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Fujikawa Shingu K, Waguri M, Takahara M, Katakami N, Shimomura I. Clinical features of overt versus diagnosed pre-existing diabetes in pregnancy. J Diabetes Investig 2025. [PMID: 40342288 DOI: 10.1111/jdi.70045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 01/27/2025] [Accepted: 03/17/2025] [Indexed: 05/11/2025] Open
Abstract
Overt diabetes in pregnancy (ODP) was originally included in gestational diabetes mellitus, which was positioned between normal glucose tolerance and pre-existing diabetes mellitus (PDM) in perinatal risk. This retrospective study aimed to clarify the differences between women with ODP and those with PDM. Compared with women with PDM (n = 162), those with ODP (n = 76) had higher HbA1c levels especially in the first trimester (8.2 ± 1.5% vs 7.2 ± 1.5%; P < 0.001). Furthermore, women with ODP had higher pre-pregnancy body mass index (30.8 ± 7.0 vs 28.5 ± 5.6 kg/m2; P = 0.010), and a higher incidence of congenital anomalies (19.7% vs 9.3%; P = 0.035). In conclusion, ODP was not milder than PDM; women with ODP did not only have poorer glycemic control but also had poorer pre-pregnant weight control. Their burdens could be relieved through appropriate management before pregnancy.
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Affiliation(s)
- Kei Fujikawa Shingu
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Obstetric Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masako Waguri
- Department of Obstetric Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Shu X, Juan J, Kang X, Yao M, Chen X, Wei Z, Kong L, Chen H, Cui S, Gao F, Zhu P, Yan J, Xu X, Zhang L, Wang Y, Mi Y, Yang H. Comparative analysis of perinatal outcomes in pregnant women with pregestational diabetes mellitus based on diagnostic timing. Sci Rep 2025; 15:9613. [PMID: 40113921 PMCID: PMC11926075 DOI: 10.1038/s41598-025-93449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Accepted: 03/06/2025] [Indexed: 03/22/2025] Open
Abstract
Diabetes is a major concern in healthcare worldwide and is detrimental to mothers and fetuses during pregnancy. However, half of the women were unaware of hyperglycemia before pregnancy, and there is no consensus on their identification during pregnancy. We aim to understand the role that diagnostic timing plays in perinatal outcomes. This was a multicenter retrospective study of all pregestational diabetes mellitus (PGDM) women who delivered from January 2021 to June 2023. Diagnoses were made before or during gestation. Characteristics and outcomes were compared among stages, and logistic regression was performed to explore the relationship between adverse outcomes and the diagnostic timing. This study included 2,818 women; 1188 (42.2%) were self-aware before pregnancy, and 286 (10.1%), 1208 (42.9%), and 136 (4.8%) were diagnosed in the first, second, and third trimesters, respectively. Maternal body mass index, hypertensive disorders during pregnancy, glucose profile, large-for-gestational-age (LGA), etc., differed among stages (all P < 0.05). Logistic regression revealed that PGDM diagnosed during any trimester was significantly associated with an increased risk of macrosomia (aOR = 2.632, 1.502, 2.314; all P < 0.05). However, the risk of LGA decreased if the diagnosis was based on the 2 h value of the oral glucose tolerance test (OGTT) alone in the second trimester (aOR = 0.608, 95% CI: 0.444-0.831). No relationship existed between diagnostic timing and neonatal birth defects or hypoglycemia (both P > 0.05). PGDM identified during pregnancy was significantly associated with an increased risk of fetal overgrowth. The role of the 2 h-OGTT alone in diagnosis warrants further exploration. PGDM screening is essential for the entire gestational period.
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Affiliation(s)
- Xinyu Shu
- Department of Obstetrics and Gynecology and Reproductive Medicine, Peking University First Hospital, Beijing, China
| | - Juan Juan
- Department of Obstetrics and Gynecology and Reproductive Medicine, Peking University First Hospital, Beijing, China
| | - Xin Kang
- Department of Obstetrics and Gynecology and Reproductive Medicine, Peking University First Hospital, Beijing, China
| | - Mi Yao
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - Xu Chen
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Zhuo Wei
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Lingyi Kong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Haitian Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Shihong Cui
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Fengchun Gao
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Shandong First Medical University, Jinan, Shandong Province, China
| | - Ping Zhu
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Shandong First Medical University, Jinan, Shandong Province, China
| | - Jianying Yan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, Fujian, China
| | - Xia Xu
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, Fujian, China
| | - Li Zhang
- Department of Obstetrics, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu, China
| | - Yanxia Wang
- Department of Obstetrics, Northwest Women and Children's Hospital, Xian, Shanxi Province, China
| | - Yang Mi
- Department of Obstetrics, Northwest Women and Children's Hospital, Xian, Shanxi Province, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology and Reproductive Medicine, Peking University First Hospital, Beijing, China.
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Cheung NW, Rhou YJJ, Immanuel J, Hague WM, Teede H, Nolan CJ, Peek MJ, Flack JR, McLean M, Wong VW, Hibbert EJ, Kautzky-Willer A, Harreiter J, Backman H, Gianatti E, Sweeting A, Mohan V, Simmons D. Postpartum dysglycaemia after early gestational diabetes: Follow-up of women in the TOBOGM randomised controlled trial. Diabetes Res Clin Pract 2024; 218:111929. [PMID: 39536979 DOI: 10.1016/j.diabres.2024.111929] [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: 09/24/2024] [Revised: 11/01/2024] [Accepted: 11/10/2024] [Indexed: 11/16/2024]
Abstract
AIM To evaluate the incidence and predictors of postpartum dysglycaemia among high-risk women who develop early gestational diabetes (eGDM) prior to 20 weeks' gestation. METHODS This is a sub-study of the Treatment of Booking Gestational Diabetes (TOBOGM) Study, a randomised controlled trial of early or deferred treatment for women with risk factors for gestational diabetes diagnosed with eGDM, using current WHO criteria. Overt diabetes in pregnancy was excluded. A repeat oral glucose tolerance test (oGTT) was recommended at 6-12 weeks postpartum. RESULTS Of 793 participants, 352 (44.4%) underwent a postpartum oGTT. Baseline characteristics of participants with and without an oGTT were similar. Ninety-two (26.1%) had postpartum dysglycaemia: 11 (3.1%) diabetes, 31 (8.8%) impaired fasting glucose (IFG), 39 (11.1%) impaired glucose tolerance (IGT), and 11 (3.1%) combined IFG/IGT. Participants with postpartum dysglycaemia were more likely to have had past GDM, lower body mass index, more gestational weight gain, and higher 1 and 2-hour glucose concentrations on the early pregnancy oGTT. On logistic regression, higher 1 and 2-hour glucose concentration, previous GDM and greater gestational weight gain were independently associated with postpartum dysglycaemia. CONCLUSION There is a high incidence of postpartum dysglycaemia among high-risk women with eGDM.
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Affiliation(s)
- N Wah Cheung
- Westmead Hospital, Westmead, NSW, Australia; University of Sydney, Sydney, NSW Australia.
| | - Yoon J J Rhou
- Westmead Hospital, Westmead, NSW, Australia; University of Sydney, Sydney, NSW Australia.
| | - Jincy Immanuel
- Western Sydney University, Campbelltown, NSW, Australia.
| | - William M Hague
- Robinson Research Institute, The University of Adelaide, SA, Australia.
| | | | - Christopher J Nolan
- Canberra Health Services, Canberra, Australia; Australian National University, Canberra, Australia.
| | - Michael J Peek
- University of Sydney, Sydney, NSW Australia; Nepean Hospital, Sydney, NSW, Australia.
| | | | | | - Vincent W Wong
- Liverpool Hospital, Sydney and University of New South Wales, NSW, Australia.
| | - Emily J Hibbert
- University of Sydney, Sydney, NSW Australia; Nepean Hospital, Sydney, NSW, Australia.
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Department of Medicine, Landesklinikum Scheibbs, Austria.
| | - Helena Backman
- Dept of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Sweden.
| | - Emily Gianatti
- Department of Endocrinology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
| | - Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Vishwanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India.
| | - David Simmons
- Western Sydney University, Campbelltown, NSW, Australia.
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Boriboonhirunsarn D, Robkhonburi A, Gusonkhum D. Incidence of overt diabetes in pregnancy among women with 50-g glucose challenge test ≥ 200 mg/dL. Diabetol Int 2024; 15:406-413. [PMID: 39101181 PMCID: PMC11291839 DOI: 10.1007/s13340-024-00694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/17/2024] [Indexed: 08/06/2024]
Abstract
Objectives To determine the incidence of overt diabetes in pregnancy (ODIP) among women with 50-g GCT results ≥ 200 mg/dL and compare characteristics and pregnancy outcomes between women with and without gestational diabetes (GDM). Methods A retrospective cohort study was conducted in 212 pregnant women whose 50-g GCT results ≥ 200 mg/dL. ODIP was diagnosed from 75-g OGTT if fasting plasma glucose ≥ 126 and/or 2-h plasma glucose ≥ 200 mg/dL. Various characteristics and pregnancy outcomes were compared between ODIP and those with and without GDM. Results Incidence of ODIP was 1.9% of all pregnant women and 23.6% of women with 50-g GCT ≥ 200 mg/dL. Women with ODIP and GDM were more likely to be overweight or obese than those without GDM (52%, 39.6%, and 18.2%, p < 0.001). Women with ODIP had significantly higher 50-g GCT results, lower gestational weight gain, and were less likely to deliver vaginally. Insulin therapy was significantly more common in women with ODIP compared to GDM (70.2% vs. 15.4%, p < 0.001). Rates of LGA, macrosomia, and other neonatal outcomes were comparable. BMI ≥ 25 kg/m2 and 50-g GCT ≥ 240 mg/dL independently increased the risk of any abnormal glucose tolerance [adjusted OR 3.22 (95% CI 1.55-6.70) and 2.28 (95% CI 1.14-4.58)] and ODIP [adjusted OR 9.43 (95% CI 2.15-41.38) and 6.36 (95% CI 2.85-14.18)], respectively. Conclusion Incidence of ODIP was 23.6% of women with 50-g GCT ≥ 200 mg/dL. BMI ≥ 25 kg/m2 and 50-g GCT ≥ 240 mg/dL independently increased the risk of GDM and ODIP. Neonatal complications were comparable between ODIP and those with and without GDM.
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Affiliation(s)
- Dittakarn Boriboonhirunsarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
| | - Amporn Robkhonburi
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
| | - Dawrueng Gusonkhum
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
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Gupta Y, Goyal A, Ambekar S, Kalaivani M, Bhatla N, Tandon N. Cardiometabolic profile of women with a history of overt diabetes compared to gestational diabetes and normoglycemia in index pregnancy: Results from CHIP-F study. J Diabetes 2024; 16:e13461. [PMID: 37646315 PMCID: PMC11070837 DOI: 10.1111/1753-0407.13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023] Open
Abstract
PURPOSE We aimed to evaluate the prevalence of postpartum diabetes among women with a history of overt diabetes in pregnancy (ODiP) and compare with women having a history of gestational diabetes mellitus (GDM) and normoglycemia in pregnancy. METHODS We have an established longitudinal cohort of postpartum women with a history of hyperglycemia (preexisting diabetes [PED] [n = 101], ODiP [n = 92], GDM [n = 643]), and normoglycemia (n = 183) in pregnancy. For this study, we excluded women with PED and invited other eligible women in a fasting state for clinical and biochemical evaluation. RESULTS We evaluated 918 women with a mean (SD) age of 33.6 (5.0) years and at a median (interquartile range) postpartum interval of 31 (20-45) months. Diabetes was diagnosed in 65 (70.7%) women in ODiP compared to 99 (15.4%) in GDM (p < .001) and 4 (2.2%) in normoglycemia group (p < .001). In the ODiP group, the prevalence of diabetes was 47.4% among women tested in the first year postpartum, increasing to 86.8% among women tested at >3 years postpartum. Diabetes was more common when ODiP was diagnosed in the first (27/29, 93.1%) compared to the second trimester of pregnancy (35/57, 61.4%). The adjusted odds ratio for diabetes in ODiP was 14.82 (95% confidence interval, 8.49-25.87; p < .001; reference category: GDM). CONCLUSIONS The prevalence of postpartum diabetes was significantly higher in women with ODiP compared to GDM. Nearly 50% of women with ODiP did not develop diabetes in the first year of follow-up, especially when ODiP was diagnosed after the first trimester of pregnancy and on the basis of a 2-h oral glucose tolerance test value. Such women are amenable to prevention strategies.
