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Determinants of adiponectin levels throughout pregnancy in women with type 1 diabetes mellitus

Determinants of adiponectin levels throughout pregnancy in women with type 1 diabetes mellitus RESEARCH LETTER Determinants of adiponectin levels during pregnancy in women with type 1 diabetes mellitus 1* 2 * 1 1 Paweł Gutaj , Rafał Sibiak , Przemysław Wirlstlein, Ewa Wender ‑Ożegowska 1 Department of Reproduction, Poznan University of Medical Sciences, Poznań, Poland 2 Student’s Scientific Society, Poznan University of Medical Sciences, Poznań, Poland Introduction A pregnancy complicated by mater‑ infection, miscarriage, or stillbirth were exclud‑ nal type 1 diabetes is associated with an increased ed from the study. risk of severe perinatal complications. Poorly con‑ Anthropometric data (weight, height, waist and trolled blood glucose levels could lead to numer‑ hip circumference) were collected during the first ous congenital malformations as well as an ele‑ hospitalization. Biological samples were obtained vated risk of early pregnancy loss. The optimal from patients during the 3 planned hospital stays. control of glucose levels could additionally reduce Blood samples were collected after overnight fast‑ the risk of other diabetes ‑associated conditions ing. Adiponectin concentrations were determined such as retinopathy, nephropathy, gestational hy‑ in serum by an enzyme ‑linked immunosorbent 1, 2 pertension, and neonatal acidosis. assay kit (Mediagnost, Reutlingen, Germany). Adiponectin is a type of adipose‑d erived hor ‑ Furthermore, we determined the levels and as‑ mone, which plays a signica fi nt role in the main ‑ sessed the ee ff ct of the following parameters on tenance of systemic metabolic homeostasis. It adiponectin secretion: C ‑reactive protein (CRP), has been reported that changes in adiponectin total cholesterol, high ‑density lipoprotein cho ‑ levels during pregnancy are associated with de‑ lesterol (HDL ‑C), low ‑density lipoprotein choles ‑ creased insulin sensitivity; however, their con‑ terol (LDL ‑C), triglycerides, glycated hemoglobin tribution to lipid metabolism is uncertain. Al‑ (HbA ), creatinine clearance, and estimated glu‑ 1c though the function and regulation of adipose cose disposal rate (eGDR), calculated using the fol‑ tissue hormone secretion were well described in lowing formula: eGDR = 24.31 – (12.22 × WHR) the general population, there have been no stud‑ – (3.29 × HTN) – (0.57 × HbA ), where WHR is 1c ies focusing exclusively on pregnant women with waist ‑to ‑hip ratio, HTN is hypertensive status type 1 diabetes. Therefore, the aim of this study (0 = “no”; 1 = “yes”), and HbA is expressed in %. 1c was to assess the determinants of adiponectin e  Th study protocol was approved by the Insti‑ levels throughout the pregnancy of patients with tutional Ethical Committee of the Poznan Uni‑ type 1 diabetes. versity of Medical Sciences (no. 673/12). Written informed consent was obtained from each patient Correspondence to: Patients and methods A cross ‑sectional study before enrollment. Paweł Gutaj, MD, PhD, of 88 pregnant women with type 1 diabetes Department of Reproduction, Poznan was conducted in the Department of Repro‑ Statistical analysis Statistical analysis was per‑ University of Medical Sciences, ul. Polna 33, 60-535 Poznań, duction at Poznan University of Medical Sci‑ formed using the Statistica software, version 13.3 Poland, phone: +48 61 841 93 34, ences (Poznań, Poland). According to our man‑ (TIBCO Software, Palo Alto, California, United email: pgutaj@o2.pl agement protocol for women with type 1 diabe ‑ States). Testing for normality of data distribution Received: February 22, 2020. tes, patients were admitted to our department 3 was performed using the Shapiro–Wilk test. Dif‑ Revision accepted: March 10, 2020. Published online: March 10, 2020. times during their pregnancy: the first planned ferences in adiponectin levels were analyzed us‑ Pol Arch Intern Med. 