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Soepnel LM, Nicolaou V, Huddle KRL, Klipstein-Grobusch K, Levitt NS, Norris SA. Maternal and neonatal outcomes following a diabetic pregnancy within the context of HIV. Int J Gynaecol Obstet 2019; 147:404-412. [PMID: 31479156 DOI: 10.1002/ijgo.12956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/07/2019] [Accepted: 08/30/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To characterize the demographics, comorbidities, management, and outcomes of pregnant women with pre-gestational and gestational diabetes (GDM), including overt and true GDM, taking into account HIV infection and the influence of exposure to oral hypoglycemic agents (OHAs). METHODS A review of medical records of 1071 diabetic pregnancies (between 2012 and 2018) at a tertiary hospital in South Africa. RESULTS Of the women, 43% had GDM, 19% had type 1 diabetes (T1DM), and 38% had type 2 diabetes (T2DM). Each group had a mean initial body mass index (BMI) >25 kg/m2 . Despite poor initial HbA1c for pre-gestational groups, over 90% of the cohort achieved glycemic control by the time of delivery. The rate of prematurity was 30.9%. Perinatal mortality (PNM) was 5.1% for the pre-gestational group and 1.8% for GDM. Of the cohort, 23.9% was HIV infected. PNM was higher in the HIV-infected pregnancies (9.4%) than non-HIV exposed pregnancies (1.8%, P<0.001). The macrosomia rate was higher in the glibenclamide-exposed group than the insulin-alone group (12.2% vs 0%, P=0.025). CONCLUSION Obesity is a significant predictor for macrosomia and was high in all groups. In a low-/middle-income country setting with a high prevalence of HIV and high usage of OHAs as an alternative to insulin therapy, HIV might be associated with higher PNM and glibenclamide with increased rates of macrosomia, which warrants further exploration.
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Affiliation(s)
- Larske M Soepnel
- SAMRC Developmental Pathways for Health Research Unit, Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Veronique Nicolaou
- SAMRC Developmental Pathways for Health Research Unit, Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa.,Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kenneth R L Huddle
- Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naomi S Levitt
- Diabetic Medicine and Endocrinology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa
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Chiavaroli V, Gibbins JD, Cutfield WS, Derraik JGB. Childhood obesity in New Zealand. World J Pediatr 2019; 15:322-331. [PMID: 31079339 DOI: 10.1007/s12519-019-00261-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Paediatric obesity has reached epidemic proportions globally, resulting in significant adverse effects on health and wellbeing. Early life events, including those that happen before, during, and after pregnancy can predispose children to later obesity. The purpose of this review is to examine the magnitude of obesity among New Zealand children and adolescents, and to determine their underlying risk factors and associated comorbidities. DATA SOURCES PubMed, Web of Science, and Google Scholar searches were performed using the key terms "obesity", "overweight", "children", "adolescents", and "New Zealand". RESULTS Obesity is a major public health concern in New Zealand, with more than 33% of children and adolescents aged 2-14 years being overweight or obese. Obesity disproportionately affects Māori (New Zealand's indigenous population) and Pacific children and adolescents, as well as those of lower socioeconomic status. New Zealand's obesity epidemic is associated with numerous health issues, including cardiometabolic, gastrointestinal, and psychological problems, which also disproportionately affect Māori and Pacific children and adolescents. Notably, a number of factors may be useful to identify those at increased risk (such as demographic and anthropometric characteristics) and inform possible interventions. CONCLUSIONS The prevalence of overweight and obese children and adolescents in New Zealand is markedly high, with a greater impact on particular ethnicities and those of lower socioeconomic status. Alleviating the current burden of pediatric obesity should be a key priority for New Zealand, for the benefit of both current and subsequent generations. Future strategies should focus on obesity prevention, particularly starting at a young age and targeting those at greatest risk.
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Affiliation(s)
| | - John D Gibbins
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand. .,Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand. .,Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers 2019; 5:47. [PMID: 31296866 DOI: 10.1038/s41572-019-0098-8] [Citation(s) in RCA: 768] [Impact Index Per Article: 153.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
Hyperglycaemia that develops during pregnancy and resolves after birth has been recognized for over 50 years, but uniform worldwide consensus is lacking about threshold hyperglycaemic levels that merit a diagnosis of 'gestational diabetes mellitus' (GDM) and thus treatment during pregnancy. GDM is currently the most common medical complication of pregnancy, and prevalence of undiagnosed hyperglycaemia and even overt diabetes in young women is increasing. Maternal overweight and obesity, later age at childbearing, previous history of GDM, family history of type 2 diabetes mellitus and ethnicity are major GDM risk factors. Diagnosis is usually performed using an oral glucose tolerance test (OGTT), although a non-fasting, glucose challenge test (GCT) is used in some parts of the world to screen women for those requiring a full OGTT. Dietary modification and increased physical activity are the primary treatments for GDM, but pharmacotherapy, usually insulin, is used when normoglycaemia is not achieved. Oral hypoglycaemic agents, principally metformin and glibenclamide (glyburide), are also used in some countries. Treatment improves immediate pregnancy outcomes, reducing excess fetal growth and adiposity and pregnancy-related hypertensive disorders. GDM increases the risk of long-term complications, including obesity, impaired glucose metabolism and cardiovascular disease, in both the mother and infant. Optimal management of mother and infant during long-term follow-up remains challenging, with very limited implementation of preventive strategies in most parts of the world.
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Affiliation(s)
- H David McIntyre
- Mater Research and University of Queensland, Brisbane, Queensland, Australia.
| | - Patrick Catalano
- Mother Infant Research Institute, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Elisabeth R Mathiesen
- Department of Endocrinology, Center for Pregnant Women with Diabetes, Rigshospitalet and The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet and The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Buffarini R, Barros AJD, Matijasevich A, Loret de Mola C, Santos IS. Gestational diabetes mellitus, pre-gestational BMI and offspring BMI z-score during infancy and childhood: 2004 Pelotas Birth Cohort. BMJ Open 2019; 9:e024734. [PMID: 31289054 PMCID: PMC6629409 DOI: 10.1136/bmjopen-2018-024734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) affects a significant number of women. Evidence regarding the association between GDM and offspring body mass index (BMI) is unclear due to small samples and lack of adequate confounding control. The objective of this study was to investigate the association between GDM and offspring BMI z-scores from birth to early adolescence and to examine the role of maternal pre-gestational BMI in this relationship. DESIGN Prospective study. SETTING Pelotas 2004 Birth Cohort, Brazil. PARTICIPANTS Cohort participants that were followed-up from birth up to early adolescence (~3500) and their mothers. PRIMARY OUTCOME MEASURES BMI z-scores at birth, 3, 12, 24, 48 months and 6 and 11 years of age, calculated according to the WHO growth charts. RESULTS Unadjusted and adjusted linear regressions were performed and interaction terms between maternal pre-gestational BMI and GDM were included. Prevalence of self-reported GDM was 2.6% (95% CI 2.1% to 3.1%). The offspring BMI z-scores (SD) at birth, 3, 12, 24, 48 months and at 6 and 11 years were 0.10 (1.12), -0.47 (1.10), 0.59 (1.10), 0.59 (1.08), 0.78 (1.32), 0.70 (1.43) and 0.75 (1.41), respectively. Unadjusted regression models showed positive associations between GDM and offspring BMI z-scores at birth, 6 and 11 years. After adjustment, the associations attenuated towards the null. Statistical evidence of effect modification between maternal pre-gestational BMI and GDM was observed at birth (p=0.007), with the association between GDM and offspring BMI z-score being apparent only in those children born to overweight or obese mothers (β=0.72, 95% CI 0.30 to 1.14 and β=0.61, 95% CI 0.20 to 1.01, respectively). CONCLUSIONS We observed that in the association between GDM and offspring BMI z-scores, there is a predominant role for maternal nutritional status before pregnancy and that the association between GDM and newborn's BMI is apparent only among those born to overweight or obese mothers.
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Affiliation(s)
- Romina Buffarini
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Aluisio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | | | | | - Ina S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
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Kua KL, Hu S, Wang C, Yao J, Dang D, Sawatzke AB, Segar JL, Wang K, Norris AW. Fetal hyperglycemia acutely induces persistent insulin resistance in skeletal muscle. J Endocrinol 2019; 242:M1-M15. [PMID: 30444716 PMCID: PMC6494731 DOI: 10.1530/joe-18-0455] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/14/2018] [Indexed: 12/13/2022]
Abstract
Offspring exposed in utero to maternal diabetes exhibit long-lasting insulin resistance, though the initiating mechanisms have received minimal experimental attention. Herein, we show that rat fetuses develop insulin resistance after only 2-day continuous exposure to isolated hyperglycemia starting on gestational day 18. Hyperglycemia-induced reductions in insulin-induced AKT phosphorylation localized primarily to fetal skeletal muscle. The skeletal muscle of hyperglycemia-exposed fetuses also exhibited impaired in vivo glucose uptake. To address longer term impacts of this short hyperglycemic exposure, neonates were cross-fostered and examined at 21 days postnatal age. Offspring formerly exposed to 2 days late gestation hyperglycemia exhibited mild glucose intolerance with insulin signaling defects localized only to skeletal muscle. Fetal hyperglycemic exposure has downstream consequences which include hyperinsulinemia and relative uteroplacental insufficiency. To determine whether these accounted for induction of insulin resistance, we examined fetuses exposed to late gestational isolated hyperinsulinemia or uterine artery ligation. Importantly, 2 days of fetal hyperinsulinemia did not impair insulin signaling in murine fetal tissues and 21-day-old offspring exposed to fetal hyperinsulinemia had normal glucose tolerance. Similarly, fetal exposure to 2-day uteroplacental insufficiency did not perturb insulin-stimulated AKT phosphorylation in fetal rats. We conclude that fetal exposure to hyperglycemia acutely produces insulin resistance. As hyperinsulinemia and placental insufficiency have no such impact, this occurs likely via direct tissue effects of hyperglycemia. Furthermore, these findings show that skeletal muscle is uniquely susceptible to immediate and persistent insulin resistance induced by hyperglycemia.
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Affiliation(s)
- Kok Lim Kua
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Shanming Hu
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Chunlin Wang
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Jianrong Yao
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Diana Dang
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Alex B. Sawatzke
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Jeffrey L. Segar
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, United States
| | - Andrew W. Norris
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
- Department of Biochemistry, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa, United States
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Kessous R, Wainstock T, Sheiner E. Smoking during pregnancy as a possible risk factor for pediatric neoplasms in the offspring: A population-based cohort study. Addict Behav 2019; 90:349-353. [PMID: 30513488 DOI: 10.1016/j.addbeh.2018.11.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between maternal smoking during pregnancy and future risk of childhood neoplasm risk. STUDY DESIGN A population based cohort analysis comparing the risk for long-term childhood neoplasms in children born (1991-2014) to mothers that smoked during pregnancy vs. those that did not. Childhood neoplasms were pre-defined based on ICD-9 codes, as recorded in the hospital medical files. Children with congenital malformations and multiple gestations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative oncological morbidity over time. Cox proportional hazards model was used to control for confounders. RESULTS 241,273 infants met the inclusion criteria; out of those 2841 were born to mothers that smoked during pregnancy. Offspring to smoking mothers had higher incidence of benign (OR 1.6, 95%CI 1.02-2.58; p value = .038) but not malignant tumors. Total cumulative neoplasm incidence was significantly higher in smoking women (Log Rank = 0.001) but no significant difference in the incidence of malignant tumors was noted (Log Rank = 0.834). In a Cox regression model controlling for maternal confounders; a history of maternal smoking during pregnancy remained independently associated only with increased risk for benign tumors (adjusted HR 2.5, 95%CI 1.57-3.83, p = .001). CONCLUSION Maternal smoking during pregnancy is associated with increased long-term risk for benign but not malignant tumors. This is important when counseling mothers regarding potential future risks and recommended lifestyle modifications. Despite this large population study with long follow-up, childhood malignancies are rare, and clarifying the possible association may require further studies.
