1451
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Jenum AK, Sommer C, Sletner L, Mørkrid K, Bærug A, Mosdøl A. Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review. Food Nutr Res 2013; 57:18889. [PMID: 23467680 PMCID: PMC3585772 DOI: 10.3402/fnr.v57i0.18889] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 01/15/2013] [Accepted: 02/03/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ethnic minorities in Europe have high susceptibility to type 2 diabetes (T2DM) and, in some groups, also cardiovascular disease (CVD). Pregnancy can be considered a stress test that predicts future morbidity patterns in women and that affects future health of the child. OBJECTIVE TO REVIEW ETHNIC DIFFERENCES IN: 1) adiposity, hyperglycaemia, and pre-eclampsia during pregnancy; 2) future risk in the mother of obesity, T2DM and CVD; and 3) prenatal development and possible influences of maternal obesity, hyperglycaemia, and pre-eclampsia on offspring's future disease risk, as relevant for ethnic minorities in Europe of Asian and African origin. DESIGN Literature review. RESULTS Maternal health among ethnic minorities is still sparsely documented. Higher pre-pregnant body mass index (BMI) is found in women of African and Middle Eastern descent, and lower BMI in women from East and South Asia compared with women from the majority population. Within study populations, risk of gestational diabetes mellitus (GDM) is considerably higher in many minority groups, particularly South Asians, than in the majority population. This increased risk is apparent at lower BMI and younger ages. Women of African origin have higher risk of pre-eclampsia. A GDM pregnancy implies approximately seven-fold higher risk of T2DM than normal pregnancies, and both GDM and pre-eclampsia increase later risk of CVD. Asian neonates have lower birth weights, and mostly also African neonates. This may translate into increased risks of later obesity, T2DM, and CVD. Foetal overgrowth can promote the same conditions. Breastfeeding represents a possible strategy to reduce risk of T2DM in both the mother and the child. CONCLUSIONS Ethnic minority women in Europe with Asian and African origin and their offspring seem to be at increased risk of T2DM and CVD, both currently and in the future. Pregnancy is an important window of opportunity for short and long-term disease prevention.
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Affiliation(s)
- Anne Karen Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Occupational Therapy and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Christine Sommer
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Line Sletner
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Child and Adolescents Medicine, Akershus University Hospital, Lørenskog, Norway
- Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Kjersti Mørkrid
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Bærug
- Norwegian Resource Centre for Breastfeeding, Oslo University Hospital, Oslo, Norway
| | - Annhild Mosdøl
- Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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1452
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Crume TL, Andrews JS, D'Agostino RB, Pettitt DJ, Mayer-Davis EJ, Law JR, Dolan L, Lawrence JM, Saydah S, Greenbaum C, Rodriguez BL, Dabelea D. The influence of exposure to maternal diabetes in utero on the rate of decline in β-cell function among youth with diabetes. J Pediatr Endocrinol Metab 2013; 26:721-7. [PMID: 23645121 PMCID: PMC4074015 DOI: 10.1515/jpem-2012-0385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/24/2013] [Indexed: 01/12/2023]
Abstract
Abstract We explored the influence of exposure to maternal diabetes in utero on β cell decline measured by fasting C-peptide (FCP) among 1079 youth <20 years with diabetes, including 941 with type 1 and 138 with type 2 diabetes. Youths exposed to maternal diabetes had FCP levels that were 17% lower among youth with type 2 diabetes [95% confidence interval (CI): -34%, +6%] and 15% higher among youth with type 1 diabetes (95%CI: -14%, +55%) than their unexposed counterparts, although differences were not statistically significant (p=0.13 and p=0.35, respectively). Exposure to maternal diabetes was not associated with FCP decline in youth with type 2 (p=0.16) or type 1 diabetes (p=0.90); nor was the effect of in utero exposure on FCP modified by diabetes type. Findings suggest that exposure to maternal diabetes in utero may not be an important determinant of short-term β-cell function decline in youth with type 1 or type 2 diabetes.
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1453
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NEGRATO CA, TARZIA O, JOVANOVIČ L, CHINELLATO LEM. Periodontal disease and diabetes mellitus. J Appl Oral Sci 2013; 21:1-12. [PMID: 23559105 PMCID: PMC3881811 DOI: 10.1590/1678-7757201302106] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 09/05/2012] [Accepted: 12/11/2012] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Periodontal disease (PD) is one of the most commonly known human chronic disorders. The relationship between PD and several systemic diseases such as diabetes mellitus (DM) has been increasingly recognized over the past decades. OBJECTIVE The purpose of this review is to provide the reader with knowledge concerning the relationship between PD and DM. Many articles have been published in the English and Portuguese literature over the last 50 years examining the relationship between these two chronic diseases. Data interpretation is often confounded by varying definitions of DM, PD and different clinical criteria were applied to determine the prevalence, extent and severity of PD, levels of glycemic control and diabetes-related complications. METHODS This paper provides a broad overview of the predominant findings from research conducted using the BBO (Bibliografia Brasileira de Odontologia), MEDLINE, LILACS and PubMed for Controlled Trials databases, in English and Portuguese languages published from 1960 to October 2012. Primary research reports on investigations of relationships between DM/DM control, PD/periodontal treatment and PD/DM/diabetes-related complications identified relevant papers and meta-analyses published in this period. RESULTS This paper describes the relationship between PD and DM and answers the following questions: 1- The effect of DM on PD, 2- The effects of glycemic control on PD and 3- The effects of PD on glycemic control and on diabetes-related complications. CONCLUSIONS The scientific evidence reviewed supports diabetes having an adverse effect on periodontal health and PD having an adverse effect on glycemic control and on diabetes-related complications. Further research is needed to clarify these relationships and larger, prospective, controlled trials with ethnically diverse populations are warranted to establish that treating PD can positively influence glycemic control and possibly reduce the burden of diabetes-related complications.
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Affiliation(s)
- Carlos Antonio NEGRATO
- PhD in Medical Sciences, Research Support Center, Diabetics Association
of Bauru, São Paulo, Brazil
| | - Olinda TARZIA
- PhD in Oral Biochemistry, Bauru School of Dentistry, University of São
Paulo, Bauru, SP, Brazil
| | - Lois JOVANOVIČ
- MD, CEO & Chief Scientific Officer - Sansum Diabetes Research
Institute, Santa Barbara, USA
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1454
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Kösüs N, Kösüs A, Duran M, Turhan NO. Effect of number of abnormal oral glucose tolerance test (OGTT) values on birthweight in women with gestational diabetes. Indian J Med Res 2013; 137:95-101. [PMID: 23481057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND & OBJECTIVES To examine the effect of abnormal oral glucose loading (OGL) and number of abnormal oral glucose tolerance test (OGTT) values on foetal weight in Turkish pregnant women. METHODS This retrospective study included 810 pregnant women between 24 and 28 wk of gestation who were screened for gestational diabetes mellitus (GDM). Women were grouped according to degree of glucose intolerance and compared for clinical, biochemical parameters. Women who delivered macrosomic infants were compared with those who delivered normal infants. RESULTS GDM was detected in 70 (8.6%) women. Median age and infant birthweight of GDM cases were higher than the other groups. Infants of women with GDM weighted 200 g more than infants of non-GDM cases. No difference was found in terms of birthweight between diabetes cases with 2, 3 or 4 OGTT values abnormality. INTERPRETATION & CONCLUSIONS The number of abnormal OGTT values in GDM cases had no effect on foetal weight. Macrosomia was observed more in GDM cases than in non-GDM cases. Birthweight was significantly higher in women with GDM despite the therapy used for regulation of blood glucose. This may be related to ethnical, dietary, nutritional differences, and treatment compliance in our study population.
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1455
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Abetew DF, Qiu C, Fida NG, Dishi M, Hevner K, Williams MA, Enquobahrie DA. Association of retinol binding protein 4 with risk of gestational diabetes. Diabetes Res Clin Pract 2013; 99:48-53. [PMID: 23153527 PMCID: PMC3544538 DOI: 10.1016/j.diabres.2012.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 06/13/2012] [Revised: 09/24/2012] [Accepted: 10/22/2012] [Indexed: 02/08/2023]
Abstract
AIM We investigated association of maternal retinol binding protein 4 (RBP4) with risk of gestational diabetes (GDM). METHODS GDM cases (N=173) and controls (N=187) were selected from among participants of a cohort study of risk factors of pregnancy complications. Early pregnancy (16 weeks on average) serum RBP4 concentration was measured using an ELISA-based immunoassay. Logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs/aORs) and 95% confidence intervals (95%CI). RESULTS Mean serum RBP4 was significantly higher among GDM cases compared with controls (47.1 vs. 41.1 μg/ml, respectively; p-value <0.05). Participants in the highest quartile for serum RBP4 had a 1.89-fold higher risk of GDM compared with participants in the lowest quartile (95%CI: 1.05-3.43). However, this relationship did not reach statistical significance after adjustment for confounders (aOR: 1.54; 95%CI: 0.82-2.90). Women who were ≥35 years old and who had high RBP4 (≥38.3 μg/ml, the median) had a 2.31-fold higher risk of GDM compared with women who were <35 years old and had low RBP4 (<38.3 μg/ml) (aOR: 2.31; 95%CI: 1.26-4.23; p-value for interaction=0.021). CONCLUSION Overall, there is modest evidence of a positive association of early pregnancy elevated RBP4 concentration with increased GDM risk, particularly among women with advanced age.
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Affiliation(s)
- Dejene F Abetew
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, United States.
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1456
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Abstract
Epigenetics generates a considerable interest in the field of research on complex traits, including obesity and diabetes. Recently, we reported a number of epipolymorphisms in the placental leptin and adiponectin genes associated with maternal hyperglycemia during pregnancy. Our results suggest that DNA methylation could partly explain the link between early exposure to a detrimental fetal environment and an increased risk to develop obesity and diabetes later in life. This brief report discusses the potential importance of adipokine epigenetic changes in fetal metabolic programming. Additionally, preliminary data showing similarities between methylation variations of different tissues and cell types will be presented along with the challenges and future perspectives of this emerging field of research.
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1457
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Lovrenčić MV, Honović L, Kralik S, Matica J, Prašek M, Pape-Medvidović E, Ivanišević M, Đelmiš J. Redefinition of gestational diabetes mellitus: implications for laboratory practice in Croatia. Biochem Med (Zagreb) 2013; 23:7-11. [PMID: 23457760 PMCID: PMC3900087 DOI: 10.11613/bm.2013.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 11/13/2012] [Indexed: 11/01/2022] Open
Abstract
An increasing prevalence of gestational diabetes has become a very challenging task in prenatal care worldwide. International Association of Diabetes and Pregnancy Study Groups (IADPSG) has recently issued recommendations on the diagnosis and classification of hyperglycaemia in pregnancy. These recommendations, the first to provide harmonised, evidence-based criteria for the diagnosis and classification of diabetes in pregnancy, are currently being discussed and accepted worldwide by the relevant authorities. As the acceptance of the proposed criteria has major implications for both clinical and laboratory settings, a concerted action towards necessary changes in practice has to be carefully planned and adjusted to national health-care specificities. IADPSG criteria have been strongly advocated by the Croatian Perinatology Society, resulting in a new strategy for the detection and diagnosis of hyperglycaemic disorders in pregnancy. To address the respective laboratory requirements, in April 2012, the Croatian Chamber of Medical Biochemists appointed a Working Group to provide a standardised procedure for the diagnosis of gestational diabetes, applicable to all laboratories involved in prenatal care, in both primary and specialised health-care facilities. In this paper we discuss key laboratory-related issues regarding succesful implementation of the IADPSG criteria in Croatia.