2020; admission was scheduled before the end of 12 ing the Friedman test. The analysis of associations 130 (3): 252-254 weeks of gestation; the second, between the 20th between adiponectin concentrations and anthro‑ doi:10.20452/pamw.15227 Copyright by Medycyna Praktyczna, and 24th week; and the third, between the 34th pometric measurements or laboratory results was Kraków 2020 and 39th week. Patients with multiple pregnan ‑ performed using the Spearman rank correlation cy, preterm delivery (before the 34th week), pre ‑ coefficient. The variables that were found to be * PG and RS contributed equally to term prelabor rupture of membranes, ongoing significantly correlated with adiponectin values this work. 252 POLISH ARCHIVES OF INTERNAL MEDICINE 2020; 130 (3) WHR. After the inclusion of WHR, the associ‑ TAbLE 1 Correlations between adiponectin levels and study parameters ations with CRP (P = 0.1) and other parameters Correlation R P value were no longer significant. In both models, a close First ‑trimester WHR –0.31 0.01 to normal distribution of residuals was noted. adiponectin First ‑trimester TG –0.29 0.02 Second trimester In the second trimester, there First ‑trimester hs ‑CRP –0.35 0.005 were negative correlations between adiponectin First ‑trimester daily protein 0.27 0.03 levels and BMI, triglyceride levels, and creatinine urinary secretion clearance. Data are presented in TAbLE 1 . There was Second ‑trimester BMI –0.38 0.02 no correlation between adiponectin levels and adiponectin Second ‑trimester TG –0.48 0.004 WHR (R = –0.2, P = 0.23). Second ‑trimester creatinine –0.36 0.04 clearance Third trimester In the third trimester, adipo‑ Third ‑trimester Third‑trimester HbA 0.44 0.007 1c nectin levels were markedly correlated only with adiponectin HbA levels (TAb LE 1). Body mass index (R = –0.07, 1c P = 0.67) and WHR (R = –0.13, P = 0.44) were not Abbreviations: BMI, body mass index; HbA , hemoglobin A; hs ‑CRP, high ‑sensitivity 1c 1c correlated with adiponectin levels. C ‑reactive protein; TG, triglycerides; WHR, waist ‑to ‑hip ratio Discussion The changes in adiponectin levels were included in the multiple regression analy‑ throughout pregnancy in women with type 1 di‑ sis. Nonnormally distributed variables prior to abetes described in our study were found to be inclusion in multiple regression models were log significant. In contrast to our results, Mazaki‑ transformed. The results were considered signifi ‑ T ‑ ovi et al did not report any differences in ad‑ cant if the estimated P value was lower than 0.05. iponectin levels during pregnancy. The discrep ‑ ancies between studies might be related to dif‑ Results The demographic and clinical charac ‑ ferent inclusion criteria, as their study group in‑ teristics of 88 patients enrolled in this study are cluded women without diabetes. Randeva et al presented in Supplementary material, Table S1 , compared adiponectin levels during pregnancy while the results of laboratory tests, in Supple‑ in women with type 1 diabetes and nondiabetic mentary material, Table S2 . women, and significantly higher adiponectin lev ‑ Median (interquartile range [IQR]) first‑ els were noted in diabetic patients. ‑trimester adiponectin levels were relatively high It has been proved that adiponectin levels in (1.7 µg 4 /ml [9.1–20.2 µg/ml]); then, in the second the general population are negatively correlat‑ trimester, a decrease in adiponectin concentra‑ ed with obesity and increased insulin resistance. tions was observed (. 01 µ 2 g/ml [. 8 – 2 . 