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Daida YG, Rosales AG, Frankland TB, Bacong AM, Waitzfelder B, Li J, Keawe'aimoku Kaholokula J, Palaniappan L, Fortmann SP. Differences in Coronary Heart Disease and Stroke Incidence Among Single-Race and Multiracial Asian and Pacific Islander Subgroups in Hawaii and California: A Retrospective Cohort Study. J Am Heart Assoc 2025; 14:e039076. [PMID: 40240959 DOI: 10.1161/jaha.124.039076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 02/12/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Little is known about clinical and sociodemographic factors affecting coronary heart disease (CHD) and stroke incidence in single-race and multiracial American Asian, Native Hawaiian, and Pacific Islander subgroups. As the US population becomes more diverse, it is important to characterize differences in risks for CHD and stroke, and their contributing factors, in these populations. METHODS AND RESULTS The study population included 303 958 patients from Kaiser Permanente Hawaii and Palo Alto Medical Foundation in California. Self-reported race and ethnicity were derived from electronic health records and 12 mutually exclusive single-race and multiracial groups were created for analyses. Cox proportional hazard models were used to compare CHD and stroke incidence. Unadjusted models were compared with models adjusted for age, income, education, body mass index, smoking, and comorbidities. We found up to a 4-fold variation in CHD and stroke rates among American Asian, Native Hawaiian, and Pacific Islander subgroups. Multiracial subgroups had higher rates than single-race groups. While most single-race American Asian, Native Hawaiian, and Pacific Islander groups had lower CHD and stroke risks, middle-aged Asian Indian men and Native Hawaiian women had higher stroke risks than non-Hispanic White controls. Income, education, body mass index, smoking, and comorbidities contributed significantly to risks in all groups, especially in Native Hawaiian, Pacific Islander, and multiracial groups. CONCLUSIONS Risks for CHD and stroke vary by racial and ethnic subgroups, demonstrating the need to unmask risks by disaggregating racial and ethnic subgroups. Multiracial American Asian, Native Hawaiian, and Pacific Islander groups had higher risks that were only partially explained by modifiable risk factors. Future studies should further explore lifestyle, psychosocial, and sociocultural factors.
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Affiliation(s)
- Yihe G Daida
- Center for Integrated Health Care Research Kaiser Permanente Honolulu HI USA
| | | | - Timothy B Frankland
- Center for Integrated Health Care Research Kaiser Permanente Honolulu HI USA
| | | | - Beth Waitzfelder
- Center for Integrated Health Care Research Kaiser Permanente Honolulu HI USA
| | - Jiang Li
- Palo Alto Medical Foundation Research Institute, Sutter Health Palo Alto CA USA
| | | | | | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research Portland OR USA
- Stanford University School of Medicine Stanford CA USA
- Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA USA
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Kusuma BP, Lalitha DL, Sivaraj N, Balaga VS, Panchanani AKR, Kutikuppala LVS, Roshan SS, Kavya K, Varshitha G. Study on MTHFR (C677T & A1298C) Gene Polymorphisms in the Condition of Glucose Intolerance During Pregnancy. Am J Reprod Immunol 2025; 93:e70081. [PMID: 40317814 DOI: 10.1111/aji.70081] [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: 12/28/2023] [Revised: 01/28/2025] [Accepted: 04/12/2025] [Indexed: 05/07/2025] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a prevalent medical complication in pregnancy, characterized by glucose intolerance. The global expected prevalence of GDM is approximately 15.1%. This study builds upon previous research by investigating elevated hematological parameters and exploring MTHFR gene polymorphisms in GDM. MATERIALS AND METHODS This study included 304 pregnant women, comprising 152 patients with GDM and an equal number of normal pregnant women. Employing PCR-RFLP techniques, we identified MTHFR gene polymorphisms (C677T & A1298C) associated with gestational diabetes. RESULTS Significant associations were found in gestational age and platelet count, indicating their relevance to GDM risk. The odds ratios for both MTHFR A1298C (p value: 0.034; OR = 0.7; 95% CI: 0.5021-0.9758) and MTHFR C677T (p value: 0.008; OR = 0.5453; 95% CI: 0.3292-0.9011) gene polymorphisms demonstrated an increased risk of GDM development. CONCLUSION The study reveals that elevated platelet count and polymorphs increase the risk of developing GDM in pregnant women. Gestational age also plays a role. The study also finds a link between the MTHFR C677T SNP and the MTHFR A1298C gene polymorphism and the risk of gestational diabetes in Andhra Pradesh. This gives us new information about genetic and hematological factors.
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Affiliation(s)
- Bunga Papa Kusuma
- Department of Research and Development, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
| | - D Lakshmi Lalitha
- Department of Biochemistry, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
| | - Nagarjuna Sivaraj
- Department of Research and Development, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
| | - Vijaya Sirisha Balaga
- Department of Obstetrics and Gynaecology, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
| | - Arun Kumar Rao Panchanani
- Department of Internal Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
| | | | - S Sai Roshan
- Department of Internal Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
| | - K Kavya
- Department of Internal Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
| | - Golla Varshitha
- Department of Internal Medicine, International School of Medicine (ISM), Bishkek, Kyrgyzstan
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Bazshahi E, Pourreza S, Jayedi A, Mirmohammadkhani M, Emadi A, Shab-Bidar S. Adherence to plant-based diet during pregnancy and risk of gestational diabetes: a prospective birth cohort study. BMC Nutr 2024; 10:139. [PMID: 39425217 PMCID: PMC11488182 DOI: 10.1186/s40795-024-00949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 10/11/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND Studies have shown that plant-based foods have a protective effect against gestational diabetes (GDM). We examined the association between plant-based dietary patterns and the risk of GDM in a sample of Iranian adults. METHODS We enrolled 635 pregnant women for the present study. Dietary intakes were evaluated by using a 90-item food frequency questionnaire during the first trimester of pregnancy. Three plant-based including plant-based (PDI), unhealthy (uPDI) and healthy (hPDI) were calculated. Cox proportional hazard model were fitted to estimate hazard ratio (HR) and 95% confidence interval (CI) of GDM across categories of the plan-based dietary indices, while controlling for age, educational level, physical activity, family income, prepregnancy body mass index, gestational weight gain, and total energy intake. RESULTS A total of 635 mothers were included, of whom 79 participants were diagnosed with GDM. Those in the third tertile of the PDI (HR: 0.55, 95% CI: 0.30, 0.98) and hPDI (HR: 0.43, 95% CI: 0.24, 0.78) had a lower risk of developing GDM during their current pregnancy as compared to the first tertile. There was no association between uPDI and risk of GDM. CONCLUSIONS We found that higher adherence to a plant-based diet during early pregnancy may be associated with a lower GDM risk among Iranian women. Confirmation of this finding is necessary in larger cohort studies, taking into account other pregnancy outcomes such as birth weight.
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Affiliation(s)
- Elham Bazshahi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Sanaz Pourreza
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St., Keshavarz Blvd, P. O. Box 14155/6117, Tehran, Iran
| | - Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Alireza Emadi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St., Keshavarz Blvd, P. O. Box 14155/6117, Tehran, Iran.
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Zhang W, Kong M, Jiang Y, Gan Q, Wei J, Zhang Q, Wang J, Shen J, Wu S. Ambient air pollutants exposure during gestation and incidence risk of hypertensive disorders of pregnancy or preeclampsia in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 359:124722. [PMID: 39147229 DOI: 10.1016/j.envpol.2024.124722] [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: 03/21/2024] [Revised: 06/27/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024]
Abstract
The relationships between the exposure to ambient air pollutants during gestation and the incidence of hypertensive disorders in pregnancy (HDPs) or preeclampsia are contradictory. This prospective cohort study enrolled the participants between January 2020 and December 2021 from the Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology. The exposure to ambient air pollutants and daily temperatures were obtained from the ChinaHighAirPollutants dataset and the Big Earth Data Platform for Three Poles, respectively. Logistic regression models were used as single- and two-pollutant models. Restricted cubic splines were applied to each ambient air pollutant exposure to further evaluate the exposure-response relationships. Quantile G-computation approaches were employed to evaluate the cumulative impact of mixed ambient air pollutants on the incidence risk HDPs and preeclampsia. Among 19,325 participants (median age: 30.2 years), 1669 (8.64%) were diagnosed with HDPs and 180 (0.94%) with preeclampsia. While mostly null risk estimates were observed, exposure to PM1, PM2.5, PM10, and NO2 correlated with a decreased incidence risk for HDPs and preeclampsia during most gestational periods. Additionally, our multi-pollutant model presented that an increase by one quartile in the cumulative effect of ambient air pollutants was associated with a significantly decreased incidence risk for HDPs in the trimester before gestation and in the third trimester during gestation, as well as for preeclampsia in the third trimester during gestation. These findings warrant further investigation into the mechanisms underlying these associations.
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Affiliation(s)
- Wenkai Zhang
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minghao Kong
- Tongji University School of Medicine, Shanghai, China
| | - Yuan Jiang
- Tongji University School of Medicine, Shanghai, China
| | - Quan Gan
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA
| | - Qing Zhang
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Wang
- School of Atmospheric Sciences, Nanjing University, Nanjing, China
| | - Jun Shen
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shijie Wu
- Tongji University School of Medicine, Shanghai, China.
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Lin J, Horswell R, Chu S, Dumas SA, Hu G. Trends in the Incidence of Gestational Diabetes Mellitus Among the Medicaid Population Before and During the COVID-19 Pandemic. J Womens Health (Larchmt) 2024; 33:1276-1282. [PMID: 39029471 PMCID: PMC11564676 DOI: 10.1089/jwh.2023.0746] [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] [Indexed: 07/21/2024] Open
Abstract
Importance: Although there are many regional and national studies on the trends in the incidence of gestational diabetes mellitus (GDM), the trends in the incidence of GDM among the Medicaid population are lacking, especially before and during coronavirus disease of 2019 (COVID-19). Objective: To investigate the trends in the incidence of GDM before and during COVID-19 pandemic (2016-2021) among the Louisiana Medicaid population. Design, Setting, and Participants: This study included 111,936, Louisiana Medicaid pregnant women of age 18-50 between January 1, 2016, to December 31, 2021. Main Outcomes and Measures: Pregnancies, GDM, and pre-pregnancy diabetes cases were identified by using the Tenth Revisions of the International Classification of Disease code. The annual incidence of GDM and annual prevalence of pre-pregnancy diabetes were calculated for each age and race subgroup. Results: The age-standardized incidence of GDM increased from 10.2% in 2016 to 14.8 in 2020 and decreased to 14.0% in 2021. The age-standardized prevalence of pre-pregnancy diabetes increased from 2.8% in 2016 to 3.4% in 2018 and decreased to 2.3% in 2021. The age-standardized rate of GDM was the highest among Asian women (23.0%), then White women (15.5%), and African American women (13.9%) (p for difference <0.001). The COVID-19 pandemic saw an increase in the incidence of GDM, with a rise in prominent GDM risk factors, such as obesity and sedentary behaviors, suggesting an association. Conclusion and Relevance: The incidence of GDM significantly increased during the COVID-19 pandemic. Potential reasons might include increased sedentary behavior and increased prevalence of obesity. GDM is a major public health issue, and the prevention of GDM is particularly essential for the Louisiana Medicaid population owing to the high prevalence of GDM-related risk factors in this population.
