Role of ischemia-modified albumin in the evaluation of oxidative stress in intrahepatic cholestasis of pregnancy

Objective: The objective of this study is to investigate the ischemia-modified albumin (IMA) level, and the IMA/albumin ratio (IMAR) in healthy pregnant women, and pregnant women with intrahepatic cholestasis of pregnancy (ICP).

Material and method: This cross-sectional study included 53 women with ICP and 52 healthy pregnant women. Their serum IMA and albumin levels were analyzed, and the women were followed up to delivery.

Results: No significant intergroup differences were identified in maternal age, body mass index, and gestational age at the time that the blood samples were taken. The gestational age at delivery and the serum albumin level was significantly lower (p?=?.002 and p?p?=?.004).

Conclusion: Serum IMA levels did not differ between pregnant women with ICP and healthy pregnant women, while the IMAR was significantly higher in the ICP group versus the healthy pregnant women.     

Ischemia-Modified Albumin (IMA): A Novel Marker for Preeclampsia Independent of Uterine Artery Notching Identified by Doppler Ultrasound

Objective: To determine the predictive value of second trimester serum ischemia-modified albumin (IMA) levels for preeclampsia (PE), small for gestational age (SGA) and gestational diabetes mellitus (GDM). Methods: The study was conducted at a tertiary care hospital between May and August 2014. Healthy pregnant women (n?=?88) who were screened for fetal anomalies with ultrasound at 20–24 weeks of gestation were included in the study. Doppler measurements of the bilateral uterine arteries were performed in all the patients. Serum samples were obtained for an IMA assay. The maternal serum IMA levels were compared in pregnant women who had normal and abnormal uterine artery Doppler findings, including notching, and also in pregnant women who subsequently developed PE, SGA, and GDM during the follow-up period. Results: Uterine artery notching was not significantly predictive for PE, GDM or SGA (p?>?0.05). There was no significant difference between notching of the uterine arteries and serum IMA levels (p?>?0.05). Eight pregnant women (9.1%) subsequently developed PE. Serum IMA levels were significantly elevated in patients with PE compared with patients who did not subsequently develop PE (p?=?0.002). However, serum IMA levels were not significantly different in patients who subsequently developed SGA and GDM compared with women who did not (p?>?0.05). There was no correlation between serum IMA levels and maternal characteristics and laboratory findings. Conclusion: Maternal serum IMA levels at 20–24 weeks’ gestation might be a predictive biomarker for PE, independent of notching of the uterine arteries, maternal characteristics and laboratory findings.     

Ischemia-modified albumin as an oxidative stress biomarker in early pregnancy loss

Background/aims: This study aimed to determine the association between early pregnancy loss and serum ischemia-modified albumin (IMA) concentrations.

Methods: Serum samples of 180 women that included healthy pregnant women, women admitted for termination of pregnancy due to the absence of fetal cardiac activity or absence of fetal pole on ultrasonographic examination, and healthy non-pregnant women attending for gynecological examination. Each group included 60 patients. Serum concentrations of IMA were compared among the groups, and the correlations with patients’ age, gravidity, BMI, gestational age and total serum albumin concentrations were calculated.

Results: When the groups were compared with respect to IMA concentrations, the group with early pregnancy loss was found to have significantly higher IMA concentrations (p?<?0.001). An IMA threshold of >163?ng/mL had a sensitivity of 75%, specificity of 55% to discriminate between healthy pregnant patients and patients with early pregnancy loss in first trimester.

Conclusion: Our findings support the theory that possible oxidative stress, a more hypoxic environment and defective placentation lead to increased serum IMA concentrations. These findings may help to shed light on the complicated pathogenesis of early pregnancy loss.     

Maternal serum adiponectin concentration in gestational diabetes

Aim. Adiponectin is an insulin sensitizing protein. Because gestational diabetes mellitus is associated with insulin resistance, we compared serum adiponectin levels in women with gestational diabetes mellitus and healthy pregnant women.

Study design. Twenty-nine women with gestational diabetes and 26 women with impaired glucose tolerance were compared with 27 normal pregnant women in control group. Controls were matched for gestational age, age and body mass index (BMI) before pregnancy with two other groups. At 28 weeks of gestation serum concentration of adiponectin, insulin and insulin resistance (calculated by the homeostasis model assessment) were measured in three groups.