41 µ 4 g/ml]). e  Th results of studies conducted in patients with In the third trimester, median (IQR) adiponectin gestational diabetes are consistent with this hy‑ 7, 8 levels returned to those observed in the first tri‑ pothesis. In our study, first ‑trimester adipo ‑ mester (13.9 µg/ml [10.5–20.8 µg/ml]). Our analy ‑ nectin concentrations were negatively correlat‑ sis revealed that the changes in serum adiponectin ed with WHR, and second ‑trimester adiponectin levels during gestation were significant ( P = 0.02). levels were negatively correlated with BMI. We er Th e were no correlations between adiponectin did not observe any signica fi nt correlations be ‑ levels and insulin requirements throughout preg‑ tween third ‑trimester adiponectin levels and obe ‑ nancy or differences in adiponectin concentra ‑ sity. Based on our results and the above studies, tions among patients treated with insulin pumps we can formulate a hypothesis that adiponectin and multiple injections (data not shown). values are more significantly associated with an ‑ thropometric parameters in patients diagnosed First trimester Adiponectin levels measured in with gestational diabetes than in those with type 1 the first trimester of pregnancy were negatively diabetes. This can be explained by much higher correlated with the WHR, but no correlation was rates of overweight and obesity in women with observed with body mass index (BMI; R = –0.24, gestational diabetes. To assess insulin resistance P = 0.06). Additionally, an inverse correlation was in early pregnancy, we used the eGDR. Surpris‑ noted between adiponectin and triglyceride levels. ingly, we did not find any significant correlation Furthermore, there was a negative correlation be‑ between adiponectin values and eGDR. tween adiponectin and CRP levels as well as a pos‑ Abnormal body fat distribution and insulin re‑ itive correlation between adiponectin levels and sistance were found to be the main determinants daily protein urinary secretion. Statistically sig‑ of CRP levels in pregnant patients with type 1 dia ‑ nificant correlations are shown in TAbLE 1 . To as‑ betes. In our study, CRP concentrations were neg‑ sess the association between adiponectin levels atively correlated with first ‑trimester adiponec ‑ and other metabolic and inflammatory parame‑ tin levels. C ‑reactive protein was also included in ters, multiple regression models were developed. the multiple regression analysis models. e  Th as ‑ The first multiple regression analysis model in ‑ sociation between CRP and first ‑trimester adipo ‑ cluded first ‑trimester CRP (P = 0.03) and triglyc ‑ nectin values was no longer significant after ad‑ erides (P = 0.46). The second regression model justment for WHR. Nevertheless, the hypothesis included: first ‑ trimester CRP, triglycerides, and that a low ‑grade inflammation during pregnancy RESEARCH LETTER Adiponectin in pregnant women with type 1 diabetes mellitus 253 How To CITE  Gutaj P, Sibiak R, Wirlstlein P, Wender ‑Ożegowska E. De‑ is responsible for decreasing serum adiponectin terminants of adiponectin levels during pregnancy in women with type 1 di‑ levels could be formulated. abetes mellitus. Pol Arch Intern Med. 2020; 130: 252‑254. doi:10.20452/ Furthermore, third ‑trimester HbA values pamw.15227 1c were found to be positively correlated with third‑ REFEREnCES ‑trimester adiponectin concentrations . In the first part of pregnancy, adiponectin concentra‑ 1 McCance DR, Casey C. Type 1 diabetes in pregnancy. Endocrinol Metab  Clin North Am. 2019; 48: 495‑509.  tions were mainly determined by both BMI and 2 Gutaj P, Mantaj U, Zawiejska A, et al. Maternal risk factors for neonatal WHR, but the situation changed in the late third acidosis in women with type 1 diabetes. Pol Arch Intern Med. 2019; 129: trimester. An increase in blood adiponectin lev‑ 316‑320.  els could sensitize the liver to insulin secretion in 3 Catalano PM, Hoegh M, Minium J, et al. Adiponectin in human preg‑ nancy: implications for regulation of glucose and lipid metabolism. Diabe‑ response to higher mean blood glucose values. tologia. 2006; 49: 1677‑1685.  Significant changes in the serum lipid profile 4 Williams KV, Erbey JR, Becker D, et al. Can clinical factors estimate in‑ are physiological in the second and third trimes‑ sulin resistance in type 1 diabetes? Diabetes. 2000; 49: 626‑632.  ter of pregnancy. Healthy pregnant women com‑ 5 MazakiT ‑ ovi S, Kanety H, Pariente C, et al. Maternal serum adiponec ‑ tin levels during human pregnancy. J Perinatol. 