BACKGROUND: Maternal diabetes adversely affects fetal cardiovascular system development. Previous studies have reported that the fetuses of mothers with diabetes exhibit both structural and functional changes; nevertheless, prior studies have not examined the association between glucose control and fetal cardiac morphology and performance. Thus, the objective was to determine the association between fetal cardiac morphology and function and maternal glucose control in type 1 diabetes and to compare the differences in measured cardiac parameters between the fetuses of mothers with diabetes and healthy controls. METHODS: In this prospective, longitudinal case-control study - including 62 pregnant women with type 1 diabetes mellitus and 30 healthy pregnant women - fetal cardiac assessment using B-mode, M-mode, and spectral pulsed-wave Doppler was performed in the second and third trimesters. In women with T1DM, glycated hemoglobin and data obtained from glucose sensors - including the percentage of time in, below, and above the range (TIR, TBR, and TAR, respectively), and coefficient of variation (CV) - were analyzed across three time periods: the last menstrual period to 13 (V1), 14-22 (V2), and 23-32 weeks (V3) of gestation. Fetal cardiac indices were compared between groups, and the correlation between glucose control and fetal cardiac indices was assessed. RESULTS: At 28-32 weeks, the fetuses of women with T1DM exhibited increased left ventricular end-diastolic length, relative interventricular septum thickness, right ventricular cardiac output, and pulmonary valve peak systolic velocity compared with healthy controls. At 18-22 weeks, pulmonary and aortic valve diameters, left and right ventricular stroke volumes, and left cardiac output inversely correlated with the CV and glycated hemoglobin levels at V1 and V2. Furthermore, at 28-32 weeks, pulmonary and aortic valve diameters, left ventricular stroke volume, cardiac output, and right/left atrioventricular valve ratio inversely correlated with the TBR at V1, V2, and V3. Moreover, diastolic functional parameters correlated with the TAR and glycated hemoglobin levels, particularly after the first trimester. CONCLUSION: In women with T1DM, maternal hyperglycemia during pregnancy correlates with fetal diastolic function, whereas glucose variability and hypoglycemia inversely correlate with fetal left ventricular systolic function in the second and third trimesters.
- MeSH
- diabetes mellitus 1. typu * komplikace MeSH
- dopplerovská echokardiografie MeSH
- fetální srdce diagnostické zobrazování MeSH
- gestační diabetes * MeSH
- glykovaný hemoglobin MeSH
- hemodynamika MeSH
- krevní glukóza MeSH
- lidé MeSH
- longitudinální studie MeSH
- prospektivní studie MeSH
- studie případů a kontrol MeSH
- syndrom Nijmegen breakage * MeSH
- těhotenství MeSH
- ultrasonografie prenatální MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Spontaneous preterm birth (sPTB) is a major cause of perinatal morbidity and mortality, even in developed countries. Prediction of sPTB is therefore a valuable tool to reduce the associated risks. The current standard for the prediction of sPTB consists, in addition to anamnestic data, of previous sPTB and previous second trimester miscarriage, measurement of cervical length by transvaginal ultrasound (TVU CL) together with assessment of fetal fibronectin levels in cervicovaginal fluid. Other evaluation parameters, such as the level of endocannabinoids in the pregnant woman's blood, could increase the sensitivity of this management. Endocannabinoids (eCBs) are a part of the endocannabinoid system (ECS); out of them anandamide (arachidonoyl-ethanolamide, AEA), in particular, plays an important role in the regulation of pregnancy and childbirth. We present the protocol for an open, non-randomized study to evaluate concentrations of AEA and other endocannabinoids: 2 linoleoylglycerol (2-AG), 2 linoleoylglycerol (2-LG), 2 oleoylglycerol (2-OG), and 2 arachidonoyldopamine (2-ADOPA or also NADA) in the blood of pregnant women as potential predictors of sPTB. In a total of 230 women with a history of sPTB or miscarriage, eCBs levels between 22 and 28 weeks of gestation will be assessed from maternal blood, in addition to the standard procedure. The aim of the study is to determine the relationship between blood concentrations of the endocannabinoids tested and the risk of sPTB. The results of this study will describe the prognostic significance of maternal blood eCBs levels for sPTB, and could subsequently enable improved screening programs for early identification of sPTB.
