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Afsar S, Yigit A, Ozcaglayan R, Usta CS, Bulbul CB, Turan G. Fetuin-A expression in human umbilical vein endothelial cells and amnion cells of patients with gestational diabetes mellitus. Saudi Med J 2022; 43:694-699. [PMID: 35831000 PMCID: PMC9749698 DOI: 10.15537/smj.2022.43.7.20220283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To elucidate the link between fetuin-A expression in human umbilical vein endothelial cells (HUVECs) and amnion cells (ACs) and clinicopathological changes in patients with gestational diabetes mellitus (GDM) and newborns. METHODS This retrospective cohort study included 82 pregnant patients (40 with GDM and 42 controls) between January 2019 and January 2022. The patients underwent a one-hour, 50 gram glucose challenge test (GCT) during the 24-28th weeks of pregnancy. Patients with positive GCTs immediately underwent a 3-hour, 100 gram oral glucose tolerance test. The expression level of fetuin-A in UVECs and ACs was evaluated by immunohistochemistry (IHC) and scored based on IHC staining in randomly selected slides. The IHC staining intensity was evaluated by the number of dots, which reflects the expression level of fetuin-A in both HUVECs and ACs. RESULTS The GDM group displayed significantly higher fetuin-A expression in both HUVECs (p<0.0001) and ACs (p=0.0001) when compared with the control group. Fetuin-A expression in HUVECs was correlated with fetal macrosomia, neonatal hypoglycemia, and placental weight. However, there was no correlation with fetuin-A expression in ACs. CONCLUSION There is a correlation between fetal macrosomia, neonatal hypoglycemia, placental weight, and fetuin-A expression of HUVECs in patients with GDM.
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Peng Z, Si S, Cheng H, Zhou H, Chi P, Mo M, Zhuang Y, Liu H, Yu Y. The Associations of Maternal Hemoglobin Concentration in Different Time Points and Its Changes during Pregnancy with Birth Weight Outcomes. Nutrients 2022; 14:nu14122542. [PMID: 35745272 PMCID: PMC9229552 DOI: 10.3390/nu14122542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
Maternal hemoglobin (Hb) is related to nutritional status, which affects neonatal birth weight. However, it is very common for maternal Hb to fluctuate during pregnancy. To evaluate the associations of maternal Hb in different time points and its changes during pregnancy with neonatal birth weight, small for gestational age (SGA)/low birth weight (LBW) and large for gestational age (LGA)/macrosomia, we conducted this study by using data from the Electronic Medical Record System (EMRS) database of Zhoushan Maternal and Child Care Hospital in Zhejiang province, China. The pregnancy was divided into five periods: first, early-second, mediate-second, late-second, early-third and late-third trimesters; we further calculated the maternal Hb changes during pregnancy. Overall, the socio-demographic characteristics, health-related information and childbirth-related information of 24,183 mother−infant pairs were obtained. The average Hb concentration during the different periods were 123.95 ± 10.14, 117.95 ± 9.84, 114.31 ± 9.03, 113.26 ± 8.82, 113.29 ± 8.68 and 115.01 ± 8.85 g/L, respectively. Significant dose−response relationships between maternal Hb and birth weight were observed in the first, late-second and later trimesters (p non-linear < 0.05). Maternal Hb < 100 g/L was related to a high risk of LGA/macrosomia in the late-second (OR: 1.47, 95% CI: 1.18, 1.83) and later trimesters; additionally, high maternal Hb (>140 g/L) increased the risk of SGA/LBW in the first (OR: 1.26, 95% CI: 1.01, 1.57) and late-third trimesters (OR: 1.96, 95% CI: 1.20, 3.18). In addition, the increase in maternal Hb from the late-second to late-third trimesters had a positive correlation with SGA/LBW. In conclusion, maternal Hb markedly fluctuated during pregnancy; the negative dose−response association of maternal Hb in the late-second and third trimesters, and Hb change during pregnancy with neonatal birth weight outcomes were observed, respectively. Furthermore, the phenomenon of high Hb in the first trimester and after the late-second trimester and the increase of maternal Hb from the late-second to late-third trimesters more significantly increasing the risk of SGA/LBW should especially be given more attention. Its biological mechanism needs to be further explored.
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Fritsche L, Heni M, Eckstein SS, Hummel J, Schürmann A, Häring HU, Preißl H, Birkenfeld AL, Peter A, Fritsche A, Wagner R. Incretin Hypersecretion in Gestational Diabetes Mellitus. J Clin Endocrinol Metab 2022; 107:e2425-e2430. [PMID: 35180296 DOI: 10.1210/clinem/dgac095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Incretins are crucial stimulators of insulin secretion following food intake. Data on incretin secretion and action during pregnancy are sparse. OBJECTIVE The aim of the study was to investigate the incretin response during an oral glucose tolerance test (OGTT) in pregnant women with and without gestational diabetes mellitus (GDM). DESIGN We analyzed data from the ongoing observational PREG study (NCT04270578). SETTING The study was conducted at the University Hospital Tübingen. PARTICIPANTS We examined 167 women (33 with GDM) during gestational week 27 ± 2.2. INTERVENTION Subjects underwent 5-point OGTT with a 75-g glucose load. MAIN OUTCOME MEASURES We assessed insulin secretion and levels of total glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), glicentin, and glucagon during OGTT. Linear regression was used to analyze the relation of GLP-1 and glucose with insulin secretion and the association of incretin levels on birth outcome. RESULTS Insulin secretion was significantly lower in women with GDM (P < 0.001). Postload GLP-1 and GIP were ~20% higher in women with GDM (all P < 0.05) independent of age, body mass index, and gestational age. GLP-1 increase was associated with insulin secretion only in GDM, but not in normal glucose tolerance. Postprandial GLP-1 levels were negatively associated with birth weight. CONCLUSIONS The more pronounced GLP-1 increase in women with GDM could be part of a compensatory mechanism counteracting GLP-1 resistance. Higher GLP-1 levels might be protective against fetal overgrowth.
