- Research
- Open access
- Published:
Impact of gene polymorphism of glutathione S-transferase and ghrelin as a risk factor in Egyptian women with gestational diabetes mellitus
Egyptian Journal of Medical Human Genetics volume 23, Article number: 15 (2022)
Abstract
Background
Gestational diabetes mellitus is the most common metabolic dysfunction that arises during pregnancy. GDM can lead to serious health complications for both the mother during pregnancy and after the delivery of the baby. Additionally, mother–offspring suffers from abnormalities in metabolism. The study aimed to investigate glutathione S‑transferase P1 and ghrelin genetic variants in pregnant women diagnosed with gestational diabetes using a tetra-primer amplification refractory mutation system.
Results
This study demonstrated that the frequencies of genotypes in women with GDM were GSTP1-AG (87.1%) and GHRL-GG (100%). The study revealed no significant differences in the frequency of either genotype or allele of both GSTP1 and ghrelin between GDM and healthy pregnant women.
Conclusions
This study may be the first study designed to demonstrate that there is no association between the genotype and allele frequencies of GSTP1 (rs1695) and ghrelin (rs696217) in the development of gestational diabetes mellitus in Egyptian women.
Background
Gestational diabetes mellitus (GDM) is the most common metabolic dysfunction of pregnant women detected in the second or third trimester of pregnancy. In recent decades, GDM has been identified in 35% of pregnant women throughout the world [1]. GDM can cause hyperglycemia, macrosomia, high blood pressure, pre-eclampsia, premature birth, and stillbirth at the end of pregnancy [2]. It is not caused by a lack of insulin but by partially blocking the effect of insulin (known as insulin resistance) by various other hormones produced by the placenta, including steroid hormones (progesterone, estradiol, and cortisol) and peptide placental hormone (human chorionic somatomammotropin (HCS) [3, 4]. Insulin resistance leads to metabolic disorders causing dyslipidemia such as high levels of total cholesterol, triglycerides, LDL-cholesterol, and low levels of HDL-cholesterol. However, hyperlipidemia is a hallmark of the second half of pregnancy to improve fetal growth [5].
Glutathione S-transferase P1 (GSTP1) gene maps on the long arm of chromosome 11, which is composed of seven exons. In humans, GSTP1 exists as a dimer of identical subunits where each subunit contains 210 amino acid residues and two binding sites [6]. GSTP1 polymorphism (rs1695) is distinguished by an adenine to guanine substitution leading to isoleucine (Ile) to valine (Val) exchange at position 105 of the coding region [7]. The glutathione S-transferases (GSTs) are isoenzyme superfamilies that detoxify toxic substances and protect macromolecules from reactive electrophiles, reactive oxygen species, chemotherapeutic agents, and environmental carcinogens [8].
The short arm of chromosome 3 (3p25-26) contains the sequence for the ghrelin (GHRL) gene. GHRL is composed of four exons encoding a precursor of preproghrelin (117-aa) [9]. Ghrelin polymorphism (rs696217) is distinguished by guanine to thymine substitution leading to leucine (Leu) to methionine (Met) exchange at position 72 in exon 2 [10]. Ghrelin is secreted by enteroendocrine cells in the stomach and binds to its growth hormone secretagogue receptor (GHSR) [11]. Ghrelin regulates the growth hormone secretion from primary pituitary cells via modulating intracellular calcium levels. Additionally, ghrelin plays a role in glucose metabolism. Thus, ghrelin is a key regulator of energy homeostasis [12].
The study aimed to evaluate the single nucleotide polymorphisms (SNPs) in glutathione S-transferase P1 (A/G rs1695) and ghrelin (G/T rs696217) and correlate its genotyping to gestational diabetes mellitus. This may be the first study designed to reveal that there is no association between the genotype and allele frequencies of both GSTP1 (rs1695) and ghrelin (rs696217) in the development of gestational diabetes mellitus in Egyptian women.
Methods
This cross-sectional comparative study evaluated women with GDM according to the ethical standards of the Institutional Research Board, Faculty of Medicine, Mansoura University. Informed consent was taken from each participant. One hundred forty pregnant women (seventy women with GDM and seventy healthy women) with a singleton pregnancy were recruited from the Obstetrics and Gynecology Department, Faculty of Medicine, Mansoura University in the period from July 2017 to March 2019.