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | - Alpesh Goyal
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | - Samita Ambekar
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | - Mani Kalaivani
- Department of StatisticsAll India Institute of Medical SciencesNew DelhiIndia
| | - Neerja Bhatla
- Department of Obstetrics and GynaecologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Nikhil Tandon
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
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Sereika SM, Moore KR, Stotz S, Chalmers LJ, Garrow H, Gonzales K, O'Banion N, Powell J, Knoki-Wilson U, Charron-Prochownik D. The Associations Between Health-Related Knowledge and Health Beliefs Regarding Risk for Gestational Diabetes in American Indian and Alaska Native Female Adolescents and Young Adults at Risk for Gestational Diabetes and Their Female Caregivers: A Cross-Sectional Dyadic Analysis. J Midwifery Womens Health 2024; 69:383-393. [PMID: 38831486 DOI: 10.1111/jmwh.13643] [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] [Revised: 04/13/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs). METHODS Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members. RESULTS Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P < .001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P < .05). DISCUSSION As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.
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Affiliation(s)
- Susan M Sereika
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelly R Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Stotz
- Department of Food Science and Human Nutrition, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado
| | - Laura J Chalmers
- Department of Pediatrics, School of Medicine, University of Oklahoma, Tulsa, Oklahoma
| | | | - Kelly Gonzales
- School of Public Health, Oregon Health Science University-Portland State University, Portland, Oregon
| | - Nancy O'Banion
- Indian Health Care Resource Center of Tulsa, Tulsa, Oklahoma
| | - Jeffrey Powell
- Northern Navajo Medical Center, Navajo Area Indian Health Service, Shiprock, New Mexico
| | | | - Denise Charron-Prochownik
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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Regnault N, Lebreton E, Tang L, Fosse-Edorh S, Barry Y, Olié V, Billionnet C, Weill A, Vambergue A, Cosson E. Maternal and neonatal outcomes according to the timing of diagnosis of hyperglycaemia in pregnancy: a nationwide cross-sectional study of 695,912 deliveries in France in 2018. Diabetologia 2024; 67:516-527. [PMID: 38182910 PMCID: PMC10844424 DOI: 10.1007/s00125-023-06066-4] [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: 08/07/2023] [Accepted: 11/02/2023] [Indexed: 01/07/2024]
Abstract
AIMS/HYPOTHESIS We aimed to assess maternal-fetal outcomes according to various subtypes of hyperglycaemia in pregnancy. METHODS We used data from the French National Health Data System (Système National des Données de Santé), which links individual data from the hospital discharge database and the French National Health Insurance information system. We included all deliveries after 22 gestational weeks (GW) in women without pre-existing diabetes recorded in 2018. Women with hyperglycaemia were classified as having overt diabetes in pregnancy or gestational diabetes mellitus (GDM), then categorised into three subgroups according to their gestational age at the time of GDM diagnosis: before 22 GW (GDM<22); between 22 and 30 GW (GDM22-30); and after 30 GW (GDM>30). Adjusted prevalence ratios (95% CI) for the outcomes were estimated after adjusting for maternal age, gestational age and socioeconomic status. Due to the multiple tests, we considered an association to be statistically significant according to the Holm-Bonferroni procedure. To take into account the potential immortal time bias, we performed analyses on deliveries at ≥31 GW and deliveries at ≥37 GW. RESULTS The study population of 695,912 women who gave birth in 2018 included 84,705 women (12.2%) with hyperglycaemia in pregnancy: overt diabetes in pregnancy, 0.4%; GDM<22, 36.8%; GDM22-30, 52.4%; and GDM>30, 10.4%. The following outcomes were statistically significant after Holm-Bonferroni adjustment for deliveries at ≥31 GW using GDM22-30 as the reference. Caesarean sections (1.54 [1.39, 1.72]), large-for-gestational-age (LGA) infants (2.00 [1.72, 2.32]), Erb's palsy or clavicle fracture (6.38 [2.42, 16.8]), preterm birth (1.84 [1.41, 2.40]) and neonatal hypoglycaemia (1.98 [1.39, 2.83]) were more frequent in women with overt diabetes. Similarly, LGA infants (1.10 [1.06, 1.14]) and Erb's palsy or clavicle fracture (1.55 [1.22, 1.99]) were more frequent in GDM<22. LGA infants (1.44 [1.37, 1.52]) were more frequent in GDM>30. Finally, women without hyperglycaemia in pregnancy were less likely to have preeclampsia or eclampsia (0.74 [0.69, 0.79]), Caesarean section (0.80 [0.79, 0.82]), pregnancy and postpartum haemorrhage (0.93 [0.89, 0.96]), LGA neonate (0.67 [0.65, 0.69]), premature neonate (0.80 [0.77, 0.83]) and neonate with neonatal hypoglycaemia (0.73 [0.66, 0.82]). Overall, the results were similar for deliveries at ≥37 GW. Although the estimation of the adjusted prevalence ratio of perinatal death was five times higher (5.06 [1.87, 13.7]) for women with overt diabetes, this result was non-significant after Holm-Bonferroni adjustment. CONCLUSIONS/INTERPRETATION Compared with GDM22-30, overt diabetes, GDM<22 and, to a lesser extent, GDM>30 were associated with poorer maternal-fetal outcomes.
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Affiliation(s)
- Nolwenn Regnault
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | - Elodie Lebreton
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | - Luveon Tang
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | | | - Yaya Barry
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | - Valérie Olié
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | | | - Alain Weill
- EPI-PHARE Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
| | - Anne Vambergue
- Endocrinology, Diabetology, Metabolism and Nutrition Department, Lille University Hospital, European Genomics Institute for Diabetes, University of Lille, Lille, France
| | - Emmanuel Cosson
- Department of Diabetology-Endocrinology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, AP-HP, Avicenne Hospital, Bobigny, France.
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), Université Sorbonne Paris Nord and Université Paris CitéInserm, INRAE, CNAM, Bobigny, France.
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Ducarme G, Planche L, Lbakhar M. Predictive Factors for Successful Cervical Ripening among Women with Gestational Diabetes Mellitus at Term: A Prospective Study. J Clin Med 2023; 13:139. [PMID: 38202146 PMCID: PMC10779893 DOI: 10.3390/jcm13010139] [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: 10/26/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The purpose of this prospective cohort study is to identify the predictive factors for vaginal delivery among women (n = 146) who underwent cervical ripening using a dinoprostone insert (PG) alone (13.7%), cervical ripening balloon (CRB) alone (52.7%), oral misoprostol (M) alone (4.1%), or repeated methods (R, 29.5%) for gestational diabetes mellitus (GDM) at term, and to analyze maternal and neonatal morbidity outcomes according to the method for cervical ripening. After cervical ripening, vaginal delivery occurred in 84.2% (n = 123) and was similar among groups (90.0% after PG, 83.1% after CRB, 83.3% after M, and 83.7% after R; p = 0.89). After a multivariable logistic regression analysis adjusted for potential confounders, the internal cervical os being open before cervical ripening was a predictor of vaginal delivery (adjusted odds ratio (OR) of 4.38, 95% confidence index (CI) of 1.62-13.3, p = 0.03), and previous cesarean delivery was a predictor of cesarean delivery (aOR of 7.67, 95% CI of 2.49-24.00, p < 0.01). Birthweight was also significantly associated with cesarean delivery (aOR of 1.15, 95% CI of 1.03-1.31, p = 0.02). The rates of maternal and neonatal morbidity outcomes were 10.9% (n = 16) and 19.9% (n = 29), respectively, and did not differ according to the mode of delivery and to the method used for cervical ripening. Identifying these specific high-risk women (previous cesarean delivery and internal cervical os being closed before cervical ripening) for cesarean delivery among women who underwent cervical ripening for GDM at term is important and practical for all physicians to make a decision in partnership with women.
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Affiliation(s)
- Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
| | - Lucie Planche
- Clinical Research Center, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
| | - Mounia Lbakhar
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
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Ramezani Tehrani F, Farzadfar F, Hosseinpanah F, Rahmati M, Firouzi F, Abedini M, Hadaegh F, Valizadeh M, Torkestani F, Khalili D, Solaymani-Dodaran M, Bidhendi-Yarandi R, Bakhshandeh M, Ostovar A, Dovom MR, Amiri M, Azizi F, Behboudi-Gandevani S. Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter? Front Endocrinol (Lausanne) 2023; 14:1155007. [PMID: 37334302 PMCID: PMC10273274 DOI: 10.3389/fendo.2023.1155007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives The aim of the study was to investigate the effect of treatment on pregnancy outcomes among women who had fasting plasma glucose (FPG) 5.1-5.6 mmol/l in the first trimester of pregnancy. Methods We performed a secondary-analysis of a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. All pregnant women with FPG values range 5.1-5.6 mmol/l in the first trimester of gestation were included in the present study (n=3297) and classified to either the (i) intervention group who received treatment for GDM along with usual prenatal care (n=1,198), (ii) control group who received usual-prenatal-care (n=2,099). Macrosomia/large for gestational age (LGA) and primary cesarean-section (C-S) were considered as primary-outcomes. A modified-Poisson-regression for binary outcome data with a log link function and robust error variance was used to RR (95%CI) for the associations between GDM status and incidence of pregnancy outcomes. Results The mean maternal age and BMI of pregnant women in both study groups were similar. There were no statistically significant differences in the adjusted risks of adverse pregnancy outcomes, including macrosomia, primary C-S, preterm birth, hyperbilirubinemia, preeclampsia, NICU-admission, birth trauma, and LBW both groups. Conclusions It is found that treating women with first-trimester FPG values of 5.1-5.6 mmol/l could not improve adverse pregnancy outcomes including macrosomia, Primary C-S, Preterm birth, hypoglycemia, hypocalcemia, preeclampsia, NICU admission, Birth trauma and LBW. Therefore, extrapolating the FPG cut-off point of the second trimester to the first -which has been proposed by the IADPSG, might therefore not be appropriate. Clinical Trial Registration https://www.irct.ir/trial/518, identifier IRCT138707081281N1.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity 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
| | - Faegheh Firouzi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marzieh Bakhshandeh
- Family Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti 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, Tehran, Iran
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Giannubilo SR, Ciavattini A. Diabetes during Pregnancy: A Transgenerational Challenge. J Clin Med 2023; 12:jcm12062144. [PMID: 36983148 PMCID: PMC10054379 DOI: 10.3390/jcm12062144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
For many years, gestational diabetes mellitus (GDM) has been defined as “a glucose intolerance of variable magnitude that begins or is first diagnosed in pregnancy” and that, in most cases, resolves after delivery [...]
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11
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Kilic F. The nature of the binding between insulin receptor and serotonin transporter in placenta (review). Placenta 2023; 133:40-44. [PMID: 36796293 DOI: 10.1016/j.placenta.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023]
Abstract
The interplay between the insulin receptor (IR) and serotonin transporter (SERT) allows reciprocal regulation of each other's physiological roles to ensure appropriate responses to specific environmental and developmental signals. The studies reported herein provided substantial evidence of how insulin signaling influences the modification and trafficking of SERT to the plasma membrane via enabling its association with specific endoplasmic reticulum (ER) proteins. While insulin signaling is important for the modifications of SERT proteins, the fact that phosphorylation of IR was significantly down-regulated in the placenta of SERT knock out (KO) mice suggests that SERT also regulates IR. Further suggestive of SERT functional regulation of IR, SERT-KO mice developed obesity and glucose intolerance with symptoms similar to those of type 2 diabetes. The picture emerging from those studies proposes that the interplay between IR and SERT maintains conditions supportive of IR phosphorylation and regulates insulin signaling in placenta which ultimately enables the trafficking of SERT to the plasma membrane. IR-SERT association thus appears to play a protective metabolic role in placenta and is impaired under diabetic conditions. This review focuses on recent findings describing the functional and physical associations between IR and SERT in placental cells, and the dysregulation of this process in diabetes.
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Affiliation(s)
- Fusun Kilic
- Biology Department, Merced College, Merced, CA, USA.