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Curtin L, Conway MC, Kilbane MT, McKenna MJ, McAuliffe FM. No effect of maternal calcium intake and bone resorption during pregnancy on offspring bone mineral density at age 5 years. Osteoporos Int 2022; 33:1165-1170. [PMID: 34853883 DOI: 10.1007/s00198-021-06250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
UNLABELLED Maternal nutrition during pregnancy plays a role in offspring bone health. In a prospective cohort study, offspring bone mineral density at 5 years was not associated with maternal calcium intake or maternal bone resorption during pregnancy. PURPOSE Suboptimal bone mineral density in childhood can result in osteoporosis later in life. We reported previously that lower calcium intake during pregnancy was associated with higher maternal bone resorption during pregnancy and that lower maternal dietary calcium and higher maternal bone resorption in pregnancy were associated with lower maternal bone mineral density (BMD) 5 years later. The current study sought to investigate the effect of both maternal dietary calcium intake and maternal bone resorption during pregnancy on offspring BMD at 5 years. METHODS Data collected as part of the ROLO longitudinal cohort study (n = 103, mother-child dyads) were used in the current analysis. ROLO started as a randomised controlled trial of a low glycemic index diet during second pregnancy in women with macrosomia in first pregnancy in order to prevent recurrence of macrosomia. Maternal dietary intakes were assessed using 3-day food diaries completed during each trimester of pregnancy. Bone resorption in early and late pregnancy was calculated through urinary excretion of cross-linked N-telopeptides (uNTX). Offspring whole-body BMD at 5 years was measured using dual-energy X-ray absorptiometry. RESULTS Offspring BMD at 5 years correlated with offspring body mass index (r = .385; p < .001) and offspring BMD was higher in boys than girls (t = 2.91; p = .004). Offspring BMD at 5 years was not associated with either maternal calcium intake or uNTX during pregnancy, after controlling for offspring body mass index and offspring sex. CONCLUSION Offspring BMD at 5 years is not associated with either maternal calcium intake or maternal bone resorption during pregnancy.
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Zhang LJ, Hu XQ, Yu JJ, Wang Y, Zhang JW, Xu XR, Yang J. [Meta-analysis of Shenqi Jiangtang Granules combined with western medicine on adverse pregnancy outcomes in women with gestational diabetes mellitus]. ZHONGGUO ZHONG YAO ZA ZHI = ZHONGGUO ZHONGYAO ZAZHI = CHINA JOURNAL OF CHINESE MATERIA MEDICA 2022; 47:2811-2818. [PMID: 35718501 DOI: 10.19540/j.cnki.cjcmm.20220218.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The present study evaluated the effect of Shenqi Jiangtang Granules(SJG) combined with western medicine on the adverse pregnancy outcomes in women with gestational diabetes mellitus(GDM). PubMed, Web of Science, CNKI, Wanfang, and VIP were searched for clinical randomized controlled trials(RCTs) of SJG combined with western medicine against GDM. The included RCTs were assessed for risks using the assessment criteria recommended by the Cochrane handbook for systematic reviews of interventions. Meta-analysis was performed using Stata 12.0 and RevMan 5.3. Nineteen RCTs were included, with 1 647 patients involved, including 824 cases treated with western medicine alone, and 823 cases treated with SJG combined with western medicine. The course of treatment ranged from 2 to 12 weeks. As revealed by Meta-analysis results, compared with western medicine treatment alone, SJG combined with western medicine could reduce the incidence of postpartum hemorrhage(OR=0.23, 95%CI[0.10, 0.53], P=0.000 6), gestational hypertension(OR=0.24, 95%CI[0.13, 0.45], P<0.000 01), polyhydramnios(OR=0.24, 95%CI[0.12, 0.45], P<0.000 1), premature rupture of membranes(OR=0.20, 95%CI[0.09, 0.45], P<0.000 1), cesarean section(OR=0.40, 95%CI[0.29, 0.55], P<0.000 01), macrosomia(OR=0.19, 95%CI[0.08, 0.47], P<0.000 3), neonatal asphyxia(OR=0.22, 95%CI[0.12, 0.40], P<0.000 01), premature delivery(OR=0.19, 95%CI[0.12, 0.30], P<0.000 01), proteinuria(OR=0.19, 95%CI[0.06, 0.58], P=0.004) and hypoglycemia(OR=0.28, 95%CI[0.16, 0.50], P<0.000 1). The funnel plots and Egger's test showed that except macrosomia, there was no significant publication bias in the results of other indicators. Therefore, as indicated by the findings, SJG combined with western medicine can reduce the incidence of adverse pregnancy outcomes in GDM patients. However, due to the uneven quality of the included trials, the clinical application of this protocol requires caution.
