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Hernandez TL, Farabi SS, Van Pelt RE, Hirsch N, Dunn EZ, Haugen EA, Reece MS, Friedman JE, Barbour LA. Continuous Glucose Monitor Metrics That Predict Neonatal Adiposity in Early and Later Pregnancy Are Higher in Obesity Despite Macronutrient-Controlled Eucaloric Diets. Nutrients 2024; 16:3489. [PMID: 39458484 PMCID: PMC11510187 DOI: 10.3390/nu16203489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/05/2024] [Accepted: 10/10/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Fasting glucose is higher in pregnancies with obesity (OB); less is known about postprandial (PP) and nocturnal patterns when the diet is eucaloric and fixed or about the continuous-glucose-monitor (CGM) metrics that predict neonatal adiposity (NB%fat). We hypothesized that continuous glucose monitors (CGMs) would reveal higher glycemia in OB vs. normal weight (NW) during Early (14-16 weeks) and Later (26-28 weeks) gestation despite macronutrient-controlled eucaloric diets and elucidate unique predictors of NB%fat. METHODS In a prospective, parallel-group comparative study, a eucaloric diet (NW: 25 kcal/kg; OB: 30 kcal/kg) was provided (50% carbohydrate [20% simple/30% complex; of total calories], 35% fat, 15% protein) to Early and Later gestation groups wearing a blinded CGM for three days. CGM metrics (mean fasting; 1 h and 2 h PP; daytime and nocturnal glucose; percent time-in-range (%TIR: 63-140 mg/dL); PP excursions; and area-under-the-curve [AUC]) were interrogated between groups and as predictors of NB%fat by dual X-ray absorptiometry(DXA). RESULTS Fifty-four women with NW (BMI: 23 kg/m2; n = 27) and OB (BMI: 32; n = 27) provided their informed consent to participate. Early, the daytime glucose was higher in OB vs. NW (mean ± SEM) (91 ± 2 vs. 85 ± 2 mg/dL, p = 0.017), driven by 2 h PP glucose (95 ± 2 vs. 88 ± 2, p = 0.004). Later, those with OB exhibited higher nocturnal (89 ± 2 vs. 81 ± 2), daytime (95 ± 2 vs. 87 ± 2), 1 h (109 ± 3 vs. 98 ± 2), and 2 h PP (101 ± 3 vs. 92 ± 2) glucose (all p < 0.05) but no difference in %TIR (95-99%). Postprandial peak excursions for all meals were markedly blunted in both the Early (9-19 mg/dL) and Later (15-26 mg/dL). In OB, the Later group's 24 h AUC was correlated with NB%fat (r = 0.534, p = 0.02). Despite similar weight gain, infants of OB had higher birthweight (3528 ± 107 vs. 3258 ± 74 g, p = 0.037); differences in NB%fat did not reach statistical significance (11.0 vs. 8.9%; p > 0.05). CONCLUSIONS Despite macronutrient-controlled eucaloric diets, pregnancies with OB had higher glycemia Early and Later in gestation; the Later 24 h glucose AUC correlated with NB%fat. However, glycemic patterns were strikingly lower than current management targets.
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Affiliation(s)
- Teri L. Hernandez
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA; (N.H.); (E.Z.D.)
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sarah S. Farabi
- Division of Nutritional Science & Obesity Medicine, Department of Medicine, Washington University, St. Louis, MO 63130, USA;
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO 63110, USA
| | - Rachael E. Van Pelt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Nicole Hirsch
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA; (N.H.); (E.Z.D.)
| | - Emily Z. Dunn
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA; (N.H.); (E.Z.D.)
| | - Elizabeth A. Haugen
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Melanie S. Reece
- Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Jacob E. Friedman
- Harold Hamm Diabetes Center, The University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA;
| | - Linda A. Barbour
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA;
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Ali YA, Sharara M, Mahrous M, Rezk AA, Abuali A, Seoudy MA, Elnaghy MY, Elsekaily AE, Elkholy ME, Ragab KM, Badawy MM, Kamal I, Fathallah AH. Maternal and Neonatal Efficacy and Safety Outcomes of Myo-Inositol in Women With or at High Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Spectr 2024; 38:82-92. [PMID: 39959527 PMCID: PMC11825409 DOI: 10.2337/ds23-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2025]
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Lin L, Huang Y, Chen L, Zheng L, Feng Y, Lin J, Yan J. Gestational weight trajectory and risk of adverse pregnancy outcomes among women with gestational diabetes mellitus: A retrospective cohort study. MATERNAL & CHILD NUTRITION 2024; 20:e13645. [PMID: 38517119 PMCID: PMC11168372 DOI: 10.1111/mcn.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
The aim of this study was to explore gestational weight gain (GWG) trajectories and their associations with adverse pregnancy outcomes. A retrospective cohort study including 11,064 women with gestational diabetes mellitus (GDM) was conducted between 2015 and 2019 in China. The latent class trajectory model was used to identify GWG trajectories, and logistic regression was performed to examine odds ratio (OR) of pregnancy outcomes. Three trajectories of GWG were identified in these 11,604 women with GDM. Trajectory 1: 64.02% of women had sustained moderate GWG throughout pregnancy; Trajectory 2: 17.75% of women showed a high initial GWG but followed by a low GWG from the third trimester until delivery; Trajectory 3: 18.23% had low initial GWG but followed by drastic GWG from the second trimester until delivery. Compared with pregnant women with Trajectory 1, women with Trajectory 2 had a higher risk of large for gestational age (adjusted odds ratio [AOR]: 1.29, 95% confidence interval [CI]: 1.12-1.48) but at a lower risk of having hypertensive disorders of pregnancy (AOR: 0.76, 95% CI: 0.57-0.96). Women in Trajectory 3 were more likely to develop small for gestational age (AOR: 2.12, 95% CI: 1.62-2.78), low birthweight (AOR: 1.49, 95% CI: 1.07-2.08), preterm birth (AOR: 1.28, 95% CI: 1.05-1.63), caesarean section (AOR: 1.26, 95% CI: 1.112-1.42) and hypertensive disorders of pregnancy (AOR: 2.24, 95% CI: 1.82-2.76). The association of GWG trajectory with adverse pregnancy outcomes differs across prepregnancy body mass index and GWG categories. Women with a slow initial GWG but followed by drastic GWG had higher risks of adverse pregnancy outcomes. Early clinical recognition of poor GWG trajectory will contribute to early intervention in high-risk groups to minimise adverse outcomes.
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Affiliation(s)
- Lihua Lin
- Department of Healthcare, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Yanhong Huang
- Department of Healthcare, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Lijuan Chen
- Department of Child Healthcare Center, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Lianghui Zheng
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Yebin Feng
- Department of Research Office, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Juan Lin
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Jianying Yan
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
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Linder T, Eppel D, Kotzaeridi G, Yerlikaya-Schatten G, Rosicky I, Morettini M, Tura A, Göbl CS. Glucometabolic Alterations in Pregnant Women with Overweight or Obesity but without Gestational Diabetes Mellitus: An Observational Study. Obes Facts 2023; 17:121-130. [PMID: 38061341 PMCID: PMC10987186 DOI: 10.1159/000535490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/19/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Maternal overweight is a risk factor for gestational diabetes mellitus (GDM). However, emerging evidence suggests that an increased maternal body mass index (BMI) promotes the development of perinatal complications even in women who do not develop GDM. This study aims to assess physiological glucometabolic changes associated with increased BMI. METHODS Twenty-one women with overweight and 21 normal weight controls received a metabolic assessment at 13 weeks of gestation, including a 60-min frequently sampled intravenous glucose tolerance test. A further investigation was performed between 24 and 28 weeks in women who remained normal glucose tolerant. RESULTS At baseline, mothers with overweight showed impaired insulin action, whereby the calculated insulin sensitivity index (CSI) was lower as compared to normal weight controls (3.5 vs. 6.7 10-4 min-1 [microU/mL]-1, p = 0.025). After excluding women who developed GDM, mothers with overweight showed higher average glucose during the oral glucose tolerance test (OGTT) at the third trimester. Moreover, early pregnancy insulin resistance and secretion were associated with increased placental weight in normal glucose-tolerant women. CONCLUSION Mothers with overweight or obesity show an unfavorable metabolic environment already at the early stage of pregnancy, possibly associated with perinatal complications in women who remain normal glucose tolerant.
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Affiliation(s)
- Tina Linder
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Daniel Eppel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Grammata Kotzaeridi
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Ingo Rosicky
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Micaela Morettini
- Department of Information Engineering, Università Politecnica Delle Marche, Ancona, Italy
| | - Andrea Tura
- CNR Institute of Neuroscience, Padova, Italy
| | - Christian S. Göbl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Visolyi GÁ, Kun A, Szalai O, Svébis MM, Domján BA, Zsirai L, Tabák ÁG. Pregnancy outcomes of women with untreated 'mild' gestational diabetes (gestational diabetes by the WHO 2013 but not by the WHO-1999 diagnostic criteria) - A population-based cohort study. Diabetes Res Clin Pract 2023; 203:110874. [PMID: 37579993 DOI: 10.1016/j.diabres.2023.110874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
AIMS We compared pregnancy outcomes of untreated 'mild' GDM (GDM by WHO 2013 but not by WHO-1999) to normal glucose tolerant women (NGT). METHODS In a universal screening program 4333 pregnant women had a 3-point 75 g OGTT in Hungary in 2009-2013. By WHO-2013 untreated NGT was diagnosed in n = 3303, 'mild' GDM in n = 336 cases. RESULTS 'Mild' GDM women were older (mean difference, SE: 1.4, 0.3 yrs), had higher fasting (1.0, 0.02), 60-minute (1.0, 0.09), and 120-minute (0.4, 0.06 mmol/l) blood glucose, and blood pressure (2.6, 0.5/2.0, 0.5 mmHg). Weight gain was similar in both groups (-0.3, 0.3 kg). GDM newborns were heavier (142, 50 g) and were more frequently macrosomic (>4000 g, OR 1.85, 95 %CI 1.35-2.54). Hypertension during pregnancy was more prevalent in the GDM group (OR 1.55, 95 %CI 1.05-2.28), as well as induced (OR 1.38, 95 %CI 1.10-1.74) and instrumental delivery (OR 1.34, 95 %CI 1.07-1.68), and acute caesarean section (OR 1.32, 95 %CI 1.04-1.64). Most of these differences substantially attenuated or became non-significant after adjustment for pre-pregnancy BMI. CONCLUSIONS Pregnancy outcomes of 'mild' GDM were worse compared to normal glucose tolerant women however these differences were explained by the pre-pregnancy BMI difference between groups.
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Affiliation(s)
- Gergely Á Visolyi
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary; Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary.
| | - Attila Kun
- Tolna County Balassa János Hospital, Department of Obstetrics and Gynaecology, Szekszárd, Hungary
| | | | - Márk M Svébis
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary; Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Beatrix A Domján
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - László Zsirai
- Department of Gynecology and Family Planning, Istenhegyi GeneDiagnostic Center, Hungary
| | - Ádám G Tabák
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary; UCL Brain Sciences, University College London, London, United Kingdom; Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary.