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Affiliation(s)
- Jessica Lin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Ronald Horswell
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - San Chu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - S. Amanda Dumas
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Sonaglioni A, Bordoni T, Naselli A, Nicolosi GL, Grasso E, Bianchi S, Ferrulli A, Lombardo M, Ambrosio G. Influence of gestational diabetes mellitus on subclinical myocardial dysfunction during pregnancy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 292:17-24. [PMID: 37951113 DOI: 10.1016/j.ejogrb.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE The correlation between gestational diabetes mellitus (GDM) and subclinical myocardial dysfunction has been poorly investigated. Accordingly, we performed a meta-analysis to examine the influence of GDM on left ventricular (LV) global longitudinal strain (GLS), assessed by speckle tracking echocardiography (STE), during pregnancy. STUDY DESIGN All echocardiographic studies assessing conventional echoDoppler parameters and LV-GLS in GDM women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. The subtotal and overall standardized mean differences (SMDs) of LV-GLS were calculated using the random-effect model. RESULTS The full-texts of 10 studies with 1147 women with GDM and 7706 pregnant women without diabetes were analyzed. GDM women enrolled in the included studies were diagnosed with a small reduction in LV-GLS in comparison to controls (average value -19.4 ± 2.5 vs -21.8 ± 2.5 %, P < 0.001) and to the accepted reference values (more negative than -20 %). Substantial heterogeneity was detected for the included studies, with an overall statistic value I2 of 94.4 % (P < 0.001). Large SMDs were obtained for the included studies, with an overall SMD of -0.97 (95 %CI -1.32, -0.63, P < 0.001). Egger's test for a regression intercept gave a P-value of 0.99, indicating no publication bias. On meta-regression analysis, all moderators and/or potential confounders (age at pregnancy, BMI, systolic blood pressure and ethnicity) were not significantly associated with effect modification (all P < 0.05). CONCLUSIONS GDM is independently associated with subclinical myocardial dysfunction in pregnancy. STE analysis allows to identify, among GDM women, those who might benefit of targeted non-pharmacological and/or pharmacological interventions, aimed at reducing the risk of developing type 2 diabetes and cardiovascular complications later in life.
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Affiliation(s)
| | - Teresa Bordoni
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | | | | | - Enzo Grasso
- Division of Cardiology, IRCCS MultiMedica, Milan, Italy
| | - Stefano Bianchi
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Anna Ferrulli
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
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Chebrolu P, Chalem A, Ponticiello M, Broderick K, Vaidyanathan A, Lorenc R, Kulkarni V, Onawale A, Mathad JS, Sundararajan R. A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001622. [PMID: 37889879 PMCID: PMC10610081 DOI: 10.1371/journal.pgph.0001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.
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Affiliation(s)
- Puja Chebrolu
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrea Chalem
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew Ponticiello
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn Broderick
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Arthi Vaidyanathan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Rachel Lorenc
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | | | | | - Jyoti S. Mathad
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
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Xu J, Lin X, Fang Y, Cui J, Li Z, Yu F, Tian L, Guo H, Lu X, Ding J, Ke L, Wu J. Lifestyle interventions to prevent adverse pregnancy outcomes in women at high risk for gestational diabetes mellitus: a randomized controlled trial. Front Immunol 2023; 14:1191184. [PMID: 37675099 PMCID: PMC10477780 DOI: 10.3389/fimmu.2023.1191184] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To examine the effects of lifestyle interventions, including dietary guidance, health education and weight management, on pregnancy outcomes in women at high risk of gestational diabetes mellitus (GDM). Methods Our study included 251 women at high risk of GDM and 128 randomized to lifestyle interventions (dietary guidance, health education, and weight management); One hundred and twenty-three people were randomly assigned to a control group (regular pregnancy check-ups). Counts between groups were compared using either chi-square test or Fisher's exact test. Results Compared with the control group, the risk of GDM was reduced by 46.9% (16.4% vs 30.9%, P = 0.007) and the risk of pregnancy induced hypertension (PIH) was reduced by 74.2% (2.3% vs 8.9%, P = 0.034) in the intervention group. There were no significant differences in macrosomia, cesarean section, or preterm birth (P >0.05). Conclusion The lifestyle intervention in this study helped pregnant women to better understand knowledge related to pregnancy, reduce stress and anxiety, and increase intake of adequate prenatal nutrition. This intervention prevented metabolic abnormalities that may occur due to inadequate nutrient intake during pregnancy. In addition, it helped women to control weight gain, maintain appropriate weight gain during pregnancy, and reduce the risk of excessive or insufficient weight gain, ultimately lowering the incidence of GDM and PIH. This highlights the importance of early screening and intervention for high-risk pregnant women. Clinical Trial Registration https://www.chictr.org.cn, identifier ChiCTR2300073766.
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Affiliation(s)
- Jiawei Xu
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Xuan Lin
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Ying Fang
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Jing Cui
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Zhi Li
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Fang Yu
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Libin Tian
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Hongyan Guo
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Xinyan Lu
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Jiahao Ding
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Lu Ke
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Jiahui Wu
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
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Ouyang P, Duan S, You Y, Jia X, Yang L. Risk prediction of gestational diabetes mellitus in women with polycystic ovary syndrome based on a nomogram model. BMC Pregnancy Childbirth 2023; 23:408. [PMID: 37268889 DOI: 10.1186/s12884-023-05670-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/03/2023] [Indexed: 06/04/2023] Open
Abstract
Women with polycystic ovary syndrome are prone to develop gestational diabetes mellitus, a disease which may have significant impact on the postpartum health of both mother and infant. We performed a retrospective cohort study to develop and test a model that could predict gestational diabetes mellitus in the first trimester in women with polycystic ovary syndrome. Our study included 434 pregnant women who were referred to the obstetrics department between December 2017 and March 2020 with a diagnosis of polycystic ovary syndrome. Of these women, 104 were diagnosed with gestational diabetes mellitus in the second trimester. Univariate analysis revealed that in the first trimester, Hemoglobin A1c (HbA1C), age, total cholesterol(TC), low-density lipoprotein cholesterol (LDL-C), SBP (systolic blood pressure), family history, body mass index (BMI), and testosterone were predictive factors of gestational diabetes mellitus (P < 0.05). Logistic regression revealed that TC, age, HbA1C, BMI and family history were independent risk factors for gestational diabetes mellitus. The area under the ROC curve of the gestational diabetes mellitus risk prediction model was 0.937 in this retrospective analysis, demonstrating a great discriminatory ability. The sensitivity and specificity of the prediction model were 0.833 and 0.923, respectively. The Hosmer-Lemeshow test also showed that the model was well calibrated.
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Affiliation(s)
- Peilin Ouyang
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China
| | - Siqi Duan
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China
| | - Yiping You
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China
| | - Xiaozhou Jia
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China
| | - Liqin Yang
- Hunan Provincial Maternal and Child Health Care Hospital, 53, Xiangchun Road, Changsha, Hunan, People's Republic of China.
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Chen N, Zeng R, Xu C, Lai F, Chen L, Wang C, Pei L, Li Z, Li Y, Xiao H, Cao X. Low Serum Creatinine Levels in Early Pregnancy Are Associated with a Higher Incidence of Postpartum Abnormal Glucose Metabolism among Women with Gestational Diabetes Mellitus: A Retrospective Cohort Study. Nutrients 2023; 15:2193. [PMID: 37432359 DOI: 10.3390/nu15092193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 07/12/2023] Open
Abstract
The predictive factors for the progression from gestational diabetes mellitus (GDM) to type 2 diabetes remain incompletely elucidated. Our objective was to investigate the link between serum creatinine, a proxy for skeletal muscle mass, and the development of postpartum abnormal glucose metabolism (AGM). METHODS A retrospective review of the medical records of 501 women with GDM was conducted, all of whom underwent a 75 g oral glucose tolerance test (OGTT) between 4 and 12 weeks postpartum. Women were grouped based on quartiles of serum creatinine at the first antenatal visit to estimate the association between serum creatinine and postpartum AGM incidence. RESULTS Compared with the highest quartile of creatinine, lower quartiles were substantially linked to an increased incidence of postpartum AGM (adjusted odds ratios 3.37 [95% CI 1.77-6.42], 2.42 [95% CI 1.29-4.51] and 2.27 [95% CI 1.23-4.18], respectively). The generalized additive model suggested a linear relationship between serum creatinine levels and the risk of postpartum AGM below 68 µmol/L of serum creatinine levels. A decrease of 2 μmol/L in serum creatinine levels was found to be associated with a 10% increase in the odds of developing postpartum AGM. Linear regression revealed that a low serum creatinine level was linked to a higher postpartum 2-h glucose level and a decreased insulinogenic index (p = 0.007 and p = 0.027, respectively). CONCLUSIONS An association was observed between lower serum creatinine levels in early pregnancy and an increased risk of postpartum AGM and poorer β-cell function in women with a recent history of GDM. Further research is needed to understand the mechanisms underlying our findings, as well as the role of skeletal muscle mass or nutritional status in early pregnancy on later glucose metabolism.
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Affiliation(s)
- Nan Chen
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Rui Zeng
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Changliu Xu
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Fenghua Lai
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Li Chen
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Chenxue Wang
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Ling Pei
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Zhuyu Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
| | - Xiaopei Cao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd., Guangzhou 510080, China
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11
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Daida Y, Pedula K. Prevalence of Overweight and Obese Prepregnancy BMI and Excessive Gestational Weight Gain Using Asian-Specific Cutoffs Among Asian and Mixed-Asian Women Living in Hawaii: A Retrospective Cohort Study. Matern Child Health J 2023; 27:728-736. [PMID: 36214801 PMCID: PMC10023603 DOI: 10.1007/s10995-022-03560-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The use of Asian-specific Body Mass Index (aBMI) cutoffs may be more appropriate than general World Health Organization BMI (gBMI) cutoffs in determining recommended gestational weight gain (GWG) for Asian women. Since aBMI cutoffs are lower than gBMI, more Asian women will be reclassified into higher aBMI categories from gBMI. The prevalence of reclassification and its impact on GWG are not known. METHODS We utilized the electronic health records of 8886 Kaiser Permanente Hawaii members aged ≥ 18 with a singleton live birth. Prepregnancy BMI was first classified using gBMI criteria, then aBMI criteria. BMI categories were "underweight", "normal", "overweight" and "obese"; GWG was classified into lower ("lGWG"), met ("mGWG"), and exceed ("eGWG") GWG per WHO recommendations. Self-reported race/ethnicity include Asian, Asian + Pacific Islander, and Asian + white. Multiple logistic regression was used to estimate adjusted odds of reclassification. The Cochran-Mantel-Haenszel test was used to evaluate associations between race/ethnicity and GWG. RESULTS > 40% of women in each racial/ethnic group were reclassified. Asian + Pacific Islander women had significantly higher odds of being reclassified (p < .0001). In the normal gBMI and aBMI category, Asian + Pacific Islander women had the largest eGWG group. In the overweight gBMI category, Asian + Pacific Islander women had the largest eGWG group; in the overweight aBMI category, Asian + white women had the largest eGWG group. DISCUSSION A sizable percent of women were reclassified into higher BMI categories when aBMI was applied. Mixed-race Asian women were more likely to exceed GWG recommendations than Asian women.
