Preview

Obstetrics, Gynecology and Reproduction

Advanced search

Gestational diabetes mellitus and obesity: effects on offspring

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.197

Full Text:

Abstract

Aim: to identify the risk factors for gestational diabetes mellitus (GDМ) and predictors of perinatal lesions of central nervous system (CNS) combined with GDМ and maternal obesity.

Materials and Methods. А retrospective observational case-control non-combined study was conducted to determine GDМ risk factors and their effect on perinatal pathology in 250 women divided into 2 groups. The main group included 150 pregnant women diagnosed with GDМ, the control group – 100 pregnant women without carbohydrate metabolism disorders. An assessment of hereditary, obstetric and gynecological history, as well as somatic health was carried out. Patients from the main group were subdivided into smaller groups: 1А (n = 77) – mothers whose newborns postnatally exerted adverse perinatal outcomes associated with impacting maternal hyperglycemia, and 1В (n = 73) – mothers whose newborns were born healthy. CHAID method (Chi Squared Automatic Interaction Detection) was used to create an algorithm for predicting adverse perinatal outcomes in GDМ. Аt the second stage, a single-center prospective observational non-combined cohort study was conducted to assess an effect of maternal hyperglycemia on formation of perinatal CNS lesions. Pre-labor concentration of neuron-specific enolase (NSE) was measured in the amniotic fluid of full-term fetuses in the group of pregnant women with GDM (n = 33) and in the group of pregnant women lacking carbohydrate metabolism disorders (n = 42).

Results. Obesity, late reproductive age, family history of type 2 diabetes mellitus, abortions, early reproductive losses, macrosomic delivery in history are the main risk factors for GDM development. An algorithm was developed that allowed to predict a risk of newborn perinatal pathology in mother with GDM with an overall percentage of correct predictions of 68.7 ± 3.8 %. Pre-labor concentration of NSE in the amniotic fluid of full-term fetuses was elevated by 1.68 times (p = 0.006) in women with combined GDM and obesity (5.56 [3.37–6.24] ng/ml) compared to pregnant women with normal weight lacking carbohydrate metabolism disorders (3.29 [1.49–4.89] ng/ml).

Conclusion. Pregnant women with obesity and type 2 diabetes mellitus familial history were featured with most prominent potential of developing perinatal complications. Rise in amniotic fluid NSE level in patients with GDМ corroborates damage of fetal CNS during antenatal period. The maximum NSE level was found in women comorbid with GDM and obesity.

About the Authors

O. V. Rozhkova
Altai State Medical University, Health Ministry of Russian Federation; Altai Regional Clinical Perinatal Center «DAR»
Russian Federation

Olga V. Rozhkova – MD, Postgraduate Student, Department of Obstetrics and Gynecology with a Course of Additional Professional Education, Altai State Medical University; Obstetrician-Gynecologist, Altai Regional Clinical Perinatal Center "DAR"

40 Lenin Ave., Barnaul 656038

154 Fomina Str., Barnaul 656045



O. V. Remneva
Altai State Medical University, Health Ministry of Russian Federation; Altai Regional Clinical Perinatal Center «DAR»
Russian Federation

Olga V. Remneva – MD, Dr Sci Med, Associate Professor, Head of the Department of Obstetrics and Gynecology with a Course of Additional Professional Education, Altai State Medical University; Consulting Physician, Altai Regional Clinical Perinatal Center "DAR"

40 Lenin Ave., Barnaul 656038

154 Fomina Str., Barnaul 656045



N. I. Fadeeva
Altai State Medical University, Health Ministry of Russian Federation
Russian Federation

Natalia I. Fadeeva – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology with a Course of Additional Professional Education

40 Lenin Ave., Barnaul 656038



Yu. V. Korenovskiy
Altai State Medical University, Health Ministry of Russian Federation
Russian Federation

Yuri V. Korenovskiy – MD, PhD, Associate Professor, Head of the Department of General and Biological Chemistry, Clinical Laboratory Diagnostics

40 Lenin Ave., Barnaul 656038



S. D. Yavorskaya
Altai State Medical University, Health Ministry of Russian Federation
Russian Federation

Svetlana D. Yavorskaya – MD, Dr Sci Med, Associate Professor, Professor, Department of Obstetrics and Gynecology with a Course of Additional Professional Education

40 Lenin Ave., Barnaul 656038



References

1. Global Guideline on Pregnancy and Diabetes. International Diabetes Federation, 2009. 36 p. Available at: https://www.idf.org/our-activities/care-prevention/gdm.