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Roverso M, Dogra R, Visentin S, Pettenuzzo S, Cappellin L, Pastore P, Bogialli S. Mass spectrometry-based "omics" technologies for the study of gestational diabetes and the discovery of new biomarkers. MASS SPECTROMETRY REVIEWS 2023; 42:1424-1461. [PMID: 35474466 DOI: 10.1002/mas.21777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/15/2021] [Accepted: 04/04/2022] [Indexed: 06/07/2023]
Abstract
Gestational diabetes (GDM) is one of the most common complications occurring during pregnancy. Diagnosis is performed by oral glucose tolerance test, but harmonized testing methods and thresholds are still lacking worldwide. Short-term and long-term effects include obesity, type 2 diabetes, and increased risk of cardiovascular disease. The identification and validation of sensitidve, selective, and robust biomarkers for early diagnosis during the first trimester of pregnancy are required, as well as for the prediction of possible adverse outcomes after birth. Mass spectrometry (MS)-based omics technologies are nowadays the method of choice to characterize various pathologies at a molecular level. Proteomics and metabolomics of GDM were widely investigated in the last 10 years, and various proteins and metabolites were proposed as possible biomarkers. Metallomics of GDM was also reported, but studies are limited in number. The present review focuses on the description of the different analytical methods and MS-based instrumental platforms applied to GDM-related omics studies. Preparation procedures for various biological specimens are described and results are briefly summarized. Generally, only preliminary findings are reported by current studies and further efforts are required to determine definitive GDM biomarkers.
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Affiliation(s)
- Marco Roverso
- Department of Chemical Sciences, University of Padova, Padova, Italy
| | - Raghav Dogra
- Department of Chemical Sciences, University of Padova, Padova, Italy
| | - Silvia Visentin
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Pettenuzzo
- Department of Chemical Sciences, University of Padova, Padova, Italy
- Center Agriculture Food Environment (C3A), University of Trento, San Michele all'Adige, Italy
| | - Luca Cappellin
- Department of Chemical Sciences, University of Padova, Padova, Italy
| | - Paolo Pastore
- Department of Chemical Sciences, University of Padova, Padova, Italy
| | - Sara Bogialli
- Department of Chemical Sciences, University of Padova, Padova, Italy
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE), National Research Council-CNR, Padova, Italy
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Chatterjee B, Thakur SS. Proteins and metabolites fingerprints of gestational diabetes mellitus forming protein-metabolite interactomes are its potential biomarkers. Proteomics 2023; 23:e2200257. [PMID: 36919629 DOI: 10.1002/pmic.202200257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Gestational diabetes mellitus (GDM) is a consequence of glucose intolerance with an inadequate production of insulin that happens during pregnancy and leads to adverse health consequences for both mother and fetus. GDM patients are at higher risk for preeclampsia, and developing diabetes mellitus type 2 in later life, while the child born to GDM mothers are more prone to macrosomia, and hypoglycemia. The universally accepted diagnostic criteria for GDM are lacking, therefore there is a need for a diagnosis of GDM that can identify GDM at its early stage (first trimester). We have reviewed the literature on proteins and metabolites fingerprints of GDM. Further, we have performed protein-protein, metabolite-metabolite, and protein-metabolite interaction network studies on GDM proteins and metabolites fingerprints. Notably, some proteins and metabolites fingerprints are forming strong interaction networks at high confidence scores. Therefore, we have suggested that those proteins and metabolites that are forming protein-metabolite interactomes are the potential biomarkers of GDM. The protein-metabolite biomarkers interactome may help in a deep understanding of the prognosis, pathogenesis of GDM, and also detection of GDM. The protein-metabolites interactome may be further applied in planning future therapeutic strategies to promote long-term health benefits in GDM mothers and their children.
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Affiliation(s)
- Bhaswati Chatterjee
- National Institute of Pharmaceutical Education and Research, Hyderabad, India
- National Institute of Animal Biotechnology (NIAB), Hyderabad, India
| | - Suman S Thakur
- Centre for Cellular and Molecular Biology, Hyderabad, India
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New Developments, Challenges and Open Questions in Diagnosis and Treatment of Gestational Diabetes Mellitus. J Clin Med 2022; 11:jcm11237197. [PMID: 36498770 PMCID: PMC9741290 DOI: 10.3390/jcm11237197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
The prevalence of gestational diabetes mellitus (GDM) is increasing alongside a rising maternal age at conception, an increasing number of people making unhealthy lifestyle choices and, especially, an increasing pregestational body weight [...].
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Kim HS, Oh SY, Cho GJ, Choi SJ, Hong SC, Kwon JY, Kwon HS. A Predictive Model for Large-for-Gestational-Age Infants among Korean Women with Gestational Diabetes Mellitus Using Maternal Characteristics and Fetal Biometric Parameters. J Clin Med 2022; 11:jcm11174951. [PMID: 36078881 PMCID: PMC9456704 DOI: 10.3390/jcm11174951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: With increasing incidence of gestational diabetes mellitus (GDM), newborn infants with perinatal morbidity, including large-for-gestational-age (LGA) or macrosomia, are also increasing. The purpose of this study was to develop a prediction model for LGA infants with GDM mothers. Methods: This was a retrospective case-control study of 660 women with GDM and singleton pregnancies in four tertiary care hospitals from 2006 to 2013 in Korea. Biometric parameters were obtained at diagnoses of GDM and within two weeks before delivery. These biometric data were all transformed retrospectively into Z-scores calculated using a reference. Interval changes of values between the two periods were obtained. Multivariable logistic and stepwise backwards regression analyses were performed to develop the most parsimonious predictive model. The prediction model included pre-pregnancy body mass index (BMI), head circumference (HC), Z-score at 24 + 0 to 30 + 6 weeks’ gestation, and abdominal circumference (AC) Z-score at 34 + 0 to 41 + 6 weeks within 2 weeks before delivery. The developed model was then internally validated. Results: Our model’s predictive performance (area under the curve (AUC): 0.925) was higher than estimated fetal weight (EFW) within two weeks before delivery (AUC: 0.744) and the interval change of EFW Z-score between the two periods (AUC: 0.874). It was internally validated (AUC: 0.916). Conclusions: A clinical model was developed and internally validated to predict fetal overgrowth in Korean women with GDM, which showed a relatively good performance.
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Affiliation(s)
- Hee-Sun Kim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Soo-Young Oh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Geum Joon Cho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea
| | - Suk-Joo Choi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Soon Cheol Hong
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea
| | - Ja-Young Kwon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea
| | - Han Sung Kwon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University School of Medicine 120-1, Neungdongno, Gwangjin-gu, Seoul 05030, Korea
- Correspondence: ; Tel.: +82-2-2030-7645; Fax: +82-2-2030-7748
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Lin LH, Lin J, Yan JY. Interactive Affection of Pre-Pregnancy Overweight or Obesity, Excessive Gestational Weight Gain and Glucose Tolerance Test Characteristics on Adverse Pregnancy Outcomes Among Women With Gestational Diabetes Mellitus. Front Endocrinol (Lausanne) 2022; 13:942271. [PMID: 35872998 PMCID: PMC9301308 DOI: 10.3389/fendo.2022.942271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 12/16/2022] Open
Abstract
Purpose To examine the combined effect of pre-pregnancy overweight or obesity, excessive gestational weight gain, and glucose tolerance status on the incidence of adverse pregnancy outcomes among women with gestational diabetes mellitus. Methods A observational study including 5529 gestational diabetes mellitus patients was performed. Logistic regression were used to assess the independent and multiplicative interactions of overweight or obese, excessive gestational weight gain, abnormal items of oral glucose tolerance test and adverse pregnancy outcomes. Additive interactions were calculated using an Excel sheet developed by Anderson to calculate relative excess risk. Results Overall 1076(19.46%) study subject were overweight or obese and 1858(33.60%) women gained weight above recommended. Based on IADPSG criteria, more than one-third women with two, or three abnormal glucose values. Preconception overweight or obesity, above recommended gestational weight gain, and two or more abnormal items of oral glucose tolerance test parameters significantly increased the risk of adverse pregnancy outcomes, separately. After accounting for confounders, each two of overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters, the pairwise interactions on adverse pregnancy outcomes appear to be multiplicative. Coexistence of preconception overweight or obesity, above recommended gestational weight gain and two or more abnormal items of oral glucose tolerance test parameters increased the highest risk for adverse pregnancy outcomes. No additive interaction was found. Conclusions Pre-pregnancy overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters contribute to adverse pregnancy outcomes independently among women with gestational diabetes mellitus. Additionally, the combined effect between these three factors and adverse pregnancy outcomes appear to be multiplicative. Interventions focus on maternal overweight or obesity and gestational weight gain should be offered to improve pregnancy outcomes.
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Affiliation(s)
- Li-hua Lin
- Department of Healthcare, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Juan Lin
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jian-ying Yan
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Oriot P, Leroy C, Van Leeuw V, Philips JC, Vanderijst JF, Vuckovic A, Costa E, Debauche C, Chantraine F. Evolution of maternal and neonatal outcomes before and after the adoption of the IADPSG/WHO guidelines in Belgium: A descriptive study of 444,228 pregnancies. Heliyon 2022; 8:e09251. [PMID: 35497044 PMCID: PMC9038558 DOI: 10.1016/j.heliyon.2022.e09251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/11/2022] [Accepted: 04/01/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives To appraise adverse pregnancy outcomes after the adoption of IADPSG/WHO guidelines in Belgium. Methods A retrospective study of the Center for Perinatal Epidemiology registry was conducted. Demographic changes and adverse pregnancy outcomes were compared between a pre- and post-guideline period in women with and without hyperglycemia in pregnancy (HIP). Adjusted odds ratios with a 95% confidence interval (CI) were used to compare maternal and neonatal outcomes controlling for potential confounders (maternal age, body mass index (BMI), hypertension, parity, and multiple births). Results The prevalence of HIP increased (6.0%-9.2%). In the overall population regardless of glycemic status, gestational weight gain (12.3 ± 5.7 vs 11.9 ± 5.8; p < 0.001), hypertension (0.92; 95% CI, 0.89-0.94; p < 0.001), and neonatal intensive care unit/special care nursery (0.89; 95% CI, 0.87-0.91; p < 0.001) decreased despite increasing maternal age and pre-pregnancy BMI. Emergency cesarean section rates (1.07; 95% CI, 1.05-1.09; p < 0.001) increased, but not in the HIP population (1.02; 95% CI, 0.95-1.10; ns). The overall incidence of preterm birth (1.09; 95% CI, 1.06-1.12; p < 0.001), stillbirth (1.10; 95% CI, 1.01-1.21; p < 0.05), and perinatal mortality (1.10; 95% CI, 1.01-1.19; p < 0.05) increased, except in the HIP population (1.03; 95% CI, 0.95-1.11; ns), (1.04; 95% CI, 0.74-1.47; ns) and (1.09; 95% CI, 0.80-1.49; ns), respectively. The overall incidence of small- for-gestational-age remained unchanged (0.99; 95%CI, 0.97-1.01; ns) regardless of glycemic status. In the HIP population, large-for-gestational age (0.90; 95% CI, 0.84-0.95; p < 0.001) and macrosomia (0.84; 95% CI, 0.78-0.92; p < 0.001) decreased. Conclusion After the implementation of IADPSG/WHO guidelines, the prevalence of HIP increased by 53.7% and the incidence of major HIP-related pregnancy complications appears to be lower. However, we cannot conclude that the reduction of LGA-macrosomia is due to a better management of diabetes or due to greater recruitment of women with mild HIP associated with a lower risk of obstetrical complications.
