An elevated blood glucose level and increased incidence of gestational diabetes mellitus in pregnant women with latent toxoplasmosis

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1 doi: Research Article An elevated blood glucose level and increased incidence of gestational diabetes mellitus in pregnant women with latent toxoplasmosis, and Czech Republic Toxoplasma gondii (Nicolle et - vs vs vs = 0.033, odds T. gondii- of gestational diabetes mellitus could have considerable clinical impact as contributors to the development of the metabolic syndrome T. gondii concentration may play a role in T. gondii oral glucose tolerance test Toxoplasma gondii ian protozoan, Toxoplasma gondii ( - on various environmental and sociological factors, including the number of cats in the environment, latitude, moisture, hygienic standards and kitchen habits (Tenter et al. signs, or accompanied by cervical lymphadenopathy with Jones viding tachyzoites in cells of many tissues often progresses spontaneously to the latent phase characterised by probably permanent presence of slowly dividing bradyzoites in tissue cysts in various organs of the host T. gondii could weaken or switch off the mechanism of spontaneous abortions, which is, under normal conditions, responsible for the elimination of embryos with developmental defects and a (statistically) slower fetal growth rate. The hypothesis was later supported by the observed increase in Republic. kankova.sarka@gmail.com This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 with moderate concentrations of anti-toxoplasma antibodies (and probably with recent but already latent infection). proportion of males in the offspring) than controls in the early phase of latent infection. One of possible physiological mechanisms that could be responsible for T. gondii-as- - T. gondii infection were detected in the autoimmune disease type younger ages, but may also point to a protective role of the - similarities in the genetic and environmental risk factors between latent T. gondii infection and diabetes mellitus abetes that is diagnosed during pregnancy and increases the risk of pregnancy and fetal complications (Johns et T. gondii-positive subjects may be mediated by an effect of T. gondii on the concentration of blood glucose. The main purpose of the present study is to search for differences in the blood glucose levels between T. gondii-negative and T. gondii-positive pregnant women and to T. gondii-positive subjects. MATERIALS AND METHODS gestational of blood glucose in three blood samples from each woman col- ter drinking the measured dose of glucose solution. The second whose tolerance test data (blood glucose concentrations) were not - unrelated to the present study, whether they had gestational dia- answer. screening for chromosomal abnormalities, routinely performed in retrospective detection of antibodies against T. gondii. onymised data set. The study was approved by the Ethical Com- Laboratory assessment was performed in a single laboratory - - women were allowed an unrestricted carbohydrate diet for 3 days eat at least eight hours before the test. They were instructed not to take their morning medication, but to wait and take it after the tion of glucose. The second and third blood samples were taken The women remained seated and stayed in the department while undergoing the test. If some glucose was lost by vomiting, the test was terminated. - drink. A positive screening result for gestational diabetes mellitus - - against T. gondii. ed measure analysis, with three dependent variables, namely the min

3 T. gondii-positive and T. gondii-negative pregnant women screened for gestational diabetes A baseline glucose levels B after the glucose drink glucose levels after the glucose drink. three dependent variables were also evaluated separately using a simple An independent continuous variable, gestational weeks, was in- ble and the numbers of women varied between analyses. RESULTS ever, all three measurement data were available only for min after the glucose drink as plasmosis and maternal body mass showed that Toxoplasma gondii-positive women had higher glucose levels in the T. gondii-negative women. The effect of the continuous predictor mater- = 0.003, eta = 0.030). gestational weeks as independent variables showed that T. gondii-positive women had higher levels of fast- CI T. gondii-negative wom- eta gestational weeks (p - T. gondii-positive mothers had higher blood glucose levels T. gondii - (p T. gondii-positive mothers had higher blood glucose levels T. gondii - (p anti-t. gondii T. gondii-positive women (partial Kendall test with maternal age as a covariate: p either at 0 min (p bodies and blood glucose level and the concentration of an-

