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Drever HJ, Davidson SJ, Callaway LK, Sekar R, DE Jersey SJ. Factors associated with higher risk of small-for-gestational-age infants in women treated for gestational diabetes. Aust N Z J Obstet Gynaecol 2023; 63:714-720. [PMID: 37221081 DOI: 10.1111/ajo.13696] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/22/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Previously, management of gestational diabetes (GDM) has focused largely on glycaemic control, with a view to reduce the occurrence of large-for-gestational-age (LGA) infants. However, tight glycaemic control in GDM is associated with a higher incidence of small-for-gestational-age (SGA) infants, which has been linked to higher rates of adverse outcomes. AIM The aim was to characterise risk factors associated with having an SGA infant in women being treated for GDM. METHODS This was a retrospective observational cohort study of 308 women with GDM. Women were split into groups based on their infant's size at delivery (SGA, appropriate-for-gestational-age (AGA) or LGA). Literature review and expert opinion helped to determine several predictors of women with GDM delivering an SGA infant, and statistical analysis was used to produce odds ratios (OR) for these predictors. RESULTS The sample included primiparous women with a mean pre-pregnancy body mass index (BMI) of 25.72 (standard deviation: 5.75). Metabolic risk factors associated with delivering an SGA infant included a lower pre-pregnancy BMI (adjusted OR 1.13, P = 0.04, 95% confidence interval (CI): 1.01-1.26), a lower fasting blood glucose level (BGL) (adjusted OR: 3.21, P = 0.01, 95% CI: 1.30-7.93) and growth that was high risk for SGA at baseline ultrasound scan (USS) (adjusted OR: 7.43, P < 0.001, 95% CI: 2.93-18.79). CONCLUSIONS The combined clinical picture of lower pre-pregnancy BMI, fasting BGL and baseline USS growth measurements may indicate a need for less aggressive glucose management in women with GDM to prevent SGA infants.
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Affiliation(s)
- Hillarie J Drever
- Perinatal Research Centre, Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston
- Department of Obstetrics & Gynaecology, Townsville Hospital and Health Service Research Education, Support and Administration, Townsville University Hospital, Douglas
| | - Sarah J Davidson
- Perinatal Research Centre, Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Duke University School of Medicine, DUMC 3710, Durham, North Carolina, USA
| | - Leonie K Callaway
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland
| | - Renuka Sekar
- Department of Maternal Fetal Medicine, Maternal and Fetal Medicine Specialist, Royal Brisbane and Women's Hospital
| | - Susan J DE Jersey
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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152
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Moon JH, Lee J, Kim KH, Kim HJ, Kim H, Cha HN, Park J, Lee H, Park SY, Jang HC, Kim H. Multiparity increases the risk of diabetes by impairing the proliferative capacity of pancreatic β cells. Exp Mol Med 2023; 55:2269-2280. [PMID: 37903900 PMCID: PMC10618440 DOI: 10.1038/s12276-023-01100-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/27/2023] [Accepted: 07/20/2023] [Indexed: 11/01/2023] Open
Abstract
Pregnancy imposes a substantial metabolic burden on women, but little is known about whether or how multiple pregnancies increase the risk of maternal postpartum diabetes. In this study, we assessed the metabolic impact of multiple pregnancies in humans and in a rodent model. Mice that underwent multiple pregnancies had increased adiposity, but their glucose tolerance was initially improved compared to those of age-matched virgin mice. Later, however, insulin resistance developed over time, but insulin secretory function and compensatory pancreatic β cell proliferation were impaired in multiparous mice. The β cells of multiparous mice exhibited aging features, including telomere shortening and increased expression of Cdkn2a. Single-cell RNA-seq analysis revealed that the β cells of multiparous mice exhibited upregulation of stress-related pathways and downregulation of cellular respiration- and oxidative phosphorylation-related pathways. In humans, women who delivered more than three times were more obese, and their plasma glucose concentrations were elevated compared to women who had delivered three or fewer times, as assessed at 2 months postpartum. The disposition index, which is a measure of the insulin secretory function of β cells, decreased when women with higher parity gained body weight after delivery. Taken together, our findings indicate that multiple pregnancies induce cellular stress and aging features in β cells, which impair their proliferative capacity to compensate for insulin resistance.
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Affiliation(s)
- Joon Ho Moon
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joonyub Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyun Hoo Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
- Biomedical Research Center, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
| | - Hyun Jung Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
| | - Hyeongseok Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
- Department of Biochemistry, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hye-Na Cha
- Department of Physiology, College of Medicine, Yeongnam University, Daegu, Korea
| | - Jungsun Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
| | - Hyeonkyu Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
| | - So-Young Park
- Department of Physiology, College of Medicine, Yeongnam University, Daegu, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Hail Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea.
- Biomedical Research Center, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea.
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153
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Cundubey CR, Ak M, Demir B, Cam S. Effects of COVID-19 Infection on the Oral Glucose Tolerance Test Results in Pregnancy. Cureus 2023; 15:e46404. [PMID: 37927616 PMCID: PMC10620980 DOI: 10.7759/cureus.46404] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the results of a 75 g oral glucose tolerance test (OGTT) performed in the second trimester of pregnancy, the prevalence of gestational diabetes mellitus (GDM), and perinatal outcomes in pregnant women with a history of coronavirus disease 2019 (COVID-19) infection and to examine the effect of COVID-19 infection history on OGTT results and GDM prevalence. METHODS We retrospectively analyzed the data of 463 patients who visited the Gynecology and Obstetrics Department of Kayseri City Hospital between March 2020 and January 2023 and were administered a 75-g OGTT in the second trimester of their pregnancy. Accordingly, we traced COVID-19 history, OGTT results, GDM prevalence, and newborn outcomes among the patients. RESULTS OGTT glucose values were higher in the study group with a history of COVID-19 infection, but there was no significant difference between the groups. GDM developed in 13 (23.2%) pregnant women in the group with a history of COVID-19 infection and 88 (21.6%) pregnant women in the control group without a history of COVID-19 (p: 0.348). In addition, in pregnant women diagnosed with GDM, insulin requirement was 8.9% in the COVID-19 (+) group and 5.1% in the COVID-19 (-) group, and the results were not statistically significant (p: 0.178). There was no significant difference in neonatal outcomes between the groups. CONCLUSIONS In our study, we found that glucose values were higher and the prevalence of GDM was higher in pregnant women with a history of COVID-19 infection before the OGTT. It is necessary to be more careful about issues such as blood glucose regulation and GDM risk in pregnancy follow-up after infections such as COVID-19, which may have widespread systemic inflammatory effects, and patients should be informed in detail for pregnancy follow-up.
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Affiliation(s)
- Cevat Rifat Cundubey
- Obstetrics and Gynecology, Kayseri City Training and Research Hospital, Kayseri, TUR
| | - Mehmet Ak
- Obstetrics and Gynecology, Kayseri City Training and Research Hospital, Kayseri, TUR
| | - Bertan Demir
- Obstetrics and Gynecology, Kayseri City Training and Research Hospital, Kayseri, TUR
| | - Seyma Cam
- Obstetrics and Gynecology, Kayseri City Training and Research Hospital, Kayseri, TUR
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154
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Nashif SK, Mahr RM, Tessier KM, Hoover EA, Ajagbe-Akingbola O, Chiu E, Andrews JI, Sabol BA, Rogers WK, Wernimont SA. Neonatal outcomes and rationale for timing of birth in perinatal diabetes: a retrospective cohort study. Am J Obstet Gynecol MFM 2023; 5:101129. [PMID: 37567447 PMCID: PMC10592060 DOI: 10.1016/j.ajogmf.2023.101129] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists recommends delivery in the 39th week of pregnancy for patients with pregestational and medication-controlled gestational diabetes with consideration for earlier delivery among those with poor glucose control. OBJECTIVE We sought to evaluate the impact of birth before 39 weeks' gestation exclusively for diabetes-related indications on neonatal outcomes and clinician rationale for these recommendations. STUDY DESIGN This was a retrospective cohort study of all singleton, nonanomalous pregnancies complicated by diabetes. Patients were identified through an obstetrical database containing information of 90,185 births from 2011 to 2021. Patients who delivered in a given week of gestation exclusively for diabetes-related indications were compared with ongoing pregnancies. Recommended births for other obstetrical indications were excluded from the diabetes-related indications cohorts. The primary outcome was neonatal intensive care unit admission. Secondary outcomes included neonatal intensive care unit length of stay, stillbirth, neonatal death, hypoglycemia, respiratory distress syndrome, and shoulder dystocia. For all births before 39 weeks' gestation, the electronic medical records were reviewed to confirm the rationale for the intervention for a diabetes-indicated condition. RESULTS From the 90,185 recorded births that occurred in 2011 to 2021, 4750 patients with diabetes were identified. Of those, 30.5% (n=1449) had a recommended birth for a diabetes-related indications with 2.2% of those (n=32) occurring at 36 weeks' gestation, 7.9% (n=114) at 37 weeks' gestation, 9.7% (n=141) at 38 weeks' gestation, and 63.0% (n=913) at 39 weeks' gestation. Births that occurred at 36 and 37 weeks' gestation exclusively for diabetes-related indications had higher rates of neonatal intensive care unit admission than the respective ongoing pregnancies (62.5% vs 8.7%; P<.001 and 25.4% vs 7.2%; P<.001). There was no difference in neonatal intensive care unit admission for births at 38 or 39 weeks' gestation when compared with ongoing pregnancy. For neonates born at 36 and 37 weeks' gestation in comparison with ongoing pregnancies, the median neonatal intensive care unit length of stay was 11.0 vs 2.8 days, (P<.001) and 4.4 vs 2.6 days (P=.026), respectively. There were significantly increased rates of neonatal hypoglycemia and respiratory distress syndrome among births that occurred at 36, 37, and 38 weeks' gestation when compared with ongoing pregnancies. There were no differences in the rate of stillbirth in this cohort. Primary factors cited for early birth were poor glycemic control (71.4%), recommendation by a maternal-fetal medicine specialist (38.7%), and suspected fetal macrosomia (27.9%). Overall, 46.7%, 32.8%, and 20.6% of patients had 1, 2, or ≥3 indications, respectively, listed as rationale for early birth. Overall, few objective measures were used to recommend birth before 39 weeks' gestation owing to diabetes. CONCLUSION In pregnancies complicated by diabetes, early birth exclusively for diabetes-related indications was associated with increased neonatal intensive care unit admission and length of stay and with neonatal morbidity. Little objective data are documented by clinicians to support their recommendations for early birth associated with diabetes. Additional clinical guidelines are needed to define suboptimal glucose control necessitating birth before 39 weeks' gestation.
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Affiliation(s)
- Sereen K Nashif
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN (Dr Nashif, Ms Mahr, Drs Hoover, Ajagbe-Akingbola, Andrews, Sabol, and Wernimont)
| | - Renee M Mahr
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN (Dr Nashif, Ms Mahr, Drs Hoover, Ajagbe-Akingbola, Andrews, Sabol, and Wernimont); Division of Molecular Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN (Ms Mahr and Dr Wernimont)
| | - Katelyn M Tessier
- Masonic Cancer Center, Biostatistics Core, University of Minnesota, Minneapolis, MN (Ms Tessier)
| | - Elizabeth A Hoover
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN (Dr Nashif, Ms Mahr, Drs Hoover, Ajagbe-Akingbola, Andrews, Sabol, and Wernimont)
| | - Oluwabukola Ajagbe-Akingbola
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN (Dr Nashif, Ms Mahr, Drs Hoover, Ajagbe-Akingbola, Andrews, Sabol, and Wernimont)
| | - Emily Chiu
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN (Dr Chiu)
| | - Janet I Andrews
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN (Dr Nashif, Ms Mahr, Drs Hoover, Ajagbe-Akingbola, Andrews, Sabol, and Wernimont)
| | - Bethany A Sabol
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN (Dr Nashif, Ms Mahr, Drs Hoover, Ajagbe-Akingbola, Andrews, Sabol, and Wernimont)
| | - William K Rogers
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN (Dr Rogers)
| | - Sarah A Wernimont
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN (Dr Nashif, Ms Mahr, Drs Hoover, Ajagbe-Akingbola, Andrews, Sabol, and Wernimont); Division of Molecular Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN (Ms Mahr and Dr Wernimont).
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155
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Saucedo R, Ortega-Camarillo C, Ferreira-Hermosillo A, Díaz-Velázquez MF, Meixueiro-Calderón C, Valencia-Ortega J. Role of Oxidative Stress and Inflammation in Gestational Diabetes Mellitus. Antioxidants (Basel) 2023; 12:1812. [PMID: 37891891 PMCID: PMC10604289 DOI: 10.3390/antiox12101812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. It is related to several gestational and fetal adverse outcomes. Moreover, women with GDM and their infants have a high risk of developing type 2 diabetes in the future. The pathogenesis of GDM is not completely understood; nevertheless, two factors that contribute to its development are oxidative stress and inflammation. Oxidative stress and inflammation are related; reactive oxygen species (ROS) production can activate inflammatory cells and enhance the production of inflammatory mediators. Inflammation, in turn, leads to an increased ROS release, causing a vicious circle to ensue. Inflammatory responses can be achieved via the activation of the NF-κB signaling pathway. Herein, we review the English literature regarding oxidative stress and inflammation evaluated simultaneously in the same population, attempting to identify mechanisms through which these factors contribute to the development of GDM. Furthermore, the modulation of oxidative stress and inflammation by different therapies used in women with GDM and in cell models of GDM is included in the review. Probiotics and nutrient supplementations have been shown to reduce biomarkers of inflammation and oxidative stress in vitro and in women with GDM.
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Affiliation(s)
- Renata Saucedo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico; (R.S.); (A.F.-H.)
| | - Clara Ortega-Camarillo
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico;
| | - Aldo Ferreira-Hermosillo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico; (R.S.); (A.F.-H.)
| | - Mary Flor Díaz-Velázquez
- Hospital de Gineco Obstetricia 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico;
| | | | - Jorge Valencia-Ortega
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, Mexico City 11000, Mexico
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156
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Lappe V, Greiner GG, Linnenkamp U, Viehmann A, Adamczewski H, Kaltheuner M, Weber D, Schubert I, Icks A. Gestational diabetes in Germany-prevalence, trend during the past decade and utilization of follow-up care: an observational study. Sci Rep 2023; 13:16157. [PMID: 37758812 PMCID: PMC10533812 DOI: 10.1038/s41598-023-43382-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy. Information on key figures such as screening rates, prevalence of GDM or utilization of follow-up care and associated factors varies widely and is often lacking. The aim of our study is to provide information on screening rates for and prevalence of GDM as well as utilization of follow-up care in Germany. We used data (2010-2020) from a large, nationwide statutory health insurance containing information on inpatient and outpatient care, including diagnoses, medication and treatments. Descriptive analyses were performed to assess screening rates, prevalence of GDM and participation rates in follow-up care. A log-binomial regression model was calculated to analyze associated factors. Screening rates among pregnant women increased from 40.2% (2010) to 93.3% (2020) and prevalence from 9.4% (2010) to 15.1% (2020). The proportion of women attending follow-up care remained stable over time (around 42%). Age, educational level, insulin prescription, hypertension and obesity were positively associated with participation in follow-up care. Although over 90% of women in Germany are screened for GDM during pregnancy, follow-up care is used much less. Further research is needed to understand the trends in GDM healthcare (from screening to follow-up care) and the reasons for women's (non-)participation, as well as the attitudes and routines of the healthcare providers involved.
