Inflammation exerts an essential role in gestational diabetes mellitus (GDM), but the relationship between peripheral blood inflammatory markers and GDM remains unclear. The purpose of this study was to explore the relationship between inflammatory markers and GDM in US adults. Data were extracted from the National Health and Nutrition Examination Survey. Five inflammatory markers were derived from complete blood count. Survey-weighted multivariable logistic regression models were used to assess the association between inflammatory markers and GDM. Restricted cubic splines and subgroup analyses were conducted to validate the stability of the results. Finally, a total of 2363 women aged 20-44 were included based on specific criteria, with 229 self-reported GDM cases (9.69%). The increased lymphocyte-monocyte ratio (LMR) was associated with the higher risk of GDM, aOR = 1.82 (CI:1.30-2.56). Compared with the lowest tertile, the highest tertile group of LMR showed a significantly increased risk of GDM, aOR = 2.24 (CI: 1.28-2.85). Conversely, the highest tertile group of systemic inflammation response index (SIRI) was negatively associated with GDM, aOR = 0.61 (95% CI: 0.40-0.94). And high platelet-lymphocyte ratio (PLR) levels are related to a lower risk of GDM. No non-linear relationships were observed. Furthermore, subgroup analysis revealed that the association between LMR, SIRI, and GDM remained consistent with the overall results. Our study indicated that LMR, PLR, and SIRI may be potential predictors of GDM. Further large-scale prospective study is needed to investigate the role of LMR, PLR and SIRI in GDM.

To investigate the therapeutic efficacy of Carthamin yellow (CY)-loaded glycyrrhetinic acid (GA) liposomes in treating diabetic nephropathy (DN), particularly in alleviating renal interstitial fibrosis and improving kidney function.

CY-loaded GA liposomes were prepared and characterized for structural stability and controlled release. DN rat models were treated with CY-loaded GA liposomes, and kidney pathology, function, collagen deposition, and TGF-β1 expression were evaluated. The effects of CY-loaded GA liposomes were compared to Vitamin E and CY alone. In vitro experiments with TGF-β1-stimulated human renal interstitial fibroblasts (hRIFs) examined the effects of CY-loaded GA liposomes on cell proliferation and the expression of fibrotic markers. Mechanistic studies assessed the role of the TGFBR1/Smad2/Smad3 pathway using TGFBR1 overexpression experiments.

The CY-loaded GA liposomes exhibited a stable structure and controlled release profile. In DN rats, treatment with CY-loaded GA liposomes significantly alleviated kidney damage, improved kidney function, reduced collagen deposition and fibrosis, and downregulated TGF-β1 expression, showing superior effects compared to Vitamin E or CY alone. In TGF-β1-stimulated hRIFs, CY-loaded GA liposomes effectively suppressed cell proliferation and reduced the expression of Cyclin D1, PCNA, fibronectin, and collagen I. The inhibitory effects were stronger than CY alone and were mediated by the inactivation of the TGFBR1/Smad2/Smad3 pathway, as confirmed by TGFBR1 overexpression studies.

CY-loaded GA liposomes demonstrated significant therapeutic efficacy in alleviating renal interstitial fibrosis in DN by targeting the TGFBR1/Smad2/Smad3 pathway. This novel drug delivery system provides a promising approach for the treatment of DN.

Background: The United States is experiencing a maternal health crisis that continues to worsen in the face of racial/ethnic disparities, rising chronic disease burden among birthing patients, and policy barriers to health care access. Longitudinal postpartum primary care is critical to mitigating these trends, but current rates of use are low, and evidence-based interventions are limited. This scoping review aims to understand the current literature and components of the Chronic Care Model (CCM) used in postpartum primary care and its impact on maternal health outcomes. Methods: We identified 74 studies published between 2000 and 2023 through comprehensive searches of four databases. Extracted data was synthesized for their impact on maternal health, including equity considerations and the primary CCM element. Results: The studies were collated based on their primary maternal health priority (general health n = 13, depression and anxiety n = 34, diabetes n = 3, hypertension n = 5, adolescent parents n = 6, and substance use disorder n = 13). The most common CCM elements were Delivery System Design and Self-Management Support. The least common CCM element was Clinical Information Systems, with electronic health record challenges noted as a barrier. We identified successful interventions that increased depression screening, postpartum hypertension follow-up via telehealth, and integrated contraceptive education within shared parent-child medical homes for adolescent parents. Interventions were largely feasible and acceptable for both patients and clinicians. Conclusions: This review highlights several potential strategies to improve and scale longitudinal postpartum primary care. Further work is needed to ensure equitable delivery, improved connection with community resources, and to expand informatics in postpartum care.

Young-onset type 2 diabetes mellitus (YT2DM) is an aggressive phenotype, with some claiming that diagnosis at <40 years of age represents a distinct higher risk group. Others have suggested restricting YT2DM to those diagnosed at <30 years of age. In this context, we examined whether pregnancy outcomes differ between women diagnosed with YT2DM at <30 years of age (T2D30) versus those diagnosed at 30 to <40 years of age (T2D40).

This retrospective analysis (2010-2019) compared pregnancy outcomes in women with pre-gestational T2D30 versus T2D40. Co-primary outcomes included preterm delivery, large for gestational age (LGA) infants, and pre-eclampsia.

Compared to T2D40 (N = 69), T2D30 (N = 66) were significantly younger, had a longer duration of diabetes, and had higher rates of smoking (p <0.05 for all). In both groups, obesity affected ≥60% of women and similar rates of preterm delivery and LGA infants were seen. Women with T2D30 had at least a twofold increase in the adjusted odds of excess gestational weight gain (GWG). Rates of proteinuria and pre-eclampsia were increased in T2D30, although significance was lost following adjustment for factors such as glycaemia. Younger age of YT2DM diagnosis and longer duration of YT2DM (as continuous variables), but not maternal age, were independently associated with higher mean pregnancy HbA1c and excess GWG (p <0.05 for both).

An earlier age of YT2DM diagnosis and/or longer duration of YT2DM were associated with excess GWG and a higher mean-pregnancy HbA1c. Rates of pre-eclampsia and proteinuria were increased in T2D30, likely mediated at least in part by factors such as glycaemia. Our findings suggest that the age of YT2DM diagnosis and/or duration of YT2DM, not just maternal age, should be considered when assessing pregnancy risks.

Women with gestational diabetes mellitus (GDM) are frequently asked to check their ketone levels by measuring ketonuria before breakfast. However, ketosis could be present even before lunch and dinner. Furthermore, blood ketone measurement could be a more accurate test. Our aim was to evaluate the effect of a blood ketone intensive measurement in the detection of ketosis in women with GDM with a negative urinary ketone test.

This was a single center, observational, prospective study involving consecutive women with GDM. Only women with negative fasting urinary ketone tests were included. During the same gestational weeks (weeks 30-32), all women were asked to perform a blood ketone test before their main meals. Ketosis was defined as the presence for at least 25% of the time of fasting blood ketone levels > 0.1 mmol/L and > 0.2 mmol/L before lunch and dinner.