Main findings. The serum adiponectin level in gestational diabetes (6379.31 ± 1934.90 ng/ml), was significantly lower than the impaired glucose tolerance test (7384.61 ± 1626.70 ng/ml) and control groups (7962.96 ± 2667.20 ng/ml),(p = 0.02). Serum level of insulin and HOMA index in gestational diabetes were higher than the normal group (p > 0.05). In patients with gestational diabetes, there was a significant correlation between serum adiponectin level and BMI before pregnancy (r = ?0.531, p = 0.013). Also, the correlation between maternal serum adiponectin levels and neonatal birth weight was not significant (r = ?0.07, p value = 0.73).

Conclusion. Our data show that serum adiponectin level was significantly lower in gestational diabetes in comparison with healthy pregnant women.     

Serum chemerin level during the first trimester of pregnancy and the risk of gestational diabetes mellitus

Objective: To investigate the association between chemerin level in the first trimester of pregnancy and the risk of gestational diabetes mellitus.

Methods: The blood samples of 212 women at 8–12?weeks of gestation were collected. After screening for gestational diabetes mellitus (GDM), 19 women with GDM and 20 women randomly selected from 144 women with normal glucose tolerance (NGT) were included in the study. Blood samples were collected from these women. Triglycerides, glucose, total cholesterol, and HDL cholesterol, LDL cholesterol, insulin and chemerin were measured. Gestational weight gain and body mass index was assessed.

Results: Serum levels of chemerin were significantly elevated during late gestation, and the risk of GDM was positively associated with maternal serum chemerin in the first trimester.

Conclusion: Serum chemerin level during the first trimester of pregnancy has the potential to predict risk of GDM.     

Clinical significance of neuregulin 4 (NRG4) in gestational diabetes mellitus

Objective: Gestational diabetes mellitus (GDM) is defined as glucose intolerance detected during pregnancy. GDM is increasing worldwide and is associated with adverse maternal and fetal outcomes. Neuregulin 4 (NGR4) is epidermal growth factor like signaling molecule. It plays an important role in cell to cell communication furthermore recent studies indicate that NRG4 may work as a novel adipokine with a possible role in maintaining energy and metabolic homeostasis. The aim of the present study was to assess serum NRG4 levels along with several metabolic parameters in patients diagnosed with gestational diabetic mellitus.

Materials and methods: In this prospective cross-sectional study, the study group was composed of 63 women with GDM and 64 healthy pregnant women matched for age, body mass index (BMI) and gestational age. Blood samples were collected at the 24–28th gestational weeks. Serum NRG4, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides, glucose levels during 75-gr OGTT, fasting insulin, glycosylated hemoglobin A1c (HbA1c), alanine aminotransferase (ALT) and creatinine levels were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) values were calculated.

Results: Serum NRG4 values were significantly elevated in the GDM group compared to the control group (p?β?=?0.910, p?β?=?0.866, p?β?=?0.222, p?Conclusions: Serum NRG4 levels were associated with metabolic parameters of GDM. The present study can be considered to be a guide for future studies to clarify the pathophysiology of NGR4 in GDM patients.     

Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus

OBJECTIVE: This study prospectively evaluated the longitudinal changes in insulin sensitivity, insulin response, and endogenous (primarily hepatic) glucose production and suppression during insulin infusion in women with normal glucose tolerance (control) and gestational diabetes mellitus before and during a planned pregnancy. STUDY DESIGN: Eight control subjects and 7 subjects in whom gestational diabetes mellitus developed were evaluated with an oral glucose tolerance test, an intravenous glucose tolerance test, and hyperinsulinemic-euglycemic clamp with infusion of [6,6 (2)H2 ]glucose before conception and at 12 to 14 and 34 to 36 weeks' gestation. Insulin response was estimated as the area under the curve during the intravenous glucose tolerance test. Basal endogenous glucose production was estimated from isotope tracer dilution during steady state with [6,6 (2)H2 ]glucose and suppression during insulin infusion. Insulin sensitivity to glucose was defined as the glucose infusion rate required to maintain euglycemia during steady-state insulin infusion. Body composition was estimated with hydrodensitometry. Data were analyzed with 2-way analysis of variance with repeated measures for 2 groups. RESULTS: There were increases in first-phase (P =.006) and second-phase (P =. 0001) insulin responses in both groups with advancing gestation, but the increase in second-phase response was significantly greater (P =. 02) in the gestational diabetes mellitus group than in the control group. Basal glucose production increased significantly (P =.0001) with advancing gestation, and there was resistance to suppression during insulin infusion in both groups (P =.0001). There was less suppression of endogenous glucose production however, in the gestational diabetes mellitus group than in the control group (P =. 01). Insulin sensitivity decreased with advancing gestation in both groups (P =.0001), and there was lower insulin sensitivity in the gestational diabetes mellitus group than in the control group (P =. 04). Significant decreases in insulin sensitivity with time (P =. 0001) and between groups (P =.03) remained when the data were adjusted for differences in insulin concentration or residual hepatic glucose production. CONCLUSION: Obese women in whom gestational diabetes mellitus develops have a significant increase in insulin response but decreases in insulin sensitivity and suppression of hepatic glucose production during insulin infusion with advancing gestation with respect to a matched control group. These metabolic abnormalities in glucose metabolism are the hallmarks of type 2 diabetes, for which these women are at increased risk in later life.     

WISP1 is a novel adipokine linked to metabolic parameters in gestational diabetes mellitus

Objective: To investigate Wnt1-inducible signaling pathway protein-1 (WISP1) levels and their correlation with metabolic parameters in pregnant women with gestational diabetes mellitus (GDM) and non-GDM healthy pregnant women.

Materials and Methods: In this prospective cross-sectional study, the study group was composed of 62 women with GDM and 73 healthy pregnant women matched for age, body mass index (BMI) and gestational age. Blood samples were collected at 25–29th gestational week. Serum WISP1, betatrophin, glucose, fasting insulin, glycosylated hemoglobin A1c, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, C reactive protein, alanine aminotransferase and creatinine levels were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) values was calculated. The level of significance was accepted as p?Results: Circulating WISP1 in the GDM group was significantly higher than the control group (p?<0.001). Further, WISP1 was positively correlated with BMI, HOMA-IR values and fasting glucose, fasting insulin, triglyceride, betatrophin levels. BMI, HOMA-IR and betatrophin independently and positively predicted WISP1 levels.

Conclusion: These results demonstrate a relationship between WISP1 and the metabolic parameters of GDM. And, WISP1 might be involved in the pathophysiology of GDM. As a part of this pathophysiological mechanism, the activation of WISP1 and betatrophin might take place through several ways; WISP1 and betatrophin might either use same signaling pathways and potentiate each other or they might also constitute the sequential steps of a common pathway.     

Management of third-trimester diabetic pregnancies with the use of continuous subcutaneous insulin infusion therapy: A pilot study

Six women with juvenile-onset diabetes were managed as outpatients during the third trimester of pregnancy with continuous subcutaneous insulin infusion therapy. Twenty-four-hour metabolic profiles for plasma glucose, β-hydroxybutyrate, and triglycerides were monitored prior to, 1 week, 5 weeks, and 10 weeks after initiation of continuous subcutaneous insulin infusion therapy and compared with the metabolic profiles of 10 normal (nondiabetic) pregnant women. Near-normal metabolic profiles were achieved in these patients after 5 weeks of therapy in this pilot study. Patient motivation, compliance, and understanding of their illness were crucial in achieving the therapeutic goals of normoglycemia.     

Could serum levels of irisin be used in gestational diabetes predicting?

ObjectiveGestational diabetes mellitus (GDM) is a metabolic disorder during pregnancy leading to acute and chronic complications in both mother and newborn. The pathogenesis of GDM has not been fully understood, However, since the disease shares risk factors with type 2 diabetes mellitus (T2DM), a relationship between these two disease states is plausible. The recently discovered peptide irisin has been hypothesized to be a regulator of body metabolism. However, studies ended up with controversial results. In the present study, we aimed to investigate the relationship between irisin levels and gestational diabetes mellitus and the possible benefits of the metabolic profile.Materials and methodsWe performed a cross-sectional analysis of circulating levels of irisin in 100 pregnant women similar for age and body mass index and the groups included 50 gestational diabetic patients and 50 healthy pregnant volunteers. Serum irisin levels were measured by ELISA kit.ResultsMean age and body mass index levels were similar in both groups. Median HbA1c, fasting blood glucose, Glucose 1 h, Glucose 2 h and fasting insülin levels were higher in with gestational diabetic patients compared to the control group. In gestational diabetic group, the median irisin level was lower than in the control group.ConclusionSerum irisin levels were lower in gestational diabetic patients. Further investigations are needed to explore the underlying biological effects of irisin on pregnant women.     

Maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in gestational diabetes mellitus

Objective: The aim of the study is to evaluate maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in patients with getational diabetes mellitus compared with a control group.

Methods: We have measured maternal serum ANP and BNP levels in 35 otherwise healthy and 45 gestational diabetic women between gestational week 24 and 28 referred to our unit in a cross-sectional study. Independent samples t-test or the Mann–Whitney U-test was used for comparison of two groups where appropriate.

Results: Mean maternal serum homeostasis model assessment of insulin resistance (HOMA-IR), HbA1c, fasting glucose and insulin levels in gestational diabetes mellitus (GDM) group were significantly higher than the control group (p?<?0.01). Mean maternal serum ANP and BNP levels of women with GDM were significantly lower than the control group (12.9?±?9.9 versus 34.8?±?16.9?pg/ml, p?<?0.001; 416.6?±?209.7 versus 629.7?±?162.2?mg/dl, p?<?0.001, respectively). Maternal serum ANP and BNP levels were negatively correlated with insulin levels, HbA1c and HOMA-IR values (p?<?0.05).

Conclusions: Maternal serum ANP and BNP levels are significantly lower in patients with GDM. These biomarkers might be valuable in clinical setting for identifying high-risk women for developing diabetes during pregnancy.     

Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus?

OBJECTIVE: The purpose of this study was to investigate the insulin response to a 3-hour oral glucose tolerance test and to compare the insulin levels in the gestational diabetes mellitus and single abnormal test value groups with a nondiabetic control group. STUDY DESIGN: One hundred ten Turkish women with uncomplicated pregnancy participated in this prospective controlled study between 24 to 28 weeks of gestation. A 100-g 3-hour oral glucose tolerance test was given, and glucose and insulin plasma levels were assayed. The subjects were classified according to established criteria. Early-phase insulin secretion was assessed by the insulinogenic index. Total insulin secretion was assessed by mean insulin level during the oral glucose tolerance test; insulin resistance was assessed by fasting insulin concentration and by the use of the homeostasis model. Data were analyzed by the Student t test and 1-way analysis of variance, with posthoc Bonferroni correction. RESULTS: The fasting insulin levels of patients with normal oral glucose tolerance test results were significantly lower than those of patients with gestational diabetes mellitus and a single value abnormality (P <.001 and P <.005, respectively). The insulinogenic index as a marker of early-phase insulin secretion was significantly lower in gestational diabetes mellitus, compared with that of patients with normal oral glucose tolerance test results (P <.05). The worsening of glycemic profile from normal oral glucose tolerance test results to gestational diabetes mellitus was associated with an increase in the homeostasis model; no significant difference was found between gestational diabetes mellitus and a single value abnormality group in terms of both the homeostasis model and the insulinogenic index. Values for total insulin secretion were highest in gestational diabetes mellitus, followed by the single value abnormality group, both significantly differing from the values of patients with normal oral glucose tolerance test results (P <.001 and P <.005, respectively). CONCLUSION: In this prospective study of Turkish subjects, we found a striking similarity in terms of patient characteristics between the gestational diabetes mellitus group and the single value abnormality group. Additionally, when we used fasting insulin level and insulin resistance as 2 separate criteria of analysis, patients with single value abnormality were indistinguishable from patients with gestational diabetes mellitus; both groups were significantly different from the normal oral glucose tolerance test group. Our findings suggest that a single abnormal test value on an oral glucose tolerance test should be regarded as a pathologic finding and that the patient with a single abnormal test value may be treated similarly to the patient with gestational diabetes mellitus.     

