The Alteration Of Maternal And Umbilical Serum Pref-1in Pregnancy With Gestational Diabetes Mellitus

Gestational diabetes mellitus(GDM) is the glucose metabolic abnormality which is first time found or occurred during pregnancy. GDM has harmfully influence on the fetus or neonate.The occurrence of fetal malformation, intrauterine fetal death,premature birth,macrosomia, asphyxia neonatorum,etc is elevated.GDM has adverse long-term influence on the offsprings,the risk of obesity, insulin resistance, metabolic syndrome in adulthood is increased significantly.Barker DJ proposed fetal origins of adult disease hypothesis(FOAD).It proposed that permanently or procedural changes will happen on the fetus when the mother has nutritional imbalance.These changes may increase the susceptibility to some chronic diseases postnatally.While,the molecular biology mechanism of the changes still unclear.Adipose tissue is an important endocrine organ which secretes many adipocyte factors.It participate in physiological activities,and play an important role in the insulin resistance formation in pregnant women.Preadipocyte facor-1(pref-1) is one of the adipocyte factors.Pref-1gene is a paternal imprinting gene,located in chromosome14q32.Pref-1gene is widely expressed in embryonic tissues.Pref-1protein is a transmembrane protein composed of385amino acids.A50kda large fragment soluble form generated after proteolysis which has the fuction of adipogenesis inhibition.Pref-1protein is synthesised and secreted by preadipocyte.Pref-1has the fuction of adipogenesis inhibition and adjusting the expression of glucolipid metabolic gene.The abnormal expression of pref-1may lead to metabolic disorder,obesity and diabetes etc.Zegher et al demonstrated that soluble pref-1is abundantly present in the fetal circulation and that SGA fetuses have significantly higher serum concentrations of pref-1than control fetuses at birth. Our group also demonstrated that fetuses born to pregnancies complicated by severe preeclampsia had increased serum pref-1concentrations while their birth weight was lower compared to normal pregnancy at birth.So,we proposed that pref-1present in the fetal circulation is related to the quantity and fuction of adipocytes.The GDM fetuses has the high morbidity of macrosomia,and the pref-1level may changed accordingly.The pref-1concentrations in fetal circulation may be among the mechanisms linking intrauterine exposure to GDM with high risk of metabolic diseases in later life.Objectives: Record the alteration of maternal and umbilical serum pref-1in pregnancy with gestational diabetes mellitus.To analysis the relationship of pref-1in the GDM mothers circulation with the fasting blood glucose,body mass index,and the relationship of pref-1in the umbilical serum with the fetal birth weight,gender etc. To demostrate that pref-1concentration is altered in fetuses born to women with GDM.To discuss pref-1’s role in increasing risk of metabolic diseases in adulthood of GDM fetuses.Methods:37women with GDM and45normal pregnant women were recruited. Maternal blood samples were taken at the day of delivry,and umbilical blood samples were taken immediately after the delivery of the baby. Serum was separated and pref-1 concentrations were measured with a commercially available enzyme-linked immunosorbant assay (ELISA) kits (R&D Systems).Results:Serum pref-1concentrations were significantly lower in fetuses of women with GDM compared to normal pregnancies (16.12±6.48vs.22.09±7.22μg/l,P=0.001). Serum pref-1concentrations have no significant alteration in the women with GDM compared to normal pregnancies (1.16±0.55vs.1.35±0.46μg/l,P=0.102).Correlation analysis revealed that umbilical serum pref-1concentrations were negatively correlated with fetal birth weight and gstational age(P<0.001),and have no significant correlation with the mothers age and materanl serum pref-(P=0.115and P=0.061).Conclusions:Pregnancies complicated by GDM have decreased fetal pref-1concentrations compared to normal pregnancies. The difference is an important pathophysiological change and may be significant in terms of their later development of metabolic conditions.