Renin Angiotensin Aldosterone System and Glycemia in Pregnancy
You-Chen, P.; Li, J.; Zi-Wang, N.; Reichetzeder, C.; Xu, H.; Gong, J.; Guang-Chen, J.; Pfab, T.; Xiao-Xiao, M.; Hocher, B.
Clinical Laboratory 58(5-6): 527-533
2012
ISSN/ISBN: 1433-6510 PMID: 22783584 Document Number: 14638
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 2 = 0.03, p = 0.007), whereas plasma aldosterone and aldosterone/PRA ratio were positively correlated with FBG (R 2 = 0.05, p 2 = 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.
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