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Affiliation(s)
- Marijana Vučić Lovrenčić
- Institute of Clinical Chemistry and Laboratory Medicine, Merkur Teaching Hospital, Zagreb,
Croatia
| | - Lorena Honović
- Department of Laboratory Diagnostics, Pula County Hospital, Pula,
Croatia
| | - Saša Kralik
- Institute of Laboratory Diagnostics, University Hospital Centre, Rijeka,
Croatia
| | - Jasminka Matica
- Institute of Laboratory Diagnostics, University Hospital Centre, Zagreb,
Croatia
| | - Manja Prašek
- Vuk Vrhovac University Clinic, Merkur Teaching Hospital, Zagreb,
Croatia
| | | | - Marina Ivanišević
- Gynaecology and Obstetrics Clinic, University Hospital Centre, Zagreb,
Croatia
| | - Josip Đelmiš
- Gynaecology and Obstetrics Clinic, University Hospital Centre, Zagreb,
Croatia
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1458
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Robledo C, Peck JD, Stoner JA, Carabin H, Cowan L, Koch HM, Goodman JR. Is bisphenol-A exposure during pregnancy associated with blood glucose levels or diagnosis of gestational diabetes? J Toxicol Environ Health A 2013; 76:865-73. [PMID: 24053363 PMCID: PMC3801171 DOI: 10.1080/15287394.2013.824395] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Recent epidemiological studies indicate bisphenol A (BPA), an estrogenic chemical used in production of epoxy, polycarbonate, and plastic may increase risk of insulin resistance and type 2 diabetes. Exposure to BPA during pregnancy may contribute to development of gestational diabetes mellitus (GDM), a precursor to type 2 diabetes in women. This pilot study examined the association between BPA exposure, fasting blood glucose levels (FBG), and GDM diagnosis during pregnancy. Banked urine samples from 22 cases of GDM and 72 controls were analyzed for total (free BPA + conjugates) urinary BPA concentrations (μg/L). FBG levels (mg/dl) were obtained from 1-h 50-g glucose tolerance tests (GTT) that women underwent for routine GDM screening (mean gestational age = 26.6 weeks, SD = 3.8). Those with an initial screening value ≥ 135 mg/dl underwent 3-h 100 g oral GTT. GDM diagnoses were made when the initial screening value was ≥ 200 mg/dl or when values at ≥ 2 time points exceeded 3-h oral GTT thresholds. Among controls, median FBG levels (mg/dL) did not differ across exposure tertiles, defined according to the distribution of total specific-gravity-adjusted urinary BPA concentrations. Logistic regression models controlling for race/ethnicity did not provide evidence of association between BPA exposure and case status across increasing tertiles of BPA exposure (number of GDM cases/controls in tertile1: 13/24; in tertile 2: 6/24; in tertile 3: 3/24). Findings do not support a relationship between total urinary BPA concentrations and altered glucose metabolism during pregnancy. However, due to study limitations, findings need to be interpreted with caution.
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Affiliation(s)
- Candace Robledo
- Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13 St., Room 309 Oklahoma City, OK 73104, USA
| | - Jennifer D. Peck
- Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13 St., Room 309 Oklahoma City, OK 73104, USA
| | - Julie A. Stoner
- Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13 St., Room 309 Oklahoma City, OK 73104, USA
| | - Hélène Carabin
- Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13 St., Room 309 Oklahoma City, OK 73104, USA
| | - Linda Cowan
- Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13 St., Room 309 Oklahoma City, OK 73104, USA
| | - Holger M. Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance - Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Jean R. Goodman
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Stritch School of Medicine, Loyola University Health System, 2160 South First Avenue, Building 103, Maywood, Illinois, 60153, USA
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1459
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Abstract
Gestational diabetes mellitus (GDM) is a complex metabolic disorder of pregnancy that is suspected to have a strong genetic predisposition. It is associated with poor perinatal outcome, and both GDM women and their offspring are at increased risk of future development of type 2 diabetes mellitus (T2DM). During the past several years, there has been progress in finding the genetic risk factors of GDM in relation to T2DM. Some of the genetic variants that were proven to be significantly associated with T2DM are also genetic risk factors of GDM. Recently, a genome-wide association study of GDM was performed and reported that genetic variants in CDKAL1 and MTNR1B were associated with GDM at a genome-wide significance level. Current investigations using next-generation sequencing will improve our insight into the pathophysiology of GDM. It would be important to know whether genetic information revealed from these studies could improve our prediction of GDM and the future development of T2DM. We hope further research on the genetics of GDM would ultimately lead us to personalized genomic medicine and improved patient care.
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Affiliation(s)
- Soo Heon Kwak
- Department of Internal Medicine, Seoul National University Hospital, Seoul 110-744, Korea
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1460
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Sak ME, Soydinç HE, Ozler A, Evsen MS, Turgut A, Sak S, Gül T. Platelet profile in patients with gestational diabetes: a retrospective study. J Turk Ger Gynecol Assoc 2012; 13:223-6. [PMID: 24592046 DOI: 10.5152/jtgga.2012.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/04/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and compare alterations in the morphology and function of platelets occurring in gestational diabetes and healthy pregnancies. MATERIAL AND METHODS A retrospective study was performed of 77 pregnant women: 42 cases with gestational diabetes and 35 healthy controls. The two groups were compared in terms of demographics and platelet parameters derived from complete blood counts. RESULTS The mean platelet volume (p=0.001) and HbA1c (p<0.001) were significantly increased in the patients with gestational diabetes. The mean platelet volume was well correlated with the platelet distribution width (rs=0.404, p<0.001) and the platelet count (rs=0.355, p=0.002). CONCLUSION The mean platelet volume and other platelet parameters may significantly aid the identification of diabetic pregnants at risk for vascular complications. The role and possible clinical relevance of these changes during diabetic pregnancy need to be investigated in further studies.
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Affiliation(s)
- Muhammet Erdal Sak
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Hatice Ender Soydinç
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Ali Ozler
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Mehmet Sıddık Evsen
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Abdülkadir Turgut
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Sibel Sak
- Diyarbakır Maternity And Children Hospital, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
| | - Talip Gül
- Dicle University, School of Medicine, Department of Obstetrics And Gynecology, Diyarbakır, Turkey
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1461
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Sumathipala D, Gamage T, Wijesiriwardena B, Jayasekara RW, Dissanayake VH. An infant born to a mother with gestational diabetes presenting with 49,XXXXY syndrome and renal agenesis-a case report. J Clin Res Pediatr Endocrinol 2012; 4:223-5. [PMID: 23032147 PMCID: PMC3537292 DOI: 10.4274/jcrpe.764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 12/25/2012] [Indexed: 12/01/2022] Open
Abstract
49,XXXXY is a rare sex chromosome polysomy with an incidence of 1 in 85 000 male births. It has a characteristic triad of mental retardation, skeletal malformation and hypogonadism. This is the first case report of a child with 49,XXXXY syndrome and renal agenesis. This child was referred for genetic testing at 14 years of age due to facial dysmorphism and hypergonadotropic hypogonadism. He had coarse facial features, cryptorchidism of the right testis, genu valgus deformities, and patent ductus arteriosus which are known associations of 49,XXXXY syndrome. He also had agenesis of the right kidney, hydronephrosis of the left kidney with hydroureter which is not a known association of 49,XXXXY syndrome. The patient was the offspring of a mother with gestational diabetes. There is a strong correlation between maternal diabetes and congenital anomalies, especially renal and cardiovascular anomalies. Additionally, it has been noted that gestational diabetes increases the incidence of chromosomal aneuploidies. The teratogenic effects of maternal diabetes during embryogenesis may be the causative factor for the final phenotype of 49,XXXXY syndrome and renal agenesis.
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Affiliation(s)
- Dulika Sumathipala
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Thilini Gamage
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Rohan W. Jayasekara
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Vajira H.W. Dissanayake
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
,* Address for Correspondence: Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Phone: +9 411 2689545 E-mail:
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1462
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Abstract
Gestational diabetes mellitus (GDM), the most common medical complication of pregnancy, is defined as carbohydrate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during pregnancy. In reality, gestational diabetes mellitus is a spectrum of maternal hyperglycemia caused or exacerbated by pregnancy, in which blood glucose levels lie along a continuum, associated with a wide spectrum of metabolic abnormalities and conferring varying degrees of pregnancy-related risk. In recent years, the WHO diagnostic thresholds in current use have been called into question, as increasing evidence mounts that 'mild gestational diabetes' confers increased maternal and fetal risk, despite glucose levels falling below current thresholds. This review summarizes the existing evidence, unanswered questions and health service implications related to women with so-called 'mild' gestational diabetes.
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Affiliation(s)
| | | | | | - M Regina Torloni
- b Obstetric Department, São Paulo Federal University, São Paulo, Brazil
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1463
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Mission JF, Ohno MS, Cheng YW, Caughey AB. Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis. Am J Obstet Gynecol 2012; 207:326.e1-9. [PMID: 22840972 PMCID: PMC4621259 DOI: 10.1016/j.ajog.2012.06.048] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [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: 03/13/2012] [Revised: 05/01/2012] [Accepted: 06/25/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study investigates the cost effectiveness of gestational diabetes mellitus screening using the new International Association of Diabetes in Pregnancy Study Group (IADPSG) guidelines. STUDY DESIGN A decision analytic model was built comparing routine screening with the 2-hour (2h) oral glucose tolerance test (OGTT) vs the 1-hour glucose challenge test. All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed. RESULTS Screening with the 2h OGTT was more expensive, more effective, and cost effective at $61,503/quality-adjusted life year. In a 1-way sensitivity analysis, the more inclusive IADPSG diagnostic approach remained cost effective as long as an additional 2.0% or more of patients were diagnosed and treated for gestational diabetes mellitus. CONCLUSION Screening at 24-28 weeks' gestational age under the new IADPSG guidelines with the 2h OGTT is expensive but cost effective in improving maternal and neonatal outcomes. How the health care system will provide expanded care to this group of women will need to be examined.
