Sharing of cutting-edge applications of PLGF | PLGF and gestational diabetes

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Categories:College of Diagnostics
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Time of issue:2021-05-08
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Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Most of the glucose metabolism of GDM patients can return to normal after delivery, but the probability of developing type II diabetes will increase in the future. The clinical manifestations of pregnant women with gestational diabetes are complicated, and both the mother and the fetus are at risk, and clinical attention should be paid to it.

At present, in order to diagnose gestational diabetes, pregnant women between 24-28 weeks of gestation generally should undergo a sugar screening test. However, with the progress of research, it is found that placental growth factor (PLGF) may be able to indicate the occurrence of gestational diabetes.

The level of PLGF in pregnant women with GDM is higher than that in normal pregnant women

The team of Professor Nicolaides[1] carried out a large-scale prospective and observational study. 31,225 single-fetus pregnant women were included in the group. Each pregnant woman recorded maternal information and tested PLGF and PAPP-A in 11-13 weeks.

Studies have shown that the level of PLGF concentration is elevated (1.053MoM, 95% CI 1.023-1.083) (p=0.004).

This study is compared with two previously published case studies,Three studies have shown that PLGF levels are elevated in pregnant women with GDM,The results are consistent (two previously published studies showed that PLGF levels in pregnant women with GDM increased by about 20% at 11-13 weeks). However, the results of the study showed that adding PLGF to screen for GDM,no improvementGDM detection rate.

In a study conducted by Gorkem et al. [2], 158 24-28 weeksPregnant women were enrolled in the group. Each pregnant woman received the GDM screening test recommended by "ACOG" and was divided into two groups, the GDM group and the normal pregnant group.

The study found,Among pregnant women in the GDM group, PLGF was significantly higher than that of normal pregnant women.

PLGF may affect the development of placenta in pregnant women with GDM

Shi Yabo et al. [3] compared the placental tissues of 20 pairs of normal pregnant women and GDM pregnant women. All study subjects were singletons, and the pregnancy was terminated by cesarean section. Focus on observing the morphological changes of placenta in the two groups, detecting cell apoptosis in the placenta, and detecting the expression of PLGF protein in the placenta. And do the in vitro culture of human chorionic trophoblast cells (HTR-8/SVneo) test to calculate the apoptosis rate of each group.

The study found:

1）In the GDM group, the apoptosis of trophoblast cells in the placenta was significantly reduced, and the activity of Caspase-3 was significantly weakened;

2）The expression of PLGF in the placenta of GDM was significantly higher than that of the control group;

3）High glucose induced an increase in HTR-8/SVneo trophoblast cell apoptosis, and PLGF pretreatment significantly reversed the increase in HTR-8/SVneo trophoblast cell apoptosis induced by high glucose.

The apoptosis of trophoblast cells in the placenta of GDM patients was significantly reduced, while the concentration of PLGF in the placenta increased. In vitro experiments further proved that PLGF can inhibit the increase of HTR-8/SVneo trophoblast cell apoptosis caused by high glucose. Therefore, the high glucose environment induced by GDM can up-regulate the expression level of PLGF in the placenta.It is speculated that PLGF may play a role in the development of GDM placenta.

In existing studies, there is no significant difference in PLGF levels between pregnant women with normal twins and pregnant women with GDM

Maymon et al. [4] compared the levels of PLGF, PAPP-A, hCG, aFP and inhibin A in 145 twin pregnant women (11 of whom developed GDM).

The study found that there was no significant difference in PLGF levels between pregnant women with GDM twins and pregnant women with normal twins.

Studies have shown that there are indeed abnormal expressions of PLGF concentration levels in GDM singleton pregnant women. Whether PLGF can be used as a diagnostic indicator of GDM and whether there is the same level change in twin pregnant women needs more research to prove.

参考文献：

[1] AAS, et al. First-trimester biochemical markers of placentation in screening for gestational diabetes mellitus[J]. Metabolism, 2015, 64( 11):1485-1489.

[2] Gorkem U, et al. Relationship between elevated serum level of placental growth factor and status of gestational diabetes mellitus[J]. Journal of Maternal Fetal & Neonatal Medicine, 2019:1-5.

[3] 史亚波, 等. 胎盘生长因子在妊娠期糖尿病患者胎盘中抑制滋养细胞凋亡的作用研究[J]. 实用妇产科杂志, 2019, 035(001):39-44.

[4]Maymon R, et al. Maternal serum screening marker levels in twin pregnancies affected by gestational diabetes[J]. Archives of Gynecology and Obstetrics, 2018.