2007; 27: 77‑81.  pared with nonpregnant controls have significant ‑ 6 Randeva HS, Vatish M, Tan BK, et al. Raised plasma adiponectin levels ly higher serum concentrations of total cholester‑ in type 1 diabetic pregnancies. Clin Endocrinol (Oxf). 2006; 65: 17‑21.  ol, triglycerides, LDL ‑C, HDL ‑C, and apolipopro ‑ 7 Lacroix M, Battista MC, Doyon M, et al. Lower adiponectin levels at first  11 12 teins. Mantzoros et al found a positive corre‑ trimester of pregnancy are associated with increased insulin resistance and higher risk of developing gestational diabetes mellitus. Diabetes Care. 2013; lation between adiponectin and HDL ‑C levels, as 36: 1577‑1583.  well as negative correlations between adiponectin 8 Soheilykhah S, Mohammadi M, Mojibian M, et al. Maternal serum ad‑ values, triglycerides, and non ‑HDL ‑C. The nega‑ iponectin concentration in gestational diabetes. Gynecol Endocrinol. 2009; 25: 593‑596.  tive correlation between serum adiponectin and 9 Gutaj P, Krzyżanowska P, Brązert J, Wender ‑Ożegowska E. Determinants  triglyceride levels found in our study is also con‑ of C ‑reactive protein concentrations in pregnant women with type 1 diabe ‑ sistent with the results reported by Mantzaros tes. Pol Arch Med Wewn. 2016; 126: 230‑236.  et al in nonpregnant women. 10 Berg AH, Combs TP, Scherer PE. ACRP30/adiponectin: an adipokine  regulating glucose and lipid metabolism. Trends Endocrinol Metab. 2002; Ethnic homogeneity (the Caucasian race), a rel‑ 13: 84‑89.  atively small study group, and the fact that an‑ 11 Mazurkiewicz JC, Watts GF, Warburton FG, et al. Serum lipids, li‑ thropometric measurements were performed poproteins and apolipoproteins in pregnant non‑ diabetic patients. J Clin Pathol. 1994; 47: 728‑731.  only during the first trimester (we cannot ex ‑ 12 Mantzoros CS, Li T, Manson JE, et al. Circulating adiponectin levels  clude that adiponectin values could correlate with are associated with better glycemic control, more favorable lipidprofile, and BMI and WHR measured at later stages of preg‑ reduced inflammation in women with type 2 diabetes. J Clin Endocrinol  Metab. 2005; 90: 4542‑4548.  nancy) could be regarded as possible limitations of our research. To conclude, this study demonstrated alter‑ ations to adiponectin concentrations during the pregnancy of women with type 1 diabetes. Our findings demonstrate an association between first ‑ and second ‑trimester adiponectin levels and anthropometric parameters, such as WHR and BMI. Based on the described correlation be‑ tween CRP and adiponectin values, we specu‑ late that chronic low ‑grade inflammation dur ‑ ing pregnancy could be regarded as a potential causative agent in the development of hypoad‑ iponectinemia. The association between adipo ‑ nectin and HbA levels should be investigated 1c in further studies. SuPPLEmEnTARy mATERIAL Supplementary material is available with the article at www.mp.pl/paim. ARTICLE InFoRmATIon no TE PG is a member of Club 35, a Polish Society of Gynecologists and Obstetricians. ACknowLEDgmEnTS We would like to thank our patients for their par‑ ticipation in the study. The study was supported by the Poznan University of Medical Sciences (grant no. 502 ‑14 ‑01 110 141 ‑99 677; to PG) and Pol‑ ish Diabetes Association (PG is a recipient of the Professor Artur Czyżyk  Scientific Grant). ConFLICT oF InTEREST None declared. oPEn ACCESS This is an Open Access article distributed under the terms of the Creative Commons AttributionNonCommercialShareAlike 4.0 Interna‑ tional License (CC BY ‑NC ‑SA 4.0),  allowing third parties to copy and redis‑ tribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distrib‑ uted under the same license, and used for noncommercial purposes only. For commercial use, please contact the journal office at pamw@mp.pl. 254 POLISH ARCHIVES OF INTERNAL MEDICINE 2020; 130 (3) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Polish Archives of Internal Medicine Unpaywall

