Apelin levels in pregnant women with and without gestational diabetes mellitus: a collaborative systematic review and meta-analysis

Abstract

Aims: This systematic review and meta-analysis investigated maternal apelin levels in pregnant women with and without GDM. Secondary outcomes were glucose- and lipid-related results.Methods: Databases including PubMed, Embase, Cochrane Library, LILACS, CNKI, and Wang Fang were searched. The methodological quality of included studies was evaluated with the Newcastle-Ottawa Scale. Mean differences (MDs) or standardized MDs (SMDs) with their 95% confidence intervals (CIs) were evaluated. Random effect model analyses were carried out and heterogeneity with the I² and Tau² statistics.Results: Fourteen observational studies (sample size: 1033 women with GDM and 1053 for control women) with a low or moderate risk of bias were included in the analysis. During the second half of pregnancy, maternal apelin estimate was significantly higher in women with GDM (SMD = 0.64; 95% CI: 0.03 to 1.25), as well as insulin (SMD = 1.41% CI: 0.84 to 1.99), glucose (SMD = 1.56; 95% CI 1.20 to 1.91), glycated hemoglobin (SMD = 1.11, 95% CI: 0.69 to 1.54), HOMA-IR (MD = 2.25; 95%CI: 1.51 to 2.98), BMI (MD = 0.80 kg/m², 95%CI: 0.52 to 1.08), total cholesterol (SMD = 0.42, 0.12 to 0.73), LDL-cholesterol (SMD = 0.63, 95%CI: 0.23 to 1.02), and triglycerides (SMD = 0.40, 95%CI: 0.19 to 0.61) as compared to control women. There was heterogeneity between studies as evidence by high I² values. Meta-regression analysis indicated statistically significant regression coefficients for age of women, glucose and total cholesterol.Conclusions: GDM was associated with increased circulating apelin, insulin, glucose, glycated hemoglobin, total cholesterol, LDL-cholesterol levels, and HOMA-IR index.

摘要

目的

本系统综述和荟萃分析研究了妊娠期和非妊娠期糖尿病孕妇的Apelin水平。次要结果是血糖和血脂相关的结果。

方法

：检索PubMed、Embase、Cochrane Library、Lilacs、CNKI、Wang Fang等数据库。采用纽卡斯尔-渥太华量表评价纳入研究的方法学质量。评估其95%可信区间的平均差异(MDS)或标准化MDS（SMDs）。用I2和TAU2统计量进行随机效应模型分析和异质性分析。

结果

14项观察性研究（样本量：1033名GDM患者和1053名对照组妇女）具有低或中等偏倚风险被纳入分析。在妊娠后半期, 妊娠期糖尿病患者Apelin值(SMD=0.64；与对照组相比, 95%CI:0.03-1.25)、胰岛素(SMD=1.41%CI:0.84-1.99)、血糖(SMD=1.56；95%CI:1.20-1.91)、糖化血红蛋白(SMD=1.11,95%CI:0.69-1.54)、HOMA-IR(MD=2.25；95%CI:1.51-2.98)、BMI(MD=0.80kg/m2,95%CI:0.52-1.08)、总胆固醇(SMD=0.42,0.12-0.73)、LDL-胆固醇(SMD=0.63,95%CI:0.23-1.02)、甘油三酯(SMD=0.40,95%CI:0.19-0.61）较非GDM患者显著升高。研究之间存在异质性, 高I2值证明了这一点。 Meta回归分析显示, 女性年龄、血糖和总胆固醇的回归系数有显著统计学意义。

结论

GDM与循环Apelin、胰岛素、血糖、糖化血红蛋白、总胆固醇、LDL-胆固醇水平及HOMA-IR指数升高有关。

Keywords:

• Apelin
• body mass index
• gestational diabetes mellitus
• glucose
• insulin
• HOMA-IR
• lipids
• meta-analysis

关键词:

• Apelin
• 体重指数
• 妊娠期糖尿病
• 血糖
• 胰岛素
• HOMA-IR
• 脂类
• 荟萃分析

Acknowledgements

The authors thank Ms. M. Salas Valero for assistance with the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Author contribution

FRPL, GRPR, and MTLB are responsible for the study concept and design, data extractions of studies and the risk of bias of studies. They wrote the first version of the entire document. JNW and LY performed the inclusion and exclusion assessment, data extraction, and the risk of bias of studies published in Chinese. They also revised the manuscript content and approved the final vesion. GPR, FRPL, and SRV participated in different steps of statistical procedures. All authors assisted with co-writing and edition of the manuscript.

Data availability statement

The data that support the findings of this study have been previously reported in the meta-analyzed articles. The entire procedure of of this systematic review and meta-analysis is included in the manuscript, tables, figures, and supplemental tables and figures as appendix of the manuscrit.

Funding

The author(s) reported there is no funding associated with the work featured in this article.