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Affiliation(s)
- John F Mission
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
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1464
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Abstract
Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. Among pregnant women, 2 to 17.8% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, that can predispose the fetus to many alterations in organogenesis, growth restriction and the mother to some diabetes-related complications like retinopathy and nephropathy or accelerate the course of these complications if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle modification; when these changes fail in keeping an optimal glycemic control, then insulin therapy must be considered. Women with type 2 diabetes in use of oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes must start an intensive glycemic control, preferably before conception. All these procedures are performed aiming to keep glycemic levels normal or near-normal as possible to avoid the occurrence of adverse perinatal outcomes to the mother and to the fetus. The aim of this review is to reinforce the need to improve the knowledge on reproductive health of women with diabetes during gestation and to understand what are the reasons for them failing to attend for prepregnancy care programs, and to understand the underlying mechanisms of adverse fetal and maternal outcomes, which in turn may lead to strategies for its prevention.
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Affiliation(s)
- Carlos Antonio Negrato
- Bauru's Diabetics Association, Department of Internal Medicine, Rua Saint Martin 27-07 CEP 17.012-433, Bauru, São Paulo, Brazil
| | - Rosiane Mattar
- Department of Gynecology and Obstetrics, São Paulo Federal University, São Paulo, Brazil
| | - Marilia B Gomes
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
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1465
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Aittasalo M, Raitanen J, Kinnunen TI, Ojala K, Kolu P, Luoto R. Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland. Int J Behav Nutr Phys Act 2012; 9:104. [PMID: 22950716 PMCID: PMC3511276 DOI: 10.1186/1479-5868-9-104] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 08/30/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women. The purpose of the intervention was to examine whether intensified physical activity (PA) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA (LTPA) among pregnant women at risk of gestational diabetes. METHODS Fourteen municipalities were randomized to intervention (INT) and usual care group (UC). Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists. In UC conventional practices were continued. Feasibility evaluation included safety (incidence of PA-related adverse events; questionnaire), realization (timing and duration of sessions, number of sessions missed, attendance at group meetings; systematic record-keeping of the nurses and physiotherapists) and applicability (nurses' views; telephone interview). Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8-12 (baseline), 26-28 and 36-37 weeks' gestation. Multilevel analysis with adjustments was used in testing for between-group differences in PA changes. RESULTS The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT (N = 219) than in UC (N = 180) from baseline to the first follow-up (0.1 vs. -1.2, p = 0.040 and -0.2 vs. -1.3, p = 0.016). A similar trend was seen in meeting the PA recommendation (-11%-points vs. -28%-points, p = 0.06). INT did not experience more adverse events classified as warning signs to terminate exercise than UC, counseling was implemented as planned and viewed positively by the nurses. CONCLUSIONS Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA. However, it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practices. TR
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Affiliation(s)
- Minna Aittasalo
- The UKK Institute for Health Promotion Research, P.O. Box 30 33501, Tampere, Finland
| | - Jani Raitanen
- The UKK Institute for Health Promotion Research, P.O. Box 30 33501, Tampere, Finland
- Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Tarja I Kinnunen
- Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Katriina Ojala
- The UKK Institute for Health Promotion Research, P.O. Box 30 33501, Tampere, Finland
| | - Päivi Kolu
- The UKK Institute for Health Promotion Research, P.O. Box 30 33501, Tampere, Finland
| | - Riitta Luoto
- The UKK Institute for Health Promotion Research, P.O. Box 30 33501, Tampere, Finland
- National Institute for Health and Welfare, Helsinki, Finland
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1466
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Abstract
AIMS It has long been hypothesized that natural selection would favour a reproductive strategy biased towards females under adverse circumstances in order to maximize the number of surviving grandchildren. An excess of daughters in women with Type 1 diabetes and a greater likelihood of gestational diabetes in women carrying male fetuses have also been reported. This study aims to compare the sex ratio across categories of maternal glycaemia. METHODS Among 288,009 mother-infant pairs delivering at Kaiser Permanente Northern California in 1996-2008, sex ratios were calculated for the following categories: pregravid diabetes, gestational diabetes, mild pregnancy hyperglycaemia (defined as an abnormal screening but normal diagnostic test for gestational diabetes) and normoglycaemia. Odds ratios for delivering a male were estimated with logistic regression; normoglycaemic pregnancies comprised the reference. RESULTS Women with pregravid diabetes delivered the fewest males (ratio male/female = 1.01), followed by women with normoglycaemic pregnancies and those with an abnormal screening only (both sex ratios = 1.05); women with gestational diabetes delivered the most males (sex ratio = 1.07). Odds ratio estimates suggested the same pattern, but none attained statistical significance. CONCLUSIONS The crude sex ratios in this cohort suggest a possible gradient by category of maternal glycaemia. Women with gestational diabetes, a condition characterized by excessive fuel substrates, appear to deliver more males. Women with pregravid diabetes delivered the fewest males, possibly reflecting the unfavourable state of chronic disease.
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Affiliation(s)
- S F Ehrlich
- Division of Research, Kaiser Permanente of Northern California, Oakland, California 94612, USA.
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1467
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Greuter MJE, van Emmerik NMA, Wouters MGAJ, van Tulder MW. Quality of guidelines on the management of diabetes in pregnancy: a systematic review. BMC Pregnancy Childbirth 2012; 12:58. [PMID: 22741571 PMCID: PMC3495039 DOI: 10.1186/1471-2393-12-58] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Diabetes during pregnancy can lead to severe risks for both mother and fetus when it is not managed properly. The use of rigorously developed guidelines with a robust implementation process can have a positive influence on the management of diabetes during pregnancy. This study aims to compare recommendations and assess the quality of clinical guidelines on gestational diabetes mellitus (GDM) and pre-existing diabetes mellitus during pregnancy. METHODS Guidelines were selected by searching PubMed, the Guideline Clearing House and Google. All guidelines developed since 2000 on diabetes during pregnancy in English or Dutch were considered. Recommendations of the guidelines were compared. Furthermore, the quality was assessed by two authors independently, using the AGREE instrument. RESULTS Eight guidelines were included. According to the AGREE instrument, the quality of most guidelines was low. The domains editorial independence, stakeholder involvement and rigour of development had the lowest scores. Recommendations were mainly comparable on glycemic control, preconceptional counseling and prenatal care and labour. Differences between recommendations were found for screening on GDM and induction of labour. CONCLUSIONS The quality of most guidelines concerning the management of diabetes during pregnancy needs to be improved. A more systematic approach in the development of these guidelines, more attention for updating procedures and piloting of the guidelines and involvement of target users and patients is recommended.
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Affiliation(s)
- Marjolein JE Greuter
- Department of Health Sciences & EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081, HV Amsterdam, The Netherlands
| | - Nathalie MA van Emmerik
- Department of Health Sciences & EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081, HV Amsterdam, The Netherlands
| | - Maurice GAJ Wouters
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences & EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081, HV Amsterdam, The Netherlands
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1468
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Huy C, Loerbroks A, Hornemann A, Röhrig S, Schneider S. Prevalence, Trend and Determining Factors of Gestational Diabetes in Germany. Geburtshilfe Frauenheilkd 2012; 72:311-315. [PMID: 25284837 DOI: 10.1055/s-0031-1298390] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/02/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022] Open
Abstract
Purpose: The true prevalence of gestational diabetes in Germany is unknown. Thus, the study's purposes were to estimate the prevalence of gestational diabetes as well as to describe the temporal prevalence trend and to identify determinants. Material and Methods: We calculated prevalence estimates based on two datasets: the register-based German perinatal statistic (n = 650 232) and the maternal self-reports from the German children and youth health survey (KiGGS; n = 15 429). Differences between prevalence estimates were analysed using χ2 and trend tests, and determinants were identified using logistic regression. Results: According to the perinatal statistic, gestational diabetes was present in 3.7 % of pregnant women in Germany in 2010. The prevalence across the years 2001 to 2006 was estimated at 1.9 % which differed significantly from the prevalence estimate derived from the KiGGS dataset for the same period of time (5.3 %; 95 % confidence interval: 4.6-6.1 %). Both datasets show an increasing trend of gestational diabetes (p < 0.001). The risk for gestational diabetes was mainly associated with age, BMI and social class of pregnant women as well as with multiple pregnancies. Conclusion: The lack of significant screening studies among representative samples hampers a sound estimation of the true prevalence of gestational diabetes in Germany. The increasing trend in gestational diabetes might continue due to the projected increase of important risk factors (e.g., maternal age, obesity). Our analyses support the current consensus recommendations regarding standardised gestational diabetes screening.
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Affiliation(s)
- C Huy
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim
| | - A Loerbroks
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim
| | - A Hornemann
- Clinic for Gynaecology and Obstetrics, Universitätsmedizin Mannheim, Mannheim
| | - S Röhrig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim
| | - S Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim
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1469
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Reeske A, Zeeb H, Razum O, Spallek J. Differences in the Incidence of Gestational Diabetes between Women of Turkish and German Origin: An Analysis of Health Insurance Data From a Statutory Health Insurance in Berlin, Germany (AOK), 2005-2007. Geburtshilfe Frauenheilkd 2012; 72:305-310. [PMID: 25284836 DOI: 10.1055/s-0031-1280428] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 11/02/2011] [Accepted: 11/13/2011] [Indexed: 02/07/2023] Open
Abstract
Background: Gestational diabetes increases the risk of maternal and infant complications and long-term health effects. A study of differences in the incidence of gestational diabetes between women of Turkish and German origin can identify high risk groups and may indicate the need for culturally sensitive diabetes information and treatment during pregnancy. Method: We analysed all pregnancy related health insurance data from the AOK Berlin (a statutory health insurance in Berlin) based on data from 2005 to 2007, using a name algorithm to identify cases with Turkish migrant background. A group of German women insured with the AOK Berlin served as a comparison group. Results: After exclusion of miscarriages and multiple births the data set comprised 3338 pregnancies in total. The incidence of gestational diabetes was significantly higher in women of Turkish origin with 183 per 1000 pregnancies than in German women (138 per 1000 pregnancies). Regression analyses showed that women of Turkish origin with obesity were at the highest risk of gestational diabetes (OR = 2.67; 95 % confidence interval 1.97-3.60). Conclusion: Obesity is an important factor in explaining the higher incidence of gestational diabetes in women of Turkish origin, especially among young Turkish women. These findings should stimulate discussion as to whether or not information about risk factors such as diabetes within the scope of prenatal care adequately addresses the needs of migrant women. Further research is needed to identify potential differences in undetected and primarily in insufficiently treated gestational diabetes between Turkish and German women.