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Affiliation(s)
- Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Casasnovas J, Jo Y, Rao X, Xuei X, Brown ME, Kua KL. High glucose alters fetal rat islet transcriptome and induces progeny islet dysfunction. J Endocrinol 2019; 240:309-323. [PMID: 30508415 DOI: 10.1530/joe-18-0493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022]
Abstract
Offspring of diabetic mothers are susceptible to developing type 2 diabetes due to pancreatic islet dysfunction. However, the initiating molecular pathways leading to offspring pancreatic islet dysfunction are unknown. We hypothesized that maternal hyperglycemia alters offspring pancreatic islet transcriptome and negatively impacts offspring islet function. We employed an infusion model capable of inducing localized hyperglycemia in fetal rats residing in the left uterine horn, thus avoiding other factors involved in programming offspring pancreatic islet health. While maintaining euglycemia in maternal dams and right uterine horn control fetuses, hyperglycemic fetuses in the left uterine horn had higher serum insulin and pancreatic beta cell area. Upon completing infusion from GD20 to 22, RNA sequencing was performed on GD22 islets to identify the hyperglycemia-induced altered gene expression. Ingenuity pathway analysis of the altered transcriptome found that diabetes mellitus and inflammation/cell death pathways were enriched. Interestingly, the downregulated genes modulate more diverse biological processes, which includes responses to stimuli and developmental processes. Next, we performed ex and in vivo studies to evaluate islet cell viability and insulin secretory function in weanling and adult offspring. Pancreatic islets of weanlings exposed to late gestation hyperglycemia had decreased cell viability in basal state and glucose-induced insulin secretion. Lastly, adult offspring exposed to in utero hyperglycemia also exhibited glucose intolerance and insulin secretory dysfunction. Together, our results demonstrate that late gestational hyperglycemia alters the fetal pancreatic islet transcriptome and increases offspring susceptibility to developing pancreatic islet dysfunction.
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Affiliation(s)
- Jose Casasnovas
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yunhee Jo
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Xi Rao
- Center for Medical Genomics, Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Xiaoling Xuei
- Center for Medical Genomics, Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mary E Brown
- The Indiana Center for Biological Microscopy, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kok Lim Kua
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Romo-Yáñez J, Domínguez-Castro M, Flores-Reyes JS, Estrada-Juárez H, Mancilla-Herrera I, Hernández-Pineda J, Bazan-Tejeda ML, Aguinaga-Ríos M, Reyes-Muñoz E. Hyperglycemia differentially affects proliferation, apoptosis, and BNIP3 and p53 mRNA expression of human umbilical cord Wharton's jelly cells from non-diabetic and diabetic pregnancies. Biochem Biophys Res Commun 2018; 508:1149-1154. [PMID: 30554659 DOI: 10.1016/j.bbrc.2018.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/05/2018] [Indexed: 01/25/2023]
Abstract
Diabetes in pregnancy constitutes an unfavorable environment for embryonic and fetal development, where the child has a higher risk of perinatal morbidity and mortality, with high incidence of congenital malformations and predisposition to long-term metabolic diseases that increase with a hypercaloric diet. To analyze whether hyperglycemia differentially affects proliferation, apoptosis, and mRNA expression in cells from children of normoglycemic pregnancies (NGPs) and diabetes mellitus pregnancies (DMPs), we used umbilical cord Wharton jelly cells as a research model. Proliferation assays were performed to analyze growth and determine the doubling time, and the rate of apoptosis was determined by flow cytometry-annexin-V assays. AMPK, BNIP3, HIF1α, and p53 mRNA gene expression was assessed by semi-quantitative RT-PCR. We found that hyperglycemia decreased proliferation in a statistically significant manner in NGP cells treated with 40 mM D-glucose and in DMP cells treated with 30 and 40 mM D-glucose. Apoptosis increased in hyperglycemic conditions in NGP and DMP cells. mRNA expression of BNIP3 and p53 was significantly increased in cells from DMPs but not in cells from NGPs. We found evidence that maternal irregular metabolic conditions, like diabetes with hyperglycemia in culture, affect biological properties of fetal cells. These observations could be a constituent of fetal programming.
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Affiliation(s)
- José Romo-Yáñez
- Departamento de Genética y Genómica Humana, INPer, Mexico City, Mexico; Coordinación de Endocrinología Ginecológica y Perinatal, INPer, Mexico.
| | - Mauricio Domínguez-Castro
- Departamento de Genética y Genómica Humana, INPer, Mexico City, Mexico; Departamento de Fisiologia y Desarrollo Celular, INPer, Mexico
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Garcia-Martin I, Penketh RJA, Janssen AB, Jones RE, Grimstead J, Baird DM, John RM. Metformin and insulin treatment prevent placental telomere attrition in boys exposed to maternal diabetes. PLoS One 2018; 13:e0208533. [PMID: 30533028 PMCID: PMC6289439 DOI: 10.1371/journal.pone.0208533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/18/2018] [Indexed: 12/30/2022] Open
Abstract
Shortened leukocyte and placental telomeres associated with gestational diabetes mellitus (GDM) suggest this exposure triggers telomere attrition contributing to adverse outcomes. We applied high resolution Single Telomere Length Analysis (STELA) to placenta from GDM pregnancies with different treatment pathways to determine their effectiveness at preventing telomere attrition. Differences in telomere length between control (N = 69), GDM lifestyle intervention (n = 14) and GDM treated with metformin and/or insulin (n = 17) was tested by Analysis of Covariance (ANCOVA) followed by group comparisons using Fisher's least significant difference. For male placenta only, there were differences in mean telomere length (F(2,54) = 4.98, P = 0.01) and percentage of telomeres under 5 kb (F(2,54) = 4.65, P = 0.01). Telomeres were shorter in the GDM lifestyle intervention group compared to both controls (P = 0.02) and medically treated pregnancies (P = 0.003). There were more telomeres under 5 kb in the GDM lifestyle intervention group compared to the other two groups (P = 0.03 and P = 0.004). Although further work is necessary, we suggest that early adoption of targeted medical treatment of GDM pregnancies where the fetus is known to be male may be an effective strategy for ameliorating adverse outcomes for children.
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Affiliation(s)
- Isabel Garcia-Martin
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Richard J. A. Penketh
- Department of Obstetrics and Gynaecology, University Hospital Wales, Cardiff, Wales, United Kingdom
| | - Anna B. Janssen
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Rhiannon E. Jones
- Division of Cancer and Genetics, Cardiff School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Julia Grimstead
- Division of Cancer and Genetics, Cardiff School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Duncan M. Baird
- Division of Cancer and Genetics, Cardiff School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Rosalind M. John
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom
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Wang J, Wang L, Liu H, Zhang S, Leng J, Li W, Zhang T, Li N, Li W, Baccarelli AA, Hou L, Hu G. Maternal gestational diabetes and different indicators of childhood obesity: a large study. Endocr Connect 2018; 7:1464-1471. [PMID: 30508416 PMCID: PMC6300863 DOI: 10.1530/ec-18-0449] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/30/2018] [Indexed: 12/16/2022]
Abstract
Previous studies found conflicting results about the associations between the exposure to hyperglycemia in utero and the later risks of childhood overweight and obesity. The aim of the present study is to compare the children's BMI growth between offspring exposed to maternal gestational diabetes mellitus (GDM) and those not exposed and assess the associations between maternal GDM and their offspring's overweight and obesity risk. We performed a large observational study in 1156 women and their offspring (578 GDM and 578 non-GDM mother-child pairs, matched by their offspring's gender and age). Maternal GDM was diagnosed according to the World Health Organization criteria. Childhood height, weight, waist circumference, body fat and skinfold were measured using standardized methods. After adjustment for maternal and children's characteristics, children born to mothers with GDM during pregnancy had higher mean values of Z scores for BMI-for-age, Z scores for weight-for-age, waist circumferences, body fat, subscapular skinfold and suprailiac skinfold, in comparison with their counterparts born to mothers with normal glucose during pregnancy (all P values <0.05). Moreover, maternal GDM was associated with a higher risk of childhood overweight and obesity with multivariate-adjusted odds ratios of 1.42 (95% confidence interval (CI): 1.02-1.97) and 1.18 (95% CI: 1.11-1.24), respectively, compared with the children of mothers without GDM during pregnancy. This study demonstrates that maternal GDM is an independent risk factor of childhood overweight and obesity and is associated with higher BMI in the offspring.
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Affiliation(s)
- Jing Wang
- Tianjin Women’s and Children’s Health CenterTianjin, China
- Chronic Disease Epidemiology LaboratoryPennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Leishen Wang
- Tianjin Women’s and Children’s Health CenterTianjin, China
| | - Huikun Liu
- Tianjin Women’s and Children’s Health CenterTianjin, China
| | - Shuang Zhang
- Tianjin Women’s and Children’s Health CenterTianjin, China
| | - Junhong Leng
- Tianjin Women’s and Children’s Health CenterTianjin, China
| | - Weiqin Li
- Tianjin Women’s and Children’s Health CenterTianjin, China
| | - Tao Zhang
- Tianjin Women’s and Children’s Health CenterTianjin, China
| | - Nan Li
- Tianjin Women’s and Children’s Health CenterTianjin, China
| | - Wei Li
- Tianjin Women’s and Children’s Health CenterTianjin, China
| | - Andrea A Baccarelli
- Department of Environmental Health SciencesColumbia University Mailman School of Public Health, New York, New York, USA
| | - Lifang Hou
- Department of Preventive MedicineFeinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gang Hu
- Chronic Disease Epidemiology LaboratoryPennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Correspondence should be addressed to G Hu:
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Hills AP, Misra A, Gill JMR, Byrne NM, Soares MJ, Ramachandran A, Palaniappan L, Street SJ, Jayawardena R, Khunti K, Arena R. Public health and health systems: implications for the prevention and management of type 2 diabetes in south Asia. Lancet Diabetes Endocrinol 2018; 6:992-1002. [PMID: 30287104 DOI: 10.1016/s2213-8587(18)30203-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
Abstract
Many non-communicable chronic diseases, including type 2 diabetes, are highly prevalent, costly, and largely preventable. The prevention and management of type 2 diabetes in south Asia requires a combination of lifestyle changes and long-term health-care management. However, public health and health-care systems in south Asian countries face serious challenges, including the need to provide services to many people with inadequate resources, and substantial between-population and within-population inequalities. In this Series paper, we explore the importance and particular challenges of public health and health systems in south Asian countries (Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka) with respect to the provision of culturally appropriate lifestyle modification to prevent and manage diabetes, especially in resource-poor settings. Effective primary prevention strategies are urgently needed to counter risk factors and behaviours preconception, in utero, in infancy, and during childhood and adolescence. A concerted focus on education, training, and capacity building at the community level would ensure the more widespread use of non-physician care, including community health workers. Major investment from governments and other sources will be essential to achieve substantial improvements in the prevention and management of type 2 diabetes in the region.
