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Yildiz EG, Tanacan A, Okutucu G, Bastemur AG, Ipek G, Sahin D. Can System Inflammation Response Index or Systemic Immune Inflammation Index predict gestational diabetes mellitus in the first trimester? A prospective observational study. Int J Gynaecol Obstet 2024; 166:837-843. [PMID: 38426227 DOI: 10.1002/ijgo.15442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate System Inflammation Response Index (SIRI) and Systemic Immune Inflammation Index (SII), which are the inflammatory indices, for the prediction of gestational diabetes mellitus (GDM) in the first trimester. METHODS This was a prospective observational study conducted in a tertiary center from April 2023 to September 2023. Ninety-four pregnant women with gestational diabetes and 107 healthy pregnant women were included. The two groups were compared according to first-trimester SIRI and SII values. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off levels of SII and SIRI in predicting GDM. RESULTS Significantly higher first-trimester SII and SIRI values were present in the gestational diabetes group (P < 0.001). Optimal cut-off values in the prediction of gestational diabetes were found to be 1.58 (area under the curve [AUC] 0.71, 67% sensitivity, 65% specificity, 95% confidence interval [CI] 0.64-0.78, P < 0.001) and 875 (AUC 0.70, 66% sensitivity, 65% specificity, 95% CI 0.63-0.77, P < 0.001) for SIRI and SII, respectively. Neutrophil counts, mean platelet volume (MPW), neutrophil to lymphocyte ratio (NLR), and red cell distribution width (RDW) were significantly higher in the GDM group (P < 0.001, P = 0.02, P = 0.01, P < 0.01, respectively). CONCLUSION Novel inflammatory indices SII and SIRI may be useful in the prediction of GDM in the first trimester, but their utility in the prediction of insulin requirement is questionable. They may be used as additional tools in routine clinical practice.
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Affiliation(s)
- Esra Gulen Yildiz
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Gulcan Okutucu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Ayse Gulcin Bastemur
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Goksun Ipek
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, Hivert MF, Immanuel J, Meek C, Oppermann ML, Nolan CJ, Ram U, Schmidt MI, Simmons D, Chivese T, Benhalima K. Epidemiology and management of gestational diabetes. Lancet 2024; 404:175-192. [PMID: 38909620 DOI: 10.1016/s0140-6736(24)00825-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.
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Affiliation(s)
- Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Wesley Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Friedman School of Nutrition Science and Policy, Tufts University School of Medicine, Tufts University, Boston, MA, USA
| | - Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Willliam H Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marie-France Hivert
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Pilgrim Health Care Institute, Harvard Medical School, Harvard University, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Sydney, NSW, Australia; Texas Woman's University, Denton, TX, USA
| | - Claire Meek
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Maria Lucia Oppermann
- Department of Obstetrics and Gynecology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Department of Endocrinology, Canberra Health Services, Woden, ACT, Australia
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, India
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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de Brun M, Magnuson A, Montgomery S, Patil S, Simmons D, Berntorp K, Jansson S, Wennerholm UB, Wikström AK, Strevens H, Ahlsson F, Sengpiel V, Schwarcz E, Storck-Lindholm E, Persson M, Petersson K, Ryen L, Ursing C, Hildén K, Backman H. Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: A stepped wedge cluster randomised trial. PLoS Med 2024; 21:e1004420. [PMID: 38976676 PMCID: PMC11262657 DOI: 10.1371/journal.pmed.1004420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 07/22/2024] [Accepted: 05/29/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The World Health Organisation (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) has been criticised due to the limited evidence of benefits on pregnancy outcomes in different populations when switching from previously higher glycemic thresholds to the lower WHO-2013 diagnostic criteria. The aim of this study was to determine whether the switch from previous Swedish (SWE-GDM) to the WHO-2013 GDM criteria in Sweden following risk factor-based screening improves pregnancy outcomes. METHODS AND FINDINGS A stepped wedge cluster randomised trial was performed between January 1 and December 31, 2018 in 11 clusters (17 delivery units) across Sweden, including all pregnancies under care and excluding preexisting diabetes, gastric bypass surgery, or multifetal pregnancies from the analysis. After implementation of uniform clinical and laboratory guidelines, a number of clusters were randomised to intervention (switch to WHO-2013 GDM criteria) each month from February to November 2018. The primary outcome was large for gestational age (LGA, defined as birth weight >90th percentile). Other secondary and prespecified outcomes included maternal and neonatal birth complications. Primary analysis was by modified intention to treat (mITT), excluding 3 clusters that were randomised before study start but were unable to implement the intervention. Prespecified subgroup analysis was undertaken among those discordant for the definition of GDM. Multilevel mixed regression models were used to compare outcome LGA between WHO-2013 and SWE-GDM groups adjusted for clusters, time periods, and potential confounders. Multiple imputation was used for missing potential confounding variables. In the mITT analysis, 47 080 pregnancies were included with 6 882 (14.6%) oral glucose tolerance tests (OGTTs) performed. The GDM prevalence increased from 595/22 797 (2.6%) to 1 591/24 283 (6.6%) after the intervention. In the mITT population, the switch was associated with no change in primary outcome LGA (2 790/24 209 (11.5%) versus 2 584/22 707 (11.4%)) producing an adjusted risk ratio (aRR) of 0.97 (95% confidence interval 0.91 to 1.02, p = 0.26). In the subgroup, the prevalence of LGA was 273/956 (28.8%) before and 278/1 239 (22.5%) after the switch, aRR 0.87 (95% CI 0.75 to 1.01, p = 0.076). No serious events were reported. Potential limitations of this trial are mainly due to the trial design, including failure to adhere to guidelines within and between the clusters and influences of unidentified temporal variations. CONCLUSIONS In this study, implementing the WHO-2013 criteria in Sweden with risk factor-based screening did not significantly reduce LGA prevalence defined as birth weight >90th percentile, in the total population, or in the subgroup discordant for the definition of GDM. Future studies are needed to evaluate the effects of treating different glucose thresholds during pregnancy in different populations, with different screening strategies and clinical management guidelines, to optimise women's and children's health in the short and long term. TRIAL REGISTRATION The trial is registered with ISRCTN (41918550).
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Affiliation(s)
- Maryam de Brun
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Snehal Patil
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - David Simmons
- School of Medical Science, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Macarthur Clinical School, Western Sydney University, Campbelltown, Australia
| | - Kerstin Berntorp
- Genetics and Diabetes Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Stefan Jansson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden
| | - Anna-Karin Wikström
- Department of Women’s and Children’s Health, Uppsala University; Uppsala University Hospital, Uppsala, Sweden
| | - Helen Strevens
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Fredrik Ahlsson
- Department of Women’s and Children’s Health, Uppsala University; Uppsala University Hospital, Uppsala, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden
| | - Erik Schwarcz
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Martina Persson
- Department of Clinical Science and Education Karolinska Institute, Department of Medicine, Clinical Epidemiology Karolinska Institutet and Sachsska Childrens’and Youth Hospital Stockholm, Stockholm, Sweden
| | - Kerstin Petersson
- Department of Obstetrics and Gynaecology Södersjukhuset, Umeå University, Umeå, Sweden
| | - Linda Ryen
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Carina Ursing
- Department of Endocrinology and Diabetology, Södersjukhuset, Stockholm, Sweden
| | - Karin Hildén
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Helena Backman
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Zhu K, Wang L, Xiao Y, Zhang X, You G, Chen Y, Wang Q, Zhao L, Zhou H, Chen G. Nanomaterial-related hemoglobin-based oxygen carriers, with emphasis on liposome and nano-capsules, for biomedical applications: current status and future perspectives. J Nanobiotechnology 2024; 22:336. [PMID: 38880905 PMCID: PMC11180412 DOI: 10.1186/s12951-024-02606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/30/2024] [Indexed: 06/18/2024] Open
Abstract
Oxygen is necessary for life and plays a key pivotal in maintaining normal physiological functions and treat of diseases. Hemoglobin-based oxygen carriers (HBOCs) have been studied and developed as a replacement for red blood cells (RBCs) in oxygen transport due to their similar oxygen-carrying capacities. However, applications of HBOCs are hindered by vasoactivity, oxidative toxicity, and a relatively short circulatory half-life. With advancements in nanotechnology, Hb encapsulation, absorption, bioconjugation, entrapment, and attachment to nanomaterials have been used to prepare nanomaterial-related HBOCs to address these challenges and pend their application in several biomedical and therapeutic contexts. This review focuses on the progress of this class of nanomaterial-related HBOCs in the fields of hemorrhagic shock, ischemic stroke, cancer, and wound healing, and speculates on future research directions. The advancements in nanomaterial-related HBOCs are expected to lead significant breakthroughs in blood substitutes, enabling their widespread use in the treatment of clinical diseases.
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Affiliation(s)
- Kai Zhu
- Academy of Military Medical Sciences, Beijing, 100850, China
| | - Lijun Wang
- Academy of Military Medical Sciences, Beijing, 100850, China
- Department of Morphology Laboratory, Zhuhai Campus of Zunyi Medical University, Zhuhai, 519041, China
| | - Yao Xiao
- Academy of Military Medical Sciences, Beijing, 100850, China
| | - Xiaoyong Zhang
- Academy of Military Medical Sciences, Beijing, 100850, China
| | - Guoxing You
- Academy of Military Medical Sciences, Beijing, 100850, China
| | - Yuzhi Chen
- Academy of Military Medical Sciences, Beijing, 100850, China
| | - Quan Wang
- Academy of Military Medical Sciences, Beijing, 100850, China
| | - Lian Zhao
- Academy of Military Medical Sciences, Beijing, 100850, China.
| | - Hong Zhou
- Academy of Military Medical Sciences, Beijing, 100850, China.
| | - Gan Chen
- Academy of Military Medical Sciences, Beijing, 100850, China.
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Li T, Xu M, Wang Y, Wang Y, Tang H, Duan H, Zhao G, Zheng M, Hu Y. Prediction model of preeclampsia using machine learning based methods: a population based cohort study in China. Front Endocrinol (Lausanne) 2024; 15:1345573. [PMID: 38919479 PMCID: PMC11198873 DOI: 10.3389/fendo.2024.1345573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Preeclampsia is a disease with an unknown pathogenesis and is one of the leading causes of maternal and perinatal morbidity. At present, early identification of high-risk groups for preeclampsia and timely intervention with aspirin is an effective preventive method against preeclampsia. This study aims to develop a robust and effective preeclampsia prediction model with good performance by machine learning algorithms based on maternal characteristics, biophysical and biochemical markers at 11-13 + 6 weeks' gestation, providing an effective tool for early screening and prediction of preeclampsia. Methods This study included 5116 singleton pregnant women who underwent PE screening and fetal aneuploidy from a prospective cohort longitudinal study in China. Maternal characteristics (such as maternal age, height, pre-pregnancy weight), past medical history, mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein A, and placental growth factor were collected as the covariates for the preeclampsia prediction model. Five classification algorithms including Logistic Regression, Extra Trees Classifier, Voting Classifier, Gaussian Process Classifier and Stacking Classifier were applied for the prediction model development. Five-fold cross-validation with an 8:2 train-test split was applied for model validation. Results We ultimately included 49 cases of preterm preeclampsia and 161 cases of term preeclampsia from the 4644 pregnant women data in the final analysis. Compared with other prediction algorithms, the AUC and detection rate at 10% FPR of the Voting Classifier algorithm showed better performance in the prediction of preterm preeclampsia (AUC=0.884, DR at 10%FPR=0.625) under all covariates included. However, its performance was similar to that of other model algorithms in all PE and term PE prediction. In the prediction of all preeclampsia, the contribution of PLGF was higher than PAPP-A (11.9% VS 8.7%), while the situation was opposite in the prediction of preterm preeclampsia (7.2% VS 16.5%). The performance for preeclampsia or preterm preeclampsia using machine learning algorithms was similar to that achieved by the fetal medicine foundation competing risk model under the same predictive factors (AUCs of 0.797 and 0.856 for PE and preterm PE, respectively). Conclusions Our models provide an accessible tool for large-scale population screening and prediction of preeclampsia, which helps reduce the disease burden and improve maternal and fetal outcomes.
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Affiliation(s)
- Taishun Li
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Medical Statistics and Analysis Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Mingyang Xu
- Information Management Division, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuan Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ya Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Huirong Tang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Honglei Duan
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Guangfeng Zhao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Mingming Zheng
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Design, rationale and protocol for Glycemic Observation and Metabolic Outcomes in Mothers and Offspring (GO MOMs): an observational cohort study. BMJ Open 2024; 14:e084216. [PMID: 38851233 PMCID: PMC11163666 DOI: 10.1136/bmjopen-2024-084216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/09/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Given the increasing prevalence of both obesity and pre-diabetes in pregnant adults, there is growing interest in identifying hyperglycaemia in early pregnancy to optimise maternal and perinatal outcomes. Multiple organisations recommend first-trimester diabetes screening for individuals with risk factors; however, the benefits and drawbacks of detecting glucose abnormalities more mild than overt diabetes in early gestation and the best screening method to detect such abnormalities remain unclear. METHODS AND ANALYSIS The goal of the Glycemic Observation and Metabolic Outcomes in Mothers and Offspring study (GO MOMs) is to evaluate how early pregnancy glycaemia, measured using continuous glucose monitoring and oral glucose tolerance testing, relates to the diagnosis of gestational diabetes (GDM) at 24-28 weeks' gestation (maternal primary outcome) and large-for-gestational-age birth weight (newborn primary outcome). Secondary objectives include relating early pregnancy glycaemia to other adverse pregnancy outcomes and comprehensively detailing longitudinal changes in glucose over the course of pregnancy. GO MOMs enrolment began in April 2021 and will continue for 3.5 years with a target sample size of 2150 participants. ETHICS AND DISSEMINATION GO MOMs is centrally overseen by Vanderbilt University's Institutional Review Board and an Observational Study Monitoring Board appointed by National Institute of Diabetes and Digestive and Kidney Diseases. GO MOMs has potential to yield data that will improve understanding of hyperglycaemia in pregnancy, elucidate better approaches for early pregnancy GDM screening, and inform future clinical trials of early GDM treatment. TRIAL REGISTRATION NUMBER NCT04860336.