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Sha J, Tan F, Liu Y, Xu Z, Wang X, Zhai J. A prenatal case of Simpson-Golabi-Behmel syndrome type 1 with a 0.26-Mb deletion fragment at Xq26.2 inherited from mother: Case report. Medicine (Baltimore) 2022; 101:e29222. [PMID: 35482990 PMCID: PMC9276221 DOI: 10.1097/md.0000000000029222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/15/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The purpose of this report was to explore how to manage the fetus of Simpson-Golabi-Behmel syndrome type 1 (SGBS1) and to provide a definite diagnosis to guide the following genetic counseling for the pregnancy. PATIENT CONCERNS A 24-year-old women, gravida 1, para 0, was 172 cm tall with weight 65 kg. She was referred to our center for counseling due to second-trimester ultrasound screening anomalies at 22 + 5 weeks of gestation age. Meanwhile the ultrasound examination indicated the overgrowth of the fetus. She and her husband were healthy and nonconsanguineous without family history. DIAGNOSES The karyotype and copy number variations sequencing (CNV-seq) combined with fetal ultrasound manifestation confirmed the diagnosis of SGBS1. INTERVENTIONS No treatment for the fetus. OUTCOMES Pregnancy was terminated. LESSIONS Once fetal overgrowth and other malformation are revealed in prenatal ultrasound, although without polyhydramnios and organomegaly, SGBS1 should be considered and further genetic testing such as CNV-seq and whole exon sequencing should be conducted to help clinicians provide a definite diagnosis to guide the following genetic counseling and the next pregnancy.
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Venkatesh KK, Lynch CD, Powe CE, Costantine MM, Thung SF, Gabbe SG, Grobman WA, Landon MB. Risk of Adverse Pregnancy Outcomes Among Pregnant Individuals With Gestational Diabetes by Race and Ethnicity in the United States, 2014-2020. JAMA 2022; 327:1356-1367. [PMID: 35412565 PMCID: PMC9006108 DOI: 10.1001/jama.2022.3189] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Gestational diabetes, which increases the risk of adverse pregnancy outcomes, has been increasing in frequency across all racial and ethnic subgroups in the US. OBJECTIVE To assess whether the frequency of adverse pregnancy outcomes among those in the US with gestational diabetes changed over time and whether the risk of these outcomes differed by maternal race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS Exploratory serial, cross-sectional, descriptive study using US National Center for Health Statistics natality data for 1 560 822 individuals with gestational diabetes aged 15 to 44 years with singleton nonanomalous live births from 2014 to 2020 in the US. EXPOSURES Year of delivery and race and ethnicity, as reported on the birth certificate, stratified as non-Hispanic American Indian, non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White (reference group). MAIN OUTCOMES AND MEASURES Maternal outcomes of interest included cesarean delivery, primary cesarean delivery, preeclampsia or gestational hypertension, intensive care unit (ICU) admission, and transfusion; neonatal outcomes included large for gestational age (LGA), macrosomia (>4000 g at birth), small for gestational age (SGA), preterm birth, and neonatal ICU (NICU) admission, as measured by the frequency (per 1000 live births) with estimation of mean annual percentage change (APC), disparity ratios, and adjusted risk ratios. RESULTS Of 1 560 822 included pregnant individuals with gestational diabetes (mean [SD] age, 31 [5.5] years), 1% were American Indian, 13% were Asian/Pacific Islander, 12% were Black, 27% were Hispanic/Latina, and 48% were White. From 2014 to 2020, there was a statistically significant increase in the overall frequency (mean APC per year) of preeclampsia or gestational hypertension (4.2% [95% CI, 3.3% to 5.2%]), transfusion (8.0% [95% CI, 3.8% to 12.4%]), preterm birth at less than 37 weeks (0.9% [95% CI, 0.3% to 1.5%]), and NICU admission (1.0% [95% CI, 0.3% to 1.7%]). There was a significant decrease in cesarean delivery (-1.4% [95% CI, -1.7% to -1.1%]), primary cesarean delivery (-1.2% [95% CI, -1.5% to -0.9%]), LGA (-2.3% [95% CI, -2.8% to -1.8%]), and macrosomia (-4.7% [95% CI, -5.3% to -4.0%]). There was no significant change in maternal ICU admission and SGA. In comparison with White individuals, Black individuals were at significantly increased risk of all assessed outcomes, except LGA and macrosomia; American Indian individuals were at significantly increased risk of all assessed outcomes except cesarean delivery and SGA; and Hispanic/Latina and Asian/Pacific Islander individuals were at significantly increased risk of maternal ICU admission, preterm birth, NICU admission, and SGA. Differences in adverse outcomes by race and ethnicity persisted through these years. CONCLUSIONS AND RELEVANCE From 2014 through 2020, the frequency of multiple adverse pregnancy outcomes in the US increased among pregnant individuals with gestational diabetes. Differences in adverse outcomes by race and ethnicity persisted.