- MeSH
- druhý trimestr těhotenství MeSH
- endokanabinoidy MeSH
- lidé MeSH
- novorozenec MeSH
- předčasný porod * diagnóza MeSH
- samovolný potrat * MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Cílem práce je podat souhrnný přehled aktuálních informací o vzájemných souvislostech mezi preeklampsií a diabetes mellitus v těhotenství. Metodika: Literární zdroje byly vyhledávány pomocí databáze PubMed a ScienceDirect. Závěr: Preeklampsie je závažným těhotenským onemocněním, které komplikuje 2–7 % těhotenství. Způsobuje komplikace u matky (orgánová dysfunkce) i plodu (porucha perfuze placenty a fetální růstová restrikce). Těhotné ženy s pregestačním diabetem mají 2–4krát vyšší riziko rozvoje preeklampsie, u žen s gestačním diabetem je riziko 1,3krát vyšší. Riziko preeklampsie zvyšuje neuspokojivá kompenzace diabetu, již přítomná diabetická nefropatie, retinopatie a délka trvání diabetu. Prevencí rozvoje preeklampsie je screening a v indikovaných případech užívání kyseliny acetylsalicylové nejpozději od 16. týdne do 36. týdne těhotenství. Preeklampsie je zároveň rizikovým faktorem pro rozvoj diabetes mellitus 2. typu a kardiovaskulárních onemocnění v budoucím životě ženy, proto je doporučena důsledná dlouhodobá dispenzarizace žen s anamnézou preeklampsie.
Objective: The purpose of this paper is to provide a review of recent research on the relationship between preeclampsia and diabetes mellitus in pregnancy. Methodology: A structured search for literary sources in PubMed and ScienceDirect databases using keywords, followed by a selection of papers based on solid methodology. Results: Preeclampsia is a serious condition, which complicates 2–7% of pregnancies. It causes maternal complications (organ dysfunction) and fetal complications (pathological haemodynamic parameters of the uteroplacental unit and fetal growth restriction). Pregnant women with pregestational diabetes have a 2- and 4-times higher risk of developing preeclampsia and the ones with gestational diabetes have 1.3-times higher risk. The main identified risk factors are inadequate compensation of diabetes, diabetic nephropathy, retinopathy and the duration of diabetes. To minimalize the risk of developing preeclampsia, a composite screening has been implemented. With a positive result a preventive use of acetylsalicylic acid from at the latest 16 and up until the 36th week is advised. Preeclampsia is also a risk factor for developing diabetes mellitus and other cardiovascular diseases later in life. For that reason, a long-term dispensary of women who had preeclampsia in pregnancy is recommended.
- MeSH
- Aspirin aplikace a dávkování MeSH
- komplikace diabetu * epidemiologie patofyziologie prevence a kontrola MeSH
- lidé MeSH
- preeklampsie * klasifikace patofyziologie prevence a kontrola MeSH
- proteinurie etiologie MeSH
- riziko MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
In the literature on the safety of ursodeoxycholic acid (UDCA) during breastfeeding, insufficient data has been reported to date. Thus, the aim of our study was to analyze bile acid (BA) concentrations in breast milk in a cohort of patients, treated with UDCA, and with various cholestatic liver diseases. The study was carried out on a cohort of 20 patients with various cholestatic diseases. All the patients were treated with UDCA (500-1500 mg daily). Concentrations of BA, sampled on day 3 after delivery were analyzed using the GS-MS technique, and then compared to untreated women. Total BA concentrations in the breast milk of the UDCA-treated patients were equal to those of the untreated women controls (3.2 ± 1 vs. 3.2 ± 0.2 μmol/L, respectively). The UDCA concentrations in breast milk remained negligible in UDCA-treated patients (0.69 μmol/L), and in any event did not contribute to the newborn BA pool. No apparent side-effects of the maternal UDCA treatment were observed in any newborn infant, and no deterioration in postnatal development was observed during the routine 1-year follow-ups. Therapeutic administration of UDCA during lactation is safe for breastfed babies since UDCA only gets into breast milk in negligible amounts. UDCA treatment should be allowed and included into the guidelines for the therapy of cholestatic diseases in breastfeeding mothers.