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Affiliation(s)
- Philippe Oriot
- Department of Diabetology, Mouscron Hospital Centre, Avenue de Fécamp 49, 7700, Mouscron, Belgium
| | - Charlotte Leroy
- Centre d'Épidémiologie Périnatale (CEpiP), Clos Chapelle-aux-Champs 30, bte B1.30.04, 1200 Brussels, Belgium
| | - Virginie Van Leeuw
- Centre d'Épidémiologie Périnatale (CEpiP), Clos Chapelle-aux-Champs 30, bte B1.30.04, 1200 Brussels, Belgium
| | - Jean Christophe Philips
- Diabetes, Nutrition and Metabolic Disorders, Liege University, CHU Sart-Tilman, Avenue de L'Hôpital 1, 4000, Liège, Belgium
| | - Jean François Vanderijst
- Department of General Internal Medicine, Clinique Saint-Pierre, Av. Reine Fabiola 9, 1340 Ottignies-Louvain-la-Neuve, Belgium
| | - Aline Vuckovic
- Neonatal Intensive Care Unit, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Av. Jean Joseph Crocq 15, 1020, Brussels, Belgium
| | - Elena Costa
- Department of Obstetrics and Gynecology, Erasme Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Christian Debauche
- Department of Neonatology, Cliniques Universitaires Saint Luc, UCLouvain, Av. Hippocrate 10, 1200 Brussels, Belgium
| | - Frederic Chantraine
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Liège, site CHR Citadelle, Boulevard du 12ème de Ligne, 1, 4000 Liège, Belgium
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12
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Song X, Shu J, Zhang S, Chen L, Diao J, Li J, Li Y, Wei J, Liu Y, Sun M, Wang T, Qin J. Pre-Pregnancy Body Mass Index and Risk of Macrosomia and Large for Gestational Age Births with Gestational Diabetes Mellitus as a Mediator: A Prospective Cohort Study in Central China. Nutrients 2022; 14:nu14051072. [PMID: 35268050 PMCID: PMC8912482 DOI: 10.3390/nu14051072] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
This study aimed to examine the risk of macrosomia and large for gestational age (LGA) births in relation to maternal pre-pregnancy body mass index (BMI) status mediated through gestational diabetes mellitus (GDM). This prospective study included 34,104 singleton pregnancies at 8–14 weeks of gestation. The interesting outcomes were macrosomia (≥4000 g) and LGA (≥90th percentile). Mediation analyses were conducted using log-binomial regression adjusted for age, education, parity, fetal sex, and gestational weight gain. The proportion mediated was estimated based on the risk difference scale, and the E-value was utilized to assess potential confounders. Overall, 15.9% of women had GDM, and there were 4.0% macrosomia and 9.9% LGA births. The proportion mediated by GDM on macrosomia was up to 40% among obese women, and the estimate of the total effect was 6.18 (95% CI: 5.26–7.26), of the natural direct effect was 4.10 (95% CI: 3.35–4.99), and of the natural indirect effect was 1.51 (95% CI: 1.31–1.76). Likewise, among overweight women, the proportion mediated by GDM on macrosomia was up to 40%. Furthermore, consistent findings were evident for the outcome of LGA births. Pre-pregnancy overweight/obesity increased the risk of macrosomia and LGA births independently and partly mediated by GDM.
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Affiliation(s)
- Xinli Song
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Jing Shu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Jingyi Diao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Jinqi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Yihuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Jianhui Wei
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Yiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Mengting Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Tingting Wang
- National Health Committee Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, 52 Xiangchun Road, Changsha 410028, China
- Correspondence: (T.W.); (J.Q.); Tel.: +86-15273188582 (T.W.); +86-15974269544 (J.Q.)
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
- National Health Committee Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, 52 Xiangchun Road, Changsha 410028, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Second Road, Guangzhou 510080, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, 110 Xiangya Road, Changsha 410078, China
- Correspondence: (T.W.); (J.Q.); Tel.: +86-15273188582 (T.W.); +86-15974269544 (J.Q.)
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Wang L, Yao H, Shen W, Wang X, Huang C, Yu X, Liu C. Gestational diabetes mellitus is associated with blood inflammatory indicators in a Chinese pregnant women population. Gynecol Endocrinol 2022; 38:153-157. [PMID: 34907826 DOI: 10.1080/09513590.2021.2015762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study aimed to investigate relationships between blood inflammatory and metabolic biomarkers in pregnant Chinese women with gestational diabetes mellitus (GDM) in Southwest China and to compare the contributions of blood inflammatory indicators to GDM identification. SUBJECTS AND METHODS In total, 1,347 pregnant women were divided by gestational week into early-, middle- and late-pregnancy groups. Fasting samples were collected for complete blood count (CBC) and biochemical indicator measurements. Receiver operating characteristic (ROC) curves were used to predict GDM. Multivariate logistic regression was used to examine the associations between blood inflammatory indicators and GDM prevalence in pregnant women. RESULTS Significant differences were found in blood inflammatory indicators and metabolic markers in different pregnancy trimesters. For the pregnant women with GDM, FPG, 1 h-PG, 2 h-PG levels, NLR and PLR, WBC and neutrophil counts were statistically differences when compared with non-GDM groups. ROC curve analysis indicated that the NLR, PLR, WBC and neutrophil counts have predictive value for GDM from 24-28 gestational weeks. The FPG levels in 24th-28th weeks of pregnant women were positively correlated with the NLR, PLR, 1 h-PG, 2 h-PG levels and negatively correlated with lymphocyte count. Following adjustment for the age, PLR, and FPG level, multivariate logistic regression showed that the NLR was an independent factor predicting GDM in the 24th-28th weeks of pregnancy. CONCLUSION The blood inflammatory indicators NLR, PLR, and WBC and neutrophil counts were higher in GDM women than in healthy pregnant women, suggesting that blood inflammatory indicators are associated with GDM.
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Affiliation(s)
- Li Wang
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Haibo Yao
- Department of Medical Records, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Shen
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuemei Wang
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Cheng Huang
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xia Yu
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chenggui Liu
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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14
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Corcillo A, Quansah DY, Kosinski C, Benhalima K, Puder JJ. Impact of Risk Factors on Short and Long-Term Maternal and Neonatal Outcomes in Women With Gestational Diabetes Mellitus: A Prospective Longitudinal Cohort Study. Front Endocrinol (Lausanne) 2022; 13:866446. [PMID: 35795139 PMCID: PMC9251201 DOI: 10.3389/fendo.2022.866446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Universal screening of gestational diabetes mellitus (GDM) in women with no risk factors (RF) for GDM remains controversial. This study identified the impact of the presence of RF on perinatal and postpartum outcomes. METHODS This prospective cohort study included 780 women with GDM. GDM RF included previous GDM, first grade family history of type 2 diabetes, high-risk ethnicity and pre-pregnancy overweight/obesity (OW/OB). Outcomes included obstetrical, neonatal and maternal metabolic parameters during pregnancy and up to 1 year postpartum. RESULTS Out of 780 patients, 24% had no RF for GDM. Despite this, 40% of them needed medical treatment and they had a high prevalence of glucose intolerance of 21 and 27% at 6-8 weeks and 1-year postpartum, respectively. Despite similar treatment, women with RF had more neonatal and obstetrical complications, but they had especially more frequent adverse metabolic outcomes in the short- and long-term. The most important RF for poor perinatal outcome were previous GDM and pre-pregnancy OW/OB, whereas high-risk ethnicity and pre-pregnancy OW/OB were RF for adverse postpartum metabolic outcomes. Increasing number of RF were associated with worsened perinatal and long-term postpartum outcomes except for pregnancy-induced hypertension, C-section delivery and neonatal hypoglycaemia. CONCLUSION Women with no RF had a high prevalence of adverse perinatal and postpartum outcomes, while the presence of RF particularly increased the risk for postpartum adverse metabolic outcomes. This calls for a RF-based long-term follow-up of women with GDM.
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Affiliation(s)
- Antonella Corcillo
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
- *Correspondence: Antonella Corcillo,
| | - Dan Yedu Quansah
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Christophe Kosinski
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Katrien Benhalima
- Department of Endocrinology, Universitair Ziekenhuis (UZ) Gasthuisberg, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Jardena J. Puder
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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15
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Li N, Li J, Zhang C, Liu G, Leng J, Liu J, Wang L, Li W, Yu Z, Hu G, Chan JCN, Yang X. Usefulness of cut-off points of International criteria for prediction of post-partum diabetes and prediabetes among Chinese women with gestational diabetes. Diabetes Metab Res Rev 2021; 37:e3456. [PMID: 33855793 DOI: 10.1002/dmrr.3456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
AIMS This study tests whether cut-off points of the International Association of Diabetes and Pregnancy Study Group's (IADPSG) criteria had threshold effects on post-partum prediabetes and diabetes among Chinese pregnant women with gestational diabetes mellitus (GDM). MATERIALS AND METHODS A total of 507 out of 1000 women with GDM (948 of them enrolled in a lifestyle trial during pregnancy) turned up for the follow-up study and underwent a 75-g 2-h oral glucose tolerance test. GDM was diagnosed based on the IADPSG's criteria while post-partum diabetes and prediabetes were defined by the World Health Organization's. Generalized logit model was used to obtain odds ratios (OR) and 95% confidence interval (CI) of fasting, 1-h and 2-h plasma glucoses (PGs) for post-partum diabetes and prediabetes. Restricted cubic spline was used to identify any threshold effects. RESULTS At a median of 9.1 weeks post-partum, 3.7% (n = 19) women developed post-partum diabetes and 35.1% (n = 178) developed post-partum prediabetes. Fasting PG ≥ 5.1 mmol/L was associated with markedly increased risk of post-partum diabetes without a discernible threshold (adjusted OR: 3.87, 95% CI: 1.03-14.52) while 2-h PG ≥ 8.5 and ≥ 9.0 mmol/L had threshold effects on post-partum prediabetes (2.10, 1.33-3.30) and diabetes (4.02, 1.04-15.56). The 1-h PG also had a threshold at ≥10.0 mmol/L for prediabetes (1.67, 1.06-2.64), but it was not significant for post-partum diabetes. CONCLUSIONS Among Chinese women with GDM, fasting PG ≥ 5.1 mmol/L was associated with post-partum diabetes without any discernible threshold effects while 2-h PG ≥ 8.5 and ≥ 9.0 mmol/L respectively identified women at high risk of post-partum prediabetes and diabetes.
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Affiliation(s)
- Ninghua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Cuiping Zhang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Gongshu Liu
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Junhong Leng
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Jinnan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Leishen Wang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Weiqin Li
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
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16
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Chen KY, Lin SY, Lee CN, Wu HT, Kuo CH, Kuo HC, Chuang CC, Kuo CH, Chen SC, Fan KC, Lin MW, Fang CT, Li HY. Maternal Plasma Lipids During Pregnancy, Insulin-like Growth Factor-1, and Excess Fetal Growth. J Clin Endocrinol Metab 2021; 106:e3461-e3472. [PMID: 34021357 DOI: 10.1210/clinem/dgab364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 12/26/2022]
Abstract
CONTEXT Maternal lipids during pregnancy and placental growth factors are associated with excess fetal growth. However, how these factors interact to increase the risk of delivering large-for-gestational-age (LGA) neonates remains unclear. In this study, we investigated the relationship between maternal plasma triglycerides (TGs) and free fatty acids (FFAs) during pregnancy, cord blood insulin-like growth factors (IGF), and LGA. OBJECTIVE In a cell model, we studied the effect of different FAs on placental IGF-1 secretion. METHODS This cohort study included pregnant women with term pregnancy and without diabetes or hypertensive disorders in pregnancy. Maternal fasting plasma TGs and FFAs were measured in the second trimester. Cord blood IGF-1, IGF-2, and IGF binding protein-1 and protein-3 were measured at the time of delivery. A human trophoblast cell line, 3A-sub-E, was used to evaluate the effect of different FFAs on placental IGF-1 secretion. RESULTS We recruited 598 pregnant women-neonate pairs. Maternal plasma TG (180 mg/dL [152.5-185.5 mg/dL] vs 166 mg/dL [133-206 mg/dL], P = .04) and cord blood IGF-1 concentrations (72.7 ± 23.0 vs 54.1 ± 22.8 ng/mL, P < .001) were higher in the LGA group and were significantly associated with birth weight z score. Maternal plasma free palmitic acid (PA) and stearic acid (SA), but not oleic acid (OA) or linoleic acid (LA), were significantly associated with cord blood IGF-1 concentrations. In 3A-sub-E cells, treatment with PA, SA, and LA, but not OA, induced IGF-1 expression and secretion. CONCLUSION Certain FFAs can induce placental IGF-1 secretion, which suggests a potential pathophysiology linking maternal plasma lipids and LGA.