2. Behboudi-Gandevani S., Amiri M., Yarandi R.B., Tehrani F.R. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019;11:11. https://doi.org/10.1186/s13098-019-0406-1.

3. Kapur A., Mahmood T., Hod M. FIGO’s response to the global challenge of hyperglycemia in pregnancy – toward a global consensus. Gynecol Endocrinol. 2018;34(1):1–3. https://doi.org/10.1080/09513590.2017.1381682.

4. Plows J.F., Stanley J.L., Baker P.N. et al. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018;19(11):3342. https://doi.org/10.3390/ijms19113342.

5. Friedman J.E. Obesity and gestational diabetes mellitus pathways for programming in mouse, monkey, and man – where do we go next? The 2014 Norbert Freinkel Award Lecture. Diabetes Care. 2015;38(8):1402–11. https://doi.org/10.2337/dc15-0628.

6. Kapustin R.V., Onopriychuk A.R., Arzhanova O.N. et al. Pathophysiology of placenta and fetus in diabetes mellitus. [Patofiziologiya placenty i ploda pri saharnom diabete]. Zhurnal akusherstva i zhenskih boleznej. 2018;67(6):79–92. (In Russ.). https://doi.org/10.17816/JOWD67679-92.

7. Babiyants A.Ya., Afonin A.A. Problems of perinatal lesions of the central nervous system in children born to women with diabetes. [Problemy perinatal'nogo porazheniya central'noj nervnoj sistemy u detej, rozhdennyh zhenshchinami s saharnym diabetom]. Zhurnal fundamental'noj mediciny i biologii. 2017;(2):28–37. (In Russ.).

8. Afonin A.A., Babiyants A.Ya., Drukker N.A. Role of endothelium dependent vasoactive factors in the development of perinatal CNS damage in children were born by women with gestational diabetes mellitus. [Rol' endotelijzavisimyh vazoaktivnyh faktorov v razvitii perinatal'nogo porazheniya CNS u detej, rozhdennyh zhenshchinami s gestacionnam saharnym diabetom]. Uspekhi sovremennogo estestvoznaniya. 2013;1(9):30–3. (In Russ.).

9. Papysheva O.V., Kotaysh G.A., Savenkova I.V. et al. The influence of pregestational obesity to perinatal outcomes in women with gestational diabetes mellitus. [Vliyanie pregestacionnogo ozhireniya na perinatal'nye iskhody u zhenshchin c gestacionnym saharnym diabetom]. Akusherstvo i ginekologiya. Novosti. Mneniya. Obuchenie. 2019;7(3):25–30. (In Russ.). https://doi.org/10.24411/2303-9698-2019-13903.

10. Yao D., Chang Q., Wu Q.-J. et al. Relationship between maternal central obesity and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of cohort studies. J Diabetes Res. 2020;2020:6303820. https://doi.org/10.1155/2020/6303820.

11. Kharitonova L.A., Papysheva O.V., Kataysh G.A. et al. The state of health of children born to mothers with diabetes mellitus. [Sostoyanie zdorov'ya detej, rozhdennyh ot materej s saharnym diabetom]. Rossijskij vestnik perinatologii i pediatrii. 2018;63(3):26–31. (In Russ.). https://doi.org/10.21508/1027.

12. Masel A.S., Kaprior E.V., Tkachuk A.S. et al. Trends of physical development and metabolic status of children born to women with gestational diabetes during the first year of life. [Trendy fizicheskogo razvitiya i metabolicheskogo statusa detej, rozhdennyh ot zhenshchin s gestacionnym saharnym diabetom, na protyazhenii pervogo goda zhizni]. Pediatriya. Consilium Medicum. 2019;(1):2–7. (In Russ.). https://doi.org/10.26442/26586630.

13. Cooray S.D., Wijeyaratne L.A., Soldatos G. et al. The unrealised potential for predicting pregnancy complications in women with gestational diabetes: A systematic review and critical appraisal. Int J Environ Res Public Health. 2020;17(9):3048. https://doi.org/10.3390/ijerph17093048.

14. Lysenko S.N., Chechneva M.A., Petrukhin V.A., Burumkulova F.F. Ultrasound diagnosis of diabetic fetopathy. [Ul'trazvukovaya diagnostika diabeticheskoj fetopatii]. Doktor.Ru. 2019;(7):19–23. (In Russ.). https://doi.org/10.31550/1727-2378-2019-162-7-19-23.

