BIOCHEMICAL MARKERS RELATED TO DIABETIC MYOPATHY DURING TWO-TIME POINTS IN PREGNANT WOMEN DIAGNOSED WITH GESTATIONAL DIABETES MELLITUS

M. Vieira Cunha Rudge1, R. L.S. Hallur1, S. M. B. Costa1, T. Pascon1, S. Kenickel Nunes1, M. Jacomin1, C. Baldini Prudencio1, I. M. P. Calderon1, A. Mércia Pascon Barbosa1,2
1Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, Sao Paulo State, Brazil, Department of Gynecology and Obstetrics, Botucatu, Brazil, 2School of Philosophy and Sciences, São Paulo State University (UNESP), Department of Physiotherapy and Occupational Therapy, Marilia, Brazil

Background: Gestational diabetes mellitus (GDM) is a serious pregnancy complication. According to the most recent (2017) International Diabetes Federation (IDF) estimates, GDM affects approximately 14% of pregnancies worldwide, representing approximately 18 million births annually. Gestational diabetes mellitus (GDM) as well as mild gestational hyperglycemia (MGH) are related to adverse short and long-term outcomes on the maternal and fetal health Diabetic myopathy is a universal complication of diabetes and is related to the loss of muscle mass and strength (i.e., sarcopenia and dynapenia).

Purpose: We hypothesized that the changes in glucose, hormones and macro-minerals level together could help in better understanding of the biochemical and metabolic abnormalities in GDM. The aim of this study was to compare the biochemical markers, hormonal and macro-element changes related to diabetic myopathy among pregnant women with GDM and non-GDM during 24-28 and 36-40 weeks gestation.

Methods: This study was conducted at Perinatal Diabetes Research Center -University Hospital of Botucatu Medical School. Pregnant women (24–28 weeks gestation) with GDM screening were included. The blood was collected from GDM and non-GDM pregnant women on 24-28 and 36-40 weeks gestation for analysis in clotting tubes and allowed the blood to clot for a minimum of 30 minutes. The serum samples were separated and analyzed for the estimation of glucose, cortisol, insulin, PTH, calcitonine, phosphorous, potassium, calcium, sodium, magnesium, vitamin A and vitamin D on the sample day of collection. The Insulin, Calcitonine, Cortisol, and PTH were estimated by using IMMULITE 2000 XPi Immunoassay System (Siemens, Brazil), The Glucose, Phosphorous, Potassium, Calcium, Sodium, Magnesium, Vitamin A were estimated by using VITROS® 4600 System and The Vitamin D was analyzed by using ARCHITECT i2000SR analyzer (Abbott, Brazil). The Vitamin A was analyzed by using HPLC (High-performance liquid chromatography). 

Results: Biochemical, hormonal and macro-elements changes during 24-28 weeks gestation among non-GDM and GDM pregnant women showed that the levels of glucose (p= 0.000), insulin (p<0.001) and calcium (p<0.026) were significantly elevated in women with GDM as compared to women without GDM. There was no stastically significant difference was found for the variables such as cortisol, PTH, calcitonin, phosphorus, potassium, sodium, magnesium, vitamin D and vitamin A. Glucose (p=0.000) and calcium (p<0.002) levels were significantly elevated in women with GDM as compared to women without GDM during 36-40 weeks gestation. For the other variables such as cortisol, insulin, PTH, calcitonin, phosphorus, potassium, sodium, magnesium, vitamin D and vitamin A didn’t show differences in their levels among the groups.

Conclusion(s): In conclusion, elevated glucose, insulin and calcium levels in during two-time points of gestation increases the risk of adverse pregnancy outcome. Vitamin D, parathyroid hormone (PTH), and various other hormones are known for their function in maintaining calcium and phosphorous homeostatic. 

Implications: Micronutrients play various important roles in pregnancy, and lack of each one causes irreversible complications in both the mother and foetus. It is suggested that these variables can be analyzed during different time points of postpartum. Further studies are warranted to determine the association between the different parameters and their involvement in development of complications.

Funding, acknowledgements: This work was supported by grant #2012/25060-3 and #2016/01743-5 , São Paulo Research Foundation (FAPESP)/Brazil.

Keywords: myophathy, diabetes, pregnancy

Topic: Musculoskeletal

Did this work require ethics approval? Yes
Institution: Botucatu Medical School - UNESP
Committee: Research Ethics Committee of Botucatu Medical School - UNESP
Ethics number: 20639813.0.0000.5411


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