Гипергликемия, выявленная во время беременности, является одним из наиболее частых состояний, с которым сталкиваются гинекологи и эндокринологи в клинической практике. Помимо негативного влияния на течение беременности и родов, в соответствии с теорией фетального программирования, гипергликемия вносит вклад как в краткосрочные, так и долгосрочные осложнения со стороны плода, новорожденного, ребенка и взрослого человека на протяжении всего периода жизни. В данной статье освещены ключевые исследования, которые способствовали пересмотру критериев диагноза гестационного диабета, приведен обзор последних данных, касающихся клинических наблюдений со стороны потомства, вклада гипергликемии в формирование физиологических процессов, хронических метаболических, нервно-психических нарушений и эпигенетических модификаций. Ключевые слова: гестационный диабет, сахарный диабет, гипергликемия, фетальное программирование, потомство, эпигенетика, эндокринология.
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Hyperglycemia, revealed during pregnancy, is one of the most frequent conditions experienced by gynecologists and endocrinologists in clinical practice. According to the theory of fetal programming, hyperglycemia leads to negative impact on pregnancy and delivery, contributes to both short-term and long-term complications on the fetus, newborn, child and adult throughout the lifespan. This article highlights key research that contributed to the revision of the criteria for gestational diabetes, provides an overview of the latest data on clinical observations from the offspring, the conduction of hyperglycemia to the formation of physiological processes, chronic metabolic, neuropsychic disorders and epigenetic modifications. Key words: gestational diabetes, diabetes mellitus, hyperglycemia, fetal programming, offspring, epigenetics, endocrinology.
Список литературы
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5. Hod M, Jovanovic L, Di Renzo G et al. Textbook of Diabetes and Pregnancy, 2003.
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8. Neilsen KK, De Courten M, Kapur A. The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus – lessons from projects funded by the World Diabetes Foundation. Glob Health Action 2012; 5. DOI: 10.3402/gha.v5i0.17277
9. Berger H, Crane J, Farine D et al. Screening for gestational diabetes mellitus. J Obstet Gynaecol Can 2002; 24 (11): 894–912.
10. Hod M, Kapur A, Sacks DA et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynecol Obstet 2015; 131 (S3) S173–S211. DOI: 10.1016/S0020-7292 (15)30033-3
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28. Plagemann A. Maternal diabetes and perinatal programming. Early Hum Dev 2011; 87:743–7. DOI: 10.1016/j.earlhumdev.2011.08.018
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30. Chiefari E, Arcidiacono B, Foti D et al. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest 2017; 40. Issue 9: 899–909. DOI: 10.1007/s40618-016-0607-5
31. Wu L, Cui L, Tam WH et al. Genetic variants associated with gestational diabetes mellitus: a meta-analysis and subgroup analysis. Sci Rep 2016; 6: 30539. DOI: 10.1038/srep30539
32. Pagán A, Sabater-Molina M, Olza J et al. A gene variant in the transcription factor 7-like 2 (TCF7L2) is associated with an increased risk of gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2014; 180: 77–82. DOI: 10.1016/j.ejogrb.2014.06.024
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1. Dedov I.I., Krasnopolskij V.I., Suhih G.T. ot imeni rabochej gruppy. Rossijskij nacionalnyj konsensus «Gestacionnyj saharnyj diabet: diagnostika, lechenie, poslerodovoe nablyudenie». Consilium Medicum. 2013; 15 (4): 5–9. [in Russian]
2. Proceedings of the 4th International Workshop-Conference on Gestational Diabetes Mellitus. Chicago, Illinois, USA. 14−16 March 1997. Diabetes Care 1998; 21 (Suppl. 2): B1–B167.
3. Serebrennikova K.G., Sheshko E.L., Mihajlova N.A. i dr. Optimizaciya akusherskoj pomoshi beremennym s gestacionnym saharnym diabetom i gruppy riska. Materialy III Rossijskogo foruma «Mat i ditya». M., 2001. [in Russian]
4. Getahun D, Nath C, Ananth CV et al. Gestational diabetes in the United States: temporal trends 1989 through 2004. Am J Obstet Gynecol 2008; 198 (5): 525.e1–5. DOI: 10.1016/j.ajog.2007.11.017
5. Hod M, Jovanovic L, Di Renzo G et al. Textbook of Diabetes and Pregnancy, 2003.
6. Hod M, Carrapato M. Diabetes and Pregnancy Evidence Based Update and Guidelines (Working group on Diabetes and pregnancy). Prague, 2006.
7. The HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations With Neonatal Anthropometrics. Diabetes 2009; 58 (2): 453–9. DOI: 10.2337/db08-1112
8. Neilsen KK, De Courten M, Kapur A. The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus – lessons from projects funded by the World Diabetes Foundation. Glob Health Action 2012; 5. DOI: 10.3402/gha.v5i0.17277
9. Berger H, Crane J, Farine D et al. Screening for gestational diabetes mellitus. J Obstet Gynaecol Can 2002; 24 (11): 894–912.
10. Hod M, Kapur A, Sacks DA et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynecol Obstet 2015; 131 (S3) S173–S211. DOI: 10.1016/S0020-7292 (15)30033-3
11. Wendland EM, Torloni MR, Falavigna M et al. Gestational diabetes and pregnancy outcomes – a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 2012; 12: 23. DOI: 10.1186/1471-2393-12-23
12. World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. http: //apps.who.int/iris/bitstream/ 10665/85975/1/WHO_ NMH_MND_13.2_eng.pdf. Published 2013.
13. HAPO Study Cooperative Research Group. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Intl J Gynaecol Obstet 2002; 78: 69–77.
14. HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991–2002. DOI: 10.1056/NEJMoa0707943
15. Horvath K, Koch K, Jeitler K et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 340: 1395. DOI: 10.1136/bmj.c1395
16. Metzger BE, Buchanan TA, Coustan DR et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007; 30 (Suppl. 2): S251–S260. DOI: 10.2337/dc07-s225
17. Nady El Hajj, Schneider E, Lehnen H et al. Epigenetics and life-long consequences of an adverse nutritional and diabetic intrauterine environment. Reproduction 2014; 148: R111–R12. DOI: 10.1530/REP-14-0334
18. Aagaard-Tillery KM, Grove K, Bishop J et al. Developmental origins of disease and determinants of chromatin structure: maternal diet modifies the primate fetal epigenome. J Mol Endocrinol 2008; 41: 91–102. DOI: 10.1677/JME-08-0025
19. Poston L. Maternal obesity, gestational weight gain and diet as determinants of offspring long term health. Best Pract Res Clin Endocrinol Metab 2012; 26, 627–39. DOI: 10.1016/j.beem.2012.03.010
20. Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabetic Medicine 2004; 21 103–13. DOI: 10.1046/j.1464-5491.2003.00985.x
21. Boney CM, Verma A, Tucker R et al. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115: e290–e296.
22. Catalano PM, Hauguel-De Mouzon S. Is it time to revisit the Pedersen hypothesis in the face of the obesity epidemic? Am J Obstet Gynecol 2011; 204: 479e87. DOI: 10.1016/j.ajog.2010.11.039
23. Radaelli T, Lepercq J, Varastehpour A et al. Differential regulation of genes for fetoplacental lipid pathways in pregnancy with gestational and type 1 diabetes mellitus. Am J Obstet Gynecol 2009; 201 (2): 209.e1–209.e10. DOI: 10.1016/j.ajog.2009.04.019
24. Radaelli T, Varastehpour A, Catalano P et al. Gestational diabetes induces placental genes for chronic stress and inflammatory pathways. Diabetes 2003; 52: 2951e8.
25. Metzger BE, Lowe LP, Dyer AR et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes 2009; 58: 453e9. DOI: 10.2337/db08-1112
26. Godfrey KM, Barker DJ. Fetal programming and adult health. Public Health Nutr 2001; 4: 611–24.
27. Myatt L. Placental adaptive responses and fetal programming. J Physiol 2006; 572: 25–30. DOI: org/10.1113/jphysiol.2006.104968
28. Plagemann A. Maternal diabetes and perinatal programming. Early Hum Dev 2011; 87:743–7. DOI: 10.1016/j.earlhumdev.2011.08.018
29. Simeoni U, Barker DJ. Offspring of diabetic pregnancy: long-term outcomes. Semin Fetal Neonatal Med 2009; 14: 119–24. DOI: 10.1016/j.siny.2009.01.002
30. Chiefari E, Arcidiacono B, Foti D et al. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest 2017; 40. Issue 9: 899–909. DOI: 10.1007/s40618-016-0607-5
31. Wu L, Cui L, Tam WH et al. Genetic variants associated with gestational diabetes mellitus: a meta-analysis and subgroup analysis. Sci Rep 2016; 6: 30539. DOI: 10.1038/srep30539
32. Pagán A, Sabater-Molina M, Olza J et al. A gene variant in the transcription factor 7-like 2 (TCF7L2) is associated with an increased risk of gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2014; 180: 77–82. DOI: 10.1016/j.ejogrb.2014.06.024
33. Godfrey KM, Sheppard A, Gluckman PD et al. Epigenetic gene promoter methylation at birth is associated with child’s later adiposity. Diabetes 2011; 60: 1528–34. DOI: 10.2337/db10-0979
34. Pedersen J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol (Copenh) 1954; 16: 330e42.
35. Ng SK, Olog A, Spinks AB et al. Risk factors and obstetric complications of large for gestational age births with adjustments for community effects: Results from a new cohort study. BMC Public Health 2010; 10: 460. DOI: 10.1186/1471-2458-10-460
36. Metzger BE, Lowe LP, Dyer AR et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care 2012; 35 (3): 574–80. DOI: 10.2337/dc11-1687
37. Metzger BE, Persson B, Lowe LP et al. Hyperglycemia and adverse pregnancy outcome study: neonatal glycemia. Pediatrics 2010; 126: E1545–52. DOI: 10.1542/peds.2009-2257
38. Vambergue A, Fajardy I. Consequences of gestational and pregestational diabetes on placental function and birth weight. World J Diabetes 2011; 2: 196–203. DOI: 10.4239/wjd.v2.i11.196
39. Glinianaia SV, Tennant PW, Bilous RW et al. HbA (1c) and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study. Diabetologia 2012; 55: 3193–203. DOI: 10.1007/s00125-012-2721-z
40. Ullmo S, Vial Y, Di Bernardo S et al. Pathologic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J 2007; 28: 1319e25.
41. Garcia-Flores J, Janez M, Gonzalez MC et al: Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2011; 154: 24–6. DOI: 10.1016/j.ejogrb.2010.08.002
42. Chu C, Gui YH, Ren YY et al. The impacts of maternal gestational diabetes mellitus (GDM) on fetal hearts. Biomed Environ Sci 2012; 25: 15–22. DOI: 10.3967/0895-3988.2012.01.003
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ФГБУ «Национальный медицинский исследовательский центр им. В.А.Алмазова» Минздрава России. 197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2
*masel.alisa@gmail.com
V.A.Almazov North-West Federal Medical Research Center of the Ministry of Health of the Russian Federation. 197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2
*masel.alisa@gmail.com