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Haque MM, Tannous WK, Herman WH, Immanuel J, Hague WM, Teede H, Enticott J, Cheung NW, Hibbert E, Nolan CJ, Peek MJ, Wong VW, Flack JR, Mclean M, Sweeting A, Gianatti E, Kautzky-Willer A, Jürgen Harreiter, Mohan V, Backman H, Simmons D. Cost-effectiveness of diagnosis and treatment of early gestational diabetes mellitus: economic evaluation of the TOBOGM study, an international multicenter randomized controlled trial. EClinicalMedicine 2024; 71:102610. [PMID: 38813447 PMCID: PMC11133791 DOI: 10.1016/j.eclinm.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/31/2024] Open
Abstract
Background A recently undertaken multicenter randomized controlled trial (RCT) "Treatment Of BOoking Gestational diabetes Mellitus" (TOBOGM: 2017-2022) found that the diagnosis and treatment of pregnant women with early gestational diabetes mellitus (GDM) improved pregnancy outcomes. Based on data from the trial, this study aimed to assess the cost-effectiveness of diagnosis and treatment of early GDM (from <20 weeks') among women with risk factors for hyperglycemia in pregnancy compared with usual care (no treatment until 24-28 weeks') from a healthcare perspective. Methods Participants' healthcare resource utilization data were collected from their self-reported questionnaires and hospital records, and valued using the unit costs obtained from standard Australian national sources. Costs were reported in US dollars ($) using the purchasing power parity (PPP) estimates to facilitate comparison of costs across countries. Intention-to-treat (ITT) principle was followed. Missing cost data were replaced using multiple imputations. Bootstrapping method was used to estimate the uncertainty around mean cost difference and cost-effectiveness results. Bootstrapped cost-effect pairs were used to plot the cost-effectiveness (CE) plane and cost-effectiveness acceptability curve (CEAC). Findings Diagnosis and treatment of early GDM was more effective and tended to be less costly, i.e., dominant (cost-saving) [-5.6% composite adverse pregnancy outcome (95% CI: -10.1%, -1.2%), -$1373 (95% CI: -$3,749, $642)] compared with usual care. Our findings were confirmed by both the CE plane (88% of the bootstrapped cost-effect pairs fall in the south-west quadrant), and CEAC (the probability of the intervention being cost-effective ranged from 84% at a willingness-to-pay (WTP) threshold value of $10,000-99% at a WTP threshold value of $100,000 per composite adverse pregnancy outcome prevented). Sub-group analyses demonstrated that diagnosis and treatment of early GDM among women in the higher glycemic range (fasting blood glucose 95-109 mg/dl [5.3-6.0 mmol/L], 1-h blood glucose ≥191 mg/dl [10.6 mmol/L] and/or 2-h blood glucose 162-199 mg/dl [9.0-11.0 mmol/L]) was more effective and less costly (dominant) [-7.8% composite adverse pregnancy outcome (95% CI: -14.6%, -0.9%), -$2795 (95% CI: -$6,638, -$533)]; the intervention was more effective and tended to be less costly [-8.9% composite adverse pregnancy outcome (95% CI: -15.1%, -2.6%), -$5548 (95% CI: -$16,740, $1547)] among women diagnosed before 14 weeks' gestation as well. Interpretation Our findings highlight the potential health and economic benefits from the diagnosis and treatment of early GDM among women with risk factors for hyperglycemia in pregnancy and supports its implementation. Long-term follow-up studies are recommended as a key future area of research to assess the potential long-term health benefits and economic consequences of the intervention. Funding National Health and Medical Research Council (grants 1104231 and 2009326), Region O¨rebro Research Committee (grants Dnr OLL-970566 and OLL-942177), Medical Scientific Fund of the Mayor of Vienna (project 15,205 and project 23,026), South Western Sydney Local Health District Academic Unit (grant 2016), and Western Sydney University Ainsworth Trust Grant (2019).
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Affiliation(s)
- Mohammad M. Haque
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - W. Kathy Tannous
- School of Business, Western Sydney University, Parramatta, NSW, Australia
| | - William H. Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - William M. Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | | | | | - N. Wah Cheung
- Westmead Hospital and University of Sydney, Westmead, NSW, Australia
| | - Emily Hibbert
- Nepean Clinical School, University of Sydney and Nepean Hospital, Nepean, NSW, Australia
| | - Christopher J. Nolan
- Canberra Hospital, Canberra, ACT, Australia
- Australian National University, Canberra, ACT, Australia
| | | | - Vincent W. Wong
- Liverpool Hospital, Liverpool and University of New South Wales, NSW, Australia
| | - Jeff R. Flack
- Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Mark Mclean
- Blacktown Hospital, Blacktown, NSW, Australia
| | - Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Emily Gianatti
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch, WA, Australia
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Department of Medicine, Landesklinikum Scheibbs, Scheibbs, Austria
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Center and Madras Diabetes Research Foundation, Chennai, India
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - TOBOGM Consortium
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- School of Business, Western Sydney University, Parramatta, NSW, Australia
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, United States
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Monash University, Melbourne, VIC, Australia
- Westmead Hospital and University of Sydney, Westmead, NSW, Australia
- Nepean Clinical School, University of Sydney and Nepean Hospital, Nepean, NSW, Australia
- Canberra Hospital, Canberra, ACT, Australia
- Australian National University, Canberra, ACT, Australia
- Liverpool Hospital, Liverpool and University of New South Wales, NSW, Australia
- Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
- Blacktown Hospital, Blacktown, NSW, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch, WA, Australia
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Department of Medicine, Landesklinikum Scheibbs, Scheibbs, Austria
- Dr. Mohan's Diabetes Specialities Center and Madras Diabetes Research Foundation, Chennai, India
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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8
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Vieira L, McCarthy K, Liu SH, Huynh M, Kennedy J, Chan HT, Mayer VL, Tabaei B, Howell F, Wye GV, Howell EA, Janevic T. Predictors and Trends in First-Trimester Hemoglobin A1c Screening in New York City, 2009 to 2017. Am J Perinatol 2024; 41:e2752-e2758. [PMID: 37604202 DOI: 10.1055/a-2157-2944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Glycated hemoglobin is an adjunct tool in early pregnancy to assess glycemic control. We examined trends and maternal predictors for those who had A1c screening in early pregnancy using hospital discharge and vital registry data between 2009 and 2017 linked with the New York City A1C Registry (N = 798,312). First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017. The likelihood of screening became less targeted to high-risk patients over time, with a decrease in mean A1c values from 5.8% (95% confidence interval [CI]: 5.8, 5.9) to 5.3 (95% CI: 5.3, 5.4). The prevalence of gestational diabetes mellitus increased while testing became less discriminate for those with high-risk factors, including pregestational type 2 diabetes, chronic hypertension, obesity, age over 40 years, as well as Asian or Black non-Hispanic race/ethnicity. KEY POINTS: · First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017 in New York City.. · The likelihood of screening became less targeted to high-risk patients over time.. · The prevalence of gestational diabetes mellitus increased, while testing became less discriminate..
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Affiliation(s)
- Luciana Vieira
- Department of Obstetrics and Gynecology, Stamford Health System, Stamford, Connecticut
| | - Katharine McCarthy
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
| | - Shelley H Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
| | - Mary Huynh
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Joseph Kennedy
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Hiu Tai Chan
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Victoria L Mayer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City
| | - Bahman Tabaei
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Frances Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
| | - Gretchen Van Wye
- Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City
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9
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Cabalar I, Le TH, Silber A, O'Hara M, Abdallah B, Parikh M, Busch R. The role of blood testing in prevention, diagnosis, and management of chronic diseases: A review. Am J Med Sci 2024:S0002-9629(24)01169-8. [PMID: 38636653 DOI: 10.1016/j.amjms.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Blood tests are vital to prevention, diagnosis, and management of chronic diseases. Despite this, it can be challenging to construct a comprehensive view of the clinical importance of blood testing because relevant literature is typically fragmented across different disease areas and patient populations. This lack of collated evidence can also make it difficult for primary care providers to adhere to best practices for blood testing across different diseases and guidelines. Thus, this review article synthesizes the recommendations for, and importance of, blood testing across several common chronic conditions encountered in primary care and internal medicine, including cardiovascular diseases, diabetes mellitus, chronic kidney disease, vitamin D deficiency, iron deficiency, and rheumatoid arthritis. Future research is needed to continue improving chronic disease management through clearer dissemination and awareness of clinical guidelines among providers, and better access to blood testing for patients (e.g., via pre-visit laboratory testing).
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Affiliation(s)
- Imelda Cabalar
- Division of Rheumatology, Department of Medicine, Adventist HealthCare Fort Washington Medical Center, Fort Washington, MD, USA
| | - Thu H Le
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | - Robert Busch
- Division of Community Endocrinology, Department of Medicine, Albany Medical Center, Albany, NY, USA.
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10
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Cordier AG, Zerbib E, Favier A, Dabi Y, Daraï E. Value of Non-Coding RNA Expression in Biofluids to Identify Patients at Low Risk of Pathologies Associated with Pregnancy. Diagnostics (Basel) 2024; 14:729. [PMID: 38611642 PMCID: PMC11011513 DOI: 10.3390/diagnostics14070729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Pregnancy-related complications (PRC) impact maternal and fetal morbidity and mortality and place a huge burden on healthcare systems. Thus, effective diagnostic screening strategies are crucial. Currently, national and international guidelines define patients at low risk of PRC exclusively based on their history, thus excluding the possibility of identifying patients with de novo risk (patients without a history of disease), which represents most women. In this setting, previous studies have underlined the potential contribution of non-coding RNAs (ncRNAs) to detect patients at risk of PRC. However, placenta biopsies or cord blood samples are required, which are not simple procedures. Our review explores the potential of ncRNAs in biofluids (fluids that are excreted, secreted, or developed because of a physiological or pathological process) as biomarkers for identifying patients with low-risk pregnancies. Beyond the regulatory roles of ncRNAs in placental development and vascular remodeling, we investigated their specific expressions in biofluids to determine favorable pregnancy outcomes as well as the most frequent pathologies of pregnant women. We report distinct ncRNA panels associated with PRC based on omics technologies and subsequently define patients at low risk. We present a comprehensive analysis of ncRNA expression in biofluids, including those using next-generation sequencing, shedding light on their predictive value in clinical practice. In conclusion, this paper underscores the emerging significance of ncRNAs in biofluids as promising biomarkers for risk stratification in PRC. The investigation of ncRNA expression patterns and their potential clinical applications is of diagnostic, prognostic, and theragnostic value and paves the way for innovative approaches to improve prenatal care and maternal and fetal outcomes.
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Affiliation(s)
| | - Elie Zerbib
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France; (A.-G.C.); (Y.D.)
| | | | | | - Emile Daraï
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France; (A.-G.C.); (Y.D.)
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11
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Paschou SA, Shalit A, Gerontiti E, Athanasiadou KI, Kalampokas T, Psaltopoulou T, Lambrinoudaki I, Anastasiou E, Wolffenbuttel BHR, Goulis DG. Efficacy and safety of metformin during pregnancy: an update. Endocrine 2024; 83:259-269. [PMID: 37798604 PMCID: PMC10850184 DOI: 10.1007/s12020-023-03550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023]
Abstract
During the last decades, gestational diabetes mellitus (GDM) prevalence has been on the rise. While insulin remains the gold standard treatment for GDM, metformin use during pregnancy is controversial. This review aimed to comprehensively assess the available data on the efficacy and safety of metformin during pregnancy, both for the mother and the offspring. Metformin has been validated for maternal efficacy and safety, achieving comparable glycemic control with insulin. Additionally, it reduces maternal weight gain and possibly the occurrence of hypertensive disorders. During the early neonatal period, metformin administration does not increase the risk of congenital anomalies or other major adverse effects, including lower APGAR score at 5 min, neonatal intensive care unit admissions, and respiratory distress syndrome. Several studies have demonstrated a reduction in neonatal hypoglycemia. Metformin has been associated with an increase in preterm births and lower birth weight, although this effect is controversial and depends on the indication for which it was administered. Evidence indicates possible altered fetal programming and predisposition to childhood obesity and metabolic syndrome during adulthood after use of metformin in pregnancy. With critical questions still requiring a final verdict, ongoing research on the field must be conducted.
