Abstract
Aims: Class A2 gestational diabetes mellitus (GDMA2) has short- and long-term effects on the mother and child. These may include abnormalities of placentation, damage to endothelial cells and cardiovascular disease. This research investigated the function and composition of high-density lipoproteins (HDL) among women with GDMA2 and their fetuses. Methods: Thirty pregnant women were recruited during admission for delivery. The function and expression of HDL, paraoxonase1 (PON1) and apolipoprotein A1 (APOA1) in the blood samples and the placental tissue were evaluated. The effect of HDL on migration of endothelial cells was measured in vitro. Results: Compared to normal pregnancy (NP), APOA1 in the maternal plasma of women with GDMA2 was decreased. More APOA1 and PON1 were released from HDL of women with GDMA2, compared to NP. Placental APOA1 and PON1 were decreased in GDMA2. For endothelial cells stimulated with TNFα, HDL cell migration was decreased when cells were evaluated with NP-HDL, as compared to GDMA2-HDL. Conclusions: GDMA2 affects the composition and function of HDL in plasma. Changes in HDL commonly seen in GDMA2 were observed in maternal and placental samples, but not in cord samples. These results might indicate a placental role in protecting the fetus by preserving the components and functions of HDL and require further investigation.
Highlights
Gestational Diabetes Mellitus (GDM) is a classification of diabetes unique to pregnancy and is subclassified to diabetes, which requires medication to be controlled (GDMA2)
High-density lipoproteins (HDL) had the strongest correlation with maternal serum apolipoprotein A1 (APOA1) in both groups (GDMA2: r= 0.945, p = 0.0001, normal pregnancy (NP): r = 0.843, p = 0.017)
No significant changes were observed in cord blood lipid profile and APOA1 between GDMA2 and NP (Table 2) and when the GDMA2 group was divided according to treatment with insulin or oral agents
Summary
Gestational Diabetes Mellitus (GDM) is a classification of diabetes unique to pregnancy and is subclassified to diabetes, which requires medication to be controlled (GDMA2). GDM is associated with increased risk of adverse outcomes for both mother and fetus, during and after the pregnancy, including development of cardiovascular disease and metabolic syndrome [1,2]. High-density lipoproteins (HDL) exert a protective effect on the cardiovascular system by reverse cholesterol transport, atherosclerotic plaque stabilization and anti-inflammatory and anti-oxidant effects [3]. HDL subfractions are heterogeneous in size, density and protein and lipid components: apolipoprotein A1 (APOA1) accounts for approximately 70% of the total protein mass of HDL and contributes to enzyme activity, stability and paraoxonase (PON1) function [4,5]. Shen et al noted that APOA1 dysfunction, decreased HDL-associated PON1 activity and their interactions are associated with the presence and severity of coronary artery disease in patients with diabetes mellitus type 2 [6]. Endothelial damage is critical in the development of cardiovascular complications and endothelial cell migration is a rate-limiting process in the repair of endothelium [7]
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