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Hannah W, Bhavadharini B, Beks H, Deepa M, Anjana RM, Uma R, Martin E, McNamara K, Versace V, Saravanan P, Mohan V. Global burden of early pregnancy gestational diabetes mellitus (eGDM): A systematic review. Acta Diabetol 2022; 59:403-427. [PMID: 34743219 DOI: 10.1007/s00592-021-01800-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/07/2021] [Indexed: 01/02/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) diagnosed during the first trimester of pregnancy is called 'early pregnancy Gestational Diabetes Mellitus' (eGDM). The burden of eGDM has only been studied sporadically. This review aims to understand the global burden of eGDM in terms of prevalence, risk factors, pregnancy outcomes, treatment and postpartum dysglycemia. METHODS: A review of epidemiologic studies reporting on early GDM screening as per Joanna Briggs Institute (JBI) methodology for prevalence reviews was conducted. A customized search strategy was used to search electronic databases namely, PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, MEDLINE, Ovid, ScienceDirect, and Google Scholar. Three independent reviewers reviewed studies using Covidence software. Observational studies irrespective of study design and regardless of diagnostic criteria were included. Quality of evidence was appraised, and findings were synthesized. RESULTS Of 58 included studies, 41 reported a prevalence of eGDM, ranging from 0.7 to 36.8%. Body mass index (BMI), previous history of GDM, family history of diabetes and multiparity were reported as eGDM risk factors. Adverse pregnancy outcomes associated with eGDM were macrosomia, caesarean delivery, induction of labour, hypertension, preterm delivery, and shoulder dystocia. The incidence of postpartum dysglycemia and the need for insulin was higher in women with eGDM. The risk of bias was moderate. Heterogeneity of studies is a limitation. Meta-analysis was not performed. CONCLUSIONS There is heterogeneity in the prevalence of eGDM and intrapartum and postpartum ill effects for the mother and the offspring. There is a need to develop a universal screening protocol for eGDM.
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Beunen K, Neys A, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, Roggen N, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Devlieger R, Mathieu C, Benhalima K. Fasting plasma glucose level to guide the need for an OGTT to screen for gestational diabetes mellitus. Acta Diabetol 2022; 59:381-394. [PMID: 34725724 DOI: 10.1007/s00592-021-01812-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
AIMS To determine the fasting plasma glucose (FPG) level at which an oral glucose tolerance test (OGTT) could be avoided to screen for gestational diabetes (GDM) and to evaluate the characteristics of women across this FPG threshold. METHODS A multi-centric prospective cohort study with 1843 women receiving universal screening for GDM with a 75 g OGTT. RESULTS In the total population, GDM prevalence was 12.5% (231). A FPG < 78 mg/dL was the cut-off with best trade-off to limit the number of missed GDM cases [44 (19.0%)] with a negative predictive value of 97.3% (95% CI 96.5-98.0) for GDM, while avoiding 52.2% OGTTs. Compared to GDM with FPG ≥ 78 mg/dL [187 (81.0%)], GDM women with FPG < 78 mg/dL had a significantly lower BMI (27.1 ± 4.5 vs. 29.6 ± 5.2 kg/m2, p = 0.003), less insulin resistance [Matsuda: 0.4 (0.4-0.7) vs. 0.3 (0.2-0.5), p < 0.001] and better β-cell function [ISSI-2: 0.13 (0.08-0.25) vs. 0.09 (0.04-0.15), p = 0.004]. Compared to NGT women (1612) with FPG ≥ 78 mg/dL [846 (52.5%)], NGT with FPG < 78 mg/dL [766 (47.5%)] had a significantly lower BMI (26.0 ± 3.9 vs. 27.8 ± 4.7 kg/m2, p < 0.001), less insulin resistance [Matsuda: 0.7 (0.5-0.9) vs. 0.5 (0.4-0.7), p < 0.001], better β-cell function [ISSI-2: 0.17 (0.10-0.30) vs. 0.12 (0.07-0.21), p < 0.001], and less often large-for-gestational age infants [9.2 (70) vs. 16.2% (136), p < 0.001]. CONCLUSIONS FPG < 78 mg/dL can be used to limit the number of OGTTs when screening for GDM. Women with FPG < 78 mg/dL had a better metabolic profile and in NGT women also less fetal overgrowth.
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Zheng Y, Dong X, Sui C, Zhang S, Yao J, Jin L, Huang B. Culture medium is associated with the risks of placenta previa and macrosomia in pregnancies after in vitro fertilization. Arch Gynecol Obstet 2022; 306:239-247. [PMID: 35224651 DOI: 10.1007/s00404-022-06443-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The culture medium plays an important role in embryonic development and subsequent pregnancy outcomes of in vitro fertilization (IVF) cycles. The sequential culture media of Vitrolife and Cook are the two most commonly used reagents in China. This study aimed to assess their effects on IVF success rates, obstetric outcomes and neonatal outcomes. METHODS This was a retrospective cohort study on 6352 patients undergoing first IVF attempts between January 2018 and December 2019, resulting in 3153 clinical pregnancies, 2646 live births, and 2668 babies. Patients were grouped according to the culture media they used. There were 4680 patients in the Vitrolife group and 1672 patients in the Cook group. The primary outcome measures were maternal and neonatal outcomes. ANOVA and Chi-square tests were used for statistical comparison, and multivariate logistic regression and multivariate general linear model were used to adjust for potential confounders. RESULTS The rates of live birth, clinical pregnancy, monozygotic twins, miscarriage, and ectopic pregnancy were all comparable between the groups of Vitrolife and Cook. The incidence of placenta previa was higher in the Vitrolife group [4.86 vs. 3.09%, adjusted odds ratio = 2.048 (1.146-3.657)]. The incidence of macrosomia was higher in the Cook group [7.51 vs. 5.39%, adjusted odds ratio = 1.445 (1.010-2.069)]. CONCLUSION The culture media of Vitrolife and Cook are comparably effective in IVF success. Vitrolife is associated with a higher risk of placenta previa, while Cook is associated with a higher risk of macrosomia.
