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Published on: May 21, 2015
Perinatal consequences of maternal-fetal Rh blood group interaction in diabetic pregnancy: a nonimmunological
1Department of Preventive and Social Pediatrics, University of Rome Tor Vergata, School of Medicine, Italy. bottini64@med.uniroma2.it
Insights
Maternal RhD protein levels influence pregnancy outcomes in diabetic mothers. Higher maternal RhD protein protects fetuses from glucose toxicity, reducing fetal loss and high birth weight, particularly in RhD-negative newborns.
Area of Science:
- Obstetrics and Gynecology
- Immunology
- Endocrinology
Background:
- Recent findings suggest Rh protein has a transport function.
- A correlation exists between Rh(D) protein and glycosylated hemoglobin in diabetes.
Purpose of the Study:
- Evaluate perinatal outcomes of maternal-fetal Rh blood group interactions in diabetic pregnancies.
- Examine the metabolic perspective of these interactions.
Main Methods:
- Studied 132 women with gestational diabetes and 120 with insulin-dependent diabetes mellitus.
- Used 387 nondiabetic women as controls.
Main Results:
- Observed increased mother Rh(+)/newborn Rh(-) and decreased mother Rh(-)/newborn Rh(+) phenotypes in diabetic pregnancies.
- Mother Rh(+)/newborn Rh(-) associated with lower fetal loss and birth weight.
- Mother Rh(-)/newborn Rh(+) associated with increased fetal loss and birth weight.
Conclusions:
- Higher maternal RhD protein density may protect fetuses from glucose toxicity.
- Conversely, higher fetal RhD protein density increases fetal susceptibility to glucose effects.
Background:
The recent discoveries about the structure of Rh protein that suggest a transport function and the recent observations of a positive correlation between Rh(D) protein and glycosylated hemoglobin levels in non-insulin-dependent diabetes mellitus prompted us to review our data on diabetic pregnancy to evaluate the perinatal consequences of maternal-fetal Rh blood group interactions in a metabolic perspective.
Subjects And Methods:
One hundred thirty-two women with gestational diabetes and 120 women with preexisting insulin-dependent diabetes mellitus were examined. Three hundred eighty-seven consecutive nondiabetic puerperae from the same population were considered control subjects.
Results:
In both gestational and insulin-dependent diabetes mellitus, an increased proportion of mother Rh(+)/newborn Rh(-) and a decreased proportion of mother Rh(-)/newborn Rh(+) joint phenotype has been observed. No deviation has been observed for joint phenotypes in which mother and newborn are similar [ie, Rh(+)/Rh(+) and Rh(-)/Rh(-)]. In the situation of mother Rh(+)/newborn Rh(-), there is a relatively lower rate of fetal loss and a decreased tendency to high birth weight. On the contrary, in pairs mother Rh(-)/newborn Rh(+) the fetus shows an increase of fetal loss and of tendency to high birth weight.
Conclusions:
The results are compatible with the hypothesis that when the density of Rh protein in the mother is higher than that in the fetus, the conceptus is relatively protected against the toxic effect of glucose. In the opposite genotypic combination (ie, density of Rh protein higher in the fetus than in the mother), the fetus is relatively more susceptible to these effects.
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