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Syngelaki A, Wright A, Gomez Fernandez C, Mitsigiorgi R, Nicolaides KH. First-Trimester Prediction of Gestational Diabetes Mellitus Based on Maternal Risk Factors. BJOG 2025; 132:972-982. [PMID: 40000426 PMCID: PMC12051238 DOI: 10.1111/1471-0528.18110] [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: 08/28/2024] [Revised: 01/15/2025] [Accepted: 02/09/2025] [Indexed: 02/27/2025]
Abstract
OBJECTIVE To develop and validate a new first-trimester model for the prediction of gestational diabetes mellitus (GDM) based on maternal demographic characteristics and elements of medical history. DESIGN Prospective cohort study. SETTING Inner-city hospital. POPULATION 41 587 women with singleton pregnancies at 11+0-13+6 weeks' gestation, including 4231 (10.2%) who subsequently developed GDM. METHODS Logistic regression model for GDM was developed and fivefold cross-validation was performed to assess the calibration and predictive performance of the model, assessed by the area under the receiver operating characteristic curve (AUROC) and detection rates (DRs) at different screen positive rates (SPRs). MAIN OUTCOME MEASURE GDM. RESULTS In both parous women with a previous history of GDM and nulliparous women or parous women with no history of GDM, significant contributors to the prediction of GDM were maternal age, weight, height, ethnicity and family history of diabetes mellitus. In parous women with no previous history of GDM, there was a contribution from the birthweight z-score of the previous pregnancy. There was good agreement between the predicted risk and observed incidence of GDM (intercept 0.000, 95% CI: -0.034, 0.034; slope 1.000, 95% CI: 0.967, 1.033). The AUROC curve was 0.757 (95% CI: 0.749, 0.765). The performance was higher for GDM treated with insulin versus metformin or diet alone. At SPR of 40%, the DR of the insulin, metformin and diet alone group was 87.2% (95% CI: 84.9, 89.3), 80.0% (77.8, 82.0) and 61.5% (59.2, 63.7), respectively. CONCLUSION Assessment of risk for GDM can be achieved in the first trimester based on maternal risk factors.
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Affiliation(s)
- Argyro Syngelaki
- Harris Birthright Research Centre for Fetal MedicineKing's CollegeLondonUK
- Department of Women and Children's Health, School of Life Course and Population SciencesKing's College LondonLondonUK
| | - Alan Wright
- Institute of Health ResearchUniversity of ExeterExeterUK
| | | | - Rea Mitsigiorgi
- Harris Birthright Research Centre for Fetal MedicineKing's CollegeLondonUK
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Carlson AL, Beck RW, Li Z, Norton E, Bergenstal RM, Johnson M, Dunnigan S, Banfield M, Krumwiede K, Sibayan J, Calhoun P, Durnwald C. Continuous Glucose Monitoring-Measured Glucose Levels During Oral Glucose Tolerance Testing in Pregnancy. Diabetes Technol Ther 2025. [PMID: 40170670 DOI: 10.1089/dia.2024.0563] [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] [Indexed: 04/03/2025]
Abstract
Background: To diagnose gestational diabetes mellitus (GDM), clinicians typically rely on the oral glucose tolerance test (OGTT). Continuous glucose monitoring (CGM) is a tool that could possibly be used to complement or replace the OGTT. Our aim is to describe CGM-derived glycemic patterns observed concurrently during the administration of a diagnostic OGTT in pregnancy. Methods: In total, 119 pregnant females underwent OGTT testing while wearing a blinded CGM sensor. Blood glucose (BG) measurements collected during the OGTT were compared with CGM-measured glucose values obtained using a Dexcom G6 Pro sensor to determine the differences between CGM-measured and BG levels during the OGTT, measure glycemic excursion during the OGTT, and determine differences in GDM diagnosis using standard BG draws during OGTT versus CGM-measured glucose levels. Results: CGM-measured glucose levels were on average higher than paired BG levels during the OGTT at each timed measurement (fasting, 1-, 2- and 3-h); fasting CGM-measured glucose levels in particular were higher than fasting BG levels by 6 ± 13 mg/dL. The median CGM minus BG-measured glycemic excursion during the OGTT was 12 and 4 mg/dL for the 75 g and 100 g OGTT, respectively. Of 28 participants diagnosed with GDM based on OGTT BG levels, 24 (86%) participants would have been diagnosed as GDM using CGM with BG-based thresholds; of 91 participants not diagnosed with GDM, 54 (59%) would also have not been diagnosed with GDM using CGM. Conclusions: CGM glucose measurements using Dexcom G6 Pro tended to be slightly higher than BG values during an OGTT, leading to more participants who would have been diagnosed with GDM if the BG-based OGTT thresholds were applied to these CGM-measured glucose values. When CGM is used for GDM diagnosis, diagnostic glucose criteria may need to be specific for the type of sensor used accounting for any bias in glucose measurement.
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Affiliation(s)
- Anders L Carlson
- International Diabetes Center, HealthPartners, Minneapolis, Minnesota, USA
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Zoey Li
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Elizabeth Norton
- School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Mary Johnson
- International Diabetes Center, HealthPartners, Minneapolis, Minnesota, USA
| | - Sean Dunnigan
- International Diabetes Center, HealthPartners, Minneapolis, Minnesota, USA
| | - Matthew Banfield
- International Diabetes Center, HealthPartners, Minneapolis, Minnesota, USA
| | - Katie Krumwiede
- International Diabetes Center, HealthPartners, Minneapolis, Minnesota, USA
| | - Judy Sibayan
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Celeste Durnwald
- School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Li R. Multifaceted therapeutic approach via thiazolidinedione-infused magnolol in chitosan nanoparticles targeting hyperlipidemia and oxidative stress in gestational diabetes mellitus in experimental mice. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2025; 398:2753-2768. [PMID: 39264385 DOI: 10.1007/s00210-024-03404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024]
Abstract
Recent advancements in nanotechnology have sparked interest in the synthesis of chitosan nanoparticles and their potential applications in medicine. This study investigates the synthesis of chitosan nanoparticles infused with thiazolidinedione and magnolol (TZ/ML-ChNPs) and their therapeutic effects on gestational diabetes mellitus (GDM) in experimental mice. Using streptozotocin-induced diabetic pregnant mice as a model, the study examines the anti-diabetic effects of TZ/ML-ChNPs in vitro and explores possible mechanisms of action. Results show a notable decrease in α-amylase and α-glucosidase activities in TZ/ML-ChNPs-treated samples. Cytocompatibility and flow cytometry analysis in streptozotocin-induced diabetic pregnant mice conducted on RIN-5F cell line demonstrate the safety profile of TZ/ML-ChNPs. The primary objective of this research is to assess whether TZ/ML-ChNPs can mitigate hyperlipidemia and oxidative stress in diabetic pregnant mice. Chitosan nanoparticles with thiazolidinedione and magnolol have therapeutic effects that may be used in clinical and pharmaceutical applications.
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Affiliation(s)
- Rui Li
- Department of Obstetrics and Gynecology, Shanxi Provincial Children's Hospital, (Shanxi Maternal and Child Health Center) 310 Changzhi Road, Xiaodian District, Taiyuan City, 030032, Shanxi Province, China.
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Feng YJ, Deng Z, Sivak A, Yeung RO, Nagpal T. Women's perspectives to improve prenatal care for gestational diabetes: A systematic review and meta-aggregation of qualitative studies. Acta Obstet Gynecol Scand 2025; 104:267-287. [PMID: 39656503 PMCID: PMC11782075 DOI: 10.1111/aogs.14973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/30/2024] [Accepted: 09/08/2024] [Indexed: 02/01/2025]
Abstract
INTRODUCTION In numerous qualitative primary studies, women have identified opportunities to improve prenatal gestational diabetes care. The objective of our systematic review and meta-aggregation was to synthesize patient-guided suggestions for improving prenatal gestational diabetes care that are informed by lived experience of women and their support persons. MATERIAL AND METHODS This study was registered a priori on PROSPERO (CRD42023394014). Our search strategy was executed in five databases (Medline, PsycInfo, CINAHL, Scopus, and Web of Science). Primary studies that were qualitative, had full texts in English, studied women who have or had gestational diabetes or their support persons, and included experiential accounts on prenatal gestational diabetes care were included. No date restrictions were applied. Studies that were not qualitative, were secondary analyses, included data on only postpartum care, or evaluated an intervention that was not standard care were excluded. Two independent authors used Covidence software to facilitate screening. The outcomes of interest were patient-reported suggestions to improve quality of gestational diabetes care that are informed by women's or their support persons' accounts of the lived experience of gestational diabetes. Meta-aggregation followed by a thematic synthesis approach was used to analyze the qualitative data to identify women's perspectives to improve gestational diabetes care. RESULTS After duplicate removal, a total of 4761 studies underwent screening and a total of 80 studies were ultimately included. Patient- and support persons-reported suggestions to improve care include timely and comprehensive education around gestational diabetes with active engagement of family members, personalized and tailored counseling, patient-centered care, incorporation of digital or online adjuncts to care, and increasing support for women. CONCLUSIONS Our systematic review and meta-aggregation identifies several actionable and patient-guided suggestions to improve prenatal gestational diabetes care that are important to consider when embarking on clinical quality improvement.
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Affiliation(s)
| | - Zhidi Deng
- Department of MedicineUniversity of AlbertaEdmontonCanada
| | - Allison Sivak
- Department of MedicineUniversity of AlbertaEdmontonCanada
| | | | - Taniya Nagpal
- Department of MedicineUniversity of AlbertaEdmontonCanada
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Luke S, Bohn MK, Boutin A, Giesbrecht E, Vallance H, Chan WS, Barakauskas V. A comparison of perinatal outcomes associated with gestational diabetes mellitus testing practices in British Columbia: A population-based retrospective cohort study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024:10.17269/s41997-024-00977-4. [PMID: 39658779 DOI: 10.17269/s41997-024-00977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 10/07/2024] [Indexed: 12/12/2024]
Abstract
OBJECTIVES This study sought to compare one-step versus two-step testing approaches for gestational diabetes mellitus (GDM) and to investigate the associations between testing approach, degree of glucose impairment, and perinatal outcomes. METHODS A retrospective population-based cohort study was conducted by combining BC's Perinatal Data Registry with laboratory and billing information from 2010 to 2014. Pregnancy characteristics were compared by GDM testing approach. Logistic regression was conducted to determine the association between testing approach, degree of glucose impairment, and outcomes. RESULTS Approximately 17% of pregnant individuals were diagnosed with GDM using the one-step test, compared to 6% using the two-step test. The odds ratios of adverse outcomes were below 1.75 for GDM pregnancies regardless of testing approach used (compared to the group with negative results on the two-step test). A dose-dependent trend was observed between increasing glucose intolerance and odds of preterm birth. The odds of large for gestational age infants (LGA) and shoulder dystocia were significantly higher when all 75 g test values were within one standard deviation below one-step diagnostic thresholds (adjOR 1.94[1.73-2.17] and 1.85[1.55-2.21], respectively). CONCLUSION The frequency of GDM was three times higher with the use of the one-step test versus the two-step test. Abnormal results on the two-step test are associated with preterm birth at an odds ratio below 1.75. Pregnant individuals with one-step test results just below diagnostic criteria may be at greater odds for LGA. The benefits of more stringent testing practices need to be weighed against the impact of additional GDM diagnoses.