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Affiliation(s)
- Veronika Lappe
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
| | - Gregory Gordon Greiner
- Institute for Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Ute Linnenkamp
- Institute for Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Anja Viehmann
- Institute for Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | | | | | - Dietmar Weber
- WinDiab gGmbH, Geranienweg 7a, 41564, Kaarst, Germany
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
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157
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Kusinski LC, Tobolska P, Jones DL, Atta N, Turner EH, Lewis HB, Oude Griep LM, Gribble FM, Meek CL. Towards Novel Nutritional Strategies in Gestational Diabetes: Eating Behaviour and Obesity in Women with Gestational Diabetes Compared with Non-Pregnant Adults. Nutrients 2023; 15:4141. [PMID: 37836424 PMCID: PMC10574012 DOI: 10.3390/nu15194141] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Gestational diabetes is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Effective nutritional strategies are needed to reduce BMI and improve long-term maternal cardiometabolic health, but the relative contribution of maternal eating behaviour, a potential barrier to dietary change, has not been explored. We compared eating behaviour in women with gestational diabetes with that of men and non-pregnant women with comparable risk factors, and tested associations between eating behaviour traits and BMI in women with gestational diabetes. We hypothesized that eating behaviour would be unfavourable in gestational diabetes and would be associated with BMI. METHODS Participants (n = 417) including 53 men, 164 non-pregnant women and 200 women with gestational diabetes (singleton pregnancy; 29 weeks' gestation) were recruited into three prospective studies assessing weight loss interventions, with similar entry criteria. The three-factor eating questionnaire (TFEQ-R18) assessed uncontrolled eating, emotional eating and cognitive restraint at study enrolment. Associations between BMI at study enrolment and TFEQ-R18 (% maximum score) were assessed using linear regression. RESULTS Women with gestational diabetes had significantly lower uncontrolled eating scores vs. men (53% vs. 65%; p < 0.001) and non-pregnant women (53% vs. 66%; p < 0.001), lower emotional eating scores vs. non-pregnant women (60% vs. 71%; p < 0.001) and higher cognitive restraint (p < 0.001 vs. men and non-pregnant women). In women with gestational diabetes, emotional eating scores were positively associated with BMI at study enrolment (beta coefficient 7.8 (95% CI 3.9 to 11.7), p < 0.001). CONCLUSIONS Women with gestational diabetes have favourable eating behaviour compared with other population groups. Because BMI at study enrolment was associated with emotional eating, nutritional strategies which reduce emotional eating may provide new opportunities to improve long-term maternal health after gestational diabetes.
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Affiliation(s)
- Laura C. Kusinski
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Patrycja Tobolska
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Danielle L. Jones
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Nooria Atta
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Elizabeth H. Turner
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Hannah B. Lewis
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | | | - Fiona M. Gribble
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Claire L. Meek
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
- Cambridge Universities NHS Foundation Trust, Cambridge CB2 0QQ, UK
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158
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Lu HY, Lu P, Hirst JE, Mackillop L, Clifton DA. A Stacked Long Short-Term Memory Approach for Predictive Blood Glucose Monitoring in Women with Gestational Diabetes Mellitus. Sensors (Basel) 2023; 23:7990. [PMID: 37766044 PMCID: PMC10536375 DOI: 10.3390/s23187990] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Gestational diabetes mellitus (GDM) is a subtype of diabetes that develops during pregnancy. Managing blood glucose (BG) within the healthy physiological range can reduce clinical complications for women with gestational diabetes. The objectives of this study are to (1) develop benchmark glucose prediction models with long short-term memory (LSTM) recurrent neural network models using time-series data collected from the GDm-Health platform, (2) compare the prediction accuracy with published results, and (3) suggest an optimized clinical review schedule with the potential to reduce the overall number of blood tests for mothers with stable and within-range glucose measurements. A total of 190,396 BG readings from 1110 patients were used for model development, validation and testing under three different prediction schemes: 7 days of BG readings to predict the next 7 or 14 days and 14 days to predict 14 days. Our results show that the optimized BG schedule based on a 7-day observational window to predict the BG of the next 14 days achieved the accuracies of the root mean square error (RMSE) = 0.958 ± 0.007, 0.876 ± 0.003, 0.898 ± 0.003, 0.622 ± 0.003, 0.814 ± 0.009 and 0.845 ± 0.005 for the after-breakfast, after-lunch, after-dinner, before-breakfast, before-lunch and before-dinner predictions, respectively. This is the first machine learning study that suggested an optimized blood glucose monitoring frequency, which is 7 days to monitor the next 14 days based on the accuracy of blood glucose prediction. Moreover, the accuracy of our proposed model based on the fingerstick blood glucose test is on par with the prediction accuracies compared with the benchmark performance of one-hour prediction models using continuous glucose monitoring (CGM) readings. In conclusion, the stacked LSTM model is a promising approach for capturing the patterns in time-series data, resulting in accurate predictions of BG levels. Using a deep learning model with routine fingerstick glucose collection is a promising, predictable and low-cost solution for BG monitoring for women with gestational diabetes.
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Affiliation(s)
- Huiqi Y. Lu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (P.L.); (D.A.C.)
| | - Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (P.L.); (D.A.C.)
| | - Jane E. Hirst
- Women’s Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; (J.E.H.); (L.M.)
- George Institute for Global Health, Imperial College London, London W12 7RZ, UK
| | - Lucy Mackillop
- Women’s Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; (J.E.H.); (L.M.)
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (P.L.); (D.A.C.)
- Oxford Suzhou Centre for Advanced Research, Suzhou 215123, China
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159
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Maor-Sagie E, Hallak M, Toledano Y, Gabbay-Benziv R. Oral Glucose Tolerance Test Performed after 28 Gestational Weeks and Risk for Future Diabetes-A 5-Year Cohort Study. J Clin Med 2023; 12:6072. [PMID: 37763012 PMCID: PMC10532090 DOI: 10.3390/jcm12186072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is diagnosed by an oral glucose tolerance test (oGTT), preferably performed at 24 + 0-28 + 6 gestational weeks, and is considered a risk factor for type 2 diabetes (T2DM). In this study, we aimed to evaluate the risk of T2DM associated with abnormal oGTT performed after 28 weeks. We conducted a retrospective cohort study that included parturients with available glucose levels during pregnancy and up to 5 years of follow-up after pregnancy. Data were extracted from the computerized laboratory system of Meuhedet HMO and cross-tabulated with the Israeli National Registry of Diabetes (INRD). The women were stratified into two groups: late oGTT (performed after 28 + 6 weeks) and on-time oGTT (performed at 24 + 0-28 + 6 weeks). The incidence of T2DM was evaluated and compared using univariate analysis followed by survival analysis adjusted to confounders. Overall, 78,326 parturients entered the analysis. Of them, 6195 (7.9%) performed on-time oGTT and 5288 (6.8%) performed late oGTT. The rest-66,846 (85.3%)-had normal glucose tolerance. Women who performed late oGTT had lower rates of GDM and T2DM. However, once GDM was diagnosed, regardless of oGTT timing, the risk of T2DM was increased (2.93 (1.69-5.1) vs. 3.64 (2.44-5.44), aHR (95% CI), late vs. on-time oGTT, p < 0.001 for both). Unlike in oGTT performed on time, one single abnormal value in late oGTT was not associated with an increased risk for T2DM.
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Affiliation(s)
- Esther Maor-Sagie
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel; (E.M.-S.); (M.H.)
- Meuhedet HMO, Rehovot 7610001, Israel;
| | - Mordechai Hallak
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel; (E.M.-S.); (M.H.)
- Meuhedet HMO, Rehovot 7610001, Israel;
| | | | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel; (E.M.-S.); (M.H.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel
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160
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White SL, Koulman A, Ozanne SE, Furse S, Poston L, Meek CL. Towards Precision Medicine in Gestational Diabetes: Pathophysiology and Glycemic Patterns in Pregnant Women With Obesity. J Clin Endocrinol Metab 2023; 108:2643-2652. [PMID: 36950879 PMCID: PMC10807907 DOI: 10.1210/clinem/dgad168] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/22/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
AIMS Precision medicine has revolutionized our understanding of type 1 diabetes and neonatal diabetes but has yet to improve insight into gestational diabetes mellitus (GDM), the most common obstetric complication and strongly linked to obesity. Here we explored if patterns of glycaemia (fasting, 1 hour, 2 hours) during the antenatal oral glucose tolerance test (OGTT), reflect distinct pathophysiological subtypes of GDM as defined by insulin secretion/sensitivity or lipid profiles. METHODS 867 pregnant women with obesity (body mass index ≥ 30 kg/m2) from the UPBEAT trial (ISRCTN 89971375) were assessed for GDM at 28 weeks' gestation (75 g oral glucose tolerance test OGTT; World Health Organization criteria). Lipid profiling of the fasting plasma OGTT sample was undertaken using direct infusion mass spectrometry and analyzed by logistic/linear regression, with and without adjustment for confounders. Insulin secretion and sensitivity were characterized by homeostatic model assessment 2b and 2s, respectively. RESULTS In women who developed GDM (n = 241), patterns of glycaemia were associated with distinct clinical and biochemical characteristics and changes to lipid abundance in the circulation. Severity of glucose derangement, rather than pattern of postload glycaemia, was most strongly related to insulin action and lipid abundance/profile. Unexpectedly, women with isolated postload hyperglycemia had comparable insulin secretion and sensitivity to euglycemic women, potentially indicative of a novel mechanistic pathway. CONCLUSIONS Patterns of glycemia during the OGTT may contribute to a precision approach to GDM as assessed by differences in insulin resistance/secretion. Further research is indicated to determine if isolated postload hyperglycemia reflects a different mechanistic pathway for targeted management.
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Affiliation(s)
- Sara L White
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, SE1 7EH, UK
| | - Albert Koulman
- Core Metabolomics and Lipidomics Laboratory, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Treatment Centre, Cambridge, CB2 0QQ, UK
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Treatment Centre, Cambridge, CB2 0QQ, UK
| | - Susan E Ozanne
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Treatment Centre, Cambridge, CB2 0QQ, UK
| | - Samuel Furse
- Core Metabolomics and Lipidomics Laboratory, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Treatment Centre, Cambridge, CB2 0QQ, UK
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Treatment Centre, Cambridge, CB2 0QQ, UK
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, SE1 7EH, UK
| | - Claire L Meek
- Core Metabolomics and Lipidomics Laboratory, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Treatment Centre, Cambridge, CB2 0QQ, UK
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Treatment Centre, Cambridge, CB2 0QQ, UK
- Department of Clinical Biochemistry/Wolfson Diabetes & Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
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161
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O'Reilly SL, Laws R, Maindal HT, Teede H, Harrison C, McAuliffe FM, Geraghty A, Campoy C, Bermúdez MG, Pirhonen L, Burden C, Davies A, Laursen DH, Skinner T. A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study. JMIR Res Protoc 2023; 12:e51431. [PMID: 37721798 PMCID: PMC10546269 DOI: 10.2196/51431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Women with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behavior change interventions during pregnancy and postpartum shows promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump2Baby is a multicenter project across 4 high-income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B&Me) designed to sit alongside usual care in the perinatal period. OBJECTIVE We aim to explore the feasibility and implementation of the B2B&Me intervention and investigate the effectiveness of this intervention in women at risk of gestational diabetes. METHODS IMPACT DIABETES Bump2Baby is a hybrid type 2 effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalized health behavior change coaching provided by health care professionals alongside antenatal care from the first antenatal visit to 12 months postpartum. The mHealth app offers the possibility of synchronous calls, asynchronous contact (including coach-participant text and video messaging exchanges tailored to the participant's needs), and ongoing access to an extensive library of bespoke intervention materials. Participants will interact asynchronously with their health coach throughout the intervention via the app. This randomized controlled trial across 4 clinical sites within Ireland, the United Kingdom, Spain, and Australia will recruit 800 women in early pregnancy to evaluate the effectiveness on postpartum weight. The Exploration, Preparation, Implementation, and Sustainment implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at the individual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources for the RE-AIM evaluation will include app and platform analytics, screening and training records, participant medical records, key informant interviews, participant and partner exit interviews, cost data, study questionnaires, staff surveys, and blood sample analyses. RESULTS The study was approved and registered with the Australian New Zealand Clinical Trials Registry on November 19, 2020. Recruitment commenced on February 9, 2021, and data collection is ongoing. Publication of the results is expected in 2024. CONCLUSIONS This is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at-risk women that we are aware of. As research aims to move toward real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multicenter study will be useful in planning the potential implementation and scale-up of evidence-based perinatal health behavior change interventions. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51431.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Rachel Laws
- School of Exercise and Nutrition Science, Deakin University, Burwood, Australia
| | | | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Fionnuala M McAuliffe
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Aisling Geraghty
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, EURISTIKOS Excellence Centre for Paediatric Research, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Health Sciences Technological Park, Granada, Spain
| | - Mercedes G Bermúdez
- Department of Paediatrics, School of Medicine, EURISTIKOS Excellence Centre for Paediatric Research, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Health Sciences Technological Park, Granada, Spain
| | - Laura Pirhonen
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Christy Burden
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anna Davies
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Timothy Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
- Australian Centre for Behavioural Research in Diabetes, Deakin University, Geelong, Australia
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162
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Rosenberg EA, Seely EW, James K, Soffer MD, Nelson S, Nicklas JM, Powe CE. Carbohydrate Intake and Oral Glucose Tolerance Test Results in the Postpartum Period. J Clin Endocrinol Metab 2023; 108:e1007-e1012. [PMID: 37097924 PMCID: PMC10505539 DOI: 10.1210/clinem/dgad234] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
CONTEXT The American Diabetes Association (ADA) recommends a 3-day preparatory diet prior to a diagnostic oral glucose tolerance test (OGTT), a test often recommended in postpartum individuals with a history of gestational diabetes (GDM). OBJECTIVE Evaluate the relationship between carbohydrate intake and OGTT glucose in 2 cohorts of postpartum individuals. METHODS We performed analyses of postpartum individuals from 2 prospective studies with recent GDM (Balance after Baby Intervention, BABI, n = 177) or risk factors for GDM (Study of Pregnancy Regulation of INsulin and Glucose, SPRING, n = 104) .We measured carbohydrate intake using 24-hour dietary recalls (SPRING) or Food Frequency Questionnaire (BABI) and performed 2-hour 75-g OGTTs. The main outcome measure was 120-minute post-OGTT glucose. RESULTS There was no relationship between carbohydrate intake and 120-minute post-OGTT glucose level in either study population (SPRING: β = 0.03, [-5.5, 5.5] mg/dL, P = .99; BABI: β = -3.1, [-9.5, 3.4] mg/dL, P = .35). Adding breastfeeding status to the model did not change results (SPRING β = -0.14, [-5.7, 5.5] mg/dL, P = .95; BABI β = -3.9, [-10.4, 2.7] mg/dL, P = .25). There was, however, an inverse relationship between glycemic index and 120-minute post OGTT glucose (BABI: β = -1.1, [-2.2, -0.03] mg/dL, P = .04). CONCLUSION Carbohydrate intake is not associated with post-OGTT glucose levels among postpartum individuals. Dietary preparation prior to the OGTT may not be necessary in this population.