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12
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Sharma AK, Yerrabelli D, Sagili H, Sahoo JP, Gaur GS, Kumar A. Relationship between advanced glycated end products and maternal cognition in gestational diabetes: a case control study. J Matern Fetal Neonatal Med 2022; 35:7806-7811. [PMID: 34154496 DOI: 10.1080/14767058.2021.1937111] [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: 01/28/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Gestational diabetes (GDM) is a form of glucose intolerance which manifests during pregnancy. There is lack of literature regarding the study of cognitive functions in GDM. Recent evidences suggests an increase in accumulation of serum Advanced glycated end products (AGE'S) during GDM. Accumulation of AGE's in brain can induce changes in permeability of blood brain barrier and creates oxidative stress and inflammation that can alter cognitive functions. In this study we hypothesize that diagnosis of GDM in pregnancy is related to lower cognitive scores which is correlated to increased serum AGE's level. METHOD This was a cross sectional case control study which recruited 60 participants in total consisting of two groups with 30 participants in each - diagnosed cases of GDM and healthy pregnant controls. Subjects were recruited from OPD of Obstetrics & Gynecology department in a tertiary care hospital in South India at gestational age of 32-36 weeks. On the first appointment, biochemical parameters of Fasting plasma glucose (FPG) & HbA1C was measured in both groups. Serum was obtained for testing levels of N Carboxy methyl lysine (N-CML) (a form of AGE). On second appointment, pen and paper neurocognitive tests including Montreal cognitive tests (MOCA) and Trail making test (TMT A & B) was presented. Event related potentials (ERP's) are time locked EEG wave signals produced in response to a sensory, motor or cognitive event. P300 is an "endogenous" ERP produced by cognitive processing in response to a stimuli presented to subject. P300 wave Latency and amplitude was recorded in both the groups as an objective marker of cognitive processing. Above mentioned biochemical and neurocognitive parameters were compared between both the groups and correlation analysis between serum AGE levels and neurocognitive parameters was performed using SPSS software. RESULTS Biochemical parameters of HbAIC & N-CML(A form of AGE) levels were increased in GDM group (HbA1C 6.01±0.30 and N CML 236.25 ± 68.9) vs Control group (HbA1C 4.11 ± 0.68 and NCML 198.42 ± 44.2). Scores in MOCA were significantly lower in GDM (28 (27-29)) group as compared to controls (24 (23-25)). GDM subjects took significantly greater time to perform TMT A (24.59 ± 2.60 s) test than controls (29.7 ± 1.72 s). Significant changes were not found in P300 Latency & amplitude in GDM group. Decreased MOCA scores and increased duration of TMT A attempt were correlated with increased serum AGE concentration in GDM group. CONCLUSIONS Our study indicates the vulnerability of women suffering from GDM to cognitive impairment during pregnancy. Lower scores in cognitive tests were correlated to AGE accumulation in GDM women.
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Affiliation(s)
- Akriti Kapila Sharma
- Department of Physiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Dhanalakshmi Yerrabelli
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Haritha Sagili
- Department of Obstetrics & Gyanecology, Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jay Prakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Girwar Singh Gaur
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Arun Kumar
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Flores-LE Roux JA, Mañé L, Gabara C, Gortazar L, Pedro-Botet J, Chillarón JJ, Pay À A, Benaiges D. Ethnic differences in the impact of gestational diabetes on macrosomia. Minerva Endocrinol (Torino) 2022; 47:403-412. [PMID: 33435645 DOI: 10.23736/s2724-6507.20.03301-5] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous studies reported an ethnic disparity in gestational diabetes mellitus-associated birth outcomes, with some suggesting that macrosomia increases to a lesser extent in groups at high risk, the opposite of the pattern observed by others. Our aim was to evaluate ethnic variation in the impact of gestational diabetes mellitus (GDM). METHODS A case-control study evaluating pregnancy outcomes was conducted in women with and without GDM from five ethnic groups. Data on GDM were collected between January 2004 and July 2017. Women giving birth between May 2013 and July 2017 in whom pre-existing diabetes had been ruled out served as controls. A multivariate logistic regression analysis was performed to determine factors independently associated with macrosomia. RESULTS Overall, 852 GDM women and 3,803 controls were included. In Caucasian and East-Asian women excessive gestational weight gain (OR 2.273, 95% CI 1.364-3.788 and OR 3.776, 95% CI 0.958-14.886) was an independent predictor of macrosomia. In Latin-American and Moroccan women, obesity (OR 1.774, 95% CI 1.219-2.581 and OR 1.656, 95% CI 1.054-2.601), GDM (OR 2.440; 95% CI 1.048-5.679 and OR 3.249, 95% CI 1.269-8.321) and gestational weight gain but only for Latin-American women (OR 2.365, 95% CI 1.039-5.384) were associated with macrosomia. In South-Central Asian women, only GDM was associated with macrosomia (OR 3.701, 95% CI 1.437-9.532). CONCLUSIONS GDM is an independent predictor of macrosomia in Latin-American, South-Central Asian and Moroccan women but not in Caucasian or East-Asian women in whom other factors play a more important role.
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Affiliation(s)
- Juana A Flores-LE Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain - .,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain -
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Gabara
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Lucia Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Pay À
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Department of Gynecology and Obstetrics, Hospital del Mar, Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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14
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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: 94] [Impact Index Per Article: 31.3] [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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15
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Abstract
Gestational diabetes mellitus (GDM) traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy. GDM has long been associated with obstetric and neonatal complications primarily relating to higher infant birthweight and is increasingly recognized as a risk factor for future maternal and offspring cardiometabolic disease. The prevalence of GDM continues to rise internationally due to epidemiological factors including the increase in background rates of obesity in women of reproductive age and rising maternal age and the implementation of the revised International Association of the Diabetes and Pregnancy Study Groups' criteria and diagnostic procedures for GDM. The current lack of international consensus for the diagnosis of GDM reflects its complex historical evolution and pragmatic antenatal resource considerations given GDM is now 1 of the most common complications of pregnancy. Regardless, the contemporary clinical approach to GDM should be informed not only by its short-term complications but also by its longer term prognosis. Recent data demonstrate the effect of early in utero exposure to maternal hyperglycemia, with evidence for fetal overgrowth present prior to the traditional diagnosis of GDM from 24 weeks' gestation, as well as the durable adverse impact of maternal hyperglycemia on child and adolescent metabolism. The major contribution of GDM to the global epidemic of intergenerational cardiometabolic disease highlights the importance of identifying GDM as an early risk factor for type 2 diabetes and cardiovascular disease, broadening the prevailing clinical approach to address longer term maternal and offspring complications following a diagnosis of GDM.
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Affiliation(s)
- Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Helen R Murphy
- Diabetes in Pregnancy Team, Cambridge University Hospitals, Cambridge, UK
- Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, UK
- Division of Women’s Health, Kings College London, London, UK
| | - Glynis P Ross
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Tong JN, Chen YX, Guan XN, Liu K, Yin AQ, Zhang HF, Wu LL, Niu JM. Association between the cut-off value of the first trimester fasting plasma glucose level and gestational diabetes mellitus: a retrospective study from southern China. BMC Pregnancy Childbirth 2022; 22:540. [PMID: 35787265 PMCID: PMC9252059 DOI: 10.1186/s12884-022-04874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Our previous studies have suggested that the first trimester fasting plasma glucose (FPG) level is associated with gestational diabetes mellitus (GDM) and is a predictor of GDM. The aim of the present study was to provide valuable insights into the accuracy of the first trimester FPG level in the screening and diagnosis of GDM in southern China. Methods This retrospective study included pregnant women who had their first trimester FPG level recorded at 9–13+6 weeks and underwent screening for GDM using the 2-h 75 g oral glucose tolerance test (OGTT) between the 24th and 28th gestational weeks. Differences between the GDM and non-GDM groups were assessed by Student’s t test and the chi-squared test according to the nature of the variables. A restricted cubic spine was used to explore the relationship between the first trimester FPG level and the odds ratio (OR) of GDM in pregnant women. Cut-off values of first trimester FPG were determined using receiver operating characteristic (ROC) curves and the area under the curve (AUC), and 95% confidence intervals (CIs), the positive predictive value (PPV) and the negative predictive value (NPV) were calculated. Results The medical records of 28,030 pregnant women were analysed, and 4,669 (16.66%) of them were diagnosed with GDM. The average first trimester FPG level was 4.62 ± 0.37 mmol/L. The OR of GDM increased with increasing first trimester FPG levels and with a value of first trimester FPG of approximately 4.6 mmol/L, which was equal to 1 (Chi-Square = 665.79, P < 0.001), and then started to increase rapidly afterwards. The ROC curve for fasting plasma glucose in the first trimester (4.735 mmol/L) for predicting gestational diabetes mellitus in pregnant women was 0.608 (95% CI: 0.598–0.617), with a sensitivity of 0.490 and a specificity of 0.676. Conclusion Based on the research, we recommend that all pregnant women undergo FPG testing in the first trimester, particularly at the first antenatal visit. Furthermore, we suggest that the risks of GDM should be given increased attention and management as soon as the first trimester FPG value is more than 4.7 mmol/L. First trimester FPG levels should be considered a screening marker when diagnosing GDM in pregnant women but this needs to be confirmed by more prospective studies. These factors may have a significant impact on the clinical treatment of pregnant women.
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Affiliation(s)
- Jia-Ning Tong
- Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China
| | - Yi-Xuan Chen
- Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China
| | - Xiao-Nian Guan
- Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China
| | - Kan Liu
- Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China
| | - Ai-Qi Yin
- Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China
| | - Hua-Fan Zhang
- Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China
| | - Lin-Lin Wu
- Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China.
| | - Jian-Min Niu
- Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China.
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Zaccara TA, Paganoti CF, Mikami FCF, Francisco RPV, Costa RA. WHO criteria for diabetes in pregnancy: a retrospective cohort. BMC Pregnancy Childbirth 2022; 22:385. [PMID: 35505301 PMCID: PMC9066879 DOI: 10.1186/s12884-022-04708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recognizing that hyperglycemia in pregnancy can impact both individually a patient's health and collectively the healthcare system and that different levels of hyperglycemia incur different consequences, we aimed to evaluate the differences and similarities between patients who met the diagnostic criteria for gestational diabetes mellitus (GDM) or diabetes in pregnancy (DIP) according to the World Health Organization diagnostic criteria based on the 75 g oral glucose tolerance test (OGTT). METHODS This retrospective study included a cohort of 1064 women followed-up at the Gestational Diabetes Unit of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (Sao Paulo, Brazil). Patients were classified into GDM and DIP groups, according to their OGTT results. Their electronic charts were reviewed to obtain clinical and laboratory data for all participants. RESULTS Women in the DIP group had a higher pre-pregnancy body mass index (30.5 vs 28.1 kg/m2, odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.11), more frequently experienced GDM in a previous pregnancy (25% vs. 11%, OR 2.71, 95% CI 1.17-6.27), and were more likely to have chronic hypertension (43.1% vs. 23.5%, OR 2.46, 95% CI 1.47-4.11), a current twin pregnancy (10.8% vs. 2.9%, OR 4.04, 95% CI 1.70-9.61), or require insulin (46.1% vs. 14.3%, OR 5.14, 95% CI 3.06-8.65) than those in the GDM group. Patients in the DIP group also had a higher frequency of large-for-gestational-age infants (12.3% vs. 5.1%, OR 2.78, 95% CI 1.23-6.27) and abnormal postpartum OGTT (45.9% vs. 12.6%, OR 5.91, 95% CI 2.93-11.90) than those in the GDM group. Nevertheless, in more than half of the DIP patients, glucose levels returned to normal after birth. CONCLUSIONS Diabetes in pregnancy is associated with an increased risk of adverse perinatal outcomes but does not equate to a diagnosis of diabetes post-pregnancy. It is necessary to identify and monitor these women more closely during and after pregnancy. Keeping patients with hyperglycemia in pregnancy engaged in healthcare is essential for accurate diagnosis and prevention of complications related to abnormal glucose metabolism.
