Abstract
Gestational diabetes mellitus (GDM) associates with fetal endothelial dysfunction (ED), which occurs independently of adequate glycemic control. Scarce information exists about the impact of different GDM therapeutic schemes on maternal dyslipidemia and obesity and their contribution to the development of fetal-ED. The aim of this study was to evaluate the effect of GDM-treatments on lipid levels in nonobese (N) and obese (O) pregnant women and the effect of maternal cholesterol levels in GDM-associated ED in the umbilical vein (UV). O-GDM women treated with diet showed decreased total cholesterol (TC) and low-density lipoproteins (LDL) levels with respect to N-GDM ones. Moreover, O-GDM women treated with diet in addition to insulin showed higher TC and LDL levels than N-GDM women. The maximum relaxation to calcitonin gene-related peptide of the UV rings was lower in the N-GDM group compared to the N one, and increased maternal levels of TC were associated with even lower dilation in the N-GDM group. We conclude that GDM-treatments modulate the TC and LDL levels depending on maternal weight. Additionally, increased TC levels worsen the GDM-associated ED of UV rings. This study suggests that it could be relevant to consider a specific GDM-treatment according to weight in order to prevent fetal-ED, as well as to consider the possible effects of maternal lipids during pregnancy.
Highlights
Gestational diabetes mellitus (GDM) is a pathology characterized by any degree of glucose intolerance first recognized during pregnancy [1,2]
O-gestational diabetes mellitus (GDM) group, the reduced levels of total cholesterol (TC) and low-density lipoproteins (LDL) were not related to maternal body mass index (BMI) (Table 2); we propose that the changes are related to the chosen treatment for GDM
O-GDM group compared to the N-GDM group, and since it has been shown that insulin resistance associates with increased cholesterol synthesis favoring the production of VLDL, and its metabolization to LDL via the cholesteryl ester transfer protein [100,101,102], we propose that cholesterol metabolism could be further altered in women of the O-GDM group who were treated with insulin
Summary
Gestational diabetes mellitus (GDM) is a pathology characterized by any degree of glucose intolerance first recognized during pregnancy [1,2]. GDM increases as maternal weight increases; the odds ratio for GDM is higher in obese women [4,5,6,7]. This pregnancy disease, with or without obesity, has consequences for the fetus, including pathological alterations of the feto-placental vasculature [8,9,10,11]. The maternal complications of GDM include an increased risk of developing endothelial dysfunction [13,14], supraphysiologic dyslipidemia [15,16], long-term type 2 diabetes mellitus (T2DM)
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