The role of endothelial dysfunction and subclinical inflammation in the development of obstetric and perinatal complications in diabetes mellitus patients
https://doi.org/10.29413/ABS.2021-6.3.1
Abstract
Diabetes mellitus in pregnant women is one of the topical problems of modern medicine. Recently, there has been an increase in cases of type 2 diabetes, especially an increase in the frequency of early onset in children and adolescents, respectively, in the fertile age, in a few years; they will enter with the burden of pathology. This is particularly problematic and important during pregnancy, since type 1 and type 2 diabetes are accompanied by a high risk of adverse obstetric and perinatal complications, which are detected in most women with type 1 and type 2 diabetes. The purpose of this review was to assess the role of vascular endothelial dysfunction and subclinical inflammation in the genesis of placental insufficiency causing the development of a number of pregnancy complications in diabetes mellitus, to search for biological markers of these processes, which may reveal some pathogenetic mechanisms for the formation and diagnosis of these disorders.
The review shows changes in the content of a number of biological markers, primarily such as pro-inflammatory cytokines (IL-1, TNFα, IL-6); CRP, for certain pregnancy complications in diabetes mellitus women. It is the imbalance of cytokines that very often determines the development of gestational complications and disrupts immunological tolerance in the mother-placenta-fetus system. The degree of severity of angiogenesis processes depends on the level of hyperglycemia, manifestations of subclinical inflammation and is reflected in the increase in the VEGF expression level and its receptors in terminal and stem villi of the placenta.
Thus, the review shows the role of endothelial dysfunction and subclinical inflammation in the development of obstetric and perinatal complications in diabetes mellitus patients, which is indicated by the changes in a range of proinflammatory cytokines and other biologically active markers.
About the Authors
Yu. A. Dudareva
Altai State Medical University of the Ministry of Health of the Russian
Federation
Russian Federation
Russian Federation
Dr.Sc. (Med), Associate Professor at the Department of Obstetrics and Gynecology
Lenin Avenue, 40, 656038, Barnaul, Altai Territory, Russian Federation
D. N. Seroshtanova
Altai Regional Clinical Perinatal Center;
Russian Federation
Russian Federation
obstetrician-gynecologist
656038, Altai territory, Barnaul, Fomin, str, 154
References
1. Khawandanah J. Khawandanah J Double or Hybrid Diabetes: A Systematic Review on Disease Prevalence, Characteristics and Risk Factors. Nutr Diabetes. 2019; 9 (1): 33–35. doi:10.1038/s41387-019-0101-1
2. Dedova II, Shestakova MV, Mayorov AYu. Algorithms for specialized medical care for patients with diabetes mellitus. 2019; 9. doi: 10.14341/DM221S1. (In Russ.)
3. Franks PW, Hanson RL, Knowler WC, Moffett C, Enos G, Infante AM. Childhood predictors of young-onset type 2 diabetes. Diabetes. 2007; 56 (12): 2964–2972. doi: 10.2337/db06–1639
4. Haritonova LA, Papysheva OV, Katajsh GA, Judina TM, Bogomaz DS. The health status of children born to mothers with diabetes. Rossijskij vestnik perinatologii i pediatrii. 2018; 63 (3): 26–31. (In Russ.). doi.org/10.21508/1027–4065–2018-63-3-26-31
5. Rozhkova OV, Brusentsov IG. Vozmozhnosti ultrazvukovoy diagnostiki diabeticheskoy fetopatii pri gestatsionnom saharnom diabete. Mother and Baby in Kuzbass. 2020; 1 (80):32–37. doi: 10.24411/2686-7338-2020-10006. (In Russ.)
6. Leiva A, Pardo F, Ramírez MA, Farías M, Casanello P, Sobrevia L. Fetoplacental Vascular Endothelial Dysfunction as an Early Phenomenon in the Programming of Human Adult Diseases in Subjects Born from gestational diabetes mellitus or obesity in pregnancy. Gestational Diabetes Mellitus or Obesity in Pregnancy. 2011; 2011: 349286. doi: 10.1155/2011/349286
7. Komilova MS, Pahomova ZhE. Significance of the endothelium in the development of gestational complications Russian Bulletin of Obstetrician-Gynecologist. Rossiyskiy vestnik akushera-ginekologa. 2015;15 (1): 18–23. doi:10.17116/rosakush 201515118–23. (In Russ.)
8. Radzinsky VE, Palieva NV, Botasheva TL, Zheleznyakova EV. Effect of endothelium-mediated factors on the formation of obstetric pathology in case ofmetabolic disorders. Sovremennye problemy nauki i obrazovanija. – Modern problems of science and education. 2016; 5: 30–32. (In Russ.)