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Affiliation(s)
- Y Daida
- Center for Integrated Healthcare Research, Kaiser Permanente Hawai'i, 501 Alakawa St Suite 201, Honolulu, HI, 96817, USA.
| | - K Pedula
- Center for Integrated Healthcare Research, Kaiser Permanente Hawai'i, 501 Alakawa St Suite 201, Honolulu, HI, 96817, USA
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12
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Sperling MM, Leonard SA, Blumenfeld YJ, Carmichael SL, Chueh J. Prepregnancy body mass index and gestational diabetes mellitus across Asian and Pacific Islander subgroups in California. AJOG GLOBAL REPORTS 2023; 3:100148. [PMID: 36632428 PMCID: PMC9826825 DOI: 10.1016/j.xagr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists recommends early screening for gestational diabetes mellitus among pregnant Asian people with a prepregnancy body mass index ≥23.0 kg/m2, in contrast with the recommended screening at a body mass index ≥25 kg/m2 for other races and ethnicities. However, there is significant heterogeneity within Asian and Pacific Islander populations, and gestational diabetes mellitus and its association with body mass index among Asian and Pacific Islander subgroups may not be uniform across all groups. OBJECTIVE This study aimed to analyze the association between body mass index and gestational diabetes mellitus among Asian and Pacific Islander subgroups in California, specifically gestational diabetes mellitus rates among those with a body mass index above vs below 23 kg/m2, which is the cutoff point for the designation of being overweight among Asians populations. STUDY DESIGN Using a linked delivery hospitalization discharge and vital records database, we identified patients who gave birth in California between 2007 and 2017 and who self-reported to be 1 of 13 Asian and Pacific Islander subgroups, which was collected from birth and fetal death certificates. In each subgroup, we evaluated the association between body mass index and gestational diabetes mellitus using multivariable logistic regression models adjusted for age, education, parity, payment method, the trimester in which prenatal care was initiated, and nativity. We fit body mass index nonlinearly with splines and categorized body mass index as being above or below 23 kg/m2. Predicted probabilities of gestational diabetes mellitus with 95% confidence intervals were calculated across body mass index values using the nonlinear regression models. RESULTS The overall prevalence of gestational diabetes mellitus was 14.3% (83,400/584,032), ranging between 8.4% and 17.1% across subgroups. The highest prevalence was among Indian (17.1%), Filipino (16.7%), and Vietnamese (15.5%) subgroups. In these subgroups, gestational diabetes mellitus was diagnosed in 10% to 13% of those with a body mass index <23.0 kg/m2 and in 22% of those with a body mass index ≥23 kg/m2. Gestational diabetes mellitus was least common among Korean (8.4%), Japanese (9.0%), and Samoan (9.8%) subgroups with a gestational diabetes mellitus rate of 5% to 7% among those with a body mass index <23.0 kg/m2 and in 10% to 15% among those with a body mass index ≥23 kg/m2. Although Samoan patients had the highest rate of obesity, defined as body mass index ≥30 kg/m2 (57.4%), they had the third lowest prevalence of gestational diabetes mellitus. Conversely, Vietnamese patients had the second lowest rate of obesity (2.4%) but the highest rate of gestational diabetes mellitus at a body mass index of ≥23 kg/m2 (22.3%). CONCLUSION Gestational diabetes mellitus and its association with body mass index varied among Asian subgroups but increased as body mass index increased. Subgroups with the lowest prevalence of obesity trended toward a higher prevalence of gestational diabetes mellitus and those with a higher prevalence of obesity trended toward a lower prevalence of gestational diabetes mellitus.
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Affiliation(s)
- Meryl M. Sperling
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Stephanie A. Leonard
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Yair J. Blumenfeld
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Suzan L. Carmichael
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
- Pediatrics (Dr Carmichael), Stanford University School of Medicine, Stanford, CA
| | - Jane Chueh
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
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13
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Jiang L, Tang K, Magee LA, von Dadelszen P, Ekeroma A, Li X, Zhang E, Bhutta ZA. A global view of hypertensive disorders and diabetes mellitus during pregnancy. Nat Rev Endocrinol 2022; 18:760-775. [PMID: 36109676 PMCID: PMC9483536 DOI: 10.1038/s41574-022-00734-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.
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Affiliation(s)
- Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Alec Ekeroma
- Department of Obstetrics and Gynecology, Wellington School of Medicine, University of Otago, Wellington, New Zealand
- National University of Samoa, Apia, Samoa
| | - Xuan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Enyao Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan.
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14
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Kragelund Nielsen K, Davidsen E, Husted Henriksen A, Andersen GS. Gestational Diabetes and International Migration. J Endocr Soc 2022; 7:bvac160. [DOI: 10.1210/jendso/bvac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
In many countries, immigrant women constitute a substantial proportion of women giving birth. With gestational diabetes being one of the most common complications in pregnancy, understanding gestational diabetes in the context of international migration becomes increasingly relevant. Here, we examine the current evidence related to international migration and gestational diabetes, including short- and long-term adverse outcomes and the experiences of immigrant women with gestational diabetes care and long-term follow-up. Existing evidence focuses on immigrants in high-income countries, and has mainly examined differences in the risk of developing gestational diabetes, or on the experiences of immigrant women diagnosed with gestational diabetes. Studies suggest that the risk of gestational diabetes may be influenced by migration and that immigrant women likely experience particular barriers to care and follow-up. Current research on perinatal outcomes is inconclusive and studies on long-term outcomes are practically absent. Future research should include data on country of origin and examine the role of premigration and postmigration factors in developing gestational diabetes and its associated short- and long-term outcomes. Understanding these factors will provide useful insights into improving the health and health care needs of migrating populations and enable inclusion of culturally appropriate health care practices, thereby improving the health of our current and future generations.
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Affiliation(s)
| | - Emma Davidsen
- Health Promotion Research, Steno Diabetes Center Copenhagen , 2730 Herlev , Denmark
| | | | - Gregers S Andersen
- Clinical Research, Steno Diabetes Center Copenhagen , 2730 Herlev , Denmark
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15
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Kisindja RM, Tugirimana PL, Prudence MN, Bosunga K, Sihalikyolo JJJ, Kayamba PKM, Tambwe-A-Nkoy AM. Prevalence of gestational diabetes in Eastern Democratic Republic of Congo. BMC Pregnancy Childbirth 2022; 22:645. [PMID: 35974333 PMCID: PMC9380361 DOI: 10.1186/s12884-022-04970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the prevalence of gestational diabetes and associated risk factors in the eastern region of the Democratic Republic of Congo (DRC). METHODS A cross-sectional study was conducted in Goma city, Idjwi, Ngungu and Rutshuru districts between April 2019 and February 2021. Pregnant women between 24-28 weeks of amenorrhea who consented to participate in the study were included. Blood sugar, anthropometric parameters and obstetrical and family history were studied. Gestational diabetes was defined as blood glucose level between 92 and 125 mg/dL. RESULTS The overall prevalence was 21.2% (n = 391) and was higher in Rutshuru [27.2% (n = 92)] and Goma [26.9% (n = 134)] compared to Ngungu [10.0% (n = 110)] (p = 0.005). An increased risk was associated with a history of a newborn weighing ≥ 4000 g [OR 2.4 95% CI (1.3 - 4.4)] or family diabetes [OR 2.9 95% CI (2.0 - 4.9)]. Median age in the pathological group was not different from that with normal blood glucose [25.0 (16.0 - 44.0) Vs 26.0 (16.0 - 44.0)] (p = 0.67). The prevalence tended to increase for pregnant women with a mid-upper arm circumference ≥ 280 mm [28.1% (n = 57)] Vs [19.3% (n = 322)] if < 280 mm, [OR (95% CI)] [1.5 (0.9-2.3)] (p = 0.13). CONCLUSION Gestational diabetes was found in one out of five pregnant women regardless their age. A history of macrosomia birth and diabetes in the family were the main risk factors.
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Affiliation(s)
| | - Pierrot Lundimu Tugirimana
- Department of Obstetrics & Gynecology, La Sapientia Catholic University (UCS)/Goma, Goma, Congo
- Department of Internal Medicine, University of Goma (UNIGOM), Goma, Congo
| | | | - Katenga Bosunga
- Department of Gyneco-Obstetrics, University of Kisangani (UNIKIS), Kisangani, Congo
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Chelu S, Bernad E, Craina M, Neamtu R, Mocanu AG, Vernic C, Chiriac VD, Tomescu L, Borza C. Prevalence of Gestational Diabetes in preCOVID-19 and COVID-19 Years and Its Impact on Pregnancy: A 5-Year Retrospective Study. Diagnostics (Basel) 2022; 12:1241. [PMID: 35626396 PMCID: PMC9140441 DOI: 10.3390/diagnostics12051241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 05/13/2022] [Indexed: 12/17/2022] Open
Abstract
Gestational diabetes mellitus (GDM) affects a total of 3% to 9% of all pregnancies. It has a high impact on both mother and baby, increases the perinatal risks, and predicts the presence of long-term chronic metabolic complications. The aim of our study is to determine the incidence of GDM in tertiary hospitals in the west part of Romania to lay out the risk factors associated with GDM and to observe the evolution of pregnancy among patients with this pathology by emphasizing the state of birth of the fetus, the birth weight, and the way of birth. We also want to compare the prevalence of GDM in preCOVID-19 (Coronavirus disease) versus COVID-19 years. The study took place between January 2017 and December 2021 at the Municipal Emergency Hospital of Timisoara, Romania. The proportion of births with GDM was significantly increased during the COVID-19 period compared to the preCOVID-19 period (chi2 Fisher exact test, p < 0.001). The period 2020−2021 represents a significant risk factor for GDM births (OR = 1.87, with 95% CI = [1.30, 2.67]). COVID years represent a risk period for developing gestational diabetes, which can be explained by reduced physical activity, anxiety, or modified dietary habits, even if the follow-up period was not impacted.
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Affiliation(s)
- Sorina Chelu
- Discipline of Pathophysiology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.C.); (C.B.)
| | - Elena Bernad
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Marius Craina
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Radu Neamtu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Adelina Geanina Mocanu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Corina Vernic
- Computer Science and Medical Biostatistics Discipline, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Veronica Daniela Chiriac
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Larisa Tomescu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Claudia Borza
- Discipline of Pathophysiology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.C.); (C.B.)
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Ortega-Contreras B, Armella A, Appel J, Mennickent D, Araya J, González M, Castro E, Obregón AM, Lamperti L, Gutiérrez J, Guzmán-Gutiérrez E. Pathophysiological Role of Genetic Factors Associated With Gestational Diabetes Mellitus. Front Physiol 2022; 13:769924. [PMID: 35450164 PMCID: PMC9016477 DOI: 10.3389/fphys.2022.769924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) is a highly prevalent maternal pathology characterized by maternal glucose intolerance during pregnancy that is, associated with severe complications for both mother and offspring. Several risk factors have been related to GDM; one of the most important among them is genetic predisposition. Numerous single nucleotide polymorphisms (SNPs) in genes that act at different levels on various tissues, could cause changes in the expression levels and activity of proteins, which result in glucose and insulin metabolism dysfunction. In this review, we describe various SNPs; which according to literature, increase the risk of developing GDM. These SNPs include: (1) those associated with transcription factors that regulate insulin production and excretion, such as rs7903146 (TCF7L2) and rs5015480 (HHEX); (2) others that cause a decrease in protective hormones against insulin resistance such as rs2241766 (ADIPOQ) and rs6257 (SHBG); (3) SNPs that cause modifications in membrane proteins, generating dysfunction in insulin signaling or cell transport in the case of rs5443 (GNB3) and rs2237892 (KCNQ1); (4) those associated with enzymes such as rs225014 (DIO2) and rs9939609 (FTO) which cause an impaired metabolism, resulting in an insulin resistance state; and (5) other polymorphisms, those are associated with growth factors such as rs2146323 (VEGFA) and rs755622 (MIF) which could cause changes in the expression levels of these proteins, producing endothelial dysfunction and an increase of pro-inflammatory cytokines, characteristic on GDM. While the pathophysiological mechanism is unclear, this review describes various potential effects of these polymorphisms on the predisposition to develop GDM.
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Affiliation(s)
- B. Ortega-Contreras
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - A. Armella
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - J. Appel
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - D. Mennickent
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
- Department of Instrumental Analysis, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - J. Araya
- Department of Instrumental Analysis, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - M. González
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - E. Castro
- Departamento de Obstetricia y Puericultura, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile
| | - A. M. Obregón
- Faculty of Health Care, Universidad San Sebastián, Concepción, Chile
| | - L. Lamperti
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
| | - J. Gutiérrez
- Faculty of Health Sciences, Universidad San Sebastián, Santiago,Chile
| | - E. Guzmán-Gutiérrez
- Pregnancy Diseases Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile
- *Correspondence: E. Guzmán-Gutiérrez,
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18
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Kawamura MY, Mau MK, Soon R, Yamasato K. A Scoping Review on Gestational Diabetes in Hawai'i: A "Window of Opportunity" to Address Intergenerational Risk for Type 2 Diabetes Mellitus. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:58-70. [PMID: 35261986 PMCID: PMC8899083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The health of women over the entire span of their reproductive years is crucial - beginning in adolescence and extending through the postpartum period. This paper provides a scoping review of the relevant literature on risk factors for gestational diabetes mellitus (GDM) and progression from GDM to type 2 diabetes mellitus (T2DM), particularly among women of Native Hawaiian and Pacific Islander (NHPI) and Asian racial/ethnic backgrounds in Hawai'i, using the PubMed database (July 2010 to July 2020). NHPI and Asian populations have a greater likelihood of developing GDM compared to their White counterparts. Risk factors such as advanced maternal age, high maternal body mass index, and lack of education about GDM have varying levels of impact on GDM diagnosis between ethnic populations. Mothers who have a history of GDM are also at higher risk of developing T2DM. Common risk factors include greater increase in postpartum body mass index and use of diabetes medications during pregnancy. However, few studies investigate the progression from GDM to T2DM in Hawai'i's Asian and NHPI populations, and no studies present upstream preconception care programs to prevent an initial GDM diagnosis among Hawai'i's women. Thus, updated reports are necessary for optimal early interventions to prevent the onset of GDM and break the intergenerational cycle of increased susceptibility to T2DM and GDM in both mother and child. Further attention to the development of culturally sensitive interventions may reduce disparities in GDM and improve the health for all affected by this condition.