Determinants of adiponectin levels throughout pregnancy in women with type 1 diabetes mellitus

Polish Archives of Internal MedicineMar 10, 2020

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0032-3772
DOI
10.20452/pamw.15227
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Abstract

RESEARCH LETTER Determinants of adiponectin levels during pregnancy in women with type 1 diabetes mellitus 1* 2 * 1 1 Paweł Gutaj , Rafał Sibiak , Przemysław Wirlstlein, Ewa Wender ‑Ożegowska 1 Department of Reproduction, Poznan University of Medical Sciences, Poznań, Poland 2 Student’s Scientific Society, Poznan University of Medical Sciences, Poznań, Poland Introduction A pregnancy complicated by mater‑ infection, miscarriage, or stillbirth were exclud‑ nal type 1 diabetes is associated with an increased ed from the study. risk of severe perinatal complications. Poorly con‑ Anthropometric data (weight, height, waist and trolled blood glucose levels could lead to numer‑ hip circumference) were collected during the first ous congenital malformations as well as an ele‑ hospitalization. Biological samples were obtained vated risk of early pregnancy loss. The optimal from patients during the 3 planned hospital stays. control of glucose levels could additionally reduce Blood samples were collected after overnight fast‑ the risk of other diabetes ‑associated conditions ing. Adiponectin concentrations were determined such as retinopathy, nephropathy, gestational hy‑ in serum by an enzyme ‑linked immunosorbent 1, 2 pertension, and neonatal acidosis. assay kit (Mediagnost, Reutlingen, Germany). Adiponectin is a type of adipose‑d erived hor ‑ Furthermore, we determined the levels and as‑ mone, which plays a signica fi nt role in the main ‑ sessed the ee ff ct of the following parameters on tenance of systemic metabolic homeostasis. It adiponectin secretion: C ‑reactive protein (CRP), has been reported that changes in adiponectin total cholesterol, high ‑density lipoprotein cho ‑ levels during pregnancy are associated with de‑ lesterol (HDL ‑C), low ‑density lipoprotein choles ‑ creased insulin sensitivity; however, their con‑ terol (LDL ‑C), triglycerides, glycated hemoglobin tribution to lipid metabolism is uncertain. Al‑ (HbA ), creatinine clearance, and estimated glu‑ 1c though the function and regulation of adipose cose disposal rate (eGDR), calculated using the fol‑ tissue hormone secretion were well described in lowing formula: eGDR = 24.31 – (12.22 × WHR) the general population, there have been no stud‑ – (3.29 × HTN) – (0.57 × HbA ), where WHR is 1c ies focusing exclusively on pregnant women with waist ‑to ‑hip ratio, HTN is hypertensive status type 1 diabetes. Therefore, the aim of this study (0 = “no”; 1 = “yes”), and HbA is expressed in %. 1c was to assess the determinants of adiponectin e  Th study protocol was approved by the Insti‑ levels throughout the pregnancy of patients with tutional Ethical Committee of the Poznan Uni‑ type 1 diabetes. versity of Medical Sciences (no. 673/12). Written informed consent was obtained from each patient Correspondence to: Patients and methods A cross ‑sectional study before enrollment. Paweł Gutaj, MD, PhD, of 88 pregnant women with type 1 diabetes Department of Reproduction, Poznan was conducted in the Department of Repro‑ Statistical analysis Statistical analysis was per‑ University of Medical Sciences, ul. Polna 33, 60-535 Poznań, duction at Poznan University of Medical Sci‑ formed using the Statistica software, version 13.3 Poland, phone: +48 61 841 93 34, ences (Poznań, Poland). According to our man‑ (TIBCO Software, Palo Alto, California, United email: pgutaj@o2.pl agement protocol for women with type 1 diabe ‑ States). Testing for normality of data distribution Received: February 22, 2020. tes, patients were admitted to our department 3 was performed using the Shapiro–Wilk test. Dif‑ Revision accepted: March 10, 2020. Published online: March 10, 2020. times during their pregnancy: the first planned ferences in adiponectin levels were analyzed us‑ Pol Arch Intern