All participants were at least 18 years of age and were diagnosed with gestational diabetes at > 24-weeks gestation. Pregnant women with type 1 diabetes mellitus, early macrosomia (baby with a birth weight more than 4000 g), polycystic ovary syndrome, or other associated serious medical disorders (hypertension, renal disease, moderate to severe anemia, thyroid disorder, etc.) interfering with maternal and perinatal outcomes were excluded.
Sample collection and DNA extraction
Venous blood samples were taken from each patient and dispensed in an EDTA-containing tube. The blood sample was separated into two portions (3 ml and 2 ml). The first portion phase was used to collect plasma after centrifugation at > 2000 χ g for 10 min. The separated plasma was used in the investigation of the biochemical analysis. The second portion was used for DNA extraction. DNA was separated using a DNA extraction kit (ABIOpure™ Genomic DNA, Cat. No. M501DP). All samples showed bands, which represent the genomic DNA when gel electrophoresis was applied. The DNA quantity and quality were measured by reading the absorbance at λ230 nm and λ260 nm by Thermo Scientific™ NanoDrop.
Tetra-primer amplification refractory mutation system (T-ARMS-PCR) analysis
PCR analysis for glutathione S‑transferase P1 gene
The primers used in this study (FOP, FIP, ROP, and RIP) are provided in Tables 1 and 2. GSTP1 gene (A/G rs1695) primers were designed by Primer3 software, while ghrelin gene (G/T rs696217) primers were designed by using http://www.primer1.soton.ac.uk/primer1.html. Polymerase chain reaction (PCR) was performed in a 20 μL volume involving 200 ng of genomic DNA, 3 μL of G allele primers (FOP and RIP) or A allele primers (FOP and RIP) (Table 1), and 10 μL 2 × Taq Master Mix (EmeraldAmp® GT PCR Master Mix–Code No. RR310A). The PCR protocol was as follows: 94 °C for 5 min, followed by 35 cycles at 94 °C for 2 min, annealing at 59 °C for 1 min, and extension at 72 °C for 1 min with a final extension at 72 °C for 10 min. The agarose gel electrophoresis (2%) was performed at 125 V and a 100 bp MaestroGen DNA ladder (Cat. No.02001_500) was used to investigate and confirm the quality of the PCR products (Cleaver Scientific Ltd, UK).
PCR analysis for ghrelin gene
The polymerase chain reaction (PCR) was performed in a 25 μL volume involving 200 ng of genomic DNA, 1 μL of T allele primers (FOP and RIP) or G allele primers (FIP and ROP) (Table 2), 12.5 μL 2 × Taq Master Mix (EmeraldAmp® GT PCR Master Mix, Cat. No. RR310A), and 4.5 μL H2O. The PCR protocol was as follows: 95 °C for 3 min, followed by 35 cycles at 95 °C for 30 s, annealing at 60 °C for 30 s, and extension at 72 °C for 1 min, and 30 s with a final extension at 72 °C for 10 min. The agarose gel electrophoresis (2%) was performed at 125 V and a 100 bp MaestroGen DNA ladder (Cat. No. 02001_500) was used to investigate and confirm the quality of the PCR products (Cleaver Scientific Ltd, UK).
Biochemical measurements
The plasma lipid profile was assayed following the kit’s instructions by Biodiagnostic (Cairo, Egypt). Plasma levels of total lipids, total cholesterol, triglycerides, and HDL cholesterol can be determined according to the methods of Zollner and Kirsch [13], Richmond [14], Fassati and Prencipe [15], and Burstein et al. [16] respectively. Plasma levels of LDL-cholesterol and VLDL-cholesterol were calculated by the Friedewald equation where VLDL equals triglycerides divided by 5 [17]:
Statistical analysis
Statistical analysis was done using the software package, SPSS version 22, and Excel Software. The data were expressed as mean ± SD. One-way ANOVA was used for determining the significant difference between women with gestational diabetes and healthy pregnant women. P values < 0.05 were statistically significant. The frequencies of either genotype or allele of GSTP1 polymorphism between two groups were analyzed by the Fisher exact test and Hardy–Weinberg equilibrium.
Results
Biochemical investigation of studied groups
Table 3 showed the demographic characteristics of pregnant women between the two groups. The data found that there was no significant difference in the mean age and body mass index (BMI) among women with gestational diabetes and healthy pregnant women.