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Affiliation(s)
- Sabrina Luke
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada.
| | - Mary Kathryn Bohn
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Amelie Boutin
- Reproduction, Mother and Youth Health & Population Health and Optimal Health Practices, CHU de Québec-Université Laval Research Centre and Department of Pediatrics, Université Laval, Quebec City, QC, Canada
| | - Ellen Giesbrecht
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Hilary Vallance
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Wee-Shian Chan
- Department of Internal Medicine, BC Women's Hospital, Vancouver, BC, Canada
| | - Vilte Barakauskas
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
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Scifres CM, Davis EM, Orris S, Costacou T, Lalama C, Abebe KZ, Catalano P. Metabolic factors and perinatal outcomes among pregnant individuals with mild glucose intolerance. Diabetes Res Clin Pract 2024; 216:111830. [PMID: 39159865 DOI: 10.1016/j.diabres.2024.111830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024]
Abstract
AIMS Metabolic characteristics and outcomes were compared among pregnant individuals with varying levels of glucose intolerance. METHODS 827 participants from a randomized clinical trial comparing the IADPSG and Carpenter Coustan Criteria were grouped as follows: normal glucose tolerance, mild glucose intolerance (100 g OGTT with one abnormal value) and treated GDM (diagnosed by Carpenter Coustan or IADPSG criteria). Differences in metabolic characteristics and perinatal outcomes were assessed using inverse probability of treatment weighting. RESULTS Mild glucose intolerance had lower insulin sensitivity and beta cell response than normal glucose tolerance, and similar findings to treated GDM. Small for gestational age (SGA) (OR 0.13, 95% CI 0.08-0.24) and neonatal composite morbidity were lower (OR 0.53, 95% CI 0.38-0.74), and maternal composite morbidity higher (OR 2.03, 95% CI 1.57-2.62) when comparing mild intolerance to normal glucose tolerance. Large for gestational age (OR 3.42 95% CI 1.39-8.41) was higher while SGA (OR 0.21, 95% CI 0.05-0.81) and neonatal composite morbidity (OR 0.31, 95% CI 0.17-0.57) were lower with mild glucose intolerance compared to treated GDM. CONCLUSIONS Mild glucose intolerance has a similar metabolic profile to treated GDM, and outcome differences are likely related to knowledge of diagnosis and treatment. CLINICAL TRIALS REGISTRY NCT02309138.
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Affiliation(s)
| | - Esa M Davis
- University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Steve Orris
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Tina Costacou
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Christna Lalama
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Kaleab Z Abebe
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Bailore V, Basany K, Banda M. Adverse pregnancy outcomes with respect to treatment modalities in women with gestational diabetes mellitus at a rural tertiary care teaching hospital. J Family Med Prim Care 2024; 13:2986-2992. [PMID: 39228532 PMCID: PMC11368366 DOI: 10.4103/jfmpc.jfmpc_1495_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 09/05/2024] Open
Abstract
Objectives To estimate the prevalence of gestational diabetes mellitus (GDM) and compare adverse pregnancy outcomes with respect to treatment modalities in a peri-urban teaching hospital in Telangana. Methods A prospective study was conducted on GDM cases delivered from January 2019 to March 2020. GDM was diagnosed using a two-step procedure of screening using IADPSG criteria. Women diagnosed with GDM were divided into four groups - diet group, metformin group, metformin plus insulin group and insulin group based on the treatment modalities. Adverse pregnancy outcomes of the women managed with different treatment modalities were recorded. Results Good glycaemic control (FBS, P = 0.04, 2 hrs PLBS, P = 0.01) was achieved in diet and metformin groups. Incidence of Gestational hypertension (P = 0.01) and preeclampsia (P = 0.01) were found to be higher in the insulin group when compared to the metformin and insulin group, metformin group and diet group. No difference was noted with respect to polyhydramnios, preterm birth, premature rupture of membranes, induction labour and caesarean delivery rates between the treatment groups. Apgar score at 5 min of <7 (P = 0.02), neonatal intensive care unit admissions for >24 hrs (P = 0.03) and neonatal hypoglycaemia (P = 0.01) were found to be higher in insulin-required groups. Rates of shoulder dystocia, stillbirth, early neonatal death within 1 week and respiratory distress did not vary significantly between the treatment groups. Conclusion Universal screening of women for GDM and multidisciplinary management of women once diagnosed tend to lessen maternal and fetal complications. Metformin can be an effective, cheaper and non-invasive alternative to insulin in the management of GDM.
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Affiliation(s)
- Vidyasri Bailore
- Department of Obstetrics and Gynecology, Fernandez Hospital, Hyderabad, Telangana, India
| | - Kalpana Basany
- Department of Obstetrics and Gynecology, Society for Health Allied Research and Education, India, MediCiti Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Maheshwari Banda
- Department of Obstetrics and Gynecology, Society for Health Allied Research and Education, India, MediCiti Institute of Medical Sciences, Hyderabad, Telangana, India
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Crimmins SD, Martin LM, Myers M, Elsamadicy E, Quebedeaux TM, Desai AN, Kopelman JN. Hemoglobin A1c as a Substitute for Oral Glucose Testing in Early Pregnancy Screening. Am J Perinatol 2024; 41:e1895-e1900. [PMID: 37308088 DOI: 10.1055/s-0043-1769796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Current recommendations for individuals with risk factors for gestational diabetes mellitus (GDM) call for screening in early pregnancy. However, there is currently no clear consensus on a specific screening modality. This study evaluates whether a hemoglobin A1c (HbA1c) screening in individuals with risk factors for gestational diabetes (GDM) could be used instead of an early 1-hour glucose challenge test (GCT). We hypothesized that the HbA1c could replace 1-hour GCT in early pregnancy evaluation STUDY DESIGN: This is a prospective observational trial at a single tertiary referral center of women with at least one risk factor for GDM who were screened at <16 weeks of gestation with both 1-hour GCT or HbA1c. Exclusion criteria include: previous diagnosis of diabetes mellitus, multiple gestation, miscarriage, or missing delivery information. The diagnosis of GDM was made by a 3-hour 100-g glucose tolerance test, using the Carpenter-Coustan criteria (at least two results >94, 179, 154, and 139 mg/dL for fasting, 1-, 2-, and 3-hour values, respectively), 1-hour GCT > 200 mg/dL, or HbA1c > 6.5%. RESULTS A total of 758 patients met inclusion criteria. A total of 566 completed a 1-hour GCT and 729 had an HbA1c collected. The median gestational age at testing was 91/7 weeks (range: 40/7-156/7 weeks]. Twenty-one participants were diagnosed with GDM at <16 weeks' GA. The receiver operating characteristic (ROC) curves identified the optimal valves for a positive screen for an HbA1c > 5.6%. The HbA1c had a sensitivity of 84.2%, a specificity of 83.3%, and a false positive rate of 16.7% (p < 0.001). The area under the ROC curve for the HbA1c was 0.898. Gestational age of delivery was slightly earlier with individuals with an elevated HbA1c but no other changes in delivery or neonatal outcomes. Contingent screening improved specificity (97.7%) and decreased false positive rate to 4.4%. CONCLUSION HbA1c may be a good assessment in early pregnancy for gestational diabetes. KEY POINTS · HbA1c is a rational assessment in early pregnancy.. · An HbA1c > 5.6% is associated with gestational diabetes.. · Contingent screening limits the need for additional testing..
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Affiliation(s)
- Sarah D Crimmins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York
| | - Lucille M Martin
- Department of Emergency Medicine, Universiy of Maryland Medical Center, Baltimore, Maryland
| | - Madalyn Myers
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York
| | - Emad Elsamadicy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Vanderbilt University, Nashville, Tennessee
| | - Tabitha M Quebedeaux
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Louisiana State University, New Orleans, Louisiana
| | - Andrea N Desai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jerome N Kopelman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
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Cissé AH, Freathy RM. New insights into the genetics of diabetes in pregnancy. Nat Genet 2024; 56:358-359. [PMID: 38413726 DOI: 10.1038/s41588-024-01675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Aminata Hallimat Cissé
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Rachel M Freathy
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Jiang Z, Ye X, Cao D, Xiang Y, Li Z. Association of Placental Tissue Metabolite Levels with Gestational Diabetes Mellitus: a Metabolomics Study. Reprod Sci 2024; 31:569-578. [PMID: 37794198 DOI: 10.1007/s43032-023-01353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/09/2023] [Indexed: 10/06/2023]
Abstract
The purpose of the study is to investigate the metabolic characteristics of placental tissue in patients diagnosed with gestational diabetes mellitus (GDM). Ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS) was employed to qualitatively and quantitatively analyze the metabolites in placental tissues obtained from 25 healthy pregnant women and 25 pregnant women diagnosed with GDM. Multilevel statistical methods are applied to process intricate metabolomics data. Meanwhile, we applied machine learning techniques to identify biomarkers that could potentially predict the risk of long-term complications in patients with GDM as well as their offspring. We identified 1902 annotated metabolites, out of which 212 metabolites exhibited significant differences in GDM placentas. In addition, the study identifies a set of risk biomarkers that effectively predict the likelihood of long-term complications in both pregnant women with GDM and their offspring. The accuracy of this panel was measured by the area under the receiver operating characteristic curve (ROC), which was found to be 0.992 and 0.960 in the training and validation sets, respectively. This study enhances our understanding of GDM pathogenesis through metabolomics. Furthermore, the panel of risk markers identified could prove to be a valuable tool in predicting potential long-term complications for both GDM patients and their offspring.
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Affiliation(s)
- Zhifa Jiang
- Department of Obstetrics and Gynecology, Huizhou First Maternal and Child Health Care Hospital, Guangdong, Huizhou, China
- Guangdong Medical University, Guangdong, Zhanjiang, China
| | - Xiangyun Ye
- Guangdong Medical University, Guangdong, Zhanjiang, China
| | - Dandan Cao
- Guangdong Medical University, Guangdong, Zhanjiang, China
| | - Yuting Xiang
- Department of Obstetrics and Gynecology, Affiliated Dongguan Hospital, Southern Medical University of Major Diseases in Obstetrics and Gynecology, Dongguan, China
| | - Zhongjun Li
- Guangdong Medical University, Guangdong, Zhanjiang, China.
- Department of Obstetrics and Gynecology, Affiliated Dongguan Hospital, Southern Medical University of Major Diseases in Obstetrics and Gynecology, Dongguan, China.
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Greco E, Calanducci M, Nicolaides KH, Barry EVH, Huda MSB, Iliodromiti S. Gestational diabetes mellitus and adverse maternal and perinatal outcomes in twin and singleton pregnancies: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:213-225. [PMID: 37595821 DOI: 10.1016/j.ajog.2023.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE This study aimed to assess the risk of adverse maternal and perinatal complications between twin and singleton pregnancies affected by gestational diabetes mellitus and the respective group without gestational diabetes mellitus (controls). DATA SOURCES A literature search was performed using MEDLINE, Embase, and Cochrane from January 1980 to May 2023. STUDY ELIGIBILITY CRITERIA Observational studies reporting maternal and perinatal outcomes in singleton and/or twin pregnancies with gestational diabetes mellitus vs controls were included. METHODS This was a systematic review and meta-analysis. Pooled estimate risk ratios with 95% confidence intervals were generated to determine the likelihood of adverse pregnancy outcomes between twin and singleton pregnancies with and without gestational diabetes mellitus. Heterogeneity among studies was evaluated in the model and expressed using the I2 statistic. A P value of <.05 was considered statistically significant. The meta-analyses were performed using Review Manager (RevMan Web). Version 5.4. The Cochrane Collaboration, 2020. Meta-regression was used to compare relative risks between singleton and twin pregnancies. The addition of multiple covariates into the models was used to address the lack of adjustments. RESULTS Overall, 85 studies in singleton pregnancies and 27 in twin pregnancies were included. In singleton pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.85; 95% confidence interval, 1.69-2.01), induction of labor (relative risk, 1.36; 95% confidence interval, 1.05-1.77), cesarean delivery (relative risk, 1.31; 95% confidence interval, 1.24-1.38), large-for-gestational-age neonate (relative risk, 1.61; 95% confidence interval, 1.46-1.77), preterm birth (relative risk, 1.36; 95% confidence interval, 1.27-1.46), and admission to the neonatal intensive care unit (relative risk, 1.43; 95% confidence interval, 1.38-1.49). In twin pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.69; 95% confidence interval, 1.51-1.90), cesarean delivery (relative risk, 1.10; 95% confidence interval, 1.06-1.13), large-for-gestational-age neonate (relative risk, 1.29; 95% confidence interval, 1.03-1.60), preterm birth (relative risk, 1.19; 95% confidence interval, 1.07-1.32), and admission to the neonatal intensive care unit (relative risk, 1.20; 95% confidence interval, 1.09-1.32) and reduced risks of small-for-gestational-age neonate (relative risk, 0.89; 95% confidence interval, 0.81-0.97) and neonatal death (relative risk, 0.50; 95% confidence interval, 0.39-0.65). When comparing relative risks in singleton vs twin pregnancies, there was sufficient evidence to suggest that twin pregnancies have a lower relative risk of cesarean delivery (P=.003), have sufficient adjustment for confounders, and have lower relative risks of admission to the neonatal intensive care unit (P=.005), stillbirths (P=.002), and neonatal death (P=.001) than singleton pregnancies. CONCLUSION In both singleton and twin pregnancies, gestational diabetes mellitus was associated with an increased risk of adverse maternal and perinatal outcomes. In twin pregnancies, gestational diabetes mellitus may have a milder effect on some adverse perinatal outcomes and may be associated with a lower risk of neonatal death.
