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 University Faculty of Medicine, Obstetrics and Gynecology 2- ZTB Maternal Health Training and Education Hospital

INTRODUCTION- OBJECTIVE Placental growth factor (PlGF) secreted by the syncytiotrophoblast is found in the maternal circulation beginning in the sixth week of gestation. Placental growth factor [PlGF] is a placenta- derived angiogenic protein involved in the regulation of placental vascular development [1]. 1- Maynard SE, et al. J Clin Invest 2003;111: 649–58.

PlGF has been extensively investigated as a first trimester biomarker for pregnancy complications related to impaired placentation such as preeclampsia and birth weight deviations [2-4]. Also, inclusion of serum PlGF improves the performance of first-trimester screening test for trisomy 21 [5]. . 2- Levine RJ, et al. N Engl J Med 2004;350:672–83. 3- Akolekar R, et al.Ultrasound Obstet Gynecol 2008;32:732–9. 4- Poon LC, et al. Prenat Diagn 2008;28:1110–5. 5- Pandya P, et al. Fetal Diagn Ther 2012;31:87–93.

Previous studies by Ong and Syngelaki et al Previous studies by Ong and Syngelaki et al. found increased serum PlGF levels in gestational diabetes (GDM) [6,7]. A recently published study also presented significantly higher first-trimester PlGF values in the GDM group [8] . Another recent study did not find a relationship between PLGF measured at 11–14 weeks and subsequent GDM among 328 women recruited prospectively [9]. 6- Syngelaki A, et al. Metabolism. 2015;64(11):1485– 9. 7- Ong CY, et al. J Reprod Med. 2004;49(6):477–80. 8- Eleftheriades M, et al. Metabolism 2014; 63: 1419–1425. 9- Mosimann B et al. . Fetal Diagn Ther. 2016;39:287–91.

At present, these findings remain contradictory. However, newer data found that serum PlGF was decreased in women with diabetes mellitus type 1 and in those with type 2 disease [8]. At present, these findings remain contradictory. Therefore, we aimed to investigate the associations of maternal serum placental growth factor (PlGF) levels with gestational diabetes mellitus (GDM). 8- Tsiakkas A, et al. Ultrasound Obstet Gynecol 2015; 45: 591–598.

MATERIAL-METHODS This cross-sectional study was underwent in the Obstetrics and Gynecology Department of Hitit University between March, 2015 and September, 2015. A total of 158 pregnant women were screened between 24 and 28 weeks of gestation. All of the low risk pregnant women were evaluated with a 50-g glucose challenge test (GCT). Women with serum glucose ≥ 140 mg/dL at 1 h after GCT were subjected to a 100-g oral glucose tolerance test (OGTT).

Pregnant women who met the inclusion criteria were divided into two groups; 76 of the GDM group, 82 of the control group. Maternal serum concentrations of PlGF, insulin and homeostasis model assessment- insulin resistance(HOMA-IR) were assessed.

Vasculogenesis and angiogenesis are essential for placental development and the VEGF family has been shown to play a key role [10]. A recent meta-analysis of studies investigating postpartum placental histology derived from pregnancies complicated by GDM demonstrates that there is increased placental volume, higher incidence of villous immaturity and increased angiogenesis [11]. 10- Geva E, et al. J Clin Endocrinol Metab 2002; 87:4213–4224. 11- Huynh J, et al. Placenta 2015; 36: 101–114.

Particularly the fetoplacental vasculature and endothelium were shown to be susceptible to hyperglycemia [12]. Fetal hyperinsulinism as a result of maternal hyperglycemia stimulates placental angiogenesis [13]. Therefore, an increase in angiogenic markers such as PlGF might be a consequence of these alterations. 12- Cvitic S, et al. Biomed Res Int 2014; 2014: 145846. 13- Lassance L, et al. J Clin Endocrinol Metab 2013; 98:e1438–e1447.

CONCLUSION We revealed that the serum PlGF levels were significantly increased in pregnants with GDM. PlGF seems to have a role in pathogenesis and early GDM diagnosis. Early identification of women at high risk for GDM could lead to an earlier diagnosis of the condition and improve the pregnancy outcomes.

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