IS THERE AN ASSOCIATION OF SERUM PLACENTAL GROWTH FACTOR LEVELS IN PREGNANT WOMEN WITH GDM?

1. IS THERE AN ASSOCIATION OF SERUM PLACENTAL GROWTH FACTOR LEVELS IN PREGNANT WOMEN WITH GDM? Ümit Görkem1, Cihan ToğruL1, Emine Arslan1, Nafiye Yılmaz2, Tayfun Güngör2 1-Hitit UniversityFaculty of Medicine, ObstetricsandGynecology 2- ZTB MaternalHealthTrainingand EducationHospital

2. INTRODUCTION- OBJECTIVE • Placentalgrowthfactor (PlGF) secretedbythesyncytiotrophoblast is found in thematernalcirculationbeginning in thesixthweek of gestation. • Placentalgrowthfactor [PlGF] is a placenta-derivedangiogenic protein involved in theregulation of placentalvasculardevelopment[1]. 1- Maynard SE, et al. J ClinInvest 2003;111: 649–58.

3. PlGF has beenextensivelyinvestigated as a firsttrimesterbiomarkerforpregnancycomplicationsrelatedtoimpairedplacentationsuch as preeclampsiaandbirthweightdeviations[2-4]. • Also, inclusion of serum PlGFimprovestheperformance of first-trimesterscreening test fortrisomy 21 [5]. . 2- Levine RJ, et al. N Engl J Med 2004;350:672–83. 3- Akolekar R, et al.UltrasoundObstetGynecol 2008;32:732–9. 4- Poon LC, et al. PrenatDiagn 2008;28:1110–5. 5- Pandya P, et al. FetalDiagnTher 2012;31:87–93.

4. PreviousstudiesbyOngandSyngelaki et al. foundincreasedserum PlGFlevels in gestationaldiabetes (GDM) [6,7]. • A recentlypublishedstudyalsopresentedsignificantlyhigherfirst-trimesterPlGFvalues in the GDM group[8] . • Anotherrecentstudydidnot finda relationshipbetween PLGF measured at 11–14 weeksandsubsequent GDM among 328 womenrecruitedprospectively[9]. 6- Syngelaki A, et al. Metabolism. 2015;64(11):1485– 9. 7- Ong CY, et al. J ReprodMed. 2004;49(6):477–80. 8- Eleftheriades M, et al. Metabolism 2014; 63: 1419–1425. 9- Mosimann B et al. . FetalDiagnTher. 2016;39:287–91.

5. However, newer data found thatserum PlGF was decreased in women with diabetes mellitustype 1 and in those with type 2 disease[8]. • At present, these findings remain contradictory. • Therefore,weaimedtoinvestigatetheassociations of maternal serum placentalgrowthfactor (PlGF) levelswithgestationaldiabetesmellitus (GDM). 8- Tsiakkas A, et al. UltrasoundObstetGynecol 2015; 45: 591–598.

6. MATERIAL-METHODS • Thiscross-sectionalstudywasunderwent in theObstetricsandGynecologyDepartment of Hitit UniversitybetweenMarch, 2015 andSeptember, 2015. • A total of 158 pregnantwomenwerescreenedbetween 24 and 28 weeks of gestation. • All of thelow risk pregnantwomenwereevaluatedwith a 50-g glucosechallenge test (GCT). Womenwith serum glucose ≥ 140 mg/dL at 1 h after GCT weresubjectedto a 100-g oral glucosetolerance test (OGTT).

7. Pregnantwomenwho met theinclusioncriteriaweredividedintotwogroups; • 76 of the GDM group, • 82 of thecontrolgroup. • Maternal serum concentrations of PlGF, insulinandhomeostasis model assessment-insulin resistance(HOMA-IR) wereassessed.

10. Vasculogenesisandangiogenesisareessentialforplacentaldevelopmentandthe VEGF family has beenshowntoplay a key role [10]. • A recent meta-analysis of studiesinvestigatingpostpartumplacentalhistologyderivedfrompregnanciescomplicatedby GDM demonstratesthatthere is increasedplacentalvolume, higherincidence of villousimmaturityandincreasedangiogenesis[11]. 10- Geva E, et al. J ClinEndocrinolMetab 2002; 87:4213–4224. 11- Huynh J, et al. Placenta 2015; 36: 101–114.

11. Particularlythefetoplacentalvasculatureandendotheliumwereshownto be susceptibletohyperglycemia[12]. • Fetalhyperinsulinism as a result of maternalhyperglycemiastimulatesplacentalangiogenesis[13]. • Therefore, an increase in angiogenicmarkerssuch as PlGFmight be a consequence of thesealterations. 12- Cvitic S, et al. BiomedResInt 2014; 2014: 145846. 13- Lassance L, et al. J ClinEndocrinolMetab 2013; 98:e1438–e1447.

12. CONCLUSION • Werevealedthatthe serum PlGFlevelsweresignificantlyincreasedin pregnantswith GDM. • PlGFseemstohave a role in pathogenesisandearly GDM diagnosis. • Earlyidentificationof women at high risk for GDM could lead to an earlierdiagnosis of the condition and improve the pregnancyoutcomes.

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