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Affiliation(s)
- Megan Y. Kawamura
- Department of Native Hawaiian Health Summer 2020 Research Intern, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Marjorie K. Mau
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Reni Soon
- Department of Obstetrics, Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Kelly Yamasato
- Department of Obstetrics, Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
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Mnatzaganian G, Woodward M, McIntyre HD, Ma L, Yuen N, He F, Nightingale H, Xu T, Huxley RR. Trends in percentages of gestational diabetes mellitus attributable to overweight, obesity, and morbid obesity in regional Victoria: an eight-year population-based panel study. BMC Pregnancy Childbirth 2022; 22:95. [PMID: 35105311 PMCID: PMC8809044 DOI: 10.1186/s12884-022-04420-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes in Australia with rates trebling over the past decades partially explained by rising obesity rates and maternal age among childbearing women. Percentage of GDM attributable to obesity has been documented, mostly focusing on metropolitan populations. In parts of regional (areas outside capital cities) and rural Australia where overweight, obesity and morbid obesity are more prevalent, intertwined with socioeconomic disadvantage and higher migrant communities, trends over time in adjusted percentages of GDM attributed to obesity are unknown. METHODS In this population-based retrospective panel study, women, without pre-existing diabetes, delivering singletons between 2010 and 2017 in a tertiary regional hospital that serves 26% of Victoria's 6.5 million Australian population were eligible for inclusion. Secular trends in GDM by body mass index (BMI) and age were evaluated. The percentage of GDM that would have been prevented each year with the elimination of overweight or obesity was estimated using risk-adjusted regression-based population attributable fractions (AFp). Trends in the AFp over time were tested using the augmented Dickey-Fuller test. RESULTS Overall 7348 women, contributing to 10,028 births were included. The age of expecting mothers, their BMI, proportion of women born overseas, and GDM incidence significantly rose over time with GDM rising from 3.5% in 2010 to 13.7% in 2017, p < 0.001, increasing in all BMI categories. The incidence was consistently highest among women with obesity (13.8%) and morbid obesity (21.6%). However, the highest relative increase was among women with BMI < 25 kg/m2, rising from 1.4% in 2010 to 7.0% in 2017. Adjusting for age, country of birth, socioeconomic status, comorbidities, antenatal and intrapartum factors, an estimated 8.6% (confidence interval (CI) 6.1-11.0%), 15.6% (95% CI 12.2-19.0%), and 19.5% (95% CI 15.3-23.6%) of GDM would have been prevented by eliminating maternal overweight, obesity, and morbid obesity, respectively. However, despite the rise in obesity over time, percentages of GDM attributable to overweight, obesity, and morbid obesity significantly dropped over time. Scenario analyses supported these findings. CONCLUSIONS Besides increasing prevalence of obesity over time, this study suggests that GDM risk factors, other than obesity, are also increasing over time.
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Affiliation(s)
- George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
| | - Mark Woodward
- The George Institute for Global Health, Imperial College, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - H David McIntyre
- Obstetric Medicine, Mater Health Services, University of Queensland, Brisbane, Queensland, Australia
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Nicola Yuen
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Fan He
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia
| | - Helen Nightingale
- Rural Department of Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Tingting Xu
- Department of Health Policy and Management, School of Public Health, Capital Medical University, Beijing, China
| | - Rachel R Huxley
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
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Di Filippo D, Ahmadzai M, Chang MHY, Horgan K, Ong RM, Darling J, Akhtar M, Henry A, Welsh A. Continuous Glucose Monitoring for the Diagnosis of Gestational Diabetes Mellitus: A Pilot Study. J Diabetes Res 2022; 2022:5142918. [PMID: 36299907 PMCID: PMC9592228 DOI: 10.1155/2022/5142918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is diabetes first diagnosed in pregnancy. GDM, together with its short- and long-term negative outcomes, is increasing in incidence all over the world. The current diagnostic method for GDM, the oral glucose tolerance test (OGTT), is dated and has been reported as inconvenient for women as well as poorly reproducible and reliable. AIMS We aimed at assessing the acceptability, feasibility, and accuracy of continuous glucose monitoring (CGM) as a diagnostic test for GDM and explore its correlation with the OGTT and risk factors for GDM. METHODS In this prospective cohort study, pregnant women due for or having completed OGTT underwent CGM for seven days, performing daily finger-prick blood glucose levels before completing an acceptability questionnaire. Data on GDM risk factors and CGM variability were analyzed and compared with OGTT results. RESULTS Seventy-three women completed CGM (40 GDM, 33 normal glucose tolerances); 34 concurrently underwent OGTT. CGM was acceptable and generally well-tolerated, with skin irritation/itchiness the only adverse event (11 mild, one severe). CGM and OGTT strongly correlated for fasting glucose values (r = 0.86, p < 0.05) only. Triangulating GDM risk factors, OGTT results and CGM variability parameters with the application of machine learning highlighted the possibility of unmasking false positive (11 showed low CGM variability and demographic risks but positive OGTT) and false-negative OGTT diagnoses (1 showed high CGM variability and demographic risks but negative OGTT). CONCLUSIONS CGM was well-tolerated, showing poorer glycaemic control in GDM, and revealing potential misdiagnosis of the OGTT when combined with GDM risk factors. Future research is needed to determine cut-off values for CGM-defined and OGTT-independent screening criteria for GDM.
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Affiliation(s)
- Daria Di Filippo
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Marrwah Ahmadzai
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Melissa Han Yiin Chang
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Ksana Horgan
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Ru Min Ong
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Justine Darling
- Diabetes Clinic, Royal Hospital for Women, Barker street-Randwick, NSW 2031, Australia
| | - Mahmood Akhtar
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Alec Welsh
- School of Women's and Children's Health, University of New South Wales Sydney, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Barker street-Randwick, NSW 2031, Australia
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Racial and Ethnic Disparities in Health Care and Health Outcomes for Pregnant Women With Diabetes. Nurs Womens Health 2021; 25:437-449. [PMID: 34634249 DOI: 10.1016/j.nwh.2021.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 08/14/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022]
Abstract
This article summarizes the current literature on racial and ethnic differences among women with diabetes in pregnancy. The PubMed, Scopus, CINAHL, and Embase databases were searched for original qualitative or quantitative studies published in English from January 1, 2009, to May 31, 2020. Consensus statements were excluded. Results of this synthesis indicate that racial and ethnic differences exist among pregnant women with diabetes, including social determinants of health, disparities in maternity care and perinatal care, and maternal and neonatal health outcomes. Health care providers should implement tailored interventions that specifically target racial and ethnic disparities in maternal and neonatal health to promote health equity in pregnant women with diabetes and their offspring, including later in life.
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A study to investigate the elevated maternal haemoglobin value as a risk biomarker for gestational diabetes: A nested case control study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Mmasa KN, Powis K, Sun S, Makhema J, Mmalane M, Kgole S, Masasa G, Moyo S, Gerschenson M, Mohammed T, Legbedze J, Abrams EJ, Kurland IJ, Geffner ME, Jao J. Gestational diabetes in women living with HIV in Botswana: lower rates with dolutegravir- than with efavirenz-based antiretroviral therapy. HIV Med 2021; 22:715-722. [PMID: 34003565 PMCID: PMC8373729 DOI: 10.1111/hiv.13120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND There are few data on the prevalence of gestational diabetes (GDM) in pregnant women living with HIV (WLHIV) in sub-Saharan Africa, particularly those using integrase strand transfer inhibitors such as dolutegravir (DTG). METHODS We prospectively enrolled pregnant WLHIV and pregnant women without HIV ≥18 years old in Gaborone, Botswana, excluding those with pre-existing diabetes. We screened for GDM using a 75 g oral glucose tolerance test (OGTT) performed at 24-28 weeks' gestation or at the earliest prenatal visit for those presenting after 28 weeks. Logistic regression models were fitted to assess the association between maternal HIV infection and GDM. Subgroup analyses were performed among WLHIV to assess the association between maternal antiretroviral therapy (ART) in pregnancy [DTG vs. efavirenz (EFV) with tenofovir/emtricitabine] and GDM. RESULTS Of 486 pregnant women, 66.5% were WLHIV, and they were older than women without HIV (median age 30 vs. 25 years, P < 0.01). Among WLHIV, 97.8% had an HIV-1 RNA level < 400 copies/mL at enrolment. Overall, 8.4% had GDM with similar rates between WLHIV and those without HIV (9.0% vs. 7.4%). The WLHIV receiving DTG-based ART had a 60% lower risk for GDM compared with those on EFV-based ART (adjusted odds ratio = 0.40, 95% CI: 0.18-0.92) after adjusting for confounders. CONCLUSIONS Pregnant WLHIV on ART in Botswana were not at increased risk of GDM compared with women without HIV. Among WLHIV, the risk of GDM was lower with DTG- than with EFV-based ART. Further studies with larger cohorts are warranted to confirm these findings.
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Affiliation(s)
- K N Mmasa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - K Powis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, MA, USA
| | - S Sun
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - J Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - M Mmalane
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - S Kgole
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - G Masasa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - S Moyo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, MA, USA
| | - M Gerschenson
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - T Mohammed
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - J Legbedze
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - E J Abrams
- ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - I J Kurland
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M E Geffner
- The Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - J Jao
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ergin A, Türkay Ü, Özdemir S, Taşkın A, Terzi H, Özsürmeli M. Age at menarche: risk factor for gestational diabetes. J OBSTET GYNAECOL 2021; 42:680-686. [PMID: 34415226 DOI: 10.1080/01443615.2021.1929116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examines the relationship between the age at menarche and gestational diabetes mellitus (GDM). This retrospective study included subjects who were diagnosed with GDM at a pregnancy polyclinic in Kocaeli, Turkey between 2014 and 2018. The mean ages at menarche were 12.6 and 13.03 years in the GDM group and control group, respectively. The analysis results showed that pre-pregnancy cycle duration, age at menarche and pre-pregnancy BMI are statistically significant in terms of the development of gestational diabetes. (p < .05).In our study showed that the risk of GDM was found to be 2.3 times higher in pregnant women with a menarche age of <12 years. If the pre-pregnancy BMI value is more than 25 kg/cm2, the risk of GDM was found to be approximately 2 times higher. The study indicated that age at menarche, cycle duration, and BMI were risk factors for GDM. IMPACT STATEMENTWhat is already known on this subject? GDM has a lasting health impact on both the mother and the foetus. While several risk factors have previously been identified for GDM such as family history, obesity, advanced maternal age, significant gaps remain in our understanding of the risk factor and pathogenesis. Recent studies suggested that earlier menarche was significantly associated with an increased risk of GDM.What do the results of this study add? There might be ethnic differences on the relationship between the GDM and menarche age. There is no study examining the relationship between the age of menarche and GDM in Turkey. In presented study, we determined the risk factors of GDM including the age of menarche, cycle duration and BMI.What are the implications of these findings for clinical practice and / or further research? Therefore, a comprehensive evaluation of the menstrual history by healthcare professionals is important for future pregnancy risks. It is important to understand risk factors for GDM and to establish preventive strategies among high-risk populations. In addition, this study will shed light on future epidemiological and cohort studies.