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Affiliation(s)
- Kuan-Yu Chen
- Department of Internal Medicine, ANSN Clinic, Hsin-Chu 300, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hung-Tsung Wu
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei 100, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Han-Chun Kuo
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chia-Chi Chuang
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chun-Heng Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
- College of Medicine, Fu Jen Catholic University, New Taipei City 243, Taiwan
| | - Szu-Chi Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei City Hospital, Ren-Ai branch, Taipei 100, Taiwan
| | - Kang-Chih Fan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu 300, Taiwan
| | - Ming-Wei Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
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Erickson ML, Patinkin ZW, Duensing AM, Dabelea D, Redman LM, Boyle KE. Maternal metabolic health drives mesenchymal stem cell metabolism and infant fat mass at birth. JCI Insight 2021; 6:146606. [PMID: 34061777 PMCID: PMC8410068 DOI: 10.1172/jci.insight.146606] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/26/2021] [Indexed: 12/25/2022] Open
Abstract
Exposure to maternal obesity may promote metabolic dysfunction in offspring. We used infant mesenchymal stem cells (MSCs) to experimentally examine cellular mechanisms of intergenerational health transmission. Our earlier reports show MSCs collected from infants of mothers with obesity had a dichotomous distribution in metabolic efficiency; they were either efficient (Ef-Ob) or inefficient (In-Ob) with respect to fatty acid oxidation (FAO). Here, we sought to determine if this was due to a primary defect in FAO. Accordingly, we measured FAO in myogenic differentiating MSCs under 3 conditions: (a) myogenesis alone, (b) excess fatty acid exposure, and (c) excess fatty acid exposure plus a chemical uncoupler to increase metabolic rate. Compared with normal weight and Ef-Ob MSCs, In-Ob displayed lower FAO in myogenesis alone and after fatty acid plus uncoupler, indicating In-Ob were less metabolically flexible after increasing lipid availability and metabolic rate, demonstrating a primary deficit in FAO. MSC FAO was negatively associated with fasting maternal glucose and insulin and positively associated with fasting HDL-cholesterol. MSC FAO was negatively associated with infant fat mass. These data indicate a less favorable maternal metabolic milieu, independent of maternal BMI, reduces intrinsic MSC FAO and is linked to higher infant adiposity as early as birth.
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Affiliation(s)
- Melissa L. Erickson
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Zachary W. Patinkin
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Allison M. Duensing
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Aurora, Colorado, USA
| | - Leanne M. Redman
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Kristen E. Boyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Aurora, Colorado, USA
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Erbağcı MO, Tuna G, Köse S, Dal-Bekar NE, Akış M, Kant M, Altunyurt S, İşlekel GH. Association between early oxidative DNA damage and iron status in women with gestational diabetes mellitus. Reprod Toxicol 2021; 103:171-180. [PMID: 34051274 DOI: 10.1016/j.reprotox.2021.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
This study aims to assess the relationship between oxidative DNA damage and iron status in women with gestational diabetes mellitus (GDM) compared to those with normal glucose tolerance in the first and the second trimesters of pregnancy. Maternal serum and urine samples were collected in the 11th-14th weeks and the 24th-28th weeks of gestation. In addition to oral glucose tolerance test in the second trimester, fasting blood glucose, HbA1c, ferritin and hemoglobin levels were measured in blood samples. Urinary levels of oxidative DNA damage products 8-hydroxy-2'-deoxyguanosine (8-OH-dG) and 8,5'-cyclo-2'-deoxyadenosines (S-cdA, R-cdA) were determined using liquid chromatography-tandem mass spectrometry with isotope-dilution. In the first trimester, urinary 8-OH-dG levels were found higher in the GDM group (n = 33) than in the control group (n = 84) (p = 0.006). R-cdA and S-cdA levels were not significantly different between the two groups (p = 0.794 and p = 0.792 respectively). When the cases were stratified according to their first trimester ferritin levels, women with ≥50th centile (≥130 ng/mL) demonstrated higher levels of 8-OH-dG and R-cdA than those under <50th centile (p = 0.034, p = 0.009). In the GDM group, there was a positive correlation between the second trimester 8-OH-dG and ferritin and 1st-hour glucose levels (p = 0.014, p = 0.020). This is the first study where oxidative DNA damage is evaluated in both early and late periods of pregnancy. Our findings reveal an association between GDM and iron status and oxidative DNA damage.
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Affiliation(s)
- Mehmet Oğuz Erbağcı
- Department of Medical Biochemistry, Sanliurfa Suruc State Hospital, Sanliurfa, Turkey
| | - Gamze Tuna
- Department of Molecular Medicine, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
| | - Semir Köse
- Division of Perinatology, Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Nazlı Ecem Dal-Bekar
- Department of Molecular Medicine, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Merve Akış
- Department of Medical Biochemistry, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Melis Kant
- Department of Medical Biochemistry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sabahattin Altunyurt
- Division of Perinatology, Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gül Hüray İşlekel
- Department of Molecular Medicine, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey; Department of Medical Biochemistry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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19
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Li J, Du B, Geng X, Zhou L. lncRNA SNHG17 is Downregulated in Gestational Diabetes Mellitus (GDM) and Has Predictive Values. Diabetes Metab Syndr Obes 2021; 14:831-838. [PMID: 33654419 PMCID: PMC7914071 DOI: 10.2147/dmso.s263942] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/18/2021] [Indexed: 02/01/2023] Open
Abstract
AIM Long non-coding RNA (lncRNA) SNHG17 has been shown to participate in type 2 diabetes mellitus, while its role in gestational diabetes mellitus (GDM) is unknown. METHODS Quantitative real-time PCR (qRT-PCR) assays were conducted to compare the differential expression of SNHG17 among 60 GDM patients and 60 healthy pregnant female controls. In addition, peripheral blood samples from 240 pregnant females were collected to evaluate the predictive value of SNHG17 for GDM patients. All females were followed-up until delivery to record the occurrence of GDM and perinatal outcomes. GDM-free curves were plotted to compare the occurrence of GDM between high- and low- SNHG17 expression groups. The diagnostic value of plasma SNHG17 for GDM was analyzed by ROC curve analysis. Moreover, the cell counting kit (CCK-8) assay was performed to evaluate the impact of SNHG17 on cell viability of INS-1, and the level of insulin secretion was detected by enzyme linked immunosorbent assay (ELISA) after overexpression or knockdown of SNHG17. RESULTS SNHG17 was downregulated in GDM patients compared to normal pregnant females. Low plasma expression levels of SNHG17 were closely correlated with the high incidence rate of GDM (GDM-free curve). Remarkably, plasma expression levels of SNHG17 at 4 weeks before the diagnosis of GDM (diagnosed by standard method) can be used to distinguish (ROC curve) GDM patients (diagnosed during follow-up) from normal pregnant females (GDM was not diagnosed during follow-up). CONCLUSION Plasma circulating SNHG17 is downregulated in GDM and has predictive values.
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Affiliation(s)
- Jingjun Li
- Department of Endocrinology, Xinxiang Central Hospital, Xinxiang, Henan Province, 453003, People's Republic of China
| | - Baoshun Du
- Department of Endocrinology, Xinxiang Central Hospital, Xinxiang, Henan Province, 453003, People's Republic of China
| | - Xiuqin Geng
- Department of Endocrinology, Xinxiang Central Hospital, Xinxiang, Henan Province, 453003, People's Republic of China
| | - Lin Zhou
- Department of Endocrinology, Xinxiang Central Hospital, Xinxiang, Henan Province, 453003, People's Republic of China
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20
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Benhalima K, Minschart C, Van Crombrugge P, Calewaert P, Verhaeghe J, Vandamme S, Theetaert K, Devlieger R, Pierssens L, Ryckeghem H, Dufraimont E, Vercammen C, Debie A, De Block C, Vandenberghe G, Van Imschoot S, Verstraete S, Buyse L, Wens J, Muyldermans J, Meskal A, De Spiegeleer S, Mathieu C. The 2019 Flemish consensus on screening for overt diabetes in early pregnancy and screening for gestational diabetes mellitus. Acta Clin Belg 2020; 75:340-347. [PMID: 31259665 DOI: 10.1080/17843286.2019.1637389] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Screening for gestational diabetes mellitus (GDM) is important to improve pregnancy outcomes and to prevent type 2 diabetes after pregnancy. The 'International Association of Diabetes and Pregnancy Study Groups' (IADPSG) recommends a universal one-step approach with the 75 g oral glucose tolerance test (OGTT) for screening of GDM. The IADPSG recommendation remains controversial due to the important increase in GDM prevalence and increased workload. After review of the latest evidence and based on data from the 'Belgian Diabetes in Pregnancy' study, members of the Diabetes Liga, the Flemish associations of general physicians (Domus Medica), obstetricians (VVOG), midwives (VVOB), diabetes nurse educators (BVVDV) and clinical chemists (RBSLM) have reached a new consensus on screening for GDM in Flanders. This new consensus recommends universal screening for overt diabetes when planning pregnancy or at the latest at first prenatal contact, preferably by measuring the fasting plasma glucose by using the same diagnostic criteria as in the non-pregnant state. In women with impaired fasting glycaemia, but also in normoglycemic obese women and women with a previous history of GDM, lifestyle counselling is advised with screening for GDM with a 75 g OGTT at 24 weeks. In all other women, we recommend a two-step screening strategy with a 50 g glucose challenge test (GCT) at 24 weeks followed by a 75 g OGTT when the glucose level 1 hour after the GCT ≥130 mg/dl. Diagnosis of GDM is made using the IADPSG criteria for GDM. Postpartum screening for subsequent glucose abnormalities should be advocated and organized for every woman with GDM.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Caro Minschart
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Paul Van Crombrugge
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Peggy Calewaert
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Siska Vandamme
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Katrien Theetaert
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Leen Pierssens
- Department of clinical Biology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Hannah Ryckeghem
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Chris Vercammen
- Department of Endocrinology Imelda ziekenhuis, Bonheiden, Belgium
| | - Ann Debie
- Department of Endocrinology Imelda ziekenhuis, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Belgium
| | - Griet Vandenberghe
- Department of Obstetrics & Gynecology, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Johan Wens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Wilrijk, Belgium
| | | | - Anissa Meskal
- Department of Clinical Biology, GZA, Wilrijk, Belgium
| | - Sandy De Spiegeleer
- Department of Clinical Biology, Laboratoire Luc Olivier SA, Fernelmont, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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21
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Asimakopoulos G, Pergialiotis V, Anastasiou E, Antsaklis P, Theodora M, Vogiatzi E, Kallergi A, Sindos M, Loutradis D, Daskalakis G. Effect of dietary myo-inositol supplementation on the insulin resistance and the prevention of gestational diabetes mellitus: study protocol for a randomized controlled trial. Trials 2020; 21:633. [PMID: 32646482 PMCID: PMC7346495 DOI: 10.1186/s13063-020-04561-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset or first recognition during pregnancy, which is characterized by an increased insulin resistance. Gestational diabetes mellitus is associated with pregnancy-related maternal and fetal morbidity (both antenatal and perinatal). Myo-inositol has been suggested to improve insulin resistance in women with polycystic ovary syndrome. The aim of this study is to examine the impact of myo-inositol supplementation during pregnancy on the incidence of gestational diabetes mellitus. Methods We will conduct a single-center, open-label, randomized controlled trial. A total of 160 healthy pregnant women with singleton pregnancy at 11–13+6 weeks of gestation will be randomly allocated in two groups: intervention group (N = 80) and control group (N = 80). The intervention group will receive myo-inositol and folic acid (4000 mg myo-inositol and 400 mcg folic acid daily) from 11 to 13+6 weeks of gestation until 26–28 weeks of gestation, while the control group will receive folic acid alone (400 mcg folic acid daily) for the same period of time as intervention group. The primary outcome will be gestational diabetes incidence rate at 26–28 weeks of gestation, according to the results of a 75 g oral glucose tolerance test held at 26–28 weeks of gestation. The secondary outcomes will include fasting blood glucose levels, glycated hemoglobin levels, insulin resistance level (evaluated by homeostasis model assessment of insulin resistance and Matsuda Index), and incidence rate of diet-treated gestational diabetes and diabetes requiring insulin therapy at 26–28 weeks of gestation. Discussion This trial will provide evidence for the effectiveness of myo-inositol supplementation during pregnancy in reducing the incidence of gestational diabetes mellitus. Trial registration ISRCTN registry: ISRCTN16142533. Registered on 9 March 2017.
