Biomarker may predict preeclampsia risk in women with type 1 diabetes
Pregnancy outcomes in women with childhood-onset type 1 diabetes are commonly poor, and a new biomarker could help predict which women may develop preeclampsia, according to two studies presented at the European Association for the Study of Diabetes Annual Meeting.
In the first study, Chris Watson, PhD, of the Centre for Experimental Medicine at Queen’s University Belfast in the United Kingdom, and colleagues evaluated data from the MAMPED cohort on 62 pregnant women with type 1 diabetes who did (n = 23) or did not (n = 21) develop preeclampsia and 18 healthy controls. Participants with diabetes were matched for age, disease duration, HbA1c levels and parity.
Watson and colleagues sought to determine the utility of leucine-rich alpha-2-glycoprotein-1 (LRG1), a marker of inflammation and angiogenesis, as a predictor for preeclampsia in the participants. Researchers collected plasma samples after overnight fasts at three study visits and analyzed them for LRG1.
“We have identified LRG1 as a novel blood-based biomarker that can predict the development of preeclampsia in women with diabetes,” Watson told Endocrine Today. “This biomarker occurs early in pregnancy and before the onset of clinical symptoms.”
Participants with type 1 diabetes who developed preeclampsia had significantly increased LRG1 protein levels at the second study visit (mean LRG1 level, 50.7 µg/mL) compared with participants with type 1 diabetes who did not develop preeclampsia (mean LRG1 level, 40.8 µg/mL; P < .01).
The risk for preeclampsia was 9% higher with each unit increase in LRG1 at study visit 2 in the multivariable analysis (P = .03).
“Having a test that could be used in women with diabetes, either before pregnancy or in the early stages of pregnancy, that can predict the likelihood of developing complications, such as preeclampsia, even before the onset of clinical symptoms would be of great clinical value,” Watson said. “Early risk-stratification would allow for personalized and intensified patient monitoring. This could support the allocation of limited health care resources to be focused on those who require the most. Early identification would also allow for timely interventions.”
In a separate study, Lowri Allen, PhD, of the Diabetes Research Group at Cardiff University in the United Kingdom, and colleagues evaluated data from the Brecon Cohort, which was linked to multiple national datasets in the Secure Anonymized Information Linkage data bank, on legal births among women younger than 35 years between 1995 and 2013. Overall, 197,796 births were included; 330 were to mothers with childhood-onset type 1 diabetes. Researchers sought to compare pregnancy outcomes in women with and without type 1 diabetes.
Participants with childhood-onset type 1 diabetes were more likely to experience preeclampsia (OR = 3.31; 95 CI, 2.46-4.46), preterm birth (OR = 11.3; 95% CI, 9.09-14.06), macrosomia (OR = 1.8; 95% CI, 1.35-2.4) and stillbirths (OR = 10.5; 95% CI, 6.12-18.01) compared with participants without diabetes. Infants of participants with childhood-onset type 1 diabetes were more likely to be large for gestational age (OR = 2.28; 95% CI, 1.7-3.05), have a low birth weight (OR = 2.45; 95% CI, 1.83-3.28) or congenital malformations (OR = 2.88; 95% CI, 1.99-4.18) and require hospital admission during the first year of life (OR = 3.35; 95% CI, 2.68-4.19) compared with infants of participants without diabetes.
“Our data shows that pregnancy outcomes remain poor in mothers with childhood-onset type 1 diabetes despite significant advances in diabetes and obstetric care,” Allen told Endocrine Today. “We have shown that pregnancy in the context of maternal childhood-onset type 1 diabetes carries an increased risk of mortality due to a threefold increase in the risk of stillbirth, as well as an excess of maternal and neonatal morbidity, for example, due to preeclampsia, preterm birth and congenital malformations. Some of these adverse outcomes may cause lifelong health programs, and also have the potential to cause detrimental effects on psychological and socioeconomic well-being. In addition, the excess of adverse pregnancy outcomes observed amongst pregnancies in women with childhood onset type 1 diabetes have implications for the planning and delivery of health care services.” – by Amber Cox
Allen L, et al. Poster 931.
Cheung AHY, et al. Poster 921. Both presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 11-15, 2017; Lisbon, Portugal.
Disclosure s : Allen reports she receives grants from the Diabetes Research and Wellness Foundation. Watson reports no relevant financial disclosures.