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Affiliation(s)
- Andrew P Hills
- College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia.
| | - Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India; National Diabetes, Obesity, and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
| | - Jason M R Gill
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nuala M Byrne
- College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Mario J Soares
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Ambady Ramachandran
- India Diabetes Research Foundation & Dr A Ramachandran's Diabetes Hospitals, Guindy, Chennai, India
| | | | - Steven J Street
- College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Badon SE, Zhu Y, Sridhar SB, Xu F, Lee C, Ehrlich SF, Quesenberry CP, Hedderson MM. A Pre-Pregnancy Biomarker Risk Score Improves Prediction of Future Gestational Diabetes. J Endocr Soc 2018; 2:1158-1169. [PMID: 30302420 PMCID: PMC6169465 DOI: 10.1210/js.2018-00200] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Previous studies have not examined the ability of multiple preconception biomarkers, considered together, to improve prediction of gestational diabetes mellitus (GDM). OBJECTIVE To develop a preconception biomarker risk score and assess its association with subsequent GDM. DESIGN A nested case-control study among a cohort of women with serum collected as part of a health examination (1984 to 1996) and subsequent pregnancy (1984 to 2009). Biomarkers associated with GDM were dichotomized into high/low risk. SETTING Integrated health care system. PARTICIPANTS Two controls were matched to each GDM case (n = 256 cases) on year and age at examination, age at pregnancy, and number of pregnancies between examination and index pregnancy. MAIN OUTCOME MEASURE GDM. RESULTS High-risk levels of sex hormone-binding globulin (SHBG; <44.2 nM), glucose (>90 mg/dL), total adiponectin (<7.2 μg/mL), and homeostasis model assessment-estimated insulin resistance (>3.9) were independently associated with 2.34 [95% confidence interval (CI): 1.50, 3.63], 2.03 (95% CI: 1.29, 3.19), 1.83 (95% CI: 1.16, 2.90), and 1.67 (95% CI: 1.07, 2.62) times the odds of GDM and included in the biomarker risk score. For each unit increase in the biomarker risk score, odds of GDM were 1.94 times greater (95% CI: 1.59, 2.36). A biomarker risk score including only SHBG and glucose was sufficient to improve prediction beyond established risk factors (age, race/ethnicity, body mass index, family history of diabetes, previous GDM; area under the curve = 0.73 vs 0.67, P = 0.002). CONCLUSIONS The improved, predictive ability of the biomarker risk score beyond established risk factors suggests clinical use of the biomarker risk score in identifying women at risk for GDM before conception for targeted prevention strategies.
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Affiliation(s)
- Sylvia E Badon
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sneha B Sridhar
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Fei Xu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Samantha F Ehrlich
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- University of Tennessee Knoxville, Knoxville, Tennessee
| | | | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Influence of maternal obesity on the association between common pregnancy complications and risk of childhood obesity: an individual participant data meta-analysis. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:812-821. [PMID: 30201470 DOI: 10.1016/s2352-4642(18)30273-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gestational diabetes and gestational hypertensive disorders are associated with offspring obesity, but the role of maternal adiposity in these associations remains unclear. We aimed to investigate whether these pregnancy complications affect the odds of offspring obesity independently of maternal obesity. METHODS We did an individual participant data (IPD) meta-analysis of mother-offspring pairs from prospective birth cohort studies that had IPD on mothers with singleton liveborn children born from 1989 onwards and had information available about maternal gestational diabetes, gestational hypertension or pre-eclampsia, and childhood body-mass index (BMI). We applied multilevel mixed-effects models to assess associations of gestational diabetes, gestational hypertension, and pre-eclampsia with BMI SD scores and the odds of overweight and obesity throughout childhood, adjusting for lifestyle characteristics (offspring's sex, maternal age, educational level, ethnicity, parity, and smoking during pregnancy). We then explored the extent to which any association was explained by maternal pre-pregnancy or early-pregnancy BMI. FINDINGS 160 757 mother-offspring pairs from 34 European or North American cohorts were analysed. Compared with uncomplicated pregnancies, gestational diabetes was associated with increased odds of overweight or obesity throughout childhood (odds ratio [OR] 1·59 [95% CI 1·36 to 1·86] for early childhood [age 2·0-4·9 years], 1·41 [1·26 to 1·57] for mid childhood [5·0-9·9 years], and 1·32 [0·97 to 1·78] for late childhood [10·0-17·9 years]); however, these associations attenuated towards the null following adjustment for maternal BMI (OR 1·35 [95% CI 1·15 to 1·58] for early childhood, 1·12 [1·00 to 1·25] for mid childhood, and 0·96 [0·71 to 1·31] for late childhood). Likewise, gestational hypertension was associated with increased odds of overweight throughout childhood (OR 1·19 [95% CI 1·01 to 1·39] for early childhood, 1·23 [1·15 to 1·32] for mid childhood, and 1·49 [1·30 to 1·70] for late childhood), but additional adjustment for maternal BMI largely explained these associations (1·01 [95% CI 0·86 to 1·19] for early childhood, 1·02 [0·95 to 1·10] for mid childhood, and 1·18 [1·03 to 1·36] for late childhood). Pre-eclampsia was associated with decreased BMI in early childhood only (difference in BMI SD score -0·05 SD score [95% CI -0·09 to -0·01]), and this association strengthened following additional adjustment for maternal BMI. INTERPRETATION Although lowering maternal risk of gestational diabetes, gestational hypertension, and pre-eclampsia is important in relation to maternal and fetal pregnancy outcomes, such interventions are unlikely to have a direct impact on childhood obesity. Preventive strategies for reducing childhood obesity should focus on maternal BMI rather than on pregnancy complications. FUNDING EU's Horizon 2020 research and innovation programme (LifeCycle Project).
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Wang J, Pan L, Liu E, Liu H, Liu J, Wang S, Guo J, Li N, Zhang C, Hu G. Gestational diabetes and offspring's growth from birth to 6 years old. Int J Obes (Lond) 2018; 43:663-672. [PMID: 30181654 DOI: 10.1038/s41366-018-0193-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study was to compare the children's body mass index (BMI) growth between offspring exposed to maternal gestational diabetes mellitus (GDM) and those not exposed, and assess the associations between maternal hyperglycemia and their offspring's overweight risk from 1 to 6 years of age. METHODS Using the healthcare records data from the Tianjin Maternal and Child Healthcare System, we conducted a population-based cohort study, which is composed of 27,155 mother-child pairs with all mothers undergoing GDM screening test in pregnancy. RESULTS After adjustment for maternal and children's characteristics, children born to mothers with abnormal glucose (including GDM or abnormal glucose challenge test (GCT) but normal oral glucose tolerance test (OGTT) results) during pregnancy had higher mean values of Z-scores for BMI for age at 1, 2, 3, 5, and 6 years of age, in comparison with those born to mothers with normal glucose (all P values < 0.05). Moreover, maternal abnormal glucose was associated with a higher risk of childhood overweight with multivariate-adjusted hazard ratios of 1.07 (95% confidence interval (CI) 1.01-1.14), 1.09 (95% CI 1.04-1.15), 1.10 (95% CI 1.04-1.15), 1.08 (95% CI 1.03-1.14), 1.08 (95% 1.03-1.13), and 1.07 (95% 1.02-1.12) at 1-6 years of age compared with children of mothers with normal glucose. CONCLUSIONS Abnormal maternal glucose tolerance during pregnancy was independently associated with children's higher BMI and overweight risk from 1 to 6 years of age. Women with positive GCT results but negative OGTT can be neglected by the health system. More attention should be paid to the health of these mothers and their offspring.
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Affiliation(s)
- Jing Wang
- Tianjin Women's and Children's Health Center, Tianjin, 300070, China.,Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Lei Pan
- Tianjin Women's and Children's Health Center, Tianjin, 300070, China
| | - Enqing Liu
- Tianjin Women's and Children's Health Center, Tianjin, 300070, China
| | - Hongyan Liu
- Tianjin Women's and Children's Health Center, Tianjin, 300070, China
| | - Jin Liu
- Tianjin Women's and Children's Health Center, Tianjin, 300070, China
| | - Shuting Wang
- Tianjin Women's and Children's Health Center, Tianjin, 300070, China
| | - Jia Guo
- Tianjin Women's and Children's Health Center, Tianjin, 300070, China
| | - Nan Li
- Tianjin Women's and Children's Health Center, Tianjin, 300070, China
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA.
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Humbwavali JB, Giugliani C, da Silva ICM, Duncan BB. Temporal trends in the nutritional status of women and children under five years of age in sub-Saharan African countries: ecological study. SAO PAULO MED J 2018; 136:454-463. [PMID: 30570097 PMCID: PMC9907765 DOI: 10.1590/1516-3180.2017.0267261117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/26/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND While the global prevalence of obesity is rapidly increasing, this pandemic has received less attention in sub-Saharan Africa, particularly in the light of the persistent undernutrition that exists in the context of maternal and child health. We aimed to describe obesity trends among women of childbearing age over recent decades, along with trends in over and undernutrition among children under five years of age, in sub-Saharan African countries. DESIGN AND SETTING Ecological study with temporal trend analysis in 13 sub-Saharan African countries. METHODS This was a description of temporal trends in nutritional status: adult obesity, childhood overweight, low height-for-age (stunting), low weight-for-height (wasting), low weight-for-age (underweight) and low birth weight. Publicly available data from repeated cross-sectional national surveys (demographic and health surveys and multiple-indicator cluster surveys) were used. We chose 13 sub-Saharan African countries from which at least four surveys conducted since 1993 were available. We investigated women aged 15-49 years and children under five years of age. RESULTS In multilevel linear models, the prevalence of obesity increased by an estimated 6 percentage points over 20 years among women of childbearing age, while the prevalence of overweight among children under 5 years old was stable. A major decrease in stunting and, to a lesser extent, wasting accompanied these findings. CONCLUSIONS The upward trend in obesity among women of childbearing age in the context of highly prevalent childhood undernutrition suggests that the focus of maternal and child health in sub-Saharan Africa needs to be expanded to consider not only nutritional deficiencies but also nutritional excess.
