Correlation of serum vitamin D, adipose tissue vitamin D receptor, and peroxisome proliferator-activated receptor γ in women with gestational diabetes mellitus

Background:Gestational diabetes mellitus(GDM)is a common complication during pregnancy.Obesity and overweight are closely related to metabolic diseases and diabetes.However,the role of adipose tissue in the pathogenesis of GDM remains to be studied.The aim of this study was to investigate the correlation of vitamin D(VD)levels,VD receptor(VDR),and peroxisome proliferatoractivated receptor g(PPARg)expression with GDM in overweight or obese women.Methods:One hundred and forty pregnant women with full-term single-birth cesarean-section were selected as the study subjects and grouped(70 GDM women,including 35 non-overweight/non-obese women[group G1]and 35 women with overweight or obesity[group G2];70 pregnant women with normal glucose tolerance,including 35 non-overweight/non-obese women[group N1]and 35 overweight/obese women[group N2]).The levels of serum VD,blood biochemistry,and adiponectin were compared in these women.Subcutaneous adipose tissue was isolated from the abdominal wall incision.VDR and PPARg messenger RNA(mRNA)transcript levels in these adipose tissues were quantified by real-time polymerase chain reaction.The differences between the levels of PPARg protein and phosphorylated PPARg Ser273 were detected by Western blotting.Results:The serum VD level ofGDM women was lower in comparison to that of women with normal glucose tolerance(G1 vs.N1:20.62±7.87 ng/mL vs.25.85±7.29 ng/mL,G2 vs.N2:17.06±6.74 ng/mL vs.21.62±7.18 ng/mL,P<0.05),and the lowest in overweight/obese GDM women.VDR and PPARg mRNA expression was higher in the adipose tissues of GDM women in comparison to that of women with normal glucose tolerance(VDR mRNA:G1 vs.N1:210.00[90.58–311.46]vs.89.34[63.74–159.92],G2 vs.N2:298.67[170.84–451.25]vs.198.28[119.46–261.23],PPARg mRNA:G1 vs.N1:100.72[88.61–123.87]vs.87.52[66.37–100.04],G2 vs.N2:117.33[100.08–149.00]vs.89.90[76.95–109.09],P<0.05),and their expression was the highest in GDM+overweight/obese women.VDR mRNA levels positively correlated with the pre-pregnancy body mass index(BMI),pre-delivery BMI,fasting blood glucose(FBG),homeostasis model assessment of insulin resistance(HOMA-IR),and PPARg mRNA while it negatively correlated with the VD and the adiponectin levels(r=0.395,0.336,0.240,0.190,0.235,–0.350,–0.294,respectively,P<0.05).The degree of PPARg Ser273 phosphorylation increased in obese and GDM pregnant women.PPARg mRNA levels positively correlated with pre-pregnancy BMI,pre-delivery BMI,FBG,HOMA-IR,serum total cholesterol,triglyceride,free fatty acid,and VDR mRNA,while it negatively correlated with the VD and adiponectin levels(r=0.276,0.199,0.210,0.230,0.182,0.214,0.270,0.235,–0.232,–0.199,respectively,P<0.05).Conclusions:Both GDM and overweight/obese women had decreased serum VD levels and up-regulated VDR and PPARg mRNA expression in adipose tissue,which was further higher in the overweight or obese women with GDM.VDmay regulate the formation and differentiation of adipocytes through the VDR and PPARg pathways and participate in the occurrence of GDM.

Intravaginal Misoprostol for Cervical Ripening and Labor Induction in Nulliparous Women： A Double-blinded, Prospective Randomized Controlled Study

Background： In China, no multicenter double-blinded prospective randomized controlled study on labor induction has been conducted till now. This study is to evaluate the efficacy and safety ofintravaginal accurate 25-μg misoprostol tablets for cervical ripening and labor induction in term pregnancy in nulliparous women. Methods： This was a double-blinded, prospective randomized controlled study including nulliparous women from 6 university hospitals across China. Subjects were randomized into misoprostol or placebo group with the sample size ratio set to 7：2. lntravaginal 25-μg misoprostol or placebo was applied at an interval of 4 h （repeated tip to 3 times） for labor induction. Primary outcome measures were the incidence of cumulative Bishop score increases ≥3 within 1211 or vaginal delivery within 24 h. Safety assessments included the incidences of maternal morbidity and adverse fetal/neonatal outcomes. Results： A total of 173 women for misoprostol group and 49 women for placebo were analyzed. The incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h was higher in the misoprostol group than in the placebo （64.2% vs. 22.5%, relative risk [RR]： 2.9, 95% confidence interval [C/]： 1.4-6.0）. The incidence of onset of labor within 24 h was significantly higher in the misoprostol group than in the placebo group （48.0% vs. 18.4%, RR： 2.6, 95% CI： 1.2-5.7）; and the induction-onset of labor interval was significantly shorter in the misoprostol group （P = 0.0003）. However, there were no significant differences in the median process time of vaginal labor （6.4 vs. 6.8 h; P = 0.695）, incidence （39.3% vs. 49.0%, RR： 0.8, 95% CI： 0.4-1.5） and indications （P = 0.683） of cesarean section deliveries, and frequencies of maternal, fetal/neonatal adverse events between the groups. Conclusion： Intravaginal misoprostol 25 μg every 4 h is efficacious and safe in labor induction and cervical ripening.