The level of insulin resistance was higher in the gestational diabetes group with a significant difference compared with the control group. Total lipids, total cholesterol, triglycerides, LDL-cholesterol, and VLDL-cholesterol levels were significantly higher, whereas HDL-cholesterol levels were significantly lower in women with GDM than healthy pregnant women (Table 4).
Genetic polymorphism and genotype frequencies
Genotype analysis of GSTP1 gene
The genetic polymorphisms in the GSTP1 gene were investigated and the genotypes were shown in Fig. 1. The frequencies of the genotype of the GSTP1 gene (rs1695) between women with gestational diabetes and healthy pregnant women were listed in Table 5. The distribution of genotypes of GSTP1 for both groups was in alignment with the Hardy_Weinberg equilibrium, which was analyzed by Fisher’s exact test (Table 6).
The major risk of gestational diabetes mellitus was evaluated by the codominant, dominant, recessive, and overdominant models as shown in Table 7. In the codominant model (AA vs AG vs GG), there was no significant risk of GDM (OR 2.40, 95% CI 0.38–14.88, P = 0.342) with the A/G and G/G genotypes compared with the AA genotype. The dominant model did not show any significant risk of GDM when compared with the AA genotype (OR 1.22, 95% CI 0.354–4.195, P = 0.753). The recessive model did not display any significant risk of GDM compared with the A/A-A/G genotype (OR 2.09, 95% CI 0.502–8.73, P = 0.301). Similarly, the overdominant did not show any significant risk of GDM compared with the A/A-G/G genotype (OR 0.791, 95% CI 0.306–2.05, P = 0.629).
Correlation between insulin resistance, lipid profile, and GSTP1 (rs1695) SNP
The association between lipid profile, insulin resistance, and GSTP1 gene (rs1695) SNP in the population under the study was presented in Table 8. In all these study cases, no significant difference was found between the lipid profile, insulin resistance, and GSTP1 (rs1695) SNP.
Genotype analysis of GHRL gene
The genetic polymorphisms in the GHRL gene were analyzed and the genotypes were shown in Fig. 2. The frequencies of genotype of the GHRL (rs696217) between pregnant women diagnosed with gestational diabetes and healthy pregnant women were listed in Table 9. In the distribution of genotypes, there were no significant differences between groups.
Discussion
Gestational diabetes mellitus is the most prevalent disease in pregnant women worldwide. It is a complex metabolic state that is distinguished by insulin resistance [18]. In this study, we assessed a possible association between glutathione S-transferase P1 Ile105Val SNP (rs1695) as well as ghrelin Leu72Met SNP (rs696217) and patient risk of gestational diabetes among Egyptian women.
Our results showed that insulin resistance was related to women with GDM. Previous studies have reported that women with GDM with high insulin resistance had a higher blood glucose level in either an early or a late pregnancy than women with GDM with less insulin resistance [19].
Hyperlipidemia is one of the metabolic disturbances that have been diagnosed in women with GDM. Insulin resistance and estrogen stimulation lead to an increase in plasma lipid levels throughout pregnancy [20]. The levels of total cholesterol, triglycerides, LDL-cholesterol, and VLDL-cholesterol were elevated in GDM due to increasing hyperphagia (an abnormally excessive appetite for the consumption of food-related to hypothalamic damage), progesterone, lipogenesis, and fat storage in the first two-thirds of gestation [21].
Our results showed that total lipids, total cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol levels increased and HDL-cholesterol levels decreased in women with GDM. Previous studies revealed that GDM changes cholesterol metabolism where total cholesterol levels were significantly elevated in GDM compared with normal pregnant women. Women with GDM had high levels of LDL cholesterol [22]. Both VLDL cholesterol and triglycerides were significantly elevated in GDM than in normal pregnant women. Shen et al. [23] reported that the levels of lipids increased steadily throughout pregnancy and reached a peak before delivery, but the levels of HDL cholesterol increased from the 1st to 2nd trimester accompanied by a little decrease in the 3rd trimester. However, hyperlipidemia may be a physiological or pathological condition, so it is difficult to determine it. In addition, there are no standards for measuring maternal lipid levels due to the heterogeneity in meta-analysis and the region of the world’s population [24].