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Affiliation(s)
- Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Almog Shalit
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Gerontiti
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleoniki I Athanasiadou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Kalampokas
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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Yeung RO, Retnakaran R, Savu A, Butalia S, Kaul P. Gestational diabetes: One size does not fit all-an observational study of maternal and neonatal outcomes by maternal glucose profile. Diabet Med 2024; 41:e15205. [PMID: 37594456 DOI: 10.1111/dme.15205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES To examine obstetrical and neonatal outcomes across maternal glucose profiles at the population level and to explore insulin sensitivity and beta-cell function across profiles in an independent, well-phenotyped cohort for potential pathophysiologic explanation. RESEARCH DESIGN AND METHODS Observational cohort study of all pregnancies with gestational diabetes screening between October 2008 and December 2018 resulting in live singleton birth in Alberta, Canada (n = 436,773) were categorized into seven maternal glucose profiles: (1) normal 50 g-glucose challenge test (nGCT), (2) normal 75-g OGTT (nOGTT), (3) isolated elevated 1 h post-load glucose (ePLPG1), (4) isolated elevated 2 h post-load glucose (ePLPG2), (5) elevated 1 and 2 h post-load glucose (ePLPG12), (6) isolated elevated FPG (eFPG), and (7) elevated FPG + elevated 1-h and/or 2-h PLG (Combined). Primary outcomes were large for gestational age (LGA) and neonatal intensive care unit (NICU) admission rates. An independent observational cohort of 1451 women was examined for measures of beta-cell function (ISSI-2, insulinogenic index/HOMA-IR) and insulin sensitivity/resistance (Matsuda index, HOMA-IR) by similar maternal glucose profiles. RESULTS Pregnancies with elevated FPG, either isolated or combined, had higher adverse events and lower insulin sensitivity. The combination of elevated FPG + elevated 1-h and/or 2-h PLG had the highest rates of LGA(20.9%), NICU admissions (14.7%), and lowest insulin sensitivity as measured by Matsuda index and HOMA-IR, and beta-cell function as measured by ISSI-2 and Insulinogenic index/HOMA-IR. CONCLUSIONS Elevated fasting plasma glucose, either alone or combined with post-load glucose elevation is associated with worse outcomes than isolated post-load glucose elevation, possibly due to higher degrees of insulin resistance. Future work is needed to better understand these differences, and explore whether tailored treatment of GDM can improve neonatal outcomes.
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Affiliation(s)
- Roseanne O Yeung
- Division of Endocrinology & Metabolism and Office of Lifelong Learning/Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Edmonton, Canada
| | - Ravi Retnakaran
- Division of Endocrinology, University of Toronto, Toronto, Canada
| | - Anamaria Savu
- Division of Cardiology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Alberta, Edmonton, Canada
| | - Sonia Butalia
- Division of Endocrinology, Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, Calgary, Canada
| | - Padma Kaul
- Division of Cardiology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Alberta, Edmonton, Canada
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13
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Ramezani Tehrani F, Sheidaei A, Rahmati M, Farzadfar F, Noroozzadeh M, Hosseinpanah F, Abedini M, Hadaegh F, Valizadeh M, Torkestani F, Khalili D, Firouzi F, Solaymani-Dodaran M, Ostovar A, Azizi F, Behboudi-Gandevani S. Various screening and diagnosis approaches for gestational diabetes mellitus and adverse pregnancy outcomes: a secondary analysis of a randomized non-inferiority field trial. BMJ Open Diabetes Res Care 2023; 11:e003510. [PMID: 38164706 PMCID: PMC10729207 DOI: 10.1136/bmjdrc-2023-003510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION We evaluate which screening and diagnostic approach resulted in the greatest reduction in adverse pregnancy outcomes due to increased treatment. RESEARCH DESIGN AND METHODS This study presents a secondary analysis of a randomized community non-inferiority trial conducted among pregnant women participating in the GULF Study in Iran. A total of 35 430 pregnant women were randomly assigned to one of the five prespecified gestational diabetes mellitus (GDM) screening protocols. The screening methods included fasting plasma glucose (FPG) in the first trimester and either a one-step or a two-step screening method in the second trimester of pregnancy. According to the results, participants were classified into 6 groups (1) First-trimester FPG: 100-126 mg/dL, GDM diagnosed at first trimester; (2) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at first trimester; (3) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at second trimester; (4) First trimester FPG: 92-99.9 mg/dL, healthy at second trimester; (5) First trimester FPG<92 mg/dL, GDM diagnosed at second trimester; (6) First trimester FPG<92 mg/dL, healthy at second trimester. For our analysis, we initially used group 6, as the reference and repeated the analysis using group 2, as the reference group. The main outcome of the study was major adverse maternal and neonatal outcomes. RESULTS Macrosomia and primary caesarean section occurred in 9.8% and 21.0% in group 1, 7.8% and 19.8% in group 2, 5.4% and 18.6% in group 3, 6.6% and 21.5% in group 4, 8.3% and 24.0% in group 5, and 5.4% and 20.0% in group 6, respectively. Compared with group 6 as the reference, there was a significant increase in the adjusted risk of neonatal intensive care unit (NICU) admission in groups 1, 3, and 5 and an increased risk of macrosomia in groups 1, 2, and 5. Compared with group 2 as the reference, there was a significant decrease in the adjusted risk of macrosomia in group 3, a decreased risk of NICU admission in group 6, and an increased risk of hyperglycemia in group 3. CONCLUSIONS We conclude that screening approaches for GDM reduced the risk of adverse pregnancy outcomes to the same or near the same risk level of healthy pregnant women, except for the risk of NICU admission that increased significantly in groups diagnosed with GDM compared with healthy pregnant women. Individuals with slight increase in FPG (92-100 mg/dL) at first trimester, who were diagnosed as GDM, had an even increased risk of macrosomia in comparison to those group of women with FPG 92-100 mg/dL in the first trimester, who were not diagnosed with GDM, and developed GDM in second trimester TRIAL REGISTRATION: IRCT138707081281N1 (registered: February 15, 2017).
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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
| | - Ali Sheidaei
- School of Public Health, Department of Epidemiology and Biostatistics, Tehran 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
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Noroozzadeh
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & DiseaseTreatment 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
| | - Faegheh Firouzi
- Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | | | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran 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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14
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Giorgino F, Battelino T, Bergenstal RM, Forst T, Green JB, Mathieu C, Rodbard HW, Schnell O, Wilmot EG. The Role of Ultra-Rapid-Acting Insulin Analogs in Diabetes: An Expert Consensus. J Diabetes Sci Technol 2023:19322968231204584. [PMID: 37937585 DOI: 10.1177/19322968231204584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Ultra-rapid-acting insulin analogs (URAA) are a further development and refinement of rapid-acting insulin analogs. Because of their adapted formulation, URAA provide an even faster pharmacokinetics and thus an accelerated onset of insulin action than conventional rapid-acting insulin analogs, allowing for a more physiologic delivery of exogenously applied insulin. Clinical trials have confirmed the superiority of URAA in controlling postprandial glucose excursions, with a safety profile that is comparable to the rapid-acting insulins. Consequently, many individuals with diabetes mellitus may benefit from URAA in terms of prandial glycemic control. Unfortunately, there are only few available recommendations from authoritative sources for use of URAA in clinical practice. Therefore, this expert consensus report aims to define populations of people with diabetes mellitus for whom URAA may be beneficial and to provide health care professionals with concrete, practical recommendations on how best to use URAA in this context.
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Affiliation(s)
- Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolism, UCH-University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Thomas Forst
- Department of Endocrinology and Metabolic Diseases, Johannes Gutenberg University Medical Center, Mainz, Germany
- Clinical Research Services, Mannheim, Germany
| | - Jennifer B Green
- Division of Endocrinology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Oliver Schnell
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Academic Unit for Translational Medical Sciences, University of Nottingham, Nottingham, England, UK
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15
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Zhong T, Huang YQ, Wang GM. Causal relationship association of cheese intake with gestational hypertension and diabetes result from a Mendelian randomization study. World J Clin Cases 2023; 11:7318-7328. [PMID: 37969456 PMCID: PMC10643065 DOI: 10.12998/wjcc.v11.i30.7318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The evidence from observational studies has been inconclusive on the causal relationship between cheese intake and gestational hypertension or diabetes. AIM To determine whether cheese consumption was causally related to hypertension and diabetes during pregnancy. METHODS This was a two-sample Mendelian randomized (MR) study. Summary-level genetic data for cheese intake was exposure and corresponding outcome data for gestational hypertension and gestational diabetes were extracted from the IEU OpenGWAS database. MR analysis was conducted using inverse variance weighting. For sensitivity analyses, MR-Egger regression, weighted median, weighted mode, and leave-one-out methods were conducted. A fixed-effect model was used to meta-analyze two sample MR estimates. The traits of gestational hypertension were pregnancy hypertension (123579 individuals) and oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium (123579 individuals), and traits of gestational diabetes were gestational diabetes (123579 individuals) and diabetes mellitus in pregnancy (116363 individuals), respectively. RESULTS Cheese intake per standard deviation increase has causally reduced the risks of gestational hypertension [odds ratio (OR) = 0.60, 95% confidence interval (CI): 0.47-0.76, P < 0.001] and gestational diabetes (OR = 0.41, 95%CI: 0.30-0.55, P < 0.001) in inverse variance weighted analysis. Sensitivity analysis showed no heterogeneity (all P > 0.05) nor horizontal pleiotropy (all P > 0.05) in the relationship between cheese intake and gestational hypertension, but heterogeneity presented (all P < 0.05) in relation to gestational diabetes in the two-sample MR analysis. CONCLUSION Cheese intake was inversely associated with gestational hypertension and gestational diabetes in MR analysis, suggesting that cheese consumption may be beneficial in preventing hypertension and diabetes during pregnancy.
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Affiliation(s)
- Tao Zhong
- Department of Cardiology, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Gui-Ming Wang
- Department of Cardiology, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
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16
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Chen XQ, Zheng Q, Liao YP, Jiang XM, Gao XX, Pan YQ, Li J, Liu R. Association between plant-based or animal-based dietary pattern and plasma glucose during oral glucose tolerance test among Chinese women with gestational diabetes mellitus: a prospective cohort study. BMJ Open 2023; 13:e075484. [PMID: 37879688 PMCID: PMC10603417 DOI: 10.1136/bmjopen-2023-075484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This study explored whether plant-based and animal-based dietary patterns are associated with plasma glucose levels during oral glucose tolerance test in women with gestational diabetes mellitus (GDM). DESIGN A prospective cohort study was conducted using a Food Frequency Questionnaire to collect dietary data. Dietary patterns were derived using principal component analysis. Multivariate logistic regression analysis was performed to explore the association between dietary patterns and plasma glucose levels. Stratified analyses were conducted according to maternal age, prepregnancy body mass index (BMI) and other confounders. SETTING AND PARTICIPANTS The study, conducted in January 2022 in two hospitals in Fujian, China, involved 424 women diagnosed with GDM using a 75 g 2-hour oral glucose tolerance test at 24-28 gestational weeks. RESULTS Six maternal dietary patterns (plant based and animal based) were identified. Participants with plant-based pattern had lower 2-hour plasma glucose levels than those with animal-based pattern (β=-0.314; 95% CI (-0.596 to -0.032)). After adjusting the regression model covariates, this significant association remained (β=-0.288; 95% CI (-0.568 to -0.008)) and appeared more pronounced in women aged 30 years or above and those with prepregnancy BMI<24 kg/m2. CONCLUSIONS Plant-based pattern is associated with lower plasma glucose levels in women with GDM, which is valuable information for dietary counselling and intervention.
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Affiliation(s)
- Xiao Qian Chen
- Nursing department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
- Nursing department, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Qingxiang Zheng
- Nursing department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
- Nursing department, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Yan Ping Liao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiu Min Jiang
- Nursing department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiao Xia Gao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yu-Qing Pan
- Nursing department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
- Nursing department, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - JiaNing Li
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - RuLin Liu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
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Yang N, Guo R, Guo Y, Wei Y, An N. Effects of dietary intervention combined with insulin aspart on serum nesfatin-1 and CTRP12 levels and pregnancy outcomes in pregnant women with gestational diabetes mellitus. Medicine (Baltimore) 2023; 102:e35498. [PMID: 37861506 PMCID: PMC10589536 DOI: 10.1097/md.0000000000035498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
To analyze the effects of dietary intervention combined with insulin aspart on the serum levels of nesfatin-1, C1q/TNF related protein-12 (CTRP12), and pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM). In this retrospective cohort study, 513 women with GDM admitted to Tangshan Central Hospital (Tangshan, China) between January 2019 and December 2022 were selected and divided into an observation group (dietary intervention combined with insulin aspart therapy; n = 284) and a control group (insulin aspart therapy, n = 229). The general characteristics, clinical outcomes, serum nesfatin-1 and CTRP12 levels, 2-hour postprandial blood glucose levels, pregnancy outcomes, and perinatal outcomes of the 2 groups were compared. After treatment, the total effective rate in the observation group was significantly higher than that of the control group (97.54% vs 86.03%, respectively; P < .001). Compared with the pretreatment levels, nesfatin-1 and CTRP12 levels were decreased in both groups; nesfatin-1 and CTRP12 levels in the observation group were significantly higher than those in the control group. After treatment, the preprandial and 2-hour postprandial blood glucose levels in the observation group were significantly lower than those in the control group. Compared with the control group, the observation group had significantly fewer cesarean sections, and a significantly lower incidence of postpartum hemorrhage, premature rupture of membranes, and other adverse pregnancy outcomes. After treatment, the risks of preterm birth, macrosomia, fetal distress, neonatal asphyxia, neonatal hypoglycemia, and other adverse perinatal outcomes were significantly lower in the observation group than in the control group. In pregnant women with GDM, dietary intervention combined with insulin aspart can improve clinical outcomes; reduce nesfatin-1, CTRP12, and blood glucose levels; and reduce the incidence of adverse pregnancy outcomes.