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Affiliation(s)
- João Baptista Humbwavali
- MSc. Nurse and Associate Professor, Instituto Superior de Ciências da Saúde, Universidade Agostinho Neto (ISCS/UAN), Luanda, Angola.
| | - Camila Giugliani
- MD, PhD. Physician and Associate Professor, Postgraduate Program on Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Inácio Crochemore Mohnsam da Silva
- MSc, PhD. Physical Educator and Collaborating Professor, Center for Equity in Health, Postgraduate Program on Epidemiology, Universidade Federal de Pelotas, Pelotas (RS), Brazil.
| | - Bruce Bartholow Duncan
- MSc, PhD. Physician and Professor, Postgraduate Program on Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
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Bashir M, E Abdel-Rahman M, Aboulfotouh M, Eltaher F, Omar K, Babarinsa I, Appiah-Sakyi K, Sharaf T, Azzam E, Abukhalil M, Boumedjane M, Yousif W, Ahmed W, Khan S, C Konje J, Abou-Samra AB. Prevalence of newly detected diabetes in pregnancy in Qatar, using universal screening. PLoS One 2018; 13:e0201247. [PMID: 30074993 PMCID: PMC6075760 DOI: 10.1371/journal.pone.0201247] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes first detected during pregnancy is currently divided into gestational diabetes mellitus (GDM) and diabetes mellitus (DM)- most of which are type 2 DM (T2DM). This study aims to define the prevalence and outcomes of diabetes first detected in pregnancy based on 75-gram oral glucose tolerance test (OGTT)using the recent WHO/IADPSG guidelines in a high-risk population. Methods This is a retrospective study that included all patients who underwent a 75 g (OGTT) between Jan 2016 and Apr 2016 and excluded patients with known pre-conception diabetes. Results The overall prevalence of newly detected diabetes in pregnancy among the 2000 patients who fulfilled the inclusion/exclusion criteria was 24.0% (95% CI 22.1–25.9) of which T2DM was 2.5% (95% CI 1.9–3.3), and GDM was 21.5% (95% CI 19.7–23.3). The prevalence of newly detected diabetes in pregnancy was similar among the different ethnic groups. The T2DM group was older (mean age in years was 34 ±5.7 vs 31.7±5.7 vs 29.7 ±5.7, p<0.001); and has a higher mean BMI (32.4±6.4 kg/m2 vs 31.7±6.2 kg/m2 vs 29.7± 6.2 kg/m2, p< 0.01) than the GDM and the non-DM groups, respectively. The frequency of pre-eclampsia, pre-term delivery, Caesarean-section, macrosomia, LGA and neonatal ICU admissions were significantly higher in the T2DM group compared to GDM and non-DM groups. Conclusion Diabetes first detected in pregnancy is equally prevalent among the various ethnic groups residing in Qatar. Newly detected T2DM carries a higher risk of poor pregnancy outcomes; stressing the importance of proper classification of cases of newly detected diabetes in pregnancy.
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Affiliation(s)
- Mohammed Bashir
- Qatar Metabolic Institute, Endocrine Department, Hamad Medical Corporation, Doha, Qatar
| | - Manar E Abdel-Rahman
- Department of Biostatistics, College of Health Sciences, Qatar University, Doha, Qatar
| | - Mahmoud Aboulfotouh
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar.,Department of Obstetrics and Gynaecology, Faculty of Medicine, Minia University-Minia, Egypt
| | - Fatin Eltaher
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Omar
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Isaac Babarinsa
- Department of Obstetrics and Gynaecology, Sidra Medical and Research Centre-Doha, Qatar
| | - Kwabena Appiah-Sakyi
- Department of Obstetrics and Gynaecology, Sidra Medical and Research Centre-Doha, Qatar
| | - Tarek Sharaf
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Eman Azzam
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Abukhalil
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Malika Boumedjane
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Wigdan Yousif
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Warda Ahmed
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sadaf Khan
- Department of Obstetrics and Gynaecology, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Justin C Konje
- Department of Obstetrics and Gynaecology, Sidra Medical and Research Centre-Doha, Qatar
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute, Endocrine Department, Hamad Medical Corporation, Doha, Qatar
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Cai S, Natarajan P, Chan JKY, Wong PC, Tan KH, Godfrey KM, Gluckman PD, Shek LPC, Yap F, Kramer MS, Chan SY, Chong YS. Maternal hyperglycemia in singleton pregnancies conceived by IVF may be modified by first-trimester BMI. Hum Reprod 2018; 32:1941-1947. [PMID: 28854717 PMCID: PMC5638004 DOI: 10.1093/humrep/dex243] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/23/2017] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION Does IVF independently increase the risk of gestational diabetes mellitus (GDM) and is this increase in risk modified by maternal body mass index? SUMMARY ANSWER IVF appears to be an independent risk factor for GDM and elevated blood glucose levels in overweight women (BMI > 25 kg/m2). WHAT IS KNOWN ALREADY IVF has been associated with increased risk of GDM, but most previous studies did not adequately assess confounding or effect modification by other risk factors. STUDY DESIGN, SIZE, DURATION Cross-sectional study using data from 1089 women with singleton pregnancies who participated in a Singaporean birth cohort study (GUSTO) and received a 75 g oral glucose tolerance test (OGTT) at 26-28 weeks gestation. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 1089 women (n = 1013 conceived spontaneously, n = 76 conceived through IVF) with singleton pregnancies received a 75 g OGTT at 26-28 weeks gestation. Fasting and 2 h postprandial blood glucose levels were assayed. World Health Organization criteria (1999) standard criteria were used to classify GDM: ≥7.0 mmol/L for fasting and/or ≥7.8 mmol/L for 2-h postprandial plasma glucose levels, which was the clinical guideline in use during the study. MAIN RESULTS AND THE ROLE OF CHANCE IVF pregnancies had nearly double the odds of GDM (OR = 1.83, 95% CI: 1.03-3.26) and elevated fasting (mean difference = 0.12 mmol/L, 95% CI: 0.00-0.24) and OGTT 2-h blood glucose levels (mean difference = 0.64 mmol/L, 95% CI: 0.27-1.01), after adjusting for commonly recognized risk factors for GDM. After stratification by first-trimester BMI, these increased risks of GDM (OR = 3.54, 95% CI: 1.44-8.72) and elevated fasting (mean difference = 0.39 mmol/L, 95% CI: 0.13-0.65) and 2-h blood (mean difference = 1.24 mmol/L, 95% CI: 0.56-1.91) glucose levels were significant only in the IVF group who is also overweight or obese (BMI > 25 kg/m2). LIMITATIONS REASONS FOR CAUTION One limitation of our study is the absence of a 1 h post-OGTT plasma glucose sample, as we were using the 1999 WHO diagnostic criteria (the clinical guideline in Singapore) at the time of our study, instead of the revised 2013 WHO diagnostic criteria. Our cohort may not be representative of the general Singapore obstetric population, although participants were recruited from the two largest maternity hospitals in the country and include both private and subsidized patients. WIDER IMPLICATIONS OF THE FINDINGS IVF appears to be an independent risk factor for GDM and elevated blood glucose levels in overweight women. Our findings reinforce the need to advise overweight or obese women contemplating IVF to lose weight before the procedure to reduce their risk of GDM and hyperglycemia-related adverse outcomes arising therefrom. In settings where universal GDM screening is not routine, overweight or obese women who conceive by IVF should be screened. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Program and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding was provided by the Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR). K.M.G. and Y.S.C. have received lecture fees from Nestle Nutrition Institute and Danone, respectively. K.M.G., Y.S.C. and S.Y.C. are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone. The other authors have nothing to disclose. The other authors have nothing to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - P Natarajan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - J K Y Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.,Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - P C Wong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - K H Tan
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore.,Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.,Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - L P C Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore 119228, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore 119074, Singapore
| | - F Yap
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - M S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada QC H3A 1A2.,Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada QC H3G 2M1
| | - S Y Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
| | - Y S Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
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Avagliano L, Mascherpa M, Massa V, Doi P, Bulfamante GP. Fetal pancreatic Langerhans islets size in pregnancies with metabolic disorders. J Matern Fetal Neonatal Med 2018; 32:3589-3594. [PMID: 29681182 DOI: 10.1080/14767058.2018.1468878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Metabolic disorders are a pandemic and increasing health problem. Women of childbearing age may also be affected, thus an abnormal metabolism may interfere with pregnancy short- and long-term outcomes, harming both mother and child. In the context of an abnormal maternal and intrauterine metabolic milieu the development of fetal organs, including pancreas, may be affected. Aim: To investigate the effects of pregnancy metabolic disorders on the morphology of pancreatic Langerhans islets in human late-third trimester stillborn fetuses. Methods: Samples from fetal pancreas underwent a quantitative histological evaluation to detect differences between pregnancy with (cases, n = 9) or without (controls, n = 6) abnormal metabolism. Results: Results show that the islets size increases in fetuses from dysmetabolic pregnancies and that this increment is related to both beta-cell hyperplasia and hypertrophy. Moreover, according to pregnancy and fetal metabolic disorders, a threshold of abnormal size of the islets has been identified. Above this threshold the size of fetal pancreatic Langerhans islets should be considered excessively increased. Conclusion: The study suggests that an accurate fetal pancreas analysis supplies an important tool in stillborn fetus, to discover metabolic disturbances that should be kept in mind and managed in future pregnancies.
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Affiliation(s)
- Laura Avagliano
- a Department of Health Sciences , San Paolo Hospital Medical School, Università degli Studi di Milano , Milan , Italy
| | - Margaret Mascherpa
- a Department of Health Sciences , San Paolo Hospital Medical School, Università degli Studi di Milano , Milan , Italy
| | - Valentina Massa
- a Department of Health Sciences , San Paolo Hospital Medical School, Università degli Studi di Milano , Milan , Italy
| | - Patrizia Doi
- a Department of Health Sciences , San Paolo Hospital Medical School, Università degli Studi di Milano , Milan , Italy
| | - Gaetano P Bulfamante
- a Department of Health Sciences , San Paolo Hospital Medical School, Università degli Studi di Milano , Milan , Italy
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Golic M, Stojanovska V, Bendix I, Wehner A, Herse F, Haase N, Kräker K, Fischer C, Alenina N, Bader M, Schütte T, Schuchardt M, van der Giet M, Henrich W, Muller DN, Felderhoff-Müser U, Scherjon S, Plösch T, Dechend R. Diabetes Mellitus in Pregnancy Leads to Growth Restriction and Epigenetic Modification of the
Srebf2
Gene in Rat Fetuses. Hypertension 2018; 71:911-920. [DOI: 10.1161/hypertensionaha.117.10782] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/08/2018] [Accepted: 02/06/2018] [Indexed: 11/16/2022]
Abstract
Diabetic pregnancy is correlated with increased risk of metabolic and neurological disorders in the offspring putatively mediated epigenetically. Little is known about epigenetic changes already present in fetuses of diabetic pregnancies. We aimed at characterizing the perinatal environment after preexisting maternal diabetes mellitus and at identifying relevant epigenetic changes in the fetus. We focused on the transcription factor
Srebf2
(sterol regulatory element binding transcription factor 2), a master gene in regulation of cholesterol metabolism. We tested whether diabetic pregnancy induces epigenetic changes in the
Srebf2
promoter and if they become manifest in altered
Srebf2
gene expression. We worked with a transgenic rat model of type 2 diabetes mellitus (Tet29) in which the insulin receptor is knocked down by doxycycline-induced RNA interference. Doxycycline was administered preconceptionally to Tet29 and wild-type control rats. Only Tet29 doxycycline dams were hyperglycemic, hyperinsulinemic, and hyperlipidemic. Gene expression was analyzed with quantitative real-time reverse transcriptase polymerase chain reaction and CpG promoter methylation with pyrosequencing. Immunohistochemistry was performed on fetal brains. Fetuses from diabetic Tet29 dams were hyperglycemic and growth restricted at the end of pregnancy. They further displayed decreased liver and brain weight with concomitant decreased microglial activation in the hippocampus in comparison to fetuses of normoglycemic mothers. Importantly, diabetic pregnancy induced CpG hypermethylation of the
Srebf2
promoter in the fetal liver and brain, which was associated with decreased
Srebf2
gene expression. In conclusion, diabetic and hyperlipidemic pregnancy induces neurological, metabolic, and epigenetic alterations in the rat fetus.