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Affiliation(s)
- Ayla Ergin
- Faculty of Health Sciences, Midwifery Department, Kocaeli University, Kocaeli, Turkey
| | - Ünal Türkay
- Department of Obstetrics and Gynecology, Derince Education and Research Hospital, T.C. Ministry of Health Kocaeli Health Sciences University, Kocaeli, Türkiye
| | - Suzi Özdemir
- Faculty of Health Sciences, Midwifery Department, Kocaeli University, Kocaeli, Turkey
| | - Ayşe Taşkın
- Department of Obstetrics and Gynecology, Derince Education and Research Hospital, T.C. Ministry of Health Kocaeli Health Sciences University, Kocaeli, Türkiye
| | - Hasan Terzi
- Department of Obstetrics and Gynecology, Derince Education and Research Hospital, T.C. Ministry of Health Kocaeli Health Sciences University, Kocaeli, Türkiye
| | - Mehmet Özsürmeli
- Department of Obstetrics and Gynecology, Derince Education and Research Hospital, T.C. Ministry of Health Kocaeli Health Sciences University, Kocaeli, Türkiye
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D'Alterio MN, Sigilli M, Succu AG, Ghisu V, Laganà AS, Sorrentino F, Nappi L, Tinelli R, Angioni S. Pregnancy outcomes in women with polycystic ovarian syndrome (PCOS). Minerva Obstet Gynecol 2021; 74:45-59. [PMID: 33876903 DOI: 10.23736/s2724-606x.21.04758-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is the most common endocrinological disease of reproductive-aged women, with an estimated incidence ranging from 5% to 15%. The clinical manifestations of PCOS are heterogeneous and vary according to the age of the patient. Insulin resistance (IR), hyperandrogenism, and obesity are widely assumed to play a pivotal role in the pathophysiological mechanism of PCOS. As previously stated by many conducted meta-analyses, PCOS can cause a rising risk of pregnancy complications, including maternal, fetal, and neonatal complications. Pregnancy-induced hypertension (PIH), preeclampsia (PE), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), and an increased necessity for a cesarean section (CS) are the most documented maternal implications. Regarding fetal outcomes, PCOS has also been correlated with elevated neonatal morbidity, prematurity, fetal growth restriction (FGR), birth weight variations (large for gestational age (LGA) and small for gestational age (SGA), and transfer to the neonatal intensive care unit (NICU). Owing to the variability of the studies performed, the association of PCOS with an elevated risk of adverse pregnancy outcomes is still controversial. This variability is found in the diagnosis and clinical presentations of PCOS, and can be influenced by pre-pregnancy circumstances and therapies as well as particular population and environmental features. The Amsterdam consensus guidelines confirm that obesity and IR can worsen maternal and fetal complications; thus, a closer follow-up should be offered to PCOS women during pregnancy.
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Affiliation(s)
- Maurizio N D'Alterio
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy -
| | - Marco Sigilli
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio G Succu
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Valeria Ghisu
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio S Laganà
- Department of Obstetrics and Gynecology, Filippo del Ponte Hospital, University of Insubria, Varese, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, Valle d'Itria Hospital, Martina Franca, Taranto, Italy
| | - Stefano Angioni
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Wang N, Peng Y, Wang L, Song L, Sun B, Wei J, Wang T, Mi Y, Cui W. Risk Factors Screening for Gestational Diabetes Mellitus Heterogeneity in Chinese Pregnant Women: A Case-Control Study. Diabetes Metab Syndr Obes 2021; 14:951-961. [PMID: 33688229 PMCID: PMC7936674 DOI: 10.2147/dmso.s295071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/04/2021] [Indexed: 04/20/2023] Open
Abstract
PURPOSE To study the risk factors of gestational diabetes mellitus (GDM) heterogeneity, and to evaluate the correlation between the risk factors and obesity. METHODS We performed a case-control study of 452 women with GDM and 516 women with normal glucose tolerance (NGT) at the first and second trimester. We defined GDM women as GDM-resistance subtype, GDM-dysfunction subtype, and GDM-mixed subtype, according to their simultaneous insulin-release test with predominant insulin-sensitivity defect, insulin-secretion defect, or both defects. RESULTS We found that higher maternal age, family history of diabetes, the elevated level of fasting blood glucose in the first trimester (≥5.1 mmol/L) were risk factors of all GDM subtypes. Pre-pregnancy overweight/obesity and the increased gestational weight gain (GWG) in the first-trimester are risk factors of the GDM-resistance subtype. Indicators including younger age at first menstruation, the elevated levels of alanine aminotransferase (ALT), total bile acid (TBA), triglyceride (TG), and the decreased level of high-density lipoprotein cholesterol (HDL-C) are risk factors of the GDM-resistance subtype. However, the associations between those risk factors and GDM-resistance subtype attenuated after adjusted by pre-pregnancy body mass index (pre-BMI) and gestational weight gain (GWG) in the first trimester. Nonalcoholic fatty liver disease (NAFLD) and the improved level of TG are independent risk factors for the GDM-resistance subtype and the GDM-mixed subtype, respectively. CONCLUSION Women with GDM exhibited heterogeneity based on glycemic physiology and their risk factors are not all the same. Some obesity-related risk factors are specific to the GDM-resistance subtype, which are mediated by pre-pregnancy overweight/obesity and the elevated GWG the first-trimester.
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Affiliation(s)
- Ning Wang
- Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, People’s Republic of China
| | - Yanqi Peng
- Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, People’s Republic of China
| | - Lu Wang
- Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, People’s Republic of China
| | - Lin Song
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi'an, People’s Republic of China
| | - Bo Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi'an, People’s Republic of China
| | - Junxiang Wei
- The Second Department of Obstetrics, Northwest Women and Children’s Hospital, Xi'an, People’s Republic of China
| | - Ting Wang
- Department of Respiratory Medicine, Xi’an No.4 Hospital, Xi'an, People’s Republic of China
| | - Yang Mi
- The Second Department of Obstetrics, Northwest Women and Children’s Hospital, Xi'an, People’s Republic of China
- Correspondence: Yang Mi The Second Department of Obstetrics, Northwest Women and Children’s Hospital, 1616 Yanxiang Road, Xi'an, Shaanxi, 710065, People’s Republic of ChinaTel +86-13700222172 Email
| | - Wei Cui
- Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, People’s Republic of China
- Wei Cui Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, People’s Republic of ChinaTel +86-13609281695 Email
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Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249517. [PMID: 33353136 PMCID: PMC7766930 DOI: 10.3390/ijerph17249517] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
Gestational diabetes mellitus (GDM) has become an epidemic and has caused a tremendous healthy and economic burden in China, especially after the "two-child policy" put into effect on October 2015. The prevalence of GDM has continued to increase during the past few decades and is likely to see a further rise in the future. The public health impact of GDM is becoming more apparent in China and it might lead to the development of chronic non-communicable diseases in the long-term for both mothers and their children. Early identification of high-risk individuals could help to take preventive and intervention measures to reduce the risk of GDM and adverse perinatal outcomes. Therefore, a focus on prevention and intervention of GDM in China is of great importance. Lifestyle interventions, including dietary and physical exercise intervention, are effective and first-line preventive strategies for GDM prevention and intervention. The GDM One-day Care Clinic established in 2011, which educates GDM patients on the basic knowledge of GDM, dietary intervention, physical exercise, weight management, and blood glucose self-monitoring methods, sets a good model for group management of GDM and has been implemented throughout the hospitals as well as maternal and child health centers in China. The current review focus on the prevalence, risk factors, as well as prevention and lifestyle intervention of GDM in China for better understanding of the latest epidemiology of GDM in China and help to improve maternal and neonatal pregnancy outcomes and promote long-term health for women with GDM.
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Boone-Heinonen J, Biel FM, Marshall NE, Snowden JM. Maternal prepregnancy BMI and size at birth: race/ethnicity-stratified, within-family associations in over 500,000 siblings. Ann Epidemiol 2020; 46:49-56.e5. [PMID: 32448735 PMCID: PMC7315911 DOI: 10.1016/j.annepidem.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/19/2019] [Accepted: 04/27/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To estimate racial/ethnic-stratified effects of maternal prepregnancy BMI on size for gestational age at birth, by comparing siblings within families. METHODS This study examined linked vital statistics and patient discharge data from 580,960 infants born to 278,770 women in the State of California (2007-2012). To control for family-level confounding, we used fixed effects multinomial regression, modeling size for gestational age (small [SGA], appropriate, large [LGA]) as a function of maternal BMI (underweight, normal weight, overweight, obesity class I, II, III) and time-varying covariates. We conducted overall and race/ethnicity-stratified (non-Hispanic white, black, Asian; Hispanic) analyses. For comparison, we fit analogous random effects models, which do not control for family-level confounding. RESULTS In fixed effects models, maternal BMI was most strongly associated with LGA in non-Hispanic white women, reaching 6.7 times greater for class III obesity (OR [95% CI]: 6.7 [5.1, 8.7]); and weakest in black women (OR [95% CI]: 3.0 [1.5, 5.7]). Associations with SGA were similar across race/ethnicity. Compared with random effects estimates, fixed effects were most attenuated for LGA associations among racial/ethnic minority women. CONCLUSIONS Maternal prepregnancy BMI was differentially associated with size for gestational age across racial/ethnic groups, with the strongest family-level confounding in racial/ethnic minority women.
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Affiliation(s)
| | - Frances M Biel
- Oregon Health & Science University, School of Public Health, Portland, OR
| | - Nicole E Marshall
- Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR
| | - Jonathan M Snowden
- Oregon Health & Science University, School of Public Health, Portland, OR; Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR
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McElwain C, McCarthy CM. Investigating mitochondrial dysfunction in gestational diabetes mellitus and elucidating if BMI is a causative mediator. Eur J Obstet Gynecol Reprod Biol 2020; 251:60-65. [PMID: 32480181 DOI: 10.1016/j.ejogrb.2020.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance which is diagnosed during pregnancy and poses considerable health risks for mother and child. Maternal body mass index (BMI) correlates with GDM diagnosis and the pathophysiology of this link may be explained through oxidative stress and mitochondrial dysfunction. In this study we investigate if mitochondrial dysfunction is evident in GDM by measuring cell free mitochondrial DNA concentration and determine if a potential relationship exists between maternal mitochondrial function and GDM diagnosis. STUDY DESIGN Plasma samples were taken at 20 weeks' gestation from women who subsequently developed GDM (n = 44) and matched with women with uncomplicated pregnancies (n = 85) as controls. Control group 1 was matched by maternal age and BMI (n = 41) to GDM cases, while control group 2 was matched by maternal age alone (n = 44). Prediction potential was determined by binary regression analysis. Statistical analysis was performed on SPSS Statistics v25. RESULTS Binary regression analysis showed a statistically significant association between mtDNA concentration and GDM diagnosis (p = 0.032) in GDM cases versus control group 2, indicating that GDM patients have higher circulating mtDNA concentrations relative to healthy control patients. The lack of statistical significance in control group 1 suggests that BMI may be linked to mitochondrial function in GDM patients. CONCLUSION These results demonstrate a potential pathogenic role for mitochondrial dysfunction in GDM, with BMI presenting as a likely physiological mediator.
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Affiliation(s)
- Colm McElwain
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland.
| | - Cathal M McCarthy
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland.