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Affiliation(s)
- Tatiana A Zaccara
- Departamento de Obstetricia e Ginecologia da Faculdade de Medicina da, Universidade de São Paulo, Sao Paulo, SP, Brazil.
| | - Cristiane F Paganoti
- Divisão de Clinica Obstetrica do Hospital das Clínicas da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fernanda C F Mikami
- Divisão de Clinica Obstetrica do Hospital das Clínicas da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rossana P V Francisco
- Departamento de Obstetricia e Ginecologia da Faculdade de Medicina da, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Rafaela A Costa
- Divisão de Clinica Obstetrica do Hospital das Clínicas da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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18
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Effect of Overt Diabetes and Gestational Diabetes Mellitus on Pregnancy Outcomes and Progression. J Obstet Gynaecol India 2022; 72:235-242. [PMID: 35928066 PMCID: PMC9343514 DOI: 10.1007/s13224-022-01649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
Background/Purpose To study the clinical characteristics, outcomes, and the incidence of postpartum diabetes in women with overt diabetes and GDM. Methods This prospective cohort observational study was done on women with GDM diagnosed after the first trimester, attending the tertiary care hospitals for 2.3 years. Comparison of clinical variables and maternal and neonatal outcomes were recorded in women with overt diabetes and GDM. The postpartum glycemic status was determined at 1 and 6 months. Results There were 32(17.9%) women with overt diabetes and 146(82.1%) women with GDM. Women with overt diabetes were older, had a higher frequency of pre-pregnancy and maternal obesity, family history of diabetes, previous history of GDM, polycystic ovarian syndrome (PCOS), signs of insulin resistance, and need for insulin treatment than women with GDM. The prevalence of gestational hypertension and frequency of spontaneous abortion and large for gestational age (LGA) neonates were significantly higher in women with overt diabetes than in GDM, despite comparable glycemic goals. Postpartum diabetes at 1 and 6 months was significantly higher in women with overt diabetes than in those with GDM. Conclusion It is critical to identify women with overt diabetes in pregnancy because of increased risk of adverse maternal and neonatal outcomes, and rapid progression to postpartum diabetes, despite achieving optimal glycemic goals.
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Abstract
AIMS Overt diabetes in pregnancy is defined as hyperglycemia first recognized during pregnancy which meets the diagnostic threshold of diabetes in non-pregnant adults. This case-based narrative review aims to describe this unique condition and discuss the potential implications for its accurate diagnosis and management. METHODS AND RESULTS We conducted a literature search in PubMed for relevant articles published in English language up to January 2022. Women with overt diabetes have a higher risk for adverse pregnancy outcomes and postpartum diabetes, compared to their counterparts with gestational diabetes mellitus (GDM). Such women often need aggressive management, including early and prompt initiation of insulin therapy, and a close follow-up during pregnancy and in the postpartum period. Not all pregnant women with overt diabetes have persistent diabetes in the postpartum period. Early diagnosis, especially during the first trimester, and fasting plasma glucose elevation (≥ 126 mg/dl or 7 mmol/L) at the time of initial diagnosis are predictors of postpartum diabetes. CONCLUSIONS Both GDM and overt diabetes in pregnancy are hyperglycemic conditions first recognized during pregnancy, but the two conditions differ in severity; the latter is a more severe form of hyperglycemia associated with worse maternal and fetal outcomes, and a higher risk of postpartum diabetes.
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Affiliation(s)
- Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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20
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Jamieson EL, Spry EP, Kirke AB, Griffiths E, Porter C, Roxburgh C, Singleton S, Sterry K, Atkinson DN, Marley JV. Real-world screening for diabetes in early pregnancy: Improved screening uptake using universal glycated haemoglobin. Prim Care Diabetes 2021; 15:995-1001. [PMID: 34696991 DOI: 10.1016/j.pcd.2021.09.011] [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: 06/01/2021] [Revised: 09/10/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Abstract
AIMS To improve perinatal outcomes, screening for hyperglycaemia using 75 g oral glucose tolerance test (OGTT) is recommended for all pregnant women at 24-28 weeks gestation (routine), and earlier if high-risk. Screening coverage for remote and Aboriginal Australian women is less than ideal. This study examined OGTT completion (early and routine) by women from rural and remote Western Australia compared with early glycated haemoglobin (HbA1c). METHODS In 2015-2018, 27 primary health care sites recruited 600 (233 Aboriginal) women aged ≥16-years, without pre-existing diabetes, who delivered >30-weeks gestation. All women presenting <20-weeks gestation (541) were offered an early study HbA1c. Early OGTTs were requested at the discretion of the local clinician, with routine OGTT offered at 24-28 weeks. RESULTS HbA1c uptake was high (85.7% Aboriginal, 86.4% non-Aboriginal); OGTT completion in Aboriginal women was low (early OGTT: 38.6% v 69.6% non-Aboriginal, P < 0.001; routine OGTT: 44.5% v 84.7% non-Aboriginal, P < 0.001). Aboriginal women with both early tests had HbA1c completed 3-weeks prior to OGTT (9.6 ± 3.5 v 12.5 ± 3.5 weeks gestation, P < 0.001). CONCLUSIONS Universal early pregnancy HbA1c appears feasible as an early screening test for women at risk of hyperglycaemia in pregnancy and would expedite and increase screening in Aboriginal women compared to an early OGTT.
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Affiliation(s)
- Emma L Jamieson
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 412, Bunbury, Western Australia 6230, Australia.
| | - Erica P Spry
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, Western Australia 6725, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Andrew B Kirke
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 412, Bunbury, Western Australia 6230, Australia.
| | - Emma Griffiths
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Cynthia Porter
- Geraldton Regional Aboriginal Medical Service, PO Box 5276, Geraldton, Western Australia 6531, Australia.
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, 35 Stirling Terrace, Albany, Western Australia 6330, Australia.
| | - Sally Singleton
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Kylie Sterry
- The Rural Clinical School of Western Australia, The University of Western Australia, St Alban's Road (rear Kalgoorlie Hospital), Kalgoorlie, Western Australia 6433, Australia.
| | - David N Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
| | - Julia V Marley
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome, Western Australia 6725, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, Western Australia 6725, Australia.
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21
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Sampaio Y, Porto LB, Lauand TCG, Marcon LP, Pedrosa HC. Gestational diabetes and overt diabetes first diagnosed in pregnancy: characteristics, therapeutic approach and perinatal outcomes in a public healthcare referral center in Brazil. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:79-84. [PMID: 33166439 PMCID: PMC10528695 DOI: 10.20945/2359-3997000000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 09/26/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil. METHODS A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted. RESULTS Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%). CONCLUSION Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.
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Affiliation(s)
- Yanara Sampaio
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil
| | - Lara Benigno Porto
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil,
| | - Thais Cabral Gomes Lauand
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil
| | - Larissa Pereira Marcon
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil
| | - Hermelinda Cordeiro Pedrosa
- Unidade de Endocrinologia e Centro de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Saúde do Distrito Federal, Taguatinga, Brasília, DF, Brasil
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22
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Cosson E, Bentounes SA, Nachtergaele C, Berkane N, Pinto S, Sal M, Bihan H, Tatulashvili S, Portal JJ, Carbillon L, Vicaut E. Prognosis Associated with Sub-Types of Hyperglycaemia in Pregnancy. J Clin Med 2021; 10:3904. [PMID: 34501352 PMCID: PMC8432067 DOI: 10.3390/jcm10173904] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022] Open
Abstract
We aimed to compare pregnancy outcomes in 4665 women according to the following types of hyperglycaemia in pregnancy sub-types: (i) normoglycaemia, (ii) gestational diabetes mellitus (GDM), (iii) diabetes in pregnancy (DIP), (iv) early-diagnosed (i.e., <22 weeks of gestation) GDM (eGDM), and (v) early-diagnosed DIP (eDIP). The prevalence of normoglycaemia, eGDM, eDIP, GDM, and DIP was 76.4%, 10.8%, 0.6%, 11.7%, and 0.6%, respectively. With regard to pregnancy outcomes, gestational weight gain (11.5 ± 5.5, 9.0 ± 5.4, 8.3 ± 4.7, 10.4 ± 5.3, and 10.1 ± 5.0 kg, p < 0.0001) and insulin requirement (none, 46.0%, 88.5%, 25.5%, and 51.7%; p < 0.001) differed according to the glycaemic sub-types. eGDM and eDIP were associated with higher rates of infant malformation. After adjustment for confounders, with normoglycaemia as the reference, only GDM was associated with large-for-gestational-age infant (odds ratio 1.34 (95% interval confidence 1.01-1.78) and only DIP was associated with hypertensive disorders (OR 3.48 (1.26-9.57)). To conclude, early-diagnosed hyperglycaemia was associated with an increased risk of malformation, suggesting that it was sometimes present at conception. Women with GDM, but not those with eGDM, had an increased risk of having a large-for-gestational-age infant, possibly because those with eGDM were treated early and therefore had less gestational weight gain. Women with DIP might benefit from specific surveillance for hypertensive disorders.
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Affiliation(s)
- Emmanuel Cosson
- AP-HP, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, 93000 Bobigny, France; (N.B.); (M.S.); (H.B.); (S.T.)
- Nutritional Epidemiology Research Unit, UMR U557 INSERM/U11125 INRAE/CNAM, Paris 13 University, Sorbonne Paris Cité, 93000 Bobigny, France
| | - Sid Ahmed Bentounes
- AP-HP, Clinical Research Unit St-Louis-Lariboisière, Denis Diderot University, 75010 Paris, France; (S.A.B.); (C.N.); (J.-J.P.); (E.V.)
| | - Charlotte Nachtergaele
- AP-HP, Clinical Research Unit St-Louis-Lariboisière, Denis Diderot University, 75010 Paris, France; (S.A.B.); (C.N.); (J.-J.P.); (E.V.)
| | - Narimane Berkane
- AP-HP, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, 93000 Bobigny, France; (N.B.); (M.S.); (H.B.); (S.T.)
| | - Sara Pinto
- AP-HP, Jean Verdier Hospital, Unit of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, 93143 Bondy, France;
| | - Meriem Sal
- AP-HP, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, 93000 Bobigny, France; (N.B.); (M.S.); (H.B.); (S.T.)
| | - Hélène Bihan
- AP-HP, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, 93000 Bobigny, France; (N.B.); (M.S.); (H.B.); (S.T.)
| | - Sopio Tatulashvili
- AP-HP, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, 93000 Bobigny, France; (N.B.); (M.S.); (H.B.); (S.T.)
| | - Jean-Jacques Portal
- AP-HP, Clinical Research Unit St-Louis-Lariboisière, Denis Diderot University, 75010 Paris, France; (S.A.B.); (C.N.); (J.-J.P.); (E.V.)
| | - Lionel Carbillon
- AP-HP, Jean Verdier Hospital, Department of Obstetrics and Gynecology, Paris 13 University, Sorbonne Paris Cité, 93143 Bondy, France;
| | - Eric Vicaut
- AP-HP, Clinical Research Unit St-Louis-Lariboisière, Denis Diderot University, 75010 Paris, France; (S.A.B.); (C.N.); (J.-J.P.); (E.V.)
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23
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Stotz SA, Charron-Prochownik D, Terry MA, Marshall G, Fischl AR, Moore KR. Stopping Gestational Diabetes in American Indian and Alaska Native Girls: Nutrition as a Key Component to Gestational Diabetes Risk Reduction. Curr Dev Nutr 2021; 5:13-21. [PMID: 34222764 PMCID: PMC8242493 DOI: 10.1093/cdn/nzaa081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND American Indian and Alaska Native (AI/AN) women have a higher risk of gestational diabetes mellitus (GDM) and subsequent diagnosis of diabetes than do non-Hispanic White women. Healthy eating is key to weight management both prior to pregnancy and between pregnancies and can reduce the risk of developing GDM. Our research team developed an innovative preconception counseling and diabetes risk-reduction program, which includes nutrition and weight-management principles and is culturally tailored for adolescent AI/AN women. The program is entitled Stopping Gestational Diabetes Mellitus (SGDM). OBJECTIVE The purpose of this article is to examine nutrition-related information collected as a part of the formative qualitative research conducted for the development of a preconception counseling and gestational diabetes risk-reduction program, SGDM. METHODS This in-depth secondary analysis explored the original qualitative data from the needs assessment for SGDM program development. Participants included AI/AN women with a history of GDM (n = 5); AI/AN girls at risk of GDM (n = 14), and their mothers (n = 11), health care providers, and health administrators who care for AI/AN girls (n = 16); AI/AN elected leaders; and Indian health system administrators (n = 12). All focus groups and interviews were reanalyzed utilizing the following research question: "How do key stakeholders discuss food and/or nutrition in terms of gestational diabetes risk reduction for AI/AN adolescent girls?" RESULTS Three primary nutrition themes emerged: 1) AI/AN women were aware of healthy nutrition, healthy weight gainduring pregnancy, and healthy nutrition for people with type 2 diabetes, but these principles were not linked to reducing the risk of GDM; 2) participants expressed the need for education on the role of nutrition and weight management in GDM risk reduction; 3) participants shared challenges of healthful eating during and before pregnancy for AI/AN women. CONCLUSIONS These stakeholders' comments informed the development of the nutrition components of SGDM.