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Affiliation(s)
- Emily A Rosenberg
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Kaitlyn James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Marti D Soffer
- Harvard Medical School, Boston, MA 02115, USA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stacey Nelson
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jacinda M Nicklas
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
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163
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Szczuko M, Golańska J, Palma J, Ziętek M. Impact of Selected Eicosanoids in Normal and Pathological Pregnancies. J Clin Med 2023; 12:5995. [PMID: 37762934 PMCID: PMC10532391 DOI: 10.3390/jcm12185995] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Pregnancy is a physiological state in which the female body undergoes a series of changes and adaptations to provide the best possible conditions for the growth and development of the forming baby. The internal adaptations that take place lead to the production of inflammation, which is necessary for the initial and final stages of pregnancy (embryo implantation and induction of labor). Gestational diabetes mellitus is considered to be the most common pathology during this period. However, many more serious health complications can arise, which include pre-eclampsia, fetal stunting, and preterm labor. The purpose of this study was to analyze the impact of the levels of individual eicosanoids on the course of normal pregnancy and the possibility of pathologies including gestational diabetes and pre-eclampsia. METHODS Sixty-nine pregnant women who were overweight or obese before and during pregnancy were studied. Eicosanoids were extracted as appropriate and then determined using liquid chromatography. The levels of eicosanoids studied in pregnant women differed not only according to the week of pregnancy but also in relation to individual anthropometric and biochemical parameters. RESULTS There was a significant correlation between being overweight and having a high BMI before pregnancy-as well as biochemical parameters of lipid and carbohydrate profiles-and the occurrence of pathological conditions in pregnancy. CONCLUSIONS Eicosanoids are involved in the pathology of pregnancy associated with the occurrence of gestational diabetes and pre-eclampsia. Salicylic acid may find use in the treatment of pregnant women exposed to both phenomena, as well as in overweight and obese women found before pregnancy. Diets rich in natural salicylates, methods of administration, and pharmacotherapy and dosage need further study. Some of the mediators (lipoxin, prostaglandin and leucotrien) may be new diagnostic markers in pregnancy pathology and intervention pathways in the future.
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Affiliation(s)
- Małgorzata Szczuko
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, W. Broniewskiego 24, 71-460 Szczecin, Poland
| | - Justyna Golańska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, W. Broniewskiego 24, 71-460 Szczecin, Poland
| | - Joanna Palma
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Maciej Ziętek
- Department of Perinatology, Obstetrics and Gynecology Pomeranian Medical University in Szczecin, Siedlecka 2, 72-010 Police, Poland;
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164
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Asuaje Pfeifer M, Langehein H, Grupe K, Müller S, Seyda J, Liebmann M, Rustenbeck I, Scherneck S. PyCreas: a tool for quantification of localization and distribution of endocrine cell types in the islets of Langerhans. Front Endocrinol (Lausanne) 2023; 14:1250023. [PMID: 37772078 PMCID: PMC10523144 DOI: 10.3389/fendo.2023.1250023] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
Manifest diabetes, but also conditions of increased insulin resistance such as pregnancy or obesity can lead to islet architecture remodeling. The contributing mechanisms are as poorly understood as the consequences of altered cell arrangement. For the quantification of the different cell types but also the frequency of different cell-cell contacts within the islets, different approaches exist. However, few methods are available to characterize islet cell distribution in a statistically valid manner. Here we describe PyCreas, an open-source tool written in Python that allows semi-automated analysis of islet cell distribution based on images of pancreatic sections stained by immunohistochemistry or immunofluorescence. To ensure that the PyCreas tool is suitable for quantitative analysis of cell distribution in the islets at different metabolic states, we studied the localization and distribution of alpha, beta, and delta cells during gestation and prediabetes. We compared the islet cell distribution of pancreatic islets from metabolically healthy NMRI mice with that of New Zealand obese (NZO) mice, which exhibit impaired glucose tolerance (IGT) both preconceptionally and during gestation, and from C57BL/6 N (B6) mice, which acquire this IGT only during gestation. Since substrain(s) of the NZO mice are known to show a variant in the Abcc8 gene, we additionally examined preconceptional SUR1 knock-out (SUR1-KO) mice. PyCreas provided quantitative evidence that alterations in the Abcc8 gene are associated with an altered distribution pattern of islet cells. Moreover, our data indicate that this cannot be a consequence of prolonged hyperglycemia, as islet architecture is already altered in the prediabetic state. Furthermore, the quantitative analysis suggests that states of transient IGT, such as during common gestational diabetes mellitus (GDM), are not associated with changes in islet architecture as observed during long-term IGT. PyCreas provides the ability to systematically analyze the localization and distribution of islet cells at different stages of metabolic disease to better understand the underlying pathophysiology.
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Affiliation(s)
| | | | | | | | | | | | | | - Stephan Scherneck
- Institute of Pharmacology, Toxicology and Clinical Pharmacy, Technische Universität Braunschweig, Braunschweig, Germany
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165
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Meng Y, Thornburg LL, Hoeger KM, Núñez ZR, Kautz A, Evans AT, Wang C, Miller RK, Groth SW, O’Connor TG, Barrett ES. Association between sex steroid hormones and subsequent hyperglycemia during pregnancy. Front Endocrinol (Lausanne) 2023; 14:1213402. [PMID: 37766683 PMCID: PMC10520461 DOI: 10.3389/fendo.2023.1213402] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Sex steroid hormones may play a role in insulin resistance and glucose dysregulation. However, evidence regarding associations between early-pregnancy sex steroid hormones and hyperglycemia during pregnancy is limited. The primary objective of this study was to assess the relationships between first trimester sex steroid hormones and the subsequent development of hyperglycemia during pregnancy; with secondary evaluation of sex steroid hormones levels in mid-late pregnancy, concurrent with and subsequent to diagnosis of gestational diabetes. Methods Retrospective analysis of a prospective pregnancy cohort study was conducted. Medically low-risk participants with no known major endocrine disorders were recruited in the first trimester of pregnancy (n=319). Sex steroid hormones in each trimester, including total testosterone, free testosterone, estrone, estradiol, and estriol, were assessed using high-performance liquid chromatography and tandem mass spectrometry. Glucose levels of the 1-hour oral glucose tolerance test and gestational diabetes diagnosis were abstracted from medical records. Multivariable linear regression models were fitted to assess the associations of individual first trimester sex steroids and glucose levels. Results In adjusted models, first trimester total testosterone (β=5.24, 95% CI: 0.01, 10.46, p=0.05) and free testosterone (β=5.98, 95% CI: 0.97, 10.98, p=0.02) were positively associated with subsequent glucose concentrations and gestational diabetes diagnosis (total testosterone: OR=3.63, 95% CI: 1.50, 8.78; free testosterone: OR=3.69; 95% CI: 1.56, 8.73). First trimester estrone was also positively associated with gestational diabetes (OR=3.66, 95% CI: 1.56, 8.55). In mid-late pregnancy, pregnant people with gestational diabetes had lower total testosterone levels (β=-0.19, 95% CI: -0.36, -0.02) after adjustment for first trimester total testosterone. Conclusion Early-pregnancy sex steroid hormones, including total testosterone, free testosterone, and estrone, were positively associated with glucose levels and gestational diabetes in mid-late pregnancy. These hormones may serve as early predictors of gestational diabetes in combination with other risk factors.
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Affiliation(s)
- Ying Meng
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Loralei L. Thornburg
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kathleen M. Hoeger
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Zorimar Rivera- Núñez
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
| | - Amber Kautz
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Adam T. Evans
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine and Clinical and Translational Science Institue, The Lundquist Institute at Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Richard K. Miller
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Susan W. Groth
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Thomas G. O’Connor
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Wynne Center for Family Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Emily S. Barrett
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
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166
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Timm A, Kragelund Nielsen K, Alvesson HM, Jensen DM, Maindal HT. Motivation for Behavior Change among Women with Recent Gestational Diabetes and Their Partners-A Qualitative Investigation among Participants in the Face-It Intervention. Nutrients 2023; 15:3906. [PMID: 37764690 PMCID: PMC10535498 DOI: 10.3390/nu15183906] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Promoting diet and physical activity is important for women with recent gestational diabetes mellitus (GDM) and their partners to reduce the risk of future type 2 diabetes (T2D). The study aimed to understand how motivation for changing diet and physical activity behaviors among women with recent GDM and their partners was experienced after participation in the Danish Face-it intervention. Fourteen couples' interviews were conducted. Data analysis followed a reflexive thematic analysis. Guided by self-determination theory and interdependence theory, we identified four themes affecting couples' motivation for health behavior change: (1) The need to feel understood after delivery; (2) adjusting health expectations; (3) individual and mutual preferences for health behaviors; and (4) the health threat of future T2D as a cue to action. We found that couples in general perceived the Face-it intervention as useful and motivating. Using couple interviews increased our understanding of how the women and partners influenced each other's perspectives after a GDM-affected pregnancy and thus how targeting couples as opposed to women alone may motivate health behavior change.
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Affiliation(s)
- Anne Timm
- Health Promotion Research, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark; (K.K.N.); (H.T.M.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Karoline Kragelund Nielsen
- Health Promotion Research, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark; (K.K.N.); (H.T.M.)
| | | | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense, Denmark;
- Department of Gynaecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark; (K.K.N.); (H.T.M.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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Papadopoulou SK, Pavlidou E, Dakanalis A, Antasouras G, Vorvolakos T, Mentzelou M, Serdari A, Pandi AL, Spanoudaki M, Alexatou O, Aggelakou EP, Giaginis C. Postpartum Depression Is Associated with Maternal Sociodemographic and Anthropometric Characteristics, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence. Nutrients 2023; 15:3853. [PMID: 37686885 PMCID: PMC10490519 DOI: 10.3390/nu15173853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023] Open
Abstract
Postpartum depression, with a prevalence ranging between 14% and 25% worldwide, has been considered an urgent health concern that negatively affects both mothers' and their infants' health. Postpartum depression may negatively affect maternal sociodemographic and anthropometric parameters and lifestyle factors. Nutrition has recently been identified as a crucial factor for the management and co-treatment of postpartum depression. This survey aims to determine the possible association of postpartum depression with mothers' socio-demographic and anthropometric characteristics, perinatal outcomes, breastfeeding practices, and Mediterranean diet (MD) adherence. METHODS This is a cross-sectional survey, which was performed on 3941 women during the postpartum period. Postpartum depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS). Anthropometric parameters and perinatal outcomes were retrieved from mothers' medical records. Sociodemographic data and breastfeeding practices were recorded by face-to-face interviews between enrolled mothers and trained personnel. Mediterranean diet adherence was assessed by MedDietScore. Both univariate and multivariate binary logistic regression were applied for analyzing our data. RESULTS Postpartum depression was significantly associated with lower educational level, Greek nationality, higher prevalence of multiparity and overweight/obesity postpartum, higher incidence of caesarean section and not breastfeeding, and lower levels of MD adherence. In multivariate analysis, postpartum depression was independently associated with mothers' educational level, postpartum BMI status, type of delivery, breastfeeding practices, and MD adherence after adjusting for multiple confounding factors. CONCLUSIONS This study has provided evidence that elevated MD compliance was related to a decreased risk of postpartum depression. Additionally, postpartum depression was associated with multiple sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Future well-designed, prospective studies with high-quality methodology should be performed to obtain conclusive results.
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Affiliation(s)
- Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Antonios Dakanalis
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Theofanis Vorvolakos
- Department of Psychiatry, School of Health Sciences, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Aspasia Serdari
- Department of Psychiatry and Child Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Aimilia-Lynn Pandi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Exakousti-Petroula Aggelakou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (G.A.); (M.M.); (A.-L.P.); (O.A.); (E.-P.A.); (C.G.)
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Gong K, Li H, Yu X, Gu Y, Cao Y, Zhu B, Tao F. [Weight gain rate in the first and second trimesters and risk of gestational diabetes:a prospective cohort study]. Wei Sheng Yan Jiu 2023; 52:726-748. [PMID: 37802901 DOI: 10.19813/j.cnki.weishengyanjiu.2023.05.007] [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] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To investigate the relationship between the rate of weight gain in the first and second trimesters and gestational diabetes mellitus(GDM). METHODS A total of 1189 maternal cases were included at baseline from May to September 2019 when they first came to the Maternal and Child Health Hospital in Ma'anshan for delivery and establishment of maternal health handbook(≤14 weeks+6). A total of 968 maternal cases were included in the final analysis, including 289 cases of GDM. Information on maternal socio-demographic characteristics, past history and lifestyle was collected through questionnaires. Oral glucose tolerance test was performed to screen for GDM at 24-28 weeks of pregnancy. Multi-factor logistic regression was used to analyze the relationship between the rate of weight gain in the first and second trimesters and GDM. RESULTS After adjusting for pre-pregnancy BMI, age, occupation, number of births, number of pregnancies, type of residence, family history of diabetes, season of conception and mode of conception, an increased risk of GDM was found for rapid weight gain in early pregnancy compared with appropriate rate of gain(rapid group: aOR=1.92, 95%CI 1.20-3.07). No risk of GDM was found for rapid or slow weight gain in mid-pregnancy(rapid group : aOR=0.89, 95%CI 0.47-1.70)(slow group: aOR=1.57, 95%CI 0.85-2.90). Further stratified by pre-pregnancy BMI, pre-pregnancy BMI <24-overly rapid growth rate in early pregnancy was a risk factor for GDM(rapid group; aOR=1.98, 95%CI 1.16-3.38) and no significant association was observed in pregnant women with pre-pregnancy BMI ≥24(slow group: aOR=0.79, 95%CI 0.29-2.12; rapid group: aOR=1.61, 95%CI 0.60-4.30). A multiplicative model showing no interaction between pre-pregnancy BMI and early pregnancy weight gain rate for GDM. CONCLUSION Excessive growth rate in the first pregnancy can affect the risk of GDM.