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Kragelund Nielsen K, Andersen GS, Damm P, Andersen AMN. Gestational Diabetes Risk in Migrants. A Nationwide, Register-Based Study of all Births in Denmark 2004 to 2015. J Clin Endocrinol Metab 2020; 105:5707566. [PMID: 31950143 DOI: 10.1210/clinem/dgaa024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Much remains to be understood about socioeconomic position and body mass index (BMI) in the pathways linking ethnicity, migration, and gestational diabetes mellitus (GDM). We investigated differences in GDM prevalence according to maternal country of origin and the role played by socioeconomic position and BMI on this relationship. Finally, we examined how length of residency was associated with GDM. METHODS A register-based cohort study of the 725 482 pregnancies that resulted in a birth in Denmark, 2004 to 2015. Of these, 14.4% were by women who had migrated to Denmark. A GDM diagnosis was registered in 19 386 (2.7%) pregnancies, of which 4464 (23.0%) were in immigrant women. The crude risk of GDM according to maternal country of origin compared to Danish-born women ranged from an odds ratio (OR) of 0.50 (95% CI 0.34-0.71) for women from Sweden to an OR of 5.11 (95% CI 4.28-6.11) for women from Sri Lanka. Adjustment for socioeconomic position slightly attenuated the risks. Adjusting for BMI resulted in increased ORs for women, especially from Asian countries. The separate and joint effects of migration and overweight on GDM risk differed substantially between the countries of origin (P value interaction term < .001). Immigrants with 10 or more years of residency had a 56% increased risk of GDM (OR 1.56, 95% CI 1.44-1.68) compared to immigrants with less than 5 years in Denmark. This risk was somewhat diluted when adjusting for age and BMI. CONCLUSIONS This study demonstrates substantial variation in the risk of GDM according to country of origin. The risk associations are only slightly affected by socioeconomic position and BMI.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Steno Diabetes Center, Gentofte, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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The association between the rs4987105 of 5-lipoxygenase (ALOX5) gene and gestational glucose metabolism in Chinese population. BMC Res Notes 2020; 13:102. [PMID: 32093765 PMCID: PMC7041080 DOI: 10.1186/s13104-020-04953-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/12/2020] [Indexed: 01/28/2023] Open
Abstract
Objective The arachidonate 5-lipoxygenase (ALOX5) pathway has been investigated in diverse chronic inflammatory diseases including metabolic disorders. Recently, the ALOX5 polymorphism rs4987105 was identified to confer susceptibility to type 2 diabetes mellitus (T2DM), implicating its role in regulating glucose homeostasis. Gestational diabetes mellitus (GDM) shares similar pathogenic mechanism with T2DM. Thus, we aimed to evaluate the association between rs4987105 and gestational glucose metabolism in Chinese pregnant women. Results A total of 380 unrelated Chinese pregnant women including 241 GDM patients and 139 controls were included in this study. The genotypes of rs4987105 were examined by the Agena MassARRAY iPLEX platform, the association between rs4987105 and fasting plasma glucose (FPG) levels at 24–28 gestational weeks was evaluated using different statistical methods. We found that carriers of rs4987105 CT/TT genotypes exhibited significantly lower FPG levels (P = 0.011). In addition, we observed a significant association between rs4987105 and FPG levels after adjusting confounding variables in the linear regression analysis using dominant genetic model (b = − 0.218; P = 0.01). The present study for the first time reported that the rs4987105 of 5-lipoxygenase (ALOX5) gene was associated with gestational glucose metabolism in Chinese pregnant women.
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Sert UY, Ozgu-Erdinc AS. Gestational Diabetes Mellitus Screening and Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:231-255. [PMID: 32314318 DOI: 10.1007/5584_2020_512] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An ideal screening test for gestational diabetes should be capable of identifying not only women with the disease but also the women with a high risk of developing gestational diabetes mellitus (GDM). Screening and diagnosis are the main steps leading to the way of management. There is a lack of consensus among healthcare professionals regarding the screening methods worldwide. Different study groups advocate a variety of screening methods with the support of evidence-based comprehensive data. Some of the organizations suggest screening for high risk or all pregnant women, while others prefer to offer definitive testing without screening. Glycemic thresholds are also not standardized to decide GDM among different guidelines. Prevalence rates of GDM vary between populations and with the choice of glucose thresholds for both screening and definitive tests. One-step or two-step methods have been used for GDM diagnosis. However, screening includes selecting patients with historical risk factors, 50 g 1-h glucose challenge test, fasting plasma glucose, random plasma glucose, and hemoglobin A1c with different cutoffs. In this chapter, screening and diagnosis methods of GDM accepted by different study groups will be discussed which will be followed by the evaluation of different glycemic thresholds. Then the advantages and disadvantages of used methods will be explained and the chapter will finish with an evaluation of the current international guidelines.
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Affiliation(s)
- U Yasemin Sert
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey.
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Chen L, Shi L, Zhang D, Chao SM. Influence of Acculturation on Risk for Gestational Diabetes Among Asian Women. Prev Chronic Dis 2019; 16:E158. [PMID: 31808419 PMCID: PMC6896832 DOI: 10.5888/pcd16.190212] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Asian women have a higher prevalence of gestational diabetes mellitus than women of other races/ethnicities. We aimed to compare the prevalence of gestational diabetes among Asian American women to other racial/ethnic groups and explore whether the higher occurrence of the disorder among Asian women can be explained by acculturation. Methods We conducted a population-based, cross-sectional study among 5,562 women who participated in the 2007 Los Angeles Mommy and Baby Study (LAMB) in Los Angeles County, California. All women included in this study had a live delivery in 2007 and did not have pre-pregnancy type I or II diabetes. We applied multivariate, weighted logistic regressions to compare gestational diabetes prevalence among racial/ethnic groups, adjusting for its known risk factors. We conducted mediation analysis to test whether the difference in prevalence across racial/ethnic groups could be explained by acculturation. Results Among the 5,562 women studied, the weighted prevalence of gestational diabetes was 15.5% among Asian American women, followed by 9.0% among non-Hispanic black women, 10.7% among Hispanic women, and 7.9% among non-Hispanic white women. Compared with non-Hispanic white women, Asian women had 2.44 (95% confidence interval [CI], 1.81–3.29; P < .001) times the odds of having gestational diabetes, independent of maternal age, education, marital status, income, prenatal care adequacy, prepregnancy BMI, and physical activity. Acculturation was negatively associated with having gestational diabetes (odds ratio [OR] = 0.93; 95% CI, 0.86–0.99) and explained 15.9% (95% CI, 11.38%–25.08%; P < .001) of the association between Asian race and the condition. Conclusion We found that Asian race was an independent risk factor for gestational diabetes, and higher acculturation may play a protective role against it in Asian American women.
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Affiliation(s)
- Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634-0745.
| | - Donglan Zhang
- Department of Health Policy and Management, University of Georgia, Athens, Georgia
| | - Shin Margaret Chao
- Department of Public Health Los Angeles County, Maternal, Child, and Adolescent Health Programs, Los Angeles, California
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Assessment of the optimal cutoff value of fasting plasma glucose to establish diagnosis of gestational diabetes mellitus in Chinese women. Sci Rep 2019; 9:15998. [PMID: 31690787 PMCID: PMC6831585 DOI: 10.1038/s41598-019-52509-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/15/2019] [Indexed: 01/05/2023] Open
Abstract
Our aim is to assess the optimal cutoff value of fasting plasma glucose (FPG) in Chinese women at 24–28 weeks’ gestation by performing oral glucose tolerance test (OGTT) to improve diagnostic rate of gestational diabetes mellitus (GDM). Data were derived from the Medical Birth Registry of Xiamen. A FPG cutoff value of 5.1 mmol/L confirmed the diagnosis of GDM in 4,794 (6.10%) pregnant women. However, a FPG cutoff value of 4.5 mmol/L should rule out the diagnosis of GDM in 35,932 (45.73%) pregnant women. If we use this cutoff value, the diagnosis of GDM to about 27.3% of pregnant women will be missed. Additionally, a 75-g OGTT was performed in pregnant women with FPG values between 4.5 and 5.1 mmol/L, avoiding the performance of formal 75-g OGTT in about 50.37% pregnant women. Meanwhile, according to maternal age and pre-pregnancy BMI categories, with FPG values between 4.5 mmol/L and 5.1 mmol/L, which had high sensitivity, to improve the diagnostic rate of GDM in all groups. Further researches are needed to present stronger evidences for the screening value of FPG in establishing the diagnosis of GDM in pregnant women.
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Mak JKL, Lee AH, Pham NM, Pan XF, Tang L, Binns CW, Sun X. Gestational diabetes incidence and delivery outcomes in Western China: A prospective cohort study. Birth 2019; 46:166-172. [PMID: 30216525 DOI: 10.1111/birt.12397] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Few studies have examined the age-standardized incidence of gestational diabetes mellitus (GDM) for comparison between populations. Information on delivery outcomes is also lacking for Chinese women with GDM. Therefore, the present study aimed to determine age-standardized GDM incidence and assess its association with maternal and neonatal outcomes. METHODS A total of 1901 pregnant women were recruited in Chengdu, Sichuan Province. GDM was diagnosed between 24 and 28 weeks' gestation using oral glucose tolerance tests. Age-standardized incidence rates of GDM were calculated using the direct method. Delivery outcomes were extracted from medical records and compared between the GDM and non-GDM groups. RESULTS The age-standardized GDM incidence was 18.3% (95% CI 15.6-21.1) and increased with maternal age and prepregnancy body mass index (BMI). Women with GDM experienced longer length of stay in hospital, shorter gestation at delivery, and a higher risk of cesarean delivery. Their newborns were more likely to be macrosomic or small for gestational age, and to require neonatal intensive care. CONCLUSIONS The incidence of GDM was high in Western China, especially among older and overweight women. Moreover, women with GDM had higher rates of adverse delivery outcomes. The findings lend further support for the screening, prevention, and management of GDM in Chinese women.
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Affiliation(s)
- Jonathan K L Mak
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Ngoc Minh Pham
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Tang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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Behboudi-Gandevani S, Ramezani Tehrani F, Rahmati M, Amiri M, Azizi F. Trend of various adiposity indices in women with and without history of gestational diabetes: a population-based cohort study. BMC Endocr Disord 2019; 19:24. [PMID: 30782162 PMCID: PMC6381680 DOI: 10.1186/s12902-019-0348-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/01/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Data of studies focusing on the trends of adiposity indices among women with prior gestational diabetes mellitus (GDM), are limited and controversial. The aim of this study was to compare overtime trends of adiposity indices in women with and without history of GDM, using data of the long term longitudinal population-based Tehran-Lipid and Glucose-Study (TLGS). METHODS A total of 3395 eligible women aged (20-50 years), including 801 women with prior history of GDM and 2594 non-GDM controls were recruited from among Tehran-Lipid and Glucose-Study participants. Generalized estimating equations were applied to assess the time trend of adiposity indices including obesity, central obesity, body mass index (BMI), lipid accumulation product index (LAP), visceral adiposity index (VAI) and a body shape index (ABSI) in women with prior GDM and the non-GDM groups after further adjustment for age and BMI. RESULTS Median follow-up years for the GDM and non-GDM groups were 12.12 and 11.62 years, respectively. Women with GDM at initiation had worse adiposity indices than their healthy counterparts. While overall odds of obesity in women with prior GDM were significantly higher those of the non-GDM groups (OR: 1.35; 95% CI, 1.03-1.7; P = 0.03), both these groups overtime revealed a positive trend in obesity (P trend < 0.001), an incremental trend which was less pronounced in GDM women (OR: 0.87; 95% CI, 0.80, 0.95; P interaction = 0.001). Women with prior GDM had higher odds of central obesity, compared to non-GDM groups (OR: 1.44; 95% CI, 1.06-1.96; P = 0.02) and showed a significant an incremental trend overtime for both groups (P trend < 0.001 for both) without statistically significant interaction in terms of their GDM status (P interaction = 0.134). Mean VAI in women with prior GDM was significantly higher than the non-GDM group (19.7, 95%CI: 6.24, 33.15, P = 0.004), although both groups overtime experienced a negative trend (- 10.9, 95%CI: -13.1, - 2.1, P < 0.001); the GDM group showed a higher decrease in VAI (mean changes: -6.62; 95% CI, - 11,-2.1; P interaction = 0.001). However overtime there was a positive trend in LAP and ABSI among both women with and without prior-GDM, though the mean changes were less obvious in women with prior GDM. CONCLUSION Women with prior GDM gained better control of their adiposity than non-GDM women. Nevertheless the increasing numbers of individuals with GDM and uncontrolled adiposity indices, require prompt attention be paid to the issue.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, Iran
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Aguayo-Mazzucato C, Diaque P, Hernandez S, Rosas S, Kostic A, Caballero AE. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev 2019; 35:e3097. [PMID: 30445663 PMCID: PMC6953173 DOI: 10.1002/dmrr.3097] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022]
Abstract
The prevalence and incidence of type 2 diabetes (T2D) among the Hispanic population in the United States are higher than the national average. This is partly due to sociocultural factors, such as lower income and decreased access to education and health care, as well as a genetic susceptibility to obesity and higher insulin resistance. This review focuses on understanding the Hispanic population living in the United States from a multidisciplinary approach and underlines the importance of cultural, social, and biological factors in determining the increased risk of T2D in this population. An overview of the acute and chronic complications of T2D upon this population is included, which is of paramount importance to understand the toll that diabetes has upon this population, the health system, and society as a whole. Specific interventions directed to the Hispanic populations are needed to prevent and alleviate some of the burdens of T2D. Different prevention strategies based on medications, lifestyle modifications, and educational programmes are discussed herein. Diabetes self-management education (DSME) is a critical element of care of all people with diabetes and is considered necessary to improve patient outcomes. To be more effective, programmes should take into consideration cultural factors that influence the development and progression of diabetes. These interventions aim to enhance long-term effects by reducing the incidence, morbidity, and mortality of T2D in the Hispanic population of the United States.