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Affiliation(s)
- Elena Greco
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
| | - Maria Calanducci
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; The Harris Birthright Research Centre, King's College, London, United Kingdom
| | - Kypros H Nicolaides
- The Harris Birthright Research Centre, King's College, London, United Kingdom
| | - Eleanor V H Barry
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Mohammed S B Huda
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Qadeer A, Ishaq MU, Safi A, Akbar A, Asif S, Komel A, Kunwar D, Bokhari SMA. Association of vitamin A with gestational diabetes and thyroid disorders in pregnancy and their influence on maternal, fetal, and neonatal outcomes. Ther Adv Reprod Health 2024; 18:26334941241271542. [PMID: 39220467 PMCID: PMC11366108 DOI: 10.1177/26334941241271542] [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: 01/04/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
Gestational diabetes mellitus (GDM) and thyroid disorders during pregnancy pose significant health concerns, impacting a substantial number of mothers globally. Globally, about 14% of pregnant women develop GDM, while thyroid disorders impact approximately 2%-3%. Both conditions contribute to adverse outcomes, including gestational hypertension, excessive fetal growth, and heightened perinatal morbidity. The central focus of this literature review is to examine the relationship between vitamin A, a crucial fat-soluble micronutrient in fetal development, and the occurrence of GDM and thyroid disorders during pregnancy. The primary research question investigates the association between vitamin A, GDM, and thyroid disorders, analyzing their combined impact on maternal, fetal, and neonatal outcomes. The review underscores the potential of vitamin A to modulate the risk and outcomes of GDM and thyroid disorders during gestation, emphasizing its role in GDM development and resolution and its influence on thyroid function in pregnancy.
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Affiliation(s)
- Abdul Qadeer
- Department of Cardiovascular Medicine, Shifa International Hospital, Islamabad, Pakistan
| | | | - Adnan Safi
- Department of Internal Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Anum Akbar
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sana Asif
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Aqsa Komel
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Digbijay Kunwar
- Department of Medicine, Bagahi Primary Healthcare Center, Parsa, Birgunj 44300, Nepal
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Bakshi RK, Kumar A, Gupta V, Radhika A, Misra P, Bhardwaj P. Review of the Screening Guidelines for Gestational Diabetes Mellitus: How to Choose Wisely. Indian J Community Med 2023; 48:828-834. [PMID: 38249691 PMCID: PMC10795887 DOI: 10.4103/ijcm.ijcm_298_23] [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: 05/08/2023] [Accepted: 09/26/2023] [Indexed: 01/23/2024] Open
Abstract
Currently, there is no international unanimity regarding the timings, the optimal cut-off points, and standardized methods of screening or diagnosis of gestational diabetes mellitus (GDM). The screening guidelines and recommendations for GDM evolved over time; concise information has been presented here in the review. We searched electronic databases for various guidelines for screening of GDM in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Cochrane, Google Scholar, Scopus, Guidelines International Network (GIN library), National Guidelines Clearinghouse (NGC); Web sites of relevant organizations; and trial registries. The mesh headings derived after reviewing the articles and were used to further search the articles are: ("Screening Guidelines GDM" or "Screening Criteria for GDM") and ("Glucose Intolerance in Pregnancy" or "Gestational Diabetes Mellitus"). The articles published from 1960 till December 2022 were included. Key outcomes included the prevalence of GDM is 14.6% according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and 13.4% according to Diabetes in Pregnancy Study Group India (DIPSI) criteria, making the DIPSI criterion a cost-effective method for low-resource settings. The IADPSG) criterion diagnoses and treats GDM earlier, thus reducing the complications associated with GDM in the mother and newborn. The IADPSG criteria at a cut-off of ≥140 mg/dL have a sensitivity of 81% and specificity of 93%, whereas the World Health Organization (2013) criteria at the same cut-off has a lower sensitivity of 59% and specificity of 81%. The risk factors of having GDM are family history, history during past pregnancy, medical history, multiple current pregnancies, and raised hemoglobin A1c. The screening guidelines have been developed by different organizations and institutions over the years. The guidelines with the threshold values for screening and their standardization for detecting GDM in Indian mothers are yet to be established.
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Affiliation(s)
| | - Akshay Kumar
- Dr. BR Ambedkar Institute of Medical Sciences, Mohali, Punjab, India
| | | | - A.G. Radhika
- Senior Consultant, UCMS & GTB Hospital, Delhi, India
| | - Puneet Misra
- Professor, Centre for Community Medicine, AIIMS, New Delhi, India
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
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Bianchi C, Resi V, Manicardi E, Burlina S, Sculli MA, Formoso G, Sciacca L. Commentary from the Italian Association of Medical Diabetologists (AMD) and Italian Society of Diabetology (SID) Interassociative Diabetes and Pregnancy Study Group on the screening and diagnostic methods for gestational diabetes: An open debate. Nutr Metab Cardiovasc Dis 2023; 33:2102-2106. [PMID: 37684171 DOI: 10.1016/j.numecd.2023.03.008] [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: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 09/10/2023]
Abstract
The current board of the interassociative Italian association of medical diabetologists (AMD)/Italian society of diabetology (SID) Diabetes and Pregnancy Italian Study Group commented about two recent papers published in the New England Journal of Medicine that investigated the screening and diagnostic methods for gestational diabetes mellitus (GDM). It is well recognized that effective screening and accurate, early diagnosis of GDM contributes to better management of these women in order to reduce adverse maternal and fetal/neonatal outcomes. However, there is worldwide controversy concerning which screening (selective or universal; one step or two steps) and which diagnostic criteria (glucose thresholds) are appropriate. The main findings of these papers are discussed along with their implications for the management of pregnant women.
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Affiliation(s)
- Cristina Bianchi
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; Metabolic Diseases and Diabetes Unit, University Hospital of Pisa, Pisa, Italy
| | - Veronica Resi
- Diabetes Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Elisa Manicardi
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; Diabetes Unit, Primary Health Care, Local Health Authority of Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Silvia Burlina
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; Department of Medicine, DIMED, University of Padova, Italy
| | - Maria Angela Sculli
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; Endocrinology and Diabetes, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Gloria Formoso
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, Ex CeSIMet) G. d'Annunzio University Chieti-Pescara, Italy
| | - Laura Sciacca
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
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15
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Hahn S, Körber S, Gerber B, Stubert J. Prediction of recurrent gestational diabetes mellitus: a retrospective cohort study. Arch Gynecol Obstet 2023; 307:689-697. [PMID: 36595021 PMCID: PMC9984506 DOI: 10.1007/s00404-022-06855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Women after gestational diabetes mellitus (GDM) are at increased risk for development of GDM recurrence. It was the aim of our study to evaluate factors for prediction of risk of recurrence. METHODS In this retrospective cohort study we included 159 women with GDM and a subsequent pregnancy. Putative risk factors for GDM recurrence were analyzed by logistic regression models. Results were compared to a cohort of age-matched women without GDM as controls (n = 318). RESULTS The overall risk of GDM recurrence was 72.3% (115/159). Risk factors of recurrence were a body mass index (BMI) ≥ 30 kg/m2 before the index pregnancy (odds ratio (OR) 2.8 [95% CI 1.3-6.2], p = 0,008), a BMI ≥ 25 kg/m2 before the subsequent pregnancy (OR 2.7 [95% CI 1.3-5.8]. p = 0.008), a positive family history (OR 4.3 [95% CI 1.2-15.4], p = 0.016) and insulin treatment during the index pregnancy (OR 2.3 [95% CI 1.1-4.6], p = 0.023). Delivery by caesarean section (index pregnancy) was of borderline significance (OR 2.2 [95% CI 0.9-5.2], p = 0.069). Interpregnancy weight gain, excessive weight gain during the index pregnancy and fetal outcome where not predictive for GDM recurrence. Neonates after GDM revealed a higher frequency of transfer to intensive care unit compared to healthy controls (OR 2.3 [95% CI 1.1-4.6], p = 0.0225). The best combined risk model for prediction of GDM recurrence including positive family history and a BMI ≥ 25 kg/m2 before the subsequent pregnancy revealed moderate test characteristics (positive likelihood ratio 7.8 [95% CI 1.1-54.7] and negative likelihood ratio 0.7 [95% CI 0.6-0.9]) with a positive predictive value of 96.6% in our cohort. CONCLUSIONS A positive family history of diabetes mellitus in combination with overweight or obesity were strongly associated with recurrence of a GDM in the subsequent pregnancy. Normalization of the pregravid BMI should be an effective approach for reducing the risk of GDM recurrence.
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Affiliation(s)
- Stephan Hahn
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Suedring 81, 18059, Rostock, Germany
| | - Sabine Körber
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Suedring 81, 18059, Rostock, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Suedring 81, 18059, Rostock, Germany
| | - Johannes Stubert
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Suedring 81, 18059, Rostock, Germany.
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16
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Yan S, Su H, Xia Y, Yan Z, Gao Y, Shi M, Liu H, Wen Y, Zhao Y, Chang Q. Association between blood selenium levels and gestational diabetes mellitus: A systematic review and meta-analysis. Front Nutr 2022; 9:1008584. [PMID: 36505252 PMCID: PMC9726795 DOI: 10.3389/fnut.2022.1008584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction The association between blood (serum or plasma) selenium concentrations and gestational diabetes mellitus (GDM) has been evaluated in some studies. However, the reported findings are debatable, and only case-control and cross-sectional studies were included. Objective This research aimed to assess the association between blood selenium levels and GDM by analyzing existing literature. To provide a reference for the prevention and treatment of GDM, we included prospective studies which are not included in previous studies to collate more high-quality evidence and better test the etiological hypothesis between blood Se concentrations and GDM. Methods The PubMed, EMBASE, and Web of Science databases were retrieved for literature up to September 2022, and relevant references were manually searched. Raw data from relevant studies were extracted, and a random effect model was adopted for meta-analysis. The total effects were reported as weighted mean differences. All data were analyzed using Stata 16.0 software. Results Fourteen studies involving 890 pregnant women with GDM and 1618 healthy pregnant women were incorporated in the meta-analysis. Pregnancies with GDM had significantly lower blood selenium levels than those with normal glucose tolerance (weighted mean difference = -8.11; 95% confidence interval: -12.68 to -3.54, P = 0.001). Subgroup analyses showed that the association between blood selenium levels and GDM was consistent in the residents of Asia and Africa, but not in European. This trend was significant in the second and third trimester subgroups, but not in the first trimester subgroup. Articles published in 2006-2015 also showed this trend, but those published before 2005 and 2016-2019 did not show significant results. This difference was evident in non-prospective studies, but not significant in prospective studies. Studies using the Carpenter and Coustan diagnostic criteria were consistent with this trend, whereas studies using other diagnostic criteria found no differences. In addition, in terms of blood selenium measurement methods, atomic absorption spectrometry showed more significant differences than other methods. In the subgroup analysis based on the sample size of included studies and the quality of the studies, each subgroup showed statistical differences. Conclusion Lower blood selenium concentrations are associated with GDM as shown in our study. Therefore, supplementing an appropriate amount of selenium may be helpful for GDM prevention and treatment.