Gene polymorphisms change the gene expression, structure, and quantity of the products that affect gene function. This is the first study to demonstrate that the frequencies of genotype and the allele of rs1695 in GSTP1 were not associated with gestational diabetes in Egyptian women. The dispersal of genotypes was in alignment with Hardy–Weinberg equilibrium. Similar to other studies, in a Chinese population, GSTP1 IIe105Val polymorphisms did not have an impact on the risk of gestational diabetes mellitus [25]. Li et al. [26] found that the GSTP1 IIe105Val polymorphism was not associated with an elevated risk of gestational diabetes mellitus in a Chinese population. Yalin et al. [27] found that the GSTP1 polymorphism was suggested to have no effect on the development of diabetes mellitus in Turkish patients. There was no significant association between the GSTP1 IIe105Val polymorphism and developing type 2 diabetes mellitus in overall studies [28].
Zhang et al. [29] revealed that the GSTP1 heterozygous genotype is significantly associated with type 2 diabetes mellitus in the north Indian population. There was an association between the GSTP1 Ile105Val gene polymorphism in overweight and obese patients for more than 60 years in southern Brazil [30]. Our study showed that there was no significant difference between the lipid profile, insulin resistance, and GSTP1 (rs1695) SNP in women with gestational diabetes. The current study is in agreement with Amer et al. [31], who demonstrated that there was no significant influence of different genotypes of the GSTP1 gene on lipid profile in the Egyptian population.
Ghrelin is a key factor in the hypothalamic melanocortin system, which is involved in various bioactivities [32]. The present study revealed that the GHRL gene (G/T rs696217) polymorphism was not significantly associated with gestational diabetes in Egyptian women. Rocha et al. revealed that the Gln90Leu polymorphism of the preproghrelin gene was not correlated with gestational diabetes in the Euro-Brazilian population [33]. Kim et al. [34] found that the Leu72Met polymorphism of the preproghrelin gene is not related to type 2 diabetes mellitus or to its complications. Joatar et al. [35] found that the Leu72Met polymorphism of GHRL was not associated with T2DM, IR, or serum ghrelin levels in a Saudi population. No associations were found between genotypes and ghrelin serum levels in a Mexican population [36]. Bai et al. [37] found that the genotype and allele frequencies of GHRL gene polymorphisms in participants with obesity showed no significant difference compared to those in nonobese controls in Chinese subjects.
In disagreement with other studies, the Leu72Met polymorphism of the GHRL gene had an impact on type 2 diabetes in the Finnish population [38]. In the Caucasian population, there was an association between the Leu72Met polymorphism of the GHRL gene and a decreased risk of type 2 diabetes [39]. A Ghrelin Arg51Gln polymorphism was detected in the Helsinki population with type 2 diabetes [40]. The Leu72Met polymorphism contributes to the development of obesity in the Swedish population [41].
Conclusions
Worldwide, pregnant women are at high risk of developing gestational diabetes. The study of risk factors will decrease the incidence. Therefore, this study aimed to evaluate the correlation between gene polymorphism in GSTP1 and ghrelin in the development of gestational diabetes. It was found that glutathione S-transferase P1 IIe105Val (A/G rs1695) and ghrelin Leu72Met SNP (G/T rs696217) were not correlated with gestational diabetes mellitus in Egyptian women.
Availability of data and materials
The authors can confirm that all relevant data are included in the manuscript.