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Affiliation(s)
- Kexin Gong
- School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Haiyan Li
- School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Xiayan Yu
- School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Yue Gu
- School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Yidan Cao
- School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Beibei Zhu
- School of Public Health, Anhui Medical University, Hefei 230032, China Key Laboratory of Population Health Across Life Cycle, Ministry of Education, Hefei 230032, China Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei 230032, China
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, Hefei 230032, China Key Laboratory of Population Health Across Life Cycle, Ministry of Education, Hefei 230032, China Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei 230032, China Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission, Hefei 230032, China
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169
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Anness AR, Nath M, Osman MW, Webb D, Robinson T, Khalil A, Mousa HA. Does treatment modality affect measures of arterial stiffness in women with gestational diabetes? Ultrasound Obstet Gynecol 2023; 62:422-429. [PMID: 37099764 DOI: 10.1002/uog.26234] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/10/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To investigate whether arterial stiffness (AS) differs between healthy women and women with gestational diabetes mellitus (GDM) managed by different treatment modalities. METHODS This was a prospective longitudinal cohort study comparing AS in pregnancies complicated by GDM and low-risk controls. AS was assessed by recording aortic pulse-wave velocity (AoPWV), brachial augmentation index (BrAIx) and aortic augmentation index (AoAIx) using the Arteriograph® at four gestational-age windows: 24 + 0 to 27 + 6 weeks (W1); 28 + 0 to 31 + 6 weeks (W2); 32 + 0 to 35 + 6 weeks (W3) and ≥ 36 + 0 weeks (W4). Women with GDM were considered both as a single group and as subgroups stratified by treatment modality. Data were analyzed using a linear mixed model on each AS variable (log-transformed) with group, gestational-age window, maternal age, ethnicity, parity, body mass index, mean arterial pressure and heart rate as fixed effects and individual as a random effect. We compared the group means including relevant contrasts and adjusted the P-values using Bonferroni correction. RESULTS The study population comprised 155 low-risk controls and 127 women with GDM, of whom 59 were treated with dietary intervention, 47 were treated with metformin only and 21 were treated with metformin + insulin. The two-way interaction term of study group and gestational age was significant for BrAIx and AoAIx (P < 0.001), but there was no evidence that mean AoPWV was different between the study groups (P = 0.729). Women in the control group demonstrated significantly lower BrAIx and AoAIx compared with the combined GDM group at W1-W3, but not at W4. The mean difference in log-transformed BrAIx was -0.37 (95% CI, -0.52 to -0.22), -0.23 (95% CI, -0.35 to -0.12) and -0.29 (95% CI, -0.40 to -0.18) at W1, W2 and W3, respectively. The mean difference in log-transformed AoAIx was -0.49 (95% CI, -0.69 to -0.30), -0.32 (95% CI, -0.47 to -0.18) and -0.38 (95% CI -0.52 to -0.24) at W1, W2 and W3, respectively. Similarly, women in the control group also demonstrated significantly lower BrAIx and AoAIx compared with each of the GDM treatment subgroups (diet, metformin only and metformin + insulin) at W1-W3. The increase in mean BrAIx and AoAIx seen between W2 and W3 in women with GDM treated with dietary management was attenuated in the metformin-only and metformin + insulin groups. However, the mean differences in BrAIx and AoAIx between these treatment groups were not statistically significant at any gestational-age window. CONCLUSIONS Pregnancies complicated by GDM demonstrate significantly higher AS compared with low-risk pregnancies regardless of treatment modality. Our data provide the basis for further investigation into the association of metformin therapy with changes in AS and risk of placenta-mediated diseases. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A R Anness
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- University of Leicester, Leicester, UK
| | - M Nath
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M W Osman
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D Webb
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - T Robinson
- College of Life Sciences, University of Leicester, Leicester, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - H A Mousa
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
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170
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Javadifar N, Siahkal SF, Najafian M, Iravani M, Zakerkish M, Heshmati R. Prioritizing the Psychosocial Support Needs of Mothers with Gestational Diabetes: A Delphi Study. Iran J Nurs Midwifery Res 2023; 28:520-527. [PMID: 37869698 PMCID: PMC10588923 DOI: 10.4103/ijnmr.ijnmr_90_22] [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: 03/24/2022] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 10/24/2023]
Abstract
Background Gestational diabetes is the most common medical complication in pregnancy, and the psychosocial health of women suffering from this condition affects their adherence to treatment and self-efficacy. However, since it is not possible to design interventions dealing with all of these needs, the aim of this study was to prioritize the psychosocial supportive needs of women with gestational diabetes. Materials and Methods This was a modified Delphi design study involving 22 experts who were selected using purposive and snowball sampling methods. The study was conducted between April 2021 and June 2021. First, the psychosocial needs of diabetic pregnant women were extracted through a qualitative study involving interviews with multidisciplinary specialists and diabetic pregnant mothers (22 participants) and a systematic review of reputable scientific databases. Throughout the two Delphi stages, the questionnaire was classified, quantified, and analyzed. Results Based on the results of this study, the following are the top priorities when addressing the psychosocial needs of mothers with gestational diabetes: paying attention to and identifying the mother's worries and anxiety, husband and family support for diabetic pregnant women, the inclusion of specialized nutrition counseling services in mothers' treatment plan, timely education of mothers about diabetes and its complications, and proper nutrition for diabetic mothers. Conclusions The priorities of the supportive needs obtained in this study can be used to design interventions aimed at promoting psychosocial health, reducing stress and anxiety, and improving medication adherence in women with gestational diabetes.
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Affiliation(s)
- Nahid Javadifar
- Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahla Faal Siahkal
- Department of Midwifery, Marand Branch, Islamic Azad University, Marand, Iran
| | - Mahin Najafian
- Department of Obstetrics and Gynecology, School of Medicine, Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Iravani
- Reproductive Health Promotion Research Center, Midwifery and Reproductive Health Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrnoosh Zakerkish
- Department of Endocrinology and Metabolism, Faculty of Medicine, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Rasoul Heshmati
- Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran
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171
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Bogdanet D, Castillo MT, Doheny H, Dervan L, Luque-Fernandez MA, Halperin J, O'Shea PM, Dunne FP. The utility of plasma glycated CD59 in predicting postpartum glucose intolerance: A prospective study of women diagnosed with GDM during a period of universal GDM screening. Diabet Med 2023; 40:e15121. [PMID: 37078256 DOI: 10.1111/dme.15121] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 04/21/2023]
Abstract
AIMS Gestational diabetes (GDM) is associated with the development of postpartum (PP) glucose intolerance. Plasma glycated CD59 (pGCD59) is an emerging biomarker for the detection of hyperglycaemia. The aim of this study was to assess the ability of PP pGCD59 to predict the development of PP GI as defined by the 2 h 75 g OGTT using the ADA criteria, in a cohort of women diagnosed with prior GDM in the index pregnancy using the 2 h 75 g OGTT at 24-28 weeks of gestation according to the World Health Organization (WHO) 2013 criteria. METHODS Of the 2017 pregnant women recruited prospectively 140 women with gestational diabetes had samples for pGCD59 taken PP at the time of the OGTT. The ability of pGCD59 to predict the results of the PP OGTT was assessed using nonparametric receiver operating characteristic (ROC) curves. RESULTS Women with PP glucose intolerance had significantly higher PP pGCD59 levels compared to women with normal glucose tolerance PP (3.8 vs. 2.7 SPU). PP pGCD59 identified women who developed glucose intolerance PP with an AUC of 0.80 (95% CI: 0.70-0.91). A PP pGCD59 cut-off value of 1.9 SPU generated a sensitivity of 100% (95% CI: 83.9-100), specificity of 16.9% (95% CI: 9.8-26.3), positive predictive value of 22.1% (95% CI: 21.0-22.6), and negative predictive value of 100% (95% CI: 87.4-100). PP fasting plasma glucose generated an AUC of 0.96 (95% CI: 0.89-0.99) for the identification of PP glucose intolerance. CONCLUSION Our study found that PP pGCD9 may be a promising biomarker to identify women not requiring PP glucose intolerance screening using the traditional OGTT. While the diagnostic accuracy of pGCD59 is good, fasting plasma glucose remains a better test for the identification of PP glucose intolerance.
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Affiliation(s)
- Delia Bogdanet
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
| | - Michelle T Castillo
- Divisions of Haematology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen Doheny
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Louise Dervan
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
| | - Miguel A Luque-Fernandez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jose Halperin
- Divisions of Haematology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paula M O'Shea
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Fidelma P Dunne
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
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Watkins OC, Pillai RA, Selvam P, Yong HE, Cracknell‐Hazra VK, Sharma N, Cazenave‐Gassiot A, Bendt AK, Godfrey KM, Lewis RM, Wenk MR, Chan S. Myo-inositol alters the effects of glucose, leptin and insulin on placental palmitic acid and oleic acid metabolism. J Physiol 2023; 601:4151-4169. [PMID: 37602663 PMCID: PMC10952252 DOI: 10.1113/jp285036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Well-regulated placental palmitic acid (PA) and oleic acid (OA) metabolism is vital for optimal placental function and fetal development, but dysregulation occurs with gestational diabetes (GDM). We hypothesized that such dysregulation might arise from increased maternofetal glucose, leptin or insulin concentrations present in GDM, and that dysregulated PA and OA lipid metabolism could be moderated by myo-inositol, a natural polyol and potential GDM intervention. Placental explants from 21 women were incubated with stable isotope-labelled 13 C-PA or 13 C-OA for 48 h. Explants were treated with glucose (5, 10 mm) or leptin (13 nm) or insulin (150 nm) in combination with myo-inositol (0.3, 30, 60 μm). Forty-seven 13 C-PA lipids and 37 13 C-OA lipids were measured by liquid chromatography-mass spectrometry (LCMS). Compared with controls (5 mm glucose), glucose (10 mm) increased 19 13 C-OA lipids and nine 13 C-PA lipids, but decreased 13 C-OA phosphatidylethanolamine 38:5 and 13 C-PA phosphatidylethanolamine 36:4. The effects of leptin and insulin were less prominent than glucose, with leptin increasing 13 C-OA acylcarnitine 18:1, and insulin increasing four 13 C-PA triacylglycerides. Most glucose, leptin and insulin-induced alterations in lipids were attenuated by co-incubation with myo-inositol (30 or 60 μm), with attenuation also occurring in all subgroups stratified by GDM status and fetal sex. However, glucose-induced increases in acylcarnitine were not attenuated by myo-inositol and were even exaggerated in some instances. Myo-inositol therefore appears to generally act as a moderator, suppressing the perturbation of lipid metabolic processes by glucose, leptin and insulin in placenta in vitro. Whether myo-inositol protects the fetus and pregnancy from unfavourable outcomes requires further research. KEY POINTS: Incubation of placental explants with additional glucose, or to a lesser extent insulin or leptin, alters the placental production of 13 C-lipids from 13 C-palmitic acid (PA) and 13 C-oleic acid (OA) in vitro compared with untreated controls from the same placenta. Co-incubation with myo-inositol attenuated most alterations induced by glucose, insulin or leptin in 13 C-lipids, but did not affect alterations in 13 C-acylcarnitines. Alterations induced by glucose and leptin in 13 C-PA triacylglycerides and 13 C-PA phospholipids were influenced by fetal sex and gestational diabetes status, but were all still attenuated by myo-inositol co-incubation. Insulin differently affected 13 C-PA triacylglycerides and 13 C-PA phospholipids depending on fetal sex, with alterations also attenuated by myo-inositol co-incubation.
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Affiliation(s)
- Oliver C. Watkins
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Reshma Appukuttan Pillai
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Preben Selvam
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Hannah E.J. Yong
- Singapore Institute for Clinical SciencesAgency for Science, Technology and ResearchSingapore
| | - Victoria K.B. Cracknell‐Hazra
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Singapore Institute for Clinical SciencesAgency for Science, Technology and ResearchSingapore
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustUK
| | - Neha Sharma
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Amaury Cazenave‐Gassiot
- Department of Biochemistry, Yong Loo Lin School of Medicine and Precision Medicine TRPNational University of SingaporeSingapore
- Singapore Lipidomics Incubator, Life Sciences InstituteNational University of SingaporeSingapore
| | - Anne K. Bendt
- Singapore Lipidomics Incubator, Life Sciences InstituteNational University of SingaporeSingapore
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustUK
| | - Rohan M. Lewis
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustUK
| | - Markus R. Wenk
- Department of Biochemistry, Yong Loo Lin School of Medicine and Precision Medicine TRPNational University of SingaporeSingapore
- Singapore Lipidomics Incubator, Life Sciences InstituteNational University of SingaporeSingapore
| | - Shiao‐Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Singapore Institute for Clinical SciencesAgency for Science, Technology and ResearchSingapore
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Bernardo DS, Carvalho CB, Conde M, Mota JA, Santos PC. Effectiveness of a structured exercise intervention in gestational weight gain in pregnant women with overweight and obesity: A systematic review with meta-analysis. Int J Gynaecol Obstet 2023; 162:811-822. [PMID: 36825992 DOI: 10.1002/ijgo.14741] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES To assess the effectiveness of exercise interventions during pregnancy in managing gestational weight gain (GWG), excessive GWG, gestational diabetes (GD), hypertensive disorders, 2-h post-oral glucose tolerance test (OGTT), and birth weight in pregnant women with overweight/obesity (OW/OB). METHODS The search strategy was conducted in five electronic databases, restricting to articles published within the past 10 years. Randomized controlled trials comparing exercise intervention with usual prenatal care in pregnant women with OW/OB were considered. Two reviewers extracted data and assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials and the quality of studies using Grading of Recommendations Assessment, Development and Evaluation classification. Continuous data were calculated as mean differences (MDs) and dichotomous data as risk ratios (RRs). RESULTS Seven trials comprising 1648 pregnant women were included. Exercise interventions were associated with lower GWG (MD, -1.19 kg [95% confidence interval, CI, -1.79 to -0.60]) and lower incidence of GD (RR, 0.56 [95% CI, 0.40-0.78]). When analyzing excessive GWG, 2-h post-OGTT, birth weight, and hypertensive disorders, there was no statistically significant difference between the exercise and usual care groups. The strength of evidence was considered moderate. CONCLUSION Exercise interventions during pregnancy in women with OW/OB were shown to influence GWG and the incidence of GD.