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Affiliation(s)
- A Reeske
- BIPS - Institute for Epidemiology and Prevention Research, Dept. of Prevention and Evaluation, Unit Social Epidemiology, Bremen
| | - H Zeeb
- BIPS - Institute for Epidemiology and Prevention Research, Dept. of Prevention and Evaluation, Unit Social Epidemiology, Bremen
| | - O Razum
- University of Bielefeld, School of Public Health, Dept. of Epidemiology & International Public Health, Bielefeld
| | - J Spallek
- BIPS - Institute for Epidemiology and Prevention Research, Dept. of Prevention and Evaluation, Unit Social Epidemiology, Bremen ; University of Bielefeld, School of Public Health, Dept. of Epidemiology & International Public Health, Bielefeld
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1470
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Katon J, Reiber G, Williams MA, Yanez D, Miller E. Antenatal haemoglobin A1c and risk of large-for-gestational-age infants in a multi-ethnic cohort of women with gestational diabetes. Paediatr Perinat Epidemiol 2012; 26:208-17. [PMID: 22471680 PMCID: PMC7442536 DOI: 10.1111/j.1365-3016.2012.01266.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gestational diabetes mellitus (GDM) is a risk factor for delivering a large-for-gestational-age (LGA) infant. Haemoglobin A1c (A1C) is an indicator of glycaemic control. The objective of this study was to test whether higher A1C quartile at the time of diagnosis of GDM is associated with increased risk of delivering a LGA or macrosomic infant. Women with singleton pregnancies treated for GDM at a large diabetes and pregnancy programme located in Charlotte, North Carolina, were eligible for inclusion in this retrospective cohort study. Clinical information, including A1C at diagnosis, treatment, prior medical and obstetric history, and birth data were abstracted from medical records. LGA was defined as birthweight >90th percentile for gestational age and sex and macrosomia as birthweight >4000 g. Logistic regression was used to analyse the association of A1C at GDM diagnosis with risk of delivering LGA or macrosomic infants. This study included 502 women. Prevalences of LGA and macrosomia were 4% and 6% respectively. After adjustment there was no detectable trend of increased risk for LGA (P for trend = 0.12) or macrosomia (P for trend = 0.20) across increasing quartiles of A1C at GDM diagnosis. A1C at GDM diagnosis may not be linearly associated with LGA or macrosomia, possibly because of the mediating effect of strict glycaemic control in this clinical setting.
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Affiliation(s)
- Jodie Katon
- Departments of Epidemiology Health Services Biostatistics, University of Washington VA Puget Sound Health Care System, Seattle, WA 98195, USA.
| | - Gayle Reiber
- Department of Epidemiology, University of Washington,Department of Health Services, University of Washington,VA Puget Sound Health Care System, Seattle, WA
| | | | - David Yanez
- Department of Biostatistics, University of Washington
| | - Edith Miller
- Carolinas Medical Center Diabetes and Pregnancy Program, Carolinas Medical Center, Charlotte, NC, USA
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1471
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Balani J, Hyer S, Johnson A, Shehata H. Pregnancy outcomes after metformin treatment for gestational diabetes: a case-control study. Obstet Med 2012; 5:78-82. [PMID: 27579140 DOI: 10.1258/om.2012.110092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is increasing evidence that metformin is safe and effective in the treatment of gestational diabetes (GDM), although it has not yet been widely accepted for routine practice. We compared pregnancy outcomes in women with gestational GDM treated with metformin or dietary measures alone. METHODS Women with GDM (324) not adequately controlled by diet received metformin according to protocol based on their home glucose results. Pregnancy outcomes in these women were compared with 175 GDM women treated with diet alone and matched for age and ethnicity. RESULTS The percentage of macrosomic babies (birth weight [BW] centile >90th centile) and small for gestational age (SGA) (BW <10th centile) in the metformin group was significantly reduced compared with the diet group (12.7% versus 20%; P < 0.05 [macrosomia]; 7.7% versus 14.3% [SGA] P < 0.05). CONCLUSIONS Metformin treatment had a favourable impact on the rates of macrosomia and SGA despite more severe glucose intolerance at baseline.
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Affiliation(s)
| | | | - Antoinette Johnson
- Maternal Medicine Unit, Epsom and St Helier University Hospitals NHS Trust , Carshalton, Surrey , UK
| | - Hassan Shehata
- Maternal Medicine Unit, Epsom and St Helier University Hospitals NHS Trust , Carshalton, Surrey , UK
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1472
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Zeng MS, Li X, Liu Y, Zhao H, Zhou JC, Li K, Huang JQ, Sun LH, Tang JY, Xia XJ, Wang KN, Lei XG. A high-selenium diet induces insulin resistance in gestating rats and their offspring. Free Radic Biol Med 2012; 52:1335-42. [PMID: 22342560 PMCID: PMC3505681 DOI: 10.1016/j.freeradbiomed.2012.01.017] [Citation(s) in RCA: 96] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 01/05/2012] [Accepted: 01/23/2012] [Indexed: 12/17/2022]
Abstract
Although supranutrition of selenium (Se) is considered a promising anti-cancer strategy, recent human studies have shown an intriguing association between high body Se status and diabetic risk. This study was done to determine if a prolonged high intake of dietary Se actually induced gestational diabetes in rat dams and insulin resistance in their offspring. Forty-five 67-day-old female Wistar rats (n=15/diet) were fed a Se-deficient (0.01 mg/kg) corn-soy basal diet (BD) or BD+Se (as Se-yeast) at 0.3 or 3.0mg/kg from 5 weeks before breeding to day 14 postpartum. Offspring (n=8/diet) of the 0.3 and 3.0mg Se/kg dams were fed with the same respective diet until age 112 days. Compared with the 0.3mg Se/kg diet, the 3.0mg/kg diet induced hyperinsulinemia (P<0.01), insulin resistance (P<0.01), and glucose intolerance (P<0.01) in the dams at late gestation and/or day 14 postpartum and in the offspring at age 112 days. These impairments concurred with decreased (P<0.05) mRNA and/or protein levels of six insulin signal proteins in liver and muscle of dams and/or pups. Dietary Se produced dose-dependent increases in Gpx1 mRNA or GPX1 activity in pancreas, liver, and erythrocytes of dams. The 3.0mg Se/kg diet decreased Selh (P<0.01), Sepp1 (P=0.06), and Sepw1 (P<0.01), but increased Sels (P<0.05) mRNA levels in the liver of the offspring, compared with the 0.3mg Se/kg diet. In conclusion, supranutrition of Se as a Se-enriched yeast in rats induced gestational diabetes and insulin resistance. Expression of six selenoprotein genes, in particular Gpx1, was linked to this metabolic disorder.
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Affiliation(s)
- Min-Shu Zeng
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Xi Li
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Yan Liu
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Hua Zhao
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Ji-Chang Zhou
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Ke Li
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Jia-Qiang Huang
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Lv-Hui Sun
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Jia-Yong Tang
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Xin-Jie Xia
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
- Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
| | - Kang-Ning Wang
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
| | - Xin Gen Lei
- International Center of Future Agriculture for Human Health, Sichuan Agricultural University, Chengdu, Sichuan, China
- Department of Animal Science, Cornell University, Ithaca, NY 14853, USA
- Corresponding author at: Department of Animal Science, Cornell University, Ithaca, NY 14853, USA. Fax: +1 607 255 9829. (X.G. Lei)
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1473
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Hunt KJ, Marlow NM, Gebregziabher M, Ellerbe CN, Mauldin J, Mayorga ME, Korte JE. Impact of maternal diabetes on birthweight is greater in non-Hispanic blacks than in non-Hispanic whites. Diabetologia 2012; 55:971-80. [PMID: 22237686 PMCID: PMC3677815 DOI: 10.1007/s00125-011-2430-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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: 09/15/2011] [Accepted: 12/02/2011] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS To determine the impact of maternal diabetes during pregnancy on racial disparities in fetal growth. METHODS Using linked birth certificate, inpatient hospital and prenatal claims data we examined live singleton births of mothers resident in South Carolina who self-reported their race as non-Hispanic white (NHW; n = 140,128) or non-Hispanic black (NHB; n = 82,492) and delivered at 28-42 weeks' gestation between 2004 and 2008. RESULTS Prepregnancy diabetes prevalence was higher in NHB (3.0%) than in NHW (1.7%), while the prevalence of gestational diabetes mellitus (GDM) was similar in NHB (6.1%) and NHW (6.3%). At a delivery BMI of 35 kg/m(2), GDM exposure was associated with an average birthweight only 17 g (95% CI 4, 30) higher in NHW, but 78 g (95% CI 61, 95) higher in NHB (controlling for gestational age, maternal age, infant sex and availability of information on prenatal care). Figures for prepregnancy diabetes were 58 g (95% CI 34, 81) in NHW and 60 g (95% CI 37, 84) in NHB. GDM had a greater impact on birthweight in NHB than in NHW (60 g racial difference [95% CI 39, 82]), while prepregnancy diabetes had a large but similar impact. Similarly, the RR for GDM of having a large- relative to a normal-weight-for-gestational-age infant was lower in NHW (RR 1.41 [95% CI 1.34, 1.49]) than in NHB (RR 2.24 [95% CI 2.05, 2.46]). CONCLUSIONS/INTERPRETATION These data suggest that the negative effects of GDM combined with obesity during pregnancy may be greater in NHB than in NHW individuals.
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Affiliation(s)
- K J Hunt
- Department of Medicine/Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA.
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1474
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Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB. The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol 2012; 206:309.e1-7. [PMID: 22464068 PMCID: PMC3403365 DOI: 10.1016/j.ajog.2012.01.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [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: 11/28/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We sought to compare the different mortality risks between delivery and expectant management in women with gestational diabetes mellitus (GDM). STUDY DESIGN This is a retrospective cohort study that included singleton pregnancies of women diagnosed with GDM delivering at 36-42 weeks' gestational age in California from 1997 through 2006. A composite mortality rate was developed to estimate the risk of expectant management at each gestational age incorporating the stillbirth risk during the week of continuing pregnancy plus the infant mortality risk at the gestational age 1 week hence. RESULTS In women with GDM, the risk of expectant management is lower than the risk of delivery at 36 weeks (17.4 vs 19.3/10,000), but at 39 weeks, the risk of expectant management exceeds that of delivery (relative risk, 1.8; 95% confidence interval, 1.2-2.6). CONCLUSION In women with GDM, infant mortality rates at 39 weeks are lower than the overall mortality risk of expectant management for 1 week; absolute risks of stillbirth and infant death are low.
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Affiliation(s)
- Melissa G Rosenstein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
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1475
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Husslein H, Worda C, Leipold H, Szalay S. Accuracy of Fetal Weight Estimation in Women with Diet Controlled Gestational Diabetes. Geburtshilfe Frauenheilkd 2012; 72:144-148. [PMID: 25284831 DOI: 10.1055/s-0031-1298278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/30/2011] [Accepted: 01/01/2012] [Indexed: 10/28/2022] Open
Abstract
Purpose: To evaluate whether ultrasound accuracy of estimated fetal weight (EFW) differs in women with diet controlled gestational diabetes mellitus (GDM) compared to nondiabetic pregnant women. Material and Methods: We included 363 patients, 121 patients with diet controlled GDM and 242 patients with a normal oral glucose tolerance test (oGTT). Each case of diet controlled GDM was matched with 2 unaffected controls. All patients were screened/diagnosed for GDM by means of an oGTT. Both groups received ultrasound examination including fetal biometry, using Hadlock's Formula, within 7 days to delivery. After birth, gestational age, birthweight and Apgar scores were collected from each newborn. Results: There was a good correlation between EFW and birth weight (coefficient = 0.747, p < 0.001 by Pearson correlation, even after adjustment for glucose status). Regression analyses, including noGDM/GDM, maternal age, maternal body mass index, birth weight and time interval between ultrasound and delivery revealed that only fetal birth weight significantly influences weight difference between ultrasound EFW and actual birth weight at term. Conclusion: Our data suggests that ultrasound accuracy of EFW using Hadlock's Formula at term does not differ in women with diet controlled GDM compared to women with normal glucose tolerance.