4 Correlation of anti-toxoplasma gondiicose drink in T. gondii-positive pregnant women screened for gestational diabetes ti-t. gondii drink for T. gondii-negative women (partial Kendall test The difference in the prevalence of gestational diabetes mellitus between T. gondii-positive and T. gondii-negative T. gondii-nega- T. gondii-positive - 2 cantly higher blood glucose levels in the oral glucose toler- el positively covaried with the concentration of anti-toxoplasma gondii antibodies, suggesting that the effects of Toxoplasma gondii-infected women showed higher prevalence of gestational diabetes than T. gondii-free women. Our results, namely the increased blood glucose level T. gondii-infected women these associations may provide new clues to the under- order has important short-term as well as long-term conse- is a predisposition to the development of metabolic syn- fact that a proper lifestyle intervention has been documented to prevent or at least reduce the development of these T. gondii ter. This is probably especially true in the countries with in the Czech Republic). T. gondii strains also needs to be taken into account. Recent studies have shown that the strains of this parasite may differ dramatically in their impact on the physiology, health and also - desirable to perform serological or even genetic typing of T. gondii isolates. Two-tailed statistical tests demonstrat- minutes, but not at the minute) before the glucose drink. It suggests that this effect might be probably linked to an increase in insulin resistance. The present study also showed higher prevalence of T. gondii-infected women. Toxoplasma gondii-positive women had higher body mass before pregnancy than T. gondii - T. gondii positivity on higher prev- - the model with body mass as a covariate. mechanisms underlying the observed associations of the T. gondii infection (Cameron -

5 nipulation of the blood glucose concentration could play Research on the role of glucose in the reproductive function opment of male blastocysts, providing a potential mecha- - he change A study using mice as an animal model for human diabetes has found that an increase in circulating glucose resulted in a male-biased Our present study suggests that T. gondii-infected women have increased blood glucose levels, which is in accordance with our hypothesis suggesting that the glucose concentration plays a role in T. gondii of a positive correlation between the concentration of anti-t. gondii and the blood glucose concentration. The concentration of anti-t. gondii is known to decrease with the time passed since infection. I mosis, i.e. in mice that delivered in the fourth month of the mice in a later phase of infection, i.e. those that deliv- ents, the probability of the birth of a boy was also increased in women with the highest concentrations of anti-t. gondii antibodies while decreased in those with a low concentration of anti-toxoplasma The reduction of the positive effect of T. gondii on the concentration of glucose with decrease of anti-t. gondii antibody level, which was observed in the present study, - Recently, it was suggested that maternal T and poten- breast milk feeding and their encounter with the antigen in mesenteric lymph nodes might play a role in development - suggested that Toxoplasma-containing cells of fetal origin could disseminate the parasite in the maternal organism Toxoplasma increases migration activity of infected leukocytes, which could help spread infection in various tissues of the Toxoplasma gondii infection during gestation and/or after birth may be responsible for development of both - T. gondii caused by chronic infection with the parasite (Krause et anti-t. gondii endothelial function characteristic for the patients with diabetes mellitus may be at least in part due to the preferential T. gondii have focused on the effect of the glucose concentration on lation of non-pregnant women in child-bearing age. The research was supported by research - the Czech Republic. ance test (screening) in pregnancy the recommended practice]. tin in support of the Travers-Willard hypothesis: evidence for a diabetes fact sheet: general information and national estimates Toxoplasma infection on the human personality, physiology, and morphology: pros and cons of the Toxoplasma-human model in studying the manipulation hy changes in human behaviour by the parasitic protozoan Toxoplasma gondii

6 in dendritic cells infected by Toxoplasma gondii Toxoplasma gondii - Toxoplasma gondii infection in - - Toxoplasma have Toxoplasma gondii strain-dependent effects on mouse behaviour. - ti-infectious antibodies and autoimmune-associated autoantibodies in patients with type I diabetes mellitus and their close - Toxoplasma gondii Toxoplasma gondii: striking homogeneous pattern between symptomatic and asymptomatic infections - tibodies directed against brain proteins in patients with autism and their families may be caused by T. gondii and fetal microchimerisms probably play an important role in these processes acting as a Trojan horse in dissemination of - T. gondii and/or after birth may be responsible for development of both - maternal microchimeric T cells targeting fetal antigens in β cells predispose to autoimmune diabetes in the child. J. Autoimmun. Toxoplasma gondii - glukose tolerance in women with prior abnormal glucose tol- runner for the development of maternal and childhood obesity Toxoplasmic encephalomyelititis. III. A new case of granulomatoces encephalomyeliti-