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Affiliation(s)
- Shuai Yan
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China,Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Han Su
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China,Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Xia
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Yan
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China,Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yitao Gao
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China,Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mengyuan Shi
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huiyuan Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Wen
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuhong Zhao
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China,Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China,Yuhong Zhao,
| | - Qing Chang
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China,Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China,*Correspondence: Qing Chang,
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17
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Agarwal MM, Lal M, Vyas CD. Gestational Diabetes Mellitus in a Multi-Ethnic, High-Risk Population: Adequacy of Screening for Diabetes Mellitus 6 Weeks after Delivery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13946. [PMID: 36360827 PMCID: PMC9658585 DOI: 10.3390/ijerph192113946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Gestational diabetes mellitus (GDM) during pregnancy is a marker for future type 2 diabetes mellitus (T2DM); therefore, a meticulous follow-up after delivery can help identify women at risk for T2DM. In a cohort of 5504 pregnant women, the postpartum follow-up of all 1043 women with GDM for hyperglycemia in a multi-ethnic, high-risk Arab population was investigated. The prevalence of GDM was 18.9%. A total of 265 (25.4%) women returned for an oral glucose tolerance test (OGTT) 4-6 weeks after delivery, with more South Asian than Arab women (p < 0.01). The other factors associated with return were (a) family history of T2DM, (b) lower basic metabolic index, (c) higher abortions and (d) lower gravida (p < 0.05), all with minimal effect. An abnormal postpartum OGTT was statistically associated with previous GDM history and hypoglycemic drug treatment, although these effects were small. Overall, the follow-up of women with GDM postpartum was dismal, ethnicity being the major factor influencing return. Urgent public measures are needed to educate women with GDM about follow-up highlighting (a) risk awareness for T2DM and (b) a healthy lifestyle after childbirth-if we are to turn the tide on the epidemic of T2DM plaguing the Arab world.
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Affiliation(s)
- Mukesh M. Agarwal
- Department of Pathology, Faculty of Medicine, California University of Science and Medicine, Colton, CA 92324, USA
| | - Madan Lal
- Department of Obstetrics and Gynecology, Saint Luke’s General Hospital, R95 FY71 Kilkenny, Ireland
| | - Chintan D. Vyas
- Department of Medicine, Burjeel Medical Center, Al Ain P.O. Box 103500, United Arab Emirates
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18
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Chung YS, Moon H, Kim EH. Risk of obstetric and neonatal morbidity in gestational diabetes in a single institution: A retrospective, observational study. Medicine (Baltimore) 2022; 101:e30777. [PMID: 36181034 PMCID: PMC9524864 DOI: 10.1097/md.0000000000030777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance with onset or first recognition occurring during pregnancy and GDM could be risk factor for various maternal fetal complications. This study aimed to investigate risks of maternal and neonatal outcomes according to GDM and normal glucose tolerance. This retrospective, observational study included singleton pregnant women who had received a 50-g oral glucose challenge test in 2nd trimester of gestation and gave birth at National Health Insurance Service Ilsan Hospital. Maternal and neonatal complications were compared between GDM and non-GDM groups. Among the 682 women, 56 were diagnosed with GDM and 626 were non-GDM group. Maternal age was older and prepregnant body mass index was higher in GDM. The rate of cesarean delivery, preeclampsia, and transfusion was similar; however, the incidence of preterm birth was higher in GDM. Multivariate analysis, however, showed that GDM was independent risk factor only for preterm birth in <37 weeks (adjusted odds ratio, 2.25; 95% confidence interval, 1.16-4.36). Regarding neonatal morbidities, APGAR score <7 at 5 minutes and the rate of macrosomia were similar; however, the rates of neonatal intensive care unit (NICU) admission, large for gestational age (LGA), and intubation were higher in GDM. Multivariate analysis, however, showed that GDM was not independent risk factor for LGA, NICU admission, and intubation rate. Compared with the non-GDM group, GDM was associated with an increased likelihood of preterm birth <37 weeks, however, did not increase cesarean delivery, postpartum hemorrhage, LGA, and NICU admission rate. This study showed that the majority of women with GDM delivered with similar maternal and neonatal outcomes in non-GDM women.
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Affiliation(s)
- Yun Soo Chung
- Department of Obstetrics and Gynecology, Yonsei University Institute of Women’s Life Medical Science, Seoul, South Korea
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Hanna Moon
- Department of Obstetrics and Gynecology, Yonsei University Institute of Women’s Life Medical Science, Seoul, South Korea
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
- *Correspondence: Eui Hyeok Kim, Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea (e-mail: ; )
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Maggiulli O, Rufo F, Johns SE, Wells JC. Food taboos during pregnancy: meta-analysis on cross cultural differences suggests specific, diet-related pressures on childbirth among agriculturalists. PeerJ 2022; 10:e13633. [PMID: 35846875 PMCID: PMC9281602 DOI: 10.7717/peerj.13633] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/03/2022] [Indexed: 01/17/2023] Open
Abstract
Pregnancy is the most delicate stage of human life history as well as a common target of food taboos across cultures. Despite puzzling evidence that many pregnant women across the world reduce their intake of nutritious foods to accomplish cultural norms, no study has provided statistical analysis of cross-cultural variation in food taboos during pregnancy. Moreover, antenatal practices among forager and agriculturalists have never been compared, despite subsistence mode being known to affect staple foods and lifestyle directly. This gap hinders to us from understanding the overall threats attributed to pregnancy, and their perceived nutritional causes around the world. The present study constitutes the first cross-cultural meta-analysis on food taboos during pregnancy. We examined thirty-two articles on dietary antenatal restrictions among agricultural and non-agricultural societies, in order to: (i) identify cross-culturally targeted animal, plant and miscellaneous foods; (ii) define major clusters of taboo focus; (iii) test the hypothesis that food types and clusters of focus distribute differently between agricultural and non-agricultural taboos; and (iv) test the hypothesis that food types distribute differently across the clusters of taboo focus. All data were analysed in SPSS and RStudio using chi-squared tests and Fisher's exact tests. We detected a gradient in taboo focus that ranged from no direct physiological interest to the fear of varied physiological complications to a very specific concern over increased birth weight and difficult delivery. Non-agricultural taboos were more likely to target non-domesticated animal foods and to be justified by concerns not directly linked to the physiological sphere, whereas agricultural taboos tended to targed more cultivated and processed products and showed a stronger association with concerns over increased birth weight. Despite some methodological discrepancies in the existing literature on food taboos during pregnancy, our results illustrate that such cultural traits are useful for detecting perception of biological pressures on reproduction across cultures. Indeed, the widespread concern over birth weight and carbohydrate rich foods overlaps with clinical evidence that obstructed labor is a major threat to maternal life in Africa, Asia and Eurasia. Furthermore, asymmetry in the frequency of such concern across subsistence modes aligns with the evolutionary perspective that agriculture may have exacerbated delivery complications. This study highlights the need for the improved understanding of dietary behaviors during pregnancy across the world, addressing the role of obstructed labor as a key point of convergence between clinical, evolutionary and cultural issues in human behavior.
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Affiliation(s)
| | | | | | - Jonathan C.K. Wells
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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20
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Meccariello L. Gestational Diabetes. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Provision of antenatal care in Europe-A scientific study commissioned by European Board and College of Obstetrics and Gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2022; 272:30-36. [PMID: 35278926 DOI: 10.1016/j.ejogrb.2022.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Differences in the way health care delivery across countries may have important impacts on health outcomes and can result in inequalities. A questionnaire survey of members of national societies through EBCOG and EAPM was carried out in 2021. A total of 53 responses were received from 26 countries. Most countries reported that routine antenatal care is primarily delivered by medical staff, involving obstetric specialists or family doctors mostly in government-run facilities. Women from minority groups are able to access antenatal care easily in most countries. Less than 10% of women did not attend antenatal care throughout the pregnancy. Most booking for antenatal care takes place in the first trimester and the number of visits range from 6 to 10 depending on parity. Most countries provide routine ultrasound with 2-3 reported scans performed by specifically trained health care professionals. Facilities for prenatal screening/diagnosis of malformations in both low- and high-risk cases varied across Europe. While antenatal care is relatively standardized throughout Europe, important differences still exist in care delivery and accessibility to care. Antenatal preventive strategies appear to be variably available throughout Europe.
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22
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Lin Y, Li T, Xiao J, Xie K, Shi Z. The Association Between Cadmium Exposure and Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Front Public Health 2022; 9:555539. [PMID: 35223753 PMCID: PMC8866184 DOI: 10.3389/fpubh.2021.555539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/28/2021] [Indexed: 12/05/2022] Open
Abstract
Objective Several studies have evaluated the association of cadmium exposure with the risk of gestational diabetes mellitus (GDM). However, the findings among these studies have been inconsistent. To further investigate the relationship, we carried out a meta-analysis to clarify the relationship between cadmium exposure and GDM risk. Methods Five databases (Scopus, PubMed, Web of Science, Cochrane, and CNKI) were searched for eligible studies until September 09, 2021. The quality of eligible studies was evaluated using the Newcastle–Ottawa quality assessment scale (NOS). The summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by random-effects models due to high heterogeneity. Sensitivity analysis was performed to explore the robustness of the results. Publication bias was evaluated by Egger's test and Begg's test. We also conducted meta-regression analysis and subgroup analysis to assess the potential sources of heterogeneity. Results A total of 10 studies with 32,000 participants related to our issue were included. Comparing the highest vs. lowest categories of cadmium exposure, no significant association was observed between cadmium exposure and the risk of GDM (OR = 1.16, 95% CI = 0.92–1.46, and P = 0.206). No publication bias was found in Begg's and Egger's tests (all P > 0.05). Meta-regression suggested that publication year was the potentially heterogeneous source (P = 0.034). Subgroup analysis of publication year showed that the OR of studies before the year of 2016 was 4.05 (95% CI = 1.87–8.76, P < 0.001), and prospective cohort studies showed a borderline increased GDM risk (OR = 1.15, 95% CI = 0.99–1.33, and P = 0.061). Conclusion Our results indicated no significant association between cadmium exposure and GDM risk. Further high-quality prospective studies, especially those using standard analytic methods for cadmium exposure, are warranted to confirm the results.
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Affiliation(s)
- Yu Lin
- Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Li
- Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Jiangbo Xiao
- Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Kaipeng Xie
- Department of Public Health, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
- Department of Women Health Care, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Kaipeng Xie
| | - Zhonghua Shi
- Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
- Zhonghua Shi
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23
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Lemieux P, Benham JL, Donovan LE, Moledina N, Pylypjuk C, Yamamoto JM. The association between gestational diabetes and stillbirth: a systematic review and meta-analysis. Diabetologia 2022; 65:37-54. [PMID: 34676425 DOI: 10.1007/s00125-021-05579-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS Controversy exists over whether gestational diabetes increases the risk of stillbirth. The aim of this review was to examine the association between gestational diabetes and stillbirth. METHODS We performed searches of the published literature to May 2021. Study selection and data extraction were performed in duplicate by independent reviewers. Meta-analyses of summary measures were conducted using random-effect models for cohort and case-control studies separately. The study protocol was registered in PROSPERO (registration ID CRD42020166939). RESULTS From 9981 citations, 419 were identified for full-text review and 73 met inclusion criteria (n = 70,292,090). There was no significant association between gestational diabetes and stillbirth in cohort studies (pooled OR 1.04 [95% CI 0.90, 1.21]; I2 86.1%) or in case-control studies (pooled OR 1.57 [95% CI 0.83, 2.98]; I2 94.8%). Gestational diabetes was associated with lower odds of stillbirth among cohort studies presenting with an adjusted OR (pooled OR 0.78 [95% CI 0.68, 0.88]; I2 42.7%). Stratified analyses by stillbirth ≥28 weeks' gestation, studies published prior to 2013 and studies identified as low quality demonstrated a significantly higher odds of stillbirth in meta-regression (p = 0.016, 0.023 and 0.005, respectively). Egger's test for all included cohort studies (p = 0.018) suggests publication bias for the main meta-analysis. CONCLUSIONS/INTERPRETATION Given the substantial heterogeneity across studies, there are insufficient data to define the relationship between stillbirth and gestational diabetes adequately. In the main analyes, gestational diabetes was not associated with an increased risk of stillbirth. However, heterogeneity across studies means this finding should be interpreted cautiously.