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Affiliation(s)
| | - Paula Diaque
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Hernandez
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
- Surgery Department, University of Chicago, Chicago, Illinois, USA
| | - Silvia Rosas
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Aleksandar Kostic
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
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Kouhkan A, Khamseh ME, Moini A, Pirjani R, Arabipoor A, Zolfaghari Z, Hosseini R, Baradaran HR. Diagnostic Accuracy of Body Mass Index and Fasting Glucose for The Prediction of Gestational Diabetes Mellitus after Assisted Reproductive Technology. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2019; 13:32-37. [PMID: 30644242 PMCID: PMC6334016 DOI: 10.22074/ijfs.2019.5505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/02/2018] [Indexed: 01/26/2023]
Abstract
Background The aim of the present study was to determine the maternal pre-pregnancy body mass index (BMI), first-trimester fasting blood sugar (FBS), and the combination of (BMI+FBS) cut-points for at-risk pregnant women conceived by assisted reproductive technology (ART) to better predict the risk of developing gestational diabetes mellitus (GDM) in infertile women. Materials and Methods In this nested case-control study, 270 singleton pregnant women consisted of 135 (GDM) and 135 (non-GDM) who conceived using ART were assessed. The diagnosis of GDM was confirmed by a one-step glucose tolerance test (O-GTT) using 75 g oral glucose. BMI was classified base on World Health Organization (WHO) criteria. The relationship between BMI, FBS, and BMI+FBS with the risk of GDM development was determined by logistic regression and adjusted for confounding factors. Receiver operating characteristic (ROC) curve analysis was performed to assess the value of BMI, FBS, and BMI+FBS for the prediction of GDM. Results The GDM group had significantly higher age, BMI, family history of diabetes, and history of polycystic ovary syndrome in comparison with the non-GDM group (P<0.05). Overweight and obese women had 3.27, and 5.14 folds increase in the odds of developing GDM, respectively. There was a 17% increase in the risk of developing GDM with each 1 mg/dl increase in fasting glucose level. The cut points for FBS 84.5 mg/dl (72.9% sensitivity, 74.4% specificity), BMI 25.4 kg/m2 (68.9% sensitivity, 62.8% specificity), and BMI+FBS 111.2 (70.7% sensitivity, 80.6% specificity) was determined. Conclusion The early screening and high-quality prenatal care should be recommended upon the co-occurrence of high FBS (≥84.5 mg/dl) in the first-trimester of the pregnancy and the BMI (≥25.4 kg/m2) in pre-pregnancy period in women undergone ART. The combination of BMI and FBS is considered a better prediction value.
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Affiliation(s)
- Azam Kouhkan
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ashraf Moini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Pirjani
- Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Zolfaghari
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Roya Hosseini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Electronic Address:
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran. Electronic Address:
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Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, Wan Sulaiman WA, Suppiah S, Mohamed MH, Veettil SK. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18:494. [PMID: 30547769 PMCID: PMC6295048 DOI: 10.1186/s12884-018-2131-4] [Citation(s) in RCA: 277] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 11/30/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a of the major public health issues in Asia. The present study aimed to determine the prevalence of, and risk factors for GDM in Asia via a systematic review and meta-analysis. METHODS We systematically searched PubMed, Ovid, Scopus and ScienceDirect for observational studies in Asia from inception to August 2017. We selected cross sectional studies reporting the prevalence and risk factors for GDM. A random effects model was used to estimate the pooled prevalence of GDM and odds ratio (OR) with 95% confidence interval (CI). RESULTS Eighty-four studies with STROBE score ≥ 14 were included in our analysis. The pooled prevalence of GDM in Asia was 11.5% (95% CI 10.9-12.1). There was considerable heterogeneity (I2 > 95%) in the prevalence of GDM in Asia, which is likely due to differences in diagnostic criteria, screening methods and study setting. Meta-analysis demonstrated that the risk factors of GDM include history of previous GDM (OR 8.42, 95% CI 5.35-13.23); macrosomia (OR 4.41, 95% CI 3.09-6.31); and congenital anomalies (OR 4.25, 95% CI 1.52-11.88). Other risk factors include a BMI ≥25 kg/m2 (OR 3.27, 95% CI 2.81-3.80); pregnancy-induced hypertension (OR 3.20, 95% CI 2.19-4.68); family history of diabetes (OR 2.77, 2.22-3.47); history of stillbirth (OR 2.39, 95% CI 1.68-3.40); polycystic ovary syndrome (OR 2.33, 95% CI1.72-3.17); history of abortion (OR 2.25, 95% CI 1.54-3.29); age ≥ 25 (OR 2.17, 95% CI 1.96-2.41); multiparity ≥2 (OR 1.37, 95% CI 1.24-1.52); and history of preterm delivery (OR 1.93, 95% CI 1.21-3.07). CONCLUSION We found a high prevalence of GDM among the Asian population. Asian women with common risk factors especially among those with history of previous GDM, congenital anomalies or macrosomia should receive additional attention from physician as high-risk cases for GDM in pregnancy. TRIAL REGISTRATION PROSPERO (2017: CRD42017070104 ).
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, University of Malaya Center for Addiction Sciences (UMCAS), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Yook Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, 47500 Bandar Sunway, Selangor Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Subapriya Suppiah
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Mohd Hazmi Mohamed
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Sajesh K. Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, 57000 Kuala Lumpur, Malaysia
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Li P, Lin S, Cui J, Li L, Zhou S, Fan J. First Trimester Neck Circumference as a Predictor for the Development of Gestational Diabetes Mellitus. Am J Med Sci 2018; 355:149-152. [DOI: 10.1016/j.amjms.2017.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 01/20/2023]
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Maternal metabolic response to dietary treatment for impaired glucose tolerance and gestational diabetes mellitus. Ir J Med Sci 2018; 187:701-708. [DOI: 10.1007/s11845-018-1744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/10/2018] [Indexed: 12/16/2022]
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Huhn EA, Rossi SW, Hoesli I, Göbl CS. Controversies in Screening and Diagnostic Criteria for Gestational Diabetes in Early and Late Pregnancy. Front Endocrinol (Lausanne) 2018; 9:696. [PMID: 30538674 PMCID: PMC6277591 DOI: 10.3389/fendo.2018.00696] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/05/2018] [Indexed: 01/14/2023] Open
Abstract
This review serves to evaluate the screening and diagnostic strategies for gestational diabetes and overt diabetes in pregnancy. We focus on the different early screening and diagnostic approaches in first trimester including fasting plasma glucose, random plasma glucose, oral glucose tolerance test, hemoglobin A1c, risk prediction models and biomarkers. Early screening for gestational diabetes is currently not recommended since the potential benefits and harms of early detection and subsequent treatment need to be further evaluated in randomized controlled trials.
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Affiliation(s)
- Evelyn A. Huhn
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
- *Correspondence: Evelyn A. Huhn
| | - Simona W. Rossi
- Department of Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Irene Hoesli
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Christian S. Göbl
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
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Teefey CP, Durnwald CP. Strategies to reduce disparities in maternal morbidity and mortality: The role of obesity and metabolic disease. Semin Perinatol 2017; 41:287-292. [PMID: 28709520 DOI: 10.1053/j.semperi.2017.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Maternal obesity, excessive gestational weight gain, and preexisting diabetes are known risk factors for increased maternal and neonatal morbidity. These conditions are more prevalent in certain racial and ethnic minorities. Identification and acknowledgement of racial and ethnic inequalities related to maternal metabolic disease is crucial for clinicians to provide the most comprehensive care in pregnancy. Research and clinical efforts should focus on implementation of healthy lifestyle interventions preconceptually and risk reduction efforts in disease complications during pregnancy. In addition, obstetrical providers can provide the framework and ongoing support for sustainable lifestyle modifications, thereby, improving a woman's long-term metabolic health.
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Affiliation(s)
- Christina Paidas Teefey
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, 2 Silverstein Building, 3400 Spruce St, Philadelphia, PA 19104.
| | - Celeste P Durnwald
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, 2 Silverstein Building, 3400 Spruce St, Philadelphia, PA 19104
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Nishikawa E, Oakley L, Seed PT, Doyle P, Oteng-Ntim E. Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK. PLoS One 2017. [PMID: 28640854 PMCID: PMC5480876 DOI: 10.1371/journal.pone.0179332] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate the ethnicity-specific association between body mass index (BMI) and diabetes in pregnancy, with a focus on the appropriateness of using BMI cut-offs to identify pregnant women at risk of diabetes. Study design Analysis of routinely-collected data from a maternity unit in London, UK. Data were available on 53 264 women delivering between 2004 and 2012. Logistic regression was used to explore the association between diabetes in pregnancy and BMI among women of different ethnicities, and adjusted probability estimates were used to derive risk equivalent cut-offs. ROC curve analysis was used to assess the performance of BMI as a predictor of diabetes in pregnancy. Results The prevalence of diabetes in pregnancy was 2.3% overall; highest in South and East Asian women (4.6% and 3.7%). In adjusted analysis, BMI category was strongly associated with diabetes in all ethnic groups. Modelled as a continuous variable with a quadratic term, BMI was an acceptable predictor of diabetes according to ROC curve analysis. Applying a BMI cut-off of 30 kg/m2 would identify just over half of Black women with diabetes in pregnancy, a third of White (32%) and South Asian (35%) women, but only 13% of East Asian women. The ‘risk equivalent’ (comparable to 30 kg/m2 in White women) threshold for South Asian and East Asian women was approximately 21 kg/m2, and 27.5 kg/m2 for Black women. Conclusions This study suggests that current BMI thresholds are likely to be ineffective for diabetes screening in South and East Asian women, as many cases of diabetes will occur at low BMI levels. Our results suggest that East Asian women appear to face a similarly high risk of diabetes to South Asian women. Current UK guidelines recommend diabetes screening should be offered to all pregnant South Asian women; extending this recommendation to include women of East Asian ethnicity may be appropriate.
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Affiliation(s)
- Erin Nishikawa
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Oakley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Paul T. Seed
- Women's Health Academic Centre, King’s College London, London, United Kingdom
| | - Pat Doyle
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eugene Oteng-Ntim
- Department of Women's Health, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Gillespie SL, Christian LM. Body Mass Index as a Measure of Obesity: Racial Differences in Predictive Value for Health Parameters During Pregnancy. J Womens Health (Larchmt) 2016; 25:1210-1218. [PMID: 27487272 DOI: 10.1089/jwh.2016.5761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As a measure of obesity, body mass index (BMI; kg/m2) is an imperfect predictor of health outcomes, particularly among African Americans. However, BMI is used to guide prenatal care. We examined racial differences in the predictive value of maternal BMI for physiologic correlates of obesity, serum interleukin (IL)-6 and C-reactive protein (CRP), as well as cesarean section and infant birth weight. METHODS One hundred five pregnant women (40 European American, 65 African American) were assessed during the second trimester. BMI was defined as per prepregnancy weight. Electrochemiluminescence and enzyme-linked immunosorbent assays were used to quantify IL-6 and CRP, respectively. Birth outcomes were determined by medical record review. RESULTS Women of both races classified as obese had higher serum IL-6 and CRP than their normal-weight counterparts (ps ≤ 0.01). However, among women with overweight, elevations in IL-6 (p < 0.01) and CRP (p = 0.06) were observed among European Americans, but not African Americans (ps ≥ 0.61). Maternal obesity was a significantly better predictor of cesarean section among European Americans versus African Americans (p = 0.03) and BMI was associated with infant birth weight among European Americans (p < 0.01), but not African Americans (p = 0.94). Effects remained after controlling for gestational age at delivery, gestational diabetes, and gestational weight gain as appropriate. CONCLUSIONS BMI may be a less valid predictor of correlates of overweight/obesity among African Americans versus European Americans during pregnancy. This should be considered in epidemiological studies of maternal-child health. In addition, studies examining the comparative validity of alternative/complementary measures to define obesity in pregnancy are warranted to inform clinical care.