Overall, a total of 101 women (mean age 34.7 ± 4.8 years, prepregnancy BMI 28.2 ± 5.2 kg/m2) were studied. Blood ketones were present in 37.6% of the cases before breakfast, 13.9% before lunch, and 11.9% before dinner. Women with at least one daily presence of blood ketones composed 40.6% of the sample. Presence of fasting blood ketones was correlated with ketone presence before lunch (r = 0.63, p < 0.0001) and before dinner (r = 0.55, p < 0.0001) and with mean glucose levels (r = 0.23, p = 0.02) 1 h after breakfast.

Blood ketone testing in women with GDM can detect a larger number of ketosis episodes than a urinary ketone test. Intensive blood ketone measurement should be recommended to women with GDM.

Large-for-gestational-age (LGA), one of the most common complications of gestational diabetes mellitus (GDM), has become a global concern. The predictive performance of common continuous glucose monitoring (CGM) metrics for LGA is limited.

We aimed to develop and validate an artificial intelligence (AI)-based model to determine the probability of women with GDM giving birth to LGA infants during pregnancy using CGM measurements together with demographic data and metabolic indicators.

A total of 371 women with GDM from a prospective cohort at a university hospital were included. CGM was performed during 20 to 34 gestational weeks, and glycemic fluctuations were evaluated and visualized in women with GDM who gave birth to LGA and non-LGA infants. A convolutional neural network (CNN)-based fusion model was developed to predict LGA. Comparisons among the novel fusion model and 3 conventional models were made using the area under the receiver operating characteristic curve (AUCROC) and accuracy.

Overall, 76 (20.5%) out of 371 GDM women developed LGA neonates. The visualized 24-hour glucose profiles differed at midmorning. This difference was consistent among subgroups categorized by pregestational body mass index, therapeutic protocol, and CGM administration period. The AI-based fusion prediction model using 24-hour CGM data and 15 clinical variables for LGA prediction (AUCROC 0.852; 95% CI, 0.680-0.966; accuracy 84.4%) showed superior discriminative power compared with the 3 classic models.

We demonstrated better performance in predicting LGA infants among women with GDM using the AI-based fusion model. The characteristics of the CGM profiles allowed us to determine the appropriate window for intervention.

Women with gestational diabetes mellitus (GDM) display adverse lifetime cardiometabolic health. We examined whether early metformin in GDM could impact cardiometabolic risk factors postpartum.

EMERGE, a double-blind, placebo-controlled trial, randomized pregnancies 1:1 to placebo or metformin at GDM diagnosis and followed participants from randomization until 12 ± 4 weeks postpartum. In total, 478 pregnancies were available for postpartum maternal assessment, 237 and 241 assigned to metformin and placebo respectively. Weight (kg), body mass index (BMI) (kg/m2), waist circumference (cm), and blood pressure (mmHg) were measured, infant feeding method documented, and blood specimens drawn for a 75-gram oral glucose tolerance test, fasting insulin, C-peptide, and lipid analysis.

Despite similar weight and BMI at trial randomization, participants receiving metformin had significantly lower weight (79.5 ± 15.9 vs 82.6 ± 16.9 kg; P = .04) and BMI (29.3 [5.6] vs 30.5 [5.4]; P = .018) at the postpartum visit. However, no difference in weight change from randomization to 12 weeks postpartum was observed between metformin and placebo groups. Overall, 29% (n = 139) of the cohort met criteria for prediabetes or diabetes, with no positive impact with metformin. There were also no differences in measurements of insulin resistance, blood pressure, or lipids between groups.

Early metformin use in GDM did not impact important cardiometabolic parameters in the early postpartum period despite significant benefits in weight gain and insulin use in pregnancy.

Glycemic dysregulation during pregnancy is common and increases risk of adverse birth outcomes and future chronic disease. Timing of eating is known to influence glycemic control but has not been thoroughly examined in the context of pregnancy. We systematically reviewed the literature assessing timing of eating and glycemic outcomes during pregnancy.

PubMed, CINAHL, EMBASE, and Web of Science were searched for studies published before March 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered the review with PROSPERO (CRD42024574992). Eligible studies were interventional or observational and collected quantitative data on the association of timing of eating with glycemic outcomes in pregnant persons with or without gestational diabetes mellitus (GDM). 1804 articles were evaluated for inclusion, of which 14 articles met criteria (from 5 interventional and 8 observational studies).

Timing of eating was associated with glycemic outcomes independent of GDM status; later timing and a shorter overnight fasting duration were associated with poorer glycemic control. Timing considerations may be a valuable addition to recommendations for glycemia management during pregnancy.

Gestational diabetes mellitus (GDM) prevalence (9-15%) is similar in Ghana and Switzerland, despite differences in sociodemographic characteristics, lifestyle, and healthcare systems. Contrary to Switzerland, data on the metabolic and mental health outcomes of women with GDM in Ghana is lacking. We compared the metabolic, mental health, and perinatal outcomes of GDM during pregnancy in Ghana and Switzerland.

This prospective observational study included 170 women with GDM from two cohorts (n = 88 in Switzerland, n = 82 in Ghana) who were followed-up until delivery. Primary outcomes were metabolic [HbA1c, gestational weight gain (GWG)], well-being (WHO-5), and depression symptoms (EPDS) during pregnancy. Secondary outcomes were obstetric and neonatal outcomes. Differences in metabolic, mental health and perinatal outcomes were tested using ANOVA, Chi-square test or ANCOVA when appropriate. For the perinatal outcomes, we adjusted for metabolic confounders.

Compared to the Swiss cohort (SC), the Ghana cohort (GC) had a higher pre-pregnancy weight (79.8 ± 18.0 vs. 71.8 ± 15.3 kg, p = 0.003) and BMI (30.8 ± 6.6 vs. 26.5 ± 4.9 kg/m2, p < 0.001), lower total GWG (6.2 ± 5.4 vs. 11.3 ± 5.8 kg, p < 0.001), but similar BMI-based excessive weight gain, higher fasting glucose (7.1 ± 2.4 vs. 5.1 ± 0.7 mmol/l) and HbA1c at GDM diagnosis (5.6 ± 1.0 vs. 5.3 ± 0.3%; both p ≤ 0.019), higher prevalence of previously undiagnosed pre-existing diabetes before 15-weeks gestational age (35.4% vs. 9.4%) and of metformin-treated women (84% vs. 1.1%, both p ≤ 0.001). The GC had higher well-being scores (74.4 ± 17.6 vs. 59.8 ± 18.3, p < 0.001), but similar symptoms of depression scores. In the GC, LGA (30% vs. 17%), and NICU hospitalizations (42% vs. 15%) were higher (all p ≤ 0.044) independent of HbA1c and pre-pregnancy BMI.

Women in the GC had worse metabolic outcomes but improved mental health during pregnancy. In this context, LGA and neonatal hospitalisations were higher, independent of HbA1c and pre-pregnancy BMI. Our results suggest the need for specialized GDM clinics in Ghana to improve metabolic and perinatal outcomes in women with GDM.

Maternal diabetes mellitus is linked to neurobiological and cognitive impairments, increasing the risk of brain and cerebellar defects in diabetic pregnant rats and their offspring. Momordica charantia (bitter melon) possesses antidiabetic properties due to its bioactive compounds, including phenolics, alkaloids, proteins, steroids, inorganic compounds, and lipids. Forty pregnant rats were randomly assigned to four groups: control; M charantia (BM); diabetic (DM); and diabetic treated with M charantia (BM+DM). Diabetic maternal rats showed significantly elevated serum glucose, insulin, leptin, and homeostasis model assessment of insulin resistance (HOMA-IR) levels, with a concomitant decrease in insulin sensitivity check index (QUICKI), glucose transporter 4 (GLUT4), adenosine monophosphate-activated protein kinase (AMPK), acetylcholine (ACh), and dopamine. Oxidative stress markers in cerebellar tissue indicated increased malondialdehyde (MDA) and decreased glutathione (GSH) levels. Cerebellar tissue analysis revealed significantly reduced superoxide dismutase (SOD), catalase (CAT), B-cell lymphoma 2 (Bcl-2), and nerve growth factor (NGF), while Bcl-2-associated X protein (BAX) and glial fibrillary acidic protein (GFAP) were elevated. Histological and ultrastructural analysis of the diabetic maternal cerebellum showed moderate vacuolation of the neuropil in all cerebellar cortical layers, along with Purkinje cell degeneration and necrosis, including Nissl substance loss. Offspring of diabetic mothers exhibited multifocal Purkinje cell loss, empty baskets, and cerebellar cortical dysplasia with abnormal tissue development and organization. In conclusion, M. charantia supports central nervous system health in diabetic pregnant rats and their offspring by enhancing antioxidant markers, regulating GFAP and NGF, and mitigating apoptosis, ultimately improving cerebellar pathology and neural development.

To assess the efficacy and safety of automated insulin delivery (AID) systems compared to standard care in managing glycaemic control during pregnancy in women with Type 1 Diabetes Mellitus (T1DM).

We searched MEDLINE, Cochrane Library, registries and conference abstracts up to June 2024 for randomized controlled trials (RCTs) and observational studies comparing AID to standard care in pregnant women with T1DM. We conducted random effects meta-analyses for % of 24-h time in range of 63-140 mg/dL (TIR), time in hyperglycaemia (> 140 mg/dl and > 180 mg/dL), hypoglycaemia (< 63 mg/dl and < 54 mg/dL), total insulin dose (units/kg/day), glycemic variability (%), changes in HbA1c (%), maternal and fetal outcomes.

Thirteen studies (450 participants) were included. AID significantly increased TIR (Mean difference, MD 7.01%, 95% CI 3.72-10.30) and reduced time in hyperglycaemia > 140 mg/dL and > 180 mg/dL (MD - 5.09%, 95% CI - 9.41 to - 0.78 and MD - 2.44%, 95% CI - 4.69 to - 0.20, respectively). Additionally, glycaemic variability was significantly reduced (MD - 1.66%, 95% CI - 2.73 to - 0.58). Other outcomes did not differ significantly.

AID systems effectively improve glycaemic control during pregnancy in women with T1DM by increasing TIR and reducing hyperglycaemia without any observed adverse short-term effects on maternal and fetal outcomes.

Metformin treatment for hyperglycemia in pregnancy (HIP) beneficially improves maternal glucose metabolism and reduces perinatal complications. However, metformin could impede pancreatic β cell development via impaired mitochondrial function. A new anti-diabetes drug imeglimin, developed based on metformin, improves mitochondrial function. Here we examine the effect of imeglimin on β cell differentiation using human induced pluripotent stem cell (iPSC)-derived pancreatic islet-like spheroid (SC-islet) models.

Human iPSCs are differentiated into SC-islets by three-dimensional culture with and without imeglimin or metformin. Differentiation efficiencies of SC-islets were analyzed by flow cytometry, immunostaining, quantitative PCR, and insulin secretion assay. RNA sequencing and oxygen consumption rate were obtained for further characterization of SC-islets. SC-islets were cultured with proinflammatory cytokines, in part mimicking the uterus environment in HIP.

Metformin perturbed SC-islet differentiation while imeglimin did not alter it. Furthermore, imeglimin enhanced the gene expressions of β cell lineage markers. Maintenance of mitochondrial function and optimization of TGF-β and Wnt signaling were considered potential mechanisms for augmented β cell maturation by imeglimin. In the presence of proinflammatory cytokines, imeglimin ameliorated β cell differentiation impaired by cytokines and metformin.

Imeglimin does not perturb differentiation of SC-islet cells and rather enhances gain in β cell identity gene sets in contrast to metformin. This may lead to the improvement of in vitro β cell differentiation protocols.

To present a detailed analysis of temporal trends in the burden of diabetes mellitus (DM) among women of childbearing age (WCBA) across global and regional levels from 1990 to 2021.

Population-based Study.

This study extracted prevalence, disability-adjusted life years (DALYs), and risk factors in WCBA from the Global Burden of Disease (GBD) database. The average annual percent change (AAPC) was utilized to evaluate the evolving trends in the burden of DM.

From 1990 to 2021, the global age-standardized prevalence of diabetes in WCBA rose from 1.80 % to 4.06 %, with an AAPC of 2.68 %. While the age-standardized prevalence of type 1 DM (T1DM) has grown and the age-standardized DALYs associated with T1DM declined from 51.8 to 47.4 per 100,000 population. Conversely, the age-standardized DALYs rate for type 2 DM (T2DM) nearly doubled from 183.8 to 353.8 per 100,000 population. The DALYs rate for total DM rose almost three times faster in countries with high-middle Sociodemographic Index (SDI) compared to those with low SDI (AAPC: 2.10 % versus 0.71 %). High fasting plasma glucose (HFPG) levels remained the most significant risk factor for DALYs, while high body-mass index (BMI) and low physical activity for T2DM exhibited the largest increases in this period.

From 1990 to 2021, a global upward trend in the prevalence of DM among WCBA has been observed. HFPG remains a major risk factor for both T1DM and T2DM, while high BMI and low physical activity have emerged as significant challenges in managing T2DM.

To inform the development and adaptation of lifestyle programs to prevent type 2 diabetes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes (GDM).

Participants are from the Balance after Baby Intervention (BABI) study, a two-year randomized clinical trial of a lifestyle program for women with recent GDM conducted in Boston, MA, and Denver, CO between 2016 and 2019. The Edinburgh Postpartum Depression Scale (EPDS) and Perceived Stress Scale (PSS-10) were administered at an average of 8-weeks postpartum. We defined an EPDS score of ≥ 9 as depressive symptoms and reviewed medical records for medical history. We conducted bivariate analyses to identify predictors of postpartum depressive symptoms, then modeled the odds of postpartum depressive symptoms using multivariable logistic regression and selected the best fit model.

Our analysis included 181 women. Thirty-five (19%) scored ≥ 9 on the EPDS. While both perceived stress and whether this was the first pregnancy complicated by GDM were significant in the bivariate analysis, only perceived stress remained a significant predictor of postpartum depressive symptoms in the multivariate regression model (OR 4.34, 95% CI [2.58-7.31]). The effect of first GDM pregnancy was no longer significant in the multivariate model (OR 2.00, 95% CI [0.63-6.33]). Additionally, a mediation model determined that perceived stress fully mediated the effect of first GDM pregnancy on depressive symptoms (Effect ratio, 0.5507/1.5377 = 0.358, p = 0.036).

Perceived stress was predictive of postpartum depressive symptoms in women with recent GDM and was found to mediate the relationship between first pregnancy complicated by GDM and postpartum depressive symptoms. Addressing perceived stress in the early postpartum period may be an important target for future lifestyle programs to maximize diabetes prevention efforts.