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Affiliation(s)
- Patricia Lemieux
- Department of Medicine, CHU de Québec - University Laval, Quebec City, QC, Canada
| | - Jamie L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lois E Donovan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nadia Moledina
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christy Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Yamamoto
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
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Kurian S, Mathews M, Reshmi VP, Divakaran B, Ajith S. Impact of diabetes on the severity of COVID-19 infection in pregnant women - A single-center descriptive study. Diabetes Metab Syndr 2022; 16:102362. [PMID: 34922215 PMCID: PMC8654463 DOI: 10.1016/j.dsx.2021.102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Pregnant women have significant morbidity and mortality due to COVID-19 infection. Pregnancy and diabetes are known risk factors for severe COVID 19 infection. Understanding the interactions between COVID-19 and diabetes in pregnancy is crucial in developing appropriate therapeutic approaches. India, like many other countries, has a very high prevalence of diabetes and COVID-19 infected cases. Such studies are minimal worldwide and none from India to the best of our knowledge. MATERIALS AND METHODS We did a retrospective cross-sectional study. 856 COVID-19 infected pregnant women were included in the study. We estimated the impact of diabetes on the severity of COVID-19 infected pregnant women and compared the outcomes with the non-diabetic group. RESULTS Prevalence of diabetes in pregnancy in the present study was 15.43%(n = 132/856). Prevalence of diabetes in non-severe infection was 14%(n = 115/818), severe infection was 44.73%(n = 17/38), and in maternal deaths was 75% (n = 6/8). The age-adjusted odds ratio for diabetes for severe infection was 4.492 (95% CI = 2.277-8.865, p < 0.001). COVID-19 infected pregnant women with diabetes were at higher risk for Cesarean section (78.3%) and ICU admission for newborns (14.81%) CONCLUSION: Diabetes in pregnant women is strongly associated with the severity of COVID-19 infection. The prevalence of diabetes in pregnancy increases as the severity of COVID-19 infection increases. Diabetes is associated with more adverse outcomes in mothers and newborns. It is necessary to identify pregnant women with diabetes and prioritize them in public health interventions like vaccination.
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Affiliation(s)
- Simi Kurian
- Department of Obstetrics and Gynecology, Government Medical College, Kannur, Kerala, India.
| | - Manu Mathews
- Department of Medicine, Government Medical College, Kannur, Kerala, India.
| | - V P Reshmi
- Department of Obstetrics and Gynecology, Government Medical College, Kannur, Kerala, India.
| | - Binoo Divakaran
- Department of Community Medicine, Government Medical College, Kannur, Kerala, India.
| | - S Ajith
- Department of Obstetrics and Gynecology, Government Medical College, Kannur, Kerala, India.
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Eroğlu H, Örgül G, Tonyalı NV, Biriken D, Polat N, Yücel A, Yazihan N, Şahin D. The Role of Afamin and Other Trace Elements in the Prediction of GDM: a Tertiary Center Experience. Biol Trace Elem Res 2021; 199:4418-4422. [PMID: 33442846 DOI: 10.1007/s12011-020-02559-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022]
Abstract
The objective of this study was to evaluate the utility of first trimester maternal serum afamin levels together with vitamin E and various elements (zinc, copper, selenium, and magnesium) for the prediction of gestational diabetes mellitus (GDM). All pregnant women between 11th and 14th weeks of gestation admitted for combined test were asked to participate in the study. A total of 797 women gave permission to participate in the study between January and September 2019. Serum was obtained by centrifugation and samples were frozen and kept at - 80 °C. For final analysis, forty-three GDM patients and forty-four healthy controls were selected. Levels of afamin, vitamin E, zinc, copper, selenium, and magnesium were compared between groups. The mean levels of afamin were found to be higher in women with GDM without statistical significance (63.69 ± 82.33 vs 44.25 ± 32.25 mg/L, p = 0.149). Vitamin E levels were found to be higher in women with GDM compared to controls without any statistical significance (5.04 ± 5.33 vs 4.47 ± 3.83 μg/mL, p = 0.568). While first trimester copper concentrations were higher among diabetic women (187.26 ± 34.78 vs 175.17 ± 30.40 μg/L, p = 0.088), this was not statistically significant. The other element levels (zinc, selenium, and magnesium) were found to be similar between the two groups (p = 0.624, p = 0.088, p = 0.254, p = 0.872, respectively). The results of our study demonstrated that mean levels of afamin, vitamin E, and copper were higher in women with GDM compared to controls. Additionally, first trimester maternal zinc, selenium, and magnesium levels were similar between diabetic and healthy pregnant women. However, more studies are needed to clarify the relationship between blood trace concentrations and GDM.
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Affiliation(s)
- Hasan Eroğlu
- Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey.
| | - Gökçen Örgül
- Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Nazan Vanlı Tonyalı
- Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Derya Biriken
- Faculty of Medicine, Microbiology Department, Ankara University, Ankara, Turkey
| | - Naci Polat
- Faculty of Medicine, Pathophysiology Department, Ankara University, Ankara, Turkey
| | - Aykan Yücel
- Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Nuray Yazihan
- Faculty of Medicine, Pathophysiology Department, Ankara University, Ankara, Turkey
| | - Dilek Şahin
- Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
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Liu X, Qian F, Fan Q, Lin L, He M, Li P, Cai H, Ma L, Cheng X, Yang X. NF-κB activation impedes the transdifferentiation of hypertrophic chondrocytes at the growth plate of mouse embryos in diabetic pregnancy. J Orthop Translat 2021; 31:52-61. [PMID: 34934622 PMCID: PMC8648796 DOI: 10.1016/j.jot.2021.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Diabetes mellitus could cause numerous complications and health problems including abnormality of endochondral bone formation during embryogenesis. However, the underlying mechanisms still remain obscure. METHODS Streptozotoci (STZ) was injected to induce pregestational diabetes mellitus (PGDM) mouse model. The femurs of E18.5 mouse embryos from control and PGDM groups were harvested. Morphological staining was implemented to determine the abnormality of the bone development. The expressions of the key genes participating in osteogenesis (e.g., Sox9, Runx2, and Osterix), the NF-κB signaling molecules (e.g., P50, P65, IκBα), and the corresponding regulatory factors (e.g., Bmp2, phospho-p38) were evaluated by immunofluorescence, quantitative PCR and western blot. Finally, in vitro chondrocyte differentiation model was employed to verify the role of NF-κB on the expressions of chondro-osteogenic markers. RESULTS Alcian blue/alizarin red double staining and H&E staining demonstrated the restriction of skeletal development and relatively extended hypertrophic zone at growth plate in E18.5 STZ-induced diabetic mouse embryos compared to the control. Immunofluorescent staining and qPCR showed that Sox9 expression increased, while Runx2 and Osterix expressions decreased in the growth plate of the offspring of PGDM mice. Immunofluorescence of P65 manifested the activation of NF-κB signaling in growth plate in PGDM mouse embryos. Furthermore, the relatively extended hypertrophic zone was also observed in the growth plate of the NF-κB-activated transgenic mice, as well as the activated p65 up-regulated the expression of Bmp2 and p-p38. In ATDC5 cells, we could observe the high glucose up-regulated the P50 and P65 expressions and down-regulated IκBα expression, but the high glucose-activated NF-κB signaling could be reversed by addition of Bay (inhibitor of NF-κB signaling). The expression changes of Bmp2, Sox9 and Runx2 in presence of high glucose were resumed too. CONCLUSION Our data revealed that NF-κB signaling was involved in mediation effects of dysfunctional trans-differentiation of hypertrophic chondrocytes in the embryonic growth plate induced by maternal diabetic mellitus.
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Affiliation(s)
- Xi Liu
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
| | - Fan Qian
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
| | - Qiwei Fan
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
| | - Li Lin
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
| | - Meiyao He
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
| | - Peizhi Li
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
| | - Hongmei Cai
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
| | - Lisha Ma
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
| | - Xin Cheng
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
- Key Laboratory for Regenerative Medicine of the Ministry of Education, Jinan University, Guangzhou, 510632, China
| | - Xuesong Yang
- Division of Histology and Embryology, International Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College, Jinan University, Guangzhou, 510632, China
- Key Laboratory for Regenerative Medicine of the Ministry of Education, Jinan University, Guangzhou, 510632, China
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First-Trimester Screening for Gestational Diabetes Mellitus in Twin Pregnancies. J Clin Med 2021; 10:jcm10173814. [PMID: 34501262 PMCID: PMC8432220 DOI: 10.3390/jcm10173814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 01/01/2023] Open
Abstract
We previously reported a logistic regression model for prediction of GDM from maternal characteristics and medical history in 75,161 singleton pregnancies. In this study of 1376 twin and 13,760 singleton pregnancies recruited at 11-13 weeks' gestation, we extend the model to include terms for twin pregnancies. We found the respective odds of GDM in dichorionic and monochorionic twin pregnancies to be 1.36 (95% CI: 1.02-1.81) and 2.78 (95% CI: 1.72-4.48) times higher than in singleton pregnancies. In both singleton and twin pregnancies, the risk for GDM increased with maternal age and weight and birth weight z-score of a baby in a previous pregnancy and is higher in women with a previous pregnancy complicated by GDM; in those with a first- or second-degree relative with diabetes mellitus; in women of Black, East Asian, and South Asian racial origin; and in pregnancies conceived through the use of ovulation-induction drugs. In singleton pregnancies, at 10% and 20% false-positive rate, the detection rate was 43% and 58%, respectively. In twin pregnancies, using risk cut-offs corresponding to 10% and 20% false-positive rates in singletons, the respective false-positive rates were 27% and 47%, and the detection rates were 63% and 81%.
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Affiliation(s)
- Elizabeth M S Lange
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstet Gynecol 2021; 138:6-15. [PMID: 34259458 DOI: 10.1097/aog.0000000000004431] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate differences in short-term perinatal outcomes between the two prominent screening strategies for gestational diabetes mellitus, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan. METHODS In this single-site, blinded, randomized, comparative effectiveness trial, participants received a nonfasting 50-g oral glucose tolerance test and, if less than 200 mg/dL (less than 11.1 mmol/L), were randomized to further screening with either IADPSG or Carpenter-Coustan criteria. Gestational diabetes treatment occurred per routine clinical care. The primary outcome was incidence of large-for-gestational-age (LGA) neonates. Prespecified secondary outcomes included small-for-gestational-age (SGA) neonates, cesarean birth, and neonatal and maternal composites of adverse perinatal outcomes. Assuming a 15% incidence of LGA neonates in the Carpenter-Coustan group, 782 participants provided more than 80% power to detect a 7% absolute risk reduction with the use of IADPSG; planned recruitment was 920 for anticipated attrition. RESULTS From June 2015 to February 2019, 1,016 participants were enrolled and 921 were randomized to IADPSG (n=461) or Carpenter-Coustan (n=460) groups. Gestational diabetes incidence (14.4% vs 4.5%, P<.001) and diabetes medication use (9.3% vs 2.4%; P<.001) were more common in the IADPSG group; there were no differences in LGA neonates, either overall (risk reduction 0.90, 97.5% CI 0.53-1.52) or among women without gestational diabetes (risk reduction 0.85, 97.5% CI 0.49-1.48). Those screened with IADPSG had higher rates of neonatal morbidity but fewer study-related adverse events. Rates of SGA neonates, cesarean birth, and maternal morbidity composite did not differ significantly between study groups. CONCLUSIONS The IADPSG screening criteria resulted in more women diagnosed and treated for gestational diabetes than Carpenter-Coustan without reducing the incidence of LGA birth weight or maternal or neonatal morbidity. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02309138.
