Gestational diabetes modifies the association between PlGF in early pregnancy and preeclampsia in women with obesity

Vieira, M. C. et al. (2018) Gestational diabetes modifies the association between PlGF in early pregnancy and preeclampsia in women with obesity. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 13, pp. 267-272. (doi: 10.1016/j.preghy.2018.07.003) (PMID:30177064) (PMCID:PMC6130745)

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Abstract

Objective: To identify clinical and biomarker risk factors for preeclampsia in women with obesity and to explore interactions with gestational diabetes, a condition associated with preeclampsia. Study design: In women with obesity (body mass index ≥ 30 kg/m2) from the UK Pregnancies Better Eating and Activity Trial (UPBEAT), we examined 8 clinical factors (socio-demographic characteristics, BMI, waist circumference and clinical variables) and 7 biomarkers (HDL cholesterol, hemoglobin A1c, adiponectin, interleukin-6, high sensitivity C-reactive protein, and placental growth factor (PlGF)) in the early second trimester for association with later development of preeclampsia using logistic regression. Factors were selected based on prior association with preeclampsia. Interaction with gestational diabetes was assessed. Main outcome measure: Preeclampsia. Results: Prevalence of preeclampsia was 7.3% (59/824). Factors independently associated with preeclampsia were higher mean arterial blood pressure (Odds Ratio (OR) 2.22; 95% Confidence Interval (CI) 1.58–3.12, per 10 mmHg) and lower PlGF (OR 1.39; 95% CI 1.03–1.87, per each lower 1 log2). The association of PlGF with preeclampsia was present amongst obese women without gestational diabetes (OR 1.91; 95% CI 1.32–2.78), but not in those with GDM (OR 1.05; 95% CI 0.67–1.63), p = 0.04 for interaction. Conclusion: The relationship between PlGF and preeclampsia differed in women with obesity according to gestational diabetes status, which may suggest different mechanistic pathways to preeclampsia. Whilst replication is required in other populations, this study suggests that performance of prediction models for preeclampsia should be confirmed in pre-specified subgroups.

Item Type:Articles
Additional Information:This study was supported by National Institute for Health Research (NIHR; RP-PG-0407-10452), Chief Scientist Office Scottish Government Health Directorates (Edinburgh; CZB/4/680), Guys and St Thomas' Charity (1060508), Tommy's Charity (SCO39280) and the Medical Research Council UK (MR/L002477/1). It was also supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and Kings College London, and the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. MCV receives support from Coordenadoria de Aperfeiçoamento de Pessoal de Ensino Superior (CAPES; BEX 9571/13-2). SLW receives support from Diabetes UK (14/0004849). DAL works in a Unit that receives support from the UK Medical Research Council (MC_UU_1201/5), and she, KMG and LP are NIHR Senior Investigators (NF-SI-0166-10196, NF-SI-0515-10042 and NF-SI-0512-10104, respectively). KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and the European Union's Seventh Framework Programme (FP7/2007-2013), projects EarlyNutrition and ODIN under grant agreement numbers 289346 and 613977. DP received support from National Institute for Health Research (NIHR) for a Clinical Lectureship.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Nelson, Professor Scott
Authors: Vieira, M. C., Begum, S., Seed, P. T., Badran, D., Briley, A. L., Gill, C., Godfrey, K. M., Lawlor, D. A., Nelson, S. M., Patel, N., Sattar, N., White, S. L., Poston, L., Pasupathy, D., and on behalf of the UPBEAT Consortium,
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
Publisher:Elsevier
ISSN:2210-7789
ISSN (Online):2210-7797
Published Online:10 July 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Pregnancy Hypertension 13:267-272
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
161372Improving pregnancy outcome in obese womenNaveed SattarNational Institute for Health Research (NIHR)RP-PG-0407-10452Institute of Cardiovascular & Medical Sciences
190127Improving Pregnancy Outcome in Obese Women - the UK Pregnancies: Better Eating and Activity Trial (UPBEAT)Scott NelsonChief Scientist Office (CSO)CZB/4/680Med - Reproductive and Maternal Medicine