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Affiliation(s)
- H Husslein
- Department of Obstetrics and Gynecology, Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - C Worda
- Department of Obstetrics and Gynecology, Medical University Vienna, Allgemeines Krankenhaus der Stadt Wien, Wien, Austria
| | - H Leipold
- Department of Obstetrics and Gynecology, Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
| | - Stefan Szalay
- Department of Obstetrics and Gynecology, Landeskrankenhaus Klagenfurt, Klagenfurt, Austria
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1476
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Cupul-Uicab LA, Skjaerven R, Haug K, Melve KK, Engel SM, Longnecker MP. In utero exposure to maternal tobacco smoke and subsequent obesity, hypertension, and gestational diabetes among women in the MoBa cohort. Environ Health Perspect 2012; 120:355-60. [PMID: 22128036 PMCID: PMC3295347 DOI: 10.1289/ehp.1103789] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 11/29/2011] [Indexed: 05/22/2023]
Abstract
BACKGROUND Environmental factors influencing the developmental origins of health and disease need to be identified and investigated. In utero exposure to tobacco smoke has been associated with obesity and a small increase in blood pressure in children; however, whether there is a corresponding increased risk of conditions such as diabetes and hypertension during adulthood remains unclear. OBJECTIVE Our goal was to assess the association of self-reported in utero exposure to tobacco smoke with the prevalence of obesity, hypertension, type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) in women 14-47 years of age. METHODS We conducted a cross-sectional analysis of the Norwegian Mother and Child Cohort Study, which enrolled pregnant women in Norway from 1999 thorough 2008. Exposure to tobacco smoke in utero (yes vs. no) was ascertained on the baseline questionnaire (obtained at ~ 17 weeks' gestation); the outcomes were ascertained from the Medical Birth Registry of Norway and the questionnaire. Our analysis included 74,023 women. RESULTS Women exposed to tobacco smoke in utero had 1.53 times the odds of obesity [95% confidence interval (CI): 1.45, 1.61] relative to those unexposed, after adjusting for age, education, and personal smoking. After further adjustment for body mass index, the odds ratio for hypertension was 1.68 (95% CI: 1.19, 2.39); for T2DM 1.14 (95% CI: 0.79, 1.65); and for GDM 1.32 (95% CI: 1.10, 1.58) among exposed compared with unexposed. CONCLUSIONS Exposure to tobacco smoke in utero was associated with obesity, hypertension, and GDM in adult women. The possibility that the associations were attributable to unmeasured confounding cannot be excluded.
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Affiliation(s)
- Lea A Cupul-Uicab
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina 27709, USA.
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1477
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Green AS, Chen X, Macko AR, Anderson MJ, Kelly AC, Hart NJ, Lynch RM, Limesand SW. Chronic pulsatile hyperglycemia reduces insulin secretion and increases accumulation of reactive oxygen species in fetal sheep islets. J Endocrinol 2012; 212:327-42. [PMID: 22182602 PMCID: PMC3516619 DOI: 10.1530/joe-11-0300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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] [Indexed: 01/21/2023]
Abstract
Children from diabetic pregnancies have a greater incidence of type 2 diabetes. Our objective was to determine if exposure to mild-moderate hyperglycemia, by modeling managed diabetic pregnancies, affects fetal β-cell function. In sheep fetuses, β-cell responsiveness was examined after 2 weeks of sustained hyperglycemia with 3 pulses/day, mimicking postprandial excursions, and compared to saline-infused controls (n = 10). Two pulsatile hyperglycemia (PHG) treatments were studied: mild (mPHG, n = 5) with +15% sustained and +55% pulse; and moderate (PHG, n = 10) with +20% sustained and +100% pulse. Fetal glucose-stimulated insulin secretion and glucose-potentiated arginine insulin secretion were lower (P < 0.05) in PHG (0.86 ± 0.13 and 2.91 ± 0.39 ng/ml plasma insulin) but not in mPHG fetuses (1.21 ± 0.08 and 4.25 ± 0.56 ng/ml) compared to controls (1.58 ± 0.25 and 4.51 ± 0.56 ng/ml). Islet insulin content was 35% lower in PHG and 35% higher in mPHG vs controls (P < 0.01). Insulin secretion and maximally stimulated insulin release were also reduced (P < 0.05) in PHG islets due to lower islet insulin content. Isolated PHG islets also had 63% greater (P < 0.01) reactive oxygen species (ROS) accumulation at 11.1 mmol/l glucose than controls (P < 0.01), but oxidative damage was not detected in islet proteins. PHG fetuses showed evidence of oxidative damage to skeletal muscle proteins (P < 0.05) but not insulin resistance. Our findings show that PHG induced dysregulation of islet ROS handling and decreased islet insulin content, but these outcomes are independent. The β-cell outcomes were dependent on the severity of hyperglycemia because mPHG fetuses had no distinguishable impairments in ROS handling or insulin secretion but greater insulin content.
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Affiliation(s)
- Alice S. Green
- Department of Animal Sciences, University of Arizona, Tucson AZ
| | - Xiaochuan Chen
- Department of Animal Sciences, University of Arizona, Tucson AZ
| | - Antoni R. Macko
- Department of Animal Sciences, University of Arizona, Tucson AZ
| | | | - Amy C. Kelly
- Department of Animal Sciences, University of Arizona, Tucson AZ
| | - Nathaniel J. Hart
- Departments of Pharmacology and Physiology, University of Arizona, Tucson AZ
| | - Ronald M. Lynch
- Departments of Pharmacology and Physiology, University of Arizona, Tucson AZ
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1478
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Abstract
Gestational diabetes mellitus is rapidly increasing in incidence, due to lifestyle changes, increasing obesity and maternal age. This increase makes universal screening mandatory; however, we are still far from it. Moreover, should we adopt rather strict oral glucose tolerance test cutoff values, resulting in a worldwide incidence of gestational diabetes mellitus of approximately 17.5%, or should we be more liberal and focus more on patients and offspring at increased risk, for example, obese women. Finally, are oral antidiabetic drugs such as glyburide and metformin safe enough to use in gestational diabetes mellitus, or should they still be considered as the 'poor man's insulin'? These issues were presented and discussed during lively debates at the Controversies in Obstetrics, Gynecology and Infertility annual meetings, but consensus was not reached.
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Affiliation(s)
- Gerard Ha Visser
- a Department of Obstetrics, University Medical Center, Utrecht, The Netherlands.
| | - Harold W de Valk
- b Department of Internal Medicine, University Medical Center, Utrecht, The Netherlands
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1479
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Ip F, Bradford J, Hng TM, Hendon S, McLean M. The obese woman with gestational diabetes: effects of body mass index and weight gain in pregnancy on obstetric and glycaemic outcomes. Obstet Med 2012; 5:65-70. [PMID: 27579138 DOI: 10.1258/om.2011.110009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obese women with gestational diabetes mellitus (GDM) represent a high-risk group in pregnancy, although the effects of increasing degrees of obesity and weight gain in pregnancy in this group is poorly defined. METHODS We performed a retrospective analysis of 375 singleton pregnancies complicated by maternal obesity and GDM. Women with a body mass index (BMI) of 30-35 kg/m(2) were compared with those with a BMI of ≥ 35 kg/m(2). Additionally, women were categorized according to weight gain in pregnancy: Group A (<0.18 kg/week), Group B (0.18-0.27 kg/week), Group C (>0.27 kg/week). RESULTS Obstetric outcomes did not differ between the groups; however, postpartum dysglycaemia was more likely in women with a BMI ≥ 35 kg/m(2) (odds ratio [OR] 3.2, 95% confidence interval [CI]: 1.2-8.9). Group B and Group C had higher odds of LGA (OR 3.8, 95% CI: 1.3-11.3; OR 5.0, 95% CI: 2.0-12.1, respectively) compared with Group A. Group C also had a lower risk of SGA (OR 0.4, 95% CI: 0.2-1.0) and a higher risk of postpartum dysglycaemia (OR 6.8, 95% CI: 1.7-26.9) compared with Group A. CONCLUSION Greater degrees of obesity are associated with higher risk of abnormal metabolic outcomes after pregnancy. Excessive weight gain in pregnancy in obese women increases adverse obstetric and glycaemic outcomes. Our findings suggest that targets for weight gain in pregnancy for obese women should be reduced from current recommendations.
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Affiliation(s)
- Flora Ip
- Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Jennifer Bradford
- Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Tien-Ming Hng
- Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Susan Hendon
- Blacktown Hospital , Sydney, New South Wales , Australia
| | - Mark McLean
- Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
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1480
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Abstract
AIMS Women with remote histories of gestational diabetes mellitus can reduce their diabetes risk through lifestyle changes, but the effectiveness of interventions in women with more recent histories of gestational diabetes has not been reported. Therefore, we conducted a pilot study of a low-intensity web-based pedometer programme targeting glucose intolerance among women with recent gestational diabetes. METHODS Women with a gestational diabetes delivery within the past 3 years were randomized to a 13-week intervention consisting of a structured web-based pedometer programme which gave personalized steps-per-week goals, pedometers and education regarding lifestyle modification, or to a letter about diabetes risk reduction and screening after delivery for gestational diabetes (control condition). The main outcome measures were change in fasting plasma glucose and 2-h glucose levels on a 75-g oral glucose tolerance test between baseline and 13-week follow-up. Weight was a secondary outcome and behavioural constructs (self-efficacy, social support, risk perception) were also assessed. RESULTS Forty-nine women were enrolled. At 13-week follow-up, women randomized to the intervention did not have significant changes in behavioural constructs, physical activity or anthropometrics compared with women in the control group. Changes in fasting plasma glucose (-0.046 mmol/l vs. 0.038 mmol/l, P = 0.65), 2-h glucose values (-0.48 mmol/l vs. -0.42 mmol/l, P = 0.91) and weight (-0.14 kg vs. -1.5 kg, P = 0.13) were similar between the control and intervention groups, respectively. CONCLUSIONS Structured web-based education utilizing pedometers is feasible although uptake may be low. Such programmes may need to be supplemented with additional measures in order to be effective for reduction of diabetes risk.
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Affiliation(s)
- C Kim
- Department of Medicine, University of Michigan, Ann Arbor, USA.