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Fox HK, Callander EJ. Health service use and health system costs associated with diabetes during pregnancy in Australia. Nutr Metab Cardiovasc Dis 2021; 31:1427-1433. [PMID: 33846005 DOI: 10.1016/j.numecd.2021.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS In the context of the rising rate of diabetes in pregnancy in Australia, this study aims to examine the health service and resource use associated with diabetes during pregnancy. METHODS AND RESULTS This project utilised a linked administrative dataset containing health and cost data for all mothers who gave birth in Queensland, Australia between 2012 and 2015 (n = 186,789, plus their babies, n = 189,909). The association between maternal characteristics and diabetes status were compared with chi-square analyses. Multiple logistic regression produced the odds ratio of having different outcomes for women who had diabetes compared to women who did not. A two-sample t-test compared the mean number of health services accessed. Generalised linear regression produced the mean costs associated with health service use. Mothers who had diabetes during pregnancy were more likely to have their labour induced at <38 weeks gestation (OR:1.39, 95% CI:1.29-1.50); have a cesarean section (OR: 1.26, 95% CI:1.22-1.31); have a preterm birth (OR:1.24, 95%: 1.18-1.32); have their baby admitted to a Special Care Nursery (OR: 2.34, 95% CI:2.26-2.43) and a Neonatal Intensive Care Unit (OR:1.25, 95%CI: 1.14-1.37). On average, mothers with diabetes access health services on more occasions during pregnancy (54.4) compared to mothers without (50.5). Total government expenditure on mothers with diabetes over the first 1000 days of the perinatal journey was significantly higher than in mothers without diabetes ($12,757 and $11,332). CONCLUSION Overall, mothers that have diabetes in pregnancy require greater health care and resource use than mothers without diabetes in pregnancy.
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Affiliation(s)
- Haylee K Fox
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.
| | - Emily J Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Feghali M, Atlass J, Abebe KZ, Comer D, Catov J, Caritis S, Arslanian S, Scifres C. Treatment of Gestational Diabetes Mellitus and Offspring Early Childhood Growth. J Clin Endocrinol Metab 2021; 106:e1849-e1858. [PMID: 33057663 PMCID: PMC7993564 DOI: 10.1210/clinem/dgaa742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with fetal overgrowth, and certain treatments are associated with an increased risk of macrosomia. However, there are limited data about the long-term effect of GDM treatment on childhood growth. METHODS Cohort study of 816 women with GDM and their offspring delivered between 2009 and 2012. Childhood height and weight through age 3 were collected from the medical record and z-scores and body mass index (BMI) were calculated. We assessed the association between GDM treatment and childhood growth using linear mixed modeling. RESULTS Treatment was divided into medical nutritional therapy (MNT) (n = 293), glyburide (n = 421), and insulin (n = 102). At delivery, birthweight, z-score, and BMI were higher in the offspring of women treated with either glyburide or insulin compared to MNT. However, weight, z-score, and BMI were similar among all offspring at 6 months and 1, 2, and 3 years of age. After controlling for covariates, there were differences in the weight z-score (P = 0.01) over the 3-year period by treatment group, but no differences in weight (P = 0.06) or change in BMI (P = 0.28). Pairwise comparisons indicated that insulin was associated with more weight gain compared with MNT (0.69 kg; 95% CI, 0.10-1.28; P = 0.02) and glyburide was associated with a trend toward lower weight z-score compared with MNT (-0.24; 95% CI, -0.47 to 0.003; P = 0.05). CONCLUSION Despite growth differences detected at birth, we observed no meaningful differences in childhood growth from 6 months to 3 years among treatment groups, including in the offspring of women with GDM treated with glyburide.
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Affiliation(s)
- Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Correspondence: Maisa Feghali, MD, 300 Halket St, Pittsburgh, PA 15213.
| | - Jacqueline Atlass
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaleab Z Abebe
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane Comer
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janet Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steve Caritis
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Silva Arslanian
- Department of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christina Scifres
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
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Zhang L, Zhang T, Sun D, Cheng G, Ren H, Hong H, Chen L, Jiao X, Du Y, Zou Y, Wang L. Diagnostic value of dysregulated microribonucleic acids in the placenta and circulating exosomes in gestational diabetes mellitus. J Diabetes Investig 2021; 12:1490-1500. [PMID: 33411988 PMCID: PMC8354507 DOI: 10.1111/jdi.13493] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/26/2020] [Accepted: 01/01/2021] [Indexed: 12/19/2022] Open
Abstract
Aims/Introduction Differentially expressed microribonucleic acids (miRNAs) in the placenta and circulating exosomes are of diagnostic value for gestational diabetes mellitus (GDM). In a cross‐sectional study, we identified miRNAs expressed both in the placenta and circulating exosomes of pregnant women with GDM, and estimated their diagnostic value. Materials and Methods Next‐generation sequencing was used to identify miRNAs in the placenta that were differentially expressed between GDM and normal glucose tolerance pregnancies. Quantitative polymerase chain reaction was used to validate the identified targets. Western blot and transmission electron microscopy were used to validate exosomes. Univariate logistic regression analysis was used to establish diagnostic models based on miRNAs expression, and the diagnostic value was estimated using the receiver operator characteristic curve. Results We identified 157 dysregulated miRNAs in the placental tissue obtained from GDM pregnancies. Of these, miRNA‐125b was downregulated (P < 0.001), whereas miRNA‐144 was upregulated (P < 0.001). The patterns of these two miRNAs remained the same in circulating exosomes from GDM pregnancies (all P < 0.001). miRNA‐144 levels in the circulating exosomes negatively correlated with body mass index both before pregnancy (P = 0.018) and before delivery (P = 0.039), and positively correlated with blood glucose at 1 h, estimated using the oral glucose tolerance test (P = 0.044). The area under curve for the established diagnostic model was 0.898, which was higher than blood glucose levels at 0 h. Conclusions These findings suggest that miRNA‐125b and miRNA‐144 are consistently dysregulated in circulating exosomes and the placenta from GDM pregnancies, and are of excellent diagnostic value for GDM.
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Affiliation(s)
- Lei Zhang
- Department of Obstetrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Ting Zhang
- Department of Pharmacy, Jinan Infectious Disease Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Daoxu Sun
- Office of Heze Health Association, Heze, China
| | - Guanghui Cheng
- Central Research Laboratory, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Hanxiao Ren
- Department of Clinical Laboratory Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Haijie Hong
- Department of Obstetrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Liyu Chen
- Department of Obstetrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Xue Jiao
- School of Medicine, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Yijia Du
- School of Medicine, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Yuqing Zou
- School of Medicine, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Lina Wang
- Department of Clinical Laboratory Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
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Correa-de-Araujo R, Yoon SS(S. Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age. J Womens Health (Larchmt) 2021; 30:160-167. [PMID: 33185505 PMCID: PMC8020515 DOI: 10.1089/jwh.2020.8860] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ≥35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.
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Affiliation(s)
- Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, U.S. Department of Health and Human Services, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Sung Sug (Sarah) Yoon
- Division of Extramural Science Programs, U.S. Department of Health and Human Services, National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
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Liu Y, Chen X, Sheng J, Sun X, Chen GQ, Zhao M, Chen Q. Complications of Pregnancy and the Risk of Developing Endometrial or Ovarian Cancer: A Case-Control Study. Front Endocrinol (Lausanne) 2021; 12:642928. [PMID: 33995276 PMCID: PMC8121171 DOI: 10.3389/fendo.2021.642928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/25/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The association of complications of pregnancy and the risk of developing gynecological cancer is controversial with the limited study. In this study, we investigated the association of preeclampsia, or gestational diabetes mellitus (GDM), or large for gestational age (LGA), or intrauterine growth restriction (IUGR) and the risk of endometrial or ovarian cancer. METHODS In this case-control study, 189 women with endometrial cancer and 119 women with ovarian cancer were included. 342 women without gynecological cancers were randomly selected as a control group. Data on the history of pregnancy and age at diagnosis of gynecological cancer as well as the use of intrauterine devices (IUDs) were collected. RESULTS Women with a history of preeclampsia or IUGR did not have an increased risk of developing endometrial or ovarian cancer. While women with a history of GDM or with the delivery of LGA infant increased the risk of developing endometrial cancer but not ovarian cancer. The odds of women with a history of GDM or with the delivery of LGA infant developing endometrial cancer was 2.691 (95% CI: 1.548, 4.3635, p=0.0003), or 6.383 (95% CI: 2.812, 13.68, p<0.0001) respectively, compared to the controls. The odds ratio of women who did not use IUDs developing ovarian cancer was 1.606 (95% CI: 1.057, 2.434), compared to the controls. There was no association of age at first birth and developing endometrial or ovarian cancer. CONCLUSION Our observational data suggested that GDM and delivery of an LGA infant are associated with an increased risk of endometrial cancer.
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Affiliation(s)
- Yang Liu
- School of Medicine, Nanjing Medical University, Nanjing, China
| | - Xingyu Chen
- School of Medicine, Nanjing Medical University, Nanjing, China
| | - Jiayi Sheng
- School of Medicine, Nanjing Medical University, Nanjing, China
| | - Xinyi Sun
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand
| | - George Qiaoqi Chen
- School of Medicine, The University of Manchester, North Manchester, United Kingdom
| | - Min Zhao
- Department of Gynaecology, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
- *Correspondence: Min Zhao, ;
| | - Qi Chen
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand
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Bayraktar B, Balikoglu M, Bayraktar M, Kanmaz A. Number of relationships between abnormal values in oral glucose tolerance test and adverse pregnancy outcome. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Odenkirk MT, Stratton KG, Gritsenko MA, Bramer LM, Webb-Robertson BJM, Bloodsworth KJ, Weitz KK, Lipton AK, Monroe ME, Ash JR, Fourches D, Taylor BD, Burnum-Johnson KE, Baker ES. Unveiling molecular signatures of preeclampsia and gestational diabetes mellitus with multi-omics and innovative cheminformatics visualization tools. Mol Omics 2020; 16:521-532. [PMID: 32966491 PMCID: PMC7736332 DOI: 10.1039/d0mo00074d] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To fully enable the development of diagnostic tools and progressive pharmaceutical drugs, it is imperative to understand the molecular changes occurring before and during disease onset and progression. Systems biology assessments utilizing multi-omic analyses (e.g. the combination of proteomics, lipidomics, genomics, etc.) have shown enormous value in determining molecules prevalent in diseases and their associated mechanisms. Herein, we utilized multi-omic evaluations, multi-dimensional analysis methods, and new cheminformatics-based visualization tools to provide an in depth understanding of the molecular changes taking place in preeclampsia (PRE) and gestational diabetes mellitus (GDM) patients. Since PRE and GDM are two prevalent pregnancy complications that result in adverse health effects for both the mother and fetus during pregnancy and later in life, a better understanding of each is essential. The multi-omic evaluations performed here provide new insight into the end-stage molecular profiles of each disease, thereby supplying information potentially crucial for earlier diagnosis and treatments.
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Affiliation(s)
- Melanie T Odenkirk
- Department of Chemistry, North Carolina State University, Raleigh, NC 27695, USA.
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Sørensen A, Sinding M. Placental Magnetic Resonance Imaging: A Method to Evaluate Placental Function In Vivo. Obstet Gynecol Clin North Am 2020; 47:197-213. [PMID: 32008669 DOI: 10.1016/j.ogc.2019.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes the use of placental magnetic resonance imaging (MRI) relaxation times in the in vivo assessment of placental function. It focuses on T2*-weighted placental MRI, the main area of the authors' research over the past decade. The rationale behind T2*-weighted placental MRI, the main findings reported in the literature, and directions for future research and clinical applications of this method are discussed. The article concludes that placental T2* relaxation time is an easily obtained and robust measurement, which can discriminate between normal and dysfunctional placenta. Placenta T2* is a promising tool for in vivo assessment of placental function.