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Affiliation(s)
- Sarah A Stotz
- University of Colorado Anschutz Medical Campus; Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Denise Charron-Prochownik
- University of Pittsburgh, Nursing and Graduate School of Public Health, Department of Health Promotion and Development, Pittsburgh, PA, USA
| | - Martha A Terry
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Andrea R Fischl
- University of Pittsburgh, Nursing and Graduate School of Public Health, Department of Health Promotion and Development, Pittsburgh, PA, USA
| | - Kelly R Moore
- University of Colorado Anschutz Medical Campus; Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
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24
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Teshome AA, Li Q, Garoma W, Chen X, Wu M, Zhang Y, Zhang X, Lin L, Wang H, Yang X, Hao L, Sun G, Han W, Chen X, Xiong G, Yang N. Gestational diabetes mellitus, pre-pregnancy body mass index and gestational weight gain predicts fetal growth and neonatal outcomes. Clin Nutr ESPEN 2021; 42:307-312. [PMID: 33745597 DOI: 10.1016/j.clnesp.2021.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM), body mass index (BMI) and gestational weight gain (GWG) are salient predictors of pregnancy-outcomes. However, findings on the association between GDM, BMI, and GWG with fetal growth measures are limited. OBJECTIVE The aim of this study was to investigate the effect of GDM on fetal growth measures and birth outcomes. METHODS All participants came from Tongji Maternal and Child health cohort, in which pregnant women were enrolled before 16 weeks of gestation and had their weights measured regularly during antenatal visits. GDM was diagnosed by oral glucose tolerance test (OGTT) during 24-28 weeks of gestation. Ultrasound measurements of fetal bi-parietal diameters (BPD), head circumferences (HC), abdominal circumferences (AC) and femur length (FL) before birth were collected and neonate outcomes were obtained from the hospital records. Odds ratios were calculated using logistic regression to assess the association of GDM, pre-pregnancy BMI, and GWG with fetal growth measures of ultrasound and birth outcomes, while controlling confounding. RESULTS Of 3253 singleton pregnant women, 293 (9.0%) were diagnosed with GDM, 357 (11.0%) were overweight before pregnancy, and 1995 (61.3%) had excessive GWG. GDM was associated with decreased intrauterine fetal growth measurements including BPD and AC. Maternal pre-pregnancy overweight was associated with increased fetal HC and neonatal birth weight and length, women gained excessive GWG had increased fetal growth measurements of BPD, HC, AC, FL, neonatal birth weight and length. Offspring of GDM women had increased odds of cesarean section 1.31 (1.03, 1.66) and preterm birth 2.02 (1.05, 3.91) in unadjusted models, but these associations disappeared after adjustment. Compared with neonate born to mothers with normal pre-pregnancy weight, those born to underweight mother had higher risk of SGA, and lower risk of cesarean section, LGA and macrosamia, whereas those born to overweight mother had increased risk of cesarean section, LGA and macrosamia. Compared with neonate born to mothers of adequate GWG, neonate of women with excessive GWG had elevated risk of cesarean section, LGA and macrosamia, but lower risk of preterm birth and SGA. CONCLUSION Pre-pregnancy BMI, GWG and GDM all associated with fetal growth and birth outcomes. The effect of GDM decreased after adjusting pre-pregnancy BMI and GWG. Early screening and management of GDM, preventing excessive GWG could help protect fetuses of GDM mothers from adverse birth outcomes.
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Affiliation(s)
- Anissa Abebe Teshome
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China; Department of Food Science and Technology, Haramaya University, Dire Dawa, 138, Ethiopia
| | - Qian Li
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Wondu Garoma
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Xi Chen
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Meng Wu
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Yu Zhang
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Xu Zhang
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Lixia Lin
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Huanzhuo Wang
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Xuefeng Yang
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Liping Hao
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Guoqiang Sun
- Department of Gynecology and Obstetrics, Maternal and Child Health Care Hospital of Hubei Province, Wuhan 430070, Hubei, China
| | - Weizhen Han
- Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Wuhan, 430014, Hubei, China
| | - Xinlin Chen
- Department of Gynecology and Obstetrics, Maternal and Child Health Care Hospital of Hubei Province, Wuhan 430070, Hubei, China
| | - Guoping Xiong
- Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Wuhan, 430014, Hubei, China
| | - Nianhong Yang
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Wuhan 430030, Hubei, China.
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25
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Iwama N, Sugiyama T, Metoki H, Saito M, Hoshiai T, Watanabe Z, Tanaka K, Sasaki S, Sakurai K, Ishikuro M, Obara T, Tatsuta N, Nishigori H, Kuriyama SI, Arima T, Nakai K, Yaegashi N. Associations between glycosylated hemoglobin level at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan: The Japan Environment and Children's Study (JECS). Diabetes Res Clin Pract 2020; 169:108377. [PMID: 32828835 DOI: 10.1016/j.diabres.2020.108377] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 01/13/2023]
Abstract
AIMS To investigate the associations between glycosylated hemoglobin (HbA1c) levels at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan. METHODS This was a prospective nationwide birth cohort study of 77,526 subjects with an HbA1c level of <6.5% (<48 mmol/mol) at less than 24 weeks of gestation. Associations of HbA1c level with adverse pregnancy outcomes were evaluated using multivariate analyses. RESULTS The adjusted odds ratios per 1% (11 mmol/mol) increase in HbA1c level were 1.77 (95% confidence interval [CI]: 1.48-2.12) for hypertensive disorders of pregnancy; 1.78 (95% CI: 1.12-2.83) for placental abruption; 1.30 (95% CI: 1.12-1.50) for preterm birth; 2.11 (95% CI: 1.41-3.16) for very preterm birth; 1.49 (95% CI: 1.33-1.68) for low birth weight infants; 1.95 (95% CI: 1.42-2.70) for macrosomia; 1.23 (95% CI: 1.09-1.39) for small for gestational age; 1.15 (95% CI: 1.04-1.28) for large for gestational age; and 1.29 (95% CI: 1.20-1.39) for the composite adverse pregnancy outcome. CONCLUSIONS The higher the HbA1c level, the higher the risk of adverse pregnancy outcomes in Japan. Further studies will be needed to determine prenatal management based on the HbA1c level in pregnant women with HbA1c <6.5% (<48 mmol/mol) at less than 24 weeks of gestation.
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Affiliation(s)
- Noriyuki Iwama
- Center for Perinatal Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan; Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan.
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan.
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Division of Public Health, Hygiene and Epidemiology, Tohoku Medical Pharmaceutical University, 1-15-1 Fukumuro, Sendai 983-8536, Miyagi, Japan.
| | - Masatoshi Saito
- Center for Perinatal Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan
| | - Tetsuro Hoshiai
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan.
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan
| | - Kosuke Tanaka
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan.
| | - Satomi Sasaki
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan
| | - Kasumi Sakurai
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan.
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan.
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan; Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan.
| | - Nozomi Tatsuta
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan.
| | - Hidekazu Nishigori
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1, Hikarigaoka, Fukushima 960-1295, Fukushima, Japan.
| | - Shin-Ichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan; International Research Institute of Disaster Science, Tohoku University, 468-1, Aramaki, Sendai 980-8572, Miyagi, Japan.
| | - Takahiro Arima
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan.
| | - Kunihiko Nakai
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan.
| | - Nobuo Yaegashi
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Miyagi, Japan; Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Miyagi, Japan; Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai 980-8572, Miyagi, Japan.
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Prognosis associated with initial care of increased fasting glucose in early pregnancy: A retrospective study. DIABETES & METABOLISM 2020; 47:101197. [PMID: 33039671 DOI: 10.1016/j.diabet.2020.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 01/25/2023]
Abstract
AIM To evaluate whether the initial care of women with fasting plasma glucose (FPG) levels at 5.1-6.9mmol/L before 22 weeks of gestation (WG), termed 'early fasting hyperglycaemia', is associated with fewer adverse outcomes than no initial care. METHODS A total of 523 women with early fasting hyperglycaemia were retrospectively selected in our department (2012-2016) and separated into two groups: (i) those who received immediate care (n=255); and (ii) those who did not (n=268), but had an oral glucose tolerance test (OGTT) at or after 22 WG, with subsequent standard care if hyperglycaemia (by WHO criteria) was present. The number of cases of large-for-gestational age (LGA) infants, shoulder dystocia and preeclampsia with initial care of early fasting hyperglycaemia were compared after propensity score modelling and accounting for covariates. RESULTS Of the 268 women with no initial care, 134 had hyperglycaemia after 22 WG and then received care. Women who received initial care vs those who did not were more likely to be insulin-treated during pregnancy (58.0% vs 20.9%, respectively; P<0.00001), gained less gestational weight (8.6±5.4kg vs 10.8±6.1kg, respectively; P<0.00001), had a lower rate of preeclampsia [1.2% vs 2.6%, respectively; adjusted odds ratio (aOR): 0.247 (0.082-0.759), P=0.01], and similar rates of LGA infants (12.2% vs 11.9%, respectively) and shoulder dystocia (1.6% vs 1.5%, respectively). When initial FPG levels were ≥5.5mmol/L (prespecified group, n=137), there was a lower rate of LGA infants [6.7% vs 16.1%, respectively; aOR: 0.332 (0.122-0.898); P=0.03]. CONCLUSION Treating women with early fasting hyperglycaemia, especially when FPG is ≥5.5mmol/L, may improve pregnancy outcomes, although this now needs to be confirmed by randomized clinical trials.
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Immanuel J, Eagleton C, Baker J, Simmons D. Pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy in an urban New Zealand population and their association with postnatal HbA1c uptake. Aust N Z J Obstet Gynaecol 2020; 61:69-77. [PMID: 32880893 DOI: 10.1111/ajo.13231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adverse pregnancy outcomes are more common in women with hyperglycaemia. Many women have suboptimal uptake of HbA1c testing postdelivery. AIMS To compare pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy, and their association with postnatal HbA1c uptake after the introduction of email reminders. MATERIALS AND METHODS A retrospective and prospective single-centre study was conducted in South Auckland in 2639 women with early gestational diabetes mellitus (GDM) (diagnosed < 20 weeks), late GDM (diagnosed ≥ 20 weeks), overt diabetes in pregnancy, or known type 2 diabetes (T2DM) during pregnancy. Automated email reminders were sent to general practitioners to increase postnatal HbA1c screening. RESULTS HbA1c during pregnancy increased across the late GDM (n = 1425), early GDM (n = 148), overt diabetes (n = 573) and T2DM (n = 493) groups (P < 0.001). Stillbirth was least common in the late GDM group (0, 0.7, 0.5, and 1.9%, respectively, P < 0.001), as were caesarean delivery (32.7, 45.1, 39.4, and 53.5%, respectively, P < 0.001), large for gestational age (LGA) (14.7, 18.2, 22.3, and 30.5%, respectively, P < 0.001), small for gestational age (8.8, 16.7, 11.0, and 11.1%, respectively, P = 0.02), and preeclampsia/eclampsia (7.7, 9.2, 13.0, and 14.8%, respectively, P < 0.001). LGA and preeclampsia/eclampsia were more common among Pacific and Māori women than European women (LGA, 30.1, 22.7, 10.3%, respectively, P < 0.001; preeclampsia/eclampsia, 13.5, 14.0, and 8.1%, respectively, P < 0.001). Postpartum HbA1c screening increased among women with GDM/overt diabetes after the introduction of the reminder emails (39.6% vs 34.0%, P = 0.03). CONCLUSIONS Women with late GDM are least likely to experience adverse outcomes. Email reminders to improve postpartum HbA1c screening warrant further investigation.
