|
1
|
Kong D, Kowalik O, Garratt E, Godfrey KM, Chan SY, Teo AKK. Genetics and epigenetics in gestational diabetes contributing to type 2 diabetes. Trends Endocrinol Metab 2025:S1043-2760(25)00074-8. [PMID: 40280863 DOI: 10.1016/j.tem.2025.03.014] [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: 11/18/2024] [Revised: 03/21/2025] [Accepted: 03/28/2025] [Indexed: 04/29/2025]
Abstract
Gestational diabetes mellitus (GDM) is a common pregnancy complication and a risk factor for the subsequent development of type 2 diabetes (T2D) in mothers and of several metabolic diseases in offspring. However, the molecular underpinnings of these risks are not well understood. Genome-wide association studies (GWAS) and epigenetic studies may provide complementary insights into the causal relationships between GDM exposure and maternal/offspring metabolic outcomes. In this review we discuss the potential pathophysiological roles of specific genetic variants and commonly reported differentially methylated loci in GDM development, and their link to the progression to T2D in both the mother and the offspring in later life, pointing to the potential for tailored interventional strategies based on these genetic and epigenetic mechanisms.
Collapse
Affiliation(s)
- Dewei Kong
- Stem Cells and Diabetes Laboratory, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore 138673, Singapore; Dean's Office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Oliwia Kowalik
- Stem Cells and Diabetes Laboratory, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore 138673, Singapore; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Human Development and Health, University of Southampton, Southampton, UK
| | - Emma Garratt
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Human Development and Health, University of Southampton, Southampton, UK
| | - Keith M Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Human Development and Health, University of Southampton, Southampton, UK; Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Shiao-Yng Chan
- Institute for Human Development and Potential (IHDP), A*STAR, Singapore 117609, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Adrian Kee Keong Teo
- Stem Cells and Diabetes Laboratory, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore 138673, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Precision Medicine Translational Research Programme (TRP), National University of Singapore, Singapore 119228, Singapore.
| |
Collapse
|
|
2
|
Brito Nunes C, Borges MC, Freathy RM, Lawlor DA, Qvigstad E, Evans DM, Moen GH. Understanding the Genetic Landscape of Gestational Diabetes: Insights into the Causes and Consequences of Elevated Glucose Levels in Pregnancy. Metabolites 2024; 14:508. [PMID: 39330515 PMCID: PMC11434570 DOI: 10.3390/metabo14090508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 09/28/2024] Open
Abstract
Background/Objectives: During pregnancy, physiological changes in maternal circulating glucose levels and its metabolism are essential to meet maternal and fetal energy demands. Major changes in glucose metabolism occur throughout pregnancy and consist of higher insulin resistance and a compensatory increase in insulin secretion to maintain glucose homeostasis. For some women, this change is insufficient to maintain normoglycemia, leading to gestational diabetes mellitus (GDM), a condition characterized by maternal glucose intolerance and hyperglycaemia first diagnosed during the second or third trimester of pregnancy. GDM is diagnosed in approximately 14.0% of pregnancies globally, and it is often associated with short- and long-term adverse health outcomes in both mothers and offspring. Although recent studies have highlighted the role of genetic determinants in the development of GDM, research in this area is still lacking, hindering the development of prevention and treatment strategies. Methods: In this paper, we review recent advances in the understanding of genetic determinants of GDM and glycaemic traits during pregnancy. Results/Conclusions: Our review highlights the need for further collaborative efforts as well as larger and more diverse genotyped pregnancy cohorts to deepen our understanding of the genetic aetiology of GDM, address research gaps, and further improve diagnostic and treatment strategies.
Collapse
Affiliation(s)
- Caroline Brito Nunes
- Institute for Molecular Bioscience, The University of Queensland, Brisbane 4067, Australia
| | - Maria Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 1QU, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Rachel M. Freathy
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX4 4PY, UK;
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 1QU, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - David M. Evans
- Institute for Molecular Bioscience, The University of Queensland, Brisbane 4067, Australia
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 1QU, UK
- Frazer Institute, University of Queensland, Brisbane 4102, Australia
| | - Gunn-Helen Moen
- Institute for Molecular Bioscience, The University of Queensland, Brisbane 4067, Australia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
- Frazer Institute, University of Queensland, Brisbane 4102, Australia
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| |
Collapse
|
|
3
|
AlShaibani T, Gherbal W, Almarabheh A, Rizk D, Alhakmani E, Alshamrani R, AlBahraini F, Taha H, Hassani A, Naguib Y. Insulin Blood Levels in Gestational Diabetes Mellitus in Relation to Ethnicity and Age in the Kingdom of Bahrain: A Cross-Sectional Study. Cureus 2024; 16:e64886. [PMID: 39035597 PMCID: PMC11258594 DOI: 10.7759/cureus.64886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It may be attributed to certain placental hormones during pregnancy which render insulin less effective. Our study aimed to focus on the levels of insulin in gestational diabetic women in the Kingdom of Bahrain as compared with non-diabetic pregnant women. Furthermore, we studied the correlation between insulin levels by ethnicity and age of the pregnant women. Methods: A cross-sectional study was conducted on 75 pregnant participants: 41 with GDM (test group) and 34 without GDM (control group). Insulin levels were determined in patients with GDM and compared to non-diabetic pregnant women. A comparison between Bahraini and non-Bahraini women was carried out in two different age groups: below and above 30 years of age. P values < 0.05 were considered significant. RESULTS The results showed higher mean values of fasting blood glucose (FBG), random blood glucose (RBG), and insulin levels in the test group when compared to the control group. There was no significant difference in FBG, RBG, and insulin levels among Bahraini women with GDM and non-Bahraini women (Indian, Pakistani. Bengali, and Filipino) with GDM. Age, less than 30 vs more than 30 years, had no significant effect on women with GDM. CONCLUSION Insulin levels were higher in pregnant women with GDM irrespective of their ethnicity or age. The lack of blood glucose control in GDM even in the presence of high insulin secretion may suggest loss of insulin effectiveness due to other factors such as stress and lactogenic placental hormones.
Collapse
Affiliation(s)
| | - Wadeea Gherbal
- Department of Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR
| | - Amer Almarabheh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, BHR
| | - Diaa Rizk
- Department of Obstetrics and Gynecology, Arabian Gulf University, Manama, BHR
| | - Elaf Alhakmani
- Department of Obstetrics and Gynecology, Arabian Gulf University, Manama, BHR
| | - Raghad Alshamrani
- Department of Obstetrics and Gynecology, Arabian Gulf University, Manama, BHR
| | - Farah AlBahraini
- Department of Obstetrics and Gynecology, Arabian Gulf University, Manama, BHR
| | - Husain Taha
- Department of Internal Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Amal Hassani
- Department of Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR
| | - Yahya Naguib
- Department of Physiology, Arabian Gulf University, Manama, BHR
- Department of Clinical Physiology, Faculty of Medicine, Menoufia University, Shibin El Kom, EGY
| |
Collapse
|
|
4
|
Afraie M, Moradi G, Zamani K, Azami M, Moradi Y. The effect of hepatitis B virus on the risk of pregnancy outcomes: a systematic review and meta-analysis of cohort studies. Virol J 2023; 20:213. [PMID: 37710321 PMCID: PMC10500763 DOI: 10.1186/s12985-023-02182-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The effect of HBV on neonatal and maternal outcomes can create a basis for more accurate clinical decision-making. So, the aim of this meta-analysis is to detrmine the effect of chronic hepatitis B virus on the risk of pregnancy outcomes by combining cohort studies. METHODS International databases in this meta-analysis included the Cumulated Index to Nursing and Allied Health Literature (CINAHL), SPORT Discuss via the EBSCO interface, PubMed (Medline), Scopus, Web of Science, Embase, which were searched up to April 2023. All cohort studies reporting the risk ratio (RR) with a 95% confidence interval (CI) were included in the study. The quality assessment was done based on the Newcastle-Ottawa Scale (NOS). RESULTS Finally, thirty-five cohort studies were selected for meta-analysis. Outcomes of interest included pre-eclampsia, gestational diabetes, abortion, preterm birth, infant death, and other related outcomes. Results showed that the pooled RR for incident gestational diabetes in pregnant women with choronic hepatitis B infection was 1.16 (RR: 1.16; 95% CI 1.13-1.18; I-square: 92.89%; P value: 0.00). Similarly, the association between the presence of hepatitis B infection in pregnant women and the occurrence of pre-eclampsia was 1.10 (RR: 1.10; 95% CI 1.04-1.16; I-square: 92.06%; P value: 0.00). The risk of preterm delivery in pregnant women with hepatitis B infection was 1.17 times that of pregnant women without hepatitis B infection (RR: 1.17; 95% CI 1.14-1.20; I-squared: 94.32%; P value: 0.00). CONCLUSION This meta-analysis found that hepatitis B infection during pregnancy may be associated with an increased risk of gestational diabetes, preterm delivery, pre-eclampsia, and eclampsia. However, confirmation of this association, as well as the specific biological pathways involved in the association between HBV infection and pregnancy outcomes, requires further investigation.
Collapse
Affiliation(s)
- Maryam Afraie
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kamran Zamani
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mobin Azami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
|
5
|
Ahmed AE, Abdelkarim S, Zenida M, Baiti MAH, Alhazmi AAY, Alfaifi BAH, Majrabi RQM, Khormi NQM, Hakami AAA, Alqaari RAM, Alhasani RA, Alajam RA, Alshehri MM, Alenazi AM, Alqahtani B, Alshamrani M, Alhowimel A, Abdelwahab SI. Prevalence and Associated Risk Factors of Urinary Tract Infection among Diabetic Patients: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11060861. [PMID: 36981518 PMCID: PMC10048613 DOI: 10.3390/healthcare11060861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
Urinary tract infections (UTIs) are one of the most common long-term complications of diabetes mellitus (DM). Additionally, various factors, such as socio-demographics, type of DM, fasting blood glucose, regular diabetes monitoring, comorbid chronic diseases, HbA1c, body mass index (BMI), and duration of DM, are also thought to predispose individuals to developing UTIs more frequently when they have DM. This research aims to evaluate the risk factors for UTIs and their prevalence among people with DM in Saudi Arabia (KSA). This cross-sectional study was conducted among 440 adults with type 1, type 2, and gestational DM. The participants had to be at least 18 years old, of both genders, and had been suffering from DM for any period of time. A self-administered questionnaire was utilized to collect data on demographic characteristics, such as sex, age, height, weight, material state, education level, income, and clinical profiles of DM and UTI. The crude (COR) and adjusted odds ratios (AOR) were calculated using logistic regression in the IBM SPSS software. The incidence of types 1 and 2 DM and gestational diabetes reached 34.1, 60.9, and 5%, respectively. Most of the participants had first-degree relatives with DM (65.9%). UTI was common in 39.3% of participants. A chi-squared statistical analysis revealed that the frequency of UTI varied depending (χ2 = 5.176, P = 0.023) on the type of DM. Burning urination and abdominal pain were the most common symptoms. The CORs for sex, marital status, hypertension, and BMI were significant (P < 0.05) and had values of 2.68 (95% CI = 1.78–4.02), 0.57 (95% CI = 0.36–0.92), 1.97 (95% CI = 1.14–3.43), and 2.83 (95% CI = 1.19–2.99), respectively. According to the adjusted model, only sex influenced the occurrence of UTIs. The AOR for sex was 3.45 (95% CI = 2.08–5.69). Based on this study, the authorities related to the health of DM patients can use its findings to guide awareness programs and clinical preparedness.
Collapse
Affiliation(s)
- Anas Elyas Ahmed
- Faculty of Medicine, Jazan University, Jazan GGGD6622, Saudi Arabia
| | | | - Maria Zenida
- Faculty of Medicine, Jazan University, Jazan GGGD6622, Saudi Arabia
| | | | | | | | | | | | | | | | | | - Ramzi Abdu Alajam
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan GGGD6622, Saudi Arabia
| | - Mohammed M. Alshehri
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan GGGD6622, Saudi Arabia
- Medical Research Centre, Jazan University, Jazan GGGD6622, Saudi Arabia
| | - Aqeel M. Alenazi
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan GGGD6622, Saudi Arabia
| | - Bader Alqahtani
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan GGGD6622, Saudi Arabia
| | - Meshal Alshamrani
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan GGGD6622, Saudi Arabia
| | - Ahmed Alhowimel
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan GGGD6622, Saudi Arabia
| | | |
Collapse
|
|
6
|
Harrison J, Melov S, Kirby AC, Athayde N, Boghossian A, Cheung W, Inglis E, Maravar K, Padmanabhan S, Luig M, Hook M, Pasupathy D. Pregnancy outcomes in women with gestational diabetes mellitus by models of care: a retrospective cohort study. BMJ Open 2022; 12:e065063. [PMID: 36167384 PMCID: PMC9516164 DOI: 10.1136/bmjopen-2022-065063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare birth outcomes of women with gestational diabetes mellitus (GDM) with background obstetric population, stratified by models of care. DESIGN Retrospective cohort study. SETTING A tertiary referral centre in Sydney, Australia. PARTICIPANTS All births 1 January 2018 to 30 November 2020. Births <24 weeks, multiple gestations and women with pre-existing diabetes were excluded. METHODS Data were obtained from electronic medical records. Women were classified according to GDM status and last clinic attended prior to delivery. Model of care included attendance at dedicated GDM obstetric clinics, and routine antenatal care. MAIN OUTCOME MEASURES Hypertensive disorders of pregnancy (HDP), pre-term birth (PTB), induction of labour (IOL), operative delivery, small for gestational age (SGA), large for gestational age, postpartum haemorrhage, obstetric anal sphincter injury (OASIS), neonatal hypoglycaemia, neonatal hypothermia, neonatal respiratory distress, neonatal intensive care unit (NICU) admission. RESULTS The GDM rate was 16.3%, with 34.0% of women managed in dedicated GDM clinics. Women with GDM had higher rates of several adverse outcomes. Only women with GDM attending non-dedicated clinics had increased odds of HDP (adjusted OR (adj OR) 1.6, 95% CI 1.2 to 2.0), PTB (adj OR 1.7, 95% CI 1.4 to 2.0), OASIS (adj OR 1.4, 95% CI 1.0 to 2.0), similar odds of induction (adj OR 1.0, 95% CI 0.9 to 1.1) compared with non-GDM women. There were increased odds of NICU admission (adj OR 1.5, 95% CI 1.3 to 1.8) similar to women attending high-risk GDM clinics. CONCLUSIONS Women with GDM receiving care in lower risk clinics had similar or higher rates of adverse outcomes. Pathways of care need to be similar in all women with GDM.
Collapse
Affiliation(s)
- Jackson Harrison
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sarah Melov
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Adrienne C Kirby
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Neil Athayde
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Araz Boghossian
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Wah Cheung
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Emma Inglis
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kavita Maravar
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Suja Padmanabhan
- Westmead Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Melissa Luig
- Westmead Department of Neonatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Monica Hook
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| |
Collapse
|
|
7
|
Al-Shwyiat RMM, Radwan AM. Fetal anomalies in gestational diabetes mellitus and risk of fetal anomalies in relation to pre-conceptional blood sugar and glycosylated hemoglobin. JOURNAL OF MOTHER AND CHILD 2022; 26:73-77. [PMID: 36803943 PMCID: PMC10032312 DOI: 10.34763/jmotherandchild.20222601.d-22-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/09/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND The risk of fetal anomalies (FAs) is increased in infants of diabetic mothers. FAs are closely related to the glycosylated hemoglobin (HbA1c) level in pregnancy. OBJECTIVES To detect the prevalence of FAs in women with gestational diabetes mellitus (GDM). MATERIAL AND METHODS 157 pregnant women with GDM were included in this study, and data from 151 women were analyzed. Beyond the regular antenatal check-up, the HbA1c was checked monthly during the antenatal follow-up. Collected data after delivery were analyzed to detect the prevalence of FAs in women with GDM and the risk of FAs in relation to the pre-conceptional blood sugar and HbA1c. RESULTS The FAs were recorded in 8.6% (13) of the 151 women with GDM. The recorded FAs were cardiovascular [2.6% (4)], musculoskeletal [1.3% (2)], urogenital [1.3% (2)], gastrointestinal [1.3% (2)], facial [0.7% (1)], central nervous system [0.7% (1)], and multiple FAs [0.7% (1)]. The uncontrolled pre-conceptional blood sugar significantly increased RR [RR 2.2 (95%CI: 1.7-2.9); P < 0.001], and odds of FAs [OR 17.05 (95%CI: 2.2-134.9); P = 0.007] in women with GDM. In addition, the HbA1c ≥6.5 significantly increased RR [RR 2.8 (95% CI: 2.1-3.8); P < 0.001], and odds of FAs [OR 24.8 (95% CI: 3.1-196.7); P = 0.002] in women with GDM. CONCLUSION In this study, the prevalence of FAs in women with GDM was 8.6%. Uncontrolled pre-conceptional blood sugar and HbA1c ≥6.5 in the first trimester significantly increased the relative risk and the odds of FAs.
Collapse
Affiliation(s)
- Rami M. M. Al-Shwyiat
- Department of Obstetrics and Gynecology, King Hussain Royal Medical Services (KH-RMS), JordanEgypt
| | - Ahmed M. Radwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| |
Collapse
|
|
8
|
Croxford S, Gupta D, Bandyopadhyay M, Itsiopoulos C. An evaluation of dietary intakes of a selected group of South Asian migrant women with gestational diabetes mellitus. ETHNICITY & HEALTH 2021; 26:487-503. [PMID: 30360630 DOI: 10.1080/13557858.2018.1539217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Background: Women of South Asian descent have an increased risk of developing gestational diabetes mellitus (GDM), and type 2 diabetes mellitus compared to Caucasian women. Dietary advice provided by health practitioners to this group has been found to be culturally inappropriate. The aim of this study was to describe the dietary intakes of South Asian women with gestational diabetes and use this information to develop culturally appropriate dietary models for education and support of dietary management.Method: An in-depth diet and lifestyle survey was administered with 13 eligible women. Dietary histories were collected for pre-pregnancy, during pregnancy and post-GDM diagnosis to evaluate changes in dietary intake, diet and health beliefs and traditional foods consumed during pregnancy.Results: The diets of participants did not meet nutrient requirements for pregnancy; specific areas on concern were dietary fibre, calcium, iron, folate and iodine. Vegetarians were particularly at risk with regards to energy and protein intake. Generally dietary intakes of these women with GDM were not consistent with guidelines for management of GDM. Confusion about what they should eat for GDM, health practitioner advice and conflict with cultural expectations about foods to consume during pregnancy was evident.Conclusion: The dietary information collected from these women was used to model sample menus for GDM that were culturally appropriate and consistent with vegetarian and non-vegetarian eating patterns.
Collapse
|
|
9
|
Nobiletin exerts anti-diabetic and anti-inflammatory effects in an in vitro human model and in vivo murine model of gestational diabetes. Clin Sci (Lond) 2020; 134:571-592. [PMID: 32129440 DOI: 10.1042/cs20191099] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
Gestational diabetes mellitus (GDM) is a global health issue, whereby pregnant women are afflicted with carbohydrate intolerance with first onset during pregnancy. GDM is characterized by maternal peripheral insulin resistance, thought to be driven by low-grade maternal inflammation. Nobiletin, a polymethoxylated flavonoid, possesses potent glucose-sensitizing and anti-inflammatory properties; however, its effects in GDM have not been assessed. The present study aimed to determine the effects of nobiletin on glucose metabolism and inflammation associated with GDM in both in vitro human tissues and an in vivo animal model of GDM. In vitro, treatment with nobiletin significantly improved TNF-impaired glucose uptake in human skeletal muscle, and suppressed mRNA expression and protein secretion of pro-inflammatory cytokines and chemokines in human placenta and visceral adipose tissue (VAT). Mechanistically, nobiletin significantly inhibited Akt and Erk activation in placenta, and NF-κB activation in VAT. In vivo, GDM mice treated with 50 mg/kg nobiletin daily via oral gavage from gestational day (gd) 1-17 or via i.p. injections from gd 10-17 significantly improved glucose tolerance. Pregnant GDM mice treated with nobiletin from either gd 1-17 or gd 10-17 exhibited significantly suppressed mRNA expression of pro-inflammatory cytokines and chemokines in placenta, VAT and subcutaneous adipose tissue (SAT). Using a quantitative mass spectrometry approach, we identified differentially abundant proteins associated with the effect of nobiletin in vivo. Together, these studies demonstrate that nobiletin improves glucose metabolism and reduces inflammation associated with GDM and may be a novel therapeutic for the prevention of GDM.
Collapse
|
|
10
|
Role of adipose tissue in regulating fetal growth in gestational diabetes mellitus. Placenta 2020; 102:39-48. [PMID: 33218577 DOI: 10.1016/j.placenta.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is a global health issue with significant short and long-term complications for both mother and baby. There is a strong need to identify an effective therapeutic that can prevent the development of GDM. A better understanding of the pathophysiology of GDM and the relationship between the adipose tissue, the placenta and fetal growth is required. The placenta regulates fetal growth by modulating nutrient transfer of glucose, amino acids and fatty acids. Various factors secreted by the adipose tissue, such as adipokines, adipocytokines and more recently identified extracellular vesicles, can influence inflammation and interact with placental nutrient transport. In this review, the role of the placental nutrient transporters and the adipose-derived factors that can influence their function will be discussed. A better understanding of these factors and their relationship may make a potential target for therapeutic interventions to prevent the development of GDM and its consequences.
Collapse
|
|
11
|
Giles ML, Davey MA, Wallace EM. Chronic hepatitis B infection and the risk of gestational diabetes: a cross-sectional study. BJOG 2020; 127:1147-1152. [PMID: 32176400 DOI: 10.1111/1471-0528.16217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE An estimated two billion people worldwide live with hepatitis B virus (HBV) infection. Many of these are women of reproductive age. Studies that have examined pregnancy outcomes in women living with HBV have reported conflicting results in relation to the incidence of gestational diabetes (GDM). The aim of this study is to examine if gestational diabetes is more common in women with chronic HBV residing in a non-Asian country. DESIGN Cross-sectional study. SETTING Victoria, Australia. POPULATION All singleton births between 2009 and 2017. METHODS Poisson regression was performed to determine whether gestational diabetes is more common in women with HBV than in women without HBV taking into account other risk factors such as maternal age, body mass index (BMI), parity and country of birth. MAIN OUTCOME MEASURE Gestational diabetes diagnosis in women with chronic HBV infection. RESULTS For women with HBV, the unadjusted incidence risk ratio for GDM was 1.75 (95% CI 1.6-1.9). After adjusting for region of birth, BMI, parity, age and smoking, the adjusted incidence risk ratio was 1.2 (95% CI 1.1-1.3). The highest incidence (37.1%) of GDM was in women with HBV and a BMI of >40. CONCLUSIONS The findings from this study confirm an association between HBV and GDM. TWEETABLE ABSTRACT HBV is associated with GDM with an incidence risk ratio for GDM of 1.75 (95% CI 1.6-1.9).
Collapse
Affiliation(s)
- M L Giles
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia.,Women's and Children's Health, Monash Health, Melbourne, Vic., Australia
| | - M-A Davey
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia
| |
Collapse
|
|
12
|
Kragelund Nielsen K, Andersen GS, Damm P, Andersen AMN. Gestational Diabetes Risk in Migrants. A Nationwide, Register-Based Study of all Births in Denmark 2004 to 2015. J Clin Endocrinol Metab 2020; 105:5707566. [PMID: 31950143 DOI: 10.1210/clinem/dgaa024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Much remains to be understood about socioeconomic position and body mass index (BMI) in the pathways linking ethnicity, migration, and gestational diabetes mellitus (GDM). We investigated differences in GDM prevalence according to maternal country of origin and the role played by socioeconomic position and BMI on this relationship. Finally, we examined how length of residency was associated with GDM. METHODS A register-based cohort study of the 725 482 pregnancies that resulted in a birth in Denmark, 2004 to 2015. Of these, 14.4% were by women who had migrated to Denmark. A GDM diagnosis was registered in 19 386 (2.7%) pregnancies, of which 4464 (23.0%) were in immigrant women. The crude risk of GDM according to maternal country of origin compared to Danish-born women ranged from an odds ratio (OR) of 0.50 (95% CI 0.34-0.71) for women from Sweden to an OR of 5.11 (95% CI 4.28-6.11) for women from Sri Lanka. Adjustment for socioeconomic position slightly attenuated the risks. Adjusting for BMI resulted in increased ORs for women, especially from Asian countries. The separate and joint effects of migration and overweight on GDM risk differed substantially between the countries of origin (P value interaction term < .001). Immigrants with 10 or more years of residency had a 56% increased risk of GDM (OR 1.56, 95% CI 1.44-1.68) compared to immigrants with less than 5 years in Denmark. This risk was somewhat diluted when adjusting for age and BMI. CONCLUSIONS This study demonstrates substantial variation in the risk of GDM according to country of origin. The risk associations are only slightly affected by socioeconomic position and BMI.
Collapse
Affiliation(s)
- Karoline Kragelund Nielsen
- Steno Diabetes Center, Gentofte, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
|
13
|
Darakhshan S, Fatehi A, Hassanshahi G, Mahmoodi S, Hashemi MS, Karimabad MN. Serum concentration of angiogenic (CXCL1, CXCL12) and angiostasis (CXCL9, CXCL10) CXC chemokines are differentially altered in normal and gestational diabetes mellitus associated pregnancies. J Diabetes Metab Disord 2019; 18:371-378. [PMID: 31890662 PMCID: PMC6915176 DOI: 10.1007/s40200-019-00421-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study was aimed and designed to determine the serum levels of CXCL1 and CXCL12 as angiogenesis along with CXCL9 and CXCL10 as angiostasis, chemokines in, Gestational diabetes mellitus mothers (GDMM) and normal pregnancy mothers (NPM) and neonates who delivered by them. METHODS We have recruited 63 pregnant GDMM and 63 normal pregnant mothers at the third trimester of pregnancy to this cross-sectional study. Cord blood specimens were obtained from neonates who were delivered from GDMM and NPM. The serum and cord blood levels of chemokines were measured by ELISA in studied groups. Data were analyzed by chi-square and student's t test between two groups. The P-values less than 0.05 were considered significant. RESULTS Our results revealed that the serum levels of CXCL1, CXCL9 and CXCL12 were increased in GDMM, while no alteration was found in the serum levels of CXCL10 when compared to NPM. We have observed that in neonates the serum levels of angiogeneic chemokines followed an inverse fashion when compared to angiostasis chemokines. Interestingly, CXCL1 and CXCL12 were both increased in neonates who were delivered by GDMM, while, CXCL9 and CXCL10 were decreased in neonates delivered by GDMM.
Collapse
Affiliation(s)
- Shokoofeh Darakhshan
- Department of Pediatrics, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Abbas Fatehi
- Department of Pediatrics, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Gholamhossein Hassanshahi
- Department of Hematology, Faculty of Biomed, Biomedical Sciences Kerman University of Medical Sciences, Kerman, Iran
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Soodabeh Mahmoodi
- Department of Pediatrics, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Monireh Seyed Hashemi
- Department of Pediatrics, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mojgan Noroozi Karimabad
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| |
Collapse
|
|
14
|
Brown J, Kapurubandara S, McGee TM. Confounding effect of ethnic diversity on booking-in body mass index and prevalence of gestational diabetes and hypertensive disorders in pregnant women in western Sydney 1997-2016. Aust N Z J Obstet Gynaecol 2019; 60:369-375. [PMID: 31591712 DOI: 10.1111/ajo.13077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Maternal obesity is a key risk factor for morbidity in pregnancy. Accurate data on trends in obesity are required in high-risk populations such as in western Sydney to implement effective policy. AIMS This study examines multi-site public hospital data on maternal ethnicity, body mass index (BMI), gestational diabetes mellitus (GDM) and hypertension across 20 years in Western Sydney Local Health District (WSLHD). MATERIALS AND METHODS This is a retrospective cohort study of all women who delivered a live birth beyond 20 weeks at Westmead, Blacktown and Auburn Hospitals (WSLHD) between 1 January 1997 and 31 December 2016. RESULTS There were 112 308 pregnant women included. Between 1997 and 2006, mean booking-in BMI climbed from 24.9 (median 23.9) to peak at 26.2 (24.9). It then fell to 25.3 (24.1) in 2012 before rising to 25.6 (24.4) in 2016. Rates of hypertensive disorders changed little over the period, with a small fall in pre-eclampsia. In contrast, there was a progressive upward trend in the prevalence of GDM, accelerating considerably after 2010. These trends were associated with a shifting ethnic profile with proportions of Australia/New Zealand-born women falling from 56.9% to 36.8%, while those from South Asia increased from 4.5% to 26.3%. CONCLUSIONS Western Sydney booking-in BMI fluctuated between 1997 and 2016, reaching its peak in 2006. Despite this, rates of GDM progressively rose, with one in six mothers in western Sydney now diagnosed with some form of the condition. Both patterns are associated with a notable shift in the ethnic profile of patients booking-in to antenatal care in the region.
Collapse
Affiliation(s)
- James Brown
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Therese M McGee
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
|
15
|
Nguyen-Ngo C, Willcox JC, Lappas M. Anti-Diabetic, Anti-Inflammatory, and Anti-Oxidant Effects of Naringenin in an In Vitro Human Model and an In Vivo Murine Model of Gestational Diabetes Mellitus. Mol Nutr Food Res 2019; 63:e1900224. [PMID: 31343820 DOI: 10.1002/mnfr.201900224] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/25/2019] [Indexed: 11/11/2022]
Abstract
SCOPE Gestational diabetes mellitus (GDM), which affects up to 20% of pregnant women, is associated with maternal peripheral insulin resistance, low-grade inflammation, and oxidative stress. The flavonoid naringenin has potent anti-diabetic, anti-inflammatory, and anti-oxidative properties; however, its effects in GDM remain unknown. The study aimed to determine the effects of naringenin on glucose metabolism, inflammation, and oxidative stress associated with GDM both in vitro and in vivo. METHODS AND RESULTS In vitro, human tissue samples obtained at term elective Caesarean section are stimulated with tumour necrosis factor alpha (TNF) to develop a GDM-like environment. Naringenin treatment significantly improves TNF-impaired glucose uptake in skeletal muscle. In placenta and visceral adipose tissue (VAT), naringenin significantly reduces expression of pro-inflammatory cytokines and chemokines and increases antioxidant mRNA expression. Mechanistically, naringenin suppresses nuclear factor κB activation. In vivo, pregnant heterozygous db/+ mice are used to model GDM. Daily intraperitoneal injections of GDM mice with naringenin from gestational day 10-17 significantly improve glucose tolerance, reduces IL1A mRNA expression, and increases antioxidant mRNA expression in placenta, VAT, and subcutaneous adipose tissue. CONCLUSION Naringenin is shown to improve insulin sensitivity, inflammation, and oxidative stress associated with GDM and shows promise as a novel preventive therapeutic.
Collapse
Affiliation(s)
- Caitlyn Nguyen-Ngo
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Jane C Willcox
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, 3086, Victoria, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| |
Collapse
|
|
16
|
Pedersen ML. Diabetes care in the dispersed population of Greenland. A new model based on continued monitoring, analysis and adjustment of initiatives taken. Int J Circumpolar Health 2019; 78:1709257. [PMID: 31996108 PMCID: PMC7034430 DOI: 10.1080/22423982.2019.1709257] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Diabetes used to be a rare condition among Inuit in Greenland. However, research in recent decades has shown a high prevalence of undiagnosed diabetes. Addressing diabetes in the geographically dispersed population of Greenland presents a challenge to the health care system. In 2008, a new model of diabetes care was introduced in Greenland that included continual monitoring, analysis, and adjustment of initiatives taken. The overall aim of this review was to review the feasibility of the monitoring of an ongoing national diabetes care programme. After ten years of observation it was clear that monitoring of such a programme based on information in electronic medical records in Greenland was feasible. It was found that the majority of the population in Greenland was in contact with the health care system. Increased diagnostic activity resulted in an increased prevalence of diagnosed diabetes. The quality of diabetes care in Greenland and the testing effectiveness of gestational diabetes were improved. Microvascular complications were frequently observed among Greenlandic diabetic patients, except for retinopathy that was as an exception. In summary, this model may improve diabetes care and potentially care for other chronic conditions in Greenland, and may also be helpful in other remote settings where chronic disease care is difficult.Abbreviations: AD: Anno Domini; ADA: American Diabetes Association; BC: Before Christ; BMI: Body Mass Index; BP: Blood Pressure; CWB: Capillary Whole Blood; EMR: Electronic Medical Record; EASD: European Association for Study of Diabetes; GA: Gestational Age; GDM: Gestational Diabetes Mellitus; FIGO: The International Federation of Gynaecology and Obstetrics; HbA1c: Glycosylated haemoglobin; IDF: International Diabetes Federation; LDL: Low density lipoprotein; NDQIA: National Diabetes Quality Improvement Alliancel; NICE: National Institute for Health and Care Excellence; OECD: Organisation for Economic Co-operation and Development; OGTT: Oral Glucose Tolerance Test; QIH: Queen Ingrid Hospital; RCT: Randomised Controlled Tria;l T1D: Type 1 Diabetes; T2D: Type 2 Diabetes; UACR: Urine Albumin Creatinine Ratio; WHO: World Health Organisation.
Collapse
Affiliation(s)
- Michael Lynge Pedersen
- Greenland Center for Health Research, Institute Nursing and Health Science, University of Greenland, Nuuk, Greenland
| |
Collapse
|
|
17
|
Zhen XM, Li X, Chen C. Longer-term outcomes in offspring of GDM mothers treated with metformin versus insulin. Diabetes Res Clin Pract 2018; 144:82-92. [PMID: 30031048 DOI: 10.1016/j.diabres.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/30/2018] [Accepted: 07/02/2018] [Indexed: 01/12/2023]
Abstract
Insulin has traditionally been the gold standard pharmacological treatment for gestational diabetes mellitus (GDM). Insulin requires multiple injections a day, can cause frequent hypoglycaemia, requires careful handling, and is generally more expensive compared to oral agents. Metformin has been increasingly popular in recent years. Based on the short-term data available, metformin appears to be safe and effective for the treatment of GDM but existing studies have all stressed the lack of longer-term offspring data. This article will analyse the evidence available on the longer-term outcomes in the offspring of women with GDM treated with metformin versus insulin. Pubmed, EMBASE, CENTRAL, and CNKI were searched for follow-up studies of randomised controlled trials that compared metformin with insulin for the treatment of GDM. Existing follow-up studies did not find any significant increase in the risk of adverse effects in terms of growth and development in the offspring of GDM mothers managed with metformin versus insulin.
Collapse
Affiliation(s)
- Xi May Zhen
- School of Medicine, The University of Queensland, Brisbane 4072, Australia; Royal Prince Alfred Hospital, Sydney 2050, Australia.
| | - Xue Li
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Chen Chen
- School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia.
| |
Collapse
|
|
18
|
Metformin versus insulin for gestational diabetes: The reporting of ethnicity and a meta-analysis combining English and Chinese literatures. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.obmed.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
|
19
|
Li KT, Naik S, Alexander M, Mathad JS. Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol 2018; 55:613-625. [PMID: 29582160 PMCID: PMC5999405 DOI: 10.1007/s00592-018-1131-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023]
Abstract
AIMS Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India. METHODS We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias. RESULTS We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33-79%). Studies specifying time of GDM diagnosis showed that patients (11-60%) develop GDM as early as the first trimester, but many GDM cases (16-40%) are missed if screened only at first visit. CONCLUSIONS In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients' needs and correlate screening criteria with pregnancy outcomes.
Collapse
Affiliation(s)
- Katherine T Li
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA.
| | - Shilpa Naik
- Department of OB-GYN, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Mallika Alexander
- Johns Hopkins University Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Jyoti S Mathad
- Departments of Medicine and OB-GYN, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
|
20
|
Khan S, Bal H, Khan ID, Paul D. Evaluation of the diabetes in pregnancy study group of India criteria and Carpenter-Coustan criteria in the diagnosis of gestational diabetes mellitus. Turk J Obstet Gynecol 2018; 15:75-79. [PMID: 29971182 PMCID: PMC6022420 DOI: 10.4274/tjod.57255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/18/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is diagnosed for the first time during pregnancy. This prospective study was undertaken to validate the single-step non-fasting 75 gm Diabetes in Pregnancy Study Group of India (DIPSI) criteria of GDM in Indian patients in comparison with the two-step fasting 100 gm glucose challenge through the Carpenter Coustan criteria (CCC). MATERIALS AND METHODS Two hundred patients underwent comparative testing using the DIPSI criteria and CCC. Plasma venous blood glucose levels were estimated using the hexokinase method; values ≥140 mg/dL at 2 hours were considered positive according to the DIPSI criteria. Any two values from ≥95 mg/dL for fasting, ≥180 mg/dL at 1 hour, ≥155 mg/dL at 2 hours, and ≥140 mg/dL at 3 hours were considered positive with the CCC. RESULTS The mean age and body mass index were 24.26±3.75 years and 20.7±3.07 kg/m2. The sensitivity, specificity, and positive and negative predictive values of the DIPSI guidelines were found as 100%, 97.14%, 83.87%, and 100%, respectively. The positive and negative likelihood ratios were 35.8 and zero. Diagnostic accuracy was found as 97.56%. CONCLUSION DIPSI having high sensitivity, specificity, negative predictive value and diagnostic accuracy. DIPSI offers simplicity, feasibility, convenience, and repeatability while economizing universal screening and diagnosis of GDM on a mass-scale. The DIPSI procedure has the potential to be applied to the entire obstetric population, in the implementation of public health programs to diagnose GDM in the community, thus reaching the needs of the developing world.
Collapse
Affiliation(s)
- Shazia Khan
- INHS Kalyani Hospital, Clinic of Obstetrics and Gynecology, Visakhapatnam, India
| | - Himadri Bal
- Dr. DY. Patil Medical College Hospital and Research Centre, Clinic of Obstetrics and Gynecology, Pune, India
| | - Inam Danish Khan
- Army College of Medical Sciences and Base Hospital, Clinic of Microbiology, New Delhi, India
| | - Debashish Paul
- Armed Forces Medical College, Clinic of Obstetrics and Gynecology, Pune, India
| |
Collapse
|
|
21
|
|
|
22
|
Schwartz N, Green MS, Yefet E, Nachum Z. Modifiable risk factors for gestational diabetes recurrence. Endocrine 2016; 54:714-722. [PMID: 27601018 DOI: 10.1007/s12020-016-1087-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
The literature on risk factors for gestational diabetes mellitus recurrence is inconsistent and sometimes contradictory. The importance of inter-pregnancy interval and parity, remains unclear. We aimed to explore controversial risk factors for gestational diabetes mellitus recurrence, especially the modifiable ones, and to develop a prediction model in a cohort of women with gestational diabetes mellitus. A retrospective, population-based, cross-sectional cohort study was performed. The study included 788 women with gestational diabetes mellitus that delivered between 1991-2012 and had consecutive deliveries at a university affiliated hospital in Israel. Women with pre-existing diabetes were excluded. Factors associated with gestational diabetes mellitus recurrence were examined using log-binomial models to estimate prevalence ratios with 95 % confidence intervals. Multivariate analysis revealed that both inter-pregnancy interval and multiparity were significant risk factors for gestational diabetes mellitus recurrence. Other significant risk factors were maternal age, gestational diabetes mellitus diagnosis week, oral glucose tolerance test values, body mass index gain between pregnancies and insulin use; the latter and multiparity had the strongest effect size (PR ≥ 1.2). Among multiparous women, the association between inter-pregnancy interval and gestational diabetes mellitus recurrence was significantly lower (P = 0.0004) compared with primiparous women (PR = 1.11 [95 % CI 1.09-1.13] versus PR = 1.17 [95 % CI 1.15-1.20], respectively). The model we developed, predicts that reducing the inter-pregnancy interval and weight gain between pregnancies can reduce substantially the risk of gestational diabetes mellitus recurrence. The results suggest that weight gain and inter-pregnancy interval are modifiable risk factors for gestational diabetes mellitus recurrence. Our model could assist physicians in advising women with gestational diabetes mellitus in reducing the risk of recurrent gestational diabetes mellitus during subsequent pregnancies.
Collapse
Affiliation(s)
- Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel.
- Clinical Research Unit, Emek Medical Center, Afula, Israel.
| | | | - Enav Yefet
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Zohar Nachum
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
|
23
|
Kayal A, Mohan V, Malanda B, Anjana RM, Bhavadharini B, Mahalakshmi MM, Maheswari K, Uma R, Unnikrishnan R, Kalaiyarasi G, Ninov L, Belton A. Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4). Indian J Endocrinol Metab 2016; 20:707-715. [PMID: 27730085 PMCID: PMC5040055 DOI: 10.4103/2230-8210.189230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIM The Women In India with GDM Strategy (WINGS) project was conducted with the aim of developing a model of care (MOC) suitable for women with gestational diabetes mellitus (GDM) in low- and middle-income countries. METHODOLOGY The WINGS project was carried out in Chennai, Southern India, in two phases. In Phase I, a situational analysis was conducted to understand the practice patterns of health-care professionals and to determine the best screening criteria through a pilot screening study. RESULTS Phase II involved developing a MOC-based on findings from the situational analysis and evaluating its effectiveness. The model focused on diagnosis, management, and follow-up of women with GDM who were followed prospectively throughout their pregnancy. An educational booklet was provided to all women with GDM, offering guidance on self-management of GDM including sample meal plans and physical activity tips. A pedometer was provided to all women to monitor step count. Medical nutrition therapy (MNT) was the first line of treatment given to women with GDM. Women were advised to undergo fasting blood glucose and postprandial blood glucose testing every fortnight. Insulin was indicated when the target blood glucose levels were not achieved with MNT. Women were evaluated for pregnancy outcomes and postpartum glucose tolerance status. CONCLUSIONS The WINGS MOC offers a comprehensive package at every level of care for women with GDM. If successful, this MOC will be scaled up to other resource-constrained settings with the hope of improving lives of women with GDM.
Collapse
Affiliation(s)
- Arivudainambi Kayal
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Viswanathan Mohan
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Belma Malanda
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Ranjit Mohan Anjana
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Balaji Bhavadharini
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | | | - Kumar Maheswari
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ram Uma
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Lyudmil Ninov
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| |
Collapse
|
|
24
|
Buhary BM, Almohareb O, Aljohani N, Alzahrani SH, Elkaissi S, Sherbeeni S, Almaghamsi A, Almalki M. Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study. Indian J Endocrinol Metab 2016; 20:481-90. [PMID: 27366714 PMCID: PMC4911837 DOI: 10.4103/2230-8210.183478] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
CONTEXT Diabetes in pregnancy (DIP) is either pregestational or gestational. AIMS To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients. SETTINGS AND DESIGN In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included. SUBJECTS AND METHODS The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6.5% (48 mmol/mol) and those with glycated hemoglobin (HbA1c) above 6.5%. The two groups were compared for differences in maternal and fetal outcomes. STATISTICAL ANALYSIS USED Independent Student's t-test and analysis of variance were performed for comparison of continuous variables and Chi-square test for frequencies. Odds ratio and 95% confidence intervals were calculated using logistic regression. RESULTS Patients with higher HbA1c were older (P = 0.0077), had significantly higher blood pressure, proteinuria (P < 0.0001), and were multiparous (P = 0.0269). They had significantly shorter gestational periods (P = 0.0002), more preterm labor (P < 0.0001), more perineal tears (P = 0.0406), more miscarriages (P < 0.0001), and more operative deliveries (P < 0.0001). Their babies were significantly of greater weight, had more Neonatal Intensive Care Unit (NICU) admissions, hypoglycemia, and macrosomia. CONCLUSIONS Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission). Especially at risk are those with preexisting diabetes, who would benefit from earlier diabetes consultation and tighter glycemic control before conception.
Collapse
Affiliation(s)
| | - Ohoud Almohareb
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Naji Aljohani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Saad H. Alzahrani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Samer Elkaissi
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Suphia Sherbeeni
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Almaghamsi
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mussa Almalki
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
|
25
|
Mahalakshmi MM, Bhavadharini B, Maheswari K, Anjana RM, Jebarani S, Ninov L, Kayal A, Malanda B, Belton A, Uma R, Mohan V, Unnikrishnan R. Current practices in the diagnosis and management of gestational diabetes mellitus in India (WINGS-5). Indian J Endocrinol Metab 2016; 20:364-368. [PMID: 27186555 PMCID: PMC4855966 DOI: 10.4103/2230-8210.180001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM To obtain information on existing practices in the diagnosis and management of gestational diabetes mellitus (GDM) among physicians/diabetologists/endocrinologists and obstetricians/gynecologists (OB/GYNs) in India. METHODS Details regarding diagnostic criteria used, screening methods, management strategies, and the postpartum follow-up of GDM were obtained from physicians/diabetologists/endocrinologists and OB/GYNs across 24 states of India using online/in-person surveys using a structured questionnaire. RESULTS A total of 3841 doctors participated in the survey of whom 68.6% worked in private clinics. Majority of OB/GYNs (84.9%) preferred universal screening for GDM, and screening in the first trimester was performed by 67% of them. Among the OB/GYNs, 600 (36.7%) reported using the nonfasting 2 h criteria for diagnosing GDM whereas 560 (29.4%) of the diabetologists/endocrinologists reported using the same. However, further questioning on the type of blood sample collected and the glucose load used revealed that, in reality, only 208 (12.7%) and 72 (3.8%), respectively, used these criteria properly. The survey also revealed that the International Association of Diabetes and Pregnancy Study Groups criteria was followed properly by 299 (18.3%) of OB/GYNs and 376 (19.7%) of physicians/diabetologists/endocrinologists. Postpartum oral glucose tolerance testing was advised by 56% of diabetologists and 71.6% of OB/GYNs. CONCLUSION More than half of the physicians/diabetologists/endocrinologists and OB/GYNs in India do not follow any of the recommended guidelines for the diagnosis of GDM. This emphasizes the need for increased awareness about screening and diagnosis of GDM both among physicians/diabetologists/endocrinologists and OB/GYNs in India.
Collapse
Affiliation(s)
- Manni Mohanraj Mahalakshmi
- Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non Communicable Diseases Prevention and Control, Chennai, Tamil Nadu, India
| | - Balaji Bhavadharini
- Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non Communicable Diseases Prevention and Control, Chennai, Tamil Nadu, India
| | - Kumar Maheswari
- Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non Communicable Diseases Prevention and Control, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non Communicable Diseases Prevention and Control, Chennai, Tamil Nadu, India
| | - Saravanan Jebarani
- Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non Communicable Diseases Prevention and Control, Chennai, Tamil Nadu, India
| | - Lyudmil Ninov
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Arivudainambi Kayal
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Belma Malanda
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium
| | - Ram Uma
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non Communicable Diseases Prevention and Control, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non Communicable Diseases Prevention and Control, Chennai, Tamil Nadu, India
| |
Collapse
|
|
26
|
Monteiro LJ, Norman JE, Rice GE, Illanes SE. Fetal programming and gestational diabetes mellitus. Placenta 2015; 48 Suppl 1:S54-S60. [PMID: 26724985 DOI: 10.1016/j.placenta.2015.11.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 01/11/2023]
Abstract
Gestational diabetes mellitus is defined by new-onset glucose intolerance during pregnancy. About 2-5% of all pregnant women develop gestational diabetes during their pregnancies and the prevalence has increased considerably during the last decade. This metabolic condition is manifested when pancreatic β-cells lose their ability to compensate for increased insulin resistance during pregnancy, however, the pathogenesis of the disease remains largely unknown. Gestational diabetes is strongly associated with adverse pregnancy outcome as well as with long-term adverse effects on the offspring which likely occurs due to epigenetic modifications of the fetal genome. In the current review we address gestational diabetes and the short and long term complications for both mothers and offspring focusing on the importance of fetal programming in conferring risk of developing diseases in adulthood.
Collapse
Affiliation(s)
- Lara J Monteiro
- Department of Obstetrics & Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Jane E Norman
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Gregory E Rice
- Centre for Clinical Diagnostics, Faculty of Medicine and Biomedical Sciences, University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
| | - Sebastián E Illanes
- Department of Obstetrics & Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile; Centre for Clinical Diagnostics, Faculty of Medicine and Biomedical Sciences, University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia.
| |
Collapse
|
|
27
|
Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World J Diabetes 2015; 6:1033-44. [PMID: 26240700 PMCID: PMC4515443 DOI: 10.4239/wjd.v6.i8.1033] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/19/2015] [Accepted: 04/27/2015] [Indexed: 02/05/2023] Open
Abstract
The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. This disease has many detrimental consequences for the woman, the unborn foetus and child. The management of GDM aims to mediate the effects of hyperglycaemia by controlling blood glucose levels. Along with pharmacology and dietary interventions, exercise has a powerful potential to assist with blood glucose control. Due to the uncertainty of risks and benefits of exercise during pregnancy, women tend to avoid exercise. However, under adequate supervision exercise is both safe and beneficial in the treatment of GDM. Therefore it is vital that exercise is incorporated into the continuum of care for women with GDM. Medical doctors should be able to refer to competently informed exercise professionals to aid in GDM treatment. It is important that exercise treatment is informed by research. Hence, the development of evidence-based guidelines is important to inform practice. Currently there are no guidelines for exercise in GDM. This review aims to assess the efficacy of exercise for the management of GDM in order to establish an exercise prescription guideline specific to the condition. It is recommended that women with GDM should do both aerobic and resistance exercise at a moderate intensity, a minimum of three times a week for 30-60 min each time.
Collapse
|
|
28
|
Lenoir-Wijnkoop I, van der Beek EM, Garssen J, Nuijten MJC, Uauy RD. Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia - a pilot evaluation. Front Pharmacol 2015; 6:103. [PMID: 26042038 PMCID: PMC4438224 DOI: 10.3389/fphar.2015.00103] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/25/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life. Objective: Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data. Results: The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences. Conclusion: Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the urgent need to collect more country-specific data on the incidence of macrosomic births and health outcomes. In addition, it would be of interest to further explore the long-term health economic consequences of macrosomia and related risk factors.
Collapse
Affiliation(s)
| | | | - Johan Garssen
- Department of Pharmaceutical Sciences, Utrecht University Utrecht, Netherlands ; Nutricia Research, Utrecht Netherlands
| | | | - Ricardo D Uauy
- Institute of Nutrition INTA, University of Chile Santiago, Chile
| |
Collapse
|
|
29
|
Sanchalika A, Teresa J. Risk of Gestational Diabetes Among South Asian Immigrants Living in New Jersey—a Retrospective Data Review. J Racial Ethn Health Disparities 2015; 2:510-6. [DOI: 10.1007/s40615-015-0099-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/23/2015] [Accepted: 02/27/2015] [Indexed: 02/09/2023]
|
|
30
|
Abouzeid M, Versace VL, Janus ED, Davey MA, Philpot B, Oats J, Dunbar JA. Socio-cultural disparities in GDM burden differ by maternal age at first delivery. PLoS One 2015; 10:e0117085. [PMID: 25679221 PMCID: PMC4334534 DOI: 10.1371/journal.pone.0117085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/27/2014] [Indexed: 12/16/2022] Open
Abstract
AIMS Several socio-cultural and biomedical risk factors for gestational diabetes mellitus (GDM) are modifiable. However, few studies globally have examined socio-cultural associations. To eliminate confounding of increased risk of diabetes in subsequent pregnancies, elucidating socio-cultural associations requires examination only of first pregnancies. METHODS Data for all women who delivered their first child in Victoria, Australia between 1999 and 2008 were extracted from the Victorian Perinatal Data Collection. Crude and adjusted GDM rates were calculated. Multivariate logistic regression was used to examine odds of GDM within and between socio-cultural groups. RESULTS From 1999 to 2008, 269,682 women delivered their first child in Victoria. GDM complicated 11,763 (4.4%) pregnancies and burden increased with maternal age, from 2.1% among women aged below 25 years at delivery to 7.0% among those aged 35 years or more. Among younger women, GDM rates were relatively stable across socioeconomic levels. Amongst older women GDM rates were highest in those living in most deprived areas, with a strong social gradient. Asian-born mothers had highest GDM rates. All migrant groups except women born in North-West Europe had higher odds of GDM than Australian-born non-Indigenous women. In all ethnic groups, these differences were not pronounced among younger mothers, but became increasingly apparent amongst older women. CONCLUSIONS Socio-cultural disparities in GDM burden differ by maternal age at first delivery. Socio-cultural gradients were not evident among younger women. Health and social programs should seek to reduce the risk amongst all older women to that of the least deprived older mothers.
Collapse
Affiliation(s)
- Marion Abouzeid
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Vincent L. Versace
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Edward D. Janus
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- Department of Medicine, Northwest Academic Centre, The University of Melbourne and Western Health, Victoria, Australia
| | - Mary-Ann Davey
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Clinical Councils Unit, Department of Health, Victoria, Australia
- Mother and Child Health Research, La Trobe University, Victoria, Australia
| | - Benjamin Philpot
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Jeremy Oats
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Clinical Councils Unit, Department of Health, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - James A. Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- * E-mail:
| |
Collapse
|
|
31
|
Ainuddin J, Karim N, Hasan AA, Naqvi SA. Metformin versus insulin treatment in gestational diabetes in pregnancy in a developing country: a randomized control trial. Diabetes Res Clin Pract 2015; 107:290-9. [PMID: 25467617 DOI: 10.1016/j.diabres.2014.10.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 10/02/2014] [Accepted: 10/19/2014] [Indexed: 12/24/2022]
Abstract
AIM To compare treatment with metformin alone, metformin plus insulin and insulin alone in women with gestational diabetes (GDM). METHOD A total of 150 gestational diabetic patients who fulfilled the eligibility criteria were included in this prospective randomized control open labeled study. A risk factor based screening was done followed by a GCT and then local GTT criteria from antenatal clinics. They were initially divided into two groups with odd numbers assigned to metformin treatment and even numbers to insulin treatment. Metformin and/or insulin treatment was given and target blood sugar levels aimed at FBS ≤ 100 mg/dl and postprandial levels ≤ 126 mg/dl. Supplemental insulin was added to metformin treatment group to maintain the glycemic targets if required. Patients were followed until delivery and maternal fetal outcomes and pharmacotherapeutic characteristics were recorded on a performa. RESULTS Less maternal weight gain was found in the metformin treated groups (9.8 ± 1.5 kg [metformin alone] vs. 9.8 ± 1.4 kg [metformin plus insulin] vs. 12.5 ± 1.1 kg [insulin alone] P < 0.000). Preeclampsia was significantly less in metformin treated groups. There were no perinatal deaths in the study. Mean birth weight was significantly less in metformin treated groups (3.4 ± 0.4 kg vs. 3.3 ± 0.5 kg vs. 3.7 ± 0.5 kg P < 0.01). Less neonatal morbidity was observed in metformin groups. 42.7% of patients required supplemental insulin (mean dose of 13.6 ± 2 units) in the metformin group. Mean gestational age at which insulin was added was 31.8 ± 5.9 weeks. CONCLUSION Metformin is an effective and cheap treatment option for women with gestational diabetes with or without supplemental insulin.
Collapse
Affiliation(s)
| | - Nasim Karim
- Bahria University, Medical and Dental College, Karachi, Pakistan.
| | | | - Sanower Ali Naqvi
- Hamdard College of Medicine and Dentistry, Hamdard University, Karachi, Pakistan.
| |
Collapse
|
|
32
|
Lin TC, Mu CF, Hsu CY. Risk factors for gestational diabetes mellitus: ethnic disparities. Aust J Rural Health 2015; 23:176-80. [PMID: 25614928 DOI: 10.1111/ajr.12151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) increases the risk of poor maternal and infant health outcomes; therefore, the objective of this study was to compare the ethnic disparities and identify the risk factors for GDM. DESIGN We performed a cross-sectional analysis using patient records from a hospital located in the Puli area of Central Taiwan. SETTING A teaching hospital located in a rural mountainous area of Central Taiwan. PARTICIPANTS Between 2002 and 2012, the hospital admitted 154 patients (107 non-aborigines, 30 aborigines, and 17 non-Taiwanese) who exhibited glucose intolerance during their pregnancy. MAIN OUTCOME MEASURES GDM was confirmed using the oral-glucose-tolerance-test administered in dose of either 100 g or 75 g. The incidence and risk factors for GDM in the aboriginal and non-aboriginal women was compared. RESULTS We excluded the patients who had overt diabetes or were non-Taiwanese. Thus, 132 patients (28 aboriginal and 104 non-aboriginal women; mean age 30 years) were enrolled in the final study. A total of 51 patients (15 aboriginal, 36 non-aboriginal women) had GDM, which was more prevalent among the aboriginal mothers (53.6% versus 34.6%). The risk factors for GDM among the aboriginal women were persistent glycosuria and prior macrosomia. CONCLUSION The Taiwanese aboriginal women exhibited higher incidence of GDM; thus, we recommend that early screening and health education for pregnant aboriginal women be provided.
Collapse
Affiliation(s)
- Tzu-Chi Lin
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Fen Mu
- Department of Family Medicine, Puli Christian Hospital, Puli, Taiwan
| | - Chao-Yu Hsu
- Department of Family Medicine, Puli Christian Hospital, Puli, Taiwan.,Department of Medical Education and Research, Puli Christian Hospital, Puli, Taiwan.,National Chi Nan University, Puli, Taiwan.,Central Taiwan University of Science and Technology, Taichung, Taiwan.,National Taichung University of Science and Technology, Taichung, Taiwan.,Chaoyang University of Technology, Taichung, Taiwan.,National Chin-Yi University of Technology, Taichung, Taiwan.,Feng Chia University, Taichung, Taiwan
| |
Collapse
|
|
33
|
McDonald R, Karahalios A, Le T, Said J. A Retrospective Analysis of the Relationship between Ethnicity, Body Mass Index, and the Diagnosis of Gestational Diabetes in Women Attending an Australian Antenatal Clinic. Int J Endocrinol 2015; 2015:297420. [PMID: 26504462 PMCID: PMC4609521 DOI: 10.1155/2015/297420] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose. To estimate the prevalence of gestational diabetes mellitus (GDM) in a multiethnic population, assess the association between country of birth (COB) and GDM, and assess whether the association varies by body mass index (BMI). Methods. A retrospective study of 5260 pregnant women attending Sunshine Hospital, Australia, between 1st July 2012 and 30th June 2013. We fitted logistic regression models to assess the association between COB and GDM. An interaction between BMI and COB was assessed by likelihood ratio test. Results. In the 4610 included in our analysis, most common were women born in Australia or New Zealand (ANZ, 1932, 41.9%) and in Southeast Asia (922, 20%). GDM was diagnosed in 606 (13.2%) women. After adjusting for confounders, women from East Asia were most likely to develop GDM (37, 24.0%) and 5-fold more likely than women from ANZ (OR = 4.77, 95% CI: 3.12, 7.31, p < 0.001). Women from other Asian countries had a 3-fold increased risk of GDM compared to women from ANZ. There was no evidence of an interaction by BMI (p = 0.24). Conclusions. Women born in Asia have higher risk of GDM compared to women born in ANZ. These data provide support for including COB in GDM management policies.
Collapse
Affiliation(s)
- Rebecca McDonald
- Monash Women's, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
- Women's and Children's Health, Sunshine Hospital, Western Health, 176 Furlong Road, Saint Albans, VIC 3021, Australia
| | - Amalia Karahalios
- Office for Research, Western Centre for Health Research & Education, 176 Furlong Road, Saint Albans, VIC 3021, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053, Australia
| | - Thao Le
- Women's and Children's Health, Sunshine Hospital, Western Health, 176 Furlong Road, Saint Albans, VIC 3021, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Joanne Said
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC 3052, Australia
- Maternal Fetal Medicine, Sunshine Hospital, Western Health, 176 Furlong Road, Saint Albans, VIC 3021, Australia
- *Joanne Said:
| |
Collapse
|
|
34
|
Abouzeid M, Versace VL, Janus ED, Davey MA, Philpot B, Oats J, Dunbar JA. A population-based observational study of diabetes during pregnancy in Victoria, Australia, 1999-2008. BMJ Open 2014; 4:e005394. [PMID: 25398676 PMCID: PMC4244457 DOI: 10.1136/bmjopen-2014-005394] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This paper reports secular trends in diabetes in pregnancy in Victoria, Australia and examines the effect of including or excluding women with pre-existing diabetes on gestational diabetes (GDM) prevalence estimates. DESIGN Population-based observational study. SETTING All births in Victoria, Australia between 1999 and 2008 PARTICIPANTS: 634,932 pregnancies resulting in a birth registered with the Victorian Perinatal Data Collection OUTCOME MEASURES Crude and age-standardised secular trends in pre-existing diabetes and GDM prevalence; secular GDM trends by maternal birthplace; effects on GDM prevalence of including and excluding pre-existing diabetes from the denominator. RESULTS Of the 634,932 pregnancies, 2954 (0.5%) occurred in women with pre-existing diabetes and 29,147 (4.6%) were complicated by GDM. Mean maternal age increased from 29.7 years in 1999 to 30.8 years in 2008. GDM prevalence increased in most maternal age groups. In 2008, age-standardised GDM prevalence was 31% higher than in 1999; secular increases were greater for Australian-born non-Indigenous (29% increase) than immigrant women (12.3% increase). The annual number of pregnancies in women with pre-existing diabetes almost doubled from 1999 to 2008 and prevalence increased from 0.4% to 0.6%. However, including or excluding pre-existing diabetes had little effect on GDM prevalence estimates. CONCLUSIONS Pre-existing diabetes and GDM prevalence increased in Victoria between 1999 and 2008 and rising maternal age does not fully explain these trends. These findings have important implications for preventive initiatives. Including or excluding small numbers of women with pre-existing diabetes resulted in minimal changes in GDM estimates. As pre-existing diabetes in young women increases, this methodological issue will likely become important.
Collapse
Affiliation(s)
- Marian Abouzeid
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Vincent L Versace
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Edward D Janus
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia Department of Medicine, Northwest Academic Centre, The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Clinical Councils Unit, Department of Health, Melbourne, Victoria, Australia Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Benjamin Philpot
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Jeremy Oats
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Clinical Councils Unit, Department of Health, Melbourne, Victoria, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - James A Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| |
Collapse
|
|
35
|
Jatrana S, Richardson K, Blakely T, Dayal S. Does mortality vary between Asian subgroups in New Zealand: an application of hierarchical Bayesian modelling. PLoS One 2014; 9:e105141. [PMID: 25140523 PMCID: PMC4139320 DOI: 10.1371/journal.pone.0105141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/08/2014] [Indexed: 12/28/2022] Open
Abstract
The aim of this paper was to see whether all-cause and cause-specific mortality rates vary between Asian ethnic subgroups, and whether overseas born Asian subgroup mortality rate ratios varied by nativity and duration of residence. We used hierarchical Bayesian methods to allow for sparse data in the analysis of linked census-mortality data for 25-75 year old New Zealanders. We found directly standardised posterior all-cause and cardiovascular mortality rates were highest for the Indian ethnic group, significantly so when compared with those of Chinese ethnicity. In contrast, cancer mortality rates were lowest for ethnic Indians. Asian overseas born subgroups have about 70% of the mortality rate of their New Zealand born Asian counterparts, a result that showed little variation by Asian subgroup or cause of death. Within the overseas born population, all-cause mortality rates for migrants living 0-9 years in New Zealand were about 60% of the mortality rate of those living more than 25 years in New Zealand regardless of ethnicity. The corresponding figure for cardiovascular mortality rates was 50%. However, while Chinese cancer mortality rates increased with duration of residence, Indian and Other Asian cancer mortality rates did not. Future research on the mechanisms of worsening of health with increased time spent in the host country is required to improve the understanding of the process, and would assist the policy-makers and health planners.