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Affiliation(s)
- Na Yang
- Department of Obstetrics, Tangshan Central Hospital, Tangshan, Hebei, China
| | - Runli Guo
- Department of Obstetrics and Gynaecology, Jingxing County Hospital, Shijiazhuang, Hebei, China
| | - Yan Guo
- Department of Obstetrics, Xingtai Third Hospital, Xingtai, Hebei, China
| | - Yongmei Wei
- Department of Obstetrics, Fourth People’s Hospital of Langfang, Langfang, Hebei, China
| | - Nan An
- Department of Obstetrics and Gynaecology, Zhengding County People’s Hospital, Shijiazhuang, Hebei, China
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18
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Fishel Bartal M, Ashby Cornthwaite J, Ghafir D, Ward C, Nazeer SA, Blackwell SC, Pedroza C, Chauhan SP, Sibai BM. Continuous glucose monitoring in individuals undergoing gestational diabetes screening. Am J Obstet Gynecol 2023; 229:441.e1-441.e14. [PMID: 37088275 DOI: 10.1016/j.ajog.2023.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/16/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Among guidelines on gestational diabetes mellitus, there is an incongruity about the threshold of maternal hyperglycemia to diagnose gestational diabetes mellitus. OBJECTIVE This study aimed to ascertain the association between continuous glucose monitoring metrics and adverse outcomes among individuals undergoing gestational diabetes mellitus screening. STUDY DESIGN This was a prospective study (from June 2020 to January 2022) of individuals who underwent 2-step gestational diabetes mellitus screening at ≤30 weeks of gestation. The participants wore a blinded continuous glucose monitoring device (Dexcom G6 Pro; Dexcom, Inc, San Diego, CA) for 10 days starting when they took the 50-g glucose challenge test. The primary outcome was a composite of adverse neonatal outcomes (large for gestational age, shoulder dystocia or neonatal injury, respiratory distress, need for intravenous glucose treatment for hypoglycemia, or fetal or neonatal death). The secondary neonatal outcomes included preterm birth, neonatal intensive care unit admission, hypoglycemia, mechanical ventilation or continuous positive airway pressure, hyperbilirubinemia, and hospital length of stay. The secondary maternal outcomes included weight gain during pregnancy, hypertensive disorders of pregnancy, induction of labor, cesarean delivery, and postpartum complications. Time within the target range (63-140 mg/dL), time above the target range (>140 mg/dL) expressed as a percentage of all continuous glucose monitoring readings, and mean glucose level were analyzed. The Youden index was used to choose the threshold of ≥10% for the time above the target range and association with adverse outcomes. RESULTS Of 136 participants recruited, data were available from 92 individuals (67.6%). The 2-step method diagnosed gestational diabetes mellitus in 2 individuals (2.2%). Continuous glucose monitoring indicated that 17 individuals (18.5%) had time above the target range of ≥10%. Individuals with time above the target range of ≥10% had a significantly higher likelihood of composite adverse neonatal outcomes than individuals with time above the target range of <10% (63% vs 18%; P=.001). Furthermore, compared with neonates born to individuals with time above the target range of <10%, neonates born to individuals with time above the target range of ≥10% had an increased likelihood for hypoglycemia (14.5% vs 47%; P=.009) and had a longer length of stay (2 vs 4 days; P=.03). No difference in maternal outcomes was noted between the groups. CONCLUSION In this prospective study of individuals undergoing gestational diabetes mellitus screening, a cutoff of the time above the target range of ≥10% using continuous glucose monitoring was associated with a higher rate of neonatal adverse outcomes. A randomized trial of continuous glucose monitoring vs 2-step screening for gestational diabetes mellitus to lower the rate of adverse outcomes is underway (identification number: NCT05430204).
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Affiliation(s)
- Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX; Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Joycelyn Ashby Cornthwaite
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Danna Ghafir
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Clara Ward
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Sarah A Nazeer
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Sean C Blackwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
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19
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Maya J, Selen DJ, Thaweethai T, Hsu S, Godbole D, Schulte CC, James K, Sen S, Kaimal A, Hivert MF, Powe CE. Gestational Glucose Intolerance and Birth Weight-Related Complications. Obstet Gynecol 2023; 142:594-602. [PMID: 37539973 PMCID: PMC10527009 DOI: 10.1097/aog.0000000000005278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/13/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To evaluate the risks of large-for-gestational-age birth weight (LGA) and birth weight-related complications in pregnant individuals with gestational glucose intolerance, an abnormal screening glucose loading test result without meeting gestational diabetes mellitus (GDM) criteria. METHODS In a retrospective cohort study of 46,989 individuals with singleton pregnancies who delivered after 28 weeks of gestation, those with glucose loading test results less than 140 mg/dL were classified as having normal glucose tolerance. Those with glucose loading test results of 140 mg/dL or higher and fewer than two abnormal values on a 3-hour 100-g oral glucose tolerance test (OGTT) were classified as having gestational glucose intolerance. Those with two or more abnormal OGTT values were classified as having GDM. We hypothesized that gestational glucose intolerance would be associated with higher odds of LGA (birth weight greater than the 90th percentile for gestational age and sex). We used generalized estimating equations to examine the odds of LGA in pregnant individuals with gestational glucose intolerance compared with those with normal glucose tolerance, after adjustment for age, body mass index, parity, health insurance, race and ethnicity, and marital status. In addition, we investigated differences in birth weight-related adverse pregnancy outcomes. RESULTS Large for gestational age was present in 7.8% of 39,685 pregnant individuals with normal glucose tolerance, 9.5% of 4,155 pregnant individuals with gestational glucose intolerance and normal OGTT, 14.5% of 1,438 pregnant individuals with gestational glucose intolerance and one abnormal OGTT value, and 16.0% of 1,711 pregnant individuals with GDM. The adjusted odds of LGA were higher in pregnant individuals with gestational glucose intolerance than in those with normal glucose tolerance overall (adjusted odds ratio [aOR] 1.35, 95% CI 1.23-1.49, P <.001). When compared separately with pregnant individuals with normal glucose tolerance, those with either gestational glucose intolerance subtype had higher adjusted LGA odds (gestational glucose intolerance with normal OGTT aOR 1.21, 95% CI 1.08-1.35, P <.001; gestational glucose intolerance with one abnormal OGTT value aOR 1.77, 95% CI 1.52-2.08, P <.001). The odds of birth weight-related adverse outcomes (including cesarean delivery, severe perineal lacerations, and shoulder dystocia or clavicular fracture) were higher in pregnant individuals with gestational glucose intolerance with one abnormal OGTT value than in those with normal glucose tolerance. CONCLUSION Gestational glucose intolerance in pregnancy is associated with birth weight-related adverse pregnancy outcomes. Glucose lowering should be investigated as a strategy for lowering the risk of these outcomes in this group.
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Affiliation(s)
- Jacqueline Maya
- Diabetes Unit and Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Daryl J. Selen
- Department of Medicine, Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Tanayott Thaweethai
- Harvard Medical School, Boston, MA, United States
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Sarah Hsu
- Diabetes Unit and Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Boston, MA, United States
| | - Devika Godbole
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Kaitlyn James
- Harvard Medical School, Boston, MA, United States
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Sarbattama Sen
- Harvard Medical School, Boston, MA, United States
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Anjali Kaimal
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Marie-France Hivert
- Diabetes Unit and Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Camille E. Powe
- Diabetes Unit and Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Broad Institute of MIT and Harvard, Boston, MA, United States
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
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20
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Palaszewski D. Prenatal Care for the Obese and Severely Obese Pregnant Patient. Obstet Gynecol Clin North Am 2023; 50:525-534. [PMID: 37500214 DOI: 10.1016/j.ogc.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Modifications of prenatal care will be needed in expected weight gain, nutritional recommendations, screening tests, thromboprophylaxis, ultrasound, antenatal testing, and timing and mode of delivery.
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21
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Mendez Y, Alpuing Radilla LA, Delgadillo Chabolla LE, Castillo Cruz A, Luna J, Surani S. Gestational diabetes mellitus and COVID-19: The epidemic during the pandemic. World J Diabetes 2023; 14:1178-1193. [PMID: 37664480 PMCID: PMC10473953 DOI: 10.4239/wjd.v14.i8.1178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
During the global coronavirus disease 2019 (COVID-19) pandemic, people worldwide have experienced an unprecedented rise in psychological distress and anxiety. In addition to this challenging situation, the prevalence of diabetes mellitus (DM), a hidden epidemic, has been steadily increasing in recent years. Lower-middle-income countries have faced significant barriers in providing accessible prenatal care and promoting a healthy diet for pregnant women, and the pandemic has made these challenges even more difficult to overcome. Pregnant women are at a higher risk of developing complications such as hyper-tension, preeclampsia, and gestational diabetes, all of which can have adverse implications for both maternal and fetal health. The occurrence of gestational diabetes has been on the rise, and it is possible that the pandemic has worsened its prevalence. Although data is limited, studies conducted in Italy and Canada suggest that the pandemic has had an impact on gestational diabetes rates, especially among women in their first trimester of pregnancy. The significant disruptions to daily routines caused by the pandemic, such as limited exercise options, indicate a possible link between COVID-19 and an increased likelihood of experiencing higher levels of weight gain during pregnancy. Notably, individuals in the United States with singleton pregnancies are at a significantly higher risk of excessive gestational weight gain, making this association particularly important to consider. Although comprehensive data is currently lacking, it is important for clinical researchers to explore the possibility of establishing correlations between the stress experienced during the pandemic, its consequences such as gestational gain weight, and the increasing incidence of gestational DM. This knowledge would contribute to better preventive measures and support for pregnant individuals during challenging times.
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Affiliation(s)
- Yamely Mendez
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Linda A Alpuing Radilla
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
| | | | - Alejandra Castillo Cruz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Johanan Luna
- Department of Medicine, Xochicalco University, Mexicali 21376, BC, Mexico
- Department of Medicine, Mt. Olympus Medical Research, Sugarland, TX 77479, United States
| | - Salim Surani
- Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
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22
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Atkins B, Kindinger L, Mahindra MP, Moatti Z, Siassakos D. Stillbirth: prevention and supportive bereavement care. BMJ MEDICINE 2023; 2:e000262. [PMID: 37564829 PMCID: PMC10410959 DOI: 10.1136/bmjmed-2022-000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/26/2023] [Indexed: 08/12/2023]
Abstract
Around half of the two million stillbirths occurring worldwide each year are preventable. This review compiles the most up-to-date evidence to inform stillbirth prevention. Many general maternal health interventions also reduce the risk of stillbirth, for example, antenatal care attendance. This review focuses on specific aspects of care: glucose metabolism, targeted aspirin prophylaxis, clotting and immune disorders, sleep positions, fetal movement monitoring, and preconception and interconception health. In the past few years, covid-19 infection during pregnancy has emerged as a risk factor for stillbirth, particularly among women who were not vaccinated. Alongside prevention, efforts to address stillbirth must include provision of high quality, supportive, and compassionate bereavement care to improve parents' wellbeing. A growing body of evidence suggests beneficial effects for parents who received supportive care and were offered choices such as mode of birth and the option to see and hold their baby. Staff need support to be able to care for parents effectively, yet, studies consistently highlight the scarcity of specific bereavement care training for healthcare providers. Action is urgently needed and is possible. Action must be taken with the evidence available now, in healthcare settings with high or low resources, to reduce stillbirths and improve training and care.
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Affiliation(s)
- Bethany Atkins
- Institute for Women's Health, University College London, London, UK
- National Institute for Health and Care Research, London, UK
| | - Lindsay Kindinger
- King Edward Memorial Hospital for Women Perth, Perth, WA, Australia
- Fiona Stanley Hospital, Perth, WA, Australia
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23
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Tano S, Kotani T, Ushida T, Yoshihara M, Imai K, Nakamura N, Iitani Y, Moriyama Y, Emoto R, Kato S, Yoshida S, Yamashita M, Kishigami Y, Oguchi H, Matsui S, Kajiyama H. Evaluating glucose variability through OGTT in early pregnancy and its association with hypertensive disorders of pregnancy in non-diabetic pregnancies: a large-scale multi-center retrospective study. Diabetol Metab Syndr 2023; 15:123. [PMID: 37296464 DOI: 10.1186/s13098-023-01103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Recent evidence suggests increased glucose variability (GV) causes endothelial dysfunction, a central pathology of hypertensive disorders of pregnancy (HDP). We aimed to investigate the association between GV in early pregnancy and subsequent HDP development among non-diabetes mellitus (DM) pregnancies. METHODS This multicenter retrospective study used data from singleton pregnancies between 2009 and 2019. Among individuals who had 75 g-OGTT before 20 weeks of gestation, we evaluated GV by 75 g-OGTT parameters and examined its relationship with HDP development, defining an initial-increase from fasting-plasma glucose (PG) to 1-h-PG and subsequent-decrease from 1-h-PG to 2-h-PG. RESULTS Approximately 3.0% pregnancies (802/26,995) had 75 g-OGTT before 20 weeks of gestation, and they had a higher prevalence of HDP (14.3% vs. 7.5%). The initial-increase was significantly associated with overall HDP (aOR 1.20, 95% CI 1.02-1.42), and the subsequent-decrease was associated with decreased and increased development of early-onset (EoHDP: aOR 0.56, 95% CI 0.38-0.82) and late-onset HDP (LoHDP: aOR 1.38, 95% CI 1.11-1.73), respectively. CONCLUSIONS A pattern of marked initial-increase and minor subsequent-decrease (i.e., sustained hyperglycemia) was associated with EoHDP. Contrarily, the pattern of marked initial-increase and subsequent-decrease (i.e., increased GV) was associated with LoHDP. This provides a new perspective for future study strategies.
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Affiliation(s)
- Sho Tano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Nagoya, Aichi, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
- Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Achi, Japan.
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Nagoya, Aichi, Japan
| | - Ryo Emoto
- Department of Biostatistics, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | | | - Yasuyuki Kishigami
- Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Nagoya, Aichi, Japan
| | - Hidenori Oguchi
- Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Nagoya, Aichi, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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24
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Abstract
Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Natalie A. Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Kathryn J. Lindley
- Department of Medicine, Vanderbilt University Medical Center
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
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25
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Punnose J, Sukhija K, Rijhwani RM. Intermediate hyperglycemia in early pregnancy: A South Asian perspective. World J Diabetes 2023; 14:573-584. [PMID: 37273252 PMCID: PMC10236988 DOI: 10.4239/wjd.v14.i5.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
“Intermediate hyperglycemia in early pregnancy (IHEP)” refers to mild hyperglycemia detected before 24 gestational weeks (GW), satisfying the criteria for the diagnosis of gestational diabetes mellitus. Many professional bodies recommend routine screening for “overt diabetes” in early pregnancy, which identifies a significant number of women with mild hyperglycemia of undetermined significance. A literature search revealed that one-third of GDM women in South Asian countries are diagnosed before the conventional screening period of 24 GW to 28 GW; hence, they belong in the IHEP category. Most hospitals in this region diagnose IHEP by oral glucose tolerance test (OGTT) using the same criteria used for GDM diagnosis after 24 GW. There is some evidence to suggest that South Asian women with IHEP are more prone to adverse pregnancy events than women with a diagnosis of GDM after 24 GW, but this observation needs to be proven by randomized control trials. Fasting plasma glucose is a reliable screening test for GDM that can obviate the need for OGTT for GDM diagnosis among 50% of South Asian pregnant women. HbA1c in the first trimester predicts GDM in later pregnancy, but it is not a reliable test for IHEP diagnosis. There is evidence to suggest that HbA1c in the first trimester is an independent risk factor for several adverse pregnancy events. Further research to identify the patho-genetic mechanisms behind the fetal and maternal effects of IHEP is strongly recommended.
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Affiliation(s)
- John Punnose
- Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Delhi 110054, India
| | - Komal Sukhija
- Department of Endocrinology, St.Stephen’s Hospital, Delhi 110054, India
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26
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Simmons D, Immanuel J, Hague WM, Teede H, Nolan CJ, Peek MJ, Flack JR, McLean M, Wong V, Hibbert E, Kautzky-Willer A, Harreiter J, Backman H, Gianatti E, Sweeting A, Mohan V, Enticott J, Cheung NW. Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy. N Engl J Med 2023. [PMID: 37144983 DOI: 10.1056/nejmoa2214956] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Whether treatment of gestational diabetes before 20 weeks' gestation improves maternal and infant health is unclear. METHODS We randomly assigned, in a 1:1 ratio, women between 4 weeks' and 19 weeks 6 days' gestation who had a risk factor for hyperglycemia and a diagnosis of gestational diabetes (World Health Organization 2013 criteria) to receive immediate treatment for gestational diabetes or deferred or no treatment, depending on the results of a repeat oral glucose-tolerance test [OGTT] at 24 to 28 weeks' gestation (control). The trial included three primary outcomes: a composite of adverse neonatal outcomes (birth at <37 weeks' gestation, birth trauma, birth weight of ≥4500 g, respiratory distress, phototherapy, stillbirth or neonatal death, or shoulder dystocia), pregnancy-related hypertension (preeclampsia, eclampsia, or gestational hypertension), and neonatal lean body mass. RESULTS A total of 802 women underwent randomization; 406 were assigned to the immediate-treatment group and 396 to the control group; follow-up data were available for 793 women (98.9%). An initial OGTT was performed at a mean (±SD) gestation of 15.6±2.5 weeks. An adverse neonatal outcome event occurred in 94 of 378 women (24.9%) in the immediate-treatment group and in 113 of 370 women (30.5%) in the control group (adjusted risk difference, -5.6 percentage points; 95% confidence interval [CI], -10.1 to -1.2). Pregnancy-related hypertension occurred in 40 of 378 women (10.6%) in the immediate-treatment group and in 37 of 372 women (9.9%) in the control group (adjusted risk difference, 0.7 percentage points; 95% CI, -1.6 to 2.9). The mean neonatal lean body mass was 2.86 g in the immediate-treatment group and 2.91 g in the control group (adjusted mean difference, -0.04 g; 95% CI, -0.09 to 0.02). No between-group differences were observed with respect to serious adverse events associated with screening and treatment. CONCLUSIONS Immediate treatment of gestational diabetes before 20 weeks' gestation led to a modestly lower incidence of a composite of adverse neonatal outcomes than no immediate treatment; no material differences were observed for pregnancy-related hypertension or neonatal lean body mass. (Funded by the National Health and Medical Research Council and others; TOBOGM Australian New Zealand Clinical Trials Registry number, ACTRN12616000924459.).
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Affiliation(s)
- David Simmons
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Jincy Immanuel
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - William M Hague
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Helena Teede
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Christopher J Nolan
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Michael J Peek
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Jeff R Flack
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Mark McLean
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Vincent Wong
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Emily Hibbert
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Alexandra Kautzky-Willer
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Jürgen Harreiter
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Helena Backman
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Emily Gianatti
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Arianne Sweeting
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Viswanathan Mohan
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - Joanne Enticott
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
| | - N Wah Cheung
- From Western Sydney University, Campbelltown, NSW (D.S., J.I.), Robinson Research Institute, University of Adelaide, Adelaide, SA (W.M.H.), Monash University, Melbourne, VIC (H.T., J.E.), Canberra Hospital and Australian National University (C.J.N.) and Australian National University (M.J.P.), Canberra, ACT, Bankstown-Lidcombe Hospital (J.R.F.), Blacktown Hospital (M.M.), Liverpool Hospital and University of New South Wales (V.W.), Nepean Clinical School, University of Sydney and Nepean Hospital (E.H.), the Department of Endocrinology, Royal Prince Alfred Hospital (A.S.), and Westmead Hospital (N.W.C.), Sydney, and the Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA (E.G.) - all in Australia; the Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna (A.K.-W., J.H.); the Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden (H.B.); and Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India (V.M)
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Eke AC, Gebreyohannes RD, Powell AM. Understanding clinical outcome measures reported in HIV pregnancy studies involving antiretroviral-naive and antiretroviral-experienced women. THE LANCET. INFECTIOUS DISEASES 2023; 23:e151-e159. [PMID: 36375478 PMCID: PMC10040432 DOI: 10.1016/s1473-3099(22)00687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
Abstract
HIV infection is a clinically significant public health disease and contributes to increased risk of maternal and fetal morbidity and mortality. HIV pregnancy studies use outcome measures as metrics to show how people with HIV feel, function, or survive. These endpoints are crucial for tracking the evolution of HIV illness over time, assessing the effectiveness of antiretroviral therapy (ART), and comparing outcomes across studies. Although the need for ideal outcome measures is widely acknowledged, selecting acceptable outcome measures for these HIV pregnancy studies can be challenging. We discuss the many outcome measures that have been implemented over time to assess HIV in pregnancy studies, their benefits, and drawbacks. Finally, we offer suggestions for improving the reporting of outcome measures in HIV in pregnancy studies. Medical professionals can best care for pregnant women living with HIV receiving ART by having a thorough understanding of these outcome metrics.
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Affiliation(s)
- Ahizechukwu C Eke
- Division of Maternal Foetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rahel D Gebreyohannes
- Department of Obstetrics and Gynaecology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Anna M Powell
- Department of Gynaecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Paschou SA, Bletsa E, Papazisi M, Mili N, Kanouta F, Kassi GN, Psaltopoulou T, Goulis DG, Lambrinoudaki I. Screening and management of major endocrinopathies during pregnancy: an update. Endocrine 2023; 80:10-19. [PMID: 36327019 PMCID: PMC10060311 DOI: 10.1007/s12020-022-03237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Endocrinopathies during pregnancy constitute a challenging issue, being prevalent and requiring appropriate management to avoid maternal and fetal complications. This review aims to summarize and present major endocrine problems during pregnancy, the appropriate screening, maternal monitoring and management, fetal monitoring, and follow-up. Glucose metabolism, thyroid function, as well as calcium and vitamin D metabolism are the main endocrine domains that should be screened and monitored during pregnancy. Gestational diabetes mellitus (GDM) is the most prevalent endocrine disease during pregnancy, followed by thyroid disorders. Specific recommendations are provided for the optimal clinical care of pregnant women and their offspring for GDM, thyroid disorders, and calcium and vitamin D disorders.
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Affiliation(s)
- Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Evanthia Bletsa
- Third Department of Cardiology, Sotiria Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Papazisi
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Mili
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Kanouta
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Georgia N Kassi
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Theodora Psaltopoulou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios G Goulis
- 1st Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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29
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Healy AM. Better Preconception Glycemic Screening Guidelines Are Needed to Improve Pregnancy Outcomes. J Womens Health (Larchmt) 2023; 32:253-254. [PMID: 36637856 DOI: 10.1089/jwh.2022.0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Amber M Healy
- Department of Specialty Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA.,Ohio Health Physicians Group Heritage College, Diabetes and Endocrinology, Athens, Ohio, USA
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Sperling MM, Leonard SA, Blumenfeld YJ, Carmichael SL, Chueh J. Prepregnancy body mass index and gestational diabetes mellitus across Asian and Pacific Islander subgroups in California. AJOG GLOBAL REPORTS 2023; 3:100148. [PMID: 36632428 PMCID: PMC9826825 DOI: 10.1016/j.xagr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists recommends early screening for gestational diabetes mellitus among pregnant Asian people with a prepregnancy body mass index ≥23.0 kg/m2, in contrast with the recommended screening at a body mass index ≥25 kg/m2 for other races and ethnicities. However, there is significant heterogeneity within Asian and Pacific Islander populations, and gestational diabetes mellitus and its association with body mass index among Asian and Pacific Islander subgroups may not be uniform across all groups. OBJECTIVE This study aimed to analyze the association between body mass index and gestational diabetes mellitus among Asian and Pacific Islander subgroups in California, specifically gestational diabetes mellitus rates among those with a body mass index above vs below 23 kg/m2, which is the cutoff point for the designation of being overweight among Asians populations. STUDY DESIGN Using a linked delivery hospitalization discharge and vital records database, we identified patients who gave birth in California between 2007 and 2017 and who self-reported to be 1 of 13 Asian and Pacific Islander subgroups, which was collected from birth and fetal death certificates. In each subgroup, we evaluated the association between body mass index and gestational diabetes mellitus using multivariable logistic regression models adjusted for age, education, parity, payment method, the trimester in which prenatal care was initiated, and nativity. We fit body mass index nonlinearly with splines and categorized body mass index as being above or below 23 kg/m2. Predicted probabilities of gestational diabetes mellitus with 95% confidence intervals were calculated across body mass index values using the nonlinear regression models. RESULTS The overall prevalence of gestational diabetes mellitus was 14.3% (83,400/584,032), ranging between 8.4% and 17.1% across subgroups. The highest prevalence was among Indian (17.1%), Filipino (16.7%), and Vietnamese (15.5%) subgroups. In these subgroups, gestational diabetes mellitus was diagnosed in 10% to 13% of those with a body mass index <23.0 kg/m2 and in 22% of those with a body mass index ≥23 kg/m2. Gestational diabetes mellitus was least common among Korean (8.4%), Japanese (9.0%), and Samoan (9.8%) subgroups with a gestational diabetes mellitus rate of 5% to 7% among those with a body mass index <23.0 kg/m2 and in 10% to 15% among those with a body mass index ≥23 kg/m2. Although Samoan patients had the highest rate of obesity, defined as body mass index ≥30 kg/m2 (57.4%), they had the third lowest prevalence of gestational diabetes mellitus. Conversely, Vietnamese patients had the second lowest rate of obesity (2.4%) but the highest rate of gestational diabetes mellitus at a body mass index of ≥23 kg/m2 (22.3%). CONCLUSION Gestational diabetes mellitus and its association with body mass index varied among Asian subgroups but increased as body mass index increased. Subgroups with the lowest prevalence of obesity trended toward a higher prevalence of gestational diabetes mellitus and those with a higher prevalence of obesity trended toward a lower prevalence of gestational diabetes mellitus.
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Affiliation(s)
- Meryl M. Sperling
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Stephanie A. Leonard
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Yair J. Blumenfeld
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
| | - Suzan L. Carmichael
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
- Pediatrics (Dr Carmichael), Stanford University School of Medicine, Stanford, CA
| | - Jane Chueh
- Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh)
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Selen DJ, Thaweethai T, Schulte CC, Hsu S, He W, James K, Kaimal A, Meigs JB, Powe CE. Gestational Glucose Intolerance and Risk of Future Diabetes. Diabetes Care 2023; 46:83-91. [PMID: 36473077 PMCID: PMC9797650 DOI: 10.2337/dc22-1390] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pregnant individuals are universally screened for gestational diabetes mellitus (GDM). Gestational glucose intolerance (GGI) (an abnormal initial GDM screening test without a GDM diagnosis) is not a recognized diabetes risk factor. We tested for an association between GGI and diabetes after pregnancy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of individuals followed for prenatal and primary care. We defined GGI as an abnormal screening glucose-loading test result at ≥24 weeks' gestation with an oral glucose tolerance test (OGTT) that did not meet GDM criteria. The primary outcome was incident diabetes. We used Cox proportional hazards models with time-varying exposures and covariates to compare incident diabetes risk in individuals with GGI and normal glucose tolerance. RESULTS Among 16,836 individuals, there were 20,359 pregnancies with normal glucose tolerance, 2,943 with GGI, and 909 with GDM. Over a median of 8.4 years of follow-up, 428 individuals developed diabetes. Individuals with GGI had increased diabetes risk compared to those with normal glucose tolerance in pregnancy (adjusted hazard ratio [aHR] 2.01 [95% CI 1.54-2.62], P < 0.001). Diabetes risk increased with the number of abnormal OGTT values (zero, aHR 1.54 [1.09-2.16], P = 0.01; one, aHR 2.97 [2.07-4.27], P < 0.001; GDM, aHR 8.26 [6.49-10.51], P < 0.001 for each compared with normal glucose tolerance). The fraction of cases of diabetes 10 years after delivery attributable to GGI and GDM was 8.5% and 28.1%, respectively. CONCLUSIONS GGI confers an increased risk of future diabetes. Routinely available clinical data identify an unrecognized group who may benefit from enhanced diabetes screening and prevention.
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Affiliation(s)
- Daryl J. Selen
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Endocrinology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Tanayott Thaweethai
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Biostatistics Center, Division of Clinical Research, Massachusetts General Hospital, Boston, MA
| | - Carolin C.M. Schulte
- Biostatistics Center, Division of Clinical Research, Massachusetts General Hospital, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sarah Hsu
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Boston, MA
| | - Wei He
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Kaitlyn James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Anjali Kaimal
- Harvard Medical School, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - James B. Meigs
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Broad Institute of MIT and Harvard, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Camille E. Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Broad Institute of MIT and Harvard, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
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Strobel KM, Kafali SG, Shih SF, Artura AM, Masamed R, Elashoff D, Wu HH, Calkins KL. Pregnancies complicated by gestational diabetes and fetal growth restriction: an analysis of maternal and fetal body composition using magnetic resonance imaging. J Perinatol 2023; 43:44-51. [PMID: 36319757 PMCID: PMC9840659 DOI: 10.1038/s41372-022-01549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Maternal body composition may influence fetal body composition. OBJECTIVE The objective of this pilot study was to investigate the relationship between maternal and fetal body composition. METHODS Three pregnant women cohorts were studied: healthy, gestational diabetes (GDM), and fetal growth restriction (FGR). Maternal body composition (visceral adipose tissue volume (VAT), subcutaneous adipose tissue volume (SAT), pancreatic and hepatic proton-density fat fraction (PDFF) and fetal body composition (abdominal SAT and hepatic PDFF) were measured using MRI between 30 to 36 weeks gestation. RESULTS Compared to healthy and FGR fetuses, GDM fetuses had greater hepatic PDFF (5.2 [4.2, 5.5]% vs. 3.2 [3, 3.3]% vs. 1.9 [1.4, 3.7]%, p = 0.004). Fetal hepatic PDFF was associated with maternal SAT (r = 0.47, p = 0.02), VAT (r = 0.62, p = 0.002), and pancreatic PDFF (r = 0.54, p = 0.008). When controlling for maternal SAT, GDM increased fetal hepatic PDFF by 0.9 ([0.51, 1.3], p = 0.001). CONCLUSION In this study, maternal SAT, VAT, and GDM status were positively associated with fetal hepatic PDFF.
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Affiliation(s)
- Katie M. Strobel
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sevgi Gokce Kafali
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rinat Masamed
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- University of California Los Angeles, Los Angeles, CA, USA
| | - Holden H. Wu
- Department of Medicine, Biostatistics and Computational Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kara L. Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
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Tong Y, Chen H, Wang Y, Wu Z, Gu J, Wu Q, Wang J, Luo H, Bao A, Zheng H. An Innovative Teaching Approach for Diabetes Mellitus in Laboratory Medicine Uses the Clinical Laboratory Diagnostic Pathway. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231219396. [PMID: 38152834 PMCID: PMC10752126 DOI: 10.1177/23821205231219396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023]
Abstract
Objectives The routine teaching mode of diabetes mellitus (DM) is divided into various sub-majors of medical laboratory, which is not conducive to clinical laboratory physicians quickly mastering relevant knowledge. A novel DM laboratory testing pathway is established to improve teaching efficiency and enhance the effects of talent cultivation in laboratory medicine. Methods The guidelines and expert consensuses of DM were gathered from professional websites and databases. The clinical laboratory diagnostic pathway was formulated, and the questionnaire and mutual evaluation were used to evaluate the teaching effectiveness of 8-year undergraduate students enrolled in 2018 and enrolled in 2019, respectively. Results Clinical laboratory physicians developed and approved the DM clinical laboratory diagnostic pathway, which included the entire process of DM diagnosis and differential diagnosis, drug selection, treatment impact monitoring, prognosis evaluation, etc. The results of the questionnaires showed that, in comparison to the teaching mode used with the students enrolled in 2018 and enrolled in 2019, the percentages of more improvement and significant improvement were significantly increased (P < 0.01) and the percentages of no improvement and slight improvement were significantly decreased (P < 0.01). Following the instruction of the DM clinical laboratory diagnostic route, the results were greatly improved, including points emphasized and the accuracy of responding to questions, among other things, according to the teachers' and students' mutual evaluation (P < 0.05). Conclusions To enhance the teaching quality in laboratory medicine, it is required to build the disease clinical laboratory diagnostic pathway for a novel teaching method. This may boost teachers' and students' confidence and broaden their knowledge.
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Affiliation(s)
- Yongqing Tong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
- Office of Laboratory Medicine Teaching Affairs, The First Clinical College of Wuhan University, Wuhan, China
| | - Hongbin Chen
- Department of Pulmonary and Critical Care Medicine of Renmin Hospital, Wuhan University, Wuhan, China
| | - YingYing Wang
- Department of Out-Patient Services, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zegang Wu
- Office of Laboratory Medicine Teaching Affairs, The First Clinical College of Wuhan University, Wuhan, China
| | - Jian Gu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Wu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingwei Wang
- Office of Laboratory Medicine Teaching Affairs, The First Clinical College of Wuhan University, Wuhan, China
| | - Hongbo Luo
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Anyu Bao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyun Zheng
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
- Office of Laboratory Medicine Teaching Affairs, The First Clinical College of Wuhan University, Wuhan, China
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Punnose J, Malhotra RK, Sukhija K, M RR, Choudhary N, Sharma A, Vij P, Bahl P. Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment. Diabet Med 2023; 40:e14993. [PMID: 36310345 DOI: 10.1111/dme.14993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
AIM To compare the pregnancy outcomes in women with gestational diabetes (GDM) based on the timing of diagnosis. METHODS This retrospective cohort study was conducted between January 2011 and September 2017 amongst 2638 Asian Indian pregnant women. The inclusion criteria included; singleton pregnancies having HbA1c <48 mmols/mol (6.5%) in the first trimester, GDM screening by 75 g OGTT using IADPSG criteria and delivery at our centre. The cohort was divided into 3 groups: Early GDM (E-GDM)-diagnosis <24 gestational weeks (Gw), Standard GDM (S-GDM)-diagnosis ≥24Gw, Non-GDM- No GDM ≥24 Gw. Multivariable logistic regression models compared the pregnancy outcomes between Non-GDM, S-GDM and E-GDM groups. A sub-group multivariable analysis was done amongst GDM women using gestational age at diagnosis both as a categorical and continuous variable. RESULTS Compared to Non-GDM women, the odds were higher for premature birth, large for gestational age (LGA) babies, macrosomia, Neonatal ICU(NICU) admission and lower for normal vaginal delivery in the E-GDM group, but for the S-GDM group, the risk was higher for premature birth, LGA babies, NICU admission and induction of labour. Compared to GDM women in the 24-28 Gw category significantly higher odds for premature birth and LGA babies were observed in the <14 Gw category. A continuous increase of 19% odds for premature birth with every 4 weeks decrease in gestational age at GDM diagnosis was observed. CONCLUSIONS Asian Indian women having a GDM diagnosis before 24Gw are at higher risk for adverse pregnancy events than those having diagnosis ≥24Gw or not having GDM.
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Affiliation(s)
- John Punnose
- Department of Endocrinology, St. Stephen's Hospital, Delhi, India
| | | | - Komal Sukhija
- Department of Endocrinology, St. Stephen's Hospital, Delhi, India
| | | | - Naimaa Choudhary
- Department of Obstetrics and Gynecology, St. Stephen's Hospital, Delhi, India
| | - Asha Sharma
- Department of Obstetrics and Gynecology, St. Stephen's Hospital, Delhi, India
| | - Prassan Vij
- Department of Reproductive Medicine, St. Stephen's Hospital, Delhi, India
| | - Pinky Bahl
- Department of Paediatrics and Neonatology, St. Stephen's hospital, Delhi, India
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Selen DJ, Powe CE. Gestational diabetes and other adverse pregnancy outcomes in polycystic ovary syndrome. Curr Opin Endocrinol Diabetes Obes 2022; 29:521-527. [PMID: 35983844 PMCID: PMC9613547 DOI: 10.1097/med.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW This review provides an update on gestational diabetes (GDM) and other adverse pregnancy outcomes in individuals with polycystic ovary syndrome (PCOS), one of the most common metabolic disorders and causes of infertility. RECENT FINDINGS Recent studies using Rotterdam diagnostic criteria for PCOS have supported prior literature suggesting that pregnant individuals with PCOS are at an increased risk of GDM. Risk factors for GDM in this population include overweight/obesity, insulin resistance, hyperandrogenism, amenorrhea, and history of miscarriage. It is possible that subtypes of PCOS (metabolic vs. lean/reproductive) pose differential risk. There are no current screening or treatment guidelines specifically for individuals with PCOS for GDM prevention. Although metformin has been studied for GDM prevention in PCOS, there has been no proven benefit. For infertility treatment, assisted reproductive technology and in-vitro fertilization do not appear to increase the risk of GDM in individuals with PCOS desiring pregnancy. SUMMARY Recent studies of pregnant individuals with PCOS suggest an increased risk of adverse pregnancy outcomes, including GDM. Larger, prospective studies using standardized diagnostic criteria are warranted to determine if the risk is from PCOS generally, or if there are subtypes of PCOS (metabolic vs. lean/reproductive) at a higher risk of GDM than others.
