Jacek Brązert

Maternal serum placental growth factor and fetal SGA in pregnancy complicated by type 1 diabetes mellitus

Abstract Aim: To analyze the role of maternal placental growth factor (PlGF) in the prediction of small for gestational age (SGA) birth weight in pregnancy complicated by type 1 diabetes mellitus (T1DM). Methods: A prospective observational study on 59 normotensive T1DM pregnant women, assessing maternal PlGF concentrations between the 10th–14th and 22nd–25th weeks of gestation. Results: Number of SGA vs. non-SGA newborns was 11 (18.6%) vs. 48 (81.4%), respectively. First trimester PlGF serum concentrations (pg/mL) were similar between SGA vs. non-SGA groups [data given as median (interquartile range)]: 65.5 (35.58–159.20) vs. 68.23 (11.59–150.03), respectively; P=0.44. A trend for lower PlGF concentrations was observed in the second trimester in the SGA vs. non-SGA group: 63.34 (12.79–119.16) vs. 116.75 (33.93–235.82); P=0.07. In the SGA group, PlGF concentrations did not differ between the first and the second trimester: 65.5 (35.58–159.20) vs. 63.34 (12.79–119.16), respectively; P=0.36. In the non-SGA group, PlGF concentrations were significantly higher at the gestational age of 22–25 weeks compared to 10–14 weeks [116.75 (33.93–235.82) vs. 68.23 (11.59–150.03); P=0.03). Conclusions: Decreased PlGF serum concentration in mid-pregnancy, as well as a lack of physiological increase in PlGF levels between early and mid-gestation, may precede development of SGA in women with T1DM.

Concentrations of eNOS, VEGF, ACE and PlGF in maternal blood as predictors of impaired fetal growth in pregnancy complicated by gestational hypertension/preeclampsia.

Objectives: To investigate into an association between circulating levels of vascular factors (VF: ACE, eNOS, PlGF and VEGF) and impaired fetal growth measured as a small for gestational age newborn (SGA) in women with gestational hypertension/preeclampsia. Methods: A prospective observational trial in 46 patients in singleton pregnancies. Concentrations of VF were compared between participants who delivered SGA versus non-SGA newborns. Results: only low levels of ACE were associated with significantly increased risk for SGA (for a cut-off value, LR: 1.4–3.6). Conclusions: Circulating levels of VF are not sufficient predictors of SGA in pregnancies complicated by gestational hypertension/preeclampsia.

Maternal lipids associated with large-for-gestational-age birth weight in women with type 1 diabetes: results from a prospective single-center study

Introduction Despite improvement in diabetes care over the years, the incidence of macrosomia in type 1 diabetic mothers is still very high and even shows an increasing tendency. It is suggested that other factors that maternal hyperglycemia might be associated with excessive fetal growth in diabetic mothers. The aim of this study was to determine whether maternal lipids might contribute to high rates of large-for-gestational-age (LGA) newborns in women with type 1 diabetes (T1DM). Material and methods This prospective, single-center study was performed in a population of women with T1DM admitted to the perinatal center for women with diabetes. Data were collected in the first trimester (< 12th week), in mid-pregnancy (20th–24th weeks), and before delivery (34th–39th weeks). Results Among 114 women included in the analysis, 30 (26.3%) delivered LGA newborns. The remaining 84 (73.7%) newborns were appropriate for gestational age (AGA). Lower high-density lipoprotein (HDL) HDL concentration in the first trimester was significantly associated with LGA (p = 0.01). Similar associations were observed for the HDL concentrations in mid-pregnancy (p = 0.04) and before delivery (p = 0.03). Higher triglyceride concentrations in the first trimester (p = 0.02) and before delivery (p = 0.008) were associated with LGA. Higher glycated haemoglobin (HbA1c) levels in mid-pregnancy and before delivery were associated with LGA. The associations between maternal lipids and LGA were independent of maternal body mass index at onset of the study, gestational weight gain and HbA1c concentrations. Conclusions Decreased HDL and increased triglycerides during pregnancy might contribute to the development of LGA in women with type 1 diabetes.

Microvascular complications are associated with low levels of maternal sE-selectin and sVCAM-1 in pregnancy complicated with pregestational diabetes mellitus.

Pregestational diabetes with vasculopathy in pregnant women is still associated with increased risk for severe maternal and foetal complications and their pathomechanism remains unclear. We investigate endothelial function in diabetic pregnant women with and without vascular disease, measured as changes in concentrations of soluble E-selectin and VCAM-1 throughout pregnancy. 121 pregnant women with PGDM and singleton pregnancy (30 participants with vasculopathy, 91 without vasculopathy) were enrolled into the prospective study. Control group consisted of 20 nondiabetic pregnant women in uncomplicated gestation, sampled cross-sectionally in early pregnancy and at term. We demonstrated lower concentrations of circulating sE-selectin both in early and in late diabetic gestation, irrespective of a concomitant vasculopathy. We also found reduced concentrations of sVCAM-1 in late gestation in diabetic pregnancies both with and without vascular disease, and reduced increase in its levels with gestation. We report significantly elevated concentrations of sVCAM-1 in early pregnancy in diabetic participants with retinopathy and nephropathy comparing with patients with retinopathy only and nondiabetic pregnant controls. We noted a general pattern of pregestational diabetes associated with reduced levels of cell adhesion molecules in early pregnancy with a further reduction during gestation, except for participants with combined retino- and nephropathy.

Chorionic thickness and PlGF concentrations as early predictors of small-for-gestational age birth weight in a low risk population

OBJECTIVES SGA is associated with higher incidence of postnatal complications, including suboptimal neurodevelopment and increased cardiovascular risk. Screening for SGA, carried out at 11-13 (+ 6d) gestational weeks enables to reduce or completely eliminate the above mentioned complications. The aim of this study was to assess the correlation between chorionic thickness, concentration of PIGF protein and foetal birth weight in a single low-risk pregnancy. MATERIAL AND METHODS The study included 76 patients at 11-13 (+ 6d) gestational weeks, monitored throughout preg-nancy. Ultrasound examinations identified the location and thickness of the chorion by measuring it in its central part at its widest point in a sagittal section. Additionally, at each visit venous blood was collected to determine the level of PlGF, PAPP-A, and BhCG. RESULTS A significant positive correlation (r = 0.37) was found between the foetal weight and chorionic thickness. This correlation was affected by the location of the chorion and a significant negative correlation was observed between the level of PLGF, FHR, weight and length of the newborn. Maternal early-pregnancy BMI did not affect neonatal weight and body length, FHR, chorionic thickness, and the levels of PlGF, PAPP-A, and BhCG. CONCLUSIONS The preliminary analysis indicates an association between chorionic thickness assessed during ultrasound at 11-13 (+ 6d) gestational weeks, PIGF levels assayed at the same time and birth weight. Increasing chorion thickness was accompanied by increasing foetal birth weight. PlGF level showed an inversely proportional effect on the foetal weight. This correlation was significant for the posterior location of the chorion.

Standards of Polish Society of Gynecologists and Obstetricians in management of women with diabetes

Ewa Wender-Ożegowska1, Dorota Bomba-Opoń2, Jacek Brązert3, Zbigniew Celewicz4, Krzysztof Czajkowski5, Paweł Gutaj1, Aneta Malinowska-Polubiec5, Agnieszka Zawiejska1, Mirosław Wielgoś2 1Division of Reproduction, Poznan University of Medical Sciences, Poznan, Poland 21st Chair and Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland 3Department of Obstetrics and Women’s Diseases, Poznan University of Medical Sciences, Poland 4Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland 52nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland