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Affiliation(s)
| | - Anna K. Schütz
- Endocrinology and Nephrology, Karl Landsteiner Institute, Vienna, Austria
| | - Marlies Eichner
- Department of Endocrinology and Nephrology, City Hospital Hietzing, Vienna, Austria
| | - Julia K. Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Austria
- Julia K. Mader, MD, Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, Graz 8036, Austria.
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Opara CN, Akintorin M, Byrd A, Cirignani N, Akintorin S, Soyemi K. Maternal diabetes mellitus as an independent risk factor for clinically significant retinopathy of prematurity severity in neonates less than 1500g. PLoS One 2020; 15:e0236639. [PMID: 32745146 PMCID: PMC7398545 DOI: 10.1371/journal.pone.0236639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 07/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background Retinopathy of prematurity (ROP) is a significant morbidity in preterm babies. Multiple risk factors for severe ROP have been extensively studied, however, only a few studies have included maternal diabetes mellitus (MDM) in their assessment. ROP and diabetic retinopathy are both retinal vascular diseases in which there is leakage and/or neovascularization from damaged retinal vessels. Diabetes may affect ROP development; however, there are conflicting results on the association between MDM and ROP. Objective To determine if MDM is an independent risk factor for clinically significant ROP (ROP > Stage II) in neonates weighing less than 1500g. Design/Method We conducted a retrospective cohort study of neonates weighing <1500g who were delivered or transferred into our institution from 2007 through 2017. Logistic regression was used to analyze the association between severe ROP and MDM. The risks for the different stages of ROP from MDM were compared using chi-square linear trend test. Results We extracted 883 paired maternal-neonatal data. The mean (standard deviation) gestational age and birthweight were 28.5 (2.9) weeks and 1052.7 (300.9) grams, respectively. Of the 883 mothers, 72 (8.2%) had DM. The incidence of ROP and severe ROP was 42.4% (374/883) and 6.5% (57/883) respectively. The odds ratio comparing MDM and severe ROP was 3.47 [95% CI: 1.51–7.96]; p<0.01). Compared to Stage I, the risk of MDM in infants with ROP increased from 1.49 in Stage II ROP to 2.59 in Stages III&IV. Severe ROP was associated with infant steroid use (OR: 5.92 [95% CI: 2.83–12.38]; p <0.01), sepsis (OR: 2.13 [95% CI: 1.09–4.14]; p = 0.03) chorioamnionitis (OR: 1.90 [95% CI: 1.03–3.50]; p = 0.04), and maternal steroid use (OR: 0.51 [95% CI: 0.32–0.79]; p<0.01). Conclusion Maternal diabetes is associated with ROP and the strength of association increased with increasing severity of ROP.
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Affiliation(s)
- Chibuzor Nonye Opara
- Department of Pediatrics, John H Stroger Hospital of Cook County, Chicago, Illinois, United States of America
- * E-mail:
| | - Mopelola Akintorin
- Department of Pediatrics, John H Stroger Hospital of Cook County, Chicago, Illinois, United States of America
| | - Allison Byrd
- Department of Pediatrics, John H Stroger Hospital of Cook County, Chicago, Illinois, United States of America
| | - Natascha Cirignani
- A. T. Still University School of Osteopathic Medicine, Arizona, United States of America
| | - Similolu Akintorin
- Keck School of Medicine University of Southern California, Los Angeles, California, United States of America
| | - Kenneth Soyemi
- Department of Pediatrics, John H Stroger Hospital of Cook County, Chicago, Illinois, United States of America
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Giuliani C, Li Volsi P, Brun E, Chiambretti A, Giandalia A, Tonutti L, Di Bartolo P, Napoli A. Breastfeeding during the COVID-19 pandemic: Suggestions on behalf of woman study group of AMD. Diabetes Res Clin Pract 2020; 165:108239. [PMID: 32479766 PMCID: PMC7260539 DOI: 10.1016/j.diabres.2020.108239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022]
Abstract
SARS-Cov2 infection has recently spread to Italy with important consequences on pregnancy management, mother and child health and mother-child contact. Breastfeeding improves the health of mother and child and reduces risk of neonatal infection with other pathogens that are likely to cause serious illness. To date no evidence confirmed COVID-19 vertical transmission from infected pregnant mother to their fetus. However it is well known that an infected mother can transmit the COVID-19 virus through respiratory droplets during breastfeeding or intimate contact. Thus, the mothers with known or suspected COVID-19 should adhere to standard and contact precautions during breastfeeding. Woman Study Group of AMD, after reviewing current knowledge about COVID-19 vertical transmission and the compatibility of breastfeeding in COVID-19 mother, the available recommendations from Health Care Organizations and main experts opinions, issued the following suggestions on breastfeeding during the COVID-19 pandemic, addressed both to mothers with and without diabetes. It should be considered that following suggestions may change in the future when more evidence is acquired regarding SARS-Cov2 infection.
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Affiliation(s)
- Chiara Giuliani
- Experimental Medicine Department, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy.
| | - Patrizia Li Volsi
- S.S.D. di Endocrinologia e Malattie del Ricambio, "ASFO" Pordenone, Italy
| | - Elisabetta Brun
- Diabetology and Metabolic Diseases Unit, ULSS 8 Vicenza, Italy
| | | | - Annalisa Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Laura Tonutti
- Endocrinology, Diabetes, Metabolism and Clinical Nutrition, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Paolo Di Bartolo
- Rete Clinica di Diabetologia Aziendale, Dipartimento Internistico di Ravenna, A.Usl della Romagna, Italy
| | - Angela Napoli
- Clinical and Molecular Medicine Department, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
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54
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Grev JE, Munger KM, Scott SM. Infant of a Diabetic Mother. S D Med 2020; 73:323-327. [PMID: 32805783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Currently, 3-10 percent of pregnancies are complicated by abnormal glucose control, and the incidence of diabetes mellitus in the U.S. has risen with the obesity epidemic. Pregnancies affected by diabetes often result in abnormal fetal development, including altered growth and nutrient distribution as well as congenital malformations. Prenatal exposure to the diabetic environment places infants at risk for perinatal compromise, complications in the neonatal period, as well as long term metabolic and neurodevelopmental consequences. It is prudent for providers who care for these newborns to be cognizant of these potential complications in order to promptly and appropriately address them.
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Affiliation(s)
- Jacquelyn Em Grev
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Sanford Health, Sioux Falls, South Dakota
| | - Kayla M Munger
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Sarah M Scott
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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55
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Affiliation(s)
- N Levy
- Department of Anaesthesia and Perioperative Medicine, West Suffolk Hospital, Bury St Edmunds, UK
| | - G M Hall
- Department of Anaesthesia, St George's Hospital Medical School, London, UK
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56
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Forde R, Collin J, Brackenridge A, Chamley M, Hunt K, Forbes A. A qualitative study exploring the factors that influence the uptake of pre-pregnancy care among women with Type 2 diabetes. Diabet Med 2020; 37:1038-1048. [PMID: 31127872 DOI: 10.1111/dme.14040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/19/2023]
Abstract
AIM To elicit the views and experiences of women with Type 2 diabetes and healthcare professionals relating to the pregnancy and pre-pregnancy care they have received or provided. METHODS A qualitative study using in-depth semi-structured interviews with women with Type 2 diabetes (n=30) and healthcare professionals (n=22) from primary and specialist care. Women were purposively sampled to include different experiences of pregnancy and pre-pregnancy care. Data were transcribed verbatim and analysed thematically using Framework Analysis. RESULTS The median age of the women was 37 years, and most were obese (median BMI 34.9 kg/m2 ), of black or Asian ethnicity (n=24, 80%) and from areas of high deprivation (n=21, 70%). Participating healthcare professionals were from primary (n=14), intermediate (n=4) and secondary (n=4) care. Seven themes expressing factors that mediate reproductive behaviour and care in women with Type 2 diabetes were identified at the patient, professional and system levels. Type 2 diabetes was generally perceived negatively by the women and the healthcare professionals. There was a lack of awareness about the pre-pregnancy care needs for this population, and communication between both groups was unhelpful in eliciting the reproductive intentions of these women. The themes also reveal a lack of systemic processes to incorporate pre-pregnancy care into the care of women with Type 2 diabetes, and consequently, health professionals in primary care have limited capacity to provide such support. CONCLUSION If the current high levels of unprepared pregnancies in women with Type 2 diabetes are to be reduced, the reproductive healthcare needs of this group need to be embedded into their mainstream diabetes management.
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Affiliation(s)
- R Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | - J Collin
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | | | - M Chamley
- North Wood Group Practice, London, UK
| | - K Hunt
- King's College Hospital NHS Foundation Trust, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
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Polsky S, Garcetti R, Pyle L, Joshee P, Demmitt JK, Snell-Bergeon JK. Continuous glucose monitor use with and without remote monitoring in pregnant women with type 1 diabetes: A pilot study. PLoS One 2020; 15:e0230476. [PMID: 32298269 PMCID: PMC7162510 DOI: 10.1371/journal.pone.0230476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To examine whether continuous glucose monitoring (CGM) with remote monitoring by followers (family/friends) changes glucose management, follower interventions, and health outcomes compared to CGM alone in pregnant women with diabetes. METHODS We prospectively stratified first trimester pregnant women with Type 1 Diabetes to CGM Share (remote monitoring) or CGM Alone. We enrolled a main follower per woman. We retrospectively acquired data for pregnant women who did not use CGM (no CGM). We compared hemoglobin A1c (HbA1c) between groups. We compared sensor glucose, follower interventions, and gestational outcomes between CGM Alone and CGM Share. Longitudinal mixed effects models were used for analyses of changes in outcomes over time. RESULTS HbA1c decreased in all groups throughout pregnancy and was significantly lower over time in women using CGM Share (n = 15) compared to CGM Alone (n = 13) or no CGM (n = 8) (p = 0.0042). CGM Share users had lower median sensor glucose levels (p = 0.0331) and percent time spent >180 mg/dL (p = 0.0228) across pregnancy. There were no significant differences in maternal and fetal outcomes between groups. CGM Share followers had more alerts for hypoglycemia, but did fewer interventions. CONCLUSIONS In this small pilot study, use of CGM with remote monitoring improved some glycemic metrics in pregnant women with diabetes.
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
| | - Rachel Garcetti
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Laura Pyle
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Prakriti Joshee
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jamie K. Demmitt
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Janet K. Snell-Bergeon
- Barbara Davis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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Peixoto AB, Bravo-Valenzuela NJM, Martins WP, Słodki M, Mattar R, Moron AF, Araujo Júnior E. Impact of type I and type II maternal diabetes mellitus on fetal cardiac function assessment parameters using spectral and tissue Doppler. Int J Cardiovasc Imaging 2020; 36:1237-1247. [PMID: 32232625 DOI: 10.1007/s10554-020-01821-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the impact of pregestational diabetes mellitus (DM) on fetal cardiac function two-dimensional parameters using spectral and tissue Doppler. Pregnant women between 20 and 36 + 6 weeks gestation were divided into three groups: controls, type I DM, and type II DM. The right ventricle (RV) and left ventricle (LV) annular velocity peaks were measured using spectral (E, A) and tissue (E', A', S') Doppler. The myocardial performance index was calculated as (isovolumetric contraction time [ICT] + isovolumetric relaxation time [IRT])/ejection time using tissue (MPI') and the spectral Doppler (MPI). A general linear model, with fetal heart rate as a covariant, was used to evaluate the effect of DM on the fetal heart function assessment parameters. To assess the association of type I and II DM with adverse perinatal outcomes, Fisher's exact test was used. A receiver operating characteristic curve was used to determine the best cutoff for fetal cardiac function assessment parameters to identify the neonatal composite outcomes. The sample comprised 179 pregnant women. DM had significant effect on RV and LV A peak velocities (p = 0.026 and p = 0.011, respectively). LV ICT (p < 0.001) and LV MPI (p < 0.001) were significantly affected by maternal DM. Fetuses from pregnant women with type II DM showed significantly higher LV MPI (0.492 vs. 0.459, p = 0.006) and RV S' (7.2 vs. 6.44 cm/s, p = 0.024) than controls. Fetuses from type I DM pregnant women showed increase in cardiac parameters that evaluated the LV and RV diastolic function (LV IRT' p < 0.001 and RV MPI' p = 0.044). Type I and II DM were associated with adverse perinatal outcomes: neonatal intensive care unit stay (p < 0.0001), macrosomia (p < 0.0001), hyperbilirubinemia (p < 0.0001), and hypoglycemia (p < 0.0001). The LV MPI' showed significant but moderate sensitivity in identifying the composite neonatal outcomes (AUC: 0.709, 95% CI 0.629-0.780, p < 0.001). Tissue Doppler and MPI parameters can be useful to detect subclinical cardiac dysfunction in the fetal heart of pregestational DM pregnant women.
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Affiliation(s)
- Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM- UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
- Gynecology and Obstetrics Service, Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba, MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Nathalie Jeanne Magioli Bravo-Valenzuela
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM- UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | | | - Maciej Słodki
- Department of Prenatal Cardiology, Polish Mother Memorial Hospital Research Institute, Łódż, Poland
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM- UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM- UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM- UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil.
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Cosson E, Vicaut E, Portal JJ, Carbillon L, Valensi P. Comment on Foussard et al. Skin Autofluorescence of Pregnant Women With Diabetes Predicts the Macrosomia of Their Children. Diabetes 2019;68:1663-1669. Diabetes 2020; 69:e3-e4. [PMID: 32079707 DOI: 10.2337/db19-1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Paris 13 University, Sorbonne Paris Cité, Centre de Recherche en Nutrition Humaine Île-de-France (CRNH-IdF), CINFO, Bobigny, France
- Unité de Recherche Epidémiologique Nutritionnelle, UMR U557 INSERM/U11125 INRA/CNAM/Université Paris13, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Eric Vicaut
- Assistance Publique-Hôpitaux de Paris Unité de Recherche Clinique Saint-Louis-Lariboisière, Université Denis Diderot, Paris, France
| | - Jean-Jacques Portal
- Assistance Publique-Hôpitaux de Paris Unité de Recherche Clinique Saint-Louis-Lariboisière, Université Denis Diderot, Paris, France
| | - Lionel Carbillon
- Department of Obstetrics and Gynecology, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Paul Valensi
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Paris 13 University, Sorbonne Paris Cité, Centre de Recherche en Nutrition Humaine Île-de-France (CRNH-IdF), CINFO, Bondy, France
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Foussard N, Cougnard-Grégoire A, Rajaobelina K, Delcourt C, Helmer C, Lamireau T, Gonzalez C, Grouthier V, Haissaguerre M, Blanco L, Alexandre L, Mohammedi K, Rigalleau V. Response to Comment on Foussard et al. Skin Autofluorescence of Pregnant Women With Diabetes Predicts the Macrosomia of Their Children. Diabetes 2019;68:1663-1669. Diabetes 2020; 69:e5-e6. [PMID: 32079708 DOI: 10.2337/dbi19-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ninon Foussard
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Audrey Cougnard-Grégoire
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Kalina Rajaobelina
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Cécile Delcourt
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Thierry Lamireau
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Concepcion Gonzalez
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Virginie Grouthier
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | | | - Laurence Blanco
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Laure Alexandre
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Kamel Mohammedi
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Vincent Rigalleau
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
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Liu Y, Ettinger AS, Téllez-Rojo M, Sánchez BN, Zhang Z, Cantoral A, Hu H, Peterson KE. Prenatal Lead Exposure, Type 2 Diabetes, and Cardiometabolic Risk Factors in Mexican Children at Age 10-18 Years. J Clin Endocrinol Metab 2020; 105:dgz038. [PMID: 31608940 PMCID: PMC7037075 DOI: 10.1210/clinem/dgz038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/26/2019] [Indexed: 12/23/2022]
Abstract
CONTEXT Several cross-sectional studies have assessed the association of lead exposure with type 2 diabetes and cardiometabolic risk factors in adults; however, studies of such associations in childhood are rare. OBJECTIVE We assessed the prospective associations of prenatal exposure to lead with type 2 diabetes and cardiometabolic risk factors in children. DESIGN The Early Life Exposure in Mexico to Environmental Toxicants is a birth cohort study of pregnant women and their offspring. SETTING Public hospitals in Mexico City. PATIENTS OR OTHER PARTICIPANTS Women were recruited during pregnancy; their offspring were recruited for a follow-up visit at age 10 to 18 years (n = 369). MAIN OUTCOME MEASURES We measured fasting serum markers of type 2 diabetes and cardiometabolic risk factors in children, including fasting glucose, insulin, and lipids. The index of insulin resistance was calculated. RESULTS The geometric mean of maternal blood lead levels (BLLs) during pregnancy was 4.3 µg/dL (95% confidence interval [CI]): 4.0-4.6 µg/dL) in the entire sample. In boys, those with maternal BLLs ≥ 5 µg/dL (compared with those with BLLs < 5 µg/dL) had significantly lower z scores for total cholesterol (β = -0.41, 95% CI: -0.71, -0.12), high-density lipoprotein cholesterol (β = -0.32, 95% CI: -0.59, -0.05), and low-density lipoprotein cholesterol (β = -0.52, 95% CI: -0.81, -0.22), adjusting for covariates. No associations were detected in girls. CONCLUSIONS In our study, we found that higher prenatal exposure to lead was associated with lower levels of cholesterol in children following a sex-specific pattern. Further studies with a larger sample size that examine whether sex is a potential modifier are needed to confirm our findings.
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Affiliation(s)
- Yun Liu
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Adrienne S Ettinger
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Martha Téllez-Rojo
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Zhenzhen Zhang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Alejandra Cantoral
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Howard Hu
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
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Sheth S, Goto L, Bhandari V, Abraham B, Mowes A. Factors associated with development of early and late pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. J Perinatol 2020; 40:138-148. [PMID: 31723236 PMCID: PMC7223406 DOI: 10.1038/s41372-019-0549-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/06/2019] [Accepted: 10/28/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate factors associated with development of early and late pulmonary hypertension (E/LPH) in preterm infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN A retrospective case-control observational study of preterm infants with BPD admitted to a level IV referral neonatal intensive care unit over 5 years. We compared pre- and postnatal characteristics between infants with or without BPD-associated EPH and LPH. RESULTS Fifty-nine out of 220 infants (26.8%) had LPH, while 85 out of 193 neonates (44%) had EPH. On multiple logistic regression, novel factors associated with development of BPD-LPH included presence of maternal diabetes, EPH, tracheostomy, tracheitis, intraventricular hemorrhage (IVH, grade ≥3) and systemic steroid use. For EPH, these were maternal diabetes, IVH grade ≥3, high frequency ventilator use, and absence of maternal antibiotics use. CONCLUSION We identified novel factors and confirmed previously established factors with development of LPH and EPH, which can help develop a screening strategy in BPD patients.
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Affiliation(s)
- Sudip Sheth
- Department of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Lisa Goto
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Vineet Bhandari
- Department of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Boban Abraham
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatric Cardiology, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Anja Mowes
- Department of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
- Drexel University College of Medicine, Philadelphia, PA, USA.
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Ducos C, Rigalleau V, Foussard N, Cambos S, Poupon P, Monlun M, Blanco L, Haissaguerre M, Grouthier V, Velayoudom-Cephise FL, Mohammedi K. Why might pumps fail in pregnant women with Type 1 diabetes? Diabet Med 2020; 37:159-160. [PMID: 31264729 DOI: 10.1111/dme.14063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 11/26/2022]
Affiliation(s)
- C Ducos
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - V Rigalleau
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - N Foussard
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - S Cambos
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - P Poupon
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - M Monlun
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - L Blanco
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - M Haissaguerre
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - V Grouthier
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - F-L Velayoudom-Cephise
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
| | - K Mohammedi
- Endocrinology-Nutrition Department, Centre Hospitalier Universitaire de Bordeaux, France
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Vestgaard M, Ásbjörnsdóttir B, Ringholm L, Andersen LLT, Jensen DM, Damm P, Mathiesen ER. White coat hypertension in early pregnancy in women with pre-existing diabetes: prevalence and pregnancy outcomes. Diabetologia 2019; 62:2188-2199. [PMID: 31628489 DOI: 10.1007/s00125-019-05002-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/26/2019] [Indexed: 02/01/2023]
Abstract
AIMS/HYPOTHESIS Hypertensive disorders are prevalent among pregnant women with pre-existing diabetes, but the prevalence and impact of white coat hypertension are unknown. Measurement of home BP before initiation of antihypertensive treatment is necessary to identify white coat hypertension since international guidelines recommend that white coat hypertension is left untreated. The aim of this study, conducted among women with pre-existing diabetes, was therefore to examine the prevalence of white coat hypertension in early pregnancy, and pregnancy outcome in women with white coat hypertension in early pregnancy. METHODS A prospective cohort study was undertaken involving women with pre-existing diabetes from a geographically well-defined area. Based on office BP in early pregnancy and home BP measured for 3 days, women were categorised in three groups: (1) white coat hypertension, defined as office BP ≥ 135/85 mmHg and mean home BP < 130/80 mmHg; (2) chronic hypertension, defined as pre-pregnancy hypertension including newly detected office BP ≥ 135/85 mmHg with home BP ≥ 130/80 mmHg; and (3) normotension. Office BP was measured every 2 weeks and, if ≥ 135/85 mmHg, home BP measurements were performed. White coat hypertension was left untreated, and tight antihypertensive treatment was initiated when both office BP ≥ 135/85 mmHg and home BP ≥ 130/80 mmHg. Pregnancy-induced hypertensive disorders were defined as office BP ≥ 140/90 mmHg with home BP ≥ 130/80 mmHg when available, with onset after 20 weeks of gestation. RESULTS In total, 32 out of 222 women with pre-existing diabetes had newly detected office BP ≥ 135/85 mmHg in early pregnancy. White coat hypertension was present in 84% (27/32) of these women, representing 12% (95% CI 8%, 17%) of the whole cohort. Chronic hypertension was present in 14% (n = 32) and normotension in 74% (n = 163). Women with white coat hypertension were characterised by higher pre-pregnancy BMI (p = 0.011), higher home BP (p < 0.001) and higher prevalence of type 2 diabetes (p = 0.009), but similar HbA1c (p = 0.409) compared to women with normotension. Regarding pregnancy outcome, pregnancy-induced hypertensive disorders developed in 44% (12/27) of women with white coat hypertension in comparison with 22% (36/163) among initially normotensive women (p = 0.013), while the prevalence of preterm delivery was comparable (p = 0.143). The adjusted analysis, performed post hoc, suggested approximately double the risk of developing pregnancy-induced hypertensive disorders (OR 2.43 [CI 0.98, 6.05]) if white coat hypertension was present in early pregnancy, independently of pre-pregnancy BMI and parity. CONCLUSIONS/INTERPRETATION White coat hypertension is prevalent in women with pre-existing diabetes and may indicate a high risk of later development of pregnancy-induced hypertensive disorders. To distinguish between persistent white coat hypertension and onset of pregnancy-induced hypertension, repeated home BP monitoring is recommended when elevated office BP is detected. The study was registered at ClinicalTrials.gov (ID: NCT02890836).
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Affiliation(s)
- Marianne Vestgaard
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Dorte M Jensen
- Department of Obstetrics, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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65
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Shah GB, Ordemann A, Daram S, Roman E, Booth T, Johnson R, Xi Y, Mitchell R. Congenital nasal pyriform aperture stenosis: Analysis of twenty cases at a single institution. Int J Pediatr Otorhinolaryngol 2019; 126:109608. [PMID: 31374389 DOI: 10.1016/j.ijporl.2019.109608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal respiratory distress that is difficult to treat. The primary objective of this study was to identify factors that predict the need for initial and revision surgery for CNAPS. The secondary objective is to identify risk factors in maternal history associated with the development of CNPAS. METHODS Infants with CNPAS between 2010 and 2017 were identified by ICD- 9 and 10 codes. Demographics, maternal history, anatomic features on imaging and medical and/or surgical management were reviewed. Frequencies, means and standard deviations were calculated. A p-value <.05 was considered significant. RESULTS Twenty infants were included. All underwent flexible nasal endoscopy with inability to pass the scope in either nostril in 65% of infants. Nineteen had a CT scan and 13 had a MRI with midline defects in 76.3% and 53.8%, respectively. Solitary central mega-incisor was present in 65%. Half underwent surgical intervention at a mean age of 74.8 days, with 90% requiring revision surgery. There was no difference in pyriform aperture distance in the surgical and non-surgical patient subgroups (5.4 mm and 5.2 mm, p = .6 respectively). No specific variables were predictive of need for initial or revision surgery. Maternal diabetes mellitus (MDM) was found in 55% of mothers of infants with CNPAS. CONCLUSION Pyriform aperture distance was not a predictor of surgical intervention. MRI should be considered in all infants with CNPAS as the rate of intracranial complications is high. MDM may be a risk factor for CNPAS.
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Affiliation(s)
- Gopi B Shah
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA.
| | - Allison Ordemann
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
| | - Shiva Daram
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
| | - Emily Roman
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
| | - Tim Booth
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Romaine Johnson
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ron Mitchell
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
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Abstract
This cohort study uses Swedish Medical Birth Register data to investigate risk of birth defects in infants born to women who had Roux-en-Y bariatric surgery between 2007 and 2014.
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Affiliation(s)
- Martin Neovius
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Björn Pasternak
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Näslund
- Department of Surgery, Örebro University, Örebro, Sweden
| | - Jonas Söderling
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Kari Johansson
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
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67
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Trojano G, Damiani GR, Olivieri C, Villa M, Malvasi A, Alfonso R, Loverro M, Cicinelli E. VBAC: antenatal predictors of success. Acta Biomed 2019; 90:300-309. [PMID: 31580319 PMCID: PMC7233729 DOI: 10.23750/abm.v90i3.7623] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/06/2019] [Indexed: 11/23/2022]
Abstract
To determine antenatal factors that may predict successful vaginal birth after Caesarean section (VBAC), to develop a relevant antenatal scoring system and a nomogram for prediction of vaginal birth after caesarean delivery. A non recurring indication for previous Caesarean section (CS), such as breech presentation or foetal distress, is associated with a much higher successful VBAC rate than recurrent indications, such as cephalopelvic disproportion (CPD). Prior vaginal deliveries are excellent prognostic indicators of successful VBAC, especially if the vaginal delivery follows the prior CS. A low vertical uterine incision does not seem to adversely affect VBAC success rates as compared to a low transverse incision. Maternal obesity and diabetes mellitus adversely affect VBAC outcomes. Foetal macrosomia does not appear to be a contraindication to VBAC, as success rates exceeding 50% are achieved and uterine rupture rates are not increased. An inter-pregnancy interval of <24 months is not associated with a decreased success of VBAC. Success rates decrease when interval increases. Twin gestation does not preclude VBAC. Post-dates pregnancies may deliver successfully by VBAC in greater than two-thirds of cases. There are few absolute contraindications to attempted VBAC. Attempted VBAC will be successful in the majority of attempted cases.
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Affiliation(s)
- Giuseppe Trojano
- Department of Obstetrics and Gynaecology, University of Bari "A. Moro" Bari, Italy.
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Foussard N, Cougnard-Grégoire A, Rajaobelina K, Delcourt C, Helmer C, Lamireau T, Gonzalez C, Grouthier V, Haissaguerre M, Blanco L, Alexandre L, Mohammedi K, Rigalleau V. Skin Autofluorescence of Pregnant Women With Diabetes Predicts the Macrosomia of Their Children. Diabetes 2019; 68:1663-1669. [PMID: 31127055 DOI: 10.2337/db18-0906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 05/18/2019] [Indexed: 11/13/2022]
Abstract
Advanced glycation end products (AGEs) accumulated during long-term hyperglycemia are involved in diabetes complications and can be estimated by skin autofluorescence (sAF). During pregnancy, hyperglycemia exposes women to the risk of having a macrosomic newborn. The aim of this study was to determine whether sAF of women with diabetes during a singleton pregnancy could predict macrosomia in their newborns. Using an AGE Reader, we measured the sAF at the first visit of 343 women who were referred to our diabetology department during years 2011-2015. Thirty-nine women had pregestational diabetes, 95 early gestational diabetes mellitus (GDM), and 209 late GDM. Macrosomia was defined as birth weight ≥4,000 g and/or large for gestational age ≥90th percentile. Forty-six newborns were macrosomic. Their mothers had 11% higher sAF compared with other mothers: 2.03 ± 0.30 arbitrary units (AUs) vs. 1.80 ± 0.34 (P < 0.0001). Using multivariate logistic regression, the relation between sAF and macrosomia was significant (odds ratio 4.13 for 1-AU increase of sAF [95% CI 1.46-11.71]) after adjusting for several potential confounders. This relation remained significant after further adjustment for HbA1c (among 263 women with available HbA1c) and for women with GDM only. sAF of pregnant women with diabetes, a marker of long-term hyperglycemic exposure, predicts macrosomia in their newborns.
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Affiliation(s)
- Ninon Foussard
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Audrey Cougnard-Grégoire
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Kalina Rajaobelina
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Cécile Delcourt
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Thierry Lamireau
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
| | - Concepcion Gonzalez
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Virginie Grouthier
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | | | - Laurence Blanco
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Laure Alexandre
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Kamel Mohammedi
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Vincent Rigalleau
- Nutrition-Diabetology, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, UMR 1219, Bordeaux, France
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69
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Lahti-Pulkkinen M, Bhattacharya S, Wild SH, Lindsay RS, Räikkönen K, Norman JE, Bhattacharya S, Reynolds RM. Consequences of being overweight or obese during pregnancy on diabetes in the offspring: a record linkage study in Aberdeen, Scotland. Diabetologia 2019; 62:1412-1419. [PMID: 31214738 PMCID: PMC6647186 DOI: 10.1007/s00125-019-4891-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/20/2019] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS Maternal obesity in pregnancy is associated with cardiovascular disease and mortality rate in the offspring. We aimed to determine whether maternal obesity is also associated with increased incidence of type 2 and type 1 diabetes in the offspring, independently of maternal diabetes as a candidate mechanistic pathway. METHODS Birth records of 118,201 children from 1950 to 2011 in the Aberdeen Maternity and Neonatal Databank were linked to Scottish Care Information-Diabetes, the national register for diagnosed diabetes in Scotland, to identify incident and prevalent type 1 and type 2 diabetes up to 1 January 2012. Maternal BMI was calculated from height and weight measured at the first antenatal visit. The effect of maternal obesity on offspring outcomes was tested using time-to-event analysis with Cox proportional hazards regression to compare outcomes in offspring of mothers in underweight, overweight or obese categories of BMI, compared with offspring of women with normal BMI. RESULTS Offspring of obese (BMI ≥30 kg/m2) and overweight (BMI 25-29.9 kg/m2) mothers had an increased hazard of type 2 diabetes compared with mothers with normal BMI, after adjustment for gestation when weight was measured, maternal history of diabetes before pregnancy, maternal history of hypertension, age at delivery, parity, socioeconomic status, and sex of the offspring: HR 3.48 (95% CI 2.33, 5.06) and HR 1.39 (1.06, 1.83), respectively. CONCLUSIONS/INTERPRETATION Maternal obesity is associated with increased incidence of type 2 diabetes in the offspring. Evidence-based strategies that reduce obesity among women of reproductive age and that might reduce the incidence of diabetes in their offspring are urgently required.
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Affiliation(s)
- Marius Lahti-Pulkkinen
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH14 6TJ, UK
- Tommy's Centre for Maternal and Fetal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca M Reynolds
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH14 6TJ, UK.
- Tommy's Centre for Maternal and Fetal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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70
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Jawad F, Kalra S. Marriage and diabetes. J PAK MED ASSOC 2019; 69:911-912. [PMID: 31201405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This communication shares the challenges and concerns associated with marriage in persons living with diabetes. It classifies the challenges as psychosocial and biomedical, and lists counselling tips to tackle these. It dispels the various myths associated with marriage, andsuggests proactive steps to improve societal attitudes and practices.
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Affiliation(s)
- Fatema Jawad
- Department of Diabetology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
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71
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Slot A, Eriksen NB, Ringholm L, Damm P, Mathiesen ER. Congenital heart defects in offspring of women with Type 2 diabetes - a systematic review. Dan Med J 2019; 66:A5543. [PMID: 31256772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The risk of congenital heart defects in the offspring of women with Type 2 diabetes is only sparsely described. The aim of this review was to estimate the prevalence of congenital heart defects in offspring of women with Type 2 diabetes in comparison to offspring of women with Type 1 diabetes and to offspring of the background population. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A literature search was performed in the PubMed, Embase and Cochrane databases. Studies were included if they were published from 2007 to 2018, comprised a minimum of 200 offspring of women with Type 2 diabetes and examined the prevalence of congenital heart defects. RESULTS Five cohort studies with a total of 23,845 offspring of women with Type 2 diabetes were included. The studies were heterogeneous with respect to method of diagnosis and whether terminated pregnancies were included, and a meta-analysis could not be performed. The mean prevalence of congenital heart defects was 44 (range: 26-65) per 1,000 offspring. The mean relative risk was 0.82 (range: 0.53-1.01) compared with offspring of women with Type 1 diabetes, and 3.83 (range: 2.53-5.49) compared with the background population. A positive association was described between the prevalence of congenital heart defects and the maternal glycated haemoglobin level, but not with medical treatment. CONCLUSIONS The risk of congenital heart defects among offspring of women with Type 2 diabetes was comparable to that of offspring of women with Type 1 diabetes and almost four times higher than in the background population.
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Abstract
Antenatal corticosteroids (ACS) successfully reduce the rates of neonatal mortality and morbidity after preterm birth. However, this translational success story is not without controversies. This chapter explores some contemporary controversies with ACS, including the choice of corticosteroid, use in threatened preterm birth less than 24 weeks' gestation, use in late preterm birth, use at term before cesarean delivery, and issues surrounding repeated and rescue dosing of antenatal corticosteroids. The use of ACS in special populations is also discussed. Finally, areas of future research in ACS are presented, focusing on the ability to individualize therapy.
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Affiliation(s)
- Anthony L Shanks
- Indiana University School of Medicine Department of Obstetrics and Gynecology, USA
| | - Jennifer L Grasch
- Indiana University School of Medicine Department of Obstetrics and Gynecology, USA
| | - Sara K Quinney
- Indiana University School of Medicine Department of Obstetrics and Gynecology, USA
| | - David M Haas
- Indiana University School of Medicine Department of Obstetrics and Gynecology, USA.
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73
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Abstract
There is evidence to support the use of antenatal corticosteroids prior to late preterm birth at 35+0 to 36+6 weeks' gestation and for specific 'at-risk' populations, such as planned cesarean section birth and infants of women with diabetes in pregnancy, to reduce short-term neonatal respiratory morbidity. However, the overall size of effect at late preterm and term gestational ages is less than for early and moderate preterm birth and should be countered against the potential harms. Evidence from randomized trials suggest an increase in the incidence of neonatal hypoglycemia after corticosteroid use prior to late preterm birth; any effect of antenatal corticosteroids on neonatal glycemic control after planned cesarean section birth or for infants born to mothers with diabetes in pregnancy is unknown. Accumulating evidence suggests neonatal hypoglycemia may adversely affect childhood development. To date, no trials of antenatal corticosteroids after 34 weeks' gestation have reliably assessed outcomes beyond the neonatal period.
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Affiliation(s)
- Katie M Groom
- Liggins Institute, University of Auckland and National Women's Health, Auckland City Hospital, Private Bag 92019, Auckland, New Zealand.
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74
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Gueneau De Mussy P, Legardeur H, Gastaldi G, Le Dizes O, Puder JJ. [Preconception care in patients with diabetes]. Rev Med Suisse 2019; 15:1143-1146. [PMID: 31148426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In patients with diabetes, pregnancy is associated with high maternal and fetal risks, especially in unplanned pregnancies. Current evidence confirms that timely family planning and interdisciplinary care and management starting at the preconceptional period can optimize metabolic control and significantly reduce these risks. The purpose of this article is to summarize the different aspects to consider as well as provide tools to use when preparing patients with diabetes for a pregnancy.
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Affiliation(s)
| | | | - Giacomo Gastaldi
- Service d'endocrinologie, diabétologie et hypertension HUG, 1205 Genève
| | - Olivier Le Dizes
- Service d'endocrinologie, diabétologie et métabolisme CHUV, 1011 Lausanne
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75
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Samii L, Kallas-Koeman M, Donovan LE, Lodha A, Crawford S, Butalia S. The association between vascular complications during pregnancy in women with Type 1 diabetes and congenital malformations. Diabet Med 2019; 36:237-242. [PMID: 30499197 DOI: 10.1111/dme.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
AIMS To assess the association between vascular complications of diabetes and the risk of congenital malformations in pregnant women with Type 1 diabetes. METHODS We conducted an observational retrospective cohort study in women with Type 1 diabetes who received care consecutively from three tertiary care diabetes-in-pregnancy clinics in Calgary, Alberta, Canada. Multivariable logistic regression was used to assess the association between vascular complications (retinopathy, nephropathy and pre-existing hypertension) and congenital malformations in offspring of women with Type 1 diabetes. RESULTS Of 232 women with Type 1 diabetes, 49 (21%) had at least one vascular complication and there were 52 babies with congenital malformations. Maternal age (31.8 ± 5.0 vs. 29.4 ± 4.7 years, P < 0.01), diabetes duration (20.9 ± 6.7 vs. 11.2 ± 7.4 years, P < 0.01) and pre-eclampsia rate (12.5% vs. 1.3%, P < 0.01) were higher in mothers with vascular complications than in those without. Multivariable analyses showed that vascular complications were not associated with an increased risk of congenital malformations (odds ratio 1.16, 95% confidence interval 0.46 to 2.88). CONCLUSIONS Vascular complications are common, occurring in one-fifth of pregnant women with Type 1 diabetes, and in this study do not appear to be associated with an increased risk of congenital malformations in children.
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Affiliation(s)
- L Samii
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
| | - M Kallas-Koeman
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
| | - L E Donovan
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary Alberta, Canada
| | - A Lodha
- Department of Community Health Sciences, University of Calgary, Calgary Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
| | - S Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary Alberta, Canada
| | - S Butalia
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary Alberta, Canada
- Libin Cardiovascular Institute, Calgary Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Cordero L, Stenger MR, Landon MB, Nankervis CA. In-hospital formula supplementation and breastfeeding initiation in infants born to women with pregestational diabetes mellitus. J Neonatal Perinatal Med 2019; 12:285-293. [PMID: 30932901 DOI: 10.3233/npm-180140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To ascertain the rate of in-hospital supplementation as it relates to early breastfeeding (BF) and early formula feeding (FF) and its effects on BF (exclusive and partial) at the time of discharge for infants born to women with pregestational diabetes mellitus (PGDM). METHODS Retrospective cohort investigation of 282 women with PGDM who intended to BF and their asymptomatic infants admitted to the newborn nursery for blood glucose monitoring and routine care. Early feeding was defined by the initial feeding if given within four hours of birth. RESULTS Of the 282 mother-infant dyads, for 134 (48%) early feeding was BF and for 148 (52%) early feeding was FF. Times from birth to BF and FF (median 1 hr, 0.3-6) were similar, while the time to first BF for those who FF and supplemented was longer (median 6 hr., 1-24). Ninety-seven infants (72%) who first BF also supplemented. Of these, 22 (23%) BF exclusively, 67 (69%) BF partially and 8 (8%) FF at discharge. One hundred seventeen (79%) who first FF also supplemented. Of these, 21 (18%) BF exclusively, 76 (65%) BF partially and 20 (17%) FF at discharge. CONCLUSION Regardless of the type of first feeding, the majority of infants born to women with PGDM require supplementation. Even when medically indicated, in-hospital supplementation is an obstacle, albeit not absolute, to exclusive BF at discharge. Parents should be reminded that occasional supplementation should not deter resumption and continuation of BF.
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Affiliation(s)
- L Cordero
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - M R Stenger
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - M B Landon
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - C A Nankervis
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Alessi J, Wiegand DM, Hirakata VN, Oppermann MLR, Reichelt AJ. Temporal changes in characteristics and outcomes among pregnant women with pre-gestational diabetes. Int J Gynaecol Obstet 2018; 143:59-65. [PMID: 29978470 DOI: 10.1002/ijgo.12590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/08/2018] [Accepted: 07/04/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate pregnancy outcomes among women with pre-gestational diabetes. METHODS Retrospective analysis of pregnant women with type 1 or type 2 diabetes attending a university hospital in Brazil. Maternal characteristics and pregnancy outcomes were compared among deliveries between May 1, 2005, and December 31, 2010, and between January 1, 2011, and December 31, 2015. Risks were calculated by Poisson regression. RESULTS In total 220 women were included. Type 1 diabetes was more frequent in 2005-2010 than in 2011-2015, and type 2 diabetes was more frequent in 2011-2015 (P=0.005). History of macrosomia (P=0.011), hypertensive disorders of pregnancy (P=0.015), and pre-gestational excess weight (body mass index >25 kg/m2 ; P=0.003) was more frequent in 2011-2015. For women with type 1 diabetes, pre-gestational weight (P=0.007) and glycated hemoglobin (P=0.026) were higher in 2011-2015. For women with type 2 diabetes, previous hypertensive disorders of pregnancy (P=0.032) were more prevalent and family history of diabetes (P<0.001) less prevalent in 2011-2015. Adverse pregnancy outcomes were similar for type 1 and type 2, and across both periods. CONCLUSION Type 2 diabetes became more common over the two time periods and women with type 1 diabetes had higher pre-gestational weight. Perinatal outcomes were similar.
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Affiliation(s)
- Janine Alessi
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela M Wiegand
- Service of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vânia N Hirakata
- Unit of Biostatics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria L R Oppermann
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Service of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Angela J Reichelt
- Service of Endocrinology and Metabology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Abstract
This cohort study uses electronic health record data to examine associations between maternal diabetes (preexisting type 1, type 2, and gestational) and autism spectrum disorder in children.
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Affiliation(s)
- Anny H. Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Xinhui Wang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Mayra P. Martinez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kathleen Page
- Division of Endocrinology and Diabetes, University of Southern California Keck School of Medicine, Los Angeles
| | - Thomas A. Buchanan
- Division of Endocrinology and Diabetes, University of Southern California Keck School of Medicine, Los Angeles
| | - R. Klara Feldman
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California, Pasadena
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79
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Yamamoto JM, Hughes DJF, Evans ML, Karunakaran V, Clark JDA, Morrish NJ, Rayman GA, Winocour PH, Hambling C, Harries AW, Sampson MJ, Murphy HR. Community-based pre-pregnancy care programme improves pregnancy preparation in women with pregestational diabetes. Diabetologia 2018; 61:1528-1537. [PMID: 29744539 PMCID: PMC6445478 DOI: 10.1007/s00125-018-4613-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/14/2018] [Indexed: 02/02/2023]
Abstract
AIMS/HYPOTHESIS Women with diabetes remain at increased risk of adverse pregnancy outcomes associated with poor pregnancy preparation. However, women with type 2 diabetes are less aware of and less likely to access pre-pregnancy care (PPC) compared with women with type 1 diabetes. We developed and evaluated a community-based PPC programme with the aim of improving pregnancy preparation in all women with pregestational diabetes. METHODS This was a prospective cohort study comparing pregnancy preparation measures before and during/after the PPC intervention in women with pre-existing diabetes from 1 June 2013 to 28 February 2017. The setting was 422 primary care practices and ten National Health Service specialist antenatal diabetes clinics. A multifaceted approach was taken to engage women with diabetes and community healthcare teams. This included identifying and sending PPC information leaflets to all eligible women, electronic preconception care templates, online education modules and resources, and regional meetings and educational events. Key outcomes were preconception folic acid supplementation, maternal HbA1c level, use of potentially harmful medications at conception and gestational age at first presentation, before and during/after the PPC programme. RESULTS A total of 306 (73%) primary care practices actively participated in the PPC programme. Primary care databases were used to identify 5075 women with diabetes aged 18-45 years. PPC leaflets were provided to 4558 (89.8%) eligible women. There were 842 consecutive pregnancies in women with diabetes: 502 before and 340 during/after the PPC intervention. During/after the PPC intervention, pregnant women with type 2 diabetes were more likely to achieve target HbA1c levels ≤48 mmol/mol (6.5%) (44.4% of women before vs 58.5% of women during/after PPC intervention; p = 0.016) and to take 5 mg folic acid daily (23.5% and 41.8%; p = 0.001). There was an almost threefold improvement in 'optimal' pregnancy preparation in women with type 2 diabetes (5.8% and 15.1%; p = 0.021). Women with type 1 diabetes presented for earlier antenatal care during/after PPC (54.0% vs 67.3% before 8 weeks' gestation; p = 0.003) with no other changes. CONCLUSIONS/INTERPRETATION A pragmatic community-based PPC programme was associated with clinically relevant improvements in pregnancy preparation in women with type 2 diabetes. To our knowledge, this is the first community-based PPC intervention to improve pregnancy preparation for women with type 2 diabetes. DATA AVAILABILITY Further details of the data collection methodology, individual clinic data and the full audit reports for healthcare professionals and service users are available from https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/our-clinical-audits-and-registries/national-pregnancy-in-diabetes-audit .
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Affiliation(s)
- Jennifer M Yamamoto
- Department of Medicine, Division of Endocrinology and Metabolism, University of Calgary, Calgary, Canada
| | - Deborah J F Hughes
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark L Evans
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Vithian Karunakaran
- North East Essex Diabetes Service (NEEDS), Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - John D A Clark
- Department of Diabetes and Endocrinology, West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | - Nicholas J Morrish
- Department of Diabetes and Endocrinology, Bedford Hospital NHS Trust, Bedford, UK
| | - Gerry A Rayman
- The Ipswich Diabetes Centre, Ipswich Hospitals NHS Trust, Ipswich, UK
| | - Peter H Winocour
- East and North Herts Institute of Diabetes and Endocrinology (ENHIDE), East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Clare Hambling
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amanda W Harries
- Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Michael J Sampson
- Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, Floor 2, Bob Champion Research and Education Building, University of East Anglia, Norwich, NR4 7UQ, UK
| | - Helen R Murphy
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK.
- Norwich Medical School, Floor 2, Bob Champion Research and Education Building, University of East Anglia, Norwich, NR4 7UQ, UK.
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Abstract
There is a pressing need for new treatment regimens that enable improved glycaemic control and reduced diabetes self-management burdens. Closed-loop, or artificial pancreas, systems represent one of the most promising avenues in this regard. Closed-loop systems connect wearable continuous glucose monitor (CGM) sensors to smartphone- or tablet-mounted algorithms that process and model CGM data to deliver precise and frequently updated doses of fast-acting insulin (and glucagon in dual-hormone systems) to users via wearable pumps. Recent studies have demonstrated that closed-loop systems offer significant benefit in terms of improved glycaemic control. However, less attention has been paid to the psychosocial impact on users of closed-loop systems. This article reviews recent research on psychosocial aspects of closed-loop usage in light of preceding research on user experience of currently available technologies such as insulin pumps and CGM sensors. The small, but growing body of research in this field reports generally positive user experience and a number of experienced benefits including: reassurance and reduced anxiety, improved sleep and confidence, and 'time off' from diabetes demands. However, these benefits are counterbalanced by important challenges, ranging from variable levels of trust to concerns about physical bulk, technical glitches and difficulties incorporating closed-loop systems into everyday life. Future research should explore psychosocial aspects of closed-loop usage in more diverse groups and with regard to clinicians, as well as users, to ensure that the clinical benefits of closed-loop systems are realized at scale in routine medical care.