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Affiliation(s)
- Daryl J. Selen
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Camille E. Powe
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Broad Institute of MIT and Harvard, Boston, MA, United States
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
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Seshiah V, Bronson SC, Balaji V, Jain R, Anjalakshi C. Prediction and Prevention of Gestational Diabetes Mellitus and Its Sequelae by Administering Metformin in the Early Weeks of Pregnancy. Cureus 2022; 14:e31532. [DOI: 10.7759/cureus.31532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
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McLaren RA, Ruymann KR, Ramos GA, Osmundson SS, Jauk V, Berghella V. Early screening for gestational diabetes mellitus: a meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM 2022; 4:100737. [PMID: 36031150 DOI: 10.1016/j.ajogmf.2022.100737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Current evidence is conflicting on whether early screening and treatment for gestational diabetes mellitus improve pregnancy outcomes. Thus, this systematic review and meta-analysis of randomized controlled trials aimed to assess the rate of adverse pregnancy outcomes among participants with early screening and treatment for gestational diabetes mellitus vs those with routine care. DATA SOURCES A systematic review of the literature was conducted using MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, ScienceDirect, the Cochrane Library at the Central Register of Controlled Trials, and SciELO from inception to November 2021. STUDY ELIGIBILITY CRITERIA Studies were eligible for inclusion if they described randomized controlled trials comparing early screening with routine care for gestational diabetes mellitus to assess the effects of early screening and treatment on pregnancy outcomes. METHODS All randomized controlled trials comparing early vs standard screening of gestational diabetes mellitus assessing the effect of early screening (defined as a screening at <20 weeks of gestation) vs routine screening (defined as a screening at ≥20 weeks of gestation) on pregnancy outcomes were included. The primary outcome was defined as large for gestational age, as defined by the trial. The secondary maternal and neonatal outcomes were also evaluated. Subgroup analyses were performed on the basis of screening strategy and methods. RESULTS After exclusion, 8 randomized clinical trials (1920 participants) of early screening and treatment vs standard care were included. There were a total of 746 participants with early gestational diabetes mellitus. The risk of large for gestational age at birth did not differ between early screening and treatment for gestational diabetes mellitus and routine care among all included trials (8.1 vs 9.0%; relative risk, 0.94; 95% confidence interval, 0.73-1.22). Trials with a protocol of universal screening of participants at their first prenatal visit (>80% screened with HbA1c) and receiving early treatment if the screening test returned positive had a lower risk of large for gestational age (2.3 vs 9.1%; relative risk, 0.29; 95% confidence interval, 0.09-0.90) than those who had routine screening and care. CONCLUSION Overall, early screening and treatment of gestational diabetes mellitus did not reduce the risk of large for gestational age at birth. However, trials that screened all participants at their first visit and treated early, most for an HbA1c of 5.7% to 6.4%, had a reduced risk of large for gestational age at birth compared with routine care, suggesting a possible benefit of screening all pregnant patients. However, future well-designed trials are needed to confirm these findings.
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Affiliation(s)
- Rodney A McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (Drs McLaren, Ruymann, and Berghella).
| | - Kathryn R Ruymann
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (Drs McLaren, Ruymann, and Berghella)
| | - Gladys A Ramos
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, CA (Dr Ramos)
| | - Sarah S Osmundson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN (Dr Osmundson)
| | - Victoria Jauk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, AL (Ms Jauk)
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (Drs McLaren, Ruymann, and Berghella)
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Hillier TA, Pedula KL, Ogasawara KK, Vesco KK, Oshiro C, Van Marter JL. Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes. J Perinat Med 2022; 50:1036-1044. [PMID: 35534914 PMCID: PMC9519183 DOI: 10.1515/jpm-2021-0581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/07/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Gestational diabetes (GDM) screening at 24-28 weeks' gestation reduces risk of adverse maternal and perinatal outcomes. While experts recommend first-trimester screening for high-risk patients, including those with obesity, data supporting this recommendation is limited. METHODS We implemented a systematic population intervention to encourage first-trimester GDM screening by oral glucose tolerance testing in a cohort of pregnant people with obesity in two integrated health systems from 2009 to 2013, and compared outcomes to the same population pre-intervention (2006-2009). Up to five years of postpartum glucose testing results (through 2018) were assessed among GDM cases in the post-intervention group. Primary outcomes were large-for-gestational-age birthweight (LGA); macrosomia; a perinatal composite outcome; gestational hypertension/preeclampsia; cesarean delivery; and medication treatment of GDM. RESULTS A total of 40,206 patients (9,156 with obesity) were screened for GDM; 2,672 (6.6%) were diagnosed with GDM. Overall, multivariate adjusted risk for LGA and cesarean delivery were lower following the intervention (LGA: aOR 0.89 [0.82, 0.96]; cesarean delivery: 0.89 [0.85, 0.93]). This difference was more pronounced in patients diagnosed with GDM (LGA: aOR 0.52 [0.39, 0.70]; cesarean delivery 0.78 [0.65, 0.94]); insulin/oral hypoglycemic treatment rates for GDM were also higher post-intervention than pre-intervention (22 vs. 29%; p<0.0001). There were no differences for the other primary outcomes. Only 20% of patients diagnosed with GDM early in pregnancy who had postpartum testing had results in the overt diabetes range, suggesting a spectrum of diabetes detected early in pregnancy. CONCLUSIONS First trimester GDM screening for pregnant people with obesity may improve GDM-associated outcomes.
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Affiliation(s)
- Teresa A. Hillier
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kathryn L. Pedula
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Hawaii Permanente Medical Group, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Keith K. Ogasawara
- Hawaii Permanente Medical Group, Kaiser Permanente Hawaii, Honolulu, HI, USA
- Department of Obstetrics & Gynecology, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Kimberly K. Vesco
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Department of Obstetrics & Gynecology, Kaiser Permanente Northwest, Portland, OR, USA
| | - Caryn Oshiro
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Jan L. Van Marter
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Lara-Cinisomo S, Loret de Mola JR, Flores-Carter K, Tabb KM, Roloff K. Prenatal Depressive Symptoms, Self-Rated Health, and Diabetes Self-Efficacy: A Moderated Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013603. [PMID: 36294181 PMCID: PMC9602843 DOI: 10.3390/ijerph192013603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Diabetes leads to risk for pregnant persons and their fetuses and requires behavioral changes that can be compromised by poor mental health. Poor self-rated health (SRH), a reliable predictor of morbidity and mortality, has been associated with depressive symptoms and lower self-efficacy in patients with diabetes. However, it is unclear whether SRH mediates the association between depressive symptoms and self-efficacy in pregnant patients with diabetes and whether the healthcare site moderates the mediation. Thus, we sought to test these associations in a racially and ethnically diverse sample of pregnant individuals diagnosed with diabetes from two clinical settings. MATERIALS AND METHODS This was an observational, cross-sectional study of 137 pregnant individuals diagnosed with diabetes at two clinical study sites. Participants self-administered a demographic questionnaire and measures designed to assess depressive symptoms, SRH in pregnancy, and diabetes self-efficacy. A moderated mediation model tested whether these indirect effects were moderated by the site. RESULTS The results show that SRH mediated the association between depressive symptoms and diabetes self-efficacy. The results also showed the site moderated the mediating effect of SRH on depressive symptoms and diabetes self-efficacy. CONCLUSIONS Understanding the role of clinical care settings can help inform when and how SRH mediates that association between prenatal depressive symptoms and self-efficacy in diabetic patients.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, Champaign, IL 61820, USA
| | - Julio Ricardo Loret de Mola
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, 415 N. 9th St. Suite 6W100, Springfield, IL 62794, USA
| | - Kendra Flores-Carter
- Department of Social Work, College of Behavioral and Social Sciences, California Baptist University, 8432 Magnolia Avenue, Riverside, CA 92504, USA
| | - Karen M. Tabb
- School of Social Work, University of Illinois Urbana-Champaign, 1010 W. Nevada St., Urbana, IL 61801, USA
| | - Kristina Roloff
- Department of Women’s Health, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA 92324, USA
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Mangione CM, Barry MJ, Nicholson WK, Cabana M, Chelmow D, Coker TR, Davidson KW, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Stevermer J, Tseng CW, Wong JB. Screening for Prediabetes and Type 2 Diabetes in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2022; 328:963-967. [PMID: 36098719 DOI: 10.1001/jama.2022.14543] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE The Centers for Disease Control and Prevention estimates that 210 000 children and adolescents younger than 20 years had diabetes as of 2018; of these, approximately 23 000 had type 2 diabetes. Youth with type 2 diabetes have an increased prevalence of associated chronic comorbid conditions, including hypertension, dyslipidemia, and nonalcoholic fatty liver disease. Data indicate that the incidence of type 2 diabetes is rising; from 2002-2003 to 2014-2015, incidence increased from 9.0 cases per 100 000 children and adolescents to 13.8 cases per 100 000 children and adolescents. OBJECTIVE The US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on screening for prediabetes and type 2 diabetes in asymptomatic, nonpregnant persons younger than 18 years. This is a new recommendation. POPULATION Children and adolescents younger than 18 years without known diabetes or prediabetes or symptoms of diabetes or prediabetes. EVIDENCE ASSESSMENT The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in children and adolescents. There is a lack of evidence on the effect of screening for, and early detection and treatment of, type 2 diabetes on health outcomes in youth, and the balance of benefits and harms cannot be determined. RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in children and adolescents. (I statement).
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Affiliation(s)
| | | | | | | | | | | | | | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Michalopoulou M, Jebb SA, MacKillop LH, Dyson P, Hirst JE, Wire A, Astbury NM. Development and testing of a reduced carbohydrate intervention for the management of obesity and reduction of gestational diabetes (RECORD): protocol for a feasibility randomised controlled trial. BMJ Open 2022; 12:e060951. [PMID: 36581990 PMCID: PMC10441568 DOI: 10.1136/bmjopen-2022-060951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/03/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Previous trials of dietary interventions to prevent gestational diabetes mellitus (GDM) have yielded only limited success. Low-carbohydrate diets have shown promise for the treatment of type 2 diabetes, but there is no evidence to support their use in pregnancy. The aim of this study is to explore the feasibility of a moderately reduced-carbohydrate dietary intervention delivered from mid-pregnancy alongside routine antenatal care. METHODS AND ANALYSIS This is a feasibility randomised controlled trial (RCT) with embedded qualitative study. Sixty women who are pregnant <20 weeks' gestation, with body mass index ≥30 kg/m2 at their antenatal booking appointment, will be randomised 2:1 intervention or control (usual care) and followed up until delivery. The intervention is a moderately reduced-carbohydrate diet (~130-150 g total carbohydrate/day), designed to be delivered alongside routine antenatal appointments. Primary outcomes are measures of adoption of the diet and retention of participants. Secondary outcomes include incidence of GDM, change in markers of glycaemic control, gestational weight gain, total carbohydrate and energy intake. Process outcomes will examine resources and management issues. Exploratory outcomes include further dietary changes, quality of life, maternal and neonatal outcomes, and qualitative measures. ETHICS AND DISSEMINATION This trial was reviewed and approved by the South-Central Oxford B Research Ethics Committee NHS National Research Ethics Committee and the Health Research Authority (Reference: 20/SC/0442). The study results will inform whether to progress to a full-scale RCT to test the clinical effectiveness of the RECORD programme to prevent GDM in women at high risk. The findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER ISRCTN16235884.
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Lucy H MacKillop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pamela Dyson
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amy Wire
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Sadiya A, Jakapure V, Shaar G, Adnan R, Tesfa Y. Lifestyle intervention in early pregnancy can prevent gestational diabetes in high-risk pregnant women in the UAE: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:668. [PMID: 36042401 PMCID: PMC9425994 DOI: 10.1186/s12884-022-04972-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose A prevalence of gestational diabetes mellitus (GDM) is approximately three times higher than the global rate in the UAE. However, it has not yet been studied whether a 12-week moderate-intensity lifestyle intervention can prevent gestational diabetes among pregnant women at high risk in this region. Patients and methods A pragmatic, open-label, randomized clinical trial was conducted. Sixty-three women aged 18 to 45 years, with ≤12 weeks of gestation, singleton pregnancy, and having ≥ two risk factors for GDM were randomly assigned to the Lifestyle Intervention (LI) group (n = 30) or Usual Care (UC) group (n = 33). The women in the LI group received a 12-week, moderate-intensity lifestyle intervention with individualized counseling on a diet, physical activity, and behavior change by a licensed dietitian. The women in the UC group received usual antenatal care. The primary outcome was the incidence of GDM based on the IADPSG criteria at 24-28 weeks of gestation. Results The incidence of GDM was 33.3% in LI group and 57.5% in UC group. The crude relative risk (RR) for GDM was 0.59 (95% CI, 0.32-1.04, p = 0.05). The multivariable logistic regression model without adjustment showed OR = 0.37 (95% CI, 0.13-1.02, p = 0.05) and after adjusting with Age, BMI and family history of diabetes reported OR = 0.26, 95%CI 0.07, 0.92, p = 0.04. in LI vs UC. The daily dietary intake of calories (− 120 kcal, p = < 0.01), carbohydrates (− 19 g, p < 0.01), and fat (− 5 g, p = 0.03) was reduced, and physical activity time (+ 52 min, p = 0.05) increased in the LI group after the intervention. However, the LI had no significant effect on maternal and neonatal outcomes. Conclusion A 12-week moderate intensity lifestyle intervention in early pregnancy could reduce the relative risk of GDM by 41% among high-risk pregnant women in the UAE. These findings could impact public health outcomes in the region. Trial registration Trial registration Retrospectively registered NCT04273412,18/02/2020.