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Affiliation(s)
- George Asimakopoulos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece.
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Eleni Anastasiou
- Endocrine Section - Diabetes Centre, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Panagiotis Antsaklis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Mariana Theodora
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Evangelia Vogiatzi
- Endocrine Section - Diabetes Centre, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Aggela Kallergi
- Endocrine Section - Diabetes Centre, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Michael Sindos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - George Daskalakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
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22
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Pénager C, Bardet P, Timsit J, Lepercq J. Determinants of the persistency of macrosomia and shoulder dystocia despite treatment of gestational diabetes mellitus. Heliyon 2020; 6:e03756. [PMID: 32346630 PMCID: PMC7182725 DOI: 10.1016/j.heliyon.2020.e03756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/03/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023] Open
Abstract
Aims to identify potentially modifiable risk factors associated with the persistency of macrosomia and/or shoulder dystocia in infants born to women treated for gestational diabetes mellitus (GDM). Methods this case-control retrospective study included 113 cases complicated by macrosomia (ponderal index ≥97th percentile) and/or shoulder dystocia, and 226 controls without these complications. Factors associated with macrosomia and/or shoulder dystocia and with failure of diabetes management were assessed by multivariable analyses. Results Macrosomia and/or shoulder dystocia were associated with previous delivery of a large for gestational age (LGA) infant (adjusted odds ratio, 2.34, 95% confidence interval [1.01–5.45]), three abnormal glucose values during oral glucose tolerance test (2.83 [1.19–6.72]), a higher gestational weight gain before treatment (1.08 [1.01–1.15]), and failure of diabetes management (2.68 [1.32–5.45]). A non-Euro Caucasian origin (3.08 [1.37–6.93]), previous delivery of a LGA infant (3.21 [1.31–7.87]), institution of treatment after 32 weeks of gestation (3.92 [1.86–8.25]), and insulin therapy (2.91 [1.20–7.03]) were associated with failure of diabetes management. Conclusions supportive care in at risk women, limitation of weight gain in early pregnancy, shortened delay between diagnosis and treatment of GDM, and intensive insulin dosage adjustments might be means to improve the neonatal prognosis of GDM.
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Affiliation(s)
- Cécile Pénager
- Department of Obstetrics, Cochin-Port-Royal Hospital, AP-HP, Paris Descartes University, DHU Risks in Pregnancy, 123 boulevard de Port-Royal, 75014, Paris, France
| | - Pascal Bardet
- Department of Diabetology, Cochin-Port-Royal Hospital, AP-HP, Paris Descartes University, DHU Authors, 123 boulevard de Port-Royal, 75014, Paris, France
| | - José Timsit
- Department of Diabetology, Cochin-Port-Royal Hospital, AP-HP, Paris Descartes University, DHU Authors, 123 boulevard de Port-Royal, 75014, Paris, France
| | - Jacques Lepercq
- Department of Obstetrics, Cochin-Port-Royal Hospital, AP-HP, Paris Descartes University, DHU Risks in Pregnancy, 123 boulevard de Port-Royal, 75014, Paris, France
- Corresponding author.
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23
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Zhu Y, Hedderson MM, Sridhar S, Xu F, Feng J, Ferrara A. Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: a prospective multi-racial/ethnic cohort study. Int J Epidemiol 2020; 48:423-432. [PMID: 30590563 DOI: 10.1093/ije/dyy285] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nutritional perturbations during pregnancy may impact fetal and long-term childhood growth, although there are limited data on overall diet quality. We investigated whether diet quality, measured by the Healthy Eating Index-2010 (HEI-2010), during pregnancy was related to birthweight z-score (BWZ) and the clinically relevant birth outcomes of large- and small-for-gestational age (LGA and SGA). METHODS In a prospective cohort of 2269 multi-racial/ethnic women from the Pregnancy Environment and Lifestyle Study (2014-2017), dietary intake was assessed by a food frequency questionnaire during early pregnancy. Offspring BWZ and LGA or SGA were derived based on gestational age-, sex-, and racial/ethnic-specific birthweight distributions. Multivariable linear and Poisson regression with robust standard errors were used. RESULTS About 80% of women did not achieve good diet quality (HEI-2010 < 80). After adjusting for covariates, infants born to women in the lowest vs highest quartile of HEI-2010 (37.5-64.4 vs 78.7-94.2) had a 0.12 standard-deviation [95% confidence interval (CI) 0.01-0.23, P-for-trend = 0.023] greater BWZ and 1.76-fold (1.08-2.87, P-for-trend = 0.037) increased risk of LGA. No association was observed between HEI-2010 and SGA. Per-5-point substitution of the reversely coded empty calories component score with the whole grains component score in the HEI-2010 was related to a 25% (95% CI 0.66-0.86) lower risk of LGA. CONCLUSIONS Poor diet quality in pregnancy was associated with higher birthweight and increased risk of LGA independent of maternal obesity and other covariates. Substitution of empty calories with whole grains may mitigate the risk of excess fetal growth. Our findings may inform potential prevention strategies and dietary guidelines for pregnant women.
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Affiliation(s)
- Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sneha Sridhar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Fei Xu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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24
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Shareef M, Saleh L, van den Meiracker AH, Visser W. The impact of implementing the WHO-2013 criteria for gestational diabetes mellitus on its prevalence and pregnancy outcomes: A comparison of the WHO-1999 and WHO-2013 diagnostic thresholds. Eur J Obstet Gynecol Reprod Biol 2020; 246:14-18. [DOI: 10.1016/j.ejogrb.2019.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022]
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25
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Shen Y, Jia Y, Zhou J, Cheng XY, Huang HY, Sun CQ, Fan LL, Chen J, Jiang LY. Association of gestational diabetes mellitus with adverse pregnancy outcomes: our experience and meta-analysis. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00802-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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26
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Lucovnik M, Steblovnik L, Verdenik I, Premru‐Srsen T, Tomazic M, Tul N. Changes in perinatal outcomes after implementation of
IADPSG
criteria for screening and diagnosis of gestational diabetes mellitus: A national survey. Int J Gynaecol Obstet 2020; 149:88-92. [DOI: 10.1002/ijgo.13098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/05/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Miha Lucovnik
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Lili Steblovnik
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Tanja Premru‐Srsen
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Marjeta Tomazic
- Division of Internal MedicineDepartment for Endocrinology, Diabetes and Metabolic DisordersUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Natasa Tul
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
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27
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Sert UY, Ozgu-Erdinc AS. Gestational Diabetes Mellitus Screening and Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:231-255. [PMID: 32314318 DOI: 10.1007/5584_2020_512] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An ideal screening test for gestational diabetes should be capable of identifying not only women with the disease but also the women with a high risk of developing gestational diabetes mellitus (GDM). Screening and diagnosis are the main steps leading to the way of management. There is a lack of consensus among healthcare professionals regarding the screening methods worldwide. Different study groups advocate a variety of screening methods with the support of evidence-based comprehensive data. Some of the organizations suggest screening for high risk or all pregnant women, while others prefer to offer definitive testing without screening. Glycemic thresholds are also not standardized to decide GDM among different guidelines. Prevalence rates of GDM vary between populations and with the choice of glucose thresholds for both screening and definitive tests. One-step or two-step methods have been used for GDM diagnosis. However, screening includes selecting patients with historical risk factors, 50 g 1-h glucose challenge test, fasting plasma glucose, random plasma glucose, and hemoglobin A1c with different cutoffs. In this chapter, screening and diagnosis methods of GDM accepted by different study groups will be discussed which will be followed by the evaluation of different glycemic thresholds. Then the advantages and disadvantages of used methods will be explained and the chapter will finish with an evaluation of the current international guidelines.
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Affiliation(s)
- U Yasemin Sert
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey.
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28
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Insulin Resistance in Pregnancy: Implications for Mother and Offspring. CONTEMPORARY ENDOCRINOLOGY 2020. [DOI: 10.1007/978-3-030-25057-7_5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Guardo FD, Currò JM, Valenti G, Rossetti P, Di Gregorio LM, Conway F, Chiofalo B, Garzon S, Bruni S, Rizzo G. Non-pharmacological management of gestational diabetes: The role of myo-inositol. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 17:/j/jcim.ahead-of-print/jcim-2019-0111/jcim-2019-0111.xml. [PMID: 31527297 DOI: 10.1515/jcim-2019-0111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/03/2019] [Indexed: 12/29/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disorder occurring in pregnancy. GDM plays an important role in the current diabetes epidemic: exposure to a high glycemic environment during the early stages of development increases the risk of the fetus to develop type two diabetes mellitus (T2DM) in adult life. Various cardiometabolic risk factors are linked to GDM. A thorough knowledge of the risk factors and genes involved in the development of GDM, along with an understanding of the underlying pathophysiological mechanisms are crucial to properly identify patients at risk of developing this condition. There is growing evidence showing that myo-inositol, combined with an appropriate therapeutic regimen for GDM, can provide additional benefits to the patient. The aim of this review is to analyze the role of inositol isomers - especially myo-inositol (MYO-INS) - in the treatment of patients with GDM.
