Gestational diabetes mellitus causes dyslipidemia in late trimester: mini review
Keywords:Dyslipidaemia, Gestational diabetes mellitus, Large for date baby, Preeclampsia
The incidence of gestational diabetes mellitus (GDM) is increasing rapidly worldwide. Many women with gestational diabetes mellitus are likely to have type 2 diabetes. With the extensive management protocol for GDM we are able to obtain a good glycaemic control but still excess morbidity prevails among GDM pregnancy compared to normal pregnancy. This may be due to the dysfunction of lipid metabolism. Changes in carbohydrate and lipid metabolism occur during pregnancy to ensure a continuous supply of nutrients to the growing fetus despite intermittent maternal food intake. Exaggerated reduction in insulin sensitivity in the peripheral tissues combined with peripheral adipose tissue lipolysis in GDM pregnancy than normal pregnancy results in increased maternal lipoprotein concentrations and elevated lipoprotein triglyceride content. An altered lipid profile on the maternal side would modulate the quantity and quality of lipids being transferred to the fetus. Hypertriacylglycerolemia in gestational diabetes mellitus has been related to a significant risk of having neonates that are large for gestational age and it is considered as a major cause of preeclampsia in the late gestational age. So, the recent researchers emphasize on targeting lipid metabolism in pregnant women with GDM to avoid the adverse outcomes of pregnancy.
Barrett HL, Dekker Nitert M, McIntyre HD, Callaway LK. Normalizing metabolism in diabetic pregnancy: is it time to target lipids? Diab Care. 2014;37(5):1484-93.
Herrera E, Ortega-Senovilla H. Lipid metabolism during pregnancy and its implications for fetal growth. Curr Pharm Biotechnol. 2014;15(1):24-31.
Ganong WF. Review of medical physiology. 22nd Mc Graw Hill; 2005:308-311.
Murray RK, editor. Harper’s illustrated biochemistry. 26th editions. New York, NY: (A Lange medical book). Lange Medical Books/McGraw-Hill; 2003:219-230.
Williams RH, Kronenberg H, editors. Williams textbook of endocrinology: website included. 11th edition, Philadelphia, Pa: Saunders, Elsevier; 2008:1589.
Butte NF. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. The Am J Clin Nutrit. 2000;71(5):1256-61.
Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF. Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta‐analysis. Int J Obstet Gynaecol. 2015;122(5):643-51.
Wulf P. Maternal-fetal cholesterol transport in the placenta. Circ Res. 2009;104(5):569-71.
Gil-Sánchez A, Demmelmair H, Parrilla JJ, Koletzko B, Larqué E. Mechanisms involved in the selective transfer of long chain polyunsaturated fatty acids to the fetus. Front Genet. 2011;2:57.
Madsen EM, Lindegaard MLS, Andersen CB, Damm P, Nielsen LB. Human placenta secretes apolipoprotein B-100-containing lipoproteins. J Biol Chem. 2004;279(53):55271-6.
Herrera E, Amusquivar E, López-Soldado I, Ortega H. Maternal lipid metabolism and placental lipid transfer. Horm Res. 2006;65 Suppl 3:59-64.
Desoye G, Gauster M, Wadsack C. Placental transport in pregnancy pathologies. Am J Clin Nutr. 2011;94(6 Suppl):1896S-1902S.
Angueira AR, Ludvik AE, Reddy TE, Wicksteed B, Lowe WL, Layden BT. New insights into gestational glucose metabolism: lessons learned from 21st century approaches. Diabetes. 2015;64(2):327-34.
Okereke NC, Uvena-Celebrezze J, Hutson-Presley L, Amini SB, Catalano PM. The effect of gender and gestational diabetes mellitus on cord leptin concentration. Am J Obstet Gynecol. 2002;187(3):798-803.
Herrera E, Ortega-Senovilla H. Disturbances in lipid metabolism in diabetic pregnancy - are these the cause of the problem? Best Pract Res Clin Endocrinol Metab. 2010;24(4):515-25.
Rebholz SL, Burke KT, Yang Q, Tso P, Woollett LA. Dietary fat impacts fetal growth and metabolism: uptake of chylomicron remnant core lipids by the placenta. Am J Physiol Endocrinol Metab. 2011;301(2):E416-425.
Xu A, Wang Y, Xu JY, Stejskal D, Tam S, Zhang J, et al. Adipocyte fatty acid-binding protein is a plasma biomarker closely associated with obesity and metabolic syndrome. Clin Chem. 2006;52(3):405-13.
Choi SH, Kwak SH, Youn BS, Lim S, Park YJ, Lee H, et al. High plasma retinol binding protein-4 and low plasma adiponectin concentrations are associated with severity of glucose intolerance in women with previous gestational diabetes mellitus. J Clin Endocrinol Metab. 2008;93(8):3142-8.
Kadowaki K, Waguri M, Nakanishi I, Miyashita Y, Nakayama M, Suehara N, et al. Adiponectin concentration in umbilical cord serum is positively associated with the weight ratio of fetus to placenta. J Clin Endocrinol Metab. 2006;91(12):5090-4.
Kersten S. Regulation of lipid metabolism via angiopoietin-like proteins. Biochem Soc Trans. 2005;33(Pt 5):1059-62.
Bharathi KR, Vijayalakshmi S, Shrunga RP. A study of lipid parameters among GDM and non GDM pregnant women: a hospital-based study. Int J Reprod Contracept Obstet Gynecol. 2017;6:5488-90.
Weissgerber TL, Mudd LM. Preeclampsia and Diabetes. Curr Diab Rep. 2015;15(3):579.
Sullivan SD, Umans JG, Ratner R. Hypertension complicating diabetic pregnancies: pathophysiology, management, and controversies. J Clin Hyper (Greenwich). 2011;13(4):275-84.