Renin angiotensin aldosterone system and glycemia in pregnancy.
BACKGROUND
The renin-angiotensin-aldosterone system (RAAS) is involved in the pathogenesis of insulin resistance and type 2 diabetes in the general population. The RAAS is activated during pregnancy. However, it is unknown whether the RAAS contributes to glycemia in pregnant women.


METHODS
Plasma renin activity (PRA) and plasma aldosterone levels were quantified at delivery in 689 Chinese mothers. An oral glucose tolerance test in fasted women was performed in the second trimester of pregnancy. The diagnosis of gestational diabetes mellitus (GDM) and impaired glucose tolerance during pregnancy were made according to the guidelines of the Chinese Society of Obstetrics.


RESULTS
Plasma aldosterone was significantly higher in pregnant women with GDM as compared to those without impairment of glycemic control (normal pregnancies: 0.27 +/- 0.21 ng/mL, GDM: 0.36 +/- 0.30 ng/mL; p < 0.05). Regression analyses revealed that PRA was negatively correlated with fasting blood glucose (FBG) (R2 = 0.03, p = 0.007), whereas plasma aldosterone and aldosterone/PRA ratio were positively correlated with FBG (R2 = 0.05, p < 0.001 and R = 0.03, p = 0.007, respectively). Multivariable regression analysis models considering relevant confounding factors confirmed these findings.


CONCLUSIONS
This study demonstrated that fasting blood glucose in pregnant women is inversely correlated with the PRA, whereas plasma aldosterone showed a highly significant positive correlation with fasting blood glucose during pregnancy. Moreover, plasma aldosterone is significantly higher in pregnant women with GDM as compared to those women with normal glucose tolerance during pregnancy. Although causality cannot be proven in association studies, these data may indicate that the RAAS during pregnancy contributes to the pathogenesis of insulin resistance/new onset of diabetes during pregnancy.
Department of Infectious Diseases, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
You-Peng
YP
Chen
Jian
J
Li
Zi-Neng
ZN
Wang
Christoph
C
Reichetzeder
Hao
H
Xu
Jian
J
Gong
Guang-Ji
GJ
Chen
Thiemo
T
Pfab
Xiao-Min
XM
Xiao
Berthold
B
Hocher
D000328:Adult; D000450:Aldosterone / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism*; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis*; D007333:Insulin Resistance / Q000502:physiology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000502:physiology*
D001786:Blood Glucose; D000450:Aldosterone; D012083:Renin