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Affiliation(s)
- C Farrington
- Cambridge Centre for Health Services Research (CCHSR), Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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81
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado
- Address correspondence to:SaritPolsky, MD, MPHBarbara Davis Center for DiabetesUniversity of Colorado Denver1775 Aurora Court, MS A140Aurora, CO 80045
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Biesty LM, Egan AM, Dunne F, Smith V, Meskell P, Dempsey E, Ni Bhuinneain GM, Devane D. Planned birth at or near term for improving health outcomes for pregnant women with pre-existing diabetes and their infants. Cochrane Database Syst Rev 2018; 2:CD012948. [PMID: 29423911 PMCID: PMC6491338 DOI: 10.1002/14651858.cd012948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pregnant women with pre-existing diabetes (Type 1 or Type 2) have increased rates of adverse maternal and neonatal outcomes. Current clinical guidelines support elective birth, at or near term, because of increased perinatal mortality during the third trimester of pregnancy.This review replaces a review previously published in 2001 that included "diabetic pregnant women", which has now been split into two reviews. This current review focuses on pregnant women with pre-existing diabetes (Type 1 or Type 2) and a sister review focuses on women with gestational diabetes. OBJECTIVES To assess the effect of planned birth (either by induction of labour or caesarean birth) at or near term gestation (37 to 40 weeks' gestation) compared with an expectant approach, for improving health outcomes for pregnant women with pre-existing diabetes and their infants. The primary outcomes relate to maternal and perinatal mortality and morbidity. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (15 August 2017), and reference lists of retrieved studies. SELECTION CRITERIA We planned to include randomised trials (including those using a cluster-randomised design) and non-randomised trials (e.g. quasi-randomised trials using alternate allocation) which compared planned birth, at or near term, with an expectant approach for pregnant women with pre-existing diabetes. DATA COLLECTION AND ANALYSIS Two of the review authors independently assessed study eligibility. In future updates of this review, at least two of the review authors will extract data and assess the risk of bias in included studies. We will also assess the quality of the evidence using the GRADE approach. MAIN RESULTS We identified no eligible published trials for inclusion in this review.We did identify one randomised trial which examined whether expectant management reduced the incidence of caesarean birth in uncomplicated pregnancies of women with gestational diabetes (requiring insulin) and with pre-existing diabetes. However, published data from this trial does not differentiate between pre-existing and gestational diabetes, and therefore we excluded this trial. AUTHORS' CONCLUSIONS In the absence of evidence, we are unable to reach any conclusions about the health outcomes associated with planned birth, at or near term, compared with an expectant approach for pregnant women with pre-existing diabetes.This review demonstrates the urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for pregnant women with pre-existing (Type 1 or Type 2) diabetes compared with an expectant approach.
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Affiliation(s)
- Linda M Biesty
- National University of Ireland GalwaySchool of Nursing and MidwiferyAras MoyolaGalwayIreland
| | - Aoife M Egan
- National University of Ireland Galway/University Hospital GalwayGalway Diabetes Research CentreNewcastle RoadGalwayIreland
| | | | - Valerie Smith
- Trinity College DublinSchool of Nursing and Midwifery24 D'Olier StreetDublinIreland2
| | - Pauline Meskell
- University of LimerickDepartment of Nursing and MidwiferyHealth Sciences BuildingUniversity of LimerickLimerickIreland
| | - Eugene Dempsey
- Cork University Maternity HospitalNeonatologyWiltonCorkIreland
| | - G Meabh Ni Bhuinneain
- Mayo University Hospital, SaoltaDepartment of Obstetrics and GynaecologyWestport RoadCastlebarMayoIreland
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyAras MoyolaGalwayIreland
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83
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Yamamoto JM, Murphy HR. Technology and Pregnancy. Diabetes Technol Ther 2018; 20:S94-S103. [PMID: 29437483 DOI: 10.1089/dia.2018.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Helen R Murphy
- 2 Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
- 3 Women's Health Academic Centre, Division of Women's and Children's Health, King's College London, London, United Kingdom
- 4 Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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84
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Affiliation(s)
- R I G Holt
- Diabetic Medicine University of Southampton, Southampton, UK
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85
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Brunerová L, Urbanová J, Brož J. [Current treatment options in Maturity-Onset Diabetes of the Young]. Vnitr Lek 2018; 64:375-379. [PMID: 29791172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The discovery of MODY (Maturity-Onset Diabetes of the Young) and the elucidation of its heritability enabled more precise clinical characteristics of different MODY subtypes and led to understanding that glucokinase MODY (GCK-MODY) is not associated with vascular complications in long term follow-up, whereas MODY of transcription factors (e.g. HNF1A-MODY) is in case of bad metabolic control connected with the acceleration of particularly microvascular complications. There is a strong evidence of the needlessness of any specific antidiabetic treatment in prognosticaly favourable GCK-MODY (except for the pregnancy). On the contrary, in MODY of transcription factors, including the most common one - HNF1A-MODY, the treatment, traditionally based on sulphonylurea derivatives (and after their failure on insulin) is required. Due to wider spectrum of available antidiabetic agents offering individualization of the treatment, the question of efficacy of other antidiabetic agents in MODY patients arises. This review article summarizes current knowledge of therapeutic options in patients with MODY.Key words: insulin - MODY - oral hypoglycemic drugs - treatment.
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86
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Abstract
BACKGROUND Pregnancies with pre-existing diabetes are high risk, with increased risk of poorer fetal, neonatal, and maternal outcomes. Identifying interventions to improving health outcomes for women with diabetes and their infants is a priority, as rates of diabetes continue to increase.Exercise has been shown to have benefits for non-pregnant individuals with pre-existing type 2 diabetes, such as improving glycaemic control, and reducing visceral adipose tissue and plasma triglycerides. For pregnant women with pre-existing diabetes, the effects of exercise interventions on the mother and her baby are unknown.An earlier Cochrane review on 'Exercise for pregnant women with diabetes' considered both pre-existing diabetes and gestational diabetes. That Cochrane review has now been split into two new reviews (following new protocols) - one on gestational diabetes and one on pre-existing diabetes (this review). OBJECTIVES To evaluate the effects of exercise interventions for improving maternal and fetal outcomes in women with pre-existing diabetes. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) on 27 June 2017, and reference lists of retrieved studies. SELECTION CRITERIA We had planned to include published or unpublished randomised controlled trials (RCT) or cluster-randomised trials, in full text or abstract format that compared any type of exercise programme, added to standard care, targeted at women with known pre-gestational diabetes (type 1 or type 2 diabetes), at any stage of pregnancy, compared with 1) standard care alone or 2) standard care plus another exercise intervention. Quasi-randomised and cross-over trials were excluded. Conference abstracts were handled in the same way as full-text publications.Women with gestational diabetes mellitus were excluded, as they were covered in a separate Cochrane review. DATA COLLECTION AND ANALYSIS We had planned that two review authors would independently assess all the potential studies we identified as a result of the search strategy. For eligible studies, two review authors would have independently extracted the data using an agreed form. We had planned to resolve discrepancies through discussion, or by consulting a third person. We also had planned to assess the evidence using the GRADE approach. MAIN RESULTS We did not identify any randomised controlled trials. AUTHORS' CONCLUSIONS There was no evidence from RCTs that evaluated the effects of exercise interventions for improving maternal and fetal outcomes in women with pre-existing diabetes.Good quality, large randomised controlled trials are urgently needed to identify exercise interventions that are safe, and improve health outcomes for women with pre-existing diabetes and their babies. Future studies in this area could utilise the standardised outcomes in this review, in order to improve consistency between trials in this area, and aid future meta-analysis.
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Affiliation(s)
- Julie Brown
- The University of AucklandLiggins InstitutePark RdGraftonAucklandNew Zealand1142
| | - Gilles Ceysens
- Ambroise Pare hospitalDepartment of Obstetrics and GynaecologyBd Kennedy, 2MonsBelgium7000
| | - Michel Boulvain
- Maternité Hôpitaux Universitaires de GenèveDépartement de Gynécologie et d'Obstétrique, Unité de Développement en ObstétriqueBoulevard de la Cluse, 32Genève 14SwitzerlandCH‐1211
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87
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Wang J, Wang F, Gui YH. [Research advances in the mechanism of congenital heart disease induced by pregestational diabetes mellitus]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19:1297-1300. [PMID: 29237533 PMCID: PMC7389805 DOI: 10.7499/j.issn.1008-8830.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
Congenital heart disease (CHD) is the most common birth defect at present and has a complex etiology which involves the combined effect of genetic and environmental factors. Pregestational diabetes mellitus is significantly associated with the development of CHD, but the detailed mechanism remains unknown. This article reviews the research advances in the molecular mechanism of CHD caused by pregestational diabetes mellitus.
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Affiliation(s)
- Jie Wang
- Department of Cardiovascular Medicine, Children's Hospital of Fudan University, Shanghai 200023, China.
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88
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Affiliation(s)
- Satish K Garg
- The Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO 80045, USA.
| | - Sarit Polsky
- The Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO 80045, USA
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89
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Ladfors L, Shaat N, Wiberg N, Katasarou A, Berntorp K, Kristensen K. Fetal overgrowth in women with type 1 and type 2 diabetes mellitus. PLoS One 2017; 12:e0187917. [PMID: 29121112 PMCID: PMC5679529 DOI: 10.1371/journal.pone.0187917] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives Despite improved glycemic control, the rate of large-for-gestational-age (LGA) infants remains high in pregnancies complicated by diabetes mellitus type 1 (T1DM) and type 2 (T2DM). Poor glycemic control, obesity, and excessive gestational weight gain are the main risk factors. The aim of this study was to determine the relative contribution of these risk factors for LGA in women with T1DM and T2DM, after controlling for important confounders such as age, smoking, and parity. Methods In this retrospective chart review study, we analyzed the medical files of pregnant women with T1DM and T2DM who attended the antenatal care program at Skåne University Hospital during the years 2006 to 2016. HbA1c was used as a measure of glycemic control. Maternal weight in early pregnancy and at term was registered. LGA was defined as birth weight > 2 standard deviations of the mean. Univariable and multivariable logistic regression analysis was used to calculate odds ratios (OR’s) and 95% confidence intervals (CIs) for LGA. Results Over the 11-year period, we identified 308 singleton pregnancies in 221 women with T1DM and in 87 women with T2DM. The rate of LGA was 50% in women with T1DM and 23% in women with T2DM. The multivariable regression model identified gestational weight gain and second-trimester HbA1c as risk factors for LGA in T1DM pregnancies (OR = 1.107, 95% CI: 1.044–1.17, and OR = 1.047, 95% CI: 1.015–1.080, respectively) and gestational weight gain as a risk factor in T2DM pregnancies (OR = 1.175, 95% CI: 1.048–1.318), independent of body mass index. Conclusions Gestational weight gain was associated with LGA in women with T1DM and T2DM, independent of maternal body mass index. The findings suggest that monitoring and regulation of gestational weight gain is important in the clinical care of these women, to minimize the risk of fetal overgrowth.