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LeBlanc ES, Hillier TA. The Impact of Gestational Weight Gain on Glucose and Insulin Physiology in Pregnancy-Does Timing Matter? J Clin Endocrinol Metab 2022; 107:e1303-e1304. [PMID: 34634099 PMCID: PMC8851914 DOI: 10.1210/clinem/dgab745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 11/19/2022]
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Chen J, Hu C, Ren L, Li J, Lei T, Chen S, Zhao P. [Clinical features and genetic analysis of a case with Perlman syndrome due to variant of DIS3L2 gene]. ZHONGHUA YI XUE YI CHUAN XUE ZA ZHI = ZHONGHUA YIXUE YICHUANXUE ZAZHI = CHINESE JOURNAL OF MEDICAL GENETICS 2022; 39:48-51. [PMID: 34964966 DOI: 10.3760/cma.j.cn511374-20210305-00191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze the clinical phenotype and genetic characteristics of a child with Perlman syndrome. METHODS Genomic DNA was extracted from peripheral blood samples from the patient and her parents. Whole exome sequencing (WES) was carried out to detect potential variant in the proband. Candidate variant was verified by Sanger sequencing. The pathogenicity of candidate variants was evaluated according to the guidelines of the American College of Medical Genetics and Genomics (ACMG). RESULTS The results of WES showed that the proband has harbored compound heterozygous variants of the DIS3L2 gene, namely c.2109delC and c.1829.c.1830insC, which were respectively inherited from her mother and father. The results were confirmed by Sanger sequencing. Based on the ACMG guidelines, the two novel variants were both predicted to be pathogenic (PVS1+PS2+PM2). CONCLUSION The compound heterozygous variants of the DIS3L2 gene probably underlay the Perlman syndrome in this patient. Above finding has enriched the spectrum of DIS3L2 gene mutations.
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Ramezani Tehrani F, Rahmati M, Farzadfar F, Abedini M, Farahmand M, Hosseinpanah F, Hadaegh F, Torkestani F, Valizadeh M, Azizi F, Behboudi-Gandevani S. One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial. Front Endocrinol (Lausanne) 2022; 13:1039643. [PMID: 36818463 PMCID: PMC9932332 DOI: 10.3389/fendo.2022.1039643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES There is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women. METHODS We conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail. RESULTS GDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester. CONCLUSION We found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring. CLINICAL TRIAL REGISTRATION https://www.irct.ir/trial/518, identifier (IRCT138707081281N1).
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Yang T, Yang Y, Zhang Q, Liu D, Liu N, Li Y, Yao Z, Zhang Y, Tian F, Zhao J, Li Y. Homeostatic Model Assessment for Insulin Resistance Is Associated With Late Miscarriage in Non-Dyslipidemic Women Undergoing Fresh IVF/ICSI Embryo Transfer. Front Endocrinol (Lausanne) 2022; 13:880518. [PMID: 35784578 PMCID: PMC9247267 DOI: 10.3389/fendo.2022.880518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the associations between homeostatic model assessment for insulin resistance (HOMA-IR) and pregnancy outcomes in non-dyslipidemic infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET). MATERIALS AND METHODS This is a retrospective study involving 3,615 non-dyslipidemic infertile women who attend to the Reproductive Medicine Center of Xiangya Hospital, Central South University (CSU) between January 2014 and October 2021. Eligible participants were divided into three groups according to the quartiles of HOMA-IR: Group 1 (HOMA-IR <1.46), Group 2 (1.46 to <2.71) and Group 3 (HOMA-IR ≥2.71). Baseline data, clinical characteristics during the assisted reproductive technology (ART) procedure, pregnancy, and neonatal outcomes were compared among the three groups. Subgroup analysis based on presence or absence of the polycystic ovary syndrome (PCOS) status was also performed to analyze the effects of HOMA-IR among non-PCOS populations. RESULTS The late miscarriage rate and percentage of macrosomia increased with the HOMA-IR group (for late miscarriage rate: 2.23% vs. 3.04% vs. 7.35%, P<0.001; for macrosomia: 0.21% vs. 1.70% vs. 3.23%, P=0.002). Increased HOMA-IR (HOMA-IR≥2.71) was positively associated with late miscarriage (crude OR 3.50, 95% CI 1.64-7.47, P=0.001; adjusted OR 3.56, 95% CI 1.56-8.15, P=0.003). In the subgroup analysis, there were 3,165 participants in the non-PCOS group and 450 were assigned to the PCOS group. Late miscarriage rate increased with the HOMA-IR group among non-PCOS populations (2.20% vs. 3.03% vs. 7.67%, P<0.001). Late miscarriage rate of PCOS women were comparable among the three HOMA-IR groups (2.50% vs. 3.06% vs. 5.71%, P=0.634). Among non-PCOS women, increased HOMA-IR (HOMA-IR≥2.71) was positively associated with late miscarriage (crude OR 3.71, 95% CI 1.66-8.30, P=0.001; adjusted OR 3.82, 95% CI 1.59-9.17, P=0.003). CONCLUSIONS Late miscarriage rate and prevalence of macrosomia increased with the HOMA-IR index. Preconception HOMA-IR is an independent risk factor for late miscarriage in normolipidemic women undergoing IVF/ICSI-ET. Controlling insulin resistance before ART might prevent the occurrence of late miscarriage and macrosomia.