To investigate the effectiveness of maternal hemoglobin A1c (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM) in the second trimester.

A total of 3000 pregnant women between 24 and 28 weeks of gestation were included in the study. Screening for gestational diabetes was performed using maternal HbA1c in 1200 pregnant women who either refused or could not tolerate the OGTT. The HbA1c value for the diagnosis of GDM was set at ≥ 5.7% in accordance with a meta-analysis by Paula B. Renz et al. A total of 154 pregnant women with HbA1c ≥ 5.7% were diagnosed with gestational diabetes, and their data were recorded prospectively. These data were compared with obstetric outcomes in 250 pregnant women diagnosed with diabetes by performing a 100-g OGTT after a 50-g glucose challenge test (GCT).

There were no significant differences between two groups in terms of maternal age, gestational age at diagnosis, gravidity, and parity. Body mass index (BMI) was found to be significantly higher in pregnant women with HbA1c levels ≥ 5.7% (p < 0.001). Polyhydramnios was more common in the HbA1c ≥ 5.7% group and oligohydramnios was more common in the OGTT group (p < 0.001). Neonatal hypoglycemia was found to be significantly higher in the OGTT group (p < 0.05). The median HbA1c value were different in each group (OGTT group 5.6%, HbA1c group 5.8%; p < 0.001).

HbA1c testing has lower accuracy rates than OGTT in diagnosing GDM because it may miss diagnosis in some groups.

To (1) explore the trajectories of blood glucose management protection motivation in pregnant women with gestational diabetes mellitus, based on a growth mixture model, and (2) identify factors associated with these trajectories.

This longitudinal study, conducted between December 2023 and June 2024 at a tertiary hospital in China, involved 313 pregnant women diagnosed with gestational diabetes mellitus who were not using medication to control their blood glucose levels. Participants were assessed at three time points: 24-28 gestational weeks, 29-35 gestational weeks, and 36-40 gestational weeks. The data collected included general demographic information and the level of blood glucose management protection motivation. A growth mixture model was employed to examine the trajectory of blood glucose management protection motivation, and binary logistic regression analysis was performed to identify predictors of the trajectory. This study was reported following the Reporting Observational Longitudinal Research statement.

The study identified two distinct trajectories of blood glucose management protection motivation: a low-motivation group (slowly increasing then rapidly declining; 124, 39.62%) and a high-motivation group (rapidly then increasing slowly declining; 189, 60.38%). The independent predictors of these trajectory categories included age, per capita monthly household income, and pregnancy complications.

Significant heterogeneity existed in the developmental trajectories of blood glucose management protection motivation among pregnant women with gestational diabetes mellitus. Future research should prioritize developing targeted interventions that consider not only different developmental trajectories but also factors such as age, per capita monthly household income, and pregnancy complications. These strategies may foster blood glucose management protection motivation among pregnant women with gestational diabetes mellitus, addressing their specific needs and enhancing the effectiveness of care.

During COVID-19, the diagnosis and treatment of GDM differed from conventional criteria. In Australia, during the alternative testing period, women with fasting glucose < 4.7 mmol/L were not diagnosed with GDM.

To describe the maternal and neonatal outcomes of pregnant women with fasting blood glucose < 4.7 mmol/L for whom the diagnosis and treatment pathways differed before and during COVID-19.

An Australian population-based data linkage study involving 3891 women with fasting blood glucose < 4.7 mmol/L between 24 and 32 weeks of gestation categorised into three groups: women diagnosed with GDM by postprandial hyperglycaemia (PPGDM; n = 226); normal glucose tolerance group (NGT; n = 3125) and women not tested for postprandial hyperglycaemia, mostly during COVID-19 (LFBG; n = 540). Perinatal outcomes were compared using generalised linear models.

There were no differences between PPGDM and NGT groups in the risk of large for gestational age infants (RR 0.98, 95% CI: 0.63-1.52) although the mean birth weight (MD -103.43, 95% CI: -175.46 to -31.40)) was lower in the PPGDM group. The maternal and neonatal outcomes in the LFBG group were mostly comparable to the NGT group.

In our study, the Australian COVID-19 GDM screening protocol, which includes initial fasting glucose testing, reduced the need for an OGTT in 67% of pregnant women. Diagnosis and treatment for postprandial hyperglycaemia in women with lower FBG should consider the benefits, as well as the financial, logistical and psychological costs involved.

While time in range (TIR) summarized over pregnancy is associated with adverse outcomes among individuals with preexisting type 1 or 2 diabetes, the impact of TIR trajectories with advancing gestation is unknown.

To identify glucose TIR trajectories across pregnancy and evaluate their association with perinatal outcomes among patients with preexisting diabetes.

Retrospective, single-center cohort study of pregnant patients with type 1 or 2 diabetes who used continuous glucose monitoring (CGM) and delivered in 2019 to 2023. Weekly TIR (65-140 mg/dL) was computed starting at 10 weeks' gestation, and joint latent-class trajectory modeling identified discrete TIR trajectory groups. Patients were classified into groups, and multivariable logistic regression estimated the associations between groups and perinatal outcomes.

Of 179 pregnant patients, 91 had type 1 and 88 had type 2 diabetes. We identified four TIR trajectory groups using data from over 5.1 million CGM measurements: (1) good control, stable (n=48), (2) moderate control, initial improvement, and late decline (n=22), (3) moderate control, late improvement (n=63), and (4) poor control, initial worsening and late improvement (n=46). All perinatal outcomes differed by TIR trajectory. Groups 2, 3, and 4 with suboptimal control in early pregnancy were associated with higher odds of preterm birth, indicated preterm birth, and NICU admission, compared to group 1. Groups 3 and 4, which had the lowest TIR during second and early third trimesters, were associated with higher odds of large-for-gestational-age (LGA). Only group 4 was associated with higher odds of preeclampsia and neonatal hypoglycemia.

Achieving glycemic control in the second and early third trimesters during fetal and placental growth and development is important to reduce the risk of adverse pregnancy outcomes, particularly LGA. Third-trimester TIR decline may impact risk of preterm birth and NICU admission.

Quality healthcare should be grounded on clinical practice with the highest benefit-risk ratio and cost-effectiveness according to the available scientific evidence. The overuse of unproven diagnostic or therapeutic procedures is common in our setting and leads to increased healthcare spending and even iatrogenic harm. Previous cost-effectiveness initiatives have proposed identifying diagnostic and therapeutic measures that are better 'not done' in certain clinical contexts under the lens of the available scientific evidence. In this regard, the Spanish Society of Endocrinology and Nutrition (SEEN) has compiled a series of 'not-to-do' recommendations from its various working groups. These recommendations cover common clinical situations classified into the following thematic areas: diabetes, nutrition, pituitary gland, neuroendocrine tumors, thyroid, and hormone replacement therapy in postmenopausal women.

Gestational diabetes is one of the most common pregnancy complications, affecting 14% of all pregnancies globally, and its prevalence is increasing. Gestational diabetes is associated with short and long-term complications for both the mother and their offspring, which are possible to prevent by glycemic control mainly facilitated by healthy lifestyle behaviors. Hence, women diagnosed with gestational diabetes have a significant role in disease management which can be perceived as burdensome. Previous research has well documented the psychological implications of diagnosis in the women and the need for support from healthcare. Despite the global burden of disease associated with gestational diabetes, recent qualitative studies exploring women's experiences are scarce, particularly in Sweden. Thus, highlighting a critical gap in understanding the impact of this condition and the women's experiences of diagnosis and prenatal healthcare, which this study aimed to address.

