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
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 insulinu podobné růstové faktory 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.
Gestational diabetes mellitus (GDM) is a complication in pregnancy, but studies focused on the steroidome in patients with GDM are not available in the public domain. This article evaluates the steroidome in GDM+ and GDM- women and its changes from 24 weeks (± of gestation) to labor. The study included GDM+ (n = 44) and GDM- women (n = 33), in weeks 24-28, 30-36 of gestation and at labor and mixed umbilical blood after delivery. Steroidomic data (101 steroids quantified by GC-MS/MS) support the concept that the increasing diabetogenic effects with the approaching term are associated with mounting progesterone levels. The GDM+ group showed lower levels of testosterone (due to reduced AKR1C3 activity), estradiol (due to a shift from the HSD17B1 towards HSD17B2 activity), 7-oxygenated androgens (competing with cortisone for HSD11B1 and shifting the balance from diabetogenic cortisol towards the inactive cortisone), reduced activities of SRD5As, and CYP17A1 in the hydroxylase but higher CYP17A1 activity in the lyase step. With the approaching term, the authors found rising activities of CYP3A7, AKR1C1, CYP17A1 in its hydroxylase step, but a decline in its lyase step, rising conjugation of neuroinhibitory and pregnancy-stabilizing steroids and weakening AKR1D1 activity.
- MeSH
- 20-hydroxysteroid dehydrogenasy metabolismus MeSH
- chromatografie plynová MeSH
- cytochrom P-450 CYP3A metabolismus MeSH
- druhý trimestr těhotenství metabolismus MeSH
- gestační diabetes metabolismus MeSH
- lidé MeSH
- metabolomika metody MeSH
- oxidoreduktasy metabolismus MeSH
- steroid-17-alfa-hydroxylasa metabolismus MeSH
- steroidy analýza MeSH
- tandemová hmotnostní spektrometrie MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Úvod: I přes stále se zlepšující péči o těhotné ženy s diabetes mellitus 1. typu (DM1) zůstává výskyt těhotenských i perinatálních komplikací oproti zdravé populaci zvýšený. Optimální kompenzace diabetu před těhotenstvím a během něj je důležitý protektivní faktor snižující riziko kongenitálních malformací, těhotenských ztrát a dalších komplikací. Těhotenství diabetiček by tedy mělo být plánované, ideálně v době uspokojivé kompenzace diabetu. Cílové hodnoty glykovaného hemoglobinu (HbA1c) do rozmezí 42–48 mmol/mol s minimálním výskytem hypoglykemie a co nejmenším kolísáním glykemie v průběhu dne by mělo být dosaženo alespoň 3 měsíce před těhotenstvím. Cílem této práce bylo zhodnotit těhotenské a perinatální výsledky těhotenství žen s DM1 a posoudit vliv prekoncepční kompenzace diabetu na průběh těhotenství a porodu. Metodika a výsledky: Retrospektivní analýza těhotenských a perinatálních výsledků těhotenství žen s DM1 sledovaných na Gynekologicko-porodnické klinice 1. LF UK a VFN v Praze v letech 2008–2018. Do analýzy bylo zařazeno 221 žen s DM1. Uspokojivou kompenzaci diabetu prekoncepčně (HbA1c ≤ 48 mmol/mol v období 3 měsíců před otěhotněním) dosáhlo 59 (27 %) žen. Naproti tomu 162 (73 %) žen mělo kompenzaci neuspokojivou. Ženy s uspokojivou kompenzací diabetu prekoncepčně častěji plánovaly své těhotenství (55,9 vs. 24,7 %; p < 0,0001), měly menší výskyt některé z forem diabetické mikroangiopatie (13,6 vs. 37,7 %; p = 0,001), preeklampsie (0 vs. 11 %; p = 0,036), lepší kompenzaci diabetu během těhotenství (průměrný HbA1c během těhotenství 39,9 ± 6,7 vs. 49,9 ± 12,2; p < 0,0001), méně často bylo jejich těhotenství uměle přerušeno ze zdravotní indikace (vrozená vývojová vada plodu nebo dekompenzace DM1) (0 vs. 12 %; p = 0,032). U novorozenců žen s prekoncepčně uspokojivou kompenzací diabetu byl menší výskyt fetální makrosomie (porodní hmotnost > 95. percentil; 22,0 vs. 35,8 %; p = 0,027). Závěr: Těhotenství žen s DM1 je zatíženo výskytem řady perinatálních a neonatálních komplikací. Ve sledovaném souboru otěhotněla většina žen s DM1 neplánovaně, v době neuspokojivé kompenzace diabetu. Ženy s uspokojivou kompenzací diabetu před otěhotněním měly nižší výskyt těhotenských a perinatálních komplikací. Je proto vhodné, aby ženy s DM1 své těhotenství plánovaly a již prekoncepčně byly sledovány v perinatologických centrech, která zajistí koordinovanou diabetologickou, gynekologicko-porodnickou a neonatologickou péči
Introduction: Despite the ever-improving medical care, pregnancies of women with type 1 diabetes mellitus (T1DM) are at increased risk of complications for both mother and child. Optimal compensation of diabetes before and during pregnancy is an essential protective factor reducing the risk of congenital malformations, pregnancy loss, and other complications. The pregnancy of women with T1DM should be planned, ideally at a time of optimal diabetes compensation. Target glycated hemoglobin (HbA1c) values until the range of 42–48 mmol/mol should be achieved at least three months before pregnancy. Our work aimed to evaluate the perinatal results of pregnancies in women with T1DM and the eff ect of preconception counseling and adequate T1DM compensation before pregnancy on perinatal outcomes. Methods and results: Retrospective analysis of pregnancy and perinatal outcomes of women with T1DM were followed up at the Department of Gynecology and Obstetrics, General University Hospital in Prague and First Faculty of Medicine, Charles University between 2008 to 2018. A total of 221 women with T1DM were included in the analysis. Adequate (HbA1c ≤ 48 mmol/mol at least 3 months before conception) and inadequate diabetes compensation at the beginning of the pregnancy had 59 (26.7%) and 162 (72.3%) women, respectively. Pregnancies of women with adequate diabetes compensation were more often planned (55.9 vs. 24.7%; P < 0.0001), had a lower incidence of any form of diabetic microangiopathy (13.6 vs. 37.7%; P = 0.001), pre-eclampsia (0 vs. 6.8%; P = 0.036), better compensation of diabetes during pregnancy (mean HbA1c during pregnancy 39.9 ± 6.7 vs. 49.9 ± 12.2; P < 0.0001), and their pregnancy was less often terminated from medical indication (congenital malformation of the fetus or decompensation of T1DM) (0 vs. 7.4%; P = 0.032). Pregnancies of women with adequate diabetes compensation before conception were less often complicated by fetal macrosomia (birth weight > 95th percentile; 22.0 vs. 35.8%; P = 0.027). Conclusion: The pregnancy of women with T1DM is burdened by a number of perinatal and neonatal complications. In the study group, most women with T1DM became pregnant unintentionally at a time of inadequate diabetes compensation. Women who achieved adequate diabetes compensation before pregnancy had a lower incidence of perinatal complications. Therefore, it is advised that women with T1DM should plan their pregnancy, attend preconception and antenatal care, and give birth in perinatal centers, which provide coordinated care from diabetologists, gynecologists, obstetricians, and neonatologists.