Med. 2020; admission was scheduled before the end of 12 ing the Friedman test. The analysis of associations 130 (3): 252-254 weeks of gestation; the second, between the 20th between adiponectin concentrations and anthro‑ doi:10.20452/pamw.15227 Copyright by Medycyna Praktyczna, and 24th week; and the third, between the 34th pometric measurements or laboratory results was Kraków 2020 and 39th week. Patients with multiple pregnan ‑ performed using the Spearman rank correlation cy, preterm delivery (before the 34th week), pre ‑ coefficient. The variables that were found to be * PG and RS contributed equally to term prelabor rupture of membranes, ongoing significantly correlated with adiponectin values this work. 252 POLISH ARCHIVES OF INTERNAL MEDICINE 2020; 130 (3) WHR. After the inclusion of WHR, the associ‑ TAbLE 1 Correlations between adiponectin levels and study parameters ations with CRP (P = 0.1) and other parameters Correlation R P value were no longer significant. In both models, a close First ‑trimester WHR –0.31 0.01 to normal distribution of residuals was noted. adiponectin First ‑trimester TG –0.29 0.02 Second trimester In the second trimester, there First ‑trimester hs ‑CRP –0.35 0.005 were negative correlations between adiponectin First ‑trimester daily protein 0.27 0.03 levels and BMI, triglyceride levels, and creatinine urinary secretion clearance. Data are presented in TAbLE 1 . There was Second ‑trimester BMI –0.38 0.02 no correlation between adiponectin levels and adiponectin Second ‑trimester TG –0.48 0.004 WHR (R = –0.2, P = 0.23). Second ‑trimester creatinine –0.36 0.04 clearance Third trimester In the third trimester, adipo‑ Third ‑trimester Third‑trimester HbA 0.44 0.007 1c nectin levels were markedly correlated only with adiponectin HbA levels (TAb LE 1). Body mass index (R = –0.07, 1c P = 0.67) and WHR (R = –0.13, P = 0.44) were not Abbreviations: BMI, body mass index; HbA , hemoglobin A; hs ‑CRP, high ‑sensitivity 1c 1c correlated with adiponectin levels. C ‑reactive protein; TG, triglycerides; WHR, waist ‑to ‑hip ratio Discussion The changes in adiponectin levels were included in the multiple regression analy‑ throughout pregnancy in women with type 1 di‑ sis. Nonnormally distributed variables prior to abetes described in our study were found to be inclusion in multiple regression models were log significant. In contrast to our results, Mazaki‑ transformed. The results were considered signifi ‑ T ‑ ovi et al did not report any differences in ad‑ cant if the estimated P value was lower than 0.05. iponectin levels during pregnancy. The discrep ‑ ancies between studies might be related to dif‑ Results The demographic and clinical charac ‑ ferent inclusion criteria, as their study group in‑ teristics of 88 patients enrolled in this study are cluded women without diabetes. Randeva et al presented in Supplementary material, Table S1 , compared adiponectin levels during pregnancy while the results of laboratory tests, in Supple‑ in women with type 1 diabetes and nondiabetic mentary material, Table S2 . women, and significantly higher adiponectin lev ‑ Median (interquartile range [IQR]) first‑ els were noted in diabetic patients. ‑trimester adiponectin levels were relatively high It has been proved that adiponectin levels in (1.7 µg 4 /ml [9.1–20.2 µg/ml]); then, in the second the general population are negatively correlat‑ trimester, a decrease in adiponectin concentra‑ ed with obesity and increased insulin resistance. tions was observed (. 01 µ 2 g/ml [. 8 – 2 . 