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Affiliation(s)
- Jincy Immanuel
- Western Sydney University, Sydney, New South Wales, Australia
| | - Carl Eagleton
- Counties Manukau District Health Board, Auckland, New Zealand
| | - John Baker
- Counties Manukau District Health Board, Auckland, New Zealand
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia
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Nadeau KJ, Stotz SA, Moore K, Garcia-Reyes Y, Sereika SM, Stein H, Charron-Prochownik D. Beta Testing of a Gestational Diabetes Risk Reduction Intervention for American Indian and Alaska Native Teens. J Pediatr Health Care 2020; 34:418-423. [PMID: 32532483 PMCID: PMC7608544 DOI: 10.1016/j.pedhc.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION American Indian and Alaska Native (AIAN) girls have double the risk of obesity, pregnancy, and gestational diabetes mellitus (GDM) than the general U.S. POPULATION The purpose of this study was to beta test Stopping GDM (SGDM), a GDM risk reduction intervention for at-risk AIAN teens, before beginning a randomized controlled trial. METHOD A sample of 11 AIAN mothers and daughters were recruited through an urban Indian health program. Daughters were at risk of GDM as assessed by a BMI ≥ 85th percentile. Pre- and posttest online questionnaires evaluated the online intervention (e-book and video). RESULTS Mean pre- to posttest knowledge increased for mothers and daughters on diabetes prevention, reproductive health, and GDM knowledge. Daughters demonstrated an increased self-efficacy for healthy living and pregnancy planning. Satisfaction for the e-book, video, and online survey was moderately high to very high. DISCUSSION The SGDM intervention is feasible and acceptable in AIAN mother-daughter dyads. These findings informed the SGDM intervention and the randomized controlled trial evaluation protocol.
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Cosson E, Vicaut E, Sandre-Banon D, Gary F, Pharisien I, Portal JJ, Baudry C, Cussac-Pillegand C, Costeniuc D, Valensi P, Carbillon L. Performance of a selective screening strategy for diagnosis of hyperglycaemia in pregnancy as defined by IADPSG/WHO criteria. DIABETES & METABOLISM 2020; 46:311-318. [DOI: 10.1016/j.diabet.2019.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/12/2019] [Accepted: 09/29/2019] [Indexed: 12/20/2022]
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Battarbee AN, Grant JH, Vladutiu CJ, Menard MK, Clark M, Manuck TA, Venkatesh KK, Boggess KA. Hemoglobin A1c and Early Gestational Diabetes. J Womens Health (Larchmt) 2020; 29:1559-1563. [PMID: 32678995 DOI: 10.1089/jwh.2019.8203] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Screening for diabetes in early pregnancy is recommended for high-risk women, however, the optimal test for the diagnosis of early gestational diabetes mellitus (GDM) is unknown. Thus, the objective of this study was to evaluate hemoglobin A1c (HbA1c) as a diagnostic test for early GDM compared with two-step testing. Materials and Methods: Retrospective cohort of women with prior GDM or obesity who had HbA1c and two-step testing <21 weeks' gestation. Early GDM was diagnosed by 1 hour, 50 g oral glucose challenge test (GCT) ≥135 mg/dL and ≥2 abnormal values on 3 hour, 100 g oral glucose tolerance test or GCT >200 mg/dL. The area under the receiver operating characteristic curve (AUC) evaluated HbA1c for diagnosis of early GDM. Results: Of 243 women, 14 (5.8%) had early GDM by two-step testing. Median HbA1c levels were higher among women with GDM versus those without GDM (5.8% vs. 5.3%, p < 0.001). The AUC for HbA1c compared with two-step testing was 0.80 (95% CI 0.69-0.91). The optimal HbA1c threshold was 5.6% (64% sensitivity, 84% specificity). Conclusions: HbA1c is moderately predictive of early GDM compared with two-step testing, and a threshold lower than that used for diabetes diagnosis among nonpregnant adults is justified.
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Affiliation(s)
- Ashley N Battarbee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jacqueline H Grant
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine J Vladutiu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Kathryn Menard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Clark
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tracy A Manuck
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kartik K Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kim A Boggess
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Moore K, Stotz S, Fischl A, Beirne S, McNealy K, Abujaradeh H, Charron-Prochownik D. Pregnancy and Gestational Diabetes Mellitus (GDM) in North American Indian Adolescents and Young Adults (AYA): Implications for Girls and Stopping GDM. Curr Diab Rep 2019; 19:113. [PMID: 31686243 DOI: 10.1007/s11892-019-1241-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW To provide an updated synopsis of the research and clinical practice findings on pregnancy and gestational diabetes mellitus (GDM) in American Indian and Alaska Native (AIAN) adolescents and to describe the newly developed "Stopping GDM," an early intervention, culturally tailored risk reduction program for AIAN girls and their mothers. RECENT FINDINGS Five research articles met our inclusion criteria. Three retrospective quantitative studies published in the past 10 years corroborated a 1.5 to 2 times higher prevalence for GDM for all age groups in the AIAN population as compared to other ethnic groups, and that the percentage of GDM cases attributable to overweight and obesity was highest for AIs (52.8%). Moreover, First Nations women across all age groups had more adverse pregnancy risk factors than non-First Nations women. Out of the five selected articles, two were qualitative research articles: one examined AIAN women's experiences of having GDM or type 2 diabetes (T2D) during pregnancy and the other appraised the understanding of GDM and reproductive health of at-risk AIAN girls. There is a paucity of research published on this topic. AIAN females are at high risk for developing GDM. Early, culturally responsive interventions and cohort follow-up studies are needed among adolescents and young adults, using technology that appeals to this age group.
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Affiliation(s)
- Kelly Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, CU Anschutz Medical Campus, 13055 East 17th Ave, Aurora, CO, 80045, USA.
| | - Sarah Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, CU Anschutz Medical Campus, 13055 East 17th Ave, Aurora, CO, 80045, USA
| | - Andrea Fischl
- University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Sandra Beirne
- Northern Navajo Medical Center, Hwy 491 N, PO Box 160, Shiprock, NM, 87420, USA
| | - Kristie McNealy
- Sundance Research Institute, 7475 Wisconsin Avenue, Bethesda, MD, 20814, USA
| | - Hiba Abujaradeh
- University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Denise Charron-Prochownik
- University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
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Ogu RN, Maduka O, Agala V, Alamina F, Adebiyi O, Edewor U, Porbeni I, Abam C. Gestational Diabetes Mellitus Knowledge Among Women of Reproductive Age in Southern Nigeria: Implications for Diabetes Education. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 40:177-183. [PMID: 31554478 DOI: 10.1177/0272684x19876526] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Diabetes mellitus (DM) has attained the status of an epidemic in slow motion. Gestational DM (GDM) is a subtype of DM, which occurs in pregnancy. As part of a baseline assessment, the knowledge of GDM was determined among women of reproductive age. Methods The study was a descriptive cross-sectional household survey involving 2,595 women of reproductive age residing in five local government areas in Southern Nigeria. It employed a multistage sampling technique to collect data using an interviewer administered questionnaire built using Open Data Kit software uploaded on android mobile phones. Results The response rate was 100%. Mean age was 29.25 ± 7.11 years. The majority (2,351; 90.6%) had heard about DM but only 991 (38.2%) knew that diabetes can occur for the first time in pregnancy. Only 747 (28.8%), 929 (35.8%), and 790 (30.4%) respondents had good knowledge scores for GDM definition and risk factors, GDM screening diagnosis and treatment, and GDM complications, respectively. Only 681 (26.2%) had good overall knowledge of GDM. The major sources of knowledge of GDM were from friends (49.8%), health workers (34.6%), and mass media (10.4%). Residence in two urban local government areas (adjusted odds ratio [adj OR] = 1.79; 95% confidence interval [CI] = 1.36–2.34 and adj OR = 1.89; 95% CI = 1.37–2.61), being married (adj OR = 1.50; 95% CI = 1.16–1.95), and having been pregnant (adj OR = 2.69; 95% CI = 1.99–3.64) positively predicted good overall knowledge of GDM. Conclusion These results underscore the need for diabetes information and education activities on a large scale targeted at women of reproductive age and their partners for the prevention and control of GDM.
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Affiliation(s)
- Rosemary N Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt, Nigeria.,Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
| | - Omosivie Maduka
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Preventive and Social Medicine, University of Port Harcourt, Nigeria
| | - Vetty Agala
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Planning, Research and Statistics, Rivers State Ministry of Health, Port Harcourt, Nigeria
| | - Folusho Alamina
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Community Medicine, University of Port Harcourt Teaching Hospital, Nigeria
| | - Obelebra Adebiyi
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Rivers State Hospitals Management Board, Port Harcourt, Nigeria
| | - Ufuoma Edewor
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Department of Medical Services, Rivers State Ministry of Health, Port Harcourt, Nigeria
| | - Ibimonye Porbeni
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.,Medical Department, Nigeria Agip Oil Company Limited, Port Harcourt, Nigeria
| | - Claribel Abam
- Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
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Mañé L, Flores-Le Roux JA, Benaiges D, Chillarón JJ, Prados M, Pedro-Botet J, Llauradó G, Gortazar L, Payà A. Impact of overt diabetes diagnosed in pregnancy in a multi-ethnic cohort in Spain. Gynecol Endocrinol 2019; 35:332-336. [PMID: 30328728 DOI: 10.1080/09513590.2018.1521387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Overt diabetes (ODM) is defined as women without diabetes meeting the criteria for diabetes at the first antenatal visit. The risk of obstetric complications increases linearly with maternal glycemia and poorer maternal-fetal outcomes than in gestational diabetes (GDM) may be expected. Studies focusing on ODM pregnancy outcomes are lacking. We aimed to analyze maternal characteristics and pregnancy outcomes in ODM women compared with those with GDM. A retrospective cohort study of women giving birth between January 2010 and April 2013 was conducted. Participants with pre-gestational diabetes were excluded. All women underwent screening for GDM at the 24th-28th weeks of gestation or at the first prenatal visit in those with risk factors. HbA1c and a fasting glucose were measured in GDM women to rule out ODM. Of the 5,633 women included, 572 (10%) were diagnosed with GDM and 50 (0.88%) with ODM. Almost 95% of ODM women were from ethnic minorities. After adjustment for confounding factors, ODM women showed increased rates of premature birth (23.1% vs. 6.7%, p < .001), emergent cesarean section (41.0% vs. 19.5%, p = .049), preeclampsia (22% vs. 3.7%, p < .001) and large-for-gestational-age babies (40.0% vs. 14.8%, p = .008) compared with GDM. In conclusion, ODM is associated with poorer obstetric outcomes than GDM and affects mainly women from ethnic minorities.
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Affiliation(s)
- Laura Mañé
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Juana Antonia Flores-Le Roux
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - David Benaiges
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Juan José Chillarón
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Montse Prados
- c Department of Endocrinology , Hospital de Martorell , Martorell , Spain
| | - Juan Pedro-Botet
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Gemma Llauradó
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Lucía Gortazar
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
| | - Antonio Payà
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
- d Department of Gynecology and Obstetrics , Hospital del Mar , Barcelona , Spain
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Sim YE, Sia AL, Tan CW, Sng BL. Implications of diabetes in obstetric anaesthesia. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Egan AM, Hod M, Mahmood T, Dunne FP. Perspectives on diagnostic strategies for hyperglycaemia in pregnancy - Dealing with the barriers and challenges: Europe. Diabetes Res Clin Pract 2018; 145:67-72. [PMID: 29902541 DOI: 10.1016/j.diabres.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 06/05/2018] [Indexed: 12/14/2022]
Abstract
Diabetes in pregnancy (DIP) is associated with an increased risk of adverse pregnancy outcomes. Unfortunately guidelines and clinical practices vary significantly and a number of key issues remain under debate. These include: glucose cut-offs for diagnosis; the approaches of universal versus selective screening; appropriate timing of screening; and acceptability of various screening strategies to the population at risk. Economic considerations are also of importance, but unfortunately data outlining the best approach from this viewpoint are limited. In this paper, we review each of these topics and examine associated barriers and challenges associated with various strategies from a European perspective. We also address options which potentially may have a future role in the care of these women including alternative diagnostic biomarkers.
