetes Federation. 2017.

3. Osmundson SS, Zhao BS, Kunz L, Wang E, Popat R, Nimbal VC, et al. First Trimester Hemoglobin A1c Prediction of Gestational Diabetes. American journal of perinatology. 2016;33(10):977–82. doi: 10.1055/s-0036-1581055 27120479

4. 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes care. 2018;41(Suppl 1):S137–S43. doi: 10.2337/dc18-S013 29222384

5. Doherty DA, Magann EF, Francis J, Morrison JC, Newnham JP. Pre-pregnancy body mass index and pregnancy outcomes. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2006;95(3):242–7.

6. Torloni MR, Betran AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obesity reviews: an official journal of the International Association for the Study of Obesity. 2009;10(2):194–203.

7. Aye IL, Lager S, Ramirez VI, Gaccioli F, Dudley DJ, Jansson T, et al. Increasing maternal body mass index is associated with systemic inflammation in the mother and the activation of distinct placental inflammatory pathways. Biology of reproduction. 2014;90(6):129. doi: 10.1095/biolreprod.113.116186 24759787

8. Pantham P, Aye IL, Powell TL. Inflammation in maternal obesity and gestational diabetes mellitus. Placenta. 2015;36(7):709–15. doi: 10.1016/j.placenta.2015.04.006 25972077

9. Shin JA, Lee JH, Lim SY, Ha HS, Kwon HS, Park YM, et al. Metabolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness. Journal of diabetes investigation. 2013;4(4):334–43. doi: 10.1111/jdi.12075 24843675

10. Chatzi L, Plana E, Pappas A, Alegkakis D, Karakosta P, Daraki V, et al. The metabolic syndrome in early pregnancy and risk of gestational diabetes mellitus. Diabetes & metabolism. 2009;35(6):490–4.

11. Lei Q, Niu J, Lv L, Duan D, Wen J, Lin X, et al. Clustering of metabolic risk factors and adverse pregnancy outcomes: a prospective cohort study. Diabetes/metabolism research and reviews. 2016;32(8):835–42. doi: 10.1002/dmrr.2803 27037671

12. Garg A. Lipodystrophies. The American journal of medicine. 2000;108(2):143–52. doi: 10.1016/s0002-9343(99)00414-3 11126308

13. Boden G. Obesity and free fatty acids. Endocrinology and metabolism clinics of North America. 2008;37(3):635–46, viii-ix. doi: 10.1016/j.ecl.2008.06.007 18775356

14. Samuel VT, Petersen KF, Shulman GI. Lipid-induced insulin resistance: unravelling the mechanism. Lancet (London, England). 2010;375(9733):2267–77.

15. Sadur CN, Eckel RH. Insulin stimulation of adipose tissue lipoprotein lipase. Use of the euglycemic clamp technique. The Journal of clinical investigation. 1982;69(5):1119–25. doi: 10.1172/JCI110547 7040473

16. Au WS, Kung HF, Lin MC. Regulation of microsomal triglyceride transfer protein gene by insulin in HepG2 cells: roles of MAPKerk and MAPKp38. Diabetes. 2003;52(5):1073–80. doi: 10.2337/diabetes.52.5.1073 12716735

17. Brunzell JD, Hokanson JE. Dyslipidemia of central obesity and insulin resistance. Diabetes care. 1999;22 Suppl 3:C10–3.

18. Hall JE, do Carmo JM, da Silva AA, Wang Z, Hall ME. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circulation research. 2015;116(6):991–1006. doi: 10.1161/CIRCRESAHA.116.305697 25767285

19. Fong A, Serra AE, Gabby L, Wing DA, Berkowitz KM. Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus. American journal of obstetrics and gynecology. 2014;211(6):641 e1–7.


Článok vyšiel v časopise

PLOS One


2019 Číslo 12