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Affiliation(s)
- Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg 9000, Denmark.
| | - Marianne Sinding
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg 9000, Denmark
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Sex Specific Expression of Interleukin 7, 8 and 15 in Placentas of Women with Gestational Diabetes. Int J Mol Sci 2020; 21:ijms21218026. [PMID: 33126577 PMCID: PMC7663521 DOI: 10.3390/ijms21218026] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is known to increase the risk for feto-maternal complications during pregnancy. A state of low-grade inflammation, with elevated levels of proinflammatory molecules, similar to patients with obesity or diabetes mellitus type 2 has also been partly described in GDM. The placenta, as unique interface between mother and fetus, is not only passively affected by changes in one of these organisms, but also acts as a modulator by expressing hormones and cytokines. This study aimed to investigate the expression of the proinflammatory cytokines Interleukin (IL) 7, 8 and 15 in GDM in placental tissue. A total number of 80 placentas were included (40 GDM/40 control group). The expression of IL-7, 8 and 15 was investigated in extravillous trophoblast (EVT) and syncytiotrophoblast (SCT) by immunohistochemistry and immunofluorescence double staining. The immunohistochemical staining was evaluated with the semiquanitfied immunoreactive score (IRS). While the expression IL-15 was significantly upregulated in EVTs of women with GDM. The expression of IL-8 was significantly decreased in EVT of the GDM group. Furthermore, significant fetal sex specific differences were detectable in all three cytokines. Our findings suggest an involvement of the investigated cytokines in the maintenance of a state of chronic low-grade inflammation on placental level in patients suffering from GDM.
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Escobar CM, Grünebaum A, Nam EY, Olson AT, Anzai Y, Benedetto-Anzai MT, Cheon T, Arslan A, McClelland WS. Non-adherence to labor guidelines in cesarean sections done for failed induction and arrest of dilation. J Perinat Med 2020; 49:17-22. [PMID: 33555148 DOI: 10.1515/jpm-2020-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/04/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In 2014, the American College of Obstetrics and Gynecology published guidelines for diagnosing failed induction of labor (FIOL) and arrest of dilation (AOD) to prevent cesarean delivery (CD). The objectives of this study were to determine the rate of adherence to these guidelines and to compare the association of guideline adherence with physician CD rates and obstetric/neonatal outcomes. METHODS Retrospective cohort review of singleton primary cesarean deliveries for FIOL and AOD at a single academic institution from 2014 to 2016. Univariate and multivariate analyses were used to compare adherence to the guidelines with physician CD rates and obstetric/neonatal outcomes. RESULTS Of the 591 cesarean deliveries in the study, 263 were for failed induction, 328 for AOD and 79% (468/591) were not adherent to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines. Of the failed inductions, 82% (215/263) and of the AODs 77% (253/328) were not adherent. There was no difference between adherent and non-adherent CDs with regard to maternal characteristics, or obstetric/neonatal outcomes. Duration of oxytocin use after rupture of membranes, dilation at time of CD, and birth weight were statistically higher in adherent CDs. On multivariate linear regression, physician CD rates were inversely correlated with adherence to ACOG/SMFM guidelines (p<0.0001), gestational age (p=0.007), and parity (p=0.003). CONCLUSIONS Our study shows that physician non-compliance with ACOG guidelines was high. Adherence to these guidelines was associated with lower physician CD rates, without an increase in obstetric or neonatal complications.
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Affiliation(s)
- Christina M Escobar
- Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY, USA
| | - Amos Grünebaum
- Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | | | | | - Yuzuru Anzai
- Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | | | - Teresa Cheon
- Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Alan Arslan
- Division of Epidemiology, Departments of Obstetrics and Gynecology, Environmental Medicine, and Population Health, New York University Langone Medical Center, New York, NY, USA
| | - W Spencer McClelland
- Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Yu Y, He JH, Hu LL, Jiang LL, Fang L, Yao GD, Wang SJ, Yang Q, Guo Y, Liu L, Shang T, Sato Y, Kawamura K, Hsueh AJ, Sun YP. Placensin is a glucogenic hormone secreted by human placenta. EMBO Rep 2020; 21:e49530. [PMID: 32329225 DOI: 10.15252/embr.201949530] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/13/2020] [Accepted: 03/27/2020] [Indexed: 01/09/2023] Open
Abstract
FBN1 encodes asprosin, a glucogenic hormone, following furin cleavage of the C-terminus of profibrillin 1. Based on evolutionary conservation between FBN1 and FBN2, together with conserved furin cleavage sites, we identified a peptide hormone placensin encoded by FBN2 based on its high expression in trophoblasts of human placenta. In primary and immortalized murine hepatocytes, placensin stimulates cAMP production, protein kinase A (PKA) activity, and glucose secretion, accompanied by increased expression of gluconeogenesis enzymes. In situ perfusion of liver and in vivo injection with placensin also stimulate glucose secretion. Placensin is secreted by immortalized human trophoblastic HTR-8/SVneo cells, whereas placensin treatment stimulates cAMP-PKA signaling in these cells, accompanied by increases in MMP9 transcripts and activities, thereby promoting cell invasion. In pregnant women, levels of serum placensin increase in a stage-dependent manner. During third trimester, serum placensin levels of patients with gestational diabetes mellitus are increased to a bigger extent compared to healthy pregnant women. Thus, placensin represents a placenta-derived hormone, capable of stimulating glucose secretion and trophoblast invasion.
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Affiliation(s)
- Yiping Yu
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jia-Huan He
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lin-Li Hu
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lin-Lin Jiang
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lanlan Fang
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gui-Dong Yao
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Si-Jia Wang
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingling Yang
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yanjie Guo
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lin Liu
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Trisha Shang
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yorino Sato
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kazuhiro Kawamura
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Aaron Jw Hsueh
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ying-Pu Sun
- Henan Key Laboratory of Reproduction and Genetics, Center for Reproductive Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Giles ML, Davey MA, Wallace EM. Chronic hepatitis B infection and the risk of gestational diabetes: a cross-sectional study. BJOG 2020; 127:1147-1152. [PMID: 32176400 DOI: 10.1111/1471-0528.16217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE An estimated two billion people worldwide live with hepatitis B virus (HBV) infection. Many of these are women of reproductive age. Studies that have examined pregnancy outcomes in women living with HBV have reported conflicting results in relation to the incidence of gestational diabetes (GDM). The aim of this study is to examine if gestational diabetes is more common in women with chronic HBV residing in a non-Asian country. DESIGN Cross-sectional study. SETTING Victoria, Australia. POPULATION All singleton births between 2009 and 2017. METHODS Poisson regression was performed to determine whether gestational diabetes is more common in women with HBV than in women without HBV taking into account other risk factors such as maternal age, body mass index (BMI), parity and country of birth. MAIN OUTCOME MEASURE Gestational diabetes diagnosis in women with chronic HBV infection. RESULTS For women with HBV, the unadjusted incidence risk ratio for GDM was 1.75 (95% CI 1.6-1.9). After adjusting for region of birth, BMI, parity, age and smoking, the adjusted incidence risk ratio was 1.2 (95% CI 1.1-1.3). The highest incidence (37.1%) of GDM was in women with HBV and a BMI of >40. CONCLUSIONS The findings from this study confirm an association between HBV and GDM. TWEETABLE ABSTRACT HBV is associated with GDM with an incidence risk ratio for GDM of 1.75 (95% CI 1.6-1.9).
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Affiliation(s)
- M L Giles
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia.,Women's and Children's Health, Monash Health, Melbourne, Vic., Australia
| | - M-A Davey
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia
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Diaz EC, Cleves MA, DiCarlo M, Sobik SR, Ruebel ML, Thakali KM, Sims CR, Dajani NK, Krukowski RA, Børsheim E, Badger TM, Shankar K, Andres A. Parental adiposity differentially associates with newborn body composition. Pediatr Obes 2020; 15:e12596. [PMID: 31856430 PMCID: PMC7367307 DOI: 10.1111/ijpo.12596] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Maternal obesity increases offspring's obesity risk. However, studies have not often considered maternal metabolic and exercise patterns as well as paternal adiposity as potential covariates. OBJECTIVE To assess the relationship between parental and newborn adiposity. METHODS Participants were mother-child pairs (n = 209) and mother-father-offspring triads (n = 136). Parental (during gestation) and offspring (2 weeks old) percent fat mass (FM) were obtained using air displacement plethysmography. Maternal race, age, resting energy expenditure (indirect calorimetry), physical activity (accelerometry), gestational weight gain (GWG), gestational age (GA), delivery mode, infant's sex and infant feeding method were incorporated in multiple linear regression analyses. The association between parental FM and offspring insulin-like growth factor 1 (IGF-1) was assessed at age 2 years. RESULTS Maternal adiposity was positively-associated with male (β = 0.11, P = .015) and female (β = 0.13, P = .008) infant FM, whereas paternal adiposity was negatively-associated with male newborn adiposity (β = -0.09, P = .014). Breastfeeding, female sex, GA and GWG positively associated with newborn adiposity. Vaginal and C-section delivery methods associated with greater adiposity than vaginal induced delivery method. Plasma IGF-1 of 2-year-old boys and girls positively associated with their respective fathers' and mothers' FM. CONCLUSIONS Maternal and paternal adiposity differentially associate with newborn adiposity. The mechanisms of this finding remain to be determined.
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Affiliation(s)
- Eva C. Diaz
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Arkansas Children’s Research Institute, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Mario A. Cleves
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Marisha DiCarlo
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | | | - Meghan L. Ruebel
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Keshari M. Thakali
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Clark R. Sims
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Nafisa K. Dajani
- Department of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences, Little Rock, AR
| | - Rebecca A. Krukowski
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Elisabet Børsheim
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Arkansas Children’s Research Institute, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Thomas M. Badger
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Kartik Shankar
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
| | - Aline Andres
- Arkansas Children’s Nutrition Center, Little Rock, AR.,Department of Pediatrics, Little Rock, AR
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Assisted reproductive technology and the risk of gestational diabetes mellitus: a systematic review and meta-analysis. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2020. [DOI: 10.1186/s43043-020-0018-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
The use of assisted reproductive technology (ART) is increasing worldwide, and observational studies have indicated that women who conceived by ART have an increased risk of pregnancy complications including gestational diabetes mellitus (GDM). We aimed to determine the risk of GDM among women who conceived with ART by systematic review and meta-analysis.
Main text
A systematic literature search was conducted in ISI Web of Knowledge, MEDLINE, Scopus, and Embase through May 2017 for English-language articles using a list of keywords. All studies comparing GDM in women conceived by ART and those who conceived spontaneously were included. Data extraction was performed by two authors independently and discrepancies were resolved by discussion. In total, 48 studies with 91,487 pregnancies conceived through ART and 2,525,234 spontaneously conceived met the inclusion criteria. There was evidence of substantial heterogeneity among these studies (P < 0.001, I2 = 98.6%). Random effects meta-analysis showed a significant increase in GDM among those who conceived by ART compared with those who conceived spontaneously (pooled relative risk = 1.51, 95% confidence interval = 1.18–1.93). Visual inspection of the funnel plot did not reveal any publication bias, which was supported by Egger’s test and Begg’s test.
Conclusion
The findings of this systematic review indicate that the use of ART treatment is associated with a 1.51-fold increase in GDM. Women need to be counselled carefully before undergoing ART treatment about the possibility and risk of GDM.
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Muche AA, Olayemi OO, Gete YK. Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia. BMC Pregnancy Childbirth 2020; 20:73. [PMID: 32013909 PMCID: PMC6998275 DOI: 10.1186/s12884-020-2759-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gestational diabetes mellitus is a leading medical condition woman encounter during pregnancy with serious short- and long-term consequences for maternal morbidity. However, limited evidence was available on potential impacts of gestational diabetes mellitus using updated international diagnostic criteria on adverse maternal outcomes. Therefore, this study aimed to assess the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes in Northwest Ethiopia. Methods A prospective cohort study was conducted among pregnant women followed from pregnancy to delivery. Gestational diabetes mellitus status was determined by using a two-hour 75 g oral glucose tolerance test and based on updated international diagnostic criteria. Multivariable log-binomial model was used to examine the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes. Results A total of 694 women completed the follow-up and included in the analysis. Women with gestational diabetes mellitus had a higher risk of composite adverse maternal outcome (ARR=1.58, 95% CI: 1.22, 2.04), caesarean delivery (ARR=1.67; 95%: 1.15, 2.44), pregnancy induced hypertension (ARR= 3.32; 95%: 1.55, 7.11), premature rupture of membranes (ARR= 1.83; 95%: 1.02, 3.27), antepartum hemorrhage (ARR= 2.10; 95%: 1.11, 3.98) and postpartum hemorrhage (ARR= 4.85; 95%:2.28, 10.30) compared to women without gestational diabetes mellitus. Conclusions Gestational diabetes mellitus increased the risk of adverse maternal outcomes. This implies that maternal care and intervention strategies relating to women with gestational diabetes mellitus should be strengthened.