Purposive sampling was used to recruit women with previous gestational diabetes in southern Sweden. Individual interviews were held with 17 participants according to a semi-structured interview guide. The interviews were audio recorded and transcribed verbatim. Data analysis was conducted according to qualitative content analysis.

The analysis generated 10 subcategories, which were grouped into three categories labeled: "experience of diagnosis", "a complex relationship with food" and "experience of prenatal healthcare". One theme emerged: to suddenly become a patient as opposed to an expectant mother. Most women were initially overwhelmed by the diagnosis and its consequences. They felt that healthy eating was important, despite it limiting their everyday lives, which also revealed a complicated relationship with food. Women felt supported during pregnancy but abandoned after labor. They requested additional information and emotional support from healthcare personnel, increased awareness and understanding of the treatment burden of gestational diabetes, improved person-centered care, and collaboration between healthcare providers, particularly to ensure better support in reducing future risk of disease.

This study provides an understanding of women's experience of gestational diabetes and the care provided in southern Sweden. Their views could improve future care regarding both successful gestational diabetes management and post-pregnancy follow-up to prevent long-term adverse health outcomes.

Obesity and pre-diabetes are metabolic disorders associated with insulin resistance (IR). Excess epicardial adipose tissue is also associated with increased IR. The triglyceride-glucose index (TyG) has been evaluated as an alternative measure of the IR in a variety of metabolic and cardiovascular disorders. However, its relationship with EAT thickness has not been studied yet. The study included 176 prediabetic and obese patients. EAT thickness was assessed using echocardiography. EAT thickness, TyG index, anthropometric obesity indices (body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR)), homeostatic model assessment (HOMA-IR), and biochemical parameters were compared. The following correlations between EAT thickness and related parameters were observed: WC (r = .529), BMI (r = .514), ALT (r = .358), TyG index (r = .338), and HOMA-IR (r = .322; P < .001 for all). Multiple regression analysis showed that WC (Beta = .428; P = .004), age (Beta = .223; P < .001), BMI (Beta = .196; P = .029), ALT (Beta = .168; P = .012), and TyG index (Beta = .128; P = .049) were the strongest independent variables correlated with EAT thickness. A model based on WC, BMI, age, TyG index, and ALT provided the best R-square (.387) for estimating EAT thickness (P < .001). The TyG index showed a significant and independent relationship with EAT, suggesting that it may be useful as an indicator of EAT thickness.

Metformin and glyburide monotherapy are used as alternatives to insulin in managing gestational diabetes. Whether a sequential strategy of these oral agents results in noninferior perinatal outcomes compared with insulin alone is unknown.

To test whether a treatment strategy of oral glucose-lowering agents is noninferior to insulin for prevention of large-for-gestational-age infants.

Randomized, open-label noninferiority trial conducted at 25 Dutch centers from June 2016 to November 2022 with follow-up completed in May 2023. The study enrolled 820 individuals with gestational diabetes and singleton pregnancies between 16 and 34 weeks of gestation who had insufficient glycemic control after 2 weeks of dietary changes (defined as fasting glucose >95 mg/dL [>5.3 mmol/L], 1-hour postprandial glucose >140 mg/dL [>7.8 mmol/L], or 2-hour postprandial glucose >120 mg/dL [>6.7 mmol/L], measured by capillary glucose self-testing).

Participants were randomly assigned to receive metformin (initiated at a dose of 500 mg once daily and increased every 3 days to 1000 mg twice daily or highest level tolerated; n = 409) or insulin (prescribed according to local practice; n = 411). Glyburide was added to metformin, and then insulin substituted for glyburide, if needed, to achieve glucose targets.

The primary outcome was the between-group difference in the percentage of infants born large for gestational age (birth weight >90th percentile based on gestational age and sex). Secondary outcomes included maternal hypoglycemia, cesarean delivery, pregnancy-induced hypertension, preeclampsia, maternal weight gain, preterm delivery, birth injury, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal intensive care unit admission.

Among 820 participants, the mean age was 33.2 (SD, 4.7) years). In participants randomized to oral agents, 79% (n = 320) maintained glycemic control without insulin. With oral agents, 23.9% of infants (n = 97) were large for gestational age vs 19.9% (n = 79) with insulin (absolute risk difference, 4.0%; 95% CI, -1.7% to 9.8%; P = .09 for noninferiority), with the confidence interval of the risk difference exceeding the absolute noninferiority margin of 8%. Maternal hypoglycemia was reported in 20.9% with oral glucose-lowering agents and 10.9% with insulin (absolute risk difference, 10.0%; 95% CI, 3.7%-21.2%). All other secondary outcomes did not differ between groups.

Treatment of gestational diabetes with metformin and additional glyburide, if needed, did not meet criteria for noninferiority compared with insulin with respect to the proportion of infants born large for gestational age.

Netherlands Trial Registry Identifier: NTR6134.

Pre-gestational diabetes occurs in approximately 1% of pregnancies in the UK and increases the risk of adverse maternal and fetal outcomes. More women with type 2 than type 1 diabetes are now becoming pregnant and tend to have higher rates of obesity and other multi-morbidities. Chronic kidney disease (CKD) affects approximately 5%-10% of pregnant women with type 1 diabetes and about 2%-3% with type 2 diabetes. Diabetic chronic kidney disease (DCKD) increases the risk of preeclampsia, preterm birth, Caesarean section, small for gestational age (SGA) infant and infant admission to neonatal intensive care unit (NICU), and risks are higher compared to those with diabetes without CKD and those with CKD from other causes. Definitions of CKD in pregnancy are not standardised, and studies are generally small, observational, heterogenous, mainly include women with type 1 diabetes and often predate modern diabetes management such as continuous glucose monitoring and insulin pumps. Therefore, there is a lack of robust data to guide practice and clinical guidelines offer conflicting advice, without precise detail.

We present our approach to caring for women with diabetes and CKD in pregnancy based on available guidelines and clinical experience.

Our practice is to aim for intensive targets for blood pressure and glycaemic control pre and during pregnancy, lower than suggested in many guidelines. The importance of multidisciplinary team work and patient centred care is emphasised. Using standardised prospective data collection to better understand the prevalence and outcomes of diabetes and CKD in contemporary pregnancy populations, is recommended to drive future improvements in care.

The aim of this study was to evaluate differences in circulating maternal placental biomarkers and fetoplacental Dopplers in women with diabetes mellitus in pregnancy (DIP) with prenatally identified small fetuses (defined as <20th centile for gestational age) compared to women with small fetuses without DIP.

This was a prospective cohort study of women with DIP with small infants compared to a non-diabetic cohort with similarly small fetuses. Multivariable logistic regression was used to evaluate the effect of DIP on placental biomarkers, fetoplacental Dopplers, and adverse perinatal outcomes.