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1481
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Baker AM, Haeri S, Camargo CA, Stuebe AM, Boggess KA. First-trimester maternal vitamin D status and risk for gestational diabetes (GDM) a nested case-control study. Diabetes Metab Res Rev 2012; 28:164-8. [PMID: 21818838 PMCID: PMC4381548 DOI: 10.1002/dmrr.1282] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Vitamin D deficiency may contribute to impaired glucose metabolism. There are sparse data regarding vitamin D and the development of gestational diabetes (GDM). The objective of this study was to assess if first-trimester vitamin D deficiency is more prevalent in women later diagnosed with GDM compared with women with uncomplicated pregnancies. METHODS We conducted a nested case-control study of pregnant women who had previously given blood for routine genetic multiple marker screening and subsequently delivered at a tertiary hospital between November 2004 and July 2009. From an overall cohort of 4225 women, 60 cases of GDM were matched by race/ethnicity with 120 women delivering at term (≥37 weeks) with uncomplicated pregnancies. Banked maternal serum was used to measure maternal 25-hydroxyvitamin D [25(OH)D]. RESULTS The prevalence of first-trimester maternal vitamin D deficiency (defined as 25(OH)D < 50 nmol/L) was comparable among women with GDM compared with controls (5/60 vs 8/120, p = 0.90). The median 25(OH)D level for all subjects was 89 nmol/L (interquartile range, 73-106 nmol/L). Seventy three percent (117/160) of the cohort had 25(OH)D levels ≥75 nmol/L. CONCLUSIONS In a cohort of pregnant women with mostly sufficient levels of serum 25(OH)D, vitamin D deficiency was not associated with GDM. Further studies are warranted with larger cohorts, especially in populations with lower levels of vitamin D.
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Affiliation(s)
- Arthur M Baker
- Memorial Health University Medical Center, Mercer School of Medicine, Savannah Campus, Savannah, GA 31404, USA.
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1482
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Abstract
OBJECTIVE To investigate the possible association between total daily iron intake during pregnancy, haemoglobin in early pregnancy and the risk of gestational diabetes mellitus (GDM) in women at increased risk of GDM. DESIGN A prospective cohort study (based on a cluster-randomised controlled trial, where the intervention and the usual care groups were combined). SETTING Primary healthcare maternity clinics in 14 municipalities in south-western Finland. PARTICIPANTS 399 Pregnant women who were at increased risk of GDM participated in a GDM prevention trial and were followed throughout pregnancy. MAIN OUTCOME MEASUREMENTS The main outcome was GDM diagnosed with oral glucose tolerance test at 26-28 weeks' gestation or based on a diagnosis recorded in the Finnish Medical Birth registry. Data on iron intake was collected using a 181-item food frequency questionnaire and separate questions for supplement use at 26-28 weeks' gestation. RESULTS GDM was diagnosed in 72 women (18.1%) in the study population. The OR for total iron intake as a continuous variable was 1.006 (95% CI 1.000 to 1.011; p=0.038) after adjustment for body mass index, age, diabetes in first-degree or second-degree relatives, GDM or macrosomia in earlier pregnancy, total energy intake, dietary fibre, saturated fatty acids and total gestational weight gain. Women in the highest fifth of total daily iron intake had an adjusted OR of 1.66 (95% CI 0.84 to 3.30; p=0.15) for GDM. After excluding participants with low haemoglobin levels (≤120 g/l) already in early pregnancy the adjusted OR was 2.35 (95% CI 1.13 to 4.92; p=0.023). CONCLUSIONS Our results suggest that high iron intake during pregnancy increases the risk of GDM especially in women who are not anaemic in early pregnancy and who are at increased risk of GDM. These findings suggest that routine iron supplementation should be reconsidered in this risk group of women.
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Affiliation(s)
- Annika Helin
- School of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Jani Raitanen
- School of Health Sciences, University of Tampere, Tampere, Finland
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Suvi Ahonen
- School of Health Sciences, University of Tampere, Tampere, Finland
- Science Center of Pirkanmaa Hospital District and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Suvi M Virtanen
- School of Health Sciences, University of Tampere, Tampere, Finland
- Science Center of Pirkanmaa Hospital District and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Unit of Nutrition, The National Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Luoto
- The UKK Institute for Health Promotion Research, Tampere, Finland
- Unit of Sexual and Reproductive Health, The National Institute for Health and Welfare, Helsinki, Finland
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1483
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Cavassini ACM, Lima SAM, Calderon IMP, Rudge MVC. Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil. SAO PAULO MED J 2012; 130:17-26. [PMID: 22344355 PMCID: PMC10906692 DOI: 10.1590/s1516-31802012000100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 02/23/2011] [Revised: 02/23/2011] [Accepted: 07/20/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. STUDY DESIGN This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp). METHODS Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. RESULTS Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. CONCLUSION Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.
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1484
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Mohamed Ismail NA, Abd Rahman R, Abd Wahab N, Muhammad R, Nor Azmi K. Pheochromocytoma and pregnancy: a difficult and dangerous ordeal. Malays J Med Sci 2012; 19:65-68. [PMID: 22977377 PMCID: PMC3436494] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/26/2011] [Indexed: 06/01/2023] Open
Abstract
Pheochromocytoma during pregnancy is potentially disastrous to the mother and fetus. Its ambiguous presentation is often mistaken for pre-eclampsia, although it may imitate other problems during pregnancy. Early diagnosis and timely, appropriate management reduces possible maternal and fetal complications. We identified a case of pheochromocytoma during pregnancy; the condition was initially diagnosed as pre-eclampsia complicated with gestational diabetes. Surgical intervention via left adrenalectomy was successfully performed in the second trimester. After surgery, all of the patient's medical problems nearly subsided and she did not require further treatment. However, her fetus displayed restricted intrauterine growth, and the patient eventually had premature delivery via a caesarean section. A multidisciplinary team to identify and treat pheochromocytoma is mandatory to ensure optimal conditions for tumour removal and to anticipate any possible catastrophic events.
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Affiliation(s)
- Nor Azlin Mohamed Ismail
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Rahana Abd Rahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Norasyikin Abd Wahab
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Rohaizak Muhammad
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Kamaruddin Nor Azmi
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
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1485
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Ismail NAM, Olaide Raji H, Abd Wahab N, Mustafa N, Kamaruddin NA, Abdul Jamil M. Glycemic Control among Pregnant Diabetic Women on Insulin Who Fasted During Ramadan. Iran J Med Sci 2011; 36:254-9. [PMID: 23115409 PMCID: PMC3470278] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 06/20/2011] [Accepted: 07/03/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ramadan fasting for pregnant women with diabetes remains controversial and underreported. The objective of this study was to determine the glycemic control in pregnant diabetic women on insulin who fasted during Ramadan. METHODS This was a retrospective study carried out over a period of three years including pregnant diabetic women, who were on short-acting, intermediate-acting, or a combination of them, and opted to carry out Ramadan fasting. Glycemic control was assessed before, middle and after Ramadan fasting. RESULTS Thirty seven women opted to fast with 24 (64.9%) of them had type 2 diabetes mellitus and 83.8% of them required combined insulin (short- acting, intermediate-acting) therapy. The age of the participants was 32.13±4.68 years, and the age of their pregnancies was 25.60±7.12 weeks when the study was performed. The median number of days fasted was 25 days, and most of the women were able to fast for more than 15 days. There was no difference between glycemic control of type 2 diabetes mellitus and gestational diabetes mellitus women prior to fasting. In the middle of Ramadan, serum fructosamine decreased in both groups. However, only serum HbA1c reduced in gestational diabetes mellitus after Ramadan. CONCLUSION the findings indicate that pregnant diabetic women on insulin were able to fast during Ramadan and that their glycemic control was improved during fasting period. They may also suggest that instead of absolute ban on fasting for pregnant diabetic women more practical approach and close consultation with health care providers might be more helpful.
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Affiliation(s)
- Nor Azlin Mohamed Ismail
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hadijat Olaide Raji
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norashikin Abd Wahab
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norlaila Mustafa
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Azmi Kamaruddin
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Muhammad Abdul Jamil
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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1486
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Bener A, Saleh NM, Al-Hamaq A. Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons. Int J Womens Health 2011; 3:367-73. [PMID: 22140323 PMCID: PMC3225465 DOI: 10.2147/ijwh.s26094] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of gestational diabetes (GDM) is increasing all over the world. Hence, the impact of GDM on maternal and infant health is an important topic of research. No study has been conducted in Qatar to evaluate the outcome of pregnancies complicated by diabetes mellitus. Objective The aim of the study was to determine the prevalence of GDM, compare the maternal–neonatal complications among women with GDM and non-GDM pregnant women, and investigate the risk factors and potential outcomes associated with GDM. Design This is a prospective cohort study. Setting The survey was carried out at the antenatal clinics of the Women’s Hospital, Qatar. Subjects and methods A representative sample of 2056 pregnant women who attended the antenatal clinics of the Women’s Hospital were surveyed during the period from the first week of January 2010 to April 2011. From this sample, 1608 women (78.2%) expressed their consent to participate in the study. Questionnaires were administered to pregnant women who were seeking antenatal care at this urban hospital. The questionnaire covered variables related to sociodemographic factors, family history, medical history, maternal complications, and neonatal outcome. Results The prevalence of GDM in Qatar was 16.3%. Women with GDM were significantly higher in the age group of 35–45 years (45%; P = 0.001). Family history of diabetes (31.7%; P < 0.001), increased parity (55.3%; P = 0.004), and obesity (59.2%; P < 0.001) were determinants of GDM in pregnant women. Maternal complications like pregnancy-induced hypertension (19.1% vs 10.3%; P < 0.001), pre-eclampsia (7.3% vs 3.8%; P = 0.012), antepartum hemorrhage (19.2% vs 14.6%; P = 0.05), and cesarean (27.9% vs 12.4%; P < 0.001) were significantly higher in GDM women. Neonates were at increased risk of preterm birth (12.6% vs 8.3%; P = 0.03), macrosomia (10.3% vs 5.9%; P = 0.01), and birth trauma (8% vs 3%; P < 0.001). Conclusion The study findings revealed that GDM was higher in women in Qatar and that they were at increased risk of developing maternal and neonatal complications. Obesity emerged as an essential risk factor for subsequent GDM. The advanced maternal age, low monthly income, family history of diabetes, and obesity were the main significant risk factors for GDM.
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Affiliation(s)
- Abdulbari Bener
- Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, Hamad General Hospital, Department of Public Health and Medical Education, Weill Cornell Medical College, Qatar
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1487
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Steven S, Woodcock S, Small PK, Taylor R. Type 2 diabetes, bariatric surgery and the risk of subsequent gestational diabetes. Obstet Med 2011; 4:171-3. [PMID: 27579120 DOI: 10.1258/om.2011.110020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2011] [Indexed: 12/19/2022] Open
Abstract
Women with pre-existing abnormal glucose regulation are certain to develop gestational diabetes in pregnancy and pre-gestational type 2 diabetes will become more difficult to control. However, an increasing number of women with type 2 diabetes have had bariatric surgery. In this group, the effect of pregnancy on glucose metabolism is unknown. We report two women with type 2 diabetes who underwent laparoscopic gastric bypass surgery with normalization of plasma glucose levels. During subsequent pregnancy, maternal blood glucose levels remained completely normal throughout. This is remarkable given the predisposition to abnormal glucose tolerance and the ongoing obesity, in the face of the insulin resistance of pregnancy. Women with prior type 2 diabetes reversed by gastric bypass surgery are not at high risk for gestational diabetes.