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Affiliation(s)
- Aoife M Egan
- Galway Diabetes Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland; Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic School of Medicine, 200 1st Street SW, Rochester, MN 55905, USA.
| | - Moshe Hod
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel; European Association of Perinatal Medicine (EAPM), Israel; FIGO Hyperglycemia in Pregnancy (HIP) Working Group, Israel; FIGO Maternal and Offspring Health and NCD Prevention Committee, Israel
| | - Tahir Mahmood
- NHS Fife, Scotland, United Kingdom; European Board and College of Obstetrics and Gynaecology (EBCOG), United Kingdom
| | - Fidelma P Dunne
- Galway Diabetes Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland; International Diabetes in Pregnancy Study Groups (IADPSG), United Kingdom
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Casagrande SS, Linder B, Cowie CC. Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women. Diabetes Res Clin Pract 2018; 141:200-208. [PMID: 29772286 DOI: 10.1016/j.diabres.2018.05.010] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/13/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
AIMS The true prevalence of gestational diabetes (GDM) in the United States is unknown. This study determined the prevalence of GDM and a subsequent diagnosis of diabetes in a nationally representative sample of U.S. women. METHODS The crude and age-adjusted prevalence of GDM and subsequent diabetes were evaluated by sociodemographic and health-related characteristics among women age ≥20 years in the National Health and Nutrition Examination Surveys, 2007-2014 (N = 8185). Logistic regression analyzed independent factors associated with GDM and subsequent diabetes. RESULTS The prevalence of GDM was 7.6%. Women who were Mexican American (vs. non-Hispanic white), had ≥4 live births (vs. 1), had a family history of diabetes, or were obese (vs. normal weight) had a higher age-standardized prevalence of GDM (each p < 0.04). Among women with a history of GDM, 19.7% had a subsequent diagnosis of diabetes; subsequent diabetes diagnosis was higher for those with health insurance, more time since GDM diagnosis, greater parity, family history of diabetes, and obesity, and lower for those with higher education and income (all p ≤ 0.005). By logistic regression, significant factors associated with GDM were age at first birth, parity, family history of diabetes, and obesity; significant factors for subsequent diabetes were older age, greater years since GDM diagnosis, less education, family history of diabetes, and obesity (each p < 0.01). CONCLUSIONS The prevalence of GDM in the U.S. was 7.6%, with 19.7% of these women having a subsequent diabetes diagnosis. Women with a history of GDM, family history of diabetes, and obesity should be carefully monitored for dysglycemia.
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Affiliation(s)
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Blvd, Bethesda, MD 20892, USA
| | - Catherine C Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Blvd, Bethesda, MD 20892, USA
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Insulin therapy and its consequences for the mother, foetus, and newborn in gestational diabetes mellitus. Biochim Biophys Acta Mol Basis Dis 2018; 1864:2949-2956. [PMID: 29890222 DOI: 10.1016/j.bbadis.2018.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/26/2018] [Accepted: 06/06/2018] [Indexed: 11/21/2022]
Abstract
Gestational diabetes mellitus (GDM) is a disease characterised by glucose intolerance and first diagnosed in pregnancy. This condition relates to an anomalous placental environment and aberrant placental vascular function. GDM-associated hyperglycaemia changes the placenta structure leading to abnormal development and functionality of this vital organ. Aiming to avoid the GDM-hyperglycaemia and its deleterious consequences in the mother, the foetus and newborn, women with GDM are firstly treated with a controlled diet therapy; however, some of the women fail to reach the recommended glycaemia values and therefore they are passed to the second line of treatment, i.e., insulin therapy. The several protocols available in the literature regarding insulin therapy are variable and not a clear consensus is yet reached. Insulin therapy restores maternal glycaemia, but this beneficial effect is not reflected in the foetus and newborn metabolism, suggesting that other factors than d-glucose may be involved in the pathophysiology of GDM. Worryingly, insulin therapy may cause alterations in the placenta and umbilical vessels as well as the foetus and newborn additional to those seen in pregnant women with GDM treated with diet. In this review, we summarised the variable information regarding indications and protocols for administration of the insulin therapy and the possible outcomes on the function and structure of the foetoplacental unit and the neonate parameters from women with GDM.
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Jiang TT, Zhao L, Lin Y, Zhou D, Wang L, Sun GQ, Xiao M. Effects of gestational diabetes mellitus on time to delivery and pregnancy outcomes in full-term pregnancies with dinoprostone labor induction. Clin Exp Hypertens 2018; 41:44-48. [PMID: 29473764 DOI: 10.1080/10641963.2018.1441859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the effects of gestational diabetes mellitus (GDM) on time to delivery and perinatal outcomes in full-term pregnancies underwent dinoprostone-induced labor. METHODS GDM patients that underwent labor induction with dinoprostone vaginal inserts were retrospectively recruited. Full-term pregnancies with normal glucose tolerance (NGT) that underwent labor induction at the same period were recruited as control. Time to delivery and perinatal outcomes were compared between the two groups. RESULTS A total of 1555 pregnancies with 226 GDM and 1329 NGT were recruited. GDM pregnancies had older ages, lower gestational age, higher body mass index (BMI) and abortion history, and more multigravida than NGT pregnancies (P< 0.05). Univariate analysis showed no significant difference in time to delivery and delivery rates between the two groups. However, after adjusted in a multivariate analysis model, the delivery rates of GDM women delivered within 12, 24, 36 or 48 h and those vaginally delivered within 12 or 36 h were significantly lower than those in the NGT group (P< 0.05). Perinatal outcomes were clinically similar between the two groups. CONCLUSION GDM did not affect the time to delivery, cesarean delivery and other perinatal outcomes in Chinese women underwent dinoprostone-induced labor. However, it may be associated with the lower rates of delivery within different time intervals.
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Affiliation(s)
- Ting-Ting Jiang
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Lei Zhao
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Ying Lin
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Dong Zhou
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Ling Wang
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Guo-Qiang Sun
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Mei Xiao
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
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Dutton HP, Borengasser SJ, Gaudet LM, Barbour LA, Keely EJ. Obesity in Pregnancy: Optimizing Outcomes for Mom and Baby. Med Clin North Am 2018; 102:87-106. [PMID: 29156189 PMCID: PMC6016082 DOI: 10.1016/j.mcna.2017.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Obesity is common in women of childbearing age, and management of this population around the time of pregnancy involves specific challenges. Weight and medical comorbidities should be optimized both before and during pregnancy. During pregnancy, gestational weight gain should be limited, comorbidities should be appropriately screened for and managed, and fetal health should be monitored. Consideration should be given to the optimal timing of delivery and to reducing surgical and anesthetic complications. In the postpartum period, breastfeeding and weight loss should be promoted. Maternal obesity is associated with adverse metabolic effects in offspring, promoting an intergenerational cycle of obesity.
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Affiliation(s)
- Heidi Pauline Dutton
- University of Ottawa, 1967 Riverside Dr., Ottawa On Canada, K1h7W9, , 613 738 8400 ext 81946
| | - Sarah Jean Borengasser
- University of Colorado – Anschutz, 12631 E. 17 Ave. Mailstop F561, Aurora, CO 80045, USA, , 303 724 9550
| | - Laura Marie Gaudet
- University of Ottawa, 1053 Carling Ave, Ottawa On Canada, K1Y 4E9, , 613 737 8899 ext 73056
| | - Linda A Barbour
- Professor of Endocrinology and Maternal-Fetal Medicine, University of Colorado School of Medicine, 12801 E 17 Ave RC1 South Room 7103, Aurora, CO 80405, , 303 724 3921
| | - Erin Joanne Keely
- University of Ottawa, 1967 Riverside Dr., Ottawa On Canada, K1h7W9, , 613 738 8400 ext 81941
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Xu X, Liu Y, Liu D, Li X, Rao Y, Sharma M, Zhao Y. Prevalence and Determinants of Gestational Diabetes Mellitus: A Cross-Sectional Study in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121532. [PMID: 29292753 PMCID: PMC5750950 DOI: 10.3390/ijerph14121532] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/25/2017] [Accepted: 11/30/2017] [Indexed: 01/27/2023]
Abstract
UNLABELLED Objectives: This study aimed to identify the prevalence of gestational diabetes mellitus (GDM) and to examine its associations with social and behavioral factors, maternal body mass index (BMI), anemia, and hypertension. Methods: A cross-sectional analysis was performed on data collected from 2345 pregnant women from 16 hospitals in five selected provinces in mainland China. RESULTS Prevalence of GDM was as follows: overall: 3.7%; pregnant women in the first pregnancy: 3.4%; pregnant women in the second pregnancy: 4.6%. Compared with early pregnancy women, late-stage pregnant women were more likely to have GDM (OR = 4.32, 95% CI (1.82, 10.27)). Compared with 18-25 years old pregnant women, women aged 36-45 years were more likely to have GDM (OR = 3.98, 95% CI (1.41, 11.28). Compared with non-hypertensive patients, hypertensive patients were more likely to have GDM (OR = 6.93, 95% CI (1.28, 37.64)). However, second pregnancy, high maternal BMI, prolonged screen time (TV-viewing time, computer-using time, and mobile-phone using time), insufficient and excessive sleep duration, poor sleep quality, smoking, and secondhand smoke exposure were not significantly associated with an increased risk of GDM. Conclusions: Women in the second pregnancy do not appear to predict an increased risk for developing GDM than women in the first pregnancy. High-risk groups of GDM included women in their late pregnancy, aged 36-45 years old, and with hypertension. The findings will contribute to an improved understanding of social and behavioral determinants of GDM in Chinese population and contribute to the development of health-prevention promotion interventions to address GDM.
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Affiliation(s)
- Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Ying Liu
- School of the Second Clinical, Chongqing Medical University, Chongqing 400016, China; lyniniy @163.com
| | - Dengyuan Liu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Xiaoming Li
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Yunshuang Rao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS 39213, USA.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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Pirjani R, Shirzad N, Qorbani M, Phelpheli M, Nasli-Esfahani E, Bandarian F, Hemmatabadi M. Gestational diabetes mellitus its association with obesity: a prospective cohort study. Eat Weight Disord 2017; 22:445-450. [PMID: 27747467 DOI: 10.1007/s40519-016-0332-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/04/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the association between pre-pregnancy body mass index (BMI) and gestational diabetes mellitus (GDM). METHODS This prospective study was conducted on 256 pregnant women without diabetes referred for prenatal care in the first trimester of pregnancy to two referral University Hospitals (Shariati and Arash Hospitals) during the years 2012 and 2013. Eligible participants were selected consecutively and were followed until delivery and 6 weeks after that. Body weight and fasting plasma glucose were measured in each trimester, and BMI was calculated. Incidence of GDM was recorded, and BMI in this group was compared with those without GDM. RESULTS Mean age of women was 28.70 ± 5.57 years and among them, 78 women (30.5 %) developed GDM of which 21 were obese (52.5 %), 25 overweight (27.8 %), and 32 (25.4 %) were normal weight (p = 0.004). Pre-pregnancy obesity (OR 2.74, 95 % CI 1.28-5.88, p = 0.009), family history of diabetes (OR 2.01, 95 % CI 1.13-3.56, p = 0.016), and maternal age more than 30 years (OR 2.20, 95 % CI 1.25-3.88, p = 0.006) were three independent predictors for GDM, and pre-pregnancy obesity was the most potent predictor of GDM. CONCLUSION Women with high BMI and obesity have a significantly higher risk for developing GDM. Pre-pregnancy obesity, family history of diabetes, and age more than 30 years are three independent risk factors for GDM.
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Affiliation(s)
- Reihaneh Pirjani
- Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Shirzad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th Floor, Shariati Hospital, North Kargar Ave., Tehran, Iran. .,Department of Endocrinology, Vali-Asr Hospital, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mina Phelpheli
- Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bandarian
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Hemmatabadi
- Department of Endocrinology, Vali-Asr Hospital, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Doddabelavangala Mruthyunjaya M, Chapla A, Hesarghatta Shyamasunder A, Varghese D, Varshney M, Paul J, Inbakumari M, Christina F, Varghese RT, Kuruvilla KA, V. Paul T, Jose R, Regi A, Lionel J, Jeyaseelan L, Mathew J, Thomas N. Comprehensive Maturity Onset Diabetes of the Young (MODY) Gene Screening in Pregnant Women with Diabetes in India. PLoS One 2017; 12:e0168656. [PMID: 28095440 PMCID: PMC5240948 DOI: 10.1371/journal.pone.0168656] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/05/2016] [Indexed: 02/03/2023] Open
Abstract
Pregnant women with diabetes may have underlying beta cell dysfunction due to mutations/rare variants in genes associated with Maturity Onset Diabetes of the Young (MODY). MODY gene screening would reveal those women genetically predisposed and previously unrecognized with a monogenic form of diabetes for further clinical management, family screening and genetic counselling. However, there are minimal data available on MODY gene variants in pregnant women with diabetes from India. In this study, utilizing the Next generation sequencing (NGS) based protocol fifty subjects were screened for variants in a panel of thirteen MODY genes. Of these subjects 18% (9/50) were positive for definite or likely pathogenic or uncertain MODY variants. The majority of these variants was identified in subjects with autosomal dominant family history, of whom five were in women with pre-GDM and four with overt-GDM. The identified variants included one patient with HNF1A Ser3Cys, two PDX1 Glu224Lys, His94Gln, two NEUROD1 Glu59Gln, Phe318Ser, one INS Gly44Arg, one GCK, one ABCC8 Arg620Cys and one BLK Val418Met variants. In addition, three of the seven offspring screened were positive for the identified variant. These identified variants were further confirmed by Sanger sequencing. In conclusion, these findings in pregnant women with diabetes, imply that a proportion of GDM patients with autosomal dominant family history may have MODY. Further NGS based comprehensive studies with larger samples are required to confirm these finding.