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Chen Y, Guo J, Zhang Q, Zhang C. Insulin Resistance is a Risk Factor for Early Miscarriage and Macrosomia in Patients With Polycystic Ovary Syndrome From the First Embryo Transfer Cycle: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:853473. [PMID: 35498421 PMCID: PMC9046670 DOI: 10.3389/fendo.2022.853473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/08/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objective of the study was to explore the effect of insulin resistance on pregnancy outcomes in patients with polycystic ovary syndrome (PCOS) from the first embryo transfer cycle. DESIGN This was a single-center, retrospective, observational cohort study. PATIENTS Included in the study were women with PCOS for the first embryo transfer. MAIN OUTCOME MEASURES Early miscarriage rate and macrosomia rate were the main outcome measures. RESULTS With increased HOMA-IR, the early miscarriage rate (7.14, 13.21, and 16.22%, respectively; P = 0.039), macrosomia rate (5.78, 11.79, and 17.58%, respectively; P = 0.026) and the incidence of gestational diabetes (GDM) (10.00, 14.50, and 25.67% respectively; P = 0.002) significantly increased, while the live birth rate markedly decreased (63.03, 55.27, and 47.88%, respectively; P = 0.004). No significant difference was found in clinical pregnancy rate, late miscarriage rate, low birthweight rate and baby gender ratio (all P >0.05). After adjusting for confounding factors, HOMA-IR was an independent risk factor of early miscarriage rate and macrosomia rate. CONCLUSION Insulin resistance is an independent risk factor for early miscarriage and macrosomia in PCOS patients during the first embryo transfer cycle. It is essential to give more attention before and after pregnancy for PCOS women with high HOMA-IR.
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Yang J, Wang Z, Cao H, Liu L, Yuan Q, Xu H, Tang R. Birthweight After Frozen Embryos Formed on the Fifth Day Versus the Sixth Day: A Retrospective Analysis Including 17,127 Singleton Newborns. Front Endocrinol (Lausanne) 2022; 13:868335. [PMID: 35685207 PMCID: PMC9171029 DOI: 10.3389/fendo.2022.868335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transferring blastocysts frozen on day 6 (D6) may adversely affect the pregnancy rate compared with day 5 (D5). Moreover, it remains unclear whether delayed embryo transfer affects neonatal birth weight. METHODS A retrospective cohort study consisting of 17,127 singleton births from single frozen embryo transfer (FET) cycles, between January 2011 and January 2020, was performed including 14,166 blastocysts frozen on D5 and 2,961 on D6. The primary outcomes of this study were neonatal birth weight and incidence of small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), and macrosomia. RESULTS The mean neonatal birth weight in the D5 group (3.47 ± 0.49 kg) was significantly higher compared with the D6 group (3.45 ± 0.50 kg), although the discrepancy was only 0.02 kg. Multiple linear regression analysis for birth weight between the two groups showed no statistically significant difference (β= -0.01 t= -1.218; P>0.05). Logistic regression analysis revealed that the risks of SGA (OR 1.166; 95%CI, 0.911-1.491; P>0.05), LGA (OR 0.917; 95%CI, 0.831-1.012; P>0.05), LBW (OR 1.192; 95%CI, 0.926-1.533; P>0.05), and macrosomia (OR 0.975; 95%CI, 0.864-1.100; P>0.05) were similar in the two groups after adjusting for confounders. CONCLUSIONS In the FET cycle, the neonatal birth weight and incidence of LGA, SGA, LBW, or macrosomia were similar between the D5 and D6 groups, suggesting that delayed blastocyst transfer would not affect the neonatal birth weight.
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Jaffar F, Laycock K, Huda MSB. Type 1 Diabetes in Pregnancy: A Review of Complications and Management. Curr Diabetes Rev 2022; 18:e051121197761. [PMID: 34749617 DOI: 10.2174/1573399818666211105124829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/15/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pre-gestational diabetes can pose significant risk to the mother and infant, thus requiring careful counselling and management. Since Saint Vincent's declaration in 1989, adverse maternal and fetal outcomes, such as preeclampsia, perinatal mortality, congenital anomalies, and macrosomia, continue to be associated with type 1 diabetes. Although pregnancy is not considered an independent risk factor for the development of new onset microvascular complications, it is known to exacerbate pre-existing microvascular disease. Strict glycaemic control is the optimal management for pre-existing type 1 diabetes in pregnancy, as raised HbA1C is associated with increased risk of maternal and fetal complications. More recently, time in range on Continuous Glucose Monitoring glucose profiles has emerged as another useful evidence-based marker of fetal outcomes. OBJECTIVES This review summarises the complications associated with pre-gestational type 1 diabetes, appropriate evidence-based management, including preparing for pregnancy, intrapartum and postpartum care. METHODS A structured search of the PubMed and Cochrane databases was conducted. Peer-reviewed articles about complications and management guidelines on pre-gestational type 1 diabetes were selected and critically appraised. RESULTS One hundred and twenty-three manuscripts were referenced and appraised in this review, and international guidelines were summarised. CONCLUSION This review provides a comprehensive overview of the recurring themes in the literature pertaining to type 1 diabetes in pregnancy: maternal and fetal complications, microvascular disease progression, and an overview of current guideline-specific management.
