There are several treatments for mothers with gestational diabetes mellitus (GDM), but there is no one treatment of choice or preferred protocol. Ort and colleagues (pp 338–345) compared the gene expression profiles of 20 expectant obese mothers to understand how these patients can maintain a steady glucose level during pregnancy. The patients fell into three groups: those who did not have GDM; those who were treated for GDM by modified diet alone; and, those who received insulin treatment. Genes identified as treatment sensitive and insulin responsive showed that obese pregnant women undergoing insulin treatment with dietary restrictions (or combination therapy) were restored to normal glucose levels more so than with one single therapy. Furthermore, this combination therapy restored gene expression profiles closer to normal and ultimately lowered the chance for adverse pregnancy results.
Polymorphisms related to estrogen metabolism may have an effect on lipid levels in women. To examine the connection, Almeida and colleagues (pp 346–351) studied 472 women of European descent categorized as premenopausal, postmenopausal and undergoing hormone replacement therapy (HRT), or postmenopausal without HRT. The authors identified two allele variants related to estrogen metabolism: CYP1A1*2C, associated with elevated levels of LDL in premenopausal women, and CYP3A4*1B, associated with lower levels of LDL in postmenopausal women undergoing HRT. This is the first step in addressing genetic associations between postmenopausal estrogen levels, cardiovascular risk factors, as well as risks related to HRT.
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