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Affiliation(s)
- Linnea Ladfors
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nana Wiberg
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anastasia Katasarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- * E-mail:
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Adkins K, Allshouse AA, Metz TD, Heyborne KD. Impact of aspirin on fetal growth in diabetic pregnancies according to White classification. Am J Obstet Gynecol 2017; 217:465.e1-465.e5. [PMID: 28599894 DOI: 10.1016/j.ajog.2017.05.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/18/2017] [Accepted: 05/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current US Preventive Services Task Force and other guidelines recommend low-dose aspirin for all pregnant women with pregestational diabetes mellitus to prevent preeclampsia and small-for-gestational-age birth. The Maternal-Fetal Medicine Units High-Risk Aspirin trial did not show a reduction in either preeclampsia or small-for-gestational-age birth in diabetic women. OBJECTIVE Our objective was to reassess the impact of aspirin on fetal growth in diabetic pregnancies overall and according to White classification. We hypothesized that aspirin improves fetal growth in pregnancies with vascular complications of diabetes at highest risk for poor fetal growth. STUDY DESIGN We conducted secondary analysis of the cohort of diabetic women enrolled in the Maternal-Fetal Medicine Units High-Risk Aspirin trial. The impact of aspirin prophylaxis on birthweight was assessed in the overall cohort and in 2 groups categorized according to White classification as nonvascular (White class B, C, D) or vascular (White class R, F, RF). Birthweight was converted to Z-score normalized for gestational age at delivery and neonatal sex. Difference in birthweight Z-score between aspirin and placebo was tested with a 2-sample t test. The effect of vascular group, aspirin vs placebo randomization, and the interaction of the 2 on normalized birthweight percentile was estimated with linear regression with a multivariable model including covariates body mass index, tobacco use, race, and parity. The percentage of small and large-for-gestational-age newborns born to aspirin- vs placebo-treated women was compared between groups using Pearson exact χ2 analysis, and an adjusted model was estimated by logistic regression. RESULTS All 444 women with pregestational diabetes and complete outcome data were included (53 vascular, 391 nonvascular). Aspirin was significantly associated with a higher birthweight Z-score (0.283; 95% confidence interval, 0.023-0.544) in the overall cohort (P = .03). In the adjusted model, the association of aspirin with higher birthweight Z-score was confined to neonates of women with nonvascular diabetes (0.341; 95% confidence interval, 0.677-0.006; P = .044). An opposite but nonsignificant effect was observed among neonates from women with vascular diabetes (-0.416; 95% confidence interval, -1.335 to 0.503; P = .6). This difference in the relationship of aspirin and birthweight Z-score by vascular group was significant at P = .046. Aspirin-randomized women with nonvascular diabetes had more large-for-gestational-age births than those treated with placebo (40.2 vs 26.6%; P = .005). Small-for-gestational-age births occurred at the same frequency with aspirin vs placebo randomization in the overall cohort (8% in each group) and in each vascular group. CONCLUSION Inconsistent with our hypothesis, aspirin did not reduce small-for-gestational-age births in the overall cohort or either group. The increased incidence of large-for-gestational-age infants in aspirin-treated diabetic gestations is of potential concern given the known increased maternal and neonatal morbidity associated with macrosomia.
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Affiliation(s)
| | - Amanda A Allshouse
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Denver, CO
| | - Torri D Metz
- University of Colorado School of Medicine, Aurora, CO; Denver Health Medical Center, Denver, CO
| | - Kent D Heyborne
- University of Colorado School of Medicine, Aurora, CO; Denver Health Medical Center, Denver, CO.
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91
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Schwarz EB, Braughton MY, Riedel JC, Cohen S, Logan J, Howell M, Thiel de Bocanegra H. Postpartum care and contraception provided to women with gestational and preconception diabetes in California's Medicaid program. Contraception 2017; 96:432-438. [PMID: 28844877 DOI: 10.1016/j.contraception.2017.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare rates of postpartum care and contraception provided to women with gestational or preconception diabetes mellitus to women with no known diabetes mellitus. METHODS A retrospective cohort study of 199,860 women aged 15-44 years who were continuously enrolled in California's Medicaid program, Medi-Cal, from 43 days prior to 99 days after delivering in 2012. Claims for postpartum clinic visits and contraceptive supplies were compared for 11,494 mothers with preconception diabetes, 17,970 mothers with gestational diabetes, and 170,396 mothers without diabetes. Multivariable logistic regression was used to control for maternal age, race/ethnicity, primary language, residence in a primary care shortage area, state-funded healthcare program and Cesarean delivery, when examining the effects of diabetes on postpartum care and contraception. RESULTS Although postpartum clinic visits were more common with diabetes (55% preconception, 55% gestational, 48% no diabetes, p=<.0001), almost half did not receive any postpartum care within 99 days of delivery. Women with pregnancies complicated by diabetes were more likely to receive permanent contraception than women without diabetes (preconception diabetes, aOR: 1.39, 95% CI: 1.31-1.47; gestational diabetes, aOR: 1.20, 95% CI: 1.14-1.27). However, among women without permanent contraception, less than half received any reversible contraception within 99 days of delivery (44% preconception, 43% gestational, 43% no diabetes) and less effective, barrier contraceptives were more commonly provided to women with preconception diabetes than women without diabetes (aOR: 1.24, 95% CI:1.16-1.33). CONCLUSIONS Low-income Californian women with pregnancies complicated by diabetes do not consistently receive postpartum care or contraception that may prevent complication of future pregnancies. IMPLICATIONS Efforts are needed to improve rates of provision of postpartum care and high quality contraceptive services to low income women in California, particularly following pregnancies complicated by diabetes.
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Affiliation(s)
| | - Monica Y Braughton
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA
| | - Julie Cross Riedel
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA
| | - Susannah Cohen
- California Department of Health Care Services, Information Management Division, Sacramento, CA, USA
| | - Julia Logan
- California Department of Health Care Services, Office of the Medical Director, Sacramento, CA, USA
| | - Mike Howell
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA
| | - Heike Thiel de Bocanegra
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA
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92
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Lohse Z, Bytoft B, Knorr S, Clausen TD, Beck Jensen R, Beck-Nielsen H, Hermann AP, Oturai P, Frystyk J, Damm P, Gravholt CH, Højlund K, Jensen DM. Abnormal levels of adipokines in adolescent offspring of women with type 1 diabetes - Results from the EPICOM study. Metabolism 2017. [PMID: 28641783 DOI: 10.1016/j.metabol.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS To investigate long-term consequences of diabetes during pregnancy, we determined adiponectin and leptin levels in adolescents born by women with type 1 diabetic (T1D) or non-diabetic mothers, and determined associations between adiponectin and leptin levels in adolescence and the magnitude of intrauterine hyperglycemia. RESEARCH DESIGN AND METHODS We measured serum adiponectin and leptin and calculated leptin to adiponectin ratio (LAR) in 271 offspring of T1D women (index offspring) (13-20years), and 297 matched control offspring. Anthropometry included total body fat (TBF) by dual-energy X-ray absorptiometry and an oral glucose tolerance test. RESULTS Adiponectin levels were lower in index females (-8.0% (95% CI; -13.9, -1.6)), but not in index males (0.4% (95% CI; -7.3, 8.6)). Leptin levels were approximately 30% higher in index than control offspring, irrespective of gender. In males, this was seen despite similar TBF in index and control offspring. LAR was increased in index offspring (both males and females) compared with control offspring. There were no association between offspring adiponectin and maternal HbA1c levels in pregnancy. Leptin and LAR seemed to be associated with third trimester HbA1c levels in females in unadjusted, but not adjusted analyses. CONCLUSION Male and female offspring of women with T1D demonstrated increased serum leptin and LAR, whereas serum adiponectin was reduced in females only. These results suggest that abnormal regulation of adipokines is a consequence of being born to mothers with T1D. No direct association between maternal glycemic control and adiponectin and leptin levels or LAR in the adolescence was found. CLINICAL TRIAL REGISTRATION NUMBER NCT01559181.