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Affiliation(s)
- Achenef Asmamaw Muche
- Department of Obstetrics and Gynecology, Pan African University Life and Earth Sciences Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Wang L, Zhang C, Song Y, Zhang Z. Serum vitamin D deficiency and risk of gestational diabetes mellitus: a meta-analysis. Arch Med Sci 2020; 16:742-751. [PMID: 32542074 PMCID: PMC7286344 DOI: 10.5114/aoms.2020.94433] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/23/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION This meta-analysis was performed to confirm the relationship of gestational diabetes mellitus (GDM) and vitamin D. MATERIAL AND METHODS PubMed and CNKI databases were searched for relevant articles. Standard mean difference (SMD) along with 95% CI was used to compare vitamin D level between women with GDM and healthy subjects. The correlation coefficient between the vitamin D and homeostasis model assessment-insulin resistance index (HOMA-IR) was analyzed. RESULTS The vitamin D level of GDM subjects was much lower than healthy subjects (SMD = -0.71, 95% CI: -0.91, -0.50). Vitamin D deficiency was associated with high risk of GDM (OR = 1.15, 95% CI: 1.07-1.23). Vitamin D was negatively correlated with HOMA-IR (r = -0.62, 95% CI: -0.85, -0.39). The analysis showed no publication bias (Egger's: p = 0.197; Begg's: p = 0.786). CONCLUSIONS Vitamin D is closely associated with the onset of GDM.
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Affiliation(s)
- Lanling Wang
- Maternity Department, W.F. Maternity and Child Care Hospital, Weicheng District, China
- Corresponding author: Lanling Wang, W.F. Maternity and Child Care Hospital, Weicheng District, China, E-mail:
| | - Chunlei Zhang
- Neonatology Department, Weifang Medical University, Weicheng District, China
| | - Yuhuan Song
- Pharmacy Department, W.F. Maternity and Child Care Hospital, Weifang, Weicheng District, China
| | - Zhennan Zhang
- Public Computer Center, Weifang Medical University, Weifang, Kuiwen District, China
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Abstract
The review presents some renewed data on the problem of optimal time and modes of delivery for women with various types of diabetes mellitus (DM 1 and 2, gestational diabetes). The necessity of making the universal delivery strategy algorithm for women with DM comes out of adverse outcomes high frequency, where the main cases are fetal macrosomia, fetal shoulder dystocia and perinatal mortality. Despite significant interest for this issue, there is still no common delivery tactics in the world for pregnant women with carbohydrate metabolism disorders. The main obstacle is evidence-based tests and meta-analysis insufficiency. So far, further studies are necessary to obtain high quality data concerning optimal terms and modes of delivery for women with DM.
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Affiliation(s)
- Roman Kapustin
- Department of Obstetrics, Division of Maternal-Fetal Medicine, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Olga Arzhanova
- Department of Obstetrics, Division of Maternal-Fetal Medicine, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Elena Alekseenkova
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Adrey Glotov
- Department of Genetics, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia
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47
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Cheng E, Longmore DK, Barzi F, Barr ELM, Lee IL, Whitbread C, Boyle JA, Oats J, Connors C, McIntyre HD, Kirkwood M, Dempsey K, Zhang X, Thomas S, Williams D, Zimmet P, Brown ADH, Shaw JE, Maple-Brown LJ. Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study. Diabetes Res Clin Pract 2019; 157:107876. [PMID: 31586661 DOI: 10.1016/j.diabres.2019.107876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
AIMS To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. METHODS Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. RESULTS Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia. CONCLUSION Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.
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Affiliation(s)
- E Cheng
- Menzies School of Health Research, NT, Australia; Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia; Danila Dilba Health Service, Darwin, NT, Australia.
| | - D K Longmore
- Menzies School of Health Research, NT, Australia.
| | - F Barzi
- Menzies School of Health Research, NT, Australia.
| | - E L M Barr
- Menzies School of Health Research, NT, Australia; Baker Heart and Diabetes Institute, VIC, Australia.
| | - I L Lee
- Menzies School of Health Research, NT, Australia.
| | - C Whitbread
- Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia.
| | - J A Boyle
- Menzies School of Health Research, NT, Australia; Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia.
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - C Connors
- Primary Health Care Branch, Top End Health Service, NT, Australia.
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Australia.
| | - M Kirkwood
- Menzies School of Health Research, NT, Australia.
| | - K Dempsey
- Menzies School of Health Research, NT, Australia.
| | - X Zhang
- Innovation and Research, Department of Health, NT, Australia.
| | - S Thomas
- Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia.
| | - D Williams
- Darwin Midwifery Group, NT Health, Australia.
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Australia.
| | - A D H Brown
- South Australian Health and Medical Research Institute, Australia; Faculty of Health and Medical Science, University of Adelaide, Australia.
| | - J E Shaw
- Baker Heart and Diabetes Institute, VIC, Australia.
| | - L J Maple-Brown
- Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia.
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48
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Takmaz T, Yalvaç ES, Özcan P, Çoban U, Gökmen Karasu AF, Ünsal M. The predictive value of weight gain and waist circumference for gestational diabetes mellitus. Turk J Obstet Gynecol 2019; 16:199-204. [PMID: 31673474 PMCID: PMC6792050 DOI: 10.4274/tjod.galenos.2019.03266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/15/2019] [Indexed: 12/22/2022] Open
Abstract
Objective: The first objective of this study was to investigate the relationship between gestational diabetes mellitus (GDM) and gestational weight gain (WG), waist circumference (WC), prepregnancy, and gestational body mass index (BMI). The second aim of our study was to assess the ability of WG, WC, prepregnancy, and gestational BMI with special reference to their cut-off points on predicting the risk of GDM in pregnant women in Turkey. Materials and Methods: A total of 261 women who underwent screening for GDM with the 75-g glucose tolerance test (GTT) between 24th and 28th gestational weeks were included. According to the 75-g oral GTT results, women were classified into two groups: the GDM group and non-GDM group. The data collected included age, parity, plasma glucose level for fasting, 1- and 2-h tests, WC, prepregnancy and gestational BMI, prepregnancy weight, WG during pregnancy, gestational age at birth, and birth weight. Results: WC at 20-24 weeks of gestation, prepregnancy BMI, and gestational BMI had a predictive capacity for GDM. According to our results, optimal cut-off points for the best predictive value of GDM were WC of 100 cm with a sensitivity of 84% and specificity of 70%, prepregnancy BMI of 25 kg/m2 with a sensitivity of 81.8% and specificity of 76%, and gestational BMI of 28.3 kg/m2 with a sensitivity of 75% and specificity of 77.4%. Conclusion: The measurement of prepregnancy BMI, gestational BMI, and WC may be useful in predicting the risk of GDM. Pregnant women with increased prepregnancy BMI, gestational BMI, and WC measurements may be susceptible to the development of GDM.
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Affiliation(s)
- Taha Takmaz
- Bezmialem University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ethem Serdar Yalvaç
- Bozok University Faculty of Medicine, Department of Obstetrics and Gynecology, Yozgat, Turkey
| | - Pınar Özcan
- Bezmialem University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ulaş Çoban
- İstanbul Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ayşe Filiz Gökmen Karasu
- Bezmialem University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mehmet Ünsal
- Universitiy of Health Sciences, Elik Zübeyde Hanım Women's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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49
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Intensive glycemic control in gestational diabetes mellitus: a randomized controlled clinical feasibility trial. Am J Obstet Gynecol MFM 2019; 1:100050. [PMID: 33345840 DOI: 10.1016/j.ajogmf.2019.100050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/28/2019] [Accepted: 09/22/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Overweight and obese women with gestational diabetes mellitus are at increased risk for adverse perinatal outcomes, and they are also more likely to have suboptimal glycemic control. However, there is a paucity of data evaluating whether lower glycemic targets could improve outcomes. OBJECTIVE To evaluate the feasibility of intensive glycemic control in overweight and obese women with gestational diabetes mellitus. MATERIALS AND METHODS We randomized 60 overweight or obese women with gestational diabetes mellitus, diagnosed between 12 and 32 weeks' gestation to either intensive (fasting <90 mg/dL, 1 hour postprandial <120 mg/dL) or standard (fasting <95 mg/dL, 1 ho postprandial <140 mg/dL) glycemic targets. Maternal glucose was assessed in 2 ways: blinded continuous glucose monitors, worn for 5 days at 2 time points (at 12-32 weeks and again at 32-36 weeks), and self-monitored glucose measurement 4 times per day. All women underwent standardized dietary counseling, and medical therapy was prescribed as needed to achieve glycemic control. RESULTS Between December 2015 and December 2017, we randomized 60 women to either intensive (n = 30) or standard (n = 30) glycemic control. Baseline characteristics including maternal age, body mass index, and gestational age at diagnosis were similar between the intensive and standard groups. Medical therapy was more common in women in the intensive group than those in the standard group (83 vs 57%, P = .02). Women in the intensive glycemic control group had lower glucose values as assessed by continuous glucose monitors at including 24-hour mean (-8.1; 95% confidence interval, -12.0 to -4.3 mg/dL; P < .0001) and 1-h postprandial (-11.8; 95% confidence interval, -19.7 to -3.9 mg/dL, P = .004) values. Hypoglycemia <60 mg/dL was uncommon and did not differ between groups. CONCLUSION Intensive glycemic targets can be used in overweight and obese women with minimal hypoglycemia, and this approach results in improved glycemic control when compared to standard glycemic targets. Further studies are needed to determine whether intensive glycemic targets can improve maternal and neonatal outcomes in high-risk women with gestational diabetes mellitus. CLINICAL TRIAL IDENTIFIER NCT02530866; clinicaltrials.gov.
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50
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Hill AV, Menon R, Perez-Patron M, Carrillo G, Xu X, Taylor BD. High-mobility group box 1 at the time of parturition in women with gestational diabetes mellitus. Am J Reprod Immunol 2019; 82:e13175. [PMID: 31353785 DOI: 10.1111/aji.13175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
PROBLEM High-mobility group box 1 (HMGB1), a danger-associated molecular pattern marker, may indicate sterile inflammation through innate immune pathways. HMGB1 is implicated in hyperglycemia and excess glucose in trophoblast. Metabolic dysfunction and dyslipidemia are associated with gestational diabetes mellitus (GDM), but few studies examined associations between HMGB1 and GDM. We determined HMGB1 levels, and the ratio of HMGB1 to innate immune markers, in women with GDM at parturition. METHOD OF STUDY This case-control study of 50 GDM pregnancies and 100 healthy controls utilized data and plasma samples from PeriBank. HMGB1, pentraxin-3, and interleukin (IL)-6 were measured by ELISA. Logistic regression calculated odds ratios (OR) and 95% confidence intervals (CI) adjusting for age, pre-pregnancy body mass index, and type of labor. RESULTS There were no significant associations between HMGB1 and GDM. The ratio of HMGB1 to pentraxin-3 and IL-6 did not alter the odds of GDM. There was a significant statistical interaction between HMGB1 and maternal age (P = .02). When associations were examined by age groups, HMGB1 was associated with reduced odds of HMGB1 among women ≤25 (AOR = 0.007 CI 95% <0.001-0.3). Odds ratios increased as age increased (AOR range 1.2-3.8) but results were not statistically significant. CONCLUSION High-mobility group box 1 was not associated with GDM. However, we found evidence that maternal age was a potential effect modifier of the relationship between HMGB1 and GDM. As there is growing evidence that HMGB1 may play important roles in reproduction, future studies should explore maternal factors that may alter HMGB1 levels.
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Affiliation(s)
- Ashley V Hill
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA.,Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ramkumar Menon
- Division of Maternal-Fetal Medicine and Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Maria Perez-Patron
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA
| | - Genny Carrillo
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX, USA
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA
| | - Brandie D Taylor
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA.,Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
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