Srebf2
is a potential candidate mediating intrauterine environment-driven epigenetic changes and later diabetic offspring health.
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Affiliation(s)
- Michaela Golic
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Violeta Stojanovska
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Ivo Bendix
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Anika Wehner
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Florian Herse
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Nadine Haase
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Kristin Kräker
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Caroline Fischer
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Natalia Alenina
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Michael Bader
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Till Schütte
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Mirjam Schuchardt
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Markus van der Giet
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Wolfgang Henrich
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Dominik N. Muller
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Ursula Felderhoff-Müser
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Sicco Scherjon
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Torsten Plösch
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
| | - Ralf Dechend
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Germany (M.G., W.H.); Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Gynecology with Breast Center, Campus Charité Mitte, Germany (M.G.); Experimental and Clinical Research Center, a cooperation between the
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70
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Patel N, Hellmuth C, Uhl O, Godfrey K, Briley A, Welsh P, Pasupathy D, Seed PT, Koletzko B, Poston L. Cord Metabolic Profiles in Obese Pregnant Women: Insights Into Offspring Growth and Body Composition. J Clin Endocrinol Metab 2018; 103:346-355. [PMID: 29140440 PMCID: PMC5761489 DOI: 10.1210/jc.2017-00876] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022]
Abstract
Context Offspring exposed in utero to maternal obesity have an increased risk of later obesity; however, the underlying mechanisms remain unknown. Objective To assess the effect of an antenatal lifestyle intervention in obese women on the offspring's cord blood metabolic profile and to examine associations of the cord blood metabolic profile with maternal clinical characteristics and offspring anthropometry at birth and age 6 months. Design Randomized controlled trial and cohort study. Setting The UK Pregnancies Better Eating and Activity Trial. Participants Three hundred forty-four mother-offspring pairs. Intervention Antenatal behavioral lifestyle (diet and physical activity) intervention. Main Outcome Measures Targeted cord blood metabolic profile, including candidate hormone and metabolomic analyses. Results The lifestyle intervention was not associated with change in the cord blood metabolic profile. Higher maternal glycemia, specifically fasting glucose at 28 weeks gestation, had a linear association with higher cord blood concentrations of lysophosphatidylcholines (LPCs) 16.1 (β = 0.65; 95% confidence interval: 0.03 to 0.10) and 18.1 (0.52; 0.02 to 0.80), independent of the lifestyle intervention. A principal component of cord blood phosphatidylcholines and LPCs was associated with infant z scores of birth weight (0.04; 0.02 to 0.07) and weight at age 6 months (0.05; 0.00 to 0.10). Cord blood insulin growth factor (IGF)-1 and adiponectin concentrations were positively associated with infant weight z score at birth and at 6 months. Conclusions Concentrations of LPCs and IGF-1 in cord blood are related to infant weight. These findings support the hypothesis that susceptibility to childhood obesity may be programmed in utero, but further investigation is required to establish whether these associations are causally related.
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Affiliation(s)
- Nashita Patel
- Department of Women and Children’s Health, School
of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College
London, St. Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Christian Hellmuth
- Ludwig-Maximilians-Universität München, Dr.
von Haunersches Kinderspital, Division of Metabolic and Nutritional Medicine,
University of Munich Medical Centre, Lindwurmstraße 4, 80337 München,
Germany
| | - Olaf Uhl
- Ludwig-Maximilians-Universität München, Dr.
von Haunersches Kinderspital, Division of Metabolic and Nutritional Medicine,
University of Munich Medical Centre, Lindwurmstraße 4, 80337 München,
Germany
| | - Keith Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton
Biomedical Research Centre, University of Southampton and University Hospital
Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Annette Briley
- Department of Women and Children’s Health, School
of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College
London, St. Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow G12 8TD, United Kingdom
| | - Dharmintra Pasupathy
- Department of Women and Children’s Health, School
of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College
London, St. Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Paul T. Seed
- Department of Women and Children’s Health, School
of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College
London, St. Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Berthold Koletzko
- Ludwig-Maximilians-Universität München, Dr.
von Haunersches Kinderspital, Division of Metabolic and Nutritional Medicine,
University of Munich Medical Centre, Lindwurmstraße 4, 80337 München,
Germany
| | - Lucilla Poston
- Department of Women and Children’s Health, School
of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College
London, St. Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - on behalf of the UPBEAT Consortium
- Department of Women and Children’s Health, School
of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College
London, St. Thomas’ Hospital, London SE1 7EH, United Kingdom
- Ludwig-Maximilians-Universität München, Dr.
von Haunersches Kinderspital, Division of Metabolic and Nutritional Medicine,
University of Munich Medical Centre, Lindwurmstraße 4, 80337 München,
Germany
- MRC Lifecourse Epidemiology Unit and NIHR Southampton
Biomedical Research Centre, University of Southampton and University Hospital
Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
- Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow G12 8TD, United Kingdom
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71
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Ali A, Shastry S, Nithiyananthan R, Ali A, Ganapathy R. Gestational diabetes-Predictors of response to treatment and obstetric outcome. Eur J Obstet Gynecol Reprod Biol 2017; 220:57-60. [PMID: 29172068 DOI: 10.1016/j.ejogrb.2017.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/18/2017] [Accepted: 11/19/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate patient characteristics that are predictors of treatment response and outcomes in gestational diabetes STUDY DESIGN: Retrospective cohort of 265 women with gestational diabetes treated with diet/metformin and/or insulin in a single centre over 2 years. RESULTS Multinomial logistic regression showed that (after adjusting for age and ethnicity) women who were of normal weight were more likely to be on diet and women who were obese were more likely to be on metformin or metformin and insulin(p=0.014). Women who were obese were twice more likely to have labour induced than those with normal weight. Onset of labour was the only parameter significantly associated with a treatment modality among the three groups (p<0.001). There was no difference in the incidence of large for gestational age, neonatal admission, shoulder dystocia or still birth between the three groups. CONCLUSIONS Maternal BMI appears to be the only parameter that is predictive of need for treatment with metformin/insulin and the modality of treatment does not have an effect on maternal and neonatal outcomes.
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Affiliation(s)
- Amanda Ali
- Epsom and St. Helier University Hospitals NHS Trust, UK
| | | | | | - Amira Ali
- Senior Epidemiologist, Ottawa Public Health, Canada
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72
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Schliefsteiner C, Hirschmugl B, Kopp S, Curcic S, Bernhart EM, Marsche G, Lang U, Desoye G, Wadsack C. Maternal Gestational Diabetes Mellitus increases placental and foetal lipoprotein-associated Phospholipase A2 which might exert protective functions against oxidative stress. Sci Rep 2017; 7:12628. [PMID: 28974763 PMCID: PMC5626711 DOI: 10.1038/s41598-017-13051-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022] Open
Abstract
Increased Lipoprotein associated phospholipase A2 (LpPLA2) has been associated with inflammatory pathologies, including Type 2 Diabetes. Studies on LpPLA2 and Gestational Diabetes Mellitus (GDM) are rare, and have focused mostly on maternal outcome. In the present study, we investigated whether LpPLA2 activity on foetal lipoproteins is altered by maternal GDM and/or obesity (a major risk factor for GDM), thereby contributing to changes in lipoprotein functionality. We identified HDL as the major carrier of LpPLA2 activity in the foetus, which is in contrast to adults. We observed marked expression of LpPLA2 in placental macrophages (Hofbauer cells; HBCs) and found that LpPLA2 activity in these cells was increased by insulin, leptin, and pro-inflammatory cytokines. These regulators were also increased in plasma of children born from GDM pregnancies. Our results suggest that insulin, leptin, and pro-inflammatory cytokines are positive regulators of LpPLA2 activity in the foeto-placental unit. Of particular interest, functional assays using a specific LpPLA2 inhibitor suggest that high-density lipoprotein (HDL)-associated LpPLA2 exerts anti-oxidative, athero-protective functions on placental endothelium and foetus. Our results therefore raise the possibility that foetal HDL-associated LpPLA2 might act as an anti-inflammatory enzyme improving vascular barrier function.
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Affiliation(s)
| | - Birgit Hirschmugl
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Susanne Kopp
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Sanja Curcic
- Department of Clinical and Experimental Pharmacology, Medical University of Graz, Graz, Austria
| | - Eva Maria Bernhart
- Institute of Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - Gunther Marsche
- Department of Clinical and Experimental Pharmacology, Medical University of Graz, Graz, Austria
| | - Uwe Lang
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Christian Wadsack
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
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73
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Intranasal insulin reverts central pathology and cognitive impairment in diabetic mother offspring. Mol Neurodegener 2017; 12:57. [PMID: 28768549 PMCID: PMC5541692 DOI: 10.1186/s13024-017-0198-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
Abstract
Background Adverse effects in diabetic mothers offspring (DMO) are a major concern of increasing incidence. Among these, chronic central complications in DMO remain poorly understood, and in extreme cases, diabetes can essentially function as a gestational brain insult. Nevertheless, therapeutic alternatives for DMO are limited. Methods Therefore, we have analyzed the central long-term complications in the offspring from CD1 diabetic mothers treated with streptozotozin, as well as the possible reversion of these alterations by insulin administration to neonates. Brain atrophy, neuronal morphology, tau phosphorylation, proliferation and neurogenesis were assessed in the short term (P7) and in the early adulthood (10 weeks) and cognitive function was also analyzed in the long-term. Results Central complications in DMO were still detected in the adulthood, including cortical and hippocampal thinning due to synaptic loss and neuronal simplification, increased tau hyperphosphorylation, and diminished cell proliferation and neurogenesis. Additionally, maternal diabetes increased the long-term susceptibility to spontaneous central bleeding, inflammation and cognition impairment in the offspring. On the other hand, intracerebroventricular insulin administration to neonates significantly reduced observed alterations. Moreover, non-invasive intranasal insulin reversed central atrophy and tau hyperphosphorylation, and rescued central proliferation and neurogenesis. Vascular damage, inflammation and cognitive alterations were also comparable to their counterparts born to nondiabetic mice, supporting the utility of this pathway to access the central nervous system. Conclusions Our data underlie the long-term effects of central complications in DMO. Moreover, observed improvement after insulin treatment opens the door to therapeutic alternatives for children who are exposed to poorly controlled gestational diabetes, and who may benefit from more individualized treatments.
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74
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Sandeep MS, Nandini CD. Brain heparan sulphate proteoglycans are altered in developing foetus when exposed to in-utero hyperglycaemia. Metab Brain Dis 2017; 32:1185-1194. [PMID: 28462474 DOI: 10.1007/s11011-017-0019-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 04/21/2017] [Indexed: 01/14/2023]
Abstract
In-utero exposure of foetus to hyperglycaemic condition affects the growth and development of the organism. The brain is one of the first organs that start to develop during embryonic period and glycosaminoglycans (GAGs) and proteoglycans (PGs) are one of the key molecules involved in its development. But studies on the effect of hyperglycaemic conditions on brain GAGs/PGs are few and far between. We, therefore, looked into the changes in brain GAGs and PGs at various developmental stages of pre- and post-natal rats from non-diabetic and diabetic mothers as well as in adult rats induced with diabetes using a diabetogenic agent, Streptozotocin. Increased expression of GAGs especially that of heparan sulphate class in various developmental stages were observed in the brain as a result of in-utero hyperglycaemic condition but not in that of adult rats. Changes in disaccharides of heparan sulphate (HS) were observed in various developmental stages. Furthermore, various HSPGs namely, syndecans-1 and -3 and glypican-1 were overexpressed in offspring from diabetic mother. However, in adult diabetic rats, only glypican-1 was overexpressed. The offsprings from diabetic mothers became hyperphagic at the end of 8 weeks after birth which can have implications in the long run. Our results highlight the likely impact of the in-utero exposure of foetus to hyperglycaemic condition on brain GAGs/PGs compared to diabetic adult rats.