There were 447 pregnancies in this study - 117 (26.2 %) had DIP and 330 (73.8 %) did not have diabetes. Of the DIP cohort, 57 (48.7 %) had early-onset and 27 (23.1 %) had late-onset FGR. Higher rates of low PlGF levels<100 ng/L (42.1 % vs. 25.7 %,p = 0.002), high sFlt-1/PlGF ratio (39.6 % vs. 25.4 %,p = 0.006), low MCA PI < 5th centile at recruitment (18.8 % vs. 7.6 %,p < 0.001, OR 2.37 95%CI 1.25, 4.46,p = 0.008), abnormal UA Doppler before delivery (OR 1.63 95%CI 1.00, 2.66,p = 0.048) were seen in the DIP cohort. DIP was associated with higher rates of emergency cesarean section (43.6 % vs. 26.7 %,p = 0.001) and lower birthweight (2300 (1558, 2610g) vs. 2447 (2050, 2690g),p = 0.003). The odds of early FGR (OR 1.90 95%CI 1.20, 2.98,p = 0.006), PTB<37 weeks (OR 1.66 95%CI 1.02, 2.70,p = 0.039), PTB<34 weeks' gestation (OR 3.00 95%CI 1.51, 5.96,p = 0.002), composite non-neurological neonatal morbidity (OR 1.86 95%CI 1.04, 3.33,p = 0.037), and hypoglycemia (OR 3.69 95%CI 1.59, 8.54,p = 0.002) were significantly higher in DIP.

DIP is associated with increased risks of early-onset FGR, PTB, composite severe non-neurological neonatal morbidity, and neonatal hypoglycemia in women with small infants. DIP was significantly associated with increased odds of MCA PI < 5th centile at diagnosis and abnormal UA Doppler before birth.

Xylooligosaccharides (XOS) ameliorate insulin resistance (IR) in gestational diabetes mellitus (GDM) probably by propagating Akkermansia muciniphila (Akk). This study aimed to investigate the effects and mechanisms of XOS, Akk and combination on IR in GDM mice/pseudo-germ-free (PGF) mice. Female mice were fed with AIN-93 (n = 19) and high fat diet (HFD) (n = 206). After 4 weeks, HFD-fed mice were further allotted to HFD, GDM, GDM + XOS, GDM + Akk, GDM + XOS + Akk, GDM + PGF, GDM + PGF + XOS, GDM + PGF + Akk, and GDM + PGF + XOS + Akk groups (n ≥ 19). GDM was induced by intraperitoneally injecting streptozotocin and PGF was established by intragastrically administrating antibiotic cocktails. XOS (500 mg/kg·BW) or/and Akk (4 × 108 CFU) were gavaged once a day for 10 days. Fasting blood glucose (FBG), insulin, oral glucose tolerance test (OGTT) and insulin signaling pathway were determined. Gut microbiota were detected by 16S rRNA sequencing and absolute quantities of Akk by qRT-PCR. Intestinal tissues were stained by Hematoxylin-Eosin and Periodic acid-Schiff-Alcian blue staining. Occludin and Zonula occludens-1 (ZO-1) in intestine, Natural killer group 2 member D (NKG2D) on intestinal epithelial lymphocytes (IELs) and NKG2D ligands (NKG2DL) on intestinal epithelial cells (IECs) were detected by Western blotting. In GDM mice, XOS, Akk and XOS + Akk reduced (p < 0.05) the area under the curve of OGTT (AUC), insulin and homeostasis model assessment of insulin resistance (HOMA-IR), and increased (p < 0.05) protein kinase B (Akt) phosphorylation in liver and insulin receptor substrate 1 (IRS-1) phosphorylation in muscle. Furthermore, XOS + Akk reduced (p < 0.05) FBG and increased (p < 0.05) Akt phosphorylation in muscle and IRS-1 phosphorylation in liver. XOS, Akk and XOS + Akk reshaped gut microbiota with XOS + Akk exhibiting the greatest effectiveness. XOS increased (p < 0.05) Akk and clearance of gut microbiota abolished such effect. XOS, Akk and XOS + Akk reduced (p < 0.05) the small intestine Chiu's score and the colon Dieleman's scores, increased (p < 0.05) ZO-1 and Occludin, and reduced (p < 0.05) NKG2D on IELs and NKG2DLs (H60, MULT-1, Rae-1ε) on IECs. Moreover, XOS + Akk reduced (p < 0.05) MULT-1 in duodenum. Collectively, XOS and Akk synergistically ameliorate IR by reshaping gut microbiota, improving intestinal barrier and regulating NKG2D/NKG2DL signaling in GDM mice.

Gestational diabetes mellitus (GDM) is a prevalent medical complication in pregnancy that is rapidly escalating worldwide, with epidemic implications. This systematic review aims to identify fetal brain changes using neurosonography and pinpoint potential markers for the early diagnosis of GDM. We conducted a literature search from 6 January 2013 to 4 September 2024 to identify studies examining fetal brain development using ultrasound in pregnancies affected by GDM compared to uncomplicated pregnancies. The outcome measures included the cavum septum pellucidum (CSP), corpus callosum (CC), lateral ventricle (LV), cisterna magna (CM), transcerebellar diameter (TCD), cerebral fissures (CF), and others. For pregnancies affected by GDM, results were reported. Five studies were included. The findings suggest that the width of the CSP was larger in fetuses of mothers with GDM compared to the control group, and the mean widths of LVs were also larger in the fetuses of diabetic mothers compared to the control group. The influence of GDM on fetal brain development as assessed by neurosonography necessitates thorough investigation in future studies.

Gestational diabetes mellitus is a worldwide health issue in pregnancy, posing a threat to both mother and child. One of the major risk factors for the development of gestational diabetes mellitus is polycystic ovary syndrome, primarily due to the biochemical hyperandrogenism and metabolic issues, commonly observed in these patients. In recent years, the Expert Group on Inositol in Basic and Clinical Research and on PCOS (EGOI-PCOS) has sought to better understand the pathogenesis behind polycystic ovary syndrome, in order to accurately diagnose and treat patients according to their individual needs. Through the scope of polycystic ovary syndrome, this position paper examines the characteristics of both conditions, and underlying biological mechanisms, before moving on to common treatment strategies to avoid or treat gestational diabetes mellitus in women with polycystic ovary syndrome.

Sociocultural and behavioral factors have a multifaceted impact on maternal health. In Thailand, cultural influences significantly shape behaviors of diabetes self-management in women. However, the experience of self-managing diabetes in pregnant women with preexisting Type 2 Diabetes Mellitus (T2DM) remains unclear.

The study aimed to explore challenges and support factors of diabetes self-management among pregnant women with preexisting T2DM in Thailand, and to compare these factors between women in two groups (optimal and suboptimal maternal health outcomes).

A convergent mixed-methods study was conducted at a tertiary hospital (March to October 2022). Eligible participants were Thai pregnant women, aged 20-44, diagnosed with T2DM. Participants first completed a questionnaire and then were interviewed about diabetes self-management. Maternal health outcomes (i.e., gestational weight gain and glycated hemoglobin [HbA1c]) were reviewed and extracted. Descriptive statistics were used for quantitative analysis, while directed content analysis was used for qualitative data. Side-by-side matrices were used to describe the qualitative subthemes with quantitative results.