41 µ 4 g/ml]). e  Th results of studies conducted in patients with In the third trimester, median (IQR) adiponectin gestational diabetes are consistent with this hy‑ 7, 8 levels returned to those observed in the first tri‑ pothesis. In our study, first ‑trimester adipo ‑ mester (13.9 µg/ml [10.5–20.8 µg/ml]). Our analy ‑ nectin concentrations were negatively correlat‑ sis revealed that the changes in serum adiponectin ed with WHR, and second ‑trimester adiponectin levels during gestation were significant ( P = 0.02). levels were negatively correlated with BMI. We er Th e were no correlations between adiponectin did not observe any signica fi nt correlations be ‑ levels and insulin requirements throughout preg‑ tween third ‑trimester adiponectin levels and obe ‑ nancy or differences in adiponectin concentra ‑ sity. Based on our results and the above studies, tions among patients treated with insulin pumps we can formulate a hypothesis that adiponectin and multiple injections (data not shown). values are more significantly associated with an ‑ thropometric parameters in patients diagnosed First trimester Adiponectin levels measured in with gestational diabetes than in those with type 1 the first trimester of pregnancy were negatively diabetes. This can be explained by much higher correlated with the WHR, but no correlation was rates of overweight and obesity in women with observed with body mass index (BMI; R = –0.24, gestational diabetes. To assess insulin resistance P = 0.06). Additionally, an inverse correlation was in early pregnancy, we used the eGDR. Surpris‑ noted between adiponectin and triglyceride levels. ingly, we did not find any significant correlation Furthermore, there was a negative correlation be‑ between adiponectin values and eGDR. tween adiponectin and CRP levels as well as a pos‑ Abnormal body fat distribution and insulin re‑ itive correlation between adiponectin levels and sistance were found to be the main determinants daily protein urinary secretion. Statistically sig‑ of CRP levels in pregnant patients with type 1 dia ‑ nificant correlations are shown in TAbLE 1 . To as‑ betes. In our study, CRP concentrations were neg‑ sess the association between adiponectin levels atively correlated with first ‑trimester adiponec ‑ and other metabolic and inflammatory parame‑ tin levels. C ‑reactive protein was also included in ters, multiple regression models were developed. the multiple regression analysis models. e  Th as ‑ The first multiple regression analysis model in ‑ sociation between CRP and first ‑trimester adipo ‑ cluded first ‑trimester CRP (P = 0.03) and triglyc ‑ nectin values was no longer significant after ad‑ erides (P = 0.46). The second regression model justment for WHR. Nevertheless, the hypothesis included: first ‑ trimester CRP, triglycerides, and that a low ‑grade inflammation during pregnancy RESEARCH LETTER Adiponectin in pregnant women with type 1 diabetes mellitus 253 How To CITE  Gutaj P, Sibiak R, Wirlstlein P, Wender ‑Ożegowska E. De‑ is responsible for decreasing serum adiponectin terminants of adiponectin levels during pregnancy in women with type 1 di‑ levels could be formulated. abetes mellitus. Pol Arch Intern Med. 2020; 130: 252‑254. doi:10.20452/ Furthermore, third ‑trimester HbA values pamw.15227 1c were found to be positively correlated with third‑ REFEREnCES ‑trimester adiponectin concentrations . In the first part of pregnancy, adiponectin concentra‑ 1 McCance DR, Casey C. Type 1 diabetes in pregnancy. Endocrinol Metab  Clin North Am. 2019; 48: 495‑509.  tions were mainly determined by both BMI and 2 Gutaj P, Mantaj U, Zawiejska A, et al. Maternal risk factors for neonatal WHR, but the situation changed in the late third acidosis in women with type 1 diabetes. Pol Arch Intern Med. 2019; 129: trimester. An increase in blood adiponectin lev‑ 316‑320.  els could sensitize the liver to insulin secretion in 3 Catalano PM, Hoegh M, Minium J, et al. Adiponectin in human preg‑ nancy: implications for regulation of glucose and lipid metabolism. Diabe‑ response to higher mean blood glucose values. tologia. 2006; 49: 1677‑1685.  Significant changes in the serum lipid profile 4 Williams KV, Erbey JR, Becker D, et al. Can clinical factors estimate in‑ are physiological in the second and third trimes‑ sulin resistance in type 1 diabetes? Diabetes. 2000; 49: 626‑632.  ter of pregnancy. Healthy pregnant women com‑ 5 MazakiT ‑ ovi S, Kanety H, Pariente C, et al. Maternal serum adiponec ‑ tin levels during human pregnancy. J Perinatol. 