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Affiliation(s)
- Diana Salvador Bernardo
- KinesioLab Research Unit in Human Movement, Department of Physiotherapy, School of Health, Piaget Institute, Vila Nova de Gaia, Portugal
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
| | | | - Monserrat Conde
- Nuffield Department of Primary Care Health Sciences, Center for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Jorge Augusto Mota
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), FADEUP-Faculty of Sport, University of Porto, Porto, Portugal
| | - Paula Clara Santos
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), FADEUP-Faculty of Sport, University of Porto, Porto, Portugal
- Department of Physiotherapy, Health School, Polytechnic of Porto (ESS), Porto, Portugal
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic of Porto, Porto, Portugal
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Zeinabeh MZ, Atefeh A, Masumeh GHP, Tania D, Mojgan S, Katayoun A. The Effect of Mindfulness-Based Stress Reduction Counseling on Blood Glucose and Perceived Stress in Women with Gestational Diabetes. Rev Bras Ginecol Obstet 2023; 45:e517-e523. [PMID: 37846184 PMCID: PMC10579914 DOI: 10.1055/s-0043-1775810] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/01/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Gestational diabetes can cause maternal and neonatal morbidity. Psychological factors, especially stress, play a meaningful role in diabetes management. Therefore, the present study aimed to investigate the effect of Mindfulness-Based Stress Reduction counseling on blood sugar and perceived stress in women with gestational diabetes. METHODS The present quasi-experimental interventional study was performed on 78 women with gestational diabetes. In the intervention group, a Mindfulness-Based Stress Reduction counseling program was conducted by the researcher in 8 sessions of 90 minutes twice a week. The Cohen stress questionnaire was filled in both groups. Also, fasting blood sugar and 2-hour blood sugar levels were measured in both groups. Statistical analysis was performed using the independent T-Test, the paired T-Test, the Mann-Whitney and Wilcoxon Tests using IBM SPSS Statistics for Windows version 20 version (IBM Corp., Armonk, NY, USA). RESULTS The mean age of pregnant women in the intervention group was 28.84 ± 6.20 years old and 29.03 ± 5.42 years old in the control group. There was a significant mean difference between the fasting blood sugar score (p = 0.02; - 6.01; and - 11.46) and the 2-hour fasting blood sugar score (p < 0.001;12.35; and - 5.3) and the perceived stress score (p < 0.001; 35.57; and - 49.19) existed between the intervention and control groups after the intervention. CONCLUSION The results of the present study showed that mindfulness-based stress reduction counseling is effective in reducing blood sugar levels and reducing perceived stress in women with gestational diabetes treated with diet.
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Affiliation(s)
| | | | | | - Dehesh Tania
- Kerman University of Medical Sciences, Kerman, Iran
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175
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Spinelli P, Fields AM, Falcone S, Mesaros C, Susiarjo M. Susceptibility to Low Vitamin B6 Diet-induced Gestational Diabetes Is Modulated by Strain Differences in Mice. Endocrinology 2023; 164:bqad130. [PMID: 37624591 PMCID: PMC10686696 DOI: 10.1210/endocr/bqad130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/19/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
Gestational diabetes is a common pregnancy complication that adversely influences the health and survival of mother and child. Pancreatic islet serotonin signaling plays an important role in β-cell proliferation in pregnancy, and environmental and genetic factors that disrupt serotonin signaling are associated with gestational diabetes in mice. Our previous studies show that pregnant C57BL/6J mice fed a diet that is low in vitamin B6, a critical co-factor in serotonin synthesis, develop hyperglycemia and glucose intolerance, phenotypes that are consistent with gestational diabetes in humans. The current study shows that, unlike in the C57BL/6J mice, low vitamin B6 diet does not alter glucose tolerance and insulin secretion in pregnant DBA/2J mice. The hypothesis to be tested in the current study is that pregnant DBA/2J mice are protected against low vitamin B6-induced gestational diabetes due to their higher expression and enzymatic activities of tissue nonspecific alkaline phosphatase (ALPL) relative to C57BL/6J. ALPL is a rate-limiting enzyme that regulates vitamin B6 bioavailability. Interestingly, treating pregnant DBA/2J mice with 7.5 mg/kg/day of the ALPL inhibitor SBI-425 is associated with glucose intolerance in low vitamin B6-fed mice, implying that inhibition of ALPL activity is sufficient to modulate resilience to low vitamin B6-induced metabolic impairment.
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Affiliation(s)
- Philip Spinelli
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Ashley M Fields
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Sierra Falcone
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Clementina Mesaros
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Antasouras G, Papadopoulou SK, Alexatou O, Papandreou D, Mentzelou M, Migdanis A, Psara E, Migdanis I, Chrysafi M, Tyrovolas S, Louka A, Giaginis C. Adherence to the Mediterranean Diet during Pregnancy: Associations with Sociodemographic and Anthropometric Parameters, Perinatal Outcomes, and Breastfeeding Practices. Medicina (Kaunas) 2023; 59:1547. [PMID: 37763666 PMCID: PMC10536474 DOI: 10.3390/medicina59091547] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The Mediterranean diet (MD) has been recognized as a beneficial nutritional pattern that promotes human health, decreasing the risks of a variety of human disorders and pathological states, including adverse pregnancy outcomes. In this aspect, the current survey aimed to assess the potential association of compliance with the MD during gestation with various sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Materials and Methods: This was a cross-sectional study performed on 5688 pregnant women from 10 distinctive Greek areas. Face-to-face interviews with qualified questionnaires and thorough retrievals of medical records were performed to collect data concerning the participants' sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Results: Elevated compliance with the MD during pregnancy was independently related with older age, higher educational status, and better economic status as well as decreased incidences of pre-pregnancy overweight/obesity and excess gestational weight gain and a lower likelihood of gestational diabetes. Moreover, greater adherence to the MD was independently associated with an increased prevalence of delivering vaginally and a greater prevalence of exclusive breastfeeding for at least 16 weeks postpartum. Conclusions: A higher level of compliance with the MD for the period of gestation was associated with several favorable lifestyle factors that may promote maternal health. Further studies with a prospective design as well as studies exploring the potential effects of maternal compliance with the MD for the period of pregnancy on the health of children should be performed. Future studies should also be extended beyond the MD by assessing the potential beneficial effects of adopting a Mediterranean lifestyle on maternal and child health.
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Affiliation(s)
- Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Dimitrios Papandreou
- Department of Clinical Nutrition & Dietetics, College of Health, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Athanasios Migdanis
- Department of Gastroenterology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Ioannis Migdanis
- Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Maria Chrysafi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Stefanos Tyrovolas
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon GH506, Hong Kong
| | - Aikaterini Louka
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
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177
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Song Y, Zhai X, Bai Y, Liu C, Zhang L. Progress and indication for use of continuous glucose monitoring in patients with diabetes in pregnancy: a review. Front Endocrinol (Lausanne) 2023; 14:1218602. [PMID: 37680884 PMCID: PMC10482265 DOI: 10.3389/fendo.2023.1218602] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Gestational diabetes mellitus is one of the most common endocrine diseases that occur during pregnancy. Disorders of blood glucose metabolism during pregnancy can increase the risk of adverse pregnancy outcomes, such as pregnancy-related hypertension, preeclampsia, eclampsia, miscarriage, macrosomia, and neonatal hypoglycemia. Continuous glucose monitoring (CGM) can safely and effectively monitor blood glucose changes in patients with gestational hyperglycemia, thereby reducing adverse pregnancy outcomes. Hence, this article aimed to provide a comprehensive review of the progress and indications for using CGM in pregnant patients with diabetes. CGM can reduce blood glucose fluctuations and the occurrence of serious hypoglycemia and hyperglycemia events and can provide time in range (TIR). TIR is an important indicator of blood glucose level. Patients with a higher TIR during pregnancy have better gestational outcomes.
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Affiliation(s)
| | | | | | | | - Le Zhang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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178
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Kang BS, Lee SU, Hong S, Choi SK, Shin JE, Wie JH, Jo YS, Kim YH, Kil K, Chung YH, Jung K, Hong H, Park IY, Ko HS. Prediction of gestational diabetes mellitus in Asian women using machine learning algorithms. Sci Rep 2023; 13:13356. [PMID: 37587201 PMCID: PMC10432552 DOI: 10.1038/s41598-023-39680-8] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
This study developed a machine learning algorithm to predict gestational diabetes mellitus (GDM) using retrospective data from 34,387 pregnancies in multi-centers of South Korea. Variables were collected at baseline, E0 (until 10 weeks' gestation), E1 (11-13 weeks' gestation) and M1 (14-24 weeks' gestation). The data set was randomly divided into training and test sets (7:3 ratio) to compare the performances of light gradient boosting machine (LGBM) and extreme gradient boosting (XGBoost) algorithms, with a full set of variables (original). A prediction model with the whole cohort achieved area under the receiver operating characteristics curve (AUC) and area under the precision-recall curve (AUPR) values of 0.711 and 0.246 at baseline, 0.720 and 0.256 at E0, 0.721 and 0.262 at E1, and 0.804 and 0.442 at M1, respectively. Then comparison of three models with different variable sets were performed: [a] variables from clinical guidelines; [b] selected variables from Shapley additive explanations (SHAP) values; and [c] Boruta algorithms. Based on model [c] with the least variables and similar or better performance than the other models, simple questionnaires were developed. The combined use of maternal factors and laboratory data could effectively predict individual risk of GDM using a machine learning model.
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Affiliation(s)
- Byung Soo Kang
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seon Ui Lee
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Kyung Choi
- Department of Obstetrics and Gynecology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Eun Shin
- Department of Obstetrics and Gynecology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Ha Wie
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Sung Jo
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Hee Kim
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary's Hospital,, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kicheol Kil
- Department of Obstetrics and Gynecology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Hyun Chung
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Han T, Chen Q, Huang J, Zhang J, Li A, Xu W, Peng Z, Li Z, Chen L. Low-dose esketamine with sufentanil for postcesarean analgesia in women with gestational diabetes mellitus: a prospective, randomized, double-blind study. Front Endocrinol (Lausanne) 2023; 14:1202734. [PMID: 37635978 PMCID: PMC10454896 DOI: 10.3389/fendo.2023.1202734] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Pregnant women with gestational diabetes mellitus (GDM) require more analgesics after cesarean delivery than those who do not have GDM. Uncontrolled pain following cesarean delivery is a major problem in women with GDM. We investigate the efficacy of low-dose esketamine combined with sufentanil intravenous patient-controlled analgesia (PCA)for postcesarean analgesia in women with GDM. Methods One hundred forty pregnant women with GDM were enrolled participate in this randomized controlled trial and were randomized into two groups (70 in each group). The esketamine (S) group was given esketamine +sufentanil + ondansetron, and the control (C) group was given sufentanil +ondansetron. The primary outcome is sufentanil consumption at 24 hours postoperatively, the secondary outcomes are sufentanil consumption at 6 hours postoperatively, pain scores at 6, 24 and 48 hours postoperatively. Results Compared with group C, group S had significantly lower sufentanil consumption at 6 and 24 hours postoperatively (P= 0.049 and P<0.001), significantly lower activities VAS(pain during activities)scores at 6 hours postoperatively, rest and activities VAS (pain at rest and pain during activities)scores at 24 hours postoperatively, and activities VAS scores at 48 hours postoperatively(P=0.022, P =0.002, P=0.001 and P=0.007). Compared to group C, the time to bowel function return was significantly shorter in group S. There was no significant difference in rest VAS (pain at rest) scores at 6 and 48 hours postoperatively (P>0.05). The time to first lactation was not significantly different between the two groups (P>0.05). There was no significant difference in neonatal neurobehavioral scores between the two groups (P>0.05). Conclusion Compared to sufentanil PCA, adding low dose of esketamine significantly reduced the consumption of sufentanil while providing equally effective post cesarean analgesia in the patients with gestational diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Liang Chen
- Department of Anesthesiology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
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180
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Nadeem A, Saeed M, Sadiqa A, Moin H, Khan QU. The Effect of Vitamin D3 Intervention on the Association Among Vitamin D3, Adiponectin, and Body Mass Index in Pregnant Women With Gestational Diabetes. Cureus 2023; 15:e43506. [PMID: 37719527 PMCID: PMC10500543 DOI: 10.7759/cureus.43506] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Vitamin D3 (VD3) deficiency is a strong predictor of gestational diabetes. Therefore, VD3 supplementation during the antenatal period could prevent the development of gestational diabetes via its effects on insulin secretion, insulin sensitivity, body mass index (BMI), and adiponectin production. OBJECTIVES To observe the effect of VD3 supplementation on adiponectin and BMI and to explore the effect of VD3 supplementation on the association among VD3, adiponectin, and BMI in pregnant women with gestational diabetes. METHODS A randomized control trial was performed after receiving consent at Postgraduate Medical Institute, Lahore. Subjects at 20-26 weeks of gestation with gestational diabetes and with a deficiency/insufficiency of VD3 were included. The study excluded those who were smokers, had multiple pregnancies, or had other gestational complications. Subjects were categorized into interventional (VD3 supplementation) and control groups. The institutional ethical committee approved the study. Serum samples were used for enzyme-linked immunosorbent assay estimation of VD3 and adiponectin levels. Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 21.0, Armonk, NY) software was used to analyze data. Student t-tests were applied to compare quantitative variables, and Chi-square tests were utilized to compare qualitative variables. Pearson's correlation and linear regressions were performed to explore the association. At a 95% confidence interval, a p-value of ≤0.05 was taken as significant. RESULTS With an increase in serum VD3 levels, a decrease in serum adiponectin level was observed in pregnant women with gestational diabetes (interventional group: r = -0.088, p = 0.74); however, after the intervention of VD3 supplementation in the same subjects, an increase in serum adiponectin level was noted with an increase in VD3 (interventional group: r = 0.273, p = 0.28). A significant direct relationship was found between BMI and adiponectin in the same study population (interventional group: r = 0.7, p = 0.001). Interestingly, after the intervention, BMI tends to be less likely to increase adiponectin levels (interventional group: r = 0.09, p = 0.73). Moreover, an inverse association was exhibited between BMI and VD3 levels in all the study groups before intervention (control group: r = -0.07, p = 0.78; interventional group: r = -0.035, p = 0.89) and after intervention (interventional group: r = -0.12, p = 0.65), except in the control group after the intervention span, where BMI mildly raises the VD3 levels (r = -0.12, p = 0.65). CONCLUSION BMI increases with an increase in serum adiponectin levels in gestational diabetic women, but after VD3 supplementation, BMI was less likely to influence adiponectin. Also, with an increase in BMI, a decrease in the VD3 in all study groups was observed except in the control group after VD3 supplementation.