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Affiliation(s)
- Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | | | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Paola Rossetti
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Catania, Italy
| | - Luisa Maria Di Gregorio
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Simone Bruni
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Khanna P, Chow L, Brydges E, Anukum K, Liu S, Mahon JL, Joy T, McManus R. Demographics of Women With Type 1, Type 2 and Gestational Diabetes Attending a Diabetes and Pregnancy Clinic in 2000-2002, 2010-2012 and 2014-2016. Can J Diabetes 2019; 43:636-640. [PMID: 31466826 DOI: 10.1016/j.jcjd.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | - Selina Liu
- Western University, London, Ontario, Canada
| | | | - Tisha Joy
- Western University, London, Ontario, Canada
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Farabi SS, Hernandez TL. Low-Carbohydrate Diets for Gestational Diabetes. Nutrients 2019; 11:E1737. [PMID: 31357598 PMCID: PMC6723585 DOI: 10.3390/nu11081737] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023] Open
Abstract
Nutrition therapy provides the foundation for treatment of gestational diabetes (GDM), and has historically been based on restricting carbohydrate (CHO) intake. In this paper, randomized controlled trials (RCTs) are reviewed to assess the effects of both low- and higher CHO nutrition approaches in GDM. The prevailing pattern across the evidence underscores that although CHO restriction improves glycemia at least in the short-term, similar outcomes could be achievable using less restrictive approaches that may not exacerbate IR. The quality of existing studies is limited, in part due to dietary non-adherence and confounding effects of treatment with insulin or oral medication. Recent evidence suggests that modified nutritional manipulation in GDM from usual intake, including but not limited to CHO restriction, improves maternal glucose and lowers infant birthweight. This creates a platform for future studies to further clarify the impact of multiple nutritional patterns in GDM on both maternal and infant outcomes.
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Affiliation(s)
- Sarah S Farabi
- Goldfarb School of Nursing, Office of Nursing Research, Barnes-Jewish College, St. Louis, MO 63110, USA
- Department of Medicine, Division of Nutritional Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
- College of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
- Department of Research, Innovation, and Professional Practice, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
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Farabi SS, Barbour LA, Heiss K, Hirsch NM, Dunn E, Hernandez TL. Obstructive Sleep Apnea Is Associated With Altered Glycemic Patterns in Pregnant Women With Obesity. J Clin Endocrinol Metab 2019; 104:2569-2579. [PMID: 30794722 PMCID: PMC6701202 DOI: 10.1210/jc.2019-00159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/19/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Often unrecognized, obstructive sleep apnea (OSA) worsens over pregnancy and is associated with poorer perinatal outcomes. The association between OSA in late pregnancy and metabolic biomarkers remains poorly understood. We tested the hypothesis that OSA in pregnant women with obesity is positively correlated with 24-hour patterns of glycemia and IR despite controlling for diet. DESIGN Pregnant women (32 to 34 weeks' gestation; body mass index, 30 to 40 kg/m2) wore a continuous glucose monitor for 3 days. OSA was measured in-home by WatchPAT 200™ [apnea hypopnea index (AHI), oxygen desaturation index (ODI; number per hour)]. Fasting blood was collected followed by a 2-hour, 75-g, oral glucose tolerance test to measure IR. Association between AHI and 24-hour glucose area under the curve (AUC) was the powered outcome. RESULTS Of 18 women (29.4 ± 1.4 years of age [mean ± SEM]), 12 (67%) had an AHI ≥5 (mild OSA). AHI and ODI were correlated with 24-hour glucose AUC (r = 0.50 to 0.54; P ≤ 0.03) and mean 24-hour glucose (r = 0.55 to 0.59; P ≤ 0.02). AHI and ODI were correlated with estimated hepatic IR (r = 0.59 to 0.74; P < 0.01), fasting free fatty acids (fFFAs; r = 0.53 to 0.56; P < 0.05), and waking cortisol (r = 0.49 to 0.64; P < 0.05). CONCLUSIONS Mild OSA is common in pregnant women with obesity and correlated with increased glycemic profiles, fFFAs, and estimates of hepatic IR. OSA is a potentially treatable target to optimize maternal glycemia and metabolism, fetal fuel supply, and pregnancy outcomes.
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Affiliation(s)
- Sarah S Farabi
- Office of Nursing Research, Goldfarb School of Nursing, St. Louis, Missouri
- Correspondence and Reprint Requests: Sarah S. Farabi, PhD, Goldfarb School of Nursing, Office of Nursing Research, Mailstop 90-36-697, 4483 Duncan Avenue, St. Louis, Missouri 63110. E-mail:
| | - Linda A Barbour
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristy Heiss
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nicole M Hirsch
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Emily Dunn
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Teri L Hernandez
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Minschart C, Devlieger R, Mathieu C. Risk factor screening for gestational diabetes mellitus based on the 2013 WHO criteria. Eur J Endocrinol 2019; 180:353-363. [PMID: 31120231 DOI: 10.1530/eje-19-0117] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Since many European countries use risk factor screening for gestational diabetes mellitus (GDM), we aimed to determine the performance of selective screening for GDM based on the 2013 WHO criteria. DESIGN AND METHODS Overall, 1811 women received universal screening with a 75 g oral glucose tolerance test (OGTT) with GDM in 12.5% (n = 231) women based on the 2013 WHO criteria. We retrospectively applied different European selective screening guidelines to this cohort and evaluated the performance of different clinical risk factors to screen for GDM. RESULTS By retrospectively applying the English, Irish, French and Dutch guidelines for selective screening, respectively 28.5% (n = 526), 49.7% (n = 916), 48.5% (n = 894) and 50.7% (n = 935) had at least one risk factor, with GDM prevalence of respectively 6.5% (n = 120), 7.9% (n = 146), 8.0% (n = 147) and 8.4% (n = 154). Using maternal age ≥30 and/or BMI ≥25 for screening, positive rate was 69.9% (n = 1288), GDM prevalence 10.2% (n = 188), sensitivity 81.4% (CI: 75.8–86.2%) and specificity 31.8% (CI: 29.5–34.1%). Adding other clinical risk factors did not improve detection. GDM women without risk factors had more neonatal hypoglycemia (14.4 vs 4.0%, P = 0.001) and labor inductions (39.7 vs 25.9%, P = 0.020) than normal-glucose tolerant women, and less cesarean sections than GDM women with risk factors (13.8 vs 31.0%, P = 0.010). CONCLUSIONS By applying selective screening by European guidelines, about 50% of women would need an OGTT with the lowest number of missed cases (33%) by the Dutch guidelines. Screening with age ≥30 years and/or BMI ≥25, reduced the number of missed cases to 18.6% but 70% would need an OGTT.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Paul Van Crombrugge
- Department of Endocrinology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics & Gynecology, Antwerp University Hospital, Edegem, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan Brussel, Brussel, Belgium
| | - Katrien De Clippel
- Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Brussel, Belgium
| | | | - Anne Loccufier
- Department of Obstetrics & Gynecology, AZ St Jan Brugge, Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
| | - Caro Minschart
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Mladenovic V, Dimitrijevic-Stojanovic M, Macut D, Djukic A. Glycoregulation During Pregnancy. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.1515/sjecr-2017-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Pregnancy is a period marked by profound changes in a woman’s hormonal status and metabolism, including the development of a carbohydrate-intolerant state. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
The aim of this study was to estimate and analyse the parameters of glycaemic control during pregnancy. We stratified patients into the following three groups according to OGTT results: normal glucose tolerance (NTG), gestational impaired glucose tolerance (GIGT) and GDM.
We investigated 92 pregnant women, diagnosed with vital and desired pregnancy up to 12 weeks of gestation, who had signed informed consent forms. Among them, 7 pregnant women had a spontaneous abortion, while 8 pregnant women dropped out, so a total of 77 pregnant women completed the trial. Most of the women examined had no risk factors (48%), while 35% of the women had one risk factor. The current study demonstrates that normal glucose tolerance was shown in 59 (76.6%) participants, while some form of glucose intolerance (GIGT or GDM) was shown in 18 (23.4%) patients. Our findings revealed an increase in glucose intolerance with advancing pregnancy (in the second and third trimester). In conclusion, we demonstrate that the difference in the quality of glycaemic control during pregnancy is manifested in the second and third trimester, until it manifests in the first trimester. These findings underpin the clinical significance of discovering GDM.
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Affiliation(s)
- Violeta Mladenovic
- Department of Internal Medicine, Faculty of Medical Sciences , University of Kragujevac , Serbia
| | | | - Djuro Macut
- Medical Faculty , University of Belgrade , Serbia
| | - Aleksandar Djukic
- Department of Internal Medicine, Faculty of Medical Sciences , University of Kragujevac , Serbia
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Wang YY, Liu Y, Li C, Lin J, Liu XM, Sheng JZ, Huang HF. Frequency and risk factors for recurrent gestational diabetes mellitus in primiparous women: a case control study. BMC Endocr Disord 2019; 19:22. [PMID: 30767767 PMCID: PMC6377747 DOI: 10.1186/s12902-019-0349-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 02/04/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To investigate the frequency and risk factors for recurrent gestational diabetes mellitus (GDM) in Chinese primiparous women. METHODS Case control study. We investigated primiparous women who experienced GDM complications and had a subsequent pregnancy in the same hospital from January, 2012 to January, 2017. Ultimately, 78 women with recurrent GDM and 64 women with no recurrence were included. Clinical characteristics and biochemical parameters such as fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) and lipid profiles were collected from medical records. We used an independent t-test and Chi-square test or Fisher's exact test to compare each variable. Univariate and multivariate logistic analyses were used to compute each odds ratio (OR) and 95% confidence interval (CI). RESULTS The frequency of recurrent GDM was 55%. We found postprandial 1-h glucose at the 75-g OGTT was positively related to GDM recurrence, whereas first-trimester FPG in first pregnancy was negatively related. The first-trimester HbA1c value was higher in the group with GDM recurrence than in the group with no recurrence, though the difference was not significant. Moreover, the group with GDM recurrence manifested significantly higher first-trimester triglyceride concentrations in subsequent pregnancies; the adjusted ORs (95% CI) were 1.43 (1.09-1.87), 0.24 (0.10-0.63), 3.59 (0.93-13.88) and 1.89 (1.13-3.16). CONCLUSIONS GDM recurred in more than half of subsequent pregnancies. Women with lower first-trimester FPG and higher postprandial 1-h glucose in first pregnancy, and with higher first-trimester triglyceride in subsequent pregnancy were at increased risk for GDM recurrence.