Twelve Thai pregnant women participated in the study, aged 27 to 40 years, with gestational ages ranging from 7 to 38 weeks and T2DM diagnoses spanning from 3 weeks to 10 years. Half of the participants were obese before pregnancy. Weight gain patterns revealed that 41.67% had inadequate gain, 33.33% had optimal gain, and 25% had excessive gain. HbA1C levels indicated that 75% had good glycemic control. Three women achieved optimal weight gain and glycemic control, while nine exhibited suboptimal health outcomes. We identified six main themes: 1) challenges at the individual level in managing diabetes, 2) support factors at the individual level for diabetes management, 3) challenges at the interpersonal level in controlling diet, 4) interpersonal support factors for managing diabetes, 5) challenges at the societal level in accessing healthcare, and 6) societal support factors for healthcare access.

The findings suggest that managing diabetes during pregnancy necessitates dynamic, patient-centered care throughout the pregnancy journey. Regarding the clinical implication, it is important to tailor approaches to the Thai context and to prioritize education and boost women's confidence in managing diabetes throughout pregnancy.

Carbohydrate intake (CI) has the largest impact on the short-term glycaemia of all nutrients, yet optimal CI management in gestational diabetes remains unclear.

To examine CI behaviours in individuals with recently diagnosed gestational diabetes and their association with self-monitored blood glucose.

Data from 97 individuals were collected using food and blood glucose diaries. CI (including amounts, types, and timing) was manually assessed using 15 g servings over 5-8 days, while a 3-day computerised analysis examined a broader intake of macro- and micronutrients.

Elevated fasting glycaemia (EFG) was associated with lower total CI (Mdn 10.8 vs. 12.5 servings/day, p = 0.006), missed meals (Mdn 1.4 vs. 0.0/week, p = 0.007), missed snacks (Mdn 10.5 vs. 7.5/week, p = 0.038), low-carbohydrate meals (<30 g; Mdn 4.3 vs. 2.0/week, p = 0.004), and a higher proportion of energy intake from fat (Mdn 35% vs. 33%, p = 0.047), as compared with in-target fasting glycaemia. In contrast, elevated postprandial glycaemia (EPG) was not significantly associated with total CI, low-carbohydrate meals (<30 g), low-carbohydrate snacks (<15 g), or high-carbohydrate loads (>50 g). EPG was instead associated with high-glycaemic index meals (Mdn 1.6 vs. 0.9 lunch meals/week, p = 0.026; Mdn 0.9 vs. 0.0 dinner meals/week, p = 0.023); and a lower intake of energy (Mdn 7650 kJ vs. 9070 kJ/day, p = 0.031), protein (Mdn 91 g vs. 109 g/day, p = 0.015), fat (Mdn 61 g vs. 84 g/day, p = 0.003), and multiple micronutrients (p <0.05), as compared with in-target postprandial glycaemia.

CI profiles differed for individuals with EFG, as compared with EPG, emphasising the need for dietary guidelines tailored for gestational diabetes subtypes. Further interventional studies are needed to explore these findings, particularly the associations between EFG and low CI behaviours.

There has been accumulating evidence over the past two decades that metformin can be an effective treatment for gestational diabetes mellitus (GDM) in women whose diet and exercise fail to attain optimal glycemic control. The objective of this review was to comprehensively analyze all studies investigating the effectiveness of metformin compared to insulin and other drugs utilized for the treatment of GDM. After a comprehensive literature review based on PRISMA 2020, 35 studies were included after a selection process utilizing predetermined inclusion and exclusion criteria. A variety of short-term maternal and neonatal outcomes were assessed. Metformin is a highly efficient medication for attaining optimal control of blood sugar levels in women with GDM, resulting in a significant reduction in the amount of weight gained during pregnancy. Regarding additional maternal outcomes, such as pregnancy-induced hypertension and cesarean deliveries, some studies demonstrate a link between metformin and a reduced occurrence of both conditions. In contrast, others do not find an association. Regarding short-term neonatal outcomes, metformin does not exhibit any changes in gestational age at delivery. In contrast, metformin demonstrated substantial decreases in the likelihood of greater gestational birth weight and neonatal hospitalization when compared to other drugs. When compared primarily to insulin, metformin decreases the probability of several short-term outcomes related to pregnancy and newborns. Additional data are necessary for extended follow-up studies, including patients with GDM treated with metformin.

Gestational Diabetes Mellitus (GDM) is a common endocrine condition associated with adverse pregnancy outcomes. In recent years, a growing number of risk factors associated with gestational diabetes mellitus have been defined. GDM poses a serious threat to maternal health. The etiology is complex and multifactorial and can be divided into inherent and modifiable factors. The inherent factors have been described in other literature, while the modifiable factors are mainly the risk of lifestyle habits. In this study, we performed a narrative review of the progress of risk factors associated with gestational diabetes mellitus.

In Singapore, diabetes imposes a huge population health and economic burden. Despite that, there is paucity of evidence on the health economics of screening programs for type 2 diabetes, especially in the context of screening after gestational diabetes (GDM). The objective of this study is to assess cost-effectiveness of universal lifelong screening for type 2 diabetes after GDM, which is supported by current guidelines, compared with elective screening where 54% of mothers with GDM undertake one-off screening. Despite the recommendation for universal lifelong screening, only 54% comply with this in the first postpartum year.

We perform a cost-effectiveness analysis comparing 5 screening strategies, accounting for lifetime costs to the healthcare system and quality of life for Singapore women diagnosed with GDM. In particular, a hybrid decision model, based on a decision tree and Markov models, is implemented to estimate cost and quality-adjusted life-years (QALY). Probabilities, costs, and utilities are obtained from existing literature, governmental databases, the Growing Up in Singapore Towards Healthy Outcomes birth cohort study, and the National University Hospital.

Compared with elective screening, universal annual screening reduces cost by SG$19.4 million while adding 3.8 thousand QALYs by each annual cohort of pregnant women. Furthermore, annual screening is cost-effective (lower cost and higher QALY) compared with triennial screening. Sensitivity analysis shows that the findings are robust to parameter specifications.

Universal annual screening of women with a history of GDM is cost-effective for reducing diabetes complications compared with strategies with less frequent screening in Singapore.

Gestational diabetes mellitus (GDM) has been associated with several fetal complications, such as macrosomia and fetal growth restriction (FGR). Infants from GDM associated FGR are at increased risk for adult-onset obesity and associated metabolic disorders. However, the underlying mechanisms of GDM associated FGR remain to be explored.

We analyzed placentas from GDM patients with FGR for ferroptosis markers and GLUT1 expression. High glucose conditions were established by adding different concentrations of D-Glucose to the 1640 cell culture medium. RSL3 were used to test ferroptosis sensitivity in trophoblast cells. GLUT1 was inhibited using siRNA or its inhibitor WZB117 to assess its impact on ferroptosis inhibition in HTR8/SVneo cell line. Mechanistic studies explored the effects of GLUT1 on AMPK and ACC phosphorylation, which in turn impacted lipid metabolism and ferroptosis. In mouse models, streptozotocin (STZ)-induced GDM was treated with WZB117 and the ferroptosis inhibitor liproxstatin-1 (Lip-1). Finally, AMPK and ACC phosphorylation levels were evaluated in GDM patient samples.