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Affiliation(s)
- Amna Nadeem
- Physiology, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
- Medicine and Surgery, National University of Medical Sciences (NUMS), Rawalpindi, PAK
| | - Muniza Saeed
- Physiology, Ameer-ud-Din Medical College, Lahore, PAK
| | - Ayesha Sadiqa
- Physiology, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
- Medicine and Surgery, National University of Medical Sciences (NUMS), Rawalpindi, PAK
| | - Hira Moin
- Physiology, National University of Sciences and Technology (NUST), Islamabad, PAK
| | - Qudsia U Khan
- Physiology, CMH Lahore Medical and Dental College, Lahore, PAK
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Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, Muñoz-Christian K, Schaffner A, Shields L, Heaney C, McHugh A, Wing RR. Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus. Am J Obstet Gynecol 2023; 229:158.e1-158.e14. [PMID: 36758710 DOI: 10.1016/j.ajog.2023.01.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Preconception lifestyle intervention holds potential for reducing gestational diabetes mellitus, but clinical trial data are lacking. OBJECTIVE This study aimed to determine the effects of a prepregnancy weight loss intervention on gestational diabetes mellitus recurrence in women with overweight/obesity and previous gestational diabetes mellitus. STUDY DESIGN A 2-site, randomized controlled trial comparing a prepregnancy lifestyle intervention with educational control was conducted between December 2017 and February 2022. A total of 199 English- and Spanish-speaking adults with overweight/obesity and previous gestational diabetes mellitus were randomized to a 16-week prepregnancy lifestyle intervention with ongoing treatment until conception or educational control. The primary outcome was gestational diabetes mellitus recurrence. Analyses excluded 6 participants who conceived but did not have gestational diabetes mellitus ascertained by standard methods. RESULTS In the 63 (33%) women who conceived and had gestational diabetes mellitus ascertained (Ns=38/102 [37%] intervention vs 25/91 [28.0%] control; P=.17), those in the intervention group had significantly greater weight loss at 16 weeks compared with controls (4.8 [3.4-6.0] vs 0.7 [-0.9 to 2.3] kg; P=.001) and a greater proportion lost ≥5% of body weight (50.0% [17/34] vs 13.6% [3/22]; P=.005). There was no significant difference in the incidence of gestational diabetes mellitus recurrence between the intervention (57.9% [ns=23/38]) and the control group (44.0% [ns=11/25]; odds ratio, 1.8 [0.59-5.8]). Independent of group, greater prepregnancy weight loss predicted 21% lower odds of gestational diabetes mellitus recurrence (odds ratio, 0.79 [0.66-0.94]; P=.008). A ≥5% weight loss before conception reduced the odds of gestational diabetes mellitus recurrence by 82% (odds ratio, 0.18 [0.04-0.88]; P=.03). CONCLUSION Lifestyle intervention produced considerable prepregnancy weight loss but did not affect gestational diabetes mellitus rates. Given that the conception rate was 50% lower than expected, this study was underpowered.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA.
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI; Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI
| | - Donald Coustan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | | | - Todd Hagobian
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA
| | - Karen Muñoz-Christian
- Department of World Languages and Cultures, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA
| | | | - Casey Heaney
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA
| | - Angelica McHugh
- Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI; Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI
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Cahn J, Sundaram A, Balachandar R, Berg A, Birnbaum A, Hastings S, Makansi M, Romano E, Majidi A, McCormick D, Gaffney A. The Association of Childbirth with Medical Debt in the USA, 2019-2020. J Gen Intern Med 2023; 38:2340-2346. [PMID: 37199904 PMCID: PMC10192781 DOI: 10.1007/s11606-023-08214-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Medical debt affects one in five adults in the USA and may disproportionately burden postpartum women due to pregnancy-related medical costs. OBJECTIVE To evaluate the association between childbirth and medical debt, and the correlates of medical debt among postpartum women, in the USA. DESIGN Cross-sectional. PARTICIPANTS We analyzed female "sample adults" 18-49 years old in the 2019-2020 National Health Interview Survey, a nationally representative household survey. MAIN MEASURES Our primary exposure was whether the subject gave birth in the past year. We had two family-level debt outcomes: problems paying medical bills and inability to pay medical bills. We examined the association between live birth and medical debt outcomes, unadjusted and adjusted for potential confounders in multivariable logistic regressions. Among postpartum women, we also examined the association between medical debt with maternal asthma, hypertension, and gestational diabetes and several sociodemographic factors. KEY RESULTS Our sample included n = 12,163 women, n = 645 with a live birth in the past year. Postpartum women were younger, more likely to have Medicaid, and lived in larger families than those not postpartum. 19.8% of postpartum women faced difficulty with medical bills versus 15.1% who were not; in multivariable regression, postpartum women had 48% higher adjusted odds of medical debt problems (95% CI 1.13, 1.92). Results were similar when examining inability to pay medical bills, and similar differences were seen for privately insured women. Among postpartum women, those with lower incomes and with asthma or gestational diabetes, but not hypertension, had significantly higher adjusted odds of medical debt problems. CONCLUSIONS Postpartum women experience higher levels of medical debt than other women; poorer women and those with common chronic diseases may have an even higher burden. Policies to expand and improve health coverage for this population are needed to improve maternal health and the welfare of young families.
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Affiliation(s)
- Jordan Cahn
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ayesha Sundaram
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Roopa Balachandar
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Alexandra Berg
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Aaron Birnbaum
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Stephanie Hastings
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Matthew Makansi
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Emily Romano
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ariel Majidi
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Adam Gaffney
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
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Dyck RF, Pahwa P, Karunanayake C, Osgood ND. The Contribution of Gestational Diabetes to Diabetes Risk Among First Nations and Non-First Nations Women in Saskatchewan: Results From the DIP: ORRIIGENSS Project. Can J Diabetes 2023; 47:509-518. [PMID: 37150508 DOI: 10.1016/j.jcjd.2023.04.017] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Our aim in this study was to determine the risk for diabetes mellitus (DM) among Saskatchewan First Nations (FN) and non-FN women with prior gestational DM (GDM). METHODS Using Ministry of Health administrative databases, we conducted a retrospective cohort study of DM risk by GDM occurrence among FN and non-FN women giving birth from 1980 to 2009 and followed to March 31, 2013. We determined frequencies and odds ratios (ORs) of DM in women with/without prior GDM after stratifying by FN status, while adjusting for other DM determinants. Survival curves of women until DM diagnosis were obtained by prior GDM occurrence and stratified by ethnicity and total parity. RESULTS De-identified data were obtained for 202,588 women. Of those who developed DM, 2,074 of 10,114 (20.5%) had previously experienced GDM (811 of 3,128 [25.9%]) FN and 1,263 of 6,986 [18.1%] non-FN). Cumulative survival of women with prior GDM until DM was higher for FN than for non-FN women (82% vs 46%), but prior GDM was a stronger predictor of DM within the non-FN cohort (prior GDM vs no GDM: OR, 9.64 for non-FN; OR, 7.05 for FN). Finally, higher total parity interacted with prior GDM to increase DM risk in both groups. With prior GDM and parity ≥3, 93% of FN and 57% of non-FN women subsequently developed DM. CONCLUSIONS GDM is a leading determinant of T2DM among FN and non-FN women, amplified by higher parity. This contributes to earlier onset diabetes, affecting subsequent pregnancies and increasing risk for chronic diabetic complications. It may also factor into higher type 2 DM rates observed in FN women compared with men.
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Affiliation(s)
- Roland F Dyck
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Punam Pahwa
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chandima Karunanayake
- Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nathaniel D Osgood
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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184
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Notaro NM, Budd JM. Two-hits, two-goals: An improved model for gestational diabetes mellitus and a novel link to the development of non-alcoholic fatty liver disease. J Physiol 2023; 601:3449-3451. [PMID: 37405678 DOI: 10.1113/jp284949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023] Open
Affiliation(s)
- Nicole M Notaro
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Joshua M Budd
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
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185
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Baños Cándenas L, Abehsera Davó D, Castaño Frías L, González Mesa E. Retrospective Study of First Trimester Metrorrhagia: Pregnancy Follow-Up and Relationship with the Appearance of Gestational Complications. Medicina (Kaunas) 2023; 59:1370. [PMID: 37629660 PMCID: PMC10456544 DOI: 10.3390/medicina59081370] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy. Secondarily, we assessed the associated complications in order to identify potential risk factors that could be used to select women at higher risk of adverse outcomes that could benefit from an early diagnosis and improved monitoring. Materials and Methods: We made a selection of all the women who consulted in the Emergency Department of the Hospital QuirónSalud in Malaga on 2015 presenting with first trimester metrorrhagia. We refer to first trimester metrorrhagia as that which occurs until week 12 + 6. Once these pregnant women were identified, we studied several variables not related to the gestation and some others associated with it and its natural course. Results: The average age of the patients assessed was 34.1. Associated gestational complications were metrorrhagia in the second trimester (6.3%), threatened preterm labor (7.4%), preeclampsia (2.5%), gestational diabetes (7.4%), late abortion (1.2%), and early postpartum hemorrhage (1.8%). We sought associations to assess possible risk factors, establishing an increased maternal age as an aggravating factor for the development of complications. We also studied gestational complications, finding a higher prevalence of them in older women, such as prematurity (33.11 vs. 34.48 years), gestational diabetes (33.11 vs. 36.06 years), and preeclampsia (33.25 vs. 35 years). Conclusions: Maternal age is a risk factor for first-trimester spontaneous miscarriage and for the development of complications of pregnancy. It is crucial to perform a correct screening of different pathologies throughout the pregnancy to anticipate potential complications.
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Affiliation(s)
- Laura Baños Cándenas
- Medicine School, Malaga University, 29071 Málaga, Spain
- Obstetrics and Gynecology Service, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | | | - Lucía Castaño Frías
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, 29011 Málaga, Spain
| | - Ernesto González Mesa
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, 29011 Málaga, Spain
- Surgical Specialties, Biochemistry and Immunology Department, Malaga University, 29071 Málaga, Spain
- Biomedical Research Institute of Malaga (IBIMA) Research Group in Maternal-Fetal Medicine, Epigenetics, Women’s Diseases and Reproductive Health, 29071 Málaga, Spain
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186
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Roesler A, Butten K, Calyx C, Holmes-Truscott E, Taylor P. Use and Preferences of Health Apps among Women and Healthcare Professionals Regarding GDM Postpartum Care Related to Diet, Physical Activity, and Weight Management: A Cross-Sectional Survey. Nutrients 2023; 15:3304. [PMID: 37571242 PMCID: PMC10420904 DOI: 10.3390/nu15153304] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) is a common medical complication of pregnancy, which is associated with increased risk of future diabetes. mHealth (mobile health, in this paper applications abbreviated to apps) can facilitate health modifications to decrease future risks. This study aims to understand mHealth app use and preferences among women with past GDM and healthcare professionals (HCP) in Australia. An explorative cross-sectional online survey was disseminated via social media, a national diabetes registry, and professional networks. Descriptive analyses were conducted on valid responses (women with prior GDM: n = 1475; HCP: n = 75). One third (33%) of women with prior GDM have used health apps, and a further 80% of non-app users were open to using a health app if recommended by their HCP. Over half (53%) of HCPs supported health information delivery via mHealth, although only 14% had recommended a health app to women post-GDM, and lack of knowledge about mHealth apps was common. Health app users reported that they preferred tracking features, while non-users desired credible health and dietary information and plans. Expanding mHealth app use could facilitate healthy behaviours, but endorsement by HCPs is important to women and is still currently lacking.
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Affiliation(s)
- Anna Roesler
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
| | - Kaley Butten
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
| | - Cobi Calyx
- School of Humanities and Languages, UNSW Sydney, Sydney, NSW 1466, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Institute for Health Transformation, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia;
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 15-31 Pelham Street, Carlton, VIC 3053, Australia
| | - Pennie Taylor
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
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187
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Zhang Z, Li X, Zhou X, Zhang Y, Gan X, Xu X, Wu H. Association of gestational hypertriglyceridemia, diabetes with serum ferritin levels in early pregnancy: a retrospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1067655. [PMID: 37547304 PMCID: PMC10400314 DOI: 10.3389/fendo.2023.1067655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 10/12/2022] [Accepted: 05/02/2023] [Indexed: 08/08/2023] Open
Abstract
Aims Previous studies showed conflicting results linking body iron stores to the risk of gestational diabetes mellitus (GDM) and dyslipidemia. We aim to investigate the relationship between serum ferritin, and the prevalence of GDM, insulin resistance (IR) and hypertriglyceridemia. Methods A total of 781 singleton pregnant women of gestation in Shanghai General Hospital took part in the retrospective cohort study conducted. The participants were divided into four groups by quartiles of serum ferritin levels (Q1-4). Binary logistic regressions were used to examine the strength of association between the different traits and the serum ferritin (sFer) quartiles separately, where Q1 (lowest ferritin quartile) was taken as the base reference. One-way ANOVA was adopted to compare the averages of the different variables across Sfer quartiles. Results Compared with the lowest serum ferritin quartile (Q1), the ORs for Q3, and Q4 in our population were 1.79 (1.01-2.646), and 2.07 (1.089-2.562) respectively and this trend persisted even after adjusted for age and pre-BMI. Women with higher serum ferritin quartile including Q3 (OR=2.182, 95%CI=1.729-5.527, P=0.003) and Q4(OR=3.137, 95%CI=3.137-8.523, P<0.01)are prone to develop insulin resistance disorders. No significant difference was observed between sFer concentrations and gestational hypertriglyceridemia(GTG) in the comparison among these 4 groups across logistic regressions but TG was found positively correlated with increased ferritin values in the second trimester. Conclusions Increased concentrations of plasma ferritin in early pregnancy are significantly and positively associated with insulin resistance and incidence of GDM but not gestational dyslipidemia. Further clinical studies are warranted to determine whether it is necessary to encourage pregnant women to take iron supplement as a part of routine antenatal care.