9. Strizhakov АN, Tezikov YuV, Lipatov IS, Agarkova IA, Sharypova MA. Pathogenetic rationale for diagnosing and pregestational prevention of embryoplacental dysfunction. Voprosy ginekologii, akusherstva i perinatologii. 2012; 11 (1): 5–10. (In Russ.)
10. Sukhikh GT, Van»ko LV. Immune factors in the etiology and pathogenesis of complications of pregnancy. Akusherstvo i ginekologiya. Obstetrics and Gynecology. 2012; 1: 128–136. (In Russ.)
11. Gazieva IA, Chistyakova GN, Remizova II. Role of cytokine production disorders in genesis of placental insufficiency and early reproductive losses. Medical Immunology. 2014; 16 (6): 539–550. doi: 10.15789/1563-0625-2014-6-539-550 (In Russ.)
12. Ailamazyan EK, Stepanova OI, Selkov SA, Sokolov DI. Cells of the mother»s immune system A Trophoblast cells: constructive cooperation for the sake of achieving the result of co-administration. Vestnik Rossiĭskoĭ akademii meditsinskikh nauk. 2013; 68 (11):12–21. doi.org/10.15690/vramn.v68i11.837. (In Russ.)
13. Botasheva TL, Radzinsky VE, Khloponina AV, Vasil’eva VV, Zavodnov OP, Zheleznyakova EV. et. al. Role of fetus sex in expression of angiogenic factors and supporting of citokine balance in maternal organism in physiological pregnancy and in placentary insufficiency. Medical news of Nоrth Caucasus. 2019; 14 (2):325–329. doi.org/10.14300/mnnc.2019.14079 (In Russ.)
14. Sokolov DI. Vasculogenesis and angiogenesis in the development of the placenta. Zhurnal akusherstva i zhenskih boleznej. 2007; LVI (3):129–133. (In Russ)
15. Kaufmann P, Black S, Huppertz B. Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biol Reprod. 2003; 69 (1): 1–7. doi: 10.1095/biolreprod.102.014977
16. Poulaki V, Qin WY, Joussen AM, Hurlbut P, Wiegand SJ, Rudge J. et al. Acute intensive insulin therapy exacerbates diabetic blood-retinal barrier breakdown via hypoxia-inducible factor-l alpha and VEGF. J. Clin. Invest. 2002; 109 (6): 805–815. doi: 10.1172/JCI13776
17. Belovodenko MA, Zenkova EV. Hyperglycemia effect on fetus in gestational and manifest type 2 diabetes mellitus. Journal of Siberian Medical Sciences. 2018; 2: 34–42. (In Russ)
18. Gozhenko AI, Kuznetsova HS, Kuznetsova KS, Kuznetsova OM, Byts TM, Zuk W. Morpho-functional basis of endothelial dysfunction in diabetes mellitus. Journal of Education, Health and Sport. 2017; 7 (6): 516–524
19. Schegolev AI, Dubova EA, Pavlov KA, Esayan RM, Shestakova MV, Sukhikh GT. Comparative immunohistochemical assessment of vascular endothelial growth factor and its receptors in the villi of the placenta in case of gestational and type 1 diabetes mellitus. Arhiv patologii. 2013; 75 (5): 13–18. (In Russ)
20. Arzhanova ON, Kapustin RV, Polyakova VO. Expression of vasotropic signaling molecules in placental tissue in gestational diabetes mellitus. Molekuljarnaja medicina. 2012; 5: 45–49. (In Russ)
21. Vargas R, Repke JT, Ural SH. Type 1 Diabetes Mellitus and Pregnancy. Reviews in obstetrics and gynecology. 2010; 3 (3): 92–100
22. Haider S, Knöfler M. Human tumour necrosis factor: physiological and pathological roles in placenta and endometrium. Placenta. 2009; 30 (2):111–123. doi: 10.1016/j.placenta.2008.10.012
23. Krukier II, Avrutskaya VV, Narezhnaya EV, Degtyareva AS, Kravchenko LV, Nikashina AA. Breach of production proteinogenic amino acids, angiogenic growth factors and their value in perinatal damage of central nervous system in newborn. Tavricheskij mediko-biologicheskij vestnik. 2017; 20 (2-2): 63–67. (In Russ.)