Abbreviations
- GDM:
-
Gestational diabetes
- GSTP1:
-
Glutathione S‑transferase P1
- GHRL:
-
Ghrelin
- HCS:
-
Human chorionic somatomammotropin
- GSTs:
-
Glutathione S-transferases
- GHSR:
-
Growth hormone secretagogue receptor
- SNPs:
-
Single-nucleotide polymorphisms
- T-ARMS-PCR:
-
Tetra-primer amplification refractory mutation system polymerase chain reaction
References
Shen Y, Jia Y, Zhou J et al (2020) Association of gestational diabetes mellitus with adverse pregnancy outcomes: our experience and meta-analysis. Int J Diabetes Dev Ctries 1–14
HAPO Study Cooperative Research Group, Metzger BE, Lowe LP et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358(19):1991–2002
Park S, Kim M, Baik S-H et al (2013) Gestational diabetes is associated with high energy and saturated fat intakes and with low plasma visfatin and adiponectin levels independent of prepregnancy BMI. Eur J Clin Nutr 67(2):196–201
Ngala RA, Fondjo LA, Gmagna P, Ghartey FN, Awe MA (2017) Placental peptides metabolism and maternal factors as predictors of risk of gestational diabetes in pregnant women. A case-control study. PLoS ONE 12(7):1–15
Herrera E, Desoye G (2016) Maternal and fetal lipid metabolism under normal and gestational diabetic conditions. Horm Mol Biol Clin Investig 26(2):109–127
Dong SC, Sha HH, Xu XY et al (2018) Glutathione S-transferase pi: a potential role in antitumor therapy. Drug Des Dev Ther 12:3535–3547
Yadav P, Banerjee A, Boruah N et al (2020) Glutathione S-transferasesP1 AA (105Ile) allele increases oral cancer risk, interacts strongly with c-Jun Kinase and weakly detoxifies areca-nut metabolites. Sci Rep 10(1):6032–6043
Nissar S, Sameer A, Rasool R, Chowdri N, Rashid FJJCM (2017) Glutathione S transferases: biochemistry, polymorphism and role in colorectal carcinogenesis. J Carcinog Mutagen 8(2):287–296
Bednarek MA, Feighner SD, Pong SS et al (2000) Structure-function studies on the new growth hormone-releasing peptide, ghrelin: minimal sequence of ghrelin necessary for activation of growth hormone secretagogue receptor 1a. J Med Chem 43(23):4370–4376
Zhang X, Zhai L, Rong C, Qin X, Li S (2015) Association of ghrelin gene polymorphisms and serum ghrelin levels with the risk of hepatitis B virus-related liver diseases in a Chinese population. PLoS ONE 10(11):1–14
Zallar LJ, Tunstall BJ, Richie CT et al (2019) Development and initial characterization of a novel ghrelin receptor CRISPR/Cas9 knockout wistar rat model. Int J Obes (Lond) 43(2):344–354
Sovetkina A, Nadir R, Fung JNM, Nadjarpour A, Beddoe B (2020) The physiological role of ghrelin in the regulation of energy and glucose homeostasis. Cureus 12(5):1–8
Zöllner N, Kirsch K (1962) Colorimetric method for determination of total lipids. J Exp Med 135:545–561
Richmond W (1973) Preparation and properties of a cholesterol oxidase from Nocardia sp. and its application to the enzymatic assay of total cholesterol in serum. Clin Chem 19(12):1350–1356
Fossati P, Prencipe L (1982) Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem 28(10):2077–2080
Burstein M, Scholnick HR, Morfin R (1970) Rapid method for the isolation of lipoproteins from human serum by precipitation with polyanions. J Lipid Res 11(6):583–595
Friedewald WT, Levy RI, Fredrickson D (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18(6):499–502
Grupe K, Asuaje Pfeifer M, Dannehl F et al (2020) Metabolic changes during pregnancy in glucose-intolerant NZO mice: a polygenic model with prediabetic metabolism. Physiol Rep 8(9):1–13
Benhalima K, Van Crombrugge P, Moyson C et al (2019) Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance. Diabetologia 62(11):2118–2128
Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF (2015) Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis. BJOG 122(5):643–651
Herrera EJ (2000) Metabolic adaptations in pregnancy and their implications for the availability of substrates to the fetus. Eur J Clin Nutr 54(1):S47–S51
Wang J, Li Z, Lin L (2019) Maternal lipid profiles in women with and without gestational diabetes mellitus. J Med 98(16):1–6
Shen H, Liu X, Chen Y, He B, Cheng W (2016) Associations of lipid levels during gestation with hypertensive disorders of pregnancy and gestational diabetes mellitus: a prospective longitudinal cohort study. BMJ Open 6(12):1–7
Herrera E, Ortega-Senovilla H (2014) Lipid metabolism during pregnancy and its implications for fetal growth. Curr Pharm Biotechnol 15(1):24–31
Qiu YH, Xu YL, Zhang WH (2016) Effect of GSTM1, GSTT1, and GSTP1 IIe105Val polymorphisms on susceptiblity to gestational diabetes mellitus. Genet Mol Res 15(2):1–7