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Affiliation(s)
- Yin-Yu Wang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 1961, Huashan Road, Shanghai, 200030 China
| | - Ye Liu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 1961, Huashan Road, Shanghai, 200030 China
| | - Cheng Li
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 1961, Huashan Road, Shanghai, 200030 China
| | - Jing Lin
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 1961, Huashan Road, Shanghai, 200030 China
| | - Xin-Mei Liu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 1961, Huashan Road, Shanghai, 200030 China
| | - Jian-Zhong Sheng
- Department of Pathophysiology, Zhejiang University School of Medicine, Hangzhou, 310058 People’s Republic of China
| | - He-Feng Huang
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 1961, Huashan Road, Shanghai, 200030 China
- The Key Laboratory of Reproductive Genetics (Ministry of Education), Women’s Hospital School of Medicine Zhejiang University, Hangzhou, 310058 People’s Republic of China
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Effect of prenatal zinc supplementation on adipose tissue-derived hormones and neonatal weight, height and head circumference in women with impaired glucose tolerance test: randomized clinical controlled trial. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-018-0707-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Celentano C, Matarrelli B, Pavone G, Vitacolonna E, Mattei PA, Berghella V, Liberati M. The influence of different inositol stereoisomers supplementation in pregnancy on maternal gestational diabetes mellitus and fetal outcomes in high-risk patients: a randomized controlled trial. J Matern Fetal Neonatal Med 2018; 33:743-751. [PMID: 30558466 DOI: 10.1080/14767058.2018.1500545] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: To identify the effects of different dietary inositol stereoisomers on insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk for this disorder.Design: A preliminary, prospective, randomized, placebo controlled clinical trial.Participants: Nonobese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.Intervention: Supplementation with myo-inositol, d-chiro-inositol, combined myo- and d-chiro-inositol or placebo.Main outcome measure: Development of GDM on a 75 grams oral glucose tolerance test at 24-28 weeks' gestation. Secondary outcome measures were increase in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.Results: The group of women allocated to receive myo-inositol alone had a lower incidence of abnormal oral glucose tolerance test (OGTT). Nine women in the control group (C), one of the myo-inositol (MI), five in d-chiro-inositol (DCI), three in the myo-inositol/D-chiro-inositol group (MI/DCI) required insulin (p = .134). Basal, 1-hour, and 2 hours glycemic controls were significantly lower in exposed groups (p < .001, .011, and .037, respectively). The relative risk reduction related to primary outcome was 0.083, 0.559, and 0.621 for MI, DCI, and MI/DCI groups.Conclusions: This study compared the different inositol stereoisomers in pregnancy to prevent GDM. Noninferiority analysis demonstrated the largest benefit in the myo-inositol group. The relevance of our findings is mainly related to the possibility of an effective approach in GDM. Our study confirmed the efficacy of inositol supplementation in pregnant women at risk for GDM.
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Affiliation(s)
- Claudio Celentano
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Barbara Matarrelli
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Giulia Pavone
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Science of Aging, University of Chieti, Chieti, Italy
| | - Peter A Mattei
- ITAB Institute of Advanced Biomedical Technologies, University of Chieti, Chieti, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marco Liberati
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
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Bell R, Hayes L, Pasecinic N, Heslehurst N. Implementation of national screening guidelines for gestational diabetes: A national survey of maternity units in England. Diabetes Res Clin Pract 2018; 146:58-66. [PMID: 30287228 DOI: 10.1016/j.diabres.2018.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 02/02/2023]
Abstract
AIMS To describe national implementation of gestational diabetes (GDM) risk-factor based screening guidelines, and barriers to implementation relating to maternal body mass index (BMI). METHODS National online survey of NHS Trusts offering maternity services in England. A questionnaire was emailed to clinical staff involved in care of pregnant women assessing compliance with NICE guidelines for risk-factor based screening, BMI thresholds for offering OGTT and barriers to offering OGTT to women with BMI ≥ 30 kg/m2. RESULTS Health professionals from 113 (84%) of NHS Trusts in England responded to the survey. Most Trusts (81%) offered OGTT at 26-28 weeks gestation to women with selected risk factors for GDM. However, almost 40% of Trusts were not fully compliant with NICE screening criteria for all risk factors, mainly due to not offering OGTT to women with previous GDM (25% of Trusts), BMI ≥ 30 kg/m2 or ethnic minority groups (22% of Trusts). The main barriers to compliance with the BMI threshold were lack of capacity, resource and funding given the high prevalence of maternal obesity. Forty one percent of Trusts used diagnostic thresholds for GDM which differed from NICE recommendations. CONCLUSIONS Additional resources are required for NHS Trusts to fully implement and sustain risk-factor screening, especially for women with previous GDM, BMI ≥ 30 kg/m2 and ethnic minority groups.
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Affiliation(s)
- Ruth Bell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Louise Hayes
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Nicoleta Pasecinic
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom.
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Wahlberg J, Ekman B, Arnqvist HJ. Most Women with Previous Gestational Diabetes Mellitus Have Impaired Glucose Metabolism after a Decade. Int J Mol Sci 2018; 19:ijms19123724. [PMID: 30477103 PMCID: PMC6321586 DOI: 10.3390/ijms19123724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022] Open
Abstract
Of 1324 women diagnosed with gestational diabetes mellitus (GDM) in Sweden, 25% reported >10 years after the delivery that they had developed diabetes mellitus. We assessed the long-term risk of all glucose metabolic abnormalities in a subgroup of these women. Women (n = 51) previously diagnosed with GDM by capillary blood glucose ≥9.0 mmol/L (≈plasma glucose ≥10.0 mmol/L) after a 2 h 75 g oral glucose tolerance test (OGTT) were included. All underwent a clinical and biochemical evaluation, including a second 2 h 75 g OGTT. Individuals with known type 1 diabetes were excluded. At the follow-up, 12/51 (24%) reported previously diagnosed type 2 diabetes. Another four cases were diagnosed after the second OGTT, increasing the prevalence to 16/51 cases (31%). Impaired fasting plasma glucose (IFG) was diagnosed in 13/51 women and impaired glucose tolerance (IGT) in 10/51 women, leaving only 12 women (24%) with normal glucose tolerance. In addition, 2/51 women had high levels of glutamic acid decarboxylase (GAD) antibodies; of these, one woman classified as type 2 diabetes was reclassified as type 1 diabetes, and the second GAD-positive woman was diagnosed with IGT. Of the women diagnosed with GDM by a 2 h 75 g OGTT, a large proportion had impaired glucose metabolism a decade later, including type 1 and type 2 diabetes.
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Affiliation(s)
- Jeanette Wahlberg
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, S-581 85 Linköping, Sweden.
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden.
| | - Bertil Ekman
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, S-581 85 Linköping, Sweden.
| | - Hans J Arnqvist
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden.
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Hernandez TL, Mande A, Barbour LA. Nutrition therapy within and beyond gestational diabetes. Diabetes Res Clin Pract 2018; 145:39-50. [PMID: 29679625 PMCID: PMC6195478 DOI: 10.1016/j.diabres.2018.04.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/03/2018] [Indexed: 02/08/2023]
Abstract
With the global rising prevalence of gestational diabetes (GDM), an adaptable, economical approach to nutrition therapy that effectively controls maternal glycemia while promoting normal fetal growth will have far-reaching implications. The conventional focus has been to rigidly limit all types of carbohydrate. While controlling glucose, this approach fosters maternal anxiety and is a primary barrier to adherence. Many mothers substitute fat for carbohydrate, which may unintentionally enhance lipolysis, promote elevated free fatty acids (FFA), and worsen maternal insulin resistance (IR). Nutrition that worsens IR may facilitate nutrient shunting across the placenta, promoting excess fetal fat accretion. Evidence suggests that liberalizing higher quality, nutrient-dense carbohydrates results in controlled fasting/postprandial glucose, lower FFA, improved insulin action, vascular benefits, and may reduce excess infant adiposity. Thus, a less carbohydrate-restricted approach may improve maternal adherence when combined with higher quality carbohydrates, lower fat, appropriate caloric intake, and ethnically acceptable foods. Such a diet can be culturally sensitive, socioeconomically attentive, minimize further weight gain in GDM, with potential relevance for pregnancies complicated by overweight/obesity. Future research is needed to better understand the effect of macronutrient composition on the placenta and gut microbiome, the benefits/risks of nonnutritive sweeteners, and whether precision-nutrition is beneficial in pregnancy.
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Affiliation(s)
- Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.
| | - Archana Mande
- Colorado Clinical and Translational Science Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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41
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Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Minschart C, Devlieger R, Mathieu C. A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors. J Clin Med 2018; 7:E351. [PMID: 30322138 PMCID: PMC6210855 DOI: 10.3390/jcm7100351] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022] Open
Abstract
This study determines if a modified two-step screening strategy with a glucose challenge test (GCT) ≥ 7.2 mmol/L and clinical risk factors improves the diagnostic accuracy for gestational diabetes mellitus (GDM), based on 2013 WHO criteria, while limiting the number of oral glucose tolerance tests (OGTT). This was a prospective multicentric cohort study with 1811 participants receiving both GCT and 75 g OGTT in pregnancy. Participants and health care providers were blinded for GCT. Characteristics were analyzed across four glucose tolerance groups: abnormal (≥7.2 mmol/L), GCT GDM (n = 165), normal GCT GDM (n = 63), abnormal GCT normal glucose tolerant (NGT) (n = 472); normal GCT NGT (n = 1113). Compared to normal GCT NGT women, normal GCT GDM women had increased rates of obesity (23.8% vs. 10.5%, p < 0.001), ethnic minority background (19.3% vs. 8.2%, p < 0.001) and a history of GDM (13.8% vs. 4.6%, p = 0.03). By combined screening of GCT ≥ 7.2 mmol/L with these risk factors, sensitivity increased to respectively, 74.1⁻78.1% using one risk factor, and to 82.9% using any of these risk factors with a specificity of 57.5%. By using a modified two-step screening strategy, the number of women needing both a GCT and OGTT would be reduced to 25.5%, and 52.6% of all OGTTs could be avoided, compared to a universal one-step approach.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium.
| | - Paul Van Crombrugge
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium.
| | - Carolien Moyson
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium.
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium.
| | - Sofie Vandeginste
- Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium.
| | - Hilde Verlaenen
- Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium.
| | - Chris Vercammen
- Department of Endocrinology, Imelda ziekenhuis, 2820 Bonheiden, Belgium.
| | - Toon Maes
- Department of Endocrinology, Imelda ziekenhuis, 2820 Bonheiden, Belgium.
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda Ziekenhuis, 2820 Bonheiden, Belgium.
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, 2560 Edegem, Belgium.
| | - Yves Jacquemyn
- Department of Obstetrics & Gynecology, Antwerp University Hospital, 2560 Edegem, Belgium.
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan Brussel, 1000 Brussel, Belgium.
| | - Katrien De Clippel
- Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, 1000 Brussel, Belgium.
| | | | - Anne Loccufier
- Department of Obstetrics & Gynecology, AZ St Jan Brugge, 8000 Brugge, Belgium.
| | - Annouschka Laenen
- Center of Biostatics and Statistical bioinformatics, KU Leuven, 3000 Leuven, Belgium.
| | - Caro Minschart
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium.
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium.
| | - Chantal Mathieu
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium.
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Barbour LA, Hernandez TL. Maternal Lipids and Fetal Overgrowth: Making Fat from Fat. Clin Ther 2018; 40:1638-1647. [PMID: 30236792 PMCID: PMC6195465 DOI: 10.1016/j.clinthera.2018.08.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 12/25/2022]
Abstract
There is increasing recognition that maternal glucose concentrations lower than those previously used for diagnosis of gestational diabetes mellitus (GDM) and targeted for treatment can result in excess fetal growth. Yet, mothers with GDM who appear to have optimal glycemic control and mothers with obesity and normal glucose tolerance still have a significantly increased risk for delivering infants who are large for gestational age, or even more importantly, who have increased adiposity at birth. What is less appreciated is that in addition to glucose, maternal lipids are also substrates for fetal fat accretion and that placental lipases can hydrolyze maternal triglycerides (TGs) to free fatty acids for fetal-placental availability. Maternal TG levels are 40% to 50% higher on average in mothers with obesity and GDM compared to those in normal-weight mothers early in pregnancy and are sustained at higher levels throughout gestation. Increasing evidence supports that maternal TG, both fasting and postprandial, are also predictors of newborn adiposity (newborn %fat), a risk factor for childhood obesity, and that early exposure is at least as strong of a risk factor as later exposure in mothers with obesity. In the setting of maternal nutrient excess and maternal insulin resistance, which lead to fetal hyperinsulinemia, excess free fatty acid exposure in the fetus may result in lipid storage and fetal fat development in subcutaneous and possibly other depots. In this commentary, we provide further evidence to make a case for targeting maternal fasting and postprandial TG in mothers with obesity who have elevated TG in early pregnancy to determine whether a TG-lowering interventional approach might limit fetal overgrowth and potentially mitigate the intrauterine contribution to childhood obesity and metabolic disease.