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Affiliation(s)
| | | | | | | | | | | | - Hao Wu
- *Correspondence: XianMing Xu, ; Hao Wu,
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188
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Factor PA, Corpuz H. The Efficacy and Safety of Myo-inositol Supplementation for the Prevention of Gestational Diabetes Mellitus in Overweight and Obese Pregnant Women: A Systematic Review and Meta-Analysis. J ASEAN Fed Endocr Soc 2023; 38:102-112. [PMID: 38045667 PMCID: PMC10692440 DOI: 10.15605/jafes.038.02.11] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background Myo-inositol has emerged as one of the preventive therapies for the development of gestational diabetes mellitus in at-risk populations. This systematic review and meta-analysis was conducted to determine the efficacy and safety of myo-inositol in decreasing the incidence of gestational diabetes in overweight and obese pregnant women. Methodology This meta-analysis was conducted using the standard Cochrane methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Inclusion criteria were randomized controlled trials (RCTs) that enrolled overweight and obese pregnant women and used myo-inositol supplementation. The primary outcome was the incidence of gestational diabetes mellitus at 24-28 weeks. Secondary outcomes included cesarean section rate, the incidence of pregnancy-induced hypertension, macrosomia and preterm delivery. Risk ratios (RRs) and 95% confidence intervals (CIs) were used for dichotomous data. Results Six RCTs were included. Compared to standard micronutrient supplementation, standard dose of myo-inositol (4 g) may reduce the incidence of GDM (RR 0.54; CI [0.30, 0.96]; n = 887 women), but the certainty of evidence is low to very low. With low-dose myo-inositol however, evidence is uncertain about its benefit on the incidence of gestational diabetes mellitus in overweight and obese women with RR 0.71; CI [0.14, 3.50]. No adverse effects were noted. For the secondary outcomes, standard dose myo-inositol appears to reduce the incidence of pregnancy-induced hypertension and preterm delivery, but the certainty of evidence is low to very low. Conclusion Current evidence is uncertain on the potential benefit of myo-inositol supplementation in overweight and obese pregnant women. While studies show that 4 g myo-inositol per day may decrease the incidence of GDM, pregnancy-induced hypertension and pre-term birth with no associated risk of serious adverse events, the certainty of evidence is low to very low. Future high-quality trials may provide more compelling evidence to support practice recommendations.
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Affiliation(s)
- Patricia Ann Factor
- Department of Obstetrics and Gynecology, University of the Philippines - Philippine General Hospital
| | - Hannah Corpuz
- Department of Internal Medicine, Ilocos Training and Regional Medical Center, San Fernando, La Union, Philippines
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189
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Teixeira RA, Silva C, Ferreira AC, Martins D, Leite-Moreira A, Miranda IM, Barros AS. The Association between Gestational Diabetes and the Microbiome: A Systematic Review and Meta-Analysis. Microorganisms 2023; 11:1749. [PMID: 37512921 PMCID: PMC10385443 DOI: 10.3390/microorganisms11071749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/16/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Gestational diabetes, affecting about 10% of pregnancies, is characterized by impaired glucose regulation and can lead to complications for health of pregnant women and their offspring. The microbiota, the resident microbes within the body, have been linked to the development of several metabolic conditions. This systematic review with meta-analysis aims to summarize the evidence on the differences in microbiota composition in pregnant women with gestational diabetes and their offspring compared to healthy pregnancies. A thorough search was conducted in the PubMed, Scopus, and Web of Science databases, and data from 21 studies were analyzed utilizing 41 meta-analyses. In the gut microbiota, Bifidobacterium and Alistipes were found to be more abundant in healthy pregnancies, while Roseburia appears to be more abundant in gestational diabetes. The heterogeneity among study findings regarding the microbiota in the meconium is considerable. The placental microbiota exhibited almost no heterogeneity, with an increased abundance of Firmicutes in the gestational diabetes group and a higher abundance of Proteobacteria in the control. The role of the microbiota in gestational diabetes is reinforced by these findings, which additionally point to the potential of microbiome-targeted therapies. To completely comprehend the interactions between gestational diabetes and the microbiome, standardizing methodologies and further research is necessary.
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Affiliation(s)
- Rita Almeida Teixeira
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - Cláudia Silva
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - António Carlos Ferreira
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - Diana Martins
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - Isabel M Miranda
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - António S Barros
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
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190
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Ahrens KA, Palmsten K, Lipkind HS, Pfeiffer M, Gelsinger C, Ackerman-Banks C. Mental Health Within 24 Months After Delivery Among Women with Common Pregnancy Conditions. J Womens Health (Larchmt) 2023; 32:787-800. [PMID: 37192449 PMCID: PMC10354313 DOI: 10.1089/jwh.2022.0367] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Objective: The aim of this study is to estimate the risk of a new mental health diagnosis within the first 24 months postpartum among women with common pregnancy conditions, overall and by rurality. Materials and Methods: This longitudinal population-based study used the Maine Health Data Organization's All-Payer Claims Data to estimate the cumulative risk of a new mental health disorder diagnosis in the first 24 months postpartum among women with deliveries during 2007-2019 and who did not have a mental health diagnosis before pregnancy. Cox models were used to estimate hazard ratios for common pregnancy conditions (prenatal depression, gestational diabetes [GDM], and hypertensive disorders of pregnancy [HDP]) on the new diagnosis of five mental health conditions, separately. Models were adjusted for maternal demographics and pregnancy characteristics. Results: Of the 123,125 deliveries, the cumulative risk of being diagnosed in the first 24 months postpartum with depression was 28%, anxiety 25%, bipolar disorder 3%, post-traumatic stress disorder 6%, and schizophrenia/psychotic disorder 1%. Women with prenatal depression were at higher risk of having a postpartum mental health diagnosis compared with women without prenatal depression (adjusted hazard ratios [aHRs] ranged from 2.5 [for anxiety] to 4.1 [for postpartum depression]). Risk of having postpartum depression was modestly higher among women with HDP, as was the risk of postpartum bipolar disorder among those with GDM. Findings were generally similar between women living in rural versus urban areas. Conclusions: Effective interventions to prevent, screen, and treat mental health conditions among women with pregnancy complications for an extended time postpartum are warranted.
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Affiliation(s)
- Katherine A. Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mariah Pfeiffer
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Catherine Gelsinger
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Christina Ackerman-Banks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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191
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Ekici Avci M, Tosun Ö. Evaluation of subclinical atherosclerosis and cardiac functions in children of mothers with gestational diabetes and maternal obesity. Cardiol Young 2023; 33:1157-1164. [PMID: 35903027 DOI: 10.1017/s1047951122002402] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIMS We aimed to evaluate the effects of maternal obesity or gestational diabetes on body composition, lipid, and glucose metabolism, arterial morphology, and functions in children, and to investigate these effects in terms of cardiometabolic diseases. METHODS The study group was composed of 48 children who had a history of gestational diabetes or maternal obesity, and the control group was composed of 33 children. Echocardiographic assessments were performed. Socio-economic status and education level of mothers were obtained. RESULTS In the study group, carotid intima-media thickness, epicardial adipose tissue thickness, and arterial stiffness values were found to be significantly higher compared to the control group (p < 0.001, p < 0.001, p = 0.003, respectively), while arterial distensibility and arterial strain values were found to be significantly lower (p = 0.003, p = 0.008, respectively). Among the children who had similar body mass index in both groups, children in the study group had higher carotid intima-media thickness and epicardial adipose tissue thickness values. Arterial stiffness values were significantly reduced (p = 0.028) and arterial distensibility and strain values were significantly increased (p = 0.039, p = 0.033, respectively) in the children whose mothers had gestational diabetes and high socio-economic status. Left ventricular mass and left ventricular end-diastolic internal thickness were found to be significantly increased in the children who had obese and unemployed mothers (p = 0.04, p = 0.03, respectively). CONCLUSION Low socio-economic status was found to be associated with increased maternal obesity and gestational diabetes. Poor socio-economic status, poor glycaemic control and being overweight during pregnancy indicate negative cardiometabolic outcomes for children in the long term.
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Affiliation(s)
- Melda Ekici Avci
- Department of Pediatrics, Istanbul Medeniyet University, Göztepe Profesör Doktor Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Öykü Tosun
- Department of Pediatric Cardiology, Istanbul Medeniyet University, Göztepe Profesör Doktor Süleyman Yalçın City Hospital, Istanbul, Turkey
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Tosti G, Barberio A, Tartaglione L, Rizzi A, Di Leo M, Viti L, Sirico A, De Carolis S, Pontecorvi A, Lanzone A, Pitocco D. Lights and shadows on the use of metformin in pregnancy: from the preconception phase to breastfeeding and beyond. Front Endocrinol (Lausanne) 2023; 14:1176623. [PMID: 37409227 PMCID: PMC10319127 DOI: 10.3389/fendo.2023.1176623] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/17/2023] [Indexed: 07/07/2023] Open
Abstract
During pregnancy, the complex hormonal changes lead to a progressive decrease of insulin sensitivity that can drive the onset of gestational diabetes (GDM) or worsen an already-known condition of insulin resistance like type 2 diabetes, polycystic ovarian syndrome (PCOS), and obesity, with complications for the mother and the fetus. Metformin during pregnancy is proving to be safe in a growing number of studies, although it freely crosses the placenta, leading to a fetal level similar to maternal concentration. The aim of this literature review is to analyze the main available evidence on the use of metformin during, throughout, and beyond pregnancy, including fertilization, lactation, and medium-term effects on offspring. Analyzed studies support the safety and efficacy of metformin during pregnancy. In pregnant women with GDM and type 2 diabetes, metformin improves obstetric and perinatal outcomes. There is no evidence that it prevents GDM in women with pregestational insulin resistance or improves lipid profile and risk of GDM in pregnant women with PCOS or obesity. Metformin could have a role in reducing the risk of preeclampsia in pregnant women with severe obesity, the risk of late miscarriages and preterm delivery in women with PCOS, and the risk of ovarian hyperstimulation syndrome, increasing the clinical pregnancy rate in women with PCOS undergoing in vitro fertilization (IVF/FIVET). Offspring of mothers with GDM exposed to metformin have no significant differences in body composition compared with insulin treatment, while it appears to be protective for metabolic and cardiovascular risk.
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Affiliation(s)
- Giulia Tosti
- Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Annarita Barberio
- Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Mauro Di Leo
- Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Luca Viti
- Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Angelo Sirico
- Catholic University School of Medicine, Rome, Italy
- Department of Woman and Child Health, Woman Health Area Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Sara De Carolis
- Catholic University School of Medicine, Rome, Italy
- Department of Woman and Child Health, Woman Health Area Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alfredo Pontecorvi
- Catholic University School of Medicine, Rome, Italy
- Department of Endocrinology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Antonio Lanzone
- Catholic University School of Medicine, Rome, Italy
- Department of Woman and Child Health, Woman Health Area Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Catholic University School of Medicine, Rome, Italy
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Martins MG, Silver Z, Ayoub K, Hyland L, Woodside B, Kiss ACI, Abizaid A. Maternal glucose intolerance during pregnancy affects offspring POMC expression and results in adult metabolic alterations in a sex-dependent manner. Front Endocrinol (Lausanne) 2023; 14:1189207. [PMID: 37396180 PMCID: PMC10311085 DOI: 10.3389/fendo.2023.1189207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Gestational diabetes (GDM) is associated with negative outcomes in mothers and their offspring, including greater risks of macrosomia at birth and the development of metabolic disorders. While these outcomes are well-established, the mechanisms by which this increased metabolic vulnerability is conferred on the offspring are comparatively lacking. One proposed mechanism is that maternal glycemic dysregulation alters the development of the hypothalamic regions related to metabolism and energy balance. Methods To investigate this possibility, in this study, we first examined the effects of STZ-induced maternal glucose intolerance on the offspring on pregnancy day (PD) 19, and, in a second experiment, in early adulthood (postnatal day (PND) 60). Whether effects would be influenced by sex, or exposure of offspring to a high-fat diet was also investigated. The impact of maternal STZ treatment on POMC neuron number in the ARC of offspring at both time points was also examined. Results As expected, STZ administration on PD 7 decreased maternal glucose tolerance, and increased risk for macrosomia, and loss of pups at birth. Offspring of STZ-treated mothers were also more vulnerable to developing metabolic impairments in adulthood. These were accompanied by sex-specific effects of maternal STZ treatment in the offspring, including fewer POMC neurons in the ARC of female but not male infants in late pregnancy and a higher number of POMC neurons in the ARC of both male and female adult offspring of STZ-treated dams, which was exacerbated in females exposed to a high-fat diet after weaning. Discussion This work suggests that maternal hyperglycemia induced by STZ treatment, in combination with early-life exposure to an obesogenic diet, leads to adult metabolic alterations that correlate with the increased hypothalamic expression of POMC, showing that maternal glycemic dysregulation can impact the development of hypothalamic circuits regulating energy state with a stronger impact on female offspring.
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Affiliation(s)
- Marina Galleazzo Martins
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- Department of Physiology, Institute of Biosciences of the University of São Paulo (IB/USP), São Paulo, São Paulo, Brazil
| | - Zachary Silver
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Kiara Ayoub
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Lindsay Hyland
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Barbara Woodside
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Ana Carolina Inhasz Kiss
- Department of Physiology, Institute of Biosciences of the University of São Paulo (IB/USP), São Paulo, São Paulo, Brazil
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Alfonso Abizaid
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
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Yang N, Zhang W, Ji C, Ge J, Zhang X, Li M, Wang M, Zhang T, He J, Zhu H. Metabolic alteration of circulating steroid hormones in women with gestational diabetes mellitus and the related risk factors. Front Endocrinol (Lausanne) 2023; 14:1196935. [PMID: 37396163 PMCID: PMC10310992 DOI: 10.3389/fendo.2023.1196935] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Abnormally changed steroid hormones during pregnancy are closely related to the pathological process of gestational diabetes mellitus (GDM). Our aim was to systematically profile the metabolic alteration of circulating steroid hormones in GDM women and screen for risk factors. Methods This study was a case-control study with data measured from 40 GDM women and 70 healthy pregnant women during their 24-28 gestational weeks. 36 kinds of steroid hormones, including 3 kinds of corticosteroids, 2 kinds of progestins, 5 kinds of androgens and 26 kinds of downstream estrogens in serum were systematically measured using a combined sensitive UPLC-MS/MS method. The flux of different metabolic pathways of steroid hormones was analyzed. Logistic regression and ROC curve model analyses were performed to identify potential steroid markers closely associated with GDM development. Results Serum corticosteroids, progestins and almost all the estrogen metabolites via 16-pathway from parent estrogens were higher in GDM women compared with healthy controls. Most of the estrogen metabolites via 4-pathway and more than half of the metabolites via 2-pathway were not significantly different. 16α-hydroxyestrone (16OHE1), estrone-glucuronide/sulfate (E1-G/S) and the ratio of total 2-pathway estrogens to total estrogens were screened as three indicators closely related to the risk of GDM development. The adjusted odds ratios of GDM for the highest quartile compared with the lowest were 72.22 (95% CI 11.27-462.71, P trend <0.001) for 16OHE1 and 6.28 (95% CI 1.74-22.71, P trend <0.05) for E1-G/S. The ratio of 2-pathway estrogens to total estrogens was negatively associated with the risk of GDM. Conclusion The whole metabolic flux from cholesterol to downstream steroid hormones increased in GDM condition. The most significant changes were observed in the 16-pathway metabolism of estrogens, rather than the 2- or 4-pathway or other types of steroid hormones. 16OHE1 may be a strong marker associated with the risk for GDM.