Collapse
Affiliation(s)
- Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University Waterfront Campus, Geelong, Victoria, Australia
| | - Ken Richardson
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand
| | - Tony Blakely
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand
| | - Saira Dayal
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand
| |
Collapse
|
|
36
|
Giri H, Chandel S, Dwarakanath LS, Sreekumar S, Dixit M. Increased endothelial inflammation, sTie-2 and arginase activity in umbilical cords obtained from gestational diabetic mothers. PLoS One 2013; 8:e84546. [PMID: 24376824 PMCID: PMC3869849 DOI: 10.1371/journal.pone.0084546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 11/17/2013] [Indexed: 01/08/2023] Open
Abstract
Objective The aim of this study was to determine subclinical inflammation in umbilical vein derived endothelial cells (HUVECs) obtained from Asian Indian subjects with gestational diabetes (GDM) and to determine levels of angiogenic factors and arginase activity in their cord blood. Methods This case-control study included 38 control and 30 GDM subjects. Subjects were confirmed as GDM based on 75g oral glucose tolerance test (OGTT) conducted in the second trimester of pregnancy. Angiogenic markers and arginase activity were measured in cord blood by ELISA and colorimetric methods respectively. Endothelial inflammation was assessed through adhesion of PKH26-labelled leukocytes onto HUVEC monolayer obtained from the study groups. Gene and surface expression of adhesion molecules were confirmed via reverse transcription polymerase chain reaction (RT-PCR) and flow cytometry respectively. Results The study revealed increased adhesion of leukocytes to HUVECs isolated from GDM subjects compared to controls. HUVECs of babies born to GDM mothers had increased surface and mRNA expression of E-selectin. sTie2 levels were significantly higher in the cord blood for GDM subjects (3869 ± 370 ng/L) compared to controls (3045 ± 296 ng/L). Furthermore, arginase activity was higher in cord blood of GDM mothers as opposed to the control group (7.75 ± 2.4 µmoles of urea/ml/hour vs 2.88 ±0.49 µmoles of urea/ml/hour; p-value= 0.019). Spearman’s correlation analysis revealed positive correlation of cord blood arginase activity with glucose intolerance (ρ=0.596, p=0.004) and post load glucose values (ρ=0.472, p=0.031) of mothers observed during the second trimester of pregnancy. Conclusions HUVECs derived from Asian Indian GDM mothers, exhibit signs of sub-clinical endothelial inflammation along with increased levels of sTie2 and arginase activity in their cord blood serum.
Collapse
Affiliation(s)
- Hemant Giri
- Laboratory of Vascular Biology, Department of Biotechnology, Indian Institute of Technology Madras, Chennai, India
| | - Shivam Chandel
- Laboratory of Vascular Biology, Department of Biotechnology, Indian Institute of Technology Madras, Chennai, India
| | | | | | - Madhulika Dixit
- Laboratory of Vascular Biology, Department of Biotechnology, Indian Institute of Technology Madras, Chennai, India
- * E-mail:
| |
Collapse
|
|
37
|
Current practices of prevention, detection & management of gestational diabetes mellitus in Punjab. Int J Diabetes Dev Ctries 2013. [DOI: 10.1007/s13410-013-0141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
|
38
|
Kavitha N, De S, Kanagasabai S. Oral Hypoglycemic Agents in pregnancy: An Update. J Obstet Gynaecol India 2013; 63:82-7. [PMID: 24431611 PMCID: PMC3664692 DOI: 10.1007/s13224-012-0312-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 10/29/2012] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Traditionally, insulin has been the gold standard in the management of Type 2 diabetes in pregnancy and gestational diabetes. However, insulin therapy can be inconvenient because of the needs for multiple injections, its associated cost, pain at the injection site, need for refrigeration, and skillful handling of the syringes. This has led to the exploration of oral hypoglycemic agents as an alternative to insulin therapy. OBJECTIVES This review examines and evaluates the evidences on the efficacy, safety, and current recommendations of oral hypoglycemic agents. CONCLUSION The evidence of this study supports the use of glyburide and metformin in the management of Type 2 diabetes and gestational diabetes with no increased risk of neonatal hypoglycemia or congenital anomalies. The safety of these oral hypoglycemic agents are limited to the prenatal period and more randomized controlled trials are required to provide information on the long-term follow up on neonatal and cognitive development.
Collapse
Affiliation(s)
- Nagandla Kavitha
- Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Jalan Batu Hampar, 75150 Bukit Baru, Melaka Malaysia
| | - Somsubhra De
- Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Jalan Batu Hampar, 75150 Bukit Baru, Melaka Malaysia
| | - Sachchithanantham Kanagasabai
- Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Jalan Batu Hampar, 75150 Bukit Baru, Melaka Malaysia
| |
Collapse
|
|
39
|
Gestational diabetes mellitus among women born in South East Asia: a review of the evidence. Midwifery 2013; 29:1019-26. [PMID: 23415355 DOI: 10.1016/j.midw.2012.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 08/12/2012] [Accepted: 09/03/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this paper was to examine rates of gestational diabetes mellitus (GDM) among women born in South East Asia, now residing in a developed country DATA SOURCES Established health databases including: SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001-2011. STUDY SELECTION Studies that examined GDM among women born in South East Asia (SEA) were sought. Keywords included gestational diabetes and a search term for Asian ethnicity (Asian, Asia, race, ethnic, and ethnicity). Further searches were based on citations and references found in located articles. Of 53 retrieved publications, five met inclusion criteria. DATA EXTRACTION Data were extracted and organised under the following headings: GDM rates among women born in SEA; screening for GDM; and characteristics of GDM risk for SEA born women. Study quality was assessed by using the CASP (Critical Appraisal Skills Programme) guidelines. DATA SYNTHESIS This review produced three main findings: (1) compared to combined Asian groups, GDM rates were lower among SEA women; (2) compared to other Asian sub-groups, GDM rates among SEA women were in the intermediate range; and (3) SEA born women demonstrated consistently higher rates of GDM than women from the same ethnic background who were born in countries such as the US, UK or Australia. CONCLUSIONS From this review, it was clear that a 'one size fits all' approach to Asian ethnicity was not useful for estimating GDM rates among SEA women. There was also considerable difference among women of SEA ethnicity born in South East Asia, compared to women of the same ethnic background born in developed countries. Future research should explore the unique characteristics of GDM risk for these women. Such information is necessary for the development of strategies for the prevention and treatment of GDM among SEA women.
Collapse
|
|
40
|
Savona-Ventura C, Vassallo J, Marre M, Karamanos BG. A composite risk assessment model to screen for gestational diabetes mellitus among Mediterranean women. Int J Gynaecol Obstet 2012; 120:240-4. [DOI: 10.1016/j.ijgo.2012.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/01/2012] [Accepted: 11/26/2012] [Indexed: 11/26/2022]
|
|
41
|
Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, Vellinga A, Dunne F. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabet Med 2012; 29:844-54. [PMID: 22150506 DOI: 10.1111/j.1464-5491.2011.03541.x] [Citation(s) in RCA: 249] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects of its diagnosis. METHODS The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan-European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices and barriers to screening. RESULTS Prevalence is most often reported as 2-6% of pregnancies. Prevalence may be lower towards the Northern Atlantic seaboard of Europe and higher in the Southern Mediterranean seaboard. Screening practice and policy is inconsistent across Europe, hampered by lack of consensus on testing methods, diagnostic glycaemic thresholds and the value of routine screening. Poor clinician awareness of gestational diabetes, its diagnosis and local clinical guidelines further undermine detection of gestational diabetes. CONCLUSIONS Europe-wide agreement on screening approaches and diagnostic standards for gestational diabetes could lead to better detection and treatment, improved outcomes for women and children and a strengthened evidence base. There is an urgent need for well-designed research that can inform decisions on best practice in gestational diabetes mellitus screening and diagnosis.
Collapse
Affiliation(s)
- B S Buckley
- School of Medicine, National University of Ireland, Galway, Ireland.
| | | | | | | | | | | | | | | |
Collapse
|
|
42
|
Rice GE, Illanes SE, Mitchell MD. Gestational diabetes mellitus: a positive predictor of type 2 diabetes? Int J Endocrinol 2012; 2012:721653. [PMID: 22675354 PMCID: PMC3366202 DOI: 10.1155/2012/721653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 03/08/2012] [Indexed: 12/27/2022] Open
Abstract
The aim of this paper is to consider the relative benefits of screening for type two diabetes mellitus in women with a previous pregnancy complicated by gestational diabetes mellitus. Recent studies suggest that women who experience GDM are at a greater risk of developing type 2 diabetes within 10-20 years of their index pregnancy. If considered as a stand-alone indicator of the risk of developing type 2 diabetes, GDM is a poor diagnostic test. Most women do not develop GDM during pregnancy and of those that do most do not develop type 2 diabetes. There is, however, a clear need for better early detection of predisposition to disease and/or disease onset to significantly impact on this global pandemic. The putative benefits of multivariate approaches and first trimester and preconception screening to increase the sensitivity of risk assignment modalities for type 2 diabetes are proposed.
Collapse
Affiliation(s)
- Gregory E Rice
- The University of Queensland Centre for Clinical Research, RBWH Campus, Herston, Brisbane, QLD 4029, Australia.
| | | | | |
Collapse
|
|
43
|
Grewal E, Kansara S, Kachhawa G, Ammini AC, Kriplani A, Aggarwal N, Gupta N, Khadgawat R. Prediction of gestational diabetes mellitus at 24 to 28 weeks of gestation by using first-trimester insulin sensitivity indices in Asian Indian subjects. Metabolism 2012; 61:715-20. [PMID: 22146095 DOI: 10.1016/j.metabol.2011.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 10/08/2011] [Accepted: 10/13/2011] [Indexed: 10/14/2022]
Abstract
The aim of the present study was to predict the development of gestational diabetes mellitus (GDM) after 24 weeks of gestation by using first-trimester insulin indices. A total of 298 nondiabetic pregnant women underwent 3-hour oral glucose tolerance test (OGTT) in the first trimester of pregnancy. The normoglycemic women underwent second OGTT between 24 and 28 weeks. Insulin sensitivity and resistance indices were calculated by using the Matsuda index (composite insulin sensitivity from OGTT), quantitative insulin sensitivity check index, and homeostasis model assessment for insulin resistance and sensitivity by using the results of the first-trimester OGTT. These indices were compared between subjects who were diagnosed as having GDM and subjects with normal glucose tolerance in the second OGTT. The overall prevalence of GDM was 15.49% (24 in the first trimester and 16 between 24 and 28 weeks). First-trimester fasting plasma insulin greater than 7.45 μU/mL was able to predict GDM with sensitivity and specificity of 80% and 57.4%, respectively. The negative predictive value for this parameter was 0.97. Values of first-trimester composite insulin sensitivity from OGTT less than 5.5 had sensitivity and specificity of 71.4% and 62.5% for the prediction of GDM. First-trimester hyperinsulinemia preceded the onset of hyperglycemia between 24 and 28 weeks of gestation and would predict the development of GDM with limited sensitivity and specificity.