Effect of fetal hyperinsulinism on oral glucose tolerance test results in patients with gestational diabetes mellitus

OBJECTIVE: This study was undertaken to evaluate the impact of the fetoplacental glucose steal phenomenon on the results of oral glucose tolerance testing in pregnancies complicated by gestational diabetes mellitus with fetal hyperinsulinism. STUDY DESIGN: This was an analysis of the cases of 34 patients with two consecutive abnormal oral glucose tolerance test results and amniotic fluid insulin measurement before institution of insulin therapy. Patients were divided into groups on the basis of normal versus elevated amniotic fluid insulin concentrations. RESULTS: Oral glucose tolerance tests were done at a mean (+/-SD) of 24.9 +/- 5.7 and 30.7 +/- 3.2 weeks' gestation, and amniotic fluid insulin measurements were done at 31.1 +/- 3.2 weeks' gestation. In 13 women with gestational diabetes mellitus with normal amniotic fluid insulin concentration, maternal postload blood glucose levels at 1 hour increased by 12 mg/dL (168 vs 180 mg/dL; 9.3 vs 10.0 mmol/L; P = .0006) during the course of 6 weeks. In contrast, in 21 women with gestational diabetes mellitus with elevated amniotic fluid insulin levels (>7 microU/mL; >42 pmol/L), 1-hour postload blood glucose levels decreased by 22 mg/dL (201 vs 179 mg/dL; 11.2 vs 9.9 mmol/L; P = .002) during the same period. The higher the amniotic fluid insulin level, the larger the decrease (R = 0.504; P =.02). Although low amniotic fluid insulin levels were correlated significantly with 1-hour glucose levels of the first and second oral glucose tolerance tests, high insulin levels were no longer correlated with the second oral glucose tolerance test. CONCLUSION: Exaggerated fetal glucose siphoning may provide misleading oral glucose tolerance test results in pregnancies complicated by fetal hyperinsulinism by blunting maternal postload glucose peaks. Consequently, oral glucose tolerance test results in a pregnancy complicated by gestational diabetes mellitus with a fetus that already has hyperinsulinemia may erroneously be considered normal.     

Ischemia Modified Albumin in Normal Pregnancy and Preeclampsia

Objective. Ischemia-modified albumin (IMA) has emerged as a new biomarker of myocardial ischemia. Currently, no information is available on maternal IMA levels during normal and complicated pregnancy. Preeclampsia is associated with ischemia and increased formation of free radicals in the placenta. We therefore hypothesized that production of IMA may occur in women with preeclampsia. Methods. Serum IMA and albumin concentrations were assessed in 12 patients with preeclampsia, 12 normal pregnant controls, and 12 nonpregnant controls. IMA levels were compared between groups and corrected for albumin by multivariate regression analysis. Results. Mean IMA levels were elevated in normal pregnant controls (107.3 U/mL; 95% CI, 102.5 to 112.01), compared with nonpregnant controls (94.5 U/mL; CI, 89.4 to 99.6; p = 0.015). In patients with preeclampsia, IMA levels were similar to those in normal pregnant controls (109.7 U/mL; CI, 102.2 to 117.2; p = 0.65). Also, no difference in IMA levels was observed between women with preeclampsia who delivered small-for-gestational-age (SGA) infants (99.0 U/mL; CI, 87.9 to 110.1; p = 0.13) and women with preeclampsia but without SGA. Conclusion. Serum IMA, which has been advocated as a clinical marker of cardiac ischemia, appears to be elevated during normal pregnancy. We found no significant relationship between IMA levels and preeclampsia, in women with or without SGA infants.     

Low gestational weight gain improves infant and maternal pregnancy outcomes in overweight and obese Korean women with gestational diabetes mellitus

Objective.?The aim of the study was to retrospectively assess what was the optimal gestational weight gain to have better maternal and neonatal outcomes in overweight and obese Korean women with gestational diabetes mellitus (GDM) who maintained normoglycemia throughout pregnancy by dietary modification, exercise, and/or insulin treatment.

Study design.?We performed a hospital-based study of 215 GDM women with prepregnancy BMI?≥?25 kg/m². Body weight, glucose homeostasis, lipid profiles, insulin treatment, and maternal outcomes were collected as predictors of neonatal birth weight. We divided the subjects into three groups according to modified Institute of Medicine (IOM) guidelines for weight gain during pregnancy: inadequate (n?=?42), normal (n?=?96), and excessive (n?=?77) groups.