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Affiliation(s)
- Na Yang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Wei Zhang
- Nanjing Qlife Medical Technology Co., Ltd, Nanjing, Jiangsu, China
| | - Cheng Ji
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jiajia Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaoli Zhang
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Meijuan Li
- Nanjing Qlife Medical Technology Co., Ltd, Nanjing, Jiangsu, China
| | - Min Wang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Tianqi Zhang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jun He
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huaijun Zhu
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
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195
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Fasoulakis Z, Koutras A, Antsaklis P, Theodora M, Valsamaki A, Daskalakis G, Kontomanolis EN. Intrauterine Growth Restriction Due to Gestational Diabetes: From Pathophysiology to Diagnosis and Management. Medicina (Kaunas) 2023; 59:1139. [PMID: 37374343 DOI: 10.3390/medicina59061139] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
Intrauterine growth restriction (IUGR) represents a condition where the fetal weight is less than the 10th percentile for gestational age, or the estimated fetal weight is lower than expected based on gestational age. IUGR can be caused by various factors such as maternal, placental or fetal factors and can lead to various complications for both the fetus and the mother, including fetal distress, stillbirth, preterm delivery, and maternal hypertension. Women with gestational diabetes are at an increased risk of developing IUGR. This article reviews the different aspects of gestational diabetes in addition to IUGR, the diagnostic methods available for IUGR detection, including ultrasound and Doppler studies, discusses the management strategies for women with IUGR and gestational diabetes and analyzes the importance of early detection and timely intervention to improve pregnancy outcomes.
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Affiliation(s)
- Zacharias Fasoulakis
- Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Antonios Koutras
- Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Panos Antsaklis
- Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Marianna Theodora
- Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Asimina Valsamaki
- Department of Internal Medicine, General Hospital of Larisa, Tsakalof 1, 41221 Larisa, Greece
| | - George Daskalakis
- Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Emmanuel N Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis-Makris, 68100 Alexandroupolis, Greece
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196
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Giacometti C, Ludwig K, Guidi M, Colantuono E, Coracina A, Rigano M, Cassaro M, Ambrosi A. Gestational Diabetes-Placental Expression of Human Equilibrative Nucleoside Transporter 1 (hENT1): Is Delayed Villous Maturation an Adaptive Pattern? Diagnostics (Basel) 2023; 13:2034. [PMID: 37370929 DOI: 10.3390/diagnostics13122034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a metabolic disease that can affect placental villous maturation and villous vascularity. The main effects of GDM on placental growth are a delay of villous maturation (DVM) and decreased formation of vasculo-syncytial membranes (VSM). Human equilibrative nucleoside transporter-1 (hENT1) is an adenosine transporter expressed in the human umbilical vein endothelial cells (HUVEC) and human placental microvascular endothelium cells (hPMEC). Its role is crucial in maintaining physiological fetal adenosine levels during pregnancy, and its reduction has been described in GDM. Twenty-four placentas from pregnancies with a confirmed diagnosis of GDMd and twenty-four matched non-GDM placentas (controls) were retrospectively analyzed to investigate the immunohistochemical expression of hENT1 in HUVEC and hPMEC. The study included the quantitative evaluation of VSM/mm2 in placental tissue and the immunohistochemical quantitative evaluation of Ki-67, PHH3, and p57 in villous trophoblast. hENT1 expression was higher in all the vascular districts of the control cases compared to the GDMd placentas (p < 0.0001). The VSM/mm2 were lower in the GDMd cases, while the Ki-67, PHH3, and p57 were higher when compared to the control cases. To our knowledge, this is the first report of hENT1 expression in the human placentas of GDM patients. The absence/low expression of hENT1 in all the GDMd patients may indicate a potential role in microvascular adaptative mechanisms. The trophoblasts' proliferative/antiapoptotic pattern (high Ki-67, high PHH3, and high p57 count) may explain the statistically significant lower number of VSM/mm2 found in the GDMd cases.
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Affiliation(s)
- Cinzia Giacometti
- Pathology Unit, Department of Diagnostic Services, ULSS 6 "Euganea", 35131 Padova, Italy
| | - Kathrin Ludwig
- Pathology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Monica Guidi
- Gynecology & Obstretics Unit, Department of Women's Health, Cittadella Hospital, ULSS 6 "Euganea", 35013 Padova, Italy
| | - Elvira Colantuono
- Gynecology & Obstretics Unit, Department of Women's Health, Camposampiero Hospital, ULSS 6 "Euganea", 35012 Padova, Italy
| | - Anna Coracina
- Diabetology Unit, Department of Medicine, Camposampiero Hospital, ULSS 6 "Euganea", 35012 Padova, Italy
| | - Marcello Rigano
- Gynecology & Obstretics Unit, Department of Women's Health, Camposampiero Hospital, ULSS 6 "Euganea", 35012 Padova, Italy
| | - Mauro Cassaro
- Pathology Unit, Department of Diagnostic Services, ULSS 6 "Euganea", 35131 Padova, Italy
| | - Alessandro Ambrosi
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milano, Italy
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197
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Mariana M, Cairrao E. The Relationship between Phthalates and Diabetes: A Review. Metabolites 2023; 13:746. [PMID: 37367903 DOI: 10.3390/metabo13060746] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Since the beginning of their production, in the 1930s, phthalates have been widely used in the plastics industry to provide durability and elasticity to polymers that would otherwise be rigid, or as solvents in hygiene and cosmetic products. Taking into account their wide range of applications, it is easy to understand why their use has been increasing over the years, making them ubiquitous in the environment. This way, all living organisms are easily exposed to these compounds, which have already been classified as endocrine disruptor compounds (EDC), affecting hormone homeostasis. Along with this increase in phthalate-containing products, the incidence of several metabolic diseases has also been rising, namely diabetes. That said, and considering that factors such as obesity and genetics are not enough to explain this substantial increase, it has been proposed that the exposure to environmental contaminants may also be a risk factor for diabetes. Thus, the aim of this work is to review whether there is an association between the exposure to phthalates and the development of the several forms of diabetes mellitus, during pregnancy, childhood, and adulthood.
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Affiliation(s)
- Melissa Mariana
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique s/n, 6200-506 Covilhã, Portugal
- FCS-UBI-Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Elisa Cairrao
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique s/n, 6200-506 Covilhã, Portugal
- FCS-UBI-Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
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Ramezani Tehrani F, Farzadfar F, Hosseinpanah F, Rahmati M, Firouzi F, Abedini M, Hadaegh F, Valizadeh M, Torkestani F, Khalili D, Solaymani-Dodaran M, Bidhendi-Yarandi R, Bakhshandeh M, Ostovar A, Dovom MR, Amiri M, Azizi F, Behboudi-Gandevani S. Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter? Front Endocrinol (Lausanne) 2023; 14:1155007. [PMID: 37334302 PMCID: PMC10273274 DOI: 10.3389/fendo.2023.1155007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives The aim of the study was to investigate the effect of treatment on pregnancy outcomes among women who had fasting plasma glucose (FPG) 5.1-5.6 mmol/l in the first trimester of pregnancy. Methods We performed a secondary-analysis of a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. All pregnant women with FPG values range 5.1-5.6 mmol/l in the first trimester of gestation were included in the present study (n=3297) and classified to either the (i) intervention group who received treatment for GDM along with usual prenatal care (n=1,198), (ii) control group who received usual-prenatal-care (n=2,099). Macrosomia/large for gestational age (LGA) and primary cesarean-section (C-S) were considered as primary-outcomes. A modified-Poisson-regression for binary outcome data with a log link function and robust error variance was used to RR (95%CI) for the associations between GDM status and incidence of pregnancy outcomes. Results The mean maternal age and BMI of pregnant women in both study groups were similar. There were no statistically significant differences in the adjusted risks of adverse pregnancy outcomes, including macrosomia, primary C-S, preterm birth, hyperbilirubinemia, preeclampsia, NICU-admission, birth trauma, and LBW both groups. Conclusions It is found that treating women with first-trimester FPG values of 5.1-5.6 mmol/l could not improve adverse pregnancy outcomes including macrosomia, Primary C-S, Preterm birth, hypoglycemia, hypocalcemia, preeclampsia, NICU admission, Birth trauma and LBW. Therefore, extrapolating the FPG cut-off point of the second trimester to the first -which has been proposed by the IADPSG, might therefore not be appropriate. Clinical Trial Registration https://www.irct.ir/trial/518, identifier IRCT138707081281N1.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faegheh Firouzi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marzieh Bakhshandeh
- Family Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Balke S, Weid P, Fangmann L, Rostin P, Henrich W, Koenigbauer JT. Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM). J Clin Med 2023; 12:3709. [PMID: 37297904 PMCID: PMC10254013 DOI: 10.3390/jcm12113709] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES AND BACKGROUND Gestational diabetes (GDM) is a common pregnancy complication defined as a glucose intolerance diagnosis during pregnancy. GDM is strongly associated with adverse fetal and maternal outcomes. In Germany, to screen and diagnose GDM we use a 1 h 50 g oGCT (oral glucose challenge test) followed by a 2 h 75 g oGTT if the first was pathological. This analysis examines the correlation of 75 g oGTT glucose levels and fetomaternal outcome. METHODS Data from 1664 patients from a gestational diabetes consultation clinic at the Charité University Hospital in Berlin, Germany, were analyzed retrospectively from 2015 to 2022. The 75 g oGTT blood glucose levels were categorized into isolated fasting hyperglycemia (GDM-IFH), isolated post-load hyperglycemia (GDM-IPH) and combined hyperglycemia (GDM-CH), using the levels of the fasting, 1 h and 2 h values, after glucose application. These subtypes were compared based on their baseline characteristics as well as fetal and maternal outcome. RESULTS GDM-IFH and GDM-CH women displayed higher pre-conceptional BMI and required insulin therapy more frequently (p < 0.001). The GDM-IFH group was at higher risk of having a primary cesarean section (p = 0.047), while GDM-IPH women were significantly more likely to have an emergent cesarean section (p = 0.013). The offspring of GDM-IFH and GDM-CH women were born with a significantly higher mean birthweight (p < 0.001) and birth weight percentiles (p < 0.001) and were at increased risk of being large for gestational age (LGA) (p = 0.004). Women from the GDM-IPH group delivered significantly more neonates who were small for gestational age (p = 0.027) or with low fetal weight <30th percentile (p = 0.003). CONCLUSION This analysis shows a strong association between the glucose response pattern in the 75 g oGTT and adverse perinatal fetomaternal outcome. The differences among the subgroups, specifically concerning insulin therapy, mode of delivery and fetal growth, suggest an individualized approach to prenatal care after a GDM diagnosis.
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Affiliation(s)
- Selina Balke
- Department of Obstetrics, Charité-Universitätsmedizin, 10117 Berlin, Germany; (P.W.); (L.F.); (P.R.); (W.H.); (J.T.K.)
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Li X, Zhang B, Ding W, Jia X, Han Z, Zhang L, Hu Y, Shen B, Wang H. Serum Proteomic Signatures in Umbilical Cord Blood of Preterm Neonates Delivered by Women with Gestational Diabetes. Diabetes Metab Syndr Obes 2023; 16:1525-1539. [PMID: 37260850 PMCID: PMC10228520 DOI: 10.2147/dmso.s406297] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
Background Women who develop diabetes during pregnancy are at higher risk of preterm birth. Here, we identified differentially expressed proteins (DEPs) in the serum of umbilical cord blood samples obtained from preterm neonates delivered by women with gestational diabetes to provide therapeutic targets for clinical drug development. Materials and Methods Umbilical cord blood was collected after delivery of preterm neonates by women with gestational diabetes and after delivery of healthy neonates by women without diabetes. DEPs in the serum samples were identified using liquid chromatography-tandem mass spectrometry. Gene Ontology (GO), cluster analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) were used to determine the biological functions associated with these DEPs. Enzyme linked immunosorbent assay was used to confirm the key DEPs. Results We found that 21 proteins were significantly upregulated, and 51 proteins were significantly downregulated in 72 DEPs in serum samples. GO analyses showed that the DEPs were mainly associated with the GO terms cellular process, biological regulation, cellular anatomical entity, and binding. KEGG signaling pathway analysis indicated that most of the upregulated DEPs were associated with the complement and coagulation cascades, Staphylococcus aureus infection, pertussis, HIF-1 signaling pathway and PPAR signaling pathway and that most of the downregulated DEPs were associated with the complement and coagulation cascades, dilated cardiomyopathy, pathways in cancer, Chagas disease, and hypertrophic cardiomyopathy. The results of KEGG pathway annotation and enrichment analyses indicated that changes in the complement and coagulation cascades may be importantly associated with preterm delivery of neonates by women with gestational diabetes. The key DEPs were confirmed by enzyme linked immunosorbent assay. Conclusion Our proteomics and bioinformatics analyses identified several key proteins and the complement and coagulation cascades pathway that warrant further investigation as potential novel therapeutic targets in preterm delivery among women with gestational diabetes.
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Affiliation(s)
- Xiaoyan Li
- Department of Pediatrics, Anhui Province Maternity and Child Health Hospital, Hefei, Anhui, 230001, People’s Republic of China
| | - Bin Zhang
- Department of Pediatrics, Anhui Province Maternity and Child Health Hospital, Hefei, Anhui, 230001, People’s Republic of China
| | - Wen Ding
- School of Basic Medicine, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Xianfen Jia
- Department of Pediatrics, Anhui Province Maternity and Child Health Hospital, Hefei, Anhui, 230001, People’s Republic of China
| | - Zhen Han
- Department of Pediatrics, Anhui Province Maternity and Child Health Hospital, Hefei, Anhui, 230001, People’s Republic of China
| | - Lin Zhang
- School of Basic Medicine, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Yifeng Hu
- School of Basic Medicine, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Bing Shen
- School of Basic Medicine, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Huiqin Wang
- Department of Pediatrics, Anhui Province Maternity and Child Health Hospital, Hefei, Anhui, 230001, People’s Republic of China
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