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Affiliation(s)
- Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes. University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes. University of Colorado, Anschutz Medical Campus, Aurora, Colorado; College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Lapolla A, Metzger BE. The post-HAPO situation with gestational diabetes: the bright and dark sides. Acta Diabetol 2018; 55:885-892. [PMID: 29728773 DOI: 10.1007/s00592-018-1146-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/15/2018] [Indexed: 01/19/2023]
Abstract
AIM In 2010, in light of the data coming from the HAPO study, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) proposed a new detection strategy and diagnostic criteria for gestational diabetes based on a one-step approach with a 75 g OGTT. This review analyzes and discusses the bright and dark sides of their application. METHODS The assessment of these recommendations by the international organizations involved in the care of gestational diabetes and a series of observational, retrospective and prospective studies that have been published since 2010 regarding the use of the IADPSG recommendations have been evaluated. RESULTS The different international associations involved in the care of pregnancy and of pregnancy complicated by diabetes have not taken an univocal position some of which have accepted them, while others have criticized them. Then, the actual application of the approach recommended by the IADPSG for detecting and diagnosing GDM varies, even at centers that reportedly accept the new diagnostic criteria. CONCLUSION So the challenge lies in making every effort to achieve a global standardization of the strategies for detecting, diagnosing and treating GDM.
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Affiliation(s)
- Annunziata Lapolla
- Diabetology and Dietetics Unit, Department of Medicine, Padova University, Padova, Italy.
| | - Boyd E Metzger
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
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Venkataraman H, Saravanan P. Medicalising pregnancy with new diagnostic criteria for gestational diabetes mellitus: do we need more evidence? Diabetologia 2018; 61:1886-1888. [PMID: 29936537 DOI: 10.1007/s00125-018-4666-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Hema Venkataraman
- Diabetes, Endocrinology & Metabolism, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV2 2DX, UK
- James Cook University Hospital, Middlesbrough, UK
| | - Ponnusamy Saravanan
- Diabetes, Endocrinology & Metabolism, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV2 2DX, UK.
- George Eliot Hospital, Nuneaton, UK.
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Punnose J, Malhotra RK, Sukhija K, Mathew A, Sharma A, Choudhary N. Bimodal glucose distribution in Asian Indian pregnant women: Relevance in gestational diabetes mellitus diagnosis. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2018; 13:20-25. [PMID: 30013937 PMCID: PMC6019669 DOI: 10.1016/j.jcte.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/14/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
Pregnant Asian Indian women have bimodality in plasma glucose distribution. Bimodality is evident even in very young pregnant women of age 18–23 years. Glucose cut points may suggest thresholds for gestational diabetes diagnosis. Aims Presence of bimodality in plasma glucose distribution (BPG) and its relevance for gestational diabetes mellitus (GDM) diagnosis were studied in Asian Indian pregnant women. Methods Fasting (FPG) and two hour plasma glucose (2-h PG) values of oral glucose tolerance tests performed in 36,530 pregnant women for GDM screening (2006–16 period), were analyzed for BPG. A unimodal normal and a mixture of two normal distributions were fitted to log-transformed FPG and 2-h PG data. The mixture model was compared to unimodal model for BPG using likelihood ratio test (LRT) and the comparison was further verified by bootstrapping. The cut points of the two normal distribution curves in the mixture models of FPG and 2-h PG were noted. Results Fasting and 2-h PG distribution was bimodal in all pregnant women. The comparison of mixture and unimodal models using LRT revealed p value <0.001 in all age groups. The cut points for FPG and 2-h PG were 5.81 mmol/L (95% CI: 5.69–5.92) and 8.41 mmol/l (95% CI: 8.09–8.75) respectively. Conclusion BPG is noted for both FPG and 2-hPG in Asian Indian pregnant women. The cutpoints of normal distribution curves are close to threshold values for FPG and 2-h PG proposed in NICE (National Institute for health and Care Excellence) and IADPSG (International Association of Diabetes and Pregnancy Study Group) GDM diagnostic criteria respectively. Further research on BPG in pregnant women of racial groups with high GDM prevalence, is likely to be of value in GDM diagnosis.
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Affiliation(s)
- John Punnose
- Department of Endocrinology, St. Stephen's Hospital, Delhi, India
| | | | - Komal Sukhija
- Department of Endocrinology, St. Stephen's Hospital, Delhi, India
| | - Anu Mathew
- Department of Endocrinology, St. Stephen's Hospital, Delhi, India
| | - Asha Sharma
- Department of Obstetrics and Gynaecology, St. Stephen's Hospital, Delhi, India
| | - Naimaa Choudhary
- Department of Obstetrics and Gynaecology, St. Stephen's Hospital, Delhi, India
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Barbour LA, Hernandez TL. Maternal Non-glycemic Contributors to Fetal Growth in Obesity and Gestational Diabetes: Spotlight on Lipids. Curr Diab Rep 2018; 18:37. [PMID: 29744612 DOI: 10.1007/s11892-018-1008-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Excess fetal growth is increasingly recognized as a risk factor for childhood obesity, and mounting evidence supports that maternal glucose is not the only driver. This review focuses on the role of clinically applicable maternal non-glycemic contributors to excess fetal growth, particularly lipids, in addition to amino acids (AA), insulin resistance, inflammation, maternal nutrition, and gestational weight gain (GWG) in obesity and gestational diabetes mellitus (GDM). RECENT FINDINGS Lipids, specifically triglycerides and free fatty acids, appear to be strong contributors to excess fetal fat accretion and adiposity at birth, particularly in obese pregnancies, which account for the largest number of large-for-gestational-age infants. Maternal pre-pregnancy body mass index (BMI), GWG, insulin resistance, inflammation, and glucose, lipid, and AA concentrations have both independent and interacting effects on fetal growth, operating both early and late in pregnancy. All are sensitive to maternal nutrition. Early vs. later gestational exposure to excess maternal fuels in fasting and postprandial conditions may differentially impact fetoplacental outcomes. Compelling evidence suggests that targeting interventions early in pregnancy beyond glucose may be critical to improve fetal growth patterns.
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Affiliation(s)
- Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, 12801 E 17th Ave, Room 7103; Mail Stop 8106, Aurora, CO, 80045, USA.
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, 12801 E 17th Ave, Room 7103; Mail Stop 8106, Aurora, CO, 80045, USA
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Maj M. Introduction to the Italian edition of the DSM-5. Int Rev Psychiatry 2018; 30:176-180. [PMID: 29757024 DOI: 10.1080/09540261.2018.1436679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mario Maj
- a Department of Psychiatry , University of Campania 'Luigi Vanvitelli' , Naples , Italy
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Thagaard IN, Krebs L, Holm JC, Lange T, Larsen T, Christiansen M. Adiponectin and leptin as first trimester markers for gestational diabetes mellitus: a cohort study. Clin Chem Lab Med 2017; 55:1805-1812. [PMID: 28763297 DOI: 10.1515/cclm-2017-0427] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 06/29/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is increasing partly due to the obesity epidemic. Adipocytokines have thus been suggested as first trimester screening markers for GDM. In this study we explore the associations between body mass index (BMI) and serum concentrations of adiponectin, leptin, and the adiponectin/leptin ratio. Furthermore, we investigate whether these markers can improve the ability to screen for GDM in the first trimester. METHODS A cohort study in which serum adiponectin and leptin were measured between gestational weeks 6+0 and 14+0 in 2590 pregnant women, categorized into normal weight, moderately obese, or severely obese. RESULTS Lower concentrations of adiponectin were associated with GDM in all BMI groups; the association was more pronounced in BMI<35 kg/m2 (p=0.30 for interaction). Leptin was inversely associated with GDM in severely obese (p=0.033), but showed no association in women with BMI<35 kg/m2. The adiponectin/leptin ratio was associated with GDM in women with BMI<35 kg/m2 but not in severely obese women (p=0.79). In regard to predicting GDM, maternal characteristics combined with adiponectin alone, adiponcetin and leptin, and adiponcetin/leptin ratio had the strongest associations in women with BMI<35 kg/m2. These models had a detection rate of 77.3%-80.3% when the false positive rate was fixed at 25%. CONCLUSIONS Low adiponectin measured in the first trimester is associated with the development of GDM; higher BMI was associated with lower performance of adiponectin, though this was insignificant. Leptin had an inverse relationship with GDM in severely obese women and did not improve the ability to predict GDM.
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Mohammadi T, Paknahad Z. Adiponectin Concentration in Gestational Diabetic Women: a Case-Control Study. Clin Nutr Res 2017; 6:267-276. [PMID: 29124047 PMCID: PMC5665748 DOI: 10.7762/cnr.2017.6.4.267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/16/2017] [Accepted: 09/26/2017] [Indexed: 12/15/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is an impaired fasting glucose condition during pregnancy. Adiponectin is a polypeptide hormone that is extensively released by adipocytes which regulates energy homeostasis and carbohydrate and lipid metabolism. In addition, adiponectin has antidiabetic and anti-inflammatory properties. The aim of our research was to study about the relationship of adiponectin levels to GDM and glucose intolerance. We selected 25 GDM women and 35 healthy pregnant subjects (18–46 years) who were screened between 24 and 28 weeks of gestation based on the result of oral glucose tolerance test (OGTT). We designed a case-control study and measured the concentrations of serum adiponectin and compared the concentrations between the groups. Serum adiponectin concentration was measured using enzyme-linked immunosorbent assay (ELISA). Sociodemographic data were collected by personal interview. Serum adiponectin concentrations were significantly lower in the subjects with GDM (5.10 ± 2.15 ng/mL vs. 7.86 ± 3.52 ng/mL, p = 0.001) than in healthy pregnant subjects. The mean concentration of fasting blood glucose was considerably lower in control subjects (86.9 ± 9.0 mg/dL vs. 175.9 ± 20.1 mg/dL, p < 0.001) in comparison to GDM subjects. Our findings showed that serum concentrations of adiponectin were significantly lower in gestational diabetic women and this may help to predict the risk of GDM.
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Affiliation(s)
- Tanin Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Zamzam Paknahad
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
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Lindsay RS, Mackin ST, Nelson SM. Gestational diabetes mellitus-right person, right treatment, right time? BMC Med 2017; 15:163. [PMID: 28844206 PMCID: PMC5572161 DOI: 10.1186/s12916-017-0925-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/09/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Personalised treatment that is uniquely tailored to an individual's phenotype has become a key goal of clinical and pharmaceutical development across many, particularly chronic, diseases. For type 2 diabetes, the importance of the underlying clinical heterogeneity of the condition is emphasised and a range of treatments are now available, with personalised approaches being developed. While a close connection between risk factors for type 2 diabetes and gestational diabetes has long been acknowledged, stratification of screening, treatment and obstetric intervention remains in its infancy. CONCLUSIONS Although there have been major advances in our understanding of glucose tolerance in pregnancy and of the benefits of treatment of gestational diabetes, we argue that far more vigorous approaches are needed to enable development of companion diagnostics, and to ensure the efficacious and safe use of novel therapeutic agents and strategies to improve outcomes in this common condition.
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Affiliation(s)
- Robert S Lindsay
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow, G12 8TA, UK.
| | - Sharon T Mackin
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
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