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Affiliation(s)
- M S Sandeep
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, Mysuru, 570 020, India
| | - C D Nandini
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, Mysuru, 570 020, India.
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75
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Andersen SL, Carlé A, Karmisholt J, Pedersen IB, Andersen S. MECHANISMS IN ENDOCRINOLOGY: Neurodevelopmental disorders in children born to mothers with thyroid dysfunction: evidence of fetal programming? Eur J Endocrinol 2017; 177:R27-R36. [PMID: 28377377 DOI: 10.1530/eje-16-0947] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/28/2017] [Accepted: 04/04/2017] [Indexed: 12/13/2022]
Abstract
Fetal programming is a long-standing, but still evolving, concept that links exposures during pregnancy to the later development of disease in the offspring. A fetal programming effect has been considered within different endocrine axes and in relation to different maternal endocrine diseases. In this critical review, we describe and discuss the hypothesis of fetal programming by maternal thyroid dysfunction in the context of fetal brain development and neurodevelopmental disorders in the offspring. Thyroid hormones are important regulators of early brain development, and evidence from experimental and observational human studies have demonstrated structural and functional abnormalities in the brain caused by the lack or excess of thyroid hormone during fetal brain development. The hypothesis that such abnormalities introduced during early fetal brain development increase susceptibility for the later onset of neurodevelopmental disorders in the offspring is biologically plausible. However, epidemiological studies on the association between maternal thyroid dysfunction and long-term child outcomes are observational in design, and are challenged by important methodological aspects.
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Affiliation(s)
| | | | | | | | - Stig Andersen
- GeriatricsAalborg University Hospital, Aalborg, Denmark
- Department Clinical MedicineAalborg University, Aalborg, Denmark
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76
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Nielsen GL, Welinder L, Berg Johansen M. Mortality and morbidity in offspring of mothers with diabetes compared with a population group: a Danish cohort study with 8-35 years of follow-up. Diabet Med 2017; 34:938-945. [PMID: 28004434 DOI: 10.1111/dme.13312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/19/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022]
Abstract
AIMS To assess mortality and morbidity in the offspring of mothers with diabetes compared with a control cohort of offspring of mothers without diabetes. METHODS The mortality rate, percentage of days admitted to hospital, diagnostic categories and incidence of diabetes mellitus among 691 offspring of mothers with diabetes were compared with a control group of 168 831 offspring not exposed to maternal diabetes. Offspring of mothers with diabetes were identified from the North Jutland Pregnancy database (521 Type 1; 34 Type 2; 136 gestational diabetes) born between 1976 and 2003. Outcome data were retrieved from the National Registry of Patients with follow-up until 31 December 2011. In a subgroup with the longest hospital stay we reviewed hospital records for clinical details until 2016. RESULTS Mortality was 1.45% in the diabetes group compared with 1.36% in the control group. In the first 2 years, offspring exposed to diabetes spent significantly more time in hospital than the control offspring, but this difference faded to an insignificant difference of 0.04% of time spent in hospital between age 2 and 8 years. The offspring of mothers with diabetes had a sixfold increased risk of developing diabetes mellitus. CONCLUSIONS The offspring of mothers with and without diabetes had almost identical mortality. The increased morbidity was restricted to the first 2 years of life, and was primarily attributable to a few individuals with very severe but probably non-diabetes-related disease burden. The large majority of offspring of mothers with diabetes experienced health conditions similar to those not exposed to diabetes.
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MESH Headings
- Child Development
- Cohort Studies
- Denmark/epidemiology
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/etiology
- Diabetes Mellitus, Type 1/mortality
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/mortality
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes, Gestational/physiopathology
- Female
- Fetal Development
- Follow-Up Studies
- Health Status
- Humans
- Incidence
- Infant, Newborn
- Male
- Mortality
- Pregnancy
- Pregnancy in Diabetics/physiopathology
- Prenatal Exposure Delayed Effects
- Registries
- Risk
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Affiliation(s)
- G L Nielsen
- Department of Internal Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - L Welinder
- Department of Ophthalmology, Aalborg University, Aalborg, Denmark
| | - M Berg Johansen
- Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
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Klein J, Boyle JA, Kirkham R, Connors C, Whitbread C, Oats J, Barzi F, McIntyre D, Lee I, Luey M, Shaw J, Brown ADH, Maple-Brown LJ. Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice. Diabetes Res Clin Pract 2017; 129:105-115. [PMID: 28521194 DOI: 10.1016/j.diabres.2017.03.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
AIMS Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. RESULTS Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. CONCLUSIONS Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
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Affiliation(s)
- J Klein
- Royal Darwin Hospital, Darwin, Australia; Department of Obstetrics and Gynaecology, Eastern Health, Melbourne, Australia
| | - J A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Menzies School of Health Research, Darwin, Australia
| | - R Kirkham
- Menzies School of Health Research, Darwin, Australia
| | - C Connors
- Northern Territory Department of Health, Darwin, Australia
| | - C Whitbread
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - F Barzi
- Menzies School of Health Research, Darwin, Australia
| | - D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - I Lee
- Menzies School of Health Research, Darwin, Australia
| | - M Luey
- Central Australian Aboriginal Congress, Alice Springs, Australia
| | - J Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A D H Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia; University of South Australia, Adelaide, Australia
| | - L J Maple-Brown
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia.
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78
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Zhao D, Shen L, Wei Y, Xie J, Chen S, Liang Y, Chen Y, Wu H. Identification of candidate biomarkers for the prediction of gestational diabetes mellitus in the early stages of pregnancy using iTRAQ quantitative proteomics. Proteomics Clin Appl 2017; 11. [PMID: 28220636 DOI: 10.1002/prca.201600152] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/08/2017] [Accepted: 02/17/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Danqing Zhao
- Department of General Surgery; the Second Affiliated Hospital of Soochow University; Suzhou P. R. China
- Department of Obstetrics and Gynecology; Affiliated Hospital of Guizhou Medical University; Guiyang P. R. China
| | - Liming Shen
- College of Life Science and Oceanography; Shenzhen University; Shenzhen P. R. China
| | - Yan Wei
- School of Public Health; Guizhou Medical University; Guiyang P. R. China
| | - Jiaming Xie
- Department of General Surgery; the Second Affiliated Hospital of Soochow University; Suzhou P. R. China
| | - Shuqiang Chen
- Department of Obstetrics and Gynecology; Affiliated Hospital of Guizhou Medical University; Guiyang P. R. China
| | - Yi Liang
- Department of Obstetrics and Gynecology; Affiliated Hospital of Guizhou Medical University; Guiyang P. R. China
| | - Youjiao Chen
- College of Life Science and Oceanography; Shenzhen University; Shenzhen P. R. China
| | - Haorong Wu
- Department of General Surgery; the Second Affiliated Hospital of Soochow University; Suzhou P. R. China
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79
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O'Neill SM, Kenny LC, Khashan AS, West HM, Smyth RMD, Kearney PM. Different insulin types and regimens for pregnant women with pre-existing diabetes. Cochrane Database Syst Rev 2017; 2:CD011880. [PMID: 28156005 PMCID: PMC6464609 DOI: 10.1002/14651858.cd011880.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Insulin requirements may change during pregnancy, and the optimal treatment for pre-existing diabetes is unclear. There are several insulin regimens (e.g. via syringe, pen) and types of insulin (e.g. fast-acting insulin, human insulin). OBJECTIVES To assess the effects of different insulin types and different insulin regimens in pregnant women with pre-existing type 1 or type 2 diabetes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 October 2016), ClinicalTrials.gov (17 October 2016), the WHO International Clinical Trials Registry Platform (ICTRP; 17 October 2016), and the reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared different insulin types and regimens in pregnant women with pre-existing diabetes.We had planned to include cluster-RCTs, but none were identified. We excluded quasi-randomised controlled trials and cross-over trials. We included studies published in abstract form and contacted the authors for further details when applicable. Conference abstracts were superseded by full publications. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, conducted data extraction, assessed risk of bias, and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS The findings in this review were based on very low-quality evidence, from single, small sample sized trial estimates, with wide confidence intervals (CI), some of which crossed the line of no effect; many of the prespecified outcomes were not reported. Therefore, they should be interpreted with caution. We included five trials that included 554 women and babies (four open-label, multi-centre, two-arm trials; one single centre, four-arm RCT). All five trials were at a high or unclear risk of bias due to lack of blinding, unclear methods of randomisation, and selective reporting of outcomes. Pooling of data from the trials was not possible, as each trial looked at a different comparison.1. One trial (N = 33 women) compared Lispro insulin with regular insulin and provided very low-quality evidence for the outcomes. There were seven episodes of pre-eclampsia in the Lispro group and nine in the regular insulin group, with no clear difference between the two groups (risk ratio (RR) 0.68, 95% CI 0.35 to 1.30). There were five caesarean sections in the Lispro group and nine in the regular insulin group, with no clear difference between the two groups (RR 0.59, 95% CI 0.25 to 1.39). There were no cases of fetal anomaly in the Lispro group and one in the regular insulin group, with no clear difference between the groups (RR 0.35, 95% CI 0.02 to 8.08). Macrosomia, perinatal deaths, episodes of birth trauma including shoulder dystocia, nerve palsy, and fracture, and the composite outcome measure of neonatal morbidity were not reported.2. One trial (N = 42 women) compared human insulin to animal insulin, and provided very low-quality evidence for the outcomes. There were no cases of macrosomia in the human insulin group and two in the animal insulin group, with no clear difference between the groups (RR 0.22, 95% CI 0.01 to 4.30). Perinatal death, pre-eclampsia, caesarean section, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy and fracture and the composite outcome measure of neonatal morbidity were not reported.3. One trial (N = 93 women) compared pre-mixed insulin (70 NPH/30 REG) to self-mixed, split-dose insulin and provided very low-quality evidence to support the outcomes. Two cases of macrosomia were reported in the pre-mixed insulin group and four in the self-mixed insulin group, with no clear difference between the two groups (RR 0.49, 95% CI 0.09 to 2.54). There were seven cases of caesarean section (for cephalo-pelvic disproportion) in the pre-mixed insulin group and 12 in the self-mixed insulin group, with no clear difference between groups (RR 0.57, 95% CI 0.25 to 1.32). Perinatal death, pre-eclampsia, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy, or fracture and the composite outcome measure of neonatal morbidity were not reported.4. In the same trial (N = 93 women), insulin injected with a Novolin pen was compared to insulin injected with a conventional needle (syringe), which provided very low-quality evidence to support the outcomes. There was one case of macrosomia in the pen group and five in the needle group, with no clear difference between the different insulin regimens (RR 0.21, 95% CI 0.03 to 1.76). There were five deliveries by caesarean section in the pen group compared with 14 in the needle group; women were less likely to deliver via caesarean section when insulin was injected with a pen compared to a conventional needle (RR 0.38, 95% CI 0.15 to 0.97). Perinatal death, pre-eclampsia, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy, or fracture, and the composite outcome measure of neonatal morbidity were not reported.5. One trial (N = 223 women) comparing insulin Aspart with human insulin reported none of the review's primary outcomes: macrosomia, perinatal death, pre-eclampsia, caesarean section, fetal anomaly, birth trauma including shoulder dystocia. nerve palsy, or fracture, or the composite outcome measure of neonatal morbidity.6. One trial (N = 162 women) compared insulin Detemir with NPH insulin, and supported the outcomes with very low-quality evidence. There were three cases of major fetal anomalies in the insulin Detemir group and one in the NPH insulin group, with no clear difference between the groups (RR 3.15, 95% CI 0.33 to 29.67). Macrosomia, perinatal death, pre-eclampsia, caesarean section, birth trauma including shoulder dystocia, nerve palsy, or fracture and the composite outcome of neonatal morbidity were not reported. AUTHORS' CONCLUSIONS With limited evidence and no meta-analyses, as each trial looked at a different comparison, no firm conclusions could be made about different insulin types and regimens in pregnant women with pre-existing type 1 or 2 diabetes. Further research is warranted to determine who has an increased risk of adverse pregnancy outcome. This would include larger trials, incorporating adequate randomisation and blinding, and key outcomes that include macrosomia, pregnancy loss, pre-eclampsia, caesarean section, fetal anomalies, and birth trauma.
