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  • Title: [Interaction between HLA-DRB1 gene polymorphism and environmental risk factors in the development of gestational diabetes mellitus].
    Author: Wang M, Zhang L, Liu X.
    Journal: Zhonghua Fu Chan Ke Za Zhi; 2014 Apr; 49(4):270-5. PubMed ID: 24969334.
    Abstract:
    OBJECTIVE: To explore the interactions between human leukocyte antigen (HLA) -DRB1 gene polymorphism and environmental risk factors in gestational diabetes mellitus (GDM) pathogenesis. METHODS: Pregnant women who had prenatal cares in Obstetric Department, West China Second Hospital of Sichuan University were recruited from January 1(st) to December 31(st) in 2011. A prospective cohort study was conducted in the women who had a glucose challenge test (GCT) or 75 g oral glucose tolerance test (OGTT) during 24-28 gestational weeks. A total of 104 women diagnosed with GDM were randomly included in GDM group while another 103 normal women fell into the control group. The HLA-DRB1 polymorphism was detected by Polymerase Chain Reaction - Sequence Specific Primers (PCR-SSP) method in both groups. The interactions between HLA-DRB1 polymorphism and environmental risk factors were analyzed based on the simple-case-study method. RESULTS: (1) There were 712 pregnant women with complete perinatal information during January 1(st) to December 31(st) , 2011, among whom 175 (24.6%) women were diagnosed with GDM. A logistic regression analysis showed that advanced maternal age (OR = 1.081, 95%CI: 1.027- 1.138), imbalanced diet (OR = 3.329, 95%CI: 2.167-5.116), high body mass index (BMI ≥ 24.0 kg/m(2)) before pregnancy (OR = 1.095, 95%CI:1.008-1.190), HBsAg carrier status (OR = 3.173, 95%CI: 1.387-7.260) and family history of diabetes mellitus (DM) (OR = 1.798, 95%CI: 1.063-3.041) were risk factors of GDM. (2) There were 49 HLA-DRB1 genotypes and 51 HLA-DRB1 genotypes in GDM group and the control group, respectively. We further compared the genotypes that occurred in over 3 cases in either group and found that HLA-DRB1*12, 16 was only detected in 5 cases (5/103, 4.9%) in control group, and the difference was significant between the two groups (P = 0.029). HLA-DRB1*11, 16 and HLA-DRB1*09,09 were only detected in 4 cases (3.8%, 4/104) and 5 cases (4.8%, 5/104) in GDM group respectively, but without significant differences between the two groups (P > 0.05). No significant difference was found in other genotype frequencies between the two groups (P > 0.05). (3) Thirteen types of HLA-DRB1 allele were detected but no significant differences were observed in their frequencies between two groups (P > 0.05). (4) A positive interaction was detected between HLA-DRB1*07 polymorphism and advanced maternal ages (OR = 5.952, 95%CI:1.314-26.970, P = 0.022), while no interaction was found between HLA-DRB polymorphisms to other risk factors such as imbalanced diet, high body mass index (BMI ≥ 24.0 kg/m(2)), HBsAg carrier status or DM family history. CONCLUSIONS: Advanced maternal age, unbalanced diet, high body mass index (BMI ≥ 24.0 kg/m(2)), HBsAg carrier status and DM family history are environmental risk factors of GDM in Chengdu. While HLA-DRB1*12, 16 genotype may be a protective genotype for GDM. There is a positive interaction between HLA-DRB1*07 polymorphism and advanced maternal age which may play a critic role in GDM development.
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