Pregnancy course in patients with comination of gestational diabetes mellitus on diet therapy and with placental insufficiency

Introduction. There are many works in the literature devoted to the study of the features of the course of gestational diabetes mellitus (GDM) in patients with placental insufficiency (PI) separately. However, with a combination of the above complications of pregnancy, there are very few studies, therefore, the problem requires detailed study.
Objective. To determine the characteristics of the course of pregnancy complicated by PN and GDM on diet therapy.
Materials and methods. A longitudinal cohort comparative study was conducted. The study included 120 patients in the II-III trimester of pregnancy with GDM on diet therapy. The main group consisted of 70 women whose pregnancy was complicated by sub- and decompensated forms of PI. The comparison group included 50 pregnant women without pathology of the fetoplacental complex. All patients underwent anthropometry, biochemical blood tests, with determination of the level of total protein, albumin, urea, creatinine, glucose, ALT, AST in the blood, total cholesterol, triglycerides, high, low, very low density lipoproteins, atherogenic index in the mother’s blood. Comparison of continuous quantitative data was performed using the Mann-Whitney test, which was calculated using the MedCalc 15.8 application program. The null hypothesis was rejected at p<0.05.
Result. When assessing the state of carbohydrate metabolism in patients of the study group, it was found that GDM was compensated by diet therapy. The analysis of protein, carbohydrate and lipid metabolism indices, as well as the activity of key metabolic enzymes — AST and ALT — in pregnant women with PI and GDM on diet therapy showed that patients in the main group had significantly higher levels of creatinine, De Ritis coefficient and glycated hemoglobin, as well as a decrease in transaminases, cholesterol, relative to the comparison group.
Conclusion. Our study demonstrated that in the metabolism of women with PN and GDM compensated by diet therapy, catabolic processes predominate, which may be an important pathogenetic unit.

1. Clinical guidelines “Gestational diabetes mellitus», Moscow, 2024 p. (In Russ)

2. Dodkhoeva MF, Pirmatova DA. Gestational diabetes mellitus: modern view of the current problem. Vestnik Avitsenny. 2018;20:4:455-461. (In Russ.) https://doi.org/10.25005/2074-0581-2018-20-4-455-461

3. Demidova, T. Y, Ushanova F.O. Pathophysiological aspects of the development of gestational diabetes mellitus. Russian medical journal. Medical Review. — 2019. — T. 3. — No. 10-2. — pp. 86-91. (In Russ)

4. Flenady V., Koopmans L., Middleton P. et al. Major risk factorsfor stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 2011; 377 (9774): 1331–40. https://doi.org/10.1016/S0140–6736(10)62233–7

5. International Stillbirth Alliance Collaborative for Improving Classification of Perinatal Deaths; Flenady V, Wojcieszek AM, Ellwood D, Leisher SH, Erwich JJHM, Draper ES, McClure EM, Reinebrant HE, Oats J, McCowan L, Kent AL, Gardener G, Gordon A, Tudehope D, Siassakos D, Storey C, Zuccollo J, Dahlstrom JE, Gold KJ, Gordijn S, Pettersson K, Masson V, Pattinson R, Gardosi J, Khong TY, Frøen JF, Silver RM. Classification of causes and associated conditions for stillbirths and neonatal deaths. Seminars in Fetal & Neonatal Medicine. 2017 Jun;22(3):176-185. https://doi.org/10.1016/j.siny.2017.02.009

6. Ivanova L.A., Tatarova N.A. Chronic placental insufficiency: clinical presentation, diagnostics and treatment. Russian Bulletin of Obstetrician-Gynecologist. 2020; 20(6): 32-39. (In Russ.) https://doi.org/10.17116/rosakush20202006132

7. Акушерство: учебник / под ред. В. Е. Радзинского. — 3–е изд., перераб. и доп. — Москва: ГЭОТАР–Медиа, 2022. — 912 с [Obstetrics: textbook / edited by V. E. Radzinsky. — 3rd ed., revised and enlarged. — Moscow: GEOTAR-Media, 2022. — 912 p. (In Russ.)

8. Armengaud JB, Ma RCW, Siddeek B, Visser GHA, Simeoni U. Offspring of mothers with hyperglycaemia in pregnancy: The short term and long-term impact. What is new? Diabetes Research and Clinical Practice. 2018 Nov;145:155-166. https://doi.org/10.1016/j.diabres.2018.07.039

9. Zegarra R, Dall’Asta A, Ghi T. Mechanisms of Fetal Adaptation to Chronic Hypoxia following Placental Insufficiency: A Review. Fetal Diagnosis and Therapy. 2022;49(5-6):279-292. https://doi.org/10.1159/000525717

10. Clinical guidelines “Insufficient fetal growth requiring medical care for the mother (fetal growth retardation)” — Moscow, 2022 (In Russ.)

11. Unterscheider J, Cuzzilla R. Severe early-onset fetal growth restriction: What do we tell the prospective parents? Prenatal Diagnosis. 2021 Oct;41(11):1363-1371. https://doi.org/10.1002/pd.6030

12. Клинические рекомендации «Нормальная беременность» — Москва, 2024. Clinical guidelines “Normal pregnancy” — Moscow, 2024 (In Russ.)

13. Fokina E. G., Rosly I. M. Human biochemical passport — a method for comprehensive assessment of the state of metabolism. Sports medicine: science and practice. 2015; (2): 13-23 (In Russ.)

14. Drukker N.A., Avrutskaya V.V., Selyutina S.N., Shkotova E.O., Durnitsyna O.A., Larichkin A.V. Biochemical factors of fetal growth retardation. Russian Bulletin of Obstetrician-Gynecologist. 2019; 19(6):11-15. (In Russ.) https://doi.org/10.17116/rosakush20191906111

15. Pecks U, Brieger M, Schiessl B, Bauerschlag DO, Piroth D, Bruno B, Fitzner C, Orlikowsky T, Maass N, Rath W. Maternal and fetal cord blood lipids in intrauterine growth restriction. Journal of Perinatal Medicine. 2012; 40(3):287-96. https://doi.org/10.1515/jpm.2011.135

16. Miranda J, Simões RV, Paules C, Cañueto D, Pardo-Cea MA, García-Martín ML, Crovetto F, Fuertes-Martin R, Domenech M, Gómez-Roig MD, Eixarch E, Estruch R, Hansson SR, Amigó N, Cañellas N, Crispi F, Gratacós E. Metabolic profiling and targeted lipidomics reveals a disturbed lipid profile in mothers and fetuses with intrauterine growth restriction. Scientific Reports. 2018;8(1):13614. https://doi.org/10.1038/s41598-018-31832-5

17. Nayan, S., Meena, M., Rajoria, L., Hooja, N., Gothwal, S., Fatima, A., Meena, B. S., Bairwa, G. S., Meena, P., Nawal, R., & Sharma, M. (2020). Third trimester maternal blood and at birth cord blood lipid profile characteristics in pregnant woman with or without fetal growth restriction. International Journal of Contemporary Pediatrics, 7(3), 596–601. https://doi.org/10.18203/2349-3291.ijcp20200685

18. Zeljković A, Ardalić D, Vekić J, Antonić T, Vladimirov S, Rizzo M, Gojković T, Ivanišević J, Mihajlović M, Vujčić S, Cabunac P, Spasojević-Kalimanovska V, Miković Ž, Stefanović A. Effects of Gestational Diabetes Mellitus on Cholesterol Metabolism in Women with High- Risk Pregnancies: Possible Implications for Neonatal Outcome. Metabolites. 2022 Oct 11;12(10):959. https://doi.org/10.3390/metabo12100959