Results.?Excessive weight gain resulted in increased macrosomia, HbA_1c at delivery, and postprandial blood glucose levels, but fasting blood glucose levels were not significantly different among the groups. The inadequate weight gain group (2.4?kg weight gain during pregnancy) had better neonatal outcomes and better maternal glycemic control with fewer requiring insulin treatment.

Conclusion.?Minimal weight gain, well below IOM recommendations, and tight control of blood glucose levels during pregnancy with proper medical management and dietary modification may eliminate most of the adverse pregnancy outcomes experienced by obese GDM Asian women.     

Does intensive glycemic control in diabetic pregnancies result in normalization of other metabolic fuels?

Intensive treatment of insulin-dependent diabetes mellitus during pregnancy often normalizes plasma glucose levels. However, it is unclear whether this adversely affects other metabolic fuels that are essential to normal fetal growth and development. Metabolic studies were conducted after the subjects ingested a standardized mixed meal during each trimester in 7 normal and 15 insulin-dependent diabetic pregnant women. The latter were treated with continuous subcutaneous insulin infusion or multiple injections, which were adjusted to achieve strict glucose control throughout pregnancy. Insulin, alanine, branched-chain amino acids, triglycerides, free fatty acids, and ketones were measured every 15 to 30 minutes before a standardized breakfast and for 150 minutes after the breakfast. Patients with insulin-dependent diabetes mellitus were studied while they received their unusual insulin dosages. Fasting glucose levels (87 +/- 7 mg/dl) and glucose levels 150 minutes after the meal (112 +/- 11 mg/dl) were near normal. However, normoglycemia was achieved at the expense of increased plasma insulin levels (area under insulin response curves, p less than 0.01, vs nondiabetic curves). Nevertheless, fasting and post-prandial plasma branched-chain amino acids, alanine, and free fatty acids were similar in both groups. Fasting cholesterol, triglyceride, and ketone levels were also normalized. We conclude that normalization of circulating amino acids and lipids in conjunction with correction of hyperglycemia may contribute to favorable outcomes in infants of intensively treated diabetic mothers.     

Vanadate enhances but does not normalize glucose transport and insulin receptor phosphorylation in skeletal muscle from obese women with gestational diabetes mellitus

OBJECTIVE: We compared the insulin-mimetic effects of vanadate, a protein-tyrosine phosphatase inhibitor, with the effects of insulin on skeletal muscle glucose transport and insulin receptor and insulin receptor substrate 1 phosphorylation to test the hypothesis that protein-tyrosine phosphatases participate in pregnancy-induced insulin resistance. STUDY DESIGN: Skeletal muscle fiber strips were obtained from the rectus abdominis during cesarean delivery in 7 patients with gestational diabetes mellitus, 11 pregnant women with normal glucose tolerance (pregnant control group), and 11 nonpregnant women undergoing elective surgery (nonpregnant control group). Muscle tissues were incubated in vitro for 15 to 60 minutes with or without maximal insulin (100 nmol/L) or sodium vanadate (6 micromol/L). Insulin receptor and insulin receptor substrate 1 tyrosine phosphorylation were measured, as was 2-deoxyglucose transport. The levels of protein-tyrosine phosphatase 1B were measured by Western blot analysis. RESULTS: Vanadate stimulated maximal 2-deoxyglucose transport more than did insulin alone in all samples (P<.05), but the value was still less in muscle tissues from pregnant control subjects and patients with gestational diabetes mellitus (P<.05). In muscle tissues from pregnant control subjects vanadate increased tyrosine phosphorylation of the insulin receptor and insulin receptor substrate 1 to levels similar to those in muscle tissues from nonpregnant control subjects. In patients with gestational diabetes mellitus vanadate increased insulin receptor and insulin receptor substrate 1 tyrosine phosphorylation, but these values remained less than in muscle tissues from nonpregnant control subjects (P<.05). Protein-tyrosine phosphatase 1B levels were not significantly different in skeletal muscles from each group. CONCLUSION: Vanadate did not restore normal glucose transport activity during pregnancy complicated by gestational diabetes mellitus, which indicates that decreased glucose uptake is probably not caused by impaired tyrosine phosphorylation events alone. Increased serine kinase activity and impaired glucose transporter 4 translocation probably contribute to insulin signaling abnormalities associated with pregnancy, especially in patients with gestational diabetes mellitus.     