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Affiliation(s)
- Amena Sadiya
- Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City, Ajman, PO Box-5166, UAE.
| | - Vidya Jakapure
- Education, Training and Research Department, Sheikh Khalifa Medical City, Ajman, UAE
| | - Ghida Shaar
- Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City, Ajman, PO Box-5166, UAE
| | - Rama Adnan
- Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City, Ajman, PO Box-5166, UAE
| | - Yohannes Tesfa
- Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City, Ajman, PO Box-5166, UAE
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Greene MF. Drawing the Line on Glycemia in Pregnancy. N Engl J Med 2022; 387:652-654. [PMID: 36070714 DOI: 10.1056/nejme2208339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael F Greene
- From the Department of Obstetrics and Gynecology, Harvard Medical School, Boston
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Crowther CA, Samuel D, McCowan LME, Edlin R, Tran T, McKinlay CJ. Lower versus Higher Glycemic Criteria for Diagnosis of Gestational Diabetes. N Engl J Med 2022; 387:587-598. [PMID: 36070709 DOI: 10.1056/nejmoa2204091] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment of gestational diabetes improves maternal and infant health, although diagnostic criteria remain unclear. METHODS We randomly assigned women at 24 to 32 weeks' gestation in a 1:1 ratio to be evaluated for gestational diabetes with the use of lower or higher glycemic criteria for diagnosis. The lower glycemic criterion was a fasting plasma glucose level of at least 92 mg per deciliter (≥5.1 mmol per liter), a 1-hour level of at least 180 mg per deciliter (≥10.0 mmol per liter), or a 2-hour level of at least 153 mg per deciliter (≥8.5 mmol per liter). The higher glycemic criterion was a fasting plasma glucose level of at least 99 mg per deciliter (≥5.5 mmol per liter) or a 2-hour level of at least 162 mg per deciliter (≥9.0 mmol per liter). The primary outcome was the birth of an infant who was large for gestational age (defined as a birth weight above the 90th percentile according to Fenton-World Health Organization standards). Secondary outcomes were maternal and infant health. RESULTS A total of 4061 women underwent randomization. Gestational diabetes was diagnosed in 310 of 2022 women (15.3%) in the lower-glycemic-criteria group and in 124 of 2039 women (6.1%) in the higher-glycemic-criteria group. Among 2019 infants born to women in the lower-glycemic-criteria group, 178 (8.8%) were large for gestational age, and among 2031 infants born to women in the higher-glycemic-criteria group, 181 (8.9%) were large for gestational age (adjusted relative risk, 0.98; 95% confidence interval, 0.80 to 1.19; P = 0.82). Induction of labor, use of health services, use of pharmacologic agents, and neonatal hypoglycemia were more common in the lower-glycemic-criteria group than in the higher-glycemic-criteria group. The results for the other secondary outcomes were similar in the two trial groups, and there were no substantial between-group differences in adverse events. Among the women in both groups who had glucose test results that fell between the lower and higher glycemic criteria, those who were treated for gestational diabetes (195 women), as compared with those who were not (178 women), had maternal and infant health benefits, including fewer large-for-gestational-age infants. CONCLUSIONS The use of lower glycemic criteria for the diagnosis of gestational diabetes did not result in a lower risk of a large-for-gestational-age infant than the use of higher glycemic criteria. (Funded by the Health Research Council of New Zealand and others; GEMS Australian New Zealand Clinical Trials Registry number, ACTRN12615000290594.).
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Affiliation(s)
- Caroline A Crowther
- From the Liggins Institute (C.A.C., D.S., C.J.M.), the Department of Obstetrics and Gynaecology (L.M.E.M.), and the School of Population Health (R.E.), University of Auckland, Auckland, New Zealand; and Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney (T.T.)
| | - Deborah Samuel
- From the Liggins Institute (C.A.C., D.S., C.J.M.), the Department of Obstetrics and Gynaecology (L.M.E.M.), and the School of Population Health (R.E.), University of Auckland, Auckland, New Zealand; and Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney (T.T.)
| | - Lesley M E McCowan
- From the Liggins Institute (C.A.C., D.S., C.J.M.), the Department of Obstetrics and Gynaecology (L.M.E.M.), and the School of Population Health (R.E.), University of Auckland, Auckland, New Zealand; and Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney (T.T.)
| | - Richard Edlin
- From the Liggins Institute (C.A.C., D.S., C.J.M.), the Department of Obstetrics and Gynaecology (L.M.E.M.), and the School of Population Health (R.E.), University of Auckland, Auckland, New Zealand; and Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney (T.T.)
| | - Thach Tran
- From the Liggins Institute (C.A.C., D.S., C.J.M.), the Department of Obstetrics and Gynaecology (L.M.E.M.), and the School of Population Health (R.E.), University of Auckland, Auckland, New Zealand; and Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney (T.T.)
| | - Christopher J McKinlay
- From the Liggins Institute (C.A.C., D.S., C.J.M.), the Department of Obstetrics and Gynaecology (L.M.E.M.), and the School of Population Health (R.E.), University of Auckland, Auckland, New Zealand; and Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney (T.T.)
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Abohtyra RM, Chan CL, Albers DJ, Gluckman BJ. Inferring Insulin Secretion Rate from Sparse Patient Glucose and Insulin Measures. Front Physiol 2022; 13:893862. [PMID: 35991187 PMCID: PMC9384214 DOI: 10.3389/fphys.2022.893862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/21/2022] [Indexed: 12/30/2022] Open
Abstract
The insulin secretion rate (ISR) contains information that can provide a personal, quantitative understanding of endocrine function. If the ISR can be reliably inferred from measurements, it could be used for understanding and clinically diagnosing problems with the glucose regulation system. Objective: This study aims to develop a model-based method for inferring a parametrization of the ISR and related physiological information among people with different glycemic conditions in a robust manner. The developed algorithm is applicable for both dense or sparsely sampled plasma glucose/insulin measurements, where sparseness is defined in terms of sampling time with respect to the fastest time scale of the dynamics. Methods: An algorithm for parametrizing and validating a functional form of the ISR for different compartmental models with unknown but estimable ISR function and absorption/decay rates describing the dynamics of insulin accumulation was developed. The method and modeling applies equally to c-peptide secretion rate (CSR) when c-peptide is measured. Accuracy of fit is reliant on reconstruction error of the measured trajectories, and when c-peptide is measured the relationship between CSR and ISR. The algorithm was applied to data from 17 subjects with normal glucose regulatory systems and 9 subjects with cystic fibrosis related diabetes (CFRD) in which glucose, insulin and c-peptide were measured in course of oral glucose tolerance tests (OGTT). Results: This model-based algorithm inferred parametrization of the ISR and CSR functional with relatively low reconstruction error for 12 of 17 control and 7 of 9 CFRD subjects. We demonstrate that when there are suspect measurements points, the validity of excluding them may be interrogated with this method. Significance: A new estimation method is available to infer the ISR and CSR functional profile along with plasma insulin and c-peptide absorption rates from sparse measurements of insulin, c-peptide, and plasma glucose concentrations. We propose a method to interrogate and exclude potentially erroneous OGTT measurement points based on reconstruction errors.
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Affiliation(s)
- Rammah M. Abohtyra
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, United States
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, United States
| | - Christine L. Chan
- Section of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - David J. Albers
- Department of Bioengineering, University of Colorado School of Medicine, Aurora, CO, United States
| | - Bruce J. Gluckman
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, United States
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, United States
- Department of Neurosurgery, College of Medicine, The Pennsylvania State University, University Park, PA, United States
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, United States
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Effects of Probiotic Supplementation during Pregnancy on the Future Maternal Risk of Metabolic Syndrome. Int J Mol Sci 2022; 23:ijms23158253. [PMID: 35897822 PMCID: PMC9330652 DOI: 10.3390/ijms23158253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 12/12/2022] Open
Abstract
Probiotics are live microorganisms that induce health benefits in the host. Taking probiotics is generally safe and well tolerated by pregnant women and their children. Consumption of probiotics can result in both prophylactic and therapeutic effects. In healthy adult humans, the gut microbiome is stable at the level of the dominant taxa: Bacteroidetes, Firmicutes and Actinobacteria, and has a higher presence of Verrucomicrobia. During pregnancy, an increase in the number of Proteobacteria and Actinobacteria phyla and a decrease in the beneficial species Roseburia intestinalis and Faecalibacterium prausnitzii are observed. Pregnancy is a "window" to the mother's future health. The aim of this paper is to review studies assessing the potentially beneficial effects of probiotics in preventing the development of diseases that appear during pregnancy, which are currently considered as risk factors for the development of metabolic syndrome, and consequently, reducing the risk of developing maternal metabolic syndrome in the future. The use of probiotics in gestational diabetes mellitus, preeclampsia and excessive gestational weight gain is reviewed. Probiotics are a relatively new intervention that can prevent the development of these disorders during pregnancy, and thus, would reduce the risk of metabolic syndrome resulting from these disorders in the mother's future.
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Novel Biomolecules in the Pathogenesis of Gestational Diabetes Mellitus 2.0. Int J Mol Sci 2022; 23:ijms23084364. [PMID: 35457182 PMCID: PMC9031541 DOI: 10.3390/ijms23084364] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 12/04/2022] Open
Abstract
Gestational diabetes mellitus (GDM) has become a major public health problem and one of the most discussed issues in modern obstetrics. GDM is associated with serious adverse perinatal outcomes and long-term health consequences for both the mother and child. Currently, the importance and purposefulness of finding a biopredictor that will enable the identification of women with an increased risk of developing GDM as early as the beginning of pregnancy are highly emphasized. Both “older” molecules, such as adiponectin and leptin, and “newer” adipokines, including fatty acid-binding protein 4 (FABP4), have proven to be of pathophysiological importance in GDM. Therefore, in our previous review, we presented 13 novel biomolecules, i.e., galectins, growth differentiation factor-15, chemerin, omentin-1, osteocalcin, resistin, visfatin, vaspin, irisin, apelin, FABP4, fibroblast growth factor 21, and lipocalin-2. The purpose of this review is to present the potential and importance of another nine lesser known molecules in the pathogenesis of GDM, i.e., 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF), angiopoietin-like protein-8 (ANGPTL-8), nesfatin-1, afamin, adropin, fetuin-A, zonulin, secreted frizzled-related proteins (SFRPs), and amylin. It seems that two of them, fetuin-A and zonulin in high serum levels, may be applied as biopredictors of GDM.
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Rodriguez MI, Martinez Acevedo A, Swartz JJ, Caughey AB, Valent A, McConnell KJ. Association of Prenatal Care Expansion With Use of Antidiabetic Agents During Pregnancies Among Latina Emergency Medicaid Recipients With Gestational Diabetes. JAMA Netw Open 2022; 5:e229562. [PMID: 35486400 PMCID: PMC9055460 DOI: 10.1001/jamanetworkopen.2022.9562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Access to necessary prenatal care is not guaranteed through Medicaid for some people with low income based on their immigration status. Although states have the option to extend emergency Medicaid coverage for prenatal care, many states have not expanded coverage. OBJECTIVE To evaluate whether the receipt of prenatal care services through the extension of emergency Medicaid coverage is associated with an increase in antidiabetic medication use among Latina patients with gestational diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used linked Medicaid claims and birth certificate data on live births to 4869 Latina patients from October 1, 2010, to December 31, 2019, with a difference-in-differences design to compare the rollout of prenatal care and services in Oregon in 2013 with a comparison state, South Carolina, that did not cover prenatal or postpartum care. EXPOSURE Medicaid coverage of prenatal care. MAIN OUTCOMES AND MEASURES The main outcome was the receipt of antidiabetic agents. Secondary outcomes included hypertensive disorders, cesarean delivery, postpartum contraception, and a newborn morbidity composite outcome (large size for gestational age, neonatal intensive care unit admission, and preterm birth). RESULTS The study sample included live births to 4869 Latina patients (mean [SD] age, 32.7 [5.5] years [range, 12-44 years]) enrolled in emergency Medicaid who were mainly aged 25 to 34 years (1499 of 2907 [51.6%]), multiparous (2626 of 2907 [90.3%]), and living in urban areas (2299 of 2907 [79.1%]). After Oregon's policy change to offer prenatal coverage to individuals receiving emergency Medicaid, there was a large and significant increase in the receipt of antidiabetic agents among all people with diabetes during pregnancy (gestational diabetes). Prior to the policy, only 0.3% of all Latina emergency Medicaid recipients with gestational diabetes (2 of 617) received any medication (oral agents or insulin) to manage their blood glucose level. After the policy change, 28.8% of all patients with gestational diabetes (295 of 1023) received medication to manage their blood glucose level, translating to a 27.9-percentage-point increase (95% CI, 24.5-31.2 percentage points) in the receipt of antidiabetic agents in the adjusted model. The policy was also associated with a 10.4-percentage-point (95% CI, 5.3-15.5 percentage points) increase in insulin use during pregnancy among all patients with gestational diabetes. We observed an increase in postpartum contraceptive use (21.2 percentage points; 95% CI, 14.9-27.5 percentage points), the majority of which was due to postpartum sterilization (increase of 16.1 percentage points; 95% CI, 10.4-21.8 percentage points). We did not observe a significant association with gestational hypertension, cesarean births, or newborn health. CONCLUSIONS AND RELEVANCE This retrospective cohort study suggests that expanded emergency Medicaid benefits that included prenatal care were associated with an increased use of antidiabetic medications and postpartum contraception during pregnancy.
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Affiliation(s)
- Maria I. Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Ann Martinez Acevedo
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Jonas J. Swartz
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Amy Valent
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - K. John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
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Lee WL, Lee FK, Wang PH. Pre-pregnancy body mass index is a determined risk factor for the development of gestational diabetes, regardless of singleton or twin pregnancy. Taiwan J Obstet Gynecol 2022; 61:1-2. [PMID: 35181014 DOI: 10.1016/j.tjog.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 01/06/2023] Open
Affiliation(s)
- Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fa-Kung Lee
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Antepartum Care of the Uterus Transplant Patient: The Experience of 3 Successful US Centers. Clin Obstet Gynecol 2022; 65:84-91. [DOI: 10.1097/grf.0000000000000682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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