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Lu D, Chai W, Gao X, Yan X. Interventional Treatment of Bronchiectasis Macrosomia Based on Multirow CT Tomography Monitoring. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9116765. [PMID: 34925743 PMCID: PMC8677367 DOI: 10.1155/2021/9116765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
We present in this paper an in-depth study and analysis of bronchiectasis haemoptysis by multirow CT tomography and a multifaceted treatment and analysis of the interventions monitored by the scan. Although coronary CT is of great clinical value in the diagnosis and monitoring of coronary artery disease, the potential radiation damage caused by coronary CT should not be underestimated because CT imaging is based on X-rays and the actual effective dose is 5-30 mSv, which is reported in the literature to be high when using conventional imaging modalities for coronary CT. Although there is no direct evidence of a definite causal relationship between X-ray exposure during CT examinations and tumorigenesis, theoretically, even small doses of radiation exposure may pose some potential health risk. Therefore, in clinical practice, coronary CT examinations should be performed in strict compliance with the radiation protection rule "as low as reasonably achievable" (ALARA) recognized by the radiation industry. For longitudinal openings in the range of 0° to 59° and transverse openings in the range of 0° to 44°, the CB2 catheter is significantly more stable than the MIK catheter, and for longitudinal openings in the range of 60° to 119° and transverse openings in the range of 0° to 44°, the CB2 catheter is more stable than the MIK catheter. For longitudinal openings from 0° to 120° and lateral openings from 45° to 90°, there was no significant difference in cannulation stability between the CB2 and MIK catheters. There was a potential tendency for MIK cannulation stability to be higher than CB2 for longitudinal openings in the range of 120° to 180° and lateral openings in the range of 45° to 90°, but there was no significant difference.
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Sampaio Y, Porto LB, Lauand TCG, Marcon LP, Pedrosa HC. Gestational diabetes and overt diabetes first diagnosed in pregnancy: characteristics, therapeutic approach and perinatal outcomes in a public healthcare referral center in Brazil. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:79-84. [PMID: 33166439 PMCID: PMC10528695 DOI: 10.20945/2359-3997000000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 09/26/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil. METHODS A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted. RESULTS Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%). CONCLUSION Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.
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Kim KS. Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus (Diabetes Metab J 2021;45:547-57). Diabetes Metab J 2021; 45:966-967. [PMID: 34847644 PMCID: PMC8640144 DOI: 10.4093/dmj.2021.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kim W, Park SK, Kim YL. Fetal Abdominal Obesity Detected at 24 to 28 Weeks of Gestation Persists until Delivery Despite Management of Gestational Diabetes Mellitus (Diabetes Metab J 2021;45:547-57). Diabetes Metab J 2021; 45:970-971. [PMID: 34847646 PMCID: PMC8640149 DOI: 10.4093/dmj.2021.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Shen SY, Žurauskienė J, Wei DM, Chen NN, Lu JH, Kuang YS, Liu HH, Cazier JB, Qiu X. Identification of maternal continuous glucose monitoring metrics related to newborn birth weight in pregnant women with gestational diabetes. Endocrine 2021; 74:290-299. [PMID: 34125410 DOI: 10.1007/s12020-021-02787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify the specific glucose metrics derived from maternal continuous glucose monitoring (CGM) data, which were associated with a higher percentile of offspring birth weight. METHODS In this cohort study, we recruited singleton pregnant women with GDM who underwent CGM for 5-14 days at a mean of 28.8 gestational weeks between Jan 2017 and Nov 2018. Commonly used single summary glucose metrics of glucose exposure (including mean 24-h, daytime, and nighttime glucose level) and variability (including J-index and mean amplitude of glycaemic excursions) were derived from CGM data. A novel comprehensive glucose metric-hours per-day spent in a severe variability glucose mode (HSSV)-was identified using the spectral clustering method, which reflects both glucose level and variability. Multiple linear regression models were used to estimate the associations of sex- and gestational age-adjusted birth weight percentile with CGM parameters. RESULTS Ninety-seven women comprising 127,279 glucose measurements were included. Each 1-SD increase in maternal nighttime mean glucose level and HSSV was associated with 6.0 (95% CI 0.4, 11.5) and 6.3 (95% CI 0.4, 12.2) percentage points increase in birth weight percentile, respectively. No associations were found between other glucose metrics and birth weight percentile. CONCLUSION Nighttime mean glucose level has a comparable effect size to HSSV in association with fetal growth, suggesting that endogenous hyperglycemia might drive the association between maternal hyperglycemia and birth weight. Further studies need to examine the effect of lowering nighttime glucose level and/or HSSV on preventing fetal overgrowth in GDM women.