24. Lysenko SN, Chechneva MA, Petrukhin VA, Burumkulova FF, Ermakova LB. Ultrasound diagnosis of diabetic fetopathy. Rossijskij vestnik akushera-ginekologa. 2016; 15 (3): 23–30. doi: 10.17116/rosakush201616323–30 (In Russ)
25. Rehfeldt C, Lang IS, Gоrs S et al. Limited and excess dietary protein during gestation affects growth and compositional traits in gilts and mpairs offspring fetal growth. J Animal Sci. 2011, 89 (2): 329–341. doi: 10.2527/jas.2010–2970
26. Krukier II, Grigoryants AA, Avrutskaya VV, Olina AA, Levkovich MA, еt alt. The prognostic role of cytokines and oxytocin in the choice of delivery tactics in women with diabetes. Rossijskij vestnik akushera-ginekologa. 2019; 19 (5): 7–12. doi.org/10.17116/rosakush2019190517. (In Russ)
27. Gurieva VM, Burumkulova FF, Budykina TS, Morokhotova LS, Buivalo TA. Complications of pregnancy in women with diabetes mellitus and possibilities of their correction. Almanac of Clinical Medicine. 2015; (37):24–31. doi.org/10.18786/2072-0505-2015-37-24-31 (In Russ.)
28. Whitworth KW, Baird DD, Stene LC, Skjaerven R, Longnecker MP. Fecundability among women with type 1 and type 2 diabetes in the USA. Diabetologia. 2011; 54 (3): 516–522. doi: 10.1007/s00125-010-2003-6
29. Shirshev SV. Molecular Mechanisms of Hormonal and Hormonal cytokine Control of Immune Tolerance in Pregnancy. Biological membranes. 2014; 31 (5): 303–322. doi: 10.7868/S0233475514050089. (In Russ)
30. International Diabetes Federation Diabetes Atlas, 9th edition 2019. Доступно на: https://www.diabetesatlas.org/en/. [Дата доступа: 01.09.2020]
31. Wahabi HA, Alzeidan RA, Esmaeil SA. Pre-pregnancy care for women with pregestational diabetes mellitus: a systematic review and meta-analysis. BMC Public Health. 2012;12:792. doi: 10.1186/1471-2458-12-792
32. Gordeeva LA, Oskorbina OS, Voronina EN, Sokolova EA, Shatalina IV, Olennikova RV, et al. Association between cytokine gene polymorphisms and recurrent miscarriage. Medical Immunology. 2017;19 (5):585–596. doi.org/10.15789/1563-0625-2017-5-585-596. (In Russ)
33. Battelino T, Danne T, Bergenstal RM, et al Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019; 42 (8): 1593–1603. doi.org/10.2337/dci19–0028
34. Kapustin RV, Alekseenkova EN, Arzhanova ON, et al. Preterm delivery in women with diabetes mellitus. Zhurnal akusherstva i zhenskih boleznej. 2020; 69 (1): 17–26. doi.org/10.17816/JOWD69117–26. (In Russ)
35. Modzelewska B, Kleszczewski T, Kostrzewska A. The effect of the release of exogenous nitric oxide on the responses of the pregnant human myometrium to oxytocin. Dev Period Med. 2018; 22:4:301–307
36. Saito S. J. Reprod. Immunol. 2000;47: 87–103
37. Morokhotova LS, Sidorova AA, Guryev VM, Burumkulova FF. Hypertensive complications in pregnant women with diabetes. Abstract. VI All-Russian Congress of Endocrinologists; Moscow, May 27–31; 2012: 156 Доступно на сайте: https://www.endocrincentr.ru/sites/default/files/all/PDF%20%28news%29/tezis%282%29. pdf. [Дата доступа: 01.09.2020] (In Russ)
38. Gutaj P, Zawiejska A, Mantaj U, WenderOżegowska E. Determinants of preeclampsia in women with type 1 diabetes. Acta Diabetol. 2017; 54 (12):1115–1121. doi: 10.1007/s00592-017-1053-3
39. Odegaard JI, Chawla A. Connecting type 1 and type 2 diabetes through innate immunity. Cold Spring Harb Perspect Med. 2012; 2 (3):77–79
40. Marques-Vidal P, Bastardot F, von Känel R, Paccaud F, Preisig M, Waeber G, Vollenweider. Association between circulating cytokine levels, diabetes and insulin resistance in a population-based sample (CoLaus study). Clin Endocrinol (Oxf ). 2013; 78 (2):232-241. doi: 10.1111/j.1365-2265.2012.04384.x
Review
For citations:
Dudareva Yu.A., Seroshtanova D.N. The role of endothelial dysfunction and subclinical inflammation in the development of obstetric and perinatal complications in diabetes mellitus patients. Acta Biomedica Scientifica. 2021;6(3):9-16. (In Russ.) https://doi.org/10.29413/ABS.2021-6.3.1
Views:
1174
Email this article 