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Affiliation(s)
- Sinéad M O'Neill
- University College CorkIrish Centre for Fetal and Neonatal Translational Research (INFANT)5th Floor, Cork University Maternity HospitalWiltonCorkMunsterIreland
| | - Louise C Kenny
- University College CorkIrish Centre for Fetal and Neonatal Translational Research (INFANT)5th Floor, Cork University Maternity HospitalWiltonCorkMunsterIreland
| | - Ali S Khashan
- University College CorkIrish Centre for Fetal and Neonatal Translational Research (INFANT)5th Floor, Cork University Maternity HospitalWiltonCorkMunsterIreland
- University College CorkDepartment of Epidemiology and Public HealthCorkIreland
| | - Helen M West
- The University of LiverpoolInstitute of Psychology, Health and SocietyLiverpoolUK
| | - Rebecca MD Smyth
- The University of ManchesterSchool of Nursing, Midwifery and Social WorkJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Patricia M Kearney
- University College CorkDepartment of Epidemiology and Public HealthCorkIreland
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Kara M, Orbak Z, Döneray H, Ozkan B, Akcay F. The Relationship Between Skinfold Thickness and Leptin, Ghrelin, Adiponectin, and Resistin Levels in Infants of Diabetic Mothers. Fetal Pediatr Pathol 2017; 36:1-7. [PMID: 27559858 DOI: 10.1080/15513815.2016.1217960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to investigate the relationship between skinfold thickness and serum leptin, ghrelin, adiponectin, and resistin levels in infants of diabetic mothers. Biochemical parameters were also similar for the two groups (infants of diabetic mothers and controls) (p > 0.05). We confirmed that there was a negative correlation between birth weight and serum ghrelin level (p < 0.05) in the two groups. When it was evaluated for control newborns, a positive correlation between abdominal circumference and serum resistin level was found in the controls (p < 0.05). Our results indicate that gestational diabetes by appropriate diet or insulin treatment may be effective in the protection of fetuses of diabetic mothers from the negative effects of gestational diabetes. Ghrelin alone was negatively correlated with birth weight. This negative correlation could be potentially advantageous to infants, because a reduction in appetite might prevent excessive food intake and postnatal weight gain.
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Affiliation(s)
- Mustafa Kara
- a Department of Pediatric Endocrinology , Ataturk University Medical Faculty , Erzurum , Turkey
| | - Zerrin Orbak
- a Department of Pediatric Endocrinology , Ataturk University Medical Faculty , Erzurum , Turkey
| | - Hakan Döneray
- a Department of Pediatric Endocrinology , Ataturk University Medical Faculty , Erzurum , Turkey
| | - Behzat Ozkan
- a Department of Pediatric Endocrinology , Ataturk University Medical Faculty , Erzurum , Turkey
| | - Fatih Akcay
- a Department of Pediatric Endocrinology , Ataturk University Medical Faculty , Erzurum , Turkey
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81
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Peng TY, Ehrlich SF, Crites Y, Kitzmiller JL, Kuzniewicz MW, Hedderson MM, Ferrara A. Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996-2014. Am J Obstet Gynecol 2017; 216:177.e1-177.e8. [PMID: 27751798 DOI: 10.1016/j.ajog.2016.10.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/27/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite concern for adverse perinatal outcomes in women with diabetes mellitus before pregnancy, recent data on the prevalence of pregestational type 1 and type 2 diabetes mellitus in the United States are lacking. OBJECTIVE The purpose of this study was to estimate changes in the prevalence of overall pregestational diabetes mellitus (all types) and pregestational type 1 and type 2 diabetes mellitus and to estimate whether changes varied by race-ethnicity from 1996-2014. STUDY DESIGN We conducted a cohort study among 655,428 pregnancies at a Northern California integrated health delivery system from 1996-2014. Logistic regression analyses provided estimates of prevalence and trends. RESULTS The age-adjusted prevalence (per 100 deliveries) of overall pregestational diabetes mellitus increased from 1996-1999 to 2012-2014 (from 0.58 [95% confidence interval, 0.54-0.63] to 1.06 [95% confidence interval, 1.00-1.12]; Ptrend <.0001). Significant increases occurred in all racial-ethnic groups; the largest relative increase was among Hispanic women (121.8% [95% confidence interval, 84.4-166.7]); the smallest relative increase was among non-Hispanic white women (49.6% [95% confidence interval, 27.5-75.4]). The age-adjusted prevalence of pregestational type 1 and type 2 diabetes mellitus increased from 0.14 (95% confidence interval, 0.12-0.16) to 0.23 (95% confidence interval, 0.21-0.27; Ptrend <.0001) and from 0.42 (95% confidence interval, 0.38-0.46) to 0.78 (95% confidence interval, 0.73-0.83; Ptrend <.0001), respectively. The greatest relative increase in the prevalence of type 1 diabetes mellitus was in non-Hispanic white women (118.4% [95% confidence interval, 70.0-180.5]), who had the lowest increases in the prevalence of type 2 diabetes mellitus (13.6% [95% confidence interval, -8.0 to 40.1]). The greatest relative increase in the prevalence of type 2 diabetes mellitus was in Hispanic women (125.2% [95% confidence interval, 84.8-174.4]), followed by African American women (102.0% [95% confidence interval, 38.3-194.3]) and Asian women (93.3% [95% confidence interval, 48.9-150.9]). CONCLUSIONS The prevalence of overall pregestational diabetes mellitus and pregestational type 1 and type 2 diabetes mellitus increased from 1996-1999 to 2012-2014 and racial-ethnic disparities were observed, possibly because of differing prevalence of maternal obesity. Targeted prevention efforts, preconception care, and disease management strategies are needed to reduce the burden of diabetes mellitus and its sequelae.
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82
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Vafeiadi M, Roumeliotaki T, Chalkiadaki G, Rantakokko P, Kiviranta H, Fthenou E, Kyrtopoulos SA, Kogevinas M, Chatzi L. Persistent organic pollutants in early pregnancy and risk of gestational diabetes mellitus. ENVIRONMENT INTERNATIONAL 2017; 98:89-95. [PMID: 27743729 DOI: 10.1016/j.envint.2016.10.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 10/06/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND Persistent organic pollutants (POPs) are a group of diverse substances, including polychlorinated biphenyls (PCBs) and organochlorine pesticides that are resistant to biodegradation and ubiquitously present in our environment. Exposure to endocrine disrupting chemicals such as POPs has been linked to type 2 diabetes and metabolic disturbances in epidemiological and animal studies, but little is known about POPs exposure during pregnancy and the development of gestational diabetes mellitus (GDM). The purpose of this study was to determine the extent to which exposure to current low levels of different POPs in the first trimester of pregnancy is associated with GDM risk in 939 women from the "Rhea" pregnancy cohort in Crete, Greece. METHODS Concentrations of several PCBs, dichlorodiphenyldichloroethene (DDE), and hexachlorobenzene (HCB) were determined in first trimester maternal serum by triple quadrupole mass spectrometry. We defined total PCBs as the sum of all congeners, nondioxin-like PCBs as the sum of PCB 153, 138, 170 and 180, and dioxin-like PCBs as the sum of PCB 118 and 156. Pregnant women were screened for gestational diabetes mellitus (GDM) between 24 and 28weeks of gestation, and GDM was defined by the criteria proposed by Carpenter and Coustan. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression models. RESULTS Of the 939 women, 68 (7%) developed GDM. Serum concentrations of POPs were higher in women with GDM. Women in the medium and high tertiles of PCBs had 3.90 (95% CI: 1.37, 11.06) and 3.60 (95% CI: 1.14, 11.39) fold respectively higher odds of developing GDM compared to women in the lowest tertile of PCB exposure after adjusting for pre-pregnancy BMI and several other confounders. Odds of GDM for women in the medium and high tertiles of dioxin-like PCBs was 5.63 (95% CI: 1.81, 17.51) and 4.71 (95% CI: 1.38, 16.01) and for nondioxin-like PCBs 2.36 (95% CI: 0.89, 6.23) and 2.26 (95% CI: 0.77, 6.68) respectively. Prenatal DDE and HCB exposure were not significantly associated GDM risk. CONCLUSIONS These findings suggest that women with high PCBs levels in early pregnancy had higher risk for GDM. Further studies are needed to replicate these results and to evaluate potential biological mechanisms underlying the observed associations.
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Affiliation(s)
- Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Panu Rantakokko
- Department of Environmental Health, National Institute for Health and Welfare, Chemicals and Health Unit, Kuopio, Finland
| | - Hannu Kiviranta
- Department of Environmental Health, National Institute for Health and Welfare, Chemicals and Health Unit, Kuopio, Finland
| | - Eleni Fthenou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Soterios A Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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83
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Sex-specific associations of low birth weight with adult-onset diabetes and measures of glucose homeostasis: Brazilian Longitudinal Study of Adult Health. Sci Rep 2016; 6:37032. [PMID: 27845438 PMCID: PMC5109479 DOI: 10.1038/srep37032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022] Open
Abstract
Emerging evidence suggests sex differences in the early origins of adult metabolic disease, but this has been little investigated in developing countries. We investigated sex-specific associations between low birth weight (LBW; <2.5 kg) and adult-onset diabetes in 12,525 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Diabetes was defined by self-reported information and laboratory measurements. In confounder-adjusted analyses, LBW (vs. 2.5–4 kg) was associated with higher prevalence of diabetes in women (Prevalence Ratio (PR) 1.54, 95% CI: 1.32–1.79), not in men (PR 1.06, 95% CI: 0.91–1.25; Pheterogeneity = 0.003). The association was stronger among participants with maternal diabetes (PR 1.60, 95% CI: 1.35–1.91), than those without (PR 1.15, 95% CI: 0.99–1.32; Pheterogeneity = 0.03). When jointly stratified by sex and maternal diabetes, the association was observed for women with (PR 1.77, 95% CI: 1.37–2.29) and without (PR 1.45, 95% CI: 1.20–1.75) maternal diabetes. In contrast, in men, LBW was associated with diabetes in participants with maternal diabetes (PR 1.45, 95% CI: 1.15–1.83), but not in those without (PR 0.92, 95% CI: 0.74–1.14). These sex-specific findings extended to continuous measures of glucose homeostasis. LBW was associated with higher diabetes prevalence in Brazilian women, and in men with maternal diabetes, suggesting sex-specific intrauterine effects on adult metabolic health.