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Affiliation(s)
| | - Aaron Chapla
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | | | - Deny Varghese
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Manika Varshney
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Johan Paul
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Mercy Inbakumari
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Flory Christina
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Ron Thomas Varghese
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | | | - Thomas V. Paul
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Ruby Jose
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Annie Regi
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Jessie Lionel
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - L. Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Jiji Mathew
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
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Perinatal outcome in a Caucasian population with gestational diabetes and preexisting diabetes first diagnosed in pregnancy. DIABETES & METABOLISM 2015; 42:122-5. [PMID: 26718735 DOI: 10.1016/j.diabet.2015.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 11/22/2022]
Abstract
AIM Our objective was to compare, in a Caucasian population, the perinatal outcomes of pregnancies complicated by pregestational diabetes diagnosed in the first-trimester of pregnancy with those of pregnancies complicated by gestational diabetes. METHODS A retrospective evaluation of maternal and neonatal outcomes was performed for all consecutive pregnancies complicated by gestational or pregestational diabetes that happened between 2005 and 2011. Pregestational diabetes was diagnosed for the first time in pregnancy if the first-trimester fasting glycaemia was ≥126 mg/dL. Gestational diabetes was diagnosed according to Carpenter-Coustan criteria until May 2010, and then according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) panel criteria modified by the American Diabetes Association. A specific diet, self-monitoring of blood glucose and, if required, insulin treatment were prescribed. RESULTS Overall, 411 pregnant women were considered eligible for the study (379 with gestational diabetes and 32 with pregestational diabetes). Women with pregestational vs. gestational diabetes were diagnosed earlier in pregnancy (11.6±1.0 weeks vs. 25.9±1.7 weeks; P=0.0001), had a higher mean first-trimester fasting glycaemic level (129.5±3.6 mg/dL vs. 81.6±10.5mg/dL; P=0.0001), more often had a family history of diabetes (46.9% vs. 25.9%; P=0.02) and more often needed insulin treatment (78.1% vs. 14.0%; P=0.0001). Furthermore, a higher rate of fetal malformations in women with pregestational diabetes was detected (9.4% vs. 1.6%, P=0.02). No other differences in neonatal outcomes were identified. CONCLUSION In a Caucasian population, the prevalence of fetal malformations and insulin requirements with pregestational diabetes first diagnosed in pregnancy were significantly higher compared with women with gestational diabetes. In any case, glucose impairment in pregnancy needs to be diagnosed in a timely fashion and appropriately treated to improve both maternal and fetal outcomes.
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Effect of hyperemesis gravidarum on gestational diabetes mellitus screening. Int J Gynaecol Obstet 2015; 132:156-8. [PMID: 26582348 DOI: 10.1016/j.ijgo.2015.06.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/20/2015] [Accepted: 10/22/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To clarify the effect of starvation due to hyperemesis gravidarum on the screening of gestational diabetes mellitus (GDM). METHODS A retrospective study was undertaken of pregnant women who delivered at Tsukuba University Hospital, Japan, between October 1, 2010, and September 30, 2013. GDM screening was performed in the first trimester using the random blood glucose test with a cutoff value of 5.2mmol/L and in the second trimester using a 50-g glucose challenge test with a cutoff value of 7.8mmol/L. If the screening was positive, a 75-g oral glucose tolerance test was performed for a definite diagnosis. RESULTS Among 2112 eligible women, 33 (1.6%) required hospitalization for hyperemesis; the remaining 2079 women formed the control group. In the first trimester, the positive GDM screening rate was significantly higher in the hyperemesis group than in the control group (13 [39.4%] vs 115 [5.5%]; P<0.001). Additionally, the positive predictive value was significantly lower in the hyperemesis group (23.1% vs 73.9%; P<0.001). In the second trimester, no significant differences were observed between groups. CONCLUSION Hyperemesis gravidarum affects the positive GDM screening rate in the first trimester.
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Enkhtuvshin B, Nagashima S, Saito N, Wakabayashi T, Ando A, Takahashi M, Sakai K, Yamamuro D, Nagasaka S, Tamemoto H, Ishibashi S. Successful pregnancy outcomes in a patient with type A insulin resistance syndrome. Diabet Med 2015; 32:e16-9. [PMID: 25472847 PMCID: PMC5034500 DOI: 10.1111/dme.12659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The management of severe insulin resistance during pregnancy is challenging because of the increased risk of perinatal complications for both mother and fetus. We describe two consecutive pregnancies in a patient with severe insulin resistance caused by a mutation in the β subunit of the insulin receptor. CASE REPORT A non-obese Japanese woman was diagnosed as having diabetes mellitus during her first pregnancy at age 31 years. She presented at 6 weeks' gestation with a fasting plasma glucose concentration of 15.1 mmol/l and an HbA(1c) level of 95 mmol/mol (10.8%). Fasting insulin concentration was high at 68.8 μU/ml, suggesting severe insulin resistance. Anti-insulin and insulin-receptor antibodies were both negative. Genetic analysis revealed an in-frame heterozygous deletion mutation (∆Leu(999)) in the insulin receptor gene. Despite large daily doses (up to 480 units per day) of insulin aspart and isophane, the patient's postprandial plasma glucose level exceeded 11.1 mmol/l. In the patient's second pregnancy, the addition of metformin at a dose of 2250 mg per day achieved tighter glycaemic control, with lower doses of insulin lispro and isophane (up to 174 units/day). Both newborns, who were found to carry the same mutation, were small for gestational age and developed transient hypoglycaemia after birth. CONCLUSION Adding metformin to the conventional insulin regimen effectively achieved tight glycaemic control with a lower dose of insulin. The mutation of the insulin receptor gene might underlie the intrauterine growth retardation of the newborns. To our knowledge, this is the first report of successful management of diabetes mellitus in a pregnant woman with type A insulin resistance syndrome.
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Affiliation(s)
- B Enkhtuvshin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - S Nagashima
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - N Saito
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - T Wakabayashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - A Ando
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - M Takahashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - K Sakai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - D Yamamuro
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - S Nagasaka
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
| | - H Tamemoto
- Division of Medical Biochemistry, Department of Biochemistry, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - S Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shimotsuke, Tochigi, Japan
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Allnutt KJ, Allan CA, Brown J. Early pregnancy screening for identification of undiagnosed pre-existing diabetes to improve maternal and infant health. Hippokratia 2015. [DOI: 10.1002/14651858.cd011601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Katherine J Allnutt
- Monash University; Department of Obstetrics and Gynaecology; 246 Clayton Road Clayton Victoria Australia 3168
| | - Carolyn A Allan
- Monash University; Department of Obstetrics and Gynaecology; 246 Clayton Road Clayton Victoria Australia 3168
| | - Julie Brown
- The University of Auckland; Liggins Institute; Park Rd Grafton Auckland New Zealand 1142
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Noctor E, Dunne FP. Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria. World J Diabetes 2015; 6:234-244. [PMID: 25789105 PMCID: PMC4360417 DOI: 10.4239/wjd.v6.i2.234] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/17/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
A previous diagnosis of gestational diabetes (GDM) carries a lifetime risk of progression to type 2 diabetes of up to 60%. Identification of those women at higher risk of progression to diabetes allows the timely introduction of measures to delay or prevent diabetes onset. However, there is a large degree of variability in the literature with regard to the proportion of women with a history of GDM who go on to develop diabetes. Heterogeneity between cohorts with regard to diagnostic criteria used, duration of follow-up, and the characteristics of the study population limit the ability to make meaningful comparisons across studies. As the new International Association for Diabetes in Pregnancy Study Group criteria are increasingly adopted worldwide, the prevalence of GDM is set to increase by two-to three-fold. Here, we review the literature to examine the evolution of diagnostic criteria for GDM, the implications of changing criteria on the proportion of women with previous GDM progressing to diabetes, and how the use of different diagnostic criteria may influence the development of appropriate follow-up strategies.
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Park S, Kim SH. Women with rigorously managed overt diabetes during pregnancy do not experience adverse infant outcomes but do remain at serious risk of postpartum diabetes. Endocr J 2015; 62:319-27. [PMID: 25735969 DOI: 10.1507/endocrj.ej14-0529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We retrospectively detected overt diabetes during pregnancy (ODMP) using a modified IADPSG definition and assessed whether ODMP increases the risk of developing maternal and neonatal complications and postpartum diabetes in Korean pregnant women. According to the definition of IADPSG, ODMP pregnant women were defined and 71 ODMP, 1781 gestational diabetes mellitus (GDM) and and 463 non-GDM pregnant women were included in a hospital-based study. Their blood glucose levels were tightly regulated by modifying lifestyles and insulin treatment. The pregnancy outcomes and postpartum glucose tolerances were determined among the non-GDM, GDM and ODMP groups. The ODMP women had higher plasma glucose levels after overnight-fasting and at 2 h after 100 g OGTT challenge as well as higher overnight-fasted plasma insulin and HbA1c levels than GDM women. HbA1c levels at delivery were close to the normal range in both GDM and ODMP groups. Most pregnancy outcomes such as Apgar score and the rate of preterm delivery were not significantly different among three groups. Only the rate of large for gestational age (LGA) was greater in the ODMP group than other groups. However, about 73% of ODMP women remained diabetic at 6-8 week postpartum as compared to 4.3% of GDM. The development of postpartum diabetes was also associated with postpartum waist circumferences and duration of breast feeding. In conclusion, ODMP women in this study maintained tight control of glucose homeostasis and did not experience serious adverse outcomes except for LGA infants; however most ODMP women still had postpartum glucose dysregulation.
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Affiliation(s)
- Sunmin Park
- Department of Food & Nutrition, Hoseo University, Asan 336-795, Korea
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DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis 2014; 11:E104. [PMID: 24945238 PMCID: PMC4068111 DOI: 10.5888/pcd11.130415] [Citation(s) in RCA: 410] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The true prevalence of gestational diabetes mellitus (GDM) is unknown. The objective of this study was 1) to provide the most current GDM prevalence reported on the birth certificate and the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and 2) to compare GDM prevalence from PRAMS across 2007-2008 and 2009-2010. METHODS We examined 2010 GDM prevalence reported on birth certificate or PRAMS questionnaire and concordance between the sources. We included 16 states that adopted the 2003 revised birth certificate. We also examined trends from 2007 through 2010 and included 21 states that participated in PRAMS for all 4 years. We combined GDM prevalence across 2-year intervals and conducted t tests to examine differences. Data were weighted to represent all women delivering live births in each state. RESULTS GDM prevalence in 2010 was 4.6% as reported on the birth certificate, 8.7% as reported on the PRAMS questionnaire, and 9.2% as reported on either the birth certificate or questionnaire. The agreement between sources was 94.1% (percent positive agreement = 3.7%, percent negative agreement = 90.4%). There was no significant difference in GDM prevalence between 2007-2008 (8.1%) and 2009-2010 (8.5%, P = .15). CONCLUSION Our results indicate that GDM prevalence is as high as 9.2% and is more likely to be reported on the PRAMS questionnaire than the birth certificate. We found no statistical difference in GDM prevalence between the 2 phases. Further studies are needed to understand discrepancies in reporting GDM by data source.
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Affiliation(s)
- Carla L DeSisto
- Centers for Disease Control and Prevention, 601 Sunland Park Dr, Suite 200, El Paso, TX 79912. E-mail:
| | - Shin Y Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea J Sharma
- Centers for Disease Control and Prevention, Atlanta, Georgia
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