Li Y, Li S, Zhai Q et al (2015) Association of GSTs polymorphisms with risk of gestational diabetes mellitus. Int J Clin Exp Pathol 8(11):15191–15197
Yalin S, Hatungil R, Tamer L et al (2007) Glutathione S-transferase gene polymorphisms in Turkish patients with diabetes mellitus. Cell Biochem Funct 25(5):509–513
Saadat M (2017) Evaluation of glutathione S-transferase P1 (GSTP1) Ile105Val polymorphism and susceptibility to type 2 diabetes mellitus, a meta-analysis. EXCLI J 16:1188–1197
Bid HK, Konwar R, Saxena M, Chaudhari P, Agrawal CG, Banerjee M (2010) Association of glutathione S-transferase (GSTM1, T1 and P1) gene polymorphisms with type 2 diabetes mellitus in north Indian population. J Postgrad Med 56(3):176–181
Chielle EO, Fortuna PC, Maziero JS (2016) Association between the glutathione S-transferase P1 (GSTP1) Ile105Val gene polymorphism in obese and overweight patients over 60 years. J Bras Patol Med Lab 52(4):211–216
Amer MA, Ghattas MH, Abo-Elmatty DM, Abou-El-Ela SH (2012) Evaluation of glutathione S-transferase P1 genetic variants affecting type-2 diabetes susceptibility and glycemic control. Arch Med Sci 8(4):631–636
Kim JD, Leyva S, Diano S (2014) Hormonal regulation of the hypothalamic melanocortin system. Front Physiol 5:480–487
Rocha RA, Frigeri HR, Santos-Weiss IC et al (2014) Preproghrelin polymorphism Q90L (rs4684677) in gestational diabetes. Arq Bras Endocrinol Metabol 58(1):83–84
Kim S-Y, Jo D-S, Hwang PH et al (2006) Preproghrelin Leu72Met polymorphism is not associated with type 2 diabetes mellitus. Metaboilsm 55(3):366–370
Joatar FE, Al Qarni AA, Ali ME et al (2017) Leu72Met and other intronic polymorphisms in the GHRL and GHSR genes are not associated with Type 2 diabetes mellitus, insulin resistance, or serum ghrelin levels in a saudi population. Endocrinol Metab 32(3):360–369
Rivera-León EA, Llamas-Covarrubias MA, Sánchez-Enríquez S, Martínez-López E, González-Hita M, Llamas-Covarrubias IMJBED (2020) Leu72Met polymorphism of GHRL gene decreases susceptibility to type 2 diabetes mellitus in a Mexican population. BMC Endocr Disord 20(1):1–5
Bai R, Liu Y, Zhao C, Gao J, Liu R (2021) Distribution and effect of ghrelin genotype on plasma lipid and apolipoprotein profiles in obese and nonobese Chinese subjects. Hormones (Athens) 20(3):527–535
Mager U, Lindi V, Lindstrom J et al (2006) Association of the Leu72Met polymorphism of the ghrelin gene with the risk of Type 2 diabetes in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study. Diabet Med 23(6):685–689
Berthold HK, Giannakidou E, Krone W, Mantzoros CS, Gouni-Berthold I (2009) The Leu72Met polymorphism of the ghrelin gene is associated with a decreased risk for type 2 diabetes. Clin Chim Acta 399(1–2):112–116
Poykko S, Ukkola O, Kauma H, Savolainen MJ, Kesaniemi YA (2003) Ghrelin Arg51Gln mutation is a risk factor for Type 2 diabetes and hypertension in a random sample of middle-aged subjects. Diabetologia 46(4):455–458
Ukkola O, Ravussin E, Jacobson P et al (2001) Mutations in the preproghrelin/ghrelin gene associated with obesity in humans. J Clin Endocrinol Metab 86(8):3996–3999
Acknowledgments
We express gratitude to all of the Obstetrics and Gynecology Department, Faculty of Medicine, Mansoura University for making it possible to collect maternal blood samples.
Funding
None.
Author information
Authors and Affiliations
Contributions
MMM contributed to the methodology, analysis, investigation, and writing original manuscript. FE contributed to the methodology, acquisition, analysis, and investigation. AE contributed to the methodology, analysis and investigation. AAE contributed to interpretation of data, supervision, reviewing, and editing of the manuscript. AFA contributed to designing the work, supervision, reviewing, and editing of the manuscript. All authors have read and approved the manuscript for publication.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
This study was approved by ethical standards of the Institutional Research Board, Faculty of Medicine, Mansoura University. The patient provided written informed consent.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Madkour, M.M., El-Said, A.M., El-Refaey, A.EA.A. et al. Impact of gene polymorphism of glutathione S-transferase and ghrelin as a risk factor in Egyptian women with gestational diabetes mellitus. Egypt J Med Hum Genet 23, 15 (2022). https://doi.org/10.1186/s43042-022-00228-6
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s43042-022-00228-6