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84
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Cai S, Qiu A, Broekman BFP, Wong EQ, Gluckman PD, Godfrey KM, Saw SM, Soh SE, Kwek K, Chong YS, Meaney MJ, Kramer MS, Rifkin-Graboi A. The Influence of Gestational Diabetes on Neurodevelopment of Children in the First Two Years of Life: A Prospective Study. PLoS One 2016; 11:e0162113. [PMID: 27603522 PMCID: PMC5014336 DOI: 10.1371/journal.pone.0162113] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/24/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Analyze the relation of gestational diabetes and maternal blood glucose levels to early cognitive functions in the first two years of life. METHODS In a prospective Singaporean birth cohort study, pregnant women were screened for gestational diabetes at 26-28 weeks gestation using a 75-g oral glucose tolerance test. Four hundred and seventy three children (n = 74 and n = 399 born to mothers with and without gestational diabetes respectively) underwent neurocognitive assessments at 6, 18, and/or 24 month, including electrophysiology during an attentional task and behavioral measures of attention, memory and cognition. RESULTS Gestational diabetes is related to left hemisphere EPmax amplitude differences (oddball versus standard) at both six (P = 0.039) and eighteen months (P = 0.039), with mean amplitudes suggesting offspring of mothers with gestational diabetes exhibit greater neuronal activity to standard stimuli and less to oddball stimuli. Associations between 2-hour maternal glucose levels and the difference in EPmax amplitude were marginal at 6 months [adjusted β = -0.19 (95% CI: -0.42 to +0.04) μV, P = 0.100] and significant at 18 months [adjusted β = -0.27 (95% CI: -0.49 to -0.06) μV, P = 0.014], and the EPmax amplitude difference (oddball-standard) associated with the Bayley Scales of Infant and toddler Development-III cognitive score at 24 months [β = 0.598 (95% CI: 0.158 to 1.038), P = 0.008]. CONCLUSION Gestational diabetes and maternal blood glucose levels are associated with offspring neuronal activity during an attentional task at both six and eighteen months. Such electrophysiological differences are likely functionally important, having been previously linked to attention problems later in life.
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Affiliation(s)
- Shirong Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Anqi Qiu
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
- Department of Biomedical Engineering and Clinical Imaging Research Centre, National University of Singapore, Singapore, Singapore
| | - Birit F. P. Broekman
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Eric Qinlong Wong
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Shu-E Soh
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kenneth Kwek
- Department of Maternal and Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
| | - Michael J. Meaney
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
| | - Michael S. Kramer
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montréal, Canada
- Department of Pediatrics, McGill University Faculty of Medicine, Montréal, Canada
| | - Anne Rifkin-Graboi
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
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Affiliation(s)
- Joanna D Holbrook
- NIHR Southampton Biomedical Research Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 30 Medical Drive, 117609, Singapore
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Bytoft B, Knorr S, Vlachova Z, Jensen RB, Mathiesen ER, Beck-Nielsen H, Gravholt CH, Jensen DM, Clausen TD, Mortensen EL, Damm P. Long-term Cognitive Implications of Intrauterine Hyperglycemia in Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study). Diabetes Care 2016; 39:1356-63. [PMID: 27271191 DOI: 10.2337/dc16-0168] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/17/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Exposure to maternal diabetes in utero may have a negative impact on the developing brain. The objective was to examine long-term cognitive consequences of intrauterine hyperglycemia in adolescent offspring of women with type 1 diabetes and to ascertain a possible association with maternal HbA1c. RESEARCH DESIGN AND METHODS Offspring of a prospectively followed cohort of women with type 1 diabetes (n = 277) participated in a follow-up examination at the age of 13-19 years. A control group from the background population was identified (n = 301). Cognitive function was evaluated using Reynolds Intellectual Assessment Scales and classified into indices of composite intelligence, verbal and nonverbal intelligence, and composite memory. Frequencies of reading and writing problems and attendance to classes for children with learning difficulties were assessed. RESULTS Offspring of women with type 1 diabetes scored lower in all normalized and standardized intelligence indices compared with controls: composite intelligence (95.7 vs. 100, P = 0.001), verbal intelligence (96.2 vs. 100, P = 0.004), nonverbal intelligence (96.4 vs. 100, P = 0.008), and composite memory (95.7 vs. 100, P = 0.001). A higher frequency of diabetes-exposed offspring had parent-reported learning difficulties in primary school. Differences between groups remained after adjustment for confounders and potential mediators. We found no direct association between maternal HbA1c and offspring cognitive function in the exposed group. CONCLUSIONS Adolescent offspring of women with type 1 diabetes had lower cognitive function compared with a control group, also after adjustment for confounders and potential mediators. These differences may reflect direct harmful effects of maternal diabetes on neurodevelopment in the offspring.
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Affiliation(s)
- Birgitte Bytoft
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sine Knorr
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Zuzana Vlachova
- Department of Endocrinology, Odense University Hospital, Odense, Denmark Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Rikke B Jensen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | | | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Erik L Mortensen
- Section of Environmental Health, Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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87
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Damm P, Houshmand-Oeregaard A, Kelstrup L, Lauenborg J, Mathiesen ER, Clausen TD. Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark. Diabetologia 2016; 59:1396-1399. [PMID: 27174368 DOI: 10.1007/s00125-016-3985-5] [Citation(s) in RCA: 363] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 03/30/2016] [Indexed: 12/13/2022]
Abstract
Gestational diabetes mellitus (GDM) is defined as glucose intolerance of varying severity and is present in about 2-6% of all pregnancies in Europe, making it one of the most common pregnancy disorders. Aside from the short-term maternal, fetal and neonatal consequences associated with GDM, there are long-term consequences for both mother and child. Although maternal glucose tolerance often normalises shortly after pregnancy, women with GDM have a substantially increased risk of developing type 2 diabetes later in life. Studies have reported that women are more than seven times as likely to develop diabetes after GDM, and that approximately 50% of mothers with GDM will develop diabetes within 10 years, making GDM one of the strongest predictors of type 2 diabetes. In women with previous GDM, development of type 2 diabetes can be prevented or delayed by lifestyle intervention and/or medical treatment. Systematic follow-up programmes would be ideal to prevent progression of GDM to diabetes, but such programmes are unfortunately lacking in the routine clinical set-up in most countries. Studies have found that the risks of obesity, the metabolic syndrome, type 2 diabetes and impaired insulin sensitivity and secretion in offspring of mothers with GDM are two- to eightfold those in offspring of mothers without GDM. The underlying pathogenic mechanisms behind the abnormal metabolic risk profile in offspring are unknown, but epigenetic changes induced by exposure to maternal hyperglycaemia during fetal life are implicated. Animal studies indicate that treatment can prevent long-term metabolic complications in offspring, but this remains to be confirmed in humans. Thus, diabetes begets diabetes and it is likely that GDM plays a significant role in the global diabetes epidemic. This review summarises a presentation given at the 'Gestational diabetes: what's up?' symposium at the 2015 annual meeting of the EASD. It is accompanied by two other reviews on topics from this symposium (by Marja Vääräsmäki, DOI: 10.1007/s00125-016-3976-6 , and by Cuilin Zhang and colleagues, DOI: 10.1007/s00125-016-3979-3 ) and an overview by the Session Chair, Kerstin Berntorp (DOI: 10.1007/s00125-016-3975-7 ).
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Affiliation(s)
- Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics 4031, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Azadeh Houshmand-Oeregaard
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics 4031, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Diabetes and Metabolism, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Louise Kelstrup
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics 4031, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Diabetes and Metabolism, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Jeannet Lauenborg
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics 4031, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tine D Clausen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Nordsjællands Hospital, Hilleroed, Denmark
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88
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Abstract
Gestational diabetes mellitus (GDM) is an increasingly common obstetrical problem. Due to the global escalation in the prevalence of obesity, as many as 15 % of pregnant women may soon be classified as having GDM. While often not diagnosed until late gestation, GDM is now recognized as a disorder of glucose and lipid metabolism, systemic inflammation, and insulin resistance that begins early in pregnancy. Recent large randomized trials have clarified the risk of maternal and neonatal complications caused by GDM, as well as the potential to ameliorate these risks. There is significant interest in the potential to reduce the risk for developing GDM in obese women through the performance of bariatric surgery (BS) before pregnancy. BS significantly reduces the risk for GDM, preeclampsia, and large neonates. However, it seems that the risk for small neonates and preterm delivery is increased. No significant differences are observed in regard to cesarean section, postpartum hemorrhage, or perinatal mortality. In this article, we address the effects of GDM on the mother and child, and explore the risks and benefits of BS in the obstetrical population.
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Affiliation(s)
- Kent Willis
- Our Lady of the Lake Children's Hospital, 7777 Hennessy Boulevard, Suite 6003, Baton Rouge, LA, 70808, USA.
| | - Charlotte Alexander
- The Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer-Sheva, Israel.
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89
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Chiavaroli V, Derraik JGB, Hofman PL, Cutfield WS. Born Large for Gestational Age: Bigger Is Not Always Better. J Pediatr 2016; 170:307-11. [PMID: 26707580 DOI: 10.1016/j.jpeds.2015.11.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/27/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022]
Affiliation(s)
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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90
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Moreli JB, Santos JH, Lorenzon-Ojea AR, Corrêa-Silva S, Fortunato RS, Rocha CR, Rudge MV, Damasceno DC, Bevilacqua E, Calderon IM. Hyperglycemia Differentially Affects Maternal and Fetal DNA Integrity and DNA Damage Response. Int J Biol Sci 2016; 12:466-77. [PMID: 27019630 PMCID: PMC4807165 DOI: 10.7150/ijbs.12815] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 01/13/2016] [Indexed: 12/28/2022] Open
Abstract
Objective: Investigate the DNA damage and its cellular response in blood samples from both mother and the umbilical cord of pregnancies complicated by hyperglycemia. Methods: A total of 144 subjects were divided into 4 groups: normoglycemia (ND; 46 cases), mild gestational hyperglycemia (MGH; 30 cases), gestational diabetes mellitus (GDM; 45 cases) and type-2 diabetes mellitus (DM2; 23 cases). Peripheral blood mononuclear cell (PBMC) isolation and/or leukocytes from whole maternal and umbilical cord blood were obtained from all groups at delivery. Nuclear and mitochondrial DNA damage were measured by gene-specific quantitative PCR, and the expression of mRNA and proteins involved in the base excision repair (BER) pathway were assessed by real-time qPCR and Western blot, respectively. Apoptosis was measured in vitro experiments by caspase 3/7 activity and ATP levels. Results: GDM and DM2 groups were characterized by an increase in oxidative stress biomarkers, an increase in nuclear and mitochondrial DNA damage, and decreased expression of mRNA (APE1, POLβ and FEN1) and proteins (hOGG1, APE1) involved in BER. The levels of hyperglycemia were associated with the in vitro apoptosis pathway. Blood levels of DNA