- MeSH
- cholestáza * farmakoterapie MeSH
- kyselina ursodeoxycholová * farmakologie MeSH
- laktace MeSH
- lidé MeSH
- mateřské mléko MeSH
- novorozenec MeSH
- žlučové kyseliny a soli terapeutické užití MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
To determine the optimal week for labor induction in women with diet-controlled gestational diabetes mellitus by comparing differences in perinatal and neonatal outcomes of labor induction to expectant management at different gestational weeks. Methods: This was a retrospective analysis of a prospectively recruited cohort of 797 singleton pregnancies complicated by diet-controlled gestational diabetes mellitus that were diagnosed, treated, and delivered after 37 weeks in a tertiary, university-affiliated perinatal center between January 2016 and December 2021. Results: The incidence of neonatal complications was highest when delivery occurred at 37 weeks, whereas fetal macrosomia occurred mostly at 41 weeks (20.7%); the frequency of large for gestational age infants did not differ between the groups. Conversely, the best neonatal outcomes were observed at 40 weeks due to the lowest number of neonates requiring phototherapy for neonatal jaundice (1.7%) and the smallest proportion of neonates experiencing composite adverse neonatal outcomes defined as neonatal hypoglycemia, phototherapy, clavicle fracture, or umbilical artery pH < 7.15 (10.4%). Compared with expectant management, the risk for neonatal hypoglycemia was increased for induction at 39 weeks (adjusted odds ratio 12.29, 95% confidence interval 1.35-111.75, p = 0.026) and that for fetal macrosomia was decreased for induction at 40 weeks (adjusted odds ratio 0.11, 95% confidence interval 0.01-0.92, p = 0.041), after adjusting for maternal pre-pregnancy body mass index, nulliparity, and mean pregnancy A1c. Conclusions: The lowest rate of neonatal complications was observed at 40 weeks. Labor induction at 40 weeks prevented fetal macrosomia.
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Insulin-like growth factors (IGFs) are involved in regulating growth and metabolism and increase insulin sensitivity, improve glucose metabolism, and are potentially related to gestational diabetes mellitus (GDM) and its complications for mothers and fetuses. DESIGN: This study aimed to assess serum levels and cord blood levels of IGF system components in pregnant women with (39 participants) and without GDM (22 participants). Blood samples were obtained at 28-32 and 36-38 weeks of gestation and 6-12 months after delivery. Cord blood samples were obtained during delivery. Results between both groups as well as between single visits were statistically compared. RESULTS: Both IGF1 and IGF2 maternal serum levels did not differ between the GDM and non-GDM groups. However, levels of IGF-binding proteins (IGFBPs) were different. IGFBP4 levels were decreased during pregnancy and after delivery in women with GDM, while IGFBP7 levels were increased during pregnancy in women with GDM. Cord blood IGFBP3 and IGFBP7 levels were increased (p < 0.001 for IGFBP3, p = 0.003 for IGFBP7), while IGFBP4 levels were decreased (p < 0.001) in the GDM group compared with the non-GDM group. CONCLUSIONS: Although IGF levels did not differ, changes in their function level could still persist possibly because of the effects of the binding proteins, especially their promoting or inhibitory effects on IGFs. These results should be considered in interpretation of IGF levels.