Collapse
Affiliation(s)
- Emmy Grewal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, India
| | | | | | | | | | | | | | | |
Collapse
|
|
44
|
Girgis CM, Gunton JE, Cheung NW. The influence of ethnicity on the development of type 2 diabetes mellitus in women with gestational diabetes: a prospective study and review of the literature. ISRN ENDOCRINOLOGY 2012; 2012:341638. [PMID: 22577574 PMCID: PMC3345225 DOI: 10.5402/2012/341638] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 02/15/2012] [Indexed: 12/16/2022]
Abstract
As the worldwide prevalence of type 2 diabetes continues to rise at an alarming rate, the search for susceptible populations likely to benefit from preventative measures becomes more important. One such population is women with a previous history of gestational diabetes mellitus (GDM). In this prospective study of 101 women who had GDM in Australia, ethnicity was a major risk factor for the development of diabetes following a diagnosis of GDM. With a mean followup of 5.5 years after GDM, South Asian women had a significantly higher risk of developing abnormal glucose tolerance (AGT) (69%) than women of all other ethnicities (P < 0.05). The prevalence of diabetes and impaired glucose tolerance was also very high amongst other groups: South East and East Asian (11/27, 41%), Middle-Eastern (8/18, 44%), South European backgrounds (5/12, 42%), and Australian-born women 39% (11/28). A review of the literature supports the role of ethnicity in the development of diabetes amongst these women. These findings have implications for South Asian countries and countries such as Australia where there is a population from diverse ethnic backgrounds and where the implementation of targeted measures to stem the growing tide of diabetes is needed.
Collapse
Affiliation(s)
- Christian M Girgis
- Diabetes and Transcription Factors Group, Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW 2010, Australia
| | | | | |
Collapse
|
|
45
|
Balaji V, Madhuri BS, Paneerselvam A, Arthi T, Seshiah V. Comparison of venous plasma glucose and capillary whole blood glucose in the diagnosis of gestational diabetes mellitus: a community-based study. Diabetes Technol Ther 2012; 14:131-4. [PMID: 21992269 DOI: 10.1089/dia.2011.0060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Universal screening for gestational diabetes mellitus (GDM) is advocated in Indian women as they have the highest frequency of GDM among the South Asian population. For this the diagnostic procedure has to be simple, economical, and evidence based. Hence, this study was undertaken to compare point-of-care measured capillary whole blood glucose (CBG) with a glucometer and laboratory-estimated venous plasma glucose (VPG) and to suggest which is feasible as a diagnostic tool. METHODS Consecutive pregnant women in the third trimester were included in this study with the approval of the institutional ethical committee. They were given 75 g of oral glucose in the fasting state. After 2 h, CBG was measured by finger prick using an Accu-Chek(®) glucometer (Roche Diagnostics India Pvt. Ltd., Mumbai, India), and venous blood was drawn to estimate VPG in the laboratory by the glucose oxidase-peroxidase method. The diagnosis of GDM was based on a 2-h plasma glucose level of ≥7.8 mmol/L (World Health Organization criteria). RESULTS Among 819 pregnant women, 86 (10.5%) were diagnosed as having GDM. The CBG value at a 2-h plasma glucose level of ≥7.8 mmol/L had a sensitivity of 80.2% and specificity of 98.5% with false-positive and false-negative rates of 1.5% and 19.8%, respectively. The area under the receiver operator characteristic curve of CBG was 0.991. CONCLUSION The CBG value at a 2-h plasma glucose level of ≥7.8 mmol/L may be recommended for the diagnosis of GDM in healthcare centers where laboratory technology is not available.
Collapse
Affiliation(s)
- Vijayam Balaji
- Dr. V. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Centre, Chennai, India
| | | | | | | | | |
Collapse
|
|
46
|
Bandyopadhyay M. Tackling complexities in understanding the social determinants of health: the contribution of ethnographic research. BMC Public Health 2011; 11 Suppl 5:S6. [PMID: 22168509 PMCID: PMC3247029 DOI: 10.1186/1471-2458-11-s5-s6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The complexities inherent in understanding the social determinants of health are often not well-served by quantitative approaches. My aim is to show that well-designed and well-conducted ethnographic studies have an important contribution to make in this regard. Ethnographic research designs are a difficult but rigorous approach to research questions that require us to understand the complexity of people's social and cultural lives. APPROACH I draw on an ethnographic study to describe the complexities of studying maternal health in a rural area in India. I then show how the lessons learnt in that setting and context can be applied to studies done in very different settings. RESULTS I show how ethnographic research depends for rigour on a theoretical framework for sample selection; why immersion in the community under study, and rapport building with research participants, is important to ensure rich and meaningful data; and how flexible approaches to data collection lead to the gradual emergence of an analysis based on intense cross-referencing with community views and thus a conclusion that explains the similarities and differences observed. CONCLUSION When using ethnographic research design it can be difficult to specify in advance the exact details of the study design. Researchers can encounter issues in the field that require them to change what they planned on doing. In rigorous ethnographic studies, the researcher in the field is the research instrument and needs to be well trained in the method. IMPLICATION Ethnographic research is challenging, but nevertheless provides a rewarding way of researching complex health problems that require an understanding of the social and cultural determinants of health.
Collapse
Affiliation(s)
- Mridula Bandyopadhyay
- Mother & Child Health Research, La Trobe University, 215 Franklin Street, Melbourne, Victoria 3000, Australia.
| |
Collapse
|
|
47
|
Gagnon AJ, McDermott S, Rigol-Chachamovich J, Bandyopadhyay M, Stray-Pedersen B, Stewart D. International migration and gestational diabetes mellitus: a systematic review of the literature and meta-analysis. Paediatr Perinat Epidemiol 2011; 25:575-92. [PMID: 21980947 DOI: 10.1111/j.1365-3016.2011.01230.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in countries of resettlement have a greater risk of gestational diabetes mellitus (GDM) than women in receiving countries. A systematic review of the literature from Medline, Embase, PsychInfo and CINAHL from 1990 to 2009 included studies of migrant women and GDM. Studies were excluded if there was no cross-border movement or comparison group or if the receiving country was not the country of resettlement. Studies were assessed for quality, analysed descriptively and meta-analysed. Twenty-four reports (representing >120,000 migrants) met our inclusion criteria. Migrants were described primarily by geographic origin; other relevant aspects (e.g. time in country, language fluency) were rarely studied. Migrants' results for GDM were worse than those for receiving-country women in 79% of all studies. Meta-analyses showed that, compared with receiving-country women, Caribbean, African, European and Northern European women were at greater risk of GDM, while North Africans and North Americans had risks similar to receiving-country women. Although results of the 31 comparisons of Asians, East Africans or non-Australian Oceanians were too heterogeneous to provide a single GDM risk estimate for migrant women, only one comparison was below the receiving-country comparison group, all others presented a higher risk estimate. The majority of women migrants to resettlement countries are at greater risk for GDM than women resident in receiving countries. Research using clear, specific migrant definitions, adjusting for relevant risk factors and including other aspects of migration experiences is needed to confirm and understand these findings.
Collapse
Affiliation(s)
- Anita J Gagnon
- School of Nursing, McGill University, Montreal, QC, Canada.
| | | | | | | | | | | | | |
Collapse
|
|
48
|
Abstract
Gestational diabetes mellitus (GDM) complicates a substantial number of pregnancies. There is consensus that in patients of GDM, excellent blood glucose control, with diet and, when necessary, oral hypoglycemics and insulin results in improved perinatal outcomes, and appreciably reduces the probability of serious neonatal morbidity compared with routine prenatal care. Goals of metabolic management of a pregnancy complicated with GDM have to balance the needs of a healthy pregnancy with the requirements to control glucose level. Medical nutrition therapy is the cornerstone of therapy for women with GDM. Surveillance with daily self-monitoring of blood glucose has been found to help guide management in a much better way than blood glucose checking in labs and clinics, which tends to be less frequent. Historically, insulin has been the therapeutic agent of choice for controlling hyperglycemia in pregnant women. However, difficulty in medication administration with multiple daily injections, potential for hypoglycemia, and increase in appetite and weight make this therapeutic option cumbersome for many pregnant patients. Use of oral hypogycemic agents (OHAs) in pregnancy has opened new vistas for GDM management. At present, there is a growing acceptance of glyburide (glibenclamide) use as the primary therapy for GDM. Glyburide and metformin have been found to be safe, effective and economical for the treatment of gestational diabetes. Insulin, however, still has an important role to play in GDM. GDM is a window of opportunity, which needs to be seized, for prevention of diabetes in future life. Goal of our educational programs should be not only to improve pregnancy outcomes but also to promote healthy lifestyle changes for the mother that will last long after delivery. Team effort on part of obstetricians and endocrinologists is required to make "the diabetes capital of the world" into "the diabetes care capital of the world".
Collapse
Affiliation(s)
- Navneet Magon
- Department of Obstetrics and Gynecology, Air Force Hospital, Kanpur, Uttar Pradesh, India
| | - V. Seshiah
- Diabetes Research Institute and Dr. Balaji Diabetes Care Centre, Chennai, India
| |
Collapse
|
|
49
|
BANDYOPADHYAY M, SMALL R, DAVEY MA, OATS JJN, FORSTER DA, AYLWARD A. Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia. Aust N Z J Obstet Gynaecol 2011; 51:360-4. [DOI: 10.1111/j.1479-828x.2011.01322.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
|
50
|
Abstract
Gestational diabetes mellitus is defined as glucose intolerance that begins or is first recognized during pregnancy. Its prevalence, generally situated between 2-6%, may reach 10-20% in high-risk populations, with an increasing trend across most racial/ethnic groups studied. Among traditional risk factors, previous gestational diabetes, advanced maternal age and obesity have the highest impact on gestational diabetes risk. Racial/ethnic origin and family history of type 2 diabetes have a significant but moderate impact (except for type 2 diabetes in siblings). Several non traditional factors have been recently characterized, either physiological (low birthweight and short maternal height) or pathological (polycystic ovaries). The multiplicity of risk factors and their interactions results in a low reliability of risk prediction on an individual basis.
Collapse
Affiliation(s)
- F Galtier
- HRU Montpellier, Centre d'investigation clinique et Département des Maladies Endocriniennes,, 34295 Montpellier cedex 05, France.
| |
Collapse
|