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Affiliation(s)
| | - Lisa M Christian
- 2 Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center , Columbus, Ohio.,3 Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center , Columbus, Ohio.,4 The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center , Columbus, Ohio.,5 Department of Psychology, The Ohio State University , Columbus, Ohio
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Li P, Yin Y, Lin S, Cui J, Zhou S, Li L, Fan J. Utility of Pregestational Body Mass Index and Initial Fasting Plasma Glucose in Predicting Gestational Diabetes Mellitus. Am J Med Sci 2016; 351:420-5. [PMID: 27079350 DOI: 10.1016/j.amjms.2016.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/04/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The present study aimed to evaluate the pregestational body mass index (preBMI) and initial fasting plasma glucose (FPG) in predicting gestational diabetes mellitus (GDM) in southern Chinese women. STUDY DESIGN A total of 327 pregnant women were recruited from the third affiliated hospital of Sun Yat-Sen University, Guangzhou, China. The preBMI and initial FPG at 16-18 weeks' gestation were measured. Oral glucose tolerance test was performed at 24-28 weeks' gestation. The sensitivity and specificity of preBMI and initial FPG as predictors for GDM were evaluated by receiver-operator characteristic curve analysis. RESULTS Both preBMI and initial FPG correlated with the 0-hour, 1-hour and 2-hour plasma glucose during oral glucose tolerance test (P < 0.05). The area under receiver-operator characteristic curve was 0.63 (95% CI: 0.57-0.68) for preBMI and 0.68 (95% CI: 0.61-0.72) for initial FPG in diagnosing GDM. The optimal cutoff for preBMI was 21.5 kg/m(2) (sensitivity 52.1% and specificity 69.2%) and 4.6 mmol/L (sensitivity 64.6% and specificity 65.2%) for initial FPG. Interestingly, the initial FPG had a better sensitivity compared to preBMI when the specificity was the same. Multivariate logistic regression analysis showed that initial FPG but not preBMI was the independent risk factor for the later development of GDM. After adjustment for the preBMI and the maternal age, the odds ratios of initial FPG and parity were 3.57 (95% CI: 1.72-7.45) and 2.11 (95% CI: 1.20-3.72). CONCLUSIONS Although both preBMI and initial FPG could be used as indicators for GDM, the initial FPG may be more suitable for predicting GDM in southern Chinese women.
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Affiliation(s)
- Ping Li
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuzhu Yin
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shuo Lin
- Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jinhui Cui
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shuisheng Zhou
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ling Li
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianhui Fan
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Yuen L, Wong VW. Gestational diabetes mellitus: Challenges for different ethnic groups. World J Diabetes 2015; 6:1024-1032. [PMID: 26240699 PMCID: PMC4515442 DOI: 10.4239/wjd.v6.i8.1024] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/09/2015] [Accepted: 05/06/2015] [Indexed: 02/05/2023] Open
Abstract
Ethnicity is defined as “belonging to a social group that has a common national or cultural tradition”. Membership of certain ethnic groups has long been associated with increased risk of gestational diabetes mellitus (GDM). Studies that examined ethnic differences amongst women with GDM were often conducted in western countries where women from various ethnic backgrounds were represented. The prevalence of GDM appears to be particularly high among women from South Asia and South East Asia, compared to Caucasian, African-American and Hispanic communities. For some, but not all ethnic groups, the body mass index is a risk factor for the development of GDM. Even within a particular ethnic group, those who were born in their native countries have a different risk profile for GDM compared to those born in western countries. In terms of treatment, medical nutrition therapy (MNT) plays a key role in the management of GDM and the prescription of MNT should be culturally sensitive. Limited studies have shown that women who live in an English-speaking country but predominantly speak a language other than English, have lower rates of dietary understanding compared with their English speaking counterparts, and this may affect compliance to therapy. Insulin therapy also plays an important role and there appears to be variation as to the progression of women who progress to requiring insulin among different ethnicities. As for peri-natal outcomes, women from Pacific Islander countries have higher rates of macrosomia, while women from Chinese backgrounds had lower adverse pregnancy outcomes. From a maternal outcome point of view, pregnant women from Asia with GDM have a higher incidence of abnormal glucose tolerance test results post-partum and hence a higher risk of future development of type 2 diabetes mellitus. On the other hand, women from Hispanic or African-American backgrounds with GDM are more likely to develop hypertension post-partum. This review highlights the fact that management needs to be individualised and the clinician should be mindful of the impact that differences in ethnicity may have on the clinical characteristics and pregnancy outcomes in women affected by GDM, particularly those living in Western countries. Understanding these differences is critical in the delivery of optimal antenatal care for women from diverse ethnic backgrounds.
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Kim C, Kim SY, Sappenfield W, Wilson HG, Salihu HM, Sharma AJ. Are gestational diabetes mellitus and preconception diabetes mellitus less common in non-Hispanic black women than in non-Hispanic white women? Matern Child Health J 2015; 18:698-706. [PMID: 23793482 DOI: 10.1007/s10995-013-1295-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Based on their higher risk of type 2 diabetes, non-Hispanic blacks (NHBs) would be expected to have higher gestational diabetes mellitus (GDM) risk compared to non-Hispanic whites (NHWs). However, previous studies have reported lower GDM risk in NHBs versus NHWs. We examined whether GDM risk was lower in NHBs and NHWs, and whether this disparity differed by age group. The cohort consisted of 462,296 live singleton births linked by birth certificate and hospital discharge data from 2004 to 2007 in Florida. Using multivariable regression models, we examined GDM risk stratified by age and adjusted for body mass index (BMI) and other covariates. Overall, NHBs had a lower prevalence of GDM (2.5 vs. 3.1%, p < 0.01) and a higher proportion of preconception DM births (0.5 vs. 0.3%, p ≤ 0.01) than NHWs. Among women in their teens (risk ratio 0.56, p < 0.01) and 20-29 years of age (risk ratio 0.85, p < 0.01), GDM risk was lower in NHBs than NHWs. These patterns did not change with adjustment for BMI and other covariates. Among women 30-39 years (risk ratio 1.18, p < 0.01) and ≥40 years (risk ratio 1.22, p < 0.01), GDM risk was higher in NHBs than NHWs, but risk was higher in NHWs after adjustment for BMI. Associations between BMI and GDM risk did not vary by race/ethnicity or age group. NHBs have lower risk of GDM than NHWs at younger ages, regardless of BMI. NHBs had higher risk than NHWs at older ages, largely due to racial/ethnic disparities in overweight/obesity at older ages.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA,
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McDonald R, Karahalios A, Le T, Said J. A Retrospective Analysis of the Relationship between Ethnicity, Body Mass Index, and the Diagnosis of Gestational Diabetes in Women Attending an Australian Antenatal Clinic. Int J Endocrinol 2015; 2015:297420. [PMID: 26504462 PMCID: PMC4609521 DOI: 10.1155/2015/297420] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose. To estimate the prevalence of gestational diabetes mellitus (GDM) in a multiethnic population, assess the association between country of birth (COB) and GDM, and assess whether the association varies by body mass index (BMI). Methods. A retrospective study of 5260 pregnant women attending Sunshine Hospital, Australia, between 1st July 2012 and 30th June 2013. We fitted logistic regression models to assess the association between COB and GDM. An interaction between BMI and COB was assessed by likelihood ratio test. Results. In the 4610 included in our analysis, most common were women born in Australia or New Zealand (ANZ, 1932, 41.9%) and in Southeast Asia (922, 20%). GDM was diagnosed in 606 (13.2%) women. After adjusting for confounders, women from East Asia were most likely to develop GDM (37, 24.0%) and 5-fold more likely than women from ANZ (OR = 4.77, 95% CI: 3.12, 7.31, p < 0.001). Women from other Asian countries had a 3-fold increased risk of GDM compared to women from ANZ. There was no evidence of an interaction by BMI (p = 0.24). Conclusions. Women born in Asia have higher risk of GDM compared to women born in ANZ. These data provide support for including COB in GDM management policies.
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Affiliation(s)
- Rebecca McDonald
- Monash Women's, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
- Women's and Children's Health, Sunshine Hospital, Western Health, 176 Furlong Road, Saint Albans, VIC 3021, Australia
| | - Amalia Karahalios
- Office for Research, Western Centre for Health Research & Education, 176 Furlong Road, Saint Albans, VIC 3021, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053, Australia
| | - Thao Le
- Women's and Children's Health, Sunshine Hospital, Western Health, 176 Furlong Road, Saint Albans, VIC 3021, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Joanne Said
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC 3052, Australia
- Maternal Fetal Medicine, Sunshine Hospital, Western Health, 176 Furlong Road, Saint Albans, VIC 3021, Australia
- *Joanne Said:
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50
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Ramirez VI, Miller E, Meireles CL, Gelfond J, Krummel DA, Powell TL. Adiponectin and IGFBP-1 in the development of gestational diabetes in obese mothers. BMJ Open Diabetes Res Care 2014; 2:e000010. [PMID: 25452858 PMCID: PMC4212565 DOI: 10.1136/bmjdrc-2013-000010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/05/2014] [Accepted: 04/07/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is more common in pregnancies complicated by obesity and both diseases increase the risk for fetal overgrowth and long-term adverse health consequences for the mother and child. Previous studies have linked low maternal serum adiponectin to GDM in normal and overweight women. We hypothesized that lower adiponectin, in particular the high-molecular-weight form, and insulin-like growth factor I (IGF-I) and its binding protein (IGFBP-1) are associated with GDM in pregnant obese Hispanic women. METHODS 72 obese, predominantly Hispanic (92%), women were recruited at 24-28 weeks of gestation. Adiposity was assessed, fasting serum samples were collected, and glucose, insulin, triglyceride, cholesterol levels, adipokines, and hormones associated with obesity and insulin resistance were measured. 30 women had been recently diagnosed with GDM. RESULTS Gestational weeks, body mass index, triceps skinfold thickness, mid-arm circumference, serum leptin, IGF-I, tumor necrosis factor α, and interleukin-6 did not differ in the two groups. Obese women with GDM had significantly higher fasting glucose, A1C, triglycerides, very-low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol, adiponectin, and IGFBP-1 compared to obese women without GDM. Homeostasis model assessment of insulin resistance was positively correlated to IGF-I and negatively correlated to adiponectin. CONCLUSIONS Obese pregnant women with recently diagnosed GDM had a significantly exacerbated metabolic profile, low serum adiponectin and IGFBP-1 levels at 24-28 weeks of gestation, as compared to women with obesity alone. Because low adiponectin is well established to cause insulin resistance and decreased IGFBP-1 indicates increased IGF-I bioavailability, we propose that these changes are mechanistically linked to the development of GDM in obese Hispanic women.
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Affiliation(s)
- Vanessa I Ramirez
- Department of Obstetrics and Gynecology, Center for Pregnancy and Newborn Research, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Evelyn Miller
- Department of Obstetrics and Gynecology, Center for Pregnancy and Newborn Research, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Christiane L Meireles
- Department of Obstetrics and Gynecology, Center for Pregnancy and Newborn Research, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jonathan Gelfond
- Department of Biostatistics and Epidemiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Debra A Krummel
- Department of Nutritional Sciences, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Theresa L Powell
- Department of Obstetrics and Gynecology, Center for Pregnancy and Newborn Research, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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