- MeSH
- biologická dostupnost MeSH
- fetální krev metabolismus MeSH
- gestační diabetes * metabolismus MeSH
- inzulinová rezistence * MeSH
- lidé MeSH
- proteiny vázající IGF metabolismus MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Výskyt prediabetu a DM 2. typu celosvětově stoupá. Řadu let může probíhat skrytě a často bývá zjištěn až při vzniku komplikací (ICHS, CMP, postižení zraku, ledvin, končetin s hrozícími amputacemi). Včasný záchyt onemocnění již ve stadiu prediabetu je zásadní pro včasné zahájení prevence, léčby a oddálení výskytu komplikací. Gestační diabetes mellitus (dále GDM) je významný rizikový faktor rozvoje prediabetu, DM 2. typu, kardiovaskulárních onemocnění a obezity. Ženy s anamnézou GDM mají 40–60% riziko rozvoje prediabetu a DM 2. typu. Jejich preventivním sledováním po porodu lze včas odhalit ženy se vznikající poruchou metabolismu glukózy a zahájit u nich léčbu. Rizikové jsou především ženy s genetickou predispozicí, starší ženy, obézní, PCOS, s vyšším váhovým přírůstkem během těhotenství, pro GDM léčené farmakoterapií. Spolu se stoupajícím výskytem GDM stoupá i výskyt poruchy glukózové tolerance po porodu, což je dáváno do souvislosti s vyšším BMI a věkem těhotných žen. Včasné zahájení léčby, jejíž součástí je dietní opatření, pravidelná fyzická aktivita, redukce hmotnosti a případně léčba metforminem, může zabránit rozvoji DM 2. typu s jeho komplikacemi nebo jej oddálit.
The incidence of prediabetes and type 2 diabetes is increasing worldwide. The course can be asymptomatic for several years and it is often diagnosed once the complications arise (e.g., coronary heart disease, stroke, sight, kidneys, or limbs impairment with impending amputations). Early detection of the disease at the stage of prediabetes is essential for timely prevention, treatment, and delaying complications. Gestational diabetes is a significant risk factor for prediabetes, type 2 diabetes, cardiovascular disease and obesity. Women with a history of gestational diabetes have a 40-60 % risk of developing prediabetes and type 2 diabetes. Postpartum surveillance leads to early detection and treatment of developing glucose metabolism disorders. Increased risk is particularly associated with a genetic predisposition, higher maternal age, obesity, PCOS, higher weight gain during pregnancy, and gestational diabetes treated with pharmacotherapy. In response to the increasing incidence of gestational diabetes, postpartum glucose metabolism disorders also increase. Early initiation of treatment, including dietary measures, regular physical activity, weight reduction, and possibly treatment with metformin, may prevent the onset of type 2 diabetes mellitus and associated complications.
As gestational diabetes mellitus (GDM) is both a frequent and serious complication, steroid levels in pregnancy are extremely elevated and their role in pregnancy is crucial, this review focuses on the role of steroids and related substances in the GDM pathophysiology. Low SHBG levels are associated with insulin resistance and hyperinsulinemia, while also predicting a predisposition to GDM. Other relevant agents are placental hormones such as kisspeptin and CRH, playing also an important role beyond pregnancy, but which are synthesized here in smaller amounts in the hypothalamus. These hormones affect both the course of pregnancy as well as the synthesis of pregnancy steroids and may also be involved in the GDM pathophysiology. Steroids, whose biosynthesis is mainly provided by the fetal adrenal glands, placenta, maternal adrenal glands, and both maternal and fetal livers, are also synthesized in limited amounts directly in the pancreas and may influence the development of GDM. These substances involve the sulfated ?5 steroids primarily acting via modulating different ion channels and influencing the development of GDM in different directions, mostly diabetogenic progesterone and predominantly anti-diabetic estradiol acting both in genomic and non-genomic way, androgens associated with IR and hyperinsulinemia, neuroactive steroids affecting the pituitary functioning, and cortisol whose production is stimulated by CRH but which suppresses its pro-inflammatory effects. Due to the complex actions of steroids, studies assessing their predominant effect and studies assessing their predictive values for estimating predisposition to GDM are needed.
- MeSH
- estradiol MeSH
- gestační diabetes * MeSH
- lidé MeSH
- placenta MeSH
- progesteron MeSH
- steroidy MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