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Affiliation(s)
- S Steven
- Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne
| | - S Woodcock
- Department of Surgery, North Tyneside General Hospital , North Shields
| | - P K Small
- Department of Surgery, Sunderland Royal Hospital , Sunderland
| | - R Taylor
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne; Department of Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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1488
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Chasan-Taber L, Silveira M, Marcus BH, Braun B, Stanek E, Markenson G. Feasibility and efficacy of a physical activity intervention among pregnant women: the behaviors affecting baby and you (B.A.B.Y.) study. J Phys Act Health 2011; 8 Suppl 2:S228-S238. [PMID: 21918237 PMCID: PMC4764870] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Physical activity during pregnancy is associated with reduced risk of adverse maternal and fetal outcomes. However, the majority of pregnant women are inactive and interventions designed to increase exercise during pregnancy are sparse. We evaluated the feasibility and preliminary efficacy of an exercise intervention among a diverse sample of pregnant women. METHODS The B.A.B.Y. (Behaviors Affecting Baby and You) Study is conducted at a large tertiary care facility in Western Massachusetts. We randomized 110 prenatal care patients (60% Hispanic) to an individually tailored 12-week exercise intervention arm (n = 58) or to a health and wellness control arm (n = 52) at mean = 11.9 weeks gestation. Physical activity was assessed via the Pregnancy Physical Activity Questionnaire (PPAQ). RESULTS After the 12-week intervention, the exercise arm experienced a smaller decrease (-1.0 MET-hrs/wk) in total activity vs. the control arm (-10.0 MET-hrs/wk; P = .03), and a higher increase in sports/exercise (0.9 MET-hrs/wk) vs. the control arm (-0.01 MET-hrs/wk; P = .02). Intervention participants (95%) reported being satisfied with the amount of information received and 86% reported finding the study materials interesting and useful. CONCLUSIONS Findings support the feasibility and preliminary efficacy of a tailored exercise intervention in increasing exercise in a diverse sample of pregnant women.
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Affiliation(s)
- Lisa Chasan-Taber
- Dept of Public Health, University of Massachusetts, Amherst, MA, USA
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1489
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Kim C, Sen A, Osborne E, Lee JM, Richardson CR. Associations between glucose tolerance and sex hormone binding globulin among women with recent gestational diabetes mellitus. Diabetes Res Clin Pract 2011; 93:e110-2. [PMID: 21715040 PMCID: PMC3175320 DOI: 10.1016/j.diabres.2011.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 05/04/2011] [Revised: 05/19/2011] [Accepted: 06/02/2011] [Indexed: 10/18/2022]
Abstract
We examined cross-sectional associations of sex hormone binding globulin (SHBG) with glucose among women recent GDM (n=55). SHBG was associated with fasting glucose levels before and after adjustment for covariates (p=0.015), but not with 2-h glucose. We conclude SHBG should be explored in prospective studies in GDM women.
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Affiliation(s)
- Catherine Kim
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
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1490
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Rudge MVC, Lima CP, Damasceno DC, Sinzato YK, Napoli G, Rudge CVC, Gallego FQ, Calderon IMP. Histopathological placental lesions in mild gestational hyperglycemic and diabetic women. Diabetol Metab Syndr 2011; 3:19. [PMID: 21831283 PMCID: PMC3174871 DOI: 10.1186/1758-5996-3-19] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/10/2011] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate and compare the incidence of histopathological placental lesions in mild gestational hyperglycemia, gestational diabetes and overt diabetes at term and preterm gestation. RESEARCH DESIGN AND METHODS One-hundred-and-thirty-one placental samples were collected from Diabetes mellitus (DM) positive screened patients. Two diagnostic tests, glycemic profile and 100 g oral glucose tolerance test (OGTT) in parallel identified 4 groups normoglycemic, mild gestational hyperglycemia (MGH), gestational DM (GDM) or overt DM (DM). Placental tissue specimens and sections from 4 groups were obtained by uniform random sampling and stained with hematoxylin-eosin. RESULTS Placentas from MGH group presented 17 types of histopathological change and higher rates of syncytial nodes and endarteritis. GDM placentas presented only nine types of histopathological change, high rates of dysmaturity, low rates of calcification and no syncytial nodes. Overt DM placentas showed 22 types of histopathological change, 21 of which were present in the preterm period. There were histopathological similarities between MGH and DM placentas, but the former exhibited a higher incidence of endarteritis, which has been described as a "post-mortem" phenomenon. CONCLUSION Our results confirmed that the distinct placental changes associated with DM and MGH depend on gestational period during which the diabetic insult occurs. It may reasonably be inferred that subclinical maternal hyperglycemia during pregnancy, as showed in MGH group, is responsible for increased placental endarteritis, a postmortem lesion in the live fetus.
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Affiliation(s)
- Marilza VC Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, Univ Estadual Paulista_Unesp, São Paulo State, Brazil
| | - César P Lima
- Department of Pathology, Federal School of Medical Sciences of Porto Alegre, Brazil
| | - Débora C Damasceno
- Department of Gynecology and Obstetrics, Botucatu Medical School, Univ Estadual Paulista_Unesp, São Paulo State, Brazil
| | - Yuri K Sinzato
- Department of Gynecology and Obstetrics, Botucatu Medical School, Univ Estadual Paulista_Unesp, São Paulo State, Brazil
| | - Gustavo Napoli
- Department of Pathology, Federal School of Medical Sciences of Porto Alegre, Brazil
| | - Cibele VC Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, Univ Estadual Paulista_Unesp, São Paulo State, Brazil
| | - Franciane Q Gallego
- Department of Gynecology and Obstetrics, Botucatu Medical School, Univ Estadual Paulista_Unesp, São Paulo State, Brazil
| | - Iracema MP Calderon
- Department of Gynecology and Obstetrics, Botucatu Medical School, Univ Estadual Paulista_Unesp, São Paulo State, Brazil
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1491
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Harrod JS, Rada CC, Pierce SL, England SK, Lamping KG. Altered contribution of RhoA/Rho kinase signaling in contractile activity of myometrium in leptin receptor-deficient mice. Am J Physiol Endocrinol Metab 2011; 301:E362-9. [PMID: 21558549 PMCID: PMC3154528 DOI: 10.1152/ajpendo.00696.2010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [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] [Indexed: 11/22/2022]
Abstract
In late gestation, enhanced myometrial contractility is mediated in part through increased Rho/Rho kinase. Since leptin, which is elevated in pregnancy and obesity, can directly depress myometrial function, we hypothesized that in leptin receptor-deficient mice, myometrial contractility would be greater in late pregnancy due to increased Rho/Rho kinase activity. To test this, we correlated RhoA and Rho kinase expression to contractility in myometrium from nonpregnant (NP) and late-pregnant (P18) heterozygous leptin receptor-deficient mice (db/+) vs. wild-type (WT) mice. In NP mice, KCl-induced contractions were similar between WT and db/+ myometrium. However, the Rho kinase-dependent component of the contractions was greater in db/+ mice, along with an increased expression of Rho kinase. KCl-induced contractions increased in strength in myometrium from P18 WT and db/+ compared with NP. Although the contribution of Rho kinase to contractions was unchanged in P18 WT mice, it was decreased in P18 db/+ mice. The decrease in Rho kinase-dependent contractions in P18 db/+ mice coincided with reduced RhoA and Rho kinase expression relative to NP db/+. Addition of high-fat-induced abnormal glucose utilization prevented changes in Rho kinase function. We conclude that abnormal leptin signaling increases expression and function of Rho kinase to maintain contractile function in NP myometrium and that during pregnancy the contribution of RhoA and Rho kinase expression to myometrial function is reduced despite an increase in myometrial contractility. Thus, other signaling mechanisms appear to compensate when leptin signaling is reduced to maintain contractile function during pregnancy.
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Affiliation(s)
- Jeremy S Harrod
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA
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1492
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Faraci M, Di Prima FAF, Valenti O, Hyseni E, Monte S, Giorgio E, De Domenico R. Treatment of gestational diabetes: oral hypoglycemic agents or insulin? J Prenat Med 2011; 5:63-64. [PMID: 22439078 PMCID: PMC3279167] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Our report aims to verify whether perinatal maternal glycemic control in gestational diabetes can only be achieved with insulin or with oral hypoglycaemic agents. Then we want to evaluate the efficacy and safety of oral hypoglycemic agents in the treatment of gestational diabetes and then to compare these results with those associated with the use of insulin.
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Affiliation(s)
- Marianna Faraci
- Policlinico Universitario "G. Martino", Department of Obstetrics and Gynecology, University of Messina, Italy
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1493
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Crume TL, Ogden L, Daniels S, Hamman RF, Norris JM, Dabelea D. The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: the EPOCH study. J Pediatr 2011; 158:941-6. [PMID: 21238981 DOI: 10.1016/j.jpeds.2010.12.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/21/2010] [Accepted: 12/02/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine associations between exposure to maternal diabetes in utero and body mass index (BMI) growth trajectories from birth through 13 years of age among a diverse cohort of youth. STUDY DESIGN Mixed linear effects models were constructed to assess differences in BMI and BMI growth velocity from birth through 13 years of age for 95 subjects exposed to diabetes in utero and 409 unexposed subjects enrolled in a retrospective cohort study. RESULTS The overall BMI growth trajectory (adjusted for sex and race/ethnicity) was not significantly different for exposed and unexposed subjects from birth through 26 months of age (P = .48). However, the overall growth trajectory from 27 months of age through 13 years differed by exposure status (P = .008), adjusted for sex and race/ethnicity. The difference was primarily due to a significantly higher BMI growth velocity among exposed youth between 10 and 13 years, increasing by 4.56 kg/m² compared with 3.51 kg/m² in the unexposed (P = .005). Control for demographic variables, socioeconomic factors, and maternal prepregnancy BMI did not alter the observed associations. CONCLUSIONS Exposure to maternal diabetes in utero accelerates BMI growth in late childhood, thus increasing long-term obesity risk.