In this study, placentas from GDM patients with FGR showed signs of ferroptosis and upregulation of GLUT1. In cell models, high glucose conditions sensitized trophoblast cells to ferroptosis and induced GLUT1 expression. Interestingly, GLUT1 inhibition significantly suppressed ferroptosis in trophoblast cells under high glucose conditions. Mechanistically, elevated GLUT1 inhibited AMPK phosphorylation and reduced ACC phosphorylation, thereby promoting lipid synthesis and facilitating ferroptosis. In pregnant mice, STZ-induced hyperglycemia led to FGR, and treatment with either the GLUT1 inhibitor WZB117 or the ferroptosis inhibitor Lip-1 alleviated the FGR phenotype. Moreover, in vivo elevation of GLUT1 increased ferroptosis markers, decreased AMPK/ACC phosphorylation, and resulted in altered lipid metabolism, which likely contributed to the observed phenotype. Finally, placental samples from GDM patients showed reduced AMPK and ACC phosphorylation.

Our findings suggest a potential role of ferroptosis in GDM associated FGR and indicate that the dysregulated GLUT1-AMPK-ACC axis may be involved in the pathogenesis of GDM associated FGR in clinicals.

The evaluation and diagnosis of altered mental status in the pregnant or postpartum patient largely parallels the approach used for any other patient; however, there are several critical differences including that some neuroobstetric diagnoses require emergent delivery of the fetus. Being familiar with the physiological changes and medical complications of pregnancy and delivery is therefore essential. This review first addresses pregnancy-specific disorders that may result in altered mental status, such as the hypertensive disorders of pregnancy and pregnancy-related metabolic and endocrinopathies. The focus then shifts to the complex physiologic changes in pregnancy and how these changes contribute to the distinct epidemiology of pregnancy-related cerebrovascular complications like intracranial hemorrhage, ischemic stroke, and reversible cerebral vasoconstriction syndrome. Medical disorders that are not unique to pregnancy, such as infections and autoimmune conditions, may present de novo or worsen during pregnancy and the peripartum period and require a thoughtful approach to diagnosis and management. Finally, the unique nervous system complications of obstetric anesthesia are explored. In each section, there is a focus not only on diagnosis and syndrome recognition but also on the emergent treatment needed to reverse these complications, bearing in mind the unique physiology of the pregnant patient.

Adolescents with diabetes mellitus (DM) experience poorer glycemic outcomes and lower adherence to self-management regimens compared to other age groups. The coronavirus 2019 (COVID-19) pandemic posed new barriers to DM self-management, including social distancing measures and additional stressors. We conducted a scoping review of peer-reviewed literature to examine self-management regimens and outcomes among adolescents aged 10-17 years with type 1 and type 2 DM during the pandemic. Our scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched three online databases, screened articles through a rigorous process, and assessed bias using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. The findings from the included articles were categorized into six thematic areas: glycemic control/monitoring, insulin administration/regimens, weight/lifestyle behaviors, inpatient care/acute complications, outpatient care/telemedicine utilization, and psychosocial well-being. The findings from the included articles (n = 32) varied. Adolescents who used continuous glucose monitoring (CGM), regularly adjusted insulin doses, and utilized telemedicine generally maintained or improved glycemic control during the pandemic. However, many adolescents gained weight, reduced their physical activities, worsened their diet and sleep habits, and experienced increased stress, all of which negatively impacted glycemic control. Rates of acute complications and hospitalizations varied among adolescents. Telemedicine was widely used and viewed positively by adolescents with DM. Adolescents with DM faced various physical, behavioral, and psychosocial challenges during the COVID-19 pandemic. Further research is needed to assess the long-term impacts of the pandemic on this population. Multilevel interventions and preparedness efforts are required to improve and sustain adolescents' DM self-management outcomes during public health emergencies, particularly focused on promoting CGM use, increasing physical activity levels, improving dietary habits, and reducing stress.

Pregnancy is a critical period marked by intricate physiological changes and maintaining maternal and fetal well-being is paramount. Inositols, a group of naturally occurring sugar alcohols, have gained attention for their potential benefits during pregnancy. This abstract provides a comprehensive review of the current literature on using inositols, primarily myo-inositol (MI) and D-chiro-inositol (DCI) in pregnancy. Inositols are crucial in cellular signal transduction and insulin sensitivity, making them integral to various physiological processes. Several studies suggest that inositols may contribute to preventing and managing gestational diabetes mellitus (GDM). MI, in particular, has shown promise in improving insulin sensitivity and mitigating insulin resistance, thereby influencing glucose metabolism. As our understanding of inositol's role in pregnancy deepens, it may emerge as a valuable supplement to enhance maternal and fetal health outcomes.

Minipuberty is thought to play an important role in the sexual maturation of infants. Maternal disorders during pregnancy were found to have an impact on the activity of the reproductive axis in the first year of life. This prospective, matched, cohort study was aimed at investigating whether the course of minipuberty in boys is affected by maternal gestational diabetes mellitus (GDM).

The study population consisted of three matched groups of boys: infants born to women with poorly controlled GDM, sons of women with adequately controlled GDM, and infants of healthy women with normal carbohydrate tolerance during pregnancy (control group). Salivary levels of testosterone, androstenedione, DHEA-S and estradiol, and urinary concentrations of FSH and LH were repeatedly measured over the first 12 months of life. Hormone levels were correlated with the size of genital organs (testicular volume and penile length), which were measured at each visit.

Compared with the remaining groups, the male offspring of women with poorly controlled GDM were characterized by higher concentrations of both gonadotropins, higher salivary testosterone levels, lower salivary DHEA-S concentrations, and longer periods of detection for LH and testosterone. Levels of gonadotropin, testosterone and DHEA-S in sons of mothers with poorly controlled GDM correlated with mean levels of glycated hemoglobin during pregnancy. Moreover, the infant boys assigned to this group were characterized by larger sizes of the testes and penis. Over the entire study period, there were no differences in hormone levels, testicular volume and penile length between sons of adequately treated women with GDM and sons of healthy women.

The obtained results indicate that GDM, if poorly controlled, may affect the activity of the reproductive axis and postnatal growth of male genital organs in the offspring.

To assess the best method for measuring the fetal pancreas, provide nomograms and evaluate the effect of GDM on it.

A total of 271 singleton fetuses (17-36 weeks) were included in this study. Measurements of pancreatic parameters established reference ranges. Repeatability and consistency analyzed. GDM impact on fetal pancreatic growth assessed.

Measurements of fetal pancreatic parameters fell within the 95 % confidence interval when performed by the same or different physicians. Pancreatic midline longitudinal axis demonstrated the best intraclass correlation coefficients (ICC) and follow by the pancreatic circumference. The successful display rate and measured parameters of the integral fetal pancreas achieved 90.3 %. Pancreatic midline longitudinal axis and circumference increased with gestational age, with significant differences observed among fetuses at different gestational ages (F=2060 and F=2264, p<0.05). Pancreatic midline longitudinal axis and circumference in normal fetuses from 17 to 36 weeks of gestation were positively correlated with gestational age and abdominal circumference. Poorly controlled GDM fetuses exhibited significantly larger pancreatic midline longitudinal axis and circumference compared to the normal group fetuses (Z-values were -3.82 and -3.77, both p<0.01), while no significant differences were found between well-controlled GDM group fetuses and normal group fetuses (Z-values were -0.59 and -0.042, both p>0.05).

Ultrasound method using anatomical landmarks to measure the fetal pancreatic midline longitudinal axis and circumference is reliable. Pancreatic measurements increase with gestational age. Poorly controlled gestational diabetes can lead to enlargement of the fetal pancreas.