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Mistry SK, Das Gupta R, Alam S, Kaur K, Shamim AA, Puthussery S. Gestational diabetes mellitus (GDM) and adverse pregnancy outcome in South Asia: A systematic review. Endocrinol Diabetes Metab 2021; 4:e00285. [PMID: 34505412 PMCID: PMC8502223 DOI: 10.1002/edm2.285] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 06/19/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The prevalence of gestational diabetes mellitus (GDM) is increasing in developing countries including the South Asian Nations. The current study aimed to examine the association of GDM with adverse pregnancy outcomes from foetal and maternal perspectives in South Asia. METHODS A systematic review was conducted including primary studies published since January 2020 from South Asian countries. Following electronic databases were searched to locate the articles: MEDLINE, EMBASE and EMCARE. Data were extracted using a customized extraction tool and methodological quality of the included studies was assessed using modified Effective Public Health Practice Project (EPHPP) quality assessment tool. Narrative synthesis was performed as statistical pooling was not possible due to the heterogeneous nature of the studies. RESULTS Eight studies were included in the review. Overall, the review found a positive correlation between GDM and adverse foetal outcomes such as macrosomia, neonatal hyperglycaemia, intrauterine growth retardation (IUGR), stillbirths and low birthweight (LBW), but the findings were not conclusive. GDM was also positively associated with preeclampsia but the association between GDM and C-section delivery was not conclusive. CONCLUSION Policymakers, public health practitioners and researchers in South Asia should take in to account the link between GDM and adverse pregnancy outcomes while designing interventions to promote maternal health in South Asia. Researchers should focus on conducting longitudinal studies in future to clearly understand the epidemiology and pathobiology of this issue.
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Gualdani E, Di Cianni G, Seghieri M, Francesconi P, Seghieri G. Pregnancy outcomes and maternal characteristics in women with pregestational and gestational diabetes: a retrospective study on 206,917 singleton live births. Acta Diabetol 2021; 58:1169-1176. [PMID: 33835261 DOI: 10.1007/s00592-021-01710-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/20/2021] [Indexed: 12/27/2022]
Abstract
AIMS To examine risk of adverse pregnancy outcomes, mothers' characteristics and incidence rate over time of pregestational type 1 (T1D), type 2 (T2D) or gestational diabetes (GDM). METHODS The study included all singleton live births born from women aged 15-45 year, in Tuscany, Italy from 2010 to 2018. Pregnancy outcomes were retrieved by certificates of care at delivery compiled by midwives. Pregestational diabetes and GDM were identified by regional administrative databases. Time course of pregestational diabetes and GDM across last decade was assessed by Poisson analysis. Logistic regression analysis was used to calculate adjusted odds ratios (OR; 95% CI) for maternal characteristics or neonatal outcomes. RESULTS Among 206,917 singleton live births, GDM was diagnosed in 21,613 pregnancies (10.46%) and pregestational diabetes in 979, being T2D more prevalent than T1D (606; 0.29% vs. 373; 0.18%). Pregestational T2D incidence progressively decreased over last decade, T1D remained stable while GDM progressively rose. Pre-pregnancy obesity, preterm deliveries or cesarean sections were common characteristics of pregestational diabetes and GDM. Risk of neonatal distress and neonatal malformations was higher in pregestational T1D. Risk of prior spontaneous abortions was higher in GDM and in pregestational T2D (OR: 4.19; 3.30-5.33), mostly treated with metformin. Risk of neonatal macrosomia was increased only in pregestational diabetes. CONCLUSIONS In our population, pregestational T2D was more prevalent than T1D. Neonatal complications were mostly associated with pregestational T1D. Increased risk of previous spontaneous abortions was the hallmark of pregestational T2D. GDM, even if sharing adverse outcomes with pregestational T2D, was unrelated to rise in risk of neonatal macrosomia.
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Liu Y, Sun R, Li Y, Chen H, Wu L, Shen S, Wei Y, Wang N, Zhang Z, Liu Z, Deng G. Changes in serum total bile acid concentrations are associated with the risk of developing adverse maternal and perinatal outcomes in pregnant Chinese women. Clin Chim Acta 2021; 520:160-167. [PMID: 34102134 DOI: 10.1016/j.cca.2021.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS We aimed to investigate the association between total bile acid (TBA) concentrations changes during the second and third trimesters and the risk of developing adverse maternal and perinatal outcomes (AMPO). METHODS A total of 1569 pregnant Chinese women were enrolled. Serum TBA concentrations were measured during the 16-18th and 29-34th weeks of gestation. Logistic regression models were performed. RESULTS After multivariable adjustment, each standard deviation increase in the TBA concentrations in the second trimester was associated with a 30% (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.13, 1.50) increased risk of gestational diabetes mellitus (GDM) and a 22% (OR = 1.22, 95% CI: 1.07, 1.63) increased risk of premature rupture of membranes (PROM). When we compared the highest and lowest quartiles of changes in the TBA Z-scores across the second and third trimesters, the adjusted ORs were 1.84 (95% CI: 1.28, 2.65) for PROM and 1.47 (95% CI: 1.07, 2.28) for macrosomia. CONCLUSION Elevated serum TBA concentrations during pregnancy were positively associated with increased risks of GDM and PROM. Women with more drastic changes in TBA concentrations across the second and third trimesters were at a higher risk of developing PROM and macrosomia.
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