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1494
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Hale NL, Probst JC, Liu J, Bennett KJ, Martin AB, Glover S. Variation in Excessive Fetal Growth across Levels of Prenatal Care among Women with Gestational Diabetes. J Prim Care Community Health 2011; 2:225-8. [PMID: 23804839 DOI: 10.1177/2150131911410062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Examine the association between prenatal care and excessive fetal growth outcomes among mothers with gestational diabetes mellitus (GDM). METHODS We conducted a retrospective analysis of 2004-2007 singleton live births to South Carolina women, limited to those for whom both birth certificate and hospital discharge data were available (N = 179 957). Gestational diabetes mellitus was identified from birth certificate and/or hospital discharge claims. Measures of excessive fetal growth were large for gestational age (90th and 95th percentiles) and macrosomia (birth weight > 4500 g). The Adequacy of Prenatal Care Utilization index was used to measure prenatal care. RESULTS Gestational diabetes mellitus was recorded for 6.9% of women in the study population. Women with GDM were more likely than other women to have an infant with excessive fetal growth, regardless of the level of prenatal care; however, there was a significant interaction between GDM status and levels of prenatal care. All women with GDM had increased odds for large infant outcomes. However, those receiving inadequate prenatal care were markedly more likely to experience excessive fetal growth outcomes (odds ratio = 1.38, confidence interval = 1.15-1.66) than women also with GDM and intermediate/adequate prenatal care. Similar patterns were noted for large for gestational age (95th) and macrosomia (total birth weight ≥ 4500 g). CONCLUSIONS Observed associations suggest a link between inadequate prenatal care and a higher risk for excessive fetal growth among women with GDM. Further research is needed to clarify the nature of the association and suggest ways to get high-risk women into care sooner.
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Affiliation(s)
- Nathan L Hale
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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1495
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Abstract
Between 1989 and 2004, the prevalence of gestational diabetes mellitus (GDM) in the United States increased by 122%. Glycated haemoglobin, as measured by haemoglobin A1C (A1C), can potentially identify pregnant women at high risk for adverse outcomes associated with GDM including macrosomia and post-partum glucose intolerance. Our objective was to systematically review the literature with respect to A1C levels during pregnancy and associated maternal and offspring outcomes. We used MEDLINE to identify relevant publications from 1975 to 2009. We included articles if they met the following criteria: original full text articles in English; primary exposure of antepartum A1C; women with GDM at baseline or who developed GDM during the study; primary outcome of GDM, insulin use, post-partum abnormal glucose or type 2 diabetes (T2DM), birthweight, macrosomia or large for gestational age. Case series and case reports were excluded. Twenty studies met our criteria. A1C at GDM diagnosis was positively associated with post-partum abnormal glucose. Women with post-partum T2DM or impaired glucose tolerance had mean A1C at GDM diagnosis higher than those with normal post-partum glucose (P ≤ 0.002) and a 1% increase in A1C at GDM diagnosis was associated with 2.36 times higher odds of post-partum abnormal glucose 6 weeks after delivery [95% confidence interval 1.19, 4.68]. The association of A1C and birthweight varied substantially between studies, with correlation coefficients ranging from 0.11 to 0.51. A1C, a less burdensome and costly measure than an oral glucose tolerance test, appears to be an attractive measure for identifying women at high risk of adverse outcomes associated with GDM.
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Affiliation(s)
- Jodie Katon
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98195, USA.
| | - Michelle A. Williams
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Gayle Reiber
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA,,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Edith Miller
- Carolinas Medical Center Diabetes and Pregnancy Program, Charlotte NC, USA
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1496
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Lau SM, Lin S, Stokes RA, Cheng K, Baldock PA, Enriquez RF, McLean M, Cheung NW, Sainsbury A, Gonzalez FJ, Herzog H, Gunton JE. Synergistic effects of genetic beta cell dysfunction and maternal glucose intolerance on offspring metabolic phenotype in mice. Diabetologia 2011; 54:910-21. [PMID: 21181398 PMCID: PMC6594150 DOI: 10.1007/s00125-010-1998-z] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 11/08/2010] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS Diabetes in pregnancy is linked to development of obesity in the offspring, but the mechanisms are not fully understood. Gestational diabetes mellitus (GDM) occurs when beta cells are unable to compensate for the normal insulin resistance of late pregnancy. In this study, we used a murine model of beta cell dysfunction to examine the effects of maternal GDM on phenotype in male offspring with and without an inherited predisposition for beta cell dysfunction. METHODS Beta cell-specific aryl-hydrocarbon receptor nuclear translocator-null (βArnt) mice develop GDM from beta cell dysfunction. βArnt and control female mice were used to induce GDM and non-diabetic pregnancies, respectively. RESULTS Offspring from GDM pregnancies became spontaneously obese on a normal-chow diet. They were heavier than offspring from non-diabetic pregnancies, with increased body fat. Respiratory exchange ratio (RER) was higher, indicating decreased capacity to switch to lipid oxidation. Metabolic rate in GDM offspring was decreased prior to onset of obesity. The phenotype was more pronounced in βArnt GDM offspring than in GDM offspring of control genotype, demonstrating an interaction between genotype and pregnancy exposure. βArnt GDM offspring had increased hypothalamic neuropeptide Y (Npy) and decreased pro-opiomelanocortin (Pomc) expression. Weight, body fat, insulin sensitivity and RER in all mice, and hypothalamic Npy in βArnt mice were significantly correlated with AUC of maternal late pregnancy glucose tolerance tests (p < 0.01), but not with litter size, maternal weight, triacylglycerol or pre-pregnancy glycaemia. CONCLUSIONS/INTERPRETATION In βArnt mice, exposure to GDM and inheritance of genetic beta cell dysfunction had additive effects on male offspring obesity; severity of the offspring phenotype correlated with maternal glycaemia.
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Affiliation(s)
- S M Lau
- Diabetes and Transcription Factors Group, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, Australia
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1497
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Abstract
PURPOSE OF REVIEW Little consensus exists on the definition of gestational diabetes (GDM), how the condition should be diagnosed, and if interventions for mild maternal hyperglycemia are of any benefit to the mother or fetus. Today, after several large multicenter clinical trials, we are closer than ever to a national and international consensus. RECENT FINDINGS Glucose tolerance in pregnancy is a continuum, which has a fundamental link to fetal growth. The relationship between maternal glycemia and adverse outcomes is continuous, with no distinct inflection point for increased risk. As a result, any cut-off for the diagnosis of GDM is somewhat arbitrary. Treatment for GDM, even mild cases, significantly reduces the rate of certain adverse perinatal and maternal outcomes, warranting intervention. SUMMARY Clinical guidelines for the diagnosis of GDM are expected to change in the near future provided that recommendations from the International Association of Diabetes and Pregnancy Study Group are accepted by professional organizations. The criteria for the diagnosis will likely be based on a single 75 g, 2-h oral glucose tolerance test with at least one abnormal value. The proposed threshold values are based on an international consensus regarding risk of adverse pregnancy outcomes. The public health implications for these changes are anticipated to be significant.
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Affiliation(s)
- Scarlett D Karakash
- Department of Obstetrics & Gynecology and Women's Health, Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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1498
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Abstract
The newly proposed criteria for diagnosing gestational diabetes will result in a gestational diabetes prevalence of 17.8%, doubling the numbers of pregnant women currently diagnosed. These new diagnostic criteria are based primarily on the levels of glucose associated with a 1.75-fold increased risk of giving birth to large-for-gestational age infants (LGA) in the Hyperglycemia Adverse Pregnancy Outcome (HAPO) study; they use a single OGTT. Thus, of 23,316 pregnancies, gestational diabetes would be diagnosed in 4,150 women rather than in 2,448 women if a twofold increased risk of LGA were used. It should be recognised that the majority of women with LGA have normal glucose levels during pregnancy by these proposed criteria and that maternal obesity is a stronger predictor of LGA. The expected benefit of a diagnosis of gestational diabetes in these 1,702 additional women would be the prevention of 140 cases of LGA, 21 cases of shoulder dystocia and 16 cases of birth injury. The reproducibility of an OGTT for diagnosing mild hyperglycaemia is poor. Given that (1) glucose is a weak predictor of LGA, (2) treating these extra numbers has a modest outcome benefit and (3) the diagnosis may be based on a single raised OGTT value, further debate should occur before resources are allocated to implementing this change.
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Affiliation(s)
- E A Ryan
- Division of Endocrinology and Metabolism, Department of Medicine, 362 Clinical Wing, Heritage Medical Research Building, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada.
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1499
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Abstract
AIMS/HYPOTHESIS Recent studies have provided evidence that intrauterine exposure to maternal diabetes has lifelong effects on adult offspring, including increased risks of obesity, type 2 diabetes and cardiovascular disease. The aim of this study was to assess the relationship between exposure to maternal diabetes in utero and cardiovascular risk factors in healthy children and to investigate whether these associations are independent of maternal prepregnancy BMI and offspring attained BMI. METHODS Data were from a retrospective cohort of children aged 6-13 years born during 1994-2002. Multiple linear regression was used to examine the associations between exposure and cardiovascular risk factors with adjustment for demographic factors and pubertal stage and additionally for maternal prepregnancy BMI and offspring attained BMI. RESULTS Ninety-nine offspring of diabetic pregnancies had significantly increased E-selectin, vascular adhesion molecule 1 (VCAM1), leptin, waist circumference, BMI and systolic blood pressure and decreased adiponectin levels compared with 422 offspring of non-diabetic pregnancies after adjustment for age, sex and race/ethnicity (p < 0.05 for each risk factor). Additional adjustment for maternal prepregnancy BMI substantially attenuated group differences in the risk factors except for E-selectin, VCAM1 and waist circumference, which remained significantly higher in exposed children. CONCLUSIONS/INTERPRETATION Compared with unexposed children, healthy offspring exposed to maternal diabetes in utero have a worse cardiovascular risk profile. In particular, offspring have substantially increased levels of circulating cellular adhesion molecules, which are biomarkers of adverse endothelium perturbation and may be related to the earliest preclinical stages of atherosclerosis and diabetes.
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Affiliation(s)
- N A West
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Avenue, Campus Box B-119, Aurora, CO 80045, USA.
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1500
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Shivakumar G, Brandon AR, Snell PG, Santiago-Muñoz P, Johnson NL, Trivedi MH, Freeman MP. Antenatal depression: a rationale for studying exercise. Depress Anxiety 2011; 28:234-42. [PMID: 21394856 PMCID: PMC3079921 DOI: 10.1002/da.20777] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 06/07/2010] [Revised: 11/02/2010] [Accepted: 11/06/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) in pregnancy or antenatal depression poses unique treatment challenges and has serious consequences for mothers, unborn babies, and families when untreated. This review presents current knowledge on exercise during pregnancy, antidepressant effects of exercise, and the rationale for the specific study of exercise for antenatal depression. METHOD A systematic literature review was performed using English language articles published in Medline, PsycINFO, CINAHL, and the Cochrane Library from 1985 to January 2010. RESULTS There is a broad literature supporting the antidepressant effects of exercise, but a paucity of studies specifically for antenatal depression. A small number of observational studies have reported that regular physical activities improve self-esteem and reduce symptoms of anxiety and depression during pregnancy. To date, there have not been randomized controlled studies of exercise for the treatment of MDD in pregnant women. CONCLUSIONS Systematic studies are needed to assess exercise as a treatment alternative for MDD during pregnancy. In consideration of the benefits of exercise for the mother and baby, and the burden of depression, studies are needed to determine the role of exercise for pregnant women with depression.
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Affiliation(s)
- Geetha Shivakumar
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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