SERUM GLP-2 is Increased in Association with Excess Gestational Weight Gain.

OBJECTIVE: Obesity in pregnancy bears unique maternal and fetal risks. Obesity has also been associated with chronic inflammation, including elevated serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Higher serum lipopolysaccharide (LPS) levels have been implicated in driving this inflammation, a phenomenon called metabolic endotoxemia (ME). GLP-2, a proglucagon-derived peptide, is believed to be integral in maintaining the integrity of the intestine in the face of LPS-mediated endotoxemia. We hypothesized that obesity and/or excess weight gain in pregnancy would be associated with an increase in maternal and neonatal markers of ME, as well as GLP-2. STUDY DESIGN: Paired maternal and neonatal (cord blood) serum samples (n = 159) were obtained from our pregnancy biobank repository. Serum levels of LPS, endotoxin core antibody-immunoglobulin M (EndoCAb-IgM), and GLP-2 were measured by ELISA. IL-6 and TNF-α were measured using a Milliplex assay. Results were stratified by maternal body mass index (BMI), maternal diabetes, and gestational weight gain (GWG). RESULTS: Maternal IL-6 is significantly decreased in the obese, diabetic cohort compared with the nonobese, nondiabetic cohorts (95.28 vs. 99.48 pg/mL, p = 0.047), whereas GLP-2 is significantly increased (1.92 vs. 2.89 ng/mL, p = 0.026). Neonatal TNF-α is significantly decreased in the obese cohort compared with the nonobese cohort (12.43 vs. 13.93 pg/mL, p = 0.044). Maternal GLP-2 is significantly increased in women with excess GWG compared with those with normal GWG (2.27 vs. 1.48 ng/mL, p = 0.014). We further found that neonatal IL-6 and TNF-α are negatively correlated with maternal BMI (-0.186, p = 0.036 and -0.179, p = 0.044, respectively) and that maternal and neonatal IL-6 showed a positive correlation (0.348, p < 0.001). CONCLUSION: Although we observed altered levels of markers of inflammation (IL-6 and TNF-α) with maternal obesity and diabetes, no changes in LPS or endoCAb-IgM were observed. We hypothesize that the increased GLP-2 levels in maternal serum in association with excess GWG may protect against ME in pregnancy. KEY POINTS: · Maternal serum levels of GLP-2, a proglucagon-derived peptide, are increased in obese, diabetic gravidae.. · Maternal serum GLP-2 levels are also increased in association with excess gestational weight gain compared with normal gestational weight gain.. · GLP-2 may be increased in association with obesity and weight gain to protect against metabolic endotoxemia in pregnancy..

Platelet Counts in Uncomplicated Pregnancies at Term.

OBJECTIVE: This study aimed to evaluate platelet counts at delivery in uncomplicated pregnancies between 37 and 41 weeks of gestation. STUDY DESIGN: Platelet counts in women 16 to 45 years of age from August 1, 2011, through May 15, 2018, with a singleton pregnancy that delivered from 370/7 to 416/7 weeks of gestation. Women with pregnancy-related complications, preexisting disorders, or on medications that could affect platelet counts were excluded. RESULTS: A total of 18,526 women had uncomplicated pregnancies with mean platelet count from 370/7 to 416/7 weeks of gestation of 220 × 109/L. The lower limit 95th percentile (2.5% quantile) was 120 × 109/L. Platelet counts decreased weekly from 37 to 41 weeks of gestation, becoming significant at 39 weeks of gestation and beyond, compared with 37 weeks (p < 0.01). Mean platelet counts: 225 × 109/L at 37 weeks, 223 × 109/L at 38 weeks, 219 × 109/L at 39 weeks, 218 × 109/L at 40 weeks, and 216 × 109/L at 41 weeks of gestation. Platelet counts of less than 150 × 109/L occurred in 9.7%. CONCLUSION: Platelet counts in uncomplicated pregnancies decrease weekly from 37 to 41 weeks of gestation. This will be important to consider when serial platelet values are monitored for other indications.