Data di Pubblicazione:
2006
Citazione:
Placental transport and metabolism in fetal overgrowth – a workshop report / T. Jansson, I. Cetin, T.L. Powell, G. Desoye, T. Radaelli, A. Ericsson, C.P. Sibley. - In: PLACENTA. - ISSN 0143-4004. - 27:suppl. A(2006 Apr), pp. S109-S113.
Abstract:
Fetal overgrowth in pregnancies complicated by diabetes is the result of an increased substrate availability which stimulates fetal
insulin secretion and fetal growth. However, despite strict glycemic control in modern clinical management of the pregnant woman
with diabetes, fetal overgrowth remains an important clinical problem. Recent studies in vivo provide evidence for increased
delivery of amino acids to the fetus in gestational diabetes (GDM) even when metabolic control is strict. This could be due to that
truly normal maternal substrate levels cannot be achieved in diabetic pregnancies and/or caused by altered placental nutrient
transport and metabolism. Studies in vitro demonstrate an up-regulation of placental transport systems for certain amino acids
in GDM associated with fetal overgrowth. GDM is also characterized by changes in placental gene expression, including upregulation
of inflammatory mediators and Leptin. In type-I diabetes with fetal overgrowth the in vitro activity of placental transporters
for both glucose and certain amino acids as well as placental lipoprotein lipase is increased. Furthermore, both clinical
observations in type-I diabetic pregnancies and preliminary animal experimental studies suggest that even brief periods of metabolic
perturbation early in pregnancy may affect placental growth and transport function for the remainder of pregnancy, thereby
contributing to fetal overgrowth. Ultrasound measurements of fetal fat deposits and abdominal circumference as well as 3D
ultrasound assessment of placental volume represent non-invasive techniques for in utero diagnosis of fetal and placental overgrowth.
It is proposed that these methods represent valuable additions to the clinical management of the diabetic pregnancy.
In conclusion, altered placental function may be a mechanism contributing to fetal overgrowth in diabetic pregnancies with
apparent optimal metabolic control. It is proposed that detailed information on placental metabolism and transport functions
obtained in vitro and in vivo represent a placental phenotype that provides important information and may facilitate diagnosis
and improve clinical management of fetal overgrowth.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Amino acids; Diabetes in pregnancy; Glucose; Large-for-gestational age; Metabolism; Placenta; Transport
Elenco autori:
T. Jansson, I. Cetin, T.L. Powell, G. Desoye, T. Radaelli, A. Ericsson, C.P. Sibley
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