Maternal circulating levels of irisin in intrahepatic cholestasis of pregnancy

Objective: Intrahepatic cholestasis of pregnancy (ICP), the most common liver disease in pregnancy, is characterized by elevated serum total bile acid levels and pruritus. It has become clear that bile acids are no longer labeled as simple detergent-like molecules, but also represent complex hormonal metabolic regulators. ICP has also been associated with increased incidence rates of gestational diabetes mellitus. Irisin is a newly discovered myokine that is able to regulate glucose and lipid levels, thus improving insulin sensitivity. In this study, maternal serum irisin levels were analyzed in order to provide a new perspective on the pathogenesis of ICP.

Materials and methods: In this controlled cross-sectional study, 58 consecutive pregnant women with ICP (30 with mild and 28 with severe disease) and 30 healthy women with uncomplicated pregnancies (as the control group) were examined. The maternal irisin, fasting blood glucose, fasting insulin and homeostatic model assessment of insulin resistance levels of the two groups were compared.

Results: Serum irisin levels were significantly higher in the severe ICP group than in the mild ICP and control groups (p?=?0.005 and p?<?0.001, respectively). At the best cut-off level of 908.875?pg/ml, irisin accurately predicted ICP [AUC?=?0.827 (95% CI: 0.745–0.909; p?<?0.001)] with sensitivity and specificity rates of 72.5 and 86.8%, respectively. There was a significant negative correlation between irisin and fasting blood glucose levels (r?=??0.399; p?=?0.021).

Conclusion: The results of this study indicate that serum irisin levels were significantly higher in women with ICP compared to healthy pregnant controls. However, it is difficult to infer whether high irisin level is a cause or effect of ICP.     

Perinatal HIV transmission: developing country considerations

Objective.?To examine the risk of obesity and metabolic syndrome in women with a history of gestational diabetes mellitus and in offspring born to mothers with gestational diabetes mellitus.

Methods.?A review of studies examining the development of obesity, hypertension, metabolic abnormalities, metabolic syndrome, and type II diabetes in mothers with a history of gestational diabetes mellitus and control mothers, and offspring of mothers with a history of gestational diabetes and control mothers.

Results.?Longitudinal studies demonstrate that women with a prior history of gestational diabetes mellitus and obesity are at significantly greater risk of developing metabolic syndrome than mothers with no history of gestational diabetes or obesity. The development of metabolic syndrome in children with increasing age is related to maternal gestational diabetes mellitus, maternal glycemia in the 3rd trimester, maternal obesity, neonatal macrosomia, and childhood obesity.

Conclusions.?The current prevalence of obesity in both adults and children and associated disorders of blood pressure and lipid metabolism, suggest a perpetuating cycle of increasing obesity, insulin resistance, and abnormal lipid metabolism, which has ominous consequences for future generations.     

Assessment of ischemia-modified albumin level in patients with recurrent pregnancy loss during the first trimester

Objective

The finding that ischemia-modified albumin (IMA) is increased in pre-eclamptic pregnancy suggests a role for IMA as a potential biomarker for abnormal placental development related to miscarriage. This study was undertaken to evaluate IMA levels in women with recurrent pregnancy loss (RPL).

Study design

This case-control study was performed between March 2008 and September 2009, at the Department of Obstetrics and Gynecology of Meram School of Medicine. Serum IMA and albumin concentrations were assessed in 43 women with a history of two or more unexplained first trimester miscarriages (group 1), and 42 healthy pregnant women (group 2) in the first trimester. IMA, adjusted IMA and albumin concentrations were compared between the groups. Statistical analysis was performed using Student's t-test and Mann-Whitney U test.

Results

IMA and adjusted IMA levels were significantly higher in women with RPL (1.11 + 0.08 and 1.09 + 0.09, respectively) compared to women in group 2 (0.88 + 0.10 and 0.88 + 0.11, respectively). Albumin levels in group 1 were significantly lower compared with group 2. There was a negative correlation between IMAand albumin levels in each group.

Conclusion

Maternal IMA levels appear to be elevated in women with early RPL. This finding may suggest that an abnormally high hypoxic intrauterine environment may be associated with abnormal placental development that contributes to early miscarriage.