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Affiliation(s)
- Zuzana Lohse
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Birgitte Bytoft
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark; The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sine Knorr
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, Hilleroed hospital, Hilleroed, Denmark
| | - Rikke Beck Jensen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Jan Frystyk
- Medical Research Lab., Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark; The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kurt Højlund
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Section of Molecular Diabetes & Metabolism, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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93
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Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, East C, Ford R, Amir LH. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. Lancet 2017; 389:2204-2213. [PMID: 28589894 DOI: 10.1016/s0140-6736(17)31373-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/09/2017] [Accepted: 04/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia, admission to a neonatal intensive care unit (NICU), and not being exclusively breastfed. Many clinicians encourage women with diabetes in pregnancy to express and store breastmilk in late pregnancy, yet no evidence exists for this practice. We aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy. METHODS We did a multicentre, two-group, unblinded, randomised controlled trial in six hospitals in Victoria, Australia. We recruited women with pre-existing or gestational diabetes in a singleton pregnancy from 34 to 37 weeks' gestation and randomly assigned them (1:1) to either expressing breastmilk twice per day from 36 weeks' gestation (antenatal expressing) or standard care (usual midwifery and obstetric care, supplemented by support from a diabetes educator). Randomisation was done with a computerised random number generator in blocks of size two and four, and was stratified by site, parity, and diabetes type. Investigators were masked to block size but masking of caregivers was not possible. The primary outcome was the proportion of infants admitted to the NICU. We did the analyses by intention to treat; the data were obtained and analysed masked to group allocation. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000217909. FINDINGS Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [<1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [<1%] of 315). INTERPRETATION There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia.
| | - Anita M Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia
| | - Susan E Jacobs
- Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Peter G Davis
- Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
| | | | - Gillian F Opie
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | | | | | - Christine East
- School of Nursing and Midwifery, Monash University and Monash Health, Clayton, VIC, Australia
| | - Rachael Ford
- Royal Women's Hospital, Parkville, VIC, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia
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94
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Hansen NS, Strasko KS, Hjort L, Kelstrup L, Houshmand-Øregaard A, Schrölkamp M, Schultz HS, Scheele C, Pedersen BK, Ling C, Clausen TD, Damm P, Vaag A, Broholm C. Fetal Hyperglycemia Changes Human Preadipocyte Function in Adult Life. J Clin Endocrinol Metab 2017; 102:1141-1150. [PMID: 28204515 DOI: 10.1210/jc.2016-3907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/08/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT Offspring of women with gestational diabetes (O-GDM) or type 1 diabetes mellitus (O-T1DM) have been exposed to hyperglycemia in utero and have an increased risk of developing metabolic disease in adulthood. DESIGN In total, we recruited 206 adult offspring comprising the two fetal hyperglycemic groups, O-GDM and O-T1DM, and, as a control group, offspring from the background population (O-BP). Subcutaneous fat biopsies were obtained and preadipocyte cell cultures were established from adult male O-GDM (n = 18, age 30.1 ± 2.5 years), O-T1DM (n = 18, age 31.6 ± 2.2 years), and O-BP (n = 16; age, 31.5 ± 2.7 years) and cultured in vitro. MAIN OUTCOME MEASURES First, we studied in vivo adipocyte histology. Second, we studied in vitro preadipocyte leptin secretion, gene expression, and LEP DNA methylation. This was studied in combination with in vitro preadipocyte lipogenesis, lipolysis, and mitochondrial respiration. RESULTS We show that subcutaneous adipocytes from O-GDM are enlarged compared with O-BP adipocytes. Preadipocytes isolated from male O-GDM and O-T1DM and cultured in vitro displayed decreased LEP promoter methylation, increased leptin gene expression, and elevated leptin secretion throughout differentiation, compared with adipocytes established from male O-BP. In addition, the preadipocytes demonstrated functional defects including decreased maximal mitochondrial capacity with increased lipolysis and decreased ability to store fatty acids when challenged with 3 days of extra fatty acid supply. CONCLUSIONS Taken together, these findings show that intrinsic epigenetic and functional changes exist in preadipocyte cultures from individuals exposed to fetal hyperglycemia who are at increased risk of developing metabolic disease.
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Affiliation(s)
- Ninna Schiøler Hansen
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, 2200 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 1165 Denmark
- Danish PhD School of Molecular Metabolism, Odense, 5000 Denmark
| | - Klaudia Stanislawa Strasko
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, 2200 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 1165 Denmark
| | - Line Hjort
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, 2200 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 1165 Denmark
- The Danish Diabetes Academy, Odense, 5000 Denmark
| | - Louise Kelstrup
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen, 2200 Denmark
| | - Azadeh Houshmand-Øregaard
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, 2200 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 1165 Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen, 2200 Denmark
- Novo Nordisk A/S, Søborg, 2860 Denmark
| | - Maren Schrölkamp
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, 2200 Denmark
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, 2200 Denmark
| | - Heidi Schiøler Schultz
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, 2200 Denmark
| | | | | | - Charlotte Ling
- Department of Clinical Sciences, Epigenetics and Diabetes, Lund University Diabetes Centre, CRC, Malmö, SE-221 00 Sweden
| | | | - Peter Damm
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 1165 Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen, 2200 Denmark
| | - Allan Vaag
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, 2200 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 1165 Denmark
- Astra Zeneca, Göteborg, SE-431 50 Sweden
| | - Christa Broholm
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, 2200 Denmark
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95
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Paddock M, Akram R, Jarvis DA, Armitage P, Song S, Madhuvrata P, Griffiths PD. The assessment of fetal brain growth in diabetic pregnancy using in utero magnetic resonance imaging. Clin Radiol 2017; 72:427.e1-427.e8. [PMID: 28057322 DOI: 10.1016/j.crad.2016.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/24/2016] [Accepted: 12/07/2016] [Indexed: 02/04/2023]
Abstract
AIM To assess fetal brain growth over the third trimester in pregnant women with diabetes using in utero magnetic resonance imaging (iuMRI) to determine if greater brain growth occurs in type 1 (T1DM) when compared to gestational (GDM) diabetes mellitus. MATERIALS AND METHODS Each consented participant was scanned at three fixed times during the third trimester using iuMRI. One hundred and fifty-seven patients were approached, 48 participants were recruited, and 36 complete data sets were analysed. Three-dimensional (3D) iuMRI volume data sets were manually segmented using software to construct models of the fetal brain from which brain volumes could be calculated. Inter-rater analysis was performed, and volume differences and growth rates were compared between T1DM and GDM. RESULTS Recruitment proved difficult with low uptake and high attrition rates (77.1%). Inter-rater analysis revealed excellent correlation (intraclass correlation coefficient=0.93, p<0.001) and agreement with no significant difference between operators (p=0.194). There was no evidence of increased brain volume in the T1DM group. Growth rates between visit 1 and 3 for T1DM and GDM were not significantly different (p=0.095). CONCLUSION T1DM brain volumes were not significantly larger than GDM volumes and there was no significant divergence of brain growth over the third trimester. Constructing volume models from 3D iuMRI acquisitions is a novel technique that can be used to assess fetal brain growth. No specialist software or knowledge is required. Larger studies attempting to recruit pregnant women in the later stages of pregnancy should employ multicentre recruitment to overcome recruitment difficulties and high attrition rates.
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Affiliation(s)
- M Paddock
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - R Akram
- The Medical School, The University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - D A Jarvis
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - P Armitage
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - S Song
- Department of Diabetes and Endocrinology, Northern General Hospital, Sheffield S5 7AU, UK
| | - P Madhuvrata
- Department of Obstetrics & Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - P D Griffiths
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
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97
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Kalra S, Jawad F. Insulin therapy in pregnancy. J PAK MED ASSOC 2016; 66:S48-S51. [PMID: 27582152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Insulin is the mainstay of pharmacotherapy in pregnancy complicated by diabetes. This review covers the various insulin regimes and preparations, explaining how to use them, and decide appropriate doses in pregnancy. It approaches insulin treatment from a patient - centred, as well as physician and obstetrician friendly viewpoint, providing pragmatic guidance for management of diabetes in pregnancy.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Fatema Jawad
- Department of Diabetology, SIUT, Karachi, Pakistan
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98
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Mahtab H, Bhowmik B. Diabetes in Pregnancy. J PAK MED ASSOC 2016; 66:S3-S4. [PMID: 27582147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Hajera Mahtab
- Bangladesh Institute of Health Sciences (BIHS), Diabetic Association of Bangladesh (BADAS)
| | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
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99
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Bajaj S. Non-insulin pharmacological therapy in pregnancy. J PAK MED ASSOC 2016; 66:S45-S47. [PMID: 27582151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
During pregnancy, when glycaemic levels remain uncontrolled, despite lifestyle modification, pharmacotherapy is advised, usually insulin which has been the gold standard for treatment. Recent studies however suggest that certain oral anti diabetic agents (OADs) may be safe and acceptable alternatives. There may be potential advantages for the use of metformin over insulin in GDM with respect to maternal weight gain and neonatal outcomes. However, as metformin crosses the placenta, its use during pregnancy raises concerns regarding potential adverse effects on the mother and foetus. Glibenclamide, a second generation sulfonylurea, more effective in glycaemic control in women with GDM has a lower treatment failure rate than metformin but there is lack of long term follow up data. Even though generally well tolerated, some studies report higher rates of preeclampsia, macrosomia, neonatal jaundice, neonatal hypoglycaemia and longer stay in neonatal care unit.
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Affiliation(s)
- Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, India
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100
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Hossain N. Postpartum management of diabetes pregnancy. J PAK MED ASSOC 2016; 66:S85-S87. [PMID: 27582163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Diabetes mellitus has assumed the role of an epidemic. Previously considered a disease of affluent developed countries, it has become more common in developing countries. Pakistan is included among the countries with a high prevalence of diabetes. In this scenario, postpartum management of a woman with diabetes mellitus becomes more important as in this period counseling and educating a woman is essential. Counselling includes life style modifications to prevent future risks involving all the systems of the body. This review article discusses management of diabetes mellitus in postpartum period, guidelines for postpartum screening of women with gestational diabetes mellitus, risks involved in future life and stresses upon the need of local population based studies. Primary care providers and gynaecologists must realize the importance of postpartum screening for diabetes mellitus and provide relevant information to women as well.
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Affiliation(s)
- Nazli Hossain
- Department of Obstetrics & Gynecology, Dow University of Health Sciences, Karachi
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