2007; 27: 77‑81.  pared with nonpregnant controls have significant ‑ 6 Randeva HS, Vatish M, Tan BK, et al. Raised plasma adiponectin levels ly higher serum concentrations of total cholester‑ in type 1 diabetic pregnancies. Clin Endocrinol (Oxf). 2006; 65: 17‑21.  ol, triglycerides, LDL ‑C, HDL ‑C, and apolipopro ‑ 7 Lacroix M, Battista MC, Doyon M, et al. Lower adiponectin levels at first  11 12 teins. Mantzoros et al found a positive corre‑ trimester of pregnancy are associated with increased insulin resistance and higher risk of developing gestational diabetes mellitus. Diabetes Care. 2013; lation between adiponectin and HDL ‑C levels, as 36: 1577‑1583.  well as negative correlations between adiponectin 8 Soheilykhah S, Mohammadi M, Mojibian M, et al. Maternal serum ad‑ values, triglycerides, and non ‑HDL ‑C. The nega‑ iponectin concentration in gestational diabetes. Gynecol Endocrinol. 2009; 25: 593‑596.  tive correlation between serum adiponectin and 9 Gutaj P, Krzyżanowska P, Brązert J, Wender ‑Ożegowska E. Determinants  triglyceride levels found in our study is also con‑ of C ‑reactive protein concentrations in pregnant women with type 1 diabe ‑ sistent with the results reported by Mantzaros tes. Pol Arch Med Wewn. 2016; 126: 230‑236.  et al in nonpregnant women. 10 Berg AH, Combs TP, Scherer PE. ACRP30/adiponectin: an adipokine  regulating glucose and lipid metabolism. Trends Endocrinol Metab. 2002; Ethnic homogeneity (the Caucasian race), a rel‑ 13: 84‑89.  atively small study group, and the fact that an‑ 11 Mazurkiewicz JC, Watts GF, Warburton FG, et al. Serum lipids, li‑ thropometric measurements were performed poproteins and apolipoproteins in pregnant non‑ diabetic patients. J Clin Pathol. 1994; 47: 728‑731.  only during the first trimester (we cannot ex ‑ 12 Mantzoros CS, Li T, Manson JE, et al. Circulating adiponectin levels  clude that adiponectin values could correlate with are associated with better glycemic control, more favorable lipidprofile, and BMI and WHR measured at later stages of preg‑ reduced inflammation in women with type 2 diabetes. J Clin Endocrinol  Metab. 2005; 90: 4542‑4548.  nancy) could be regarded as possible limitations of our research. To conclude, this study demonstrated alter‑ ations to adiponectin concentrations during the pregnancy of women with type 1 diabetes. Our findings demonstrate an association between first ‑ and second ‑trimester adiponectin levels and anthropometric parameters, such as WHR and BMI. Based on the described correlation be‑ tween CRP and adiponectin values, we specu‑ late that chronic low ‑grade inflammation dur ‑ ing pregnancy could be regarded as a potential causative agent in the development of hypoad‑ iponectinemia. The association between adipo ‑ nectin and HbA levels should be investigated 1c in further studies. SuPPLEmEnTARy mATERIAL Supplementary material is available with the article at www.mp.pl/paim. ARTICLE InFoRmATIon no TE PG is a member of Club 35, a Polish Society of Gynecologists and Obstetricians. ACknowLEDgmEnTS We would like to thank our patients for their par‑ ticipation in the study. The study was supported by the Poznan University of Medical Sciences (grant no. 502 ‑14 ‑01 110 141 ‑99 677; to PG) and Pol‑ ish Diabetes Association (PG is a recipient of the Professor Artur Czyżyk  Scientific Grant). ConFLICT oF InTEREST None declared. oPEn ACCESS This is an Open Access article distributed under the terms of the Creative Commons AttributionNonCommercialShareAlike 4.0 Interna‑ tional License (CC BY ‑NC ‑SA 4.0),  allowing third parties to copy and redis‑ tribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distrib‑ uted under the same license, and used for noncommercial purposes only. For commercial use, please contact the journal office at pamw@mp.pl. 254 POLISH ARCHIVES OF INTERNAL MEDICINE 2020; 130 (3)

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Published: Mar 10, 2020

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