15. Bazarnyi V.V., Volkhina S.A., Akhmanaeva E.Yu., Kovtun O.P. The serum biomarkers in diagnostic of hypoxic ischemic affection of central nervous system in children. [Syvorotochnye biomarkery v diagnostike gipoksicheski-ishemicheskogo porazheniya central'noj nervnoj sistemy u detej]. Klinicheskaya laboratornaya diagnostika. 2016;61(5):283–5. (In Russ.). https://doi.org/10.18821/0869-2084-2016-61-5-283-285.

16. Life-threatening conditions in obstetrics and perinatology. Eds. V.O. Bitsadze, A.D. Makatsariya, A.N. Strizhakov, F.A. Chervenak. [Zhizneugrozhayushchie sostoyaniya v akusherstve i perinatologii. Pod red. V.O. Bitsadze, A.D. Makatsariya, A.N. Strizhakova, F.A. Chervenaka]. Moscow: MIA, 2019. 672 p. (In Russ.).

17. Blinov D.V. The dagnostic value of EEG and biochemical markers of brain injury in hypoxic-ischemic encephalopathy. [Diagnosticheskoe znachenie EEG i biohimicheskih markerov povrezhdeniya mozga pri gipoksicheskiishemicheskoj encefalopatii]. Epilepsy and Paroxysmal Conditions. 2016;8(4):91–8. (In Russ.). https://doi.org/10.17749/2077-8333.2016.8.4.091-098.

18. Morozova A.Yu., Milyutina Yu.P., Kovalchuk-Kovalevskaya O.V. et al. Neuron-specific enolase and brainderived neurotrophic factor levels in umbilical cord blood in full-term newborns with intrauterine growth retardation. [Soderzhanie nejronspecificheskoj enolazy i mozgovogo nejrotroficheskogo faktora v pupovinnoj krovi donoshennyh novorozhdennyh s zaderzhkoj vnutriutrobnogo razvitiya]. Zhurnal akusherstva i zhenskih boleznej. 2019;68(1):29–36. (In Russ.). https://doi.org/10.17816/JOWD68129-36.

19. Morozova A.Yu., Milyutina Yu.P., Arutyunyan A.V., Evsyukova I.I. The contents of neurospecific enolase and neurotrophic growth factor in the cord blood of healthy full-term newborns elective planned cesarean section surgery and spontaneous delivery. [Soderzhanie nejronspecificheskoj enolazy i nejrotroficheskogo faktora rosta v pupovinnoj krovi zdorovyh donoshennyh detej posle operacii planovogo kesareva secheniya i spontannyh rodov]. Zhurnal akusherstva i zhenskih boleznej. 2015;64(6):38–42. (In Russ.).

20. Korenovsky Yu.V., Lytar I.A., Buryakova S.I. et al. Amniotic fluid volume regulation. [Regulyaciya ob"ema amnioticheskoj zhidkosti]. Akusherstvo i ginekologiya. 2016;(2):44–8. (In Russ.). https://doi.org/10.18565/aig.2016.2.44-48.

21. Dedov I.I., Krasnopolskiy V.I., Sukhikh G.T. Russian National Consensus Statement on gestational diabetes: diagnostics, treatment and postnatal care. [Rossijskij nacional'nyj konsensus «Gestacionnyj saharnyj diabet: diagnostika, lechenie, poslerodovoe nablyudenie»]. Saharnyj diabet. 2012;(4):4–10. (In Russ.).

22. Global report on diabetes. [Global'nyj doklad po diabetu]. Vsemirnaya organizaciya zdravoohraneniya, 2018. 88 р. (In Russ.). Available at: https://www.who.int/diabetes/global-report/ru/.

23. Elimian A., Figueroa R., Patel K. et al. Reference values of amniotic fluid neuron-specific enolase. J Matern Fetal Med. 2001;10(3):155–8. https://doi.org/10.1080/714904324.

24. Korenovskiy Yu.V., Remneva O.V., Rozhkova O.V. Diagnostic technique for perinatal involvement of fetal central nervous system in gestational diabetes mellitus. [Sposob diagnostiki perinatal'nogo porazheniya central'noj nervnoj sistemy ploda pri gestacionnom saharnom diabete]. Patent RF na izobretenie № 2707952 C1 ot 02.12.2019. Byul. № 34. 8 р. (In Russ.).


For citation:


Rozhkova O.V., Remneva O.V., Fadeeva N.I., Korenovskiy Yu.V., Yavorskaya S.D. Gestational diabetes mellitus and obesity: effects on offspring. Obstetrics, Gynecology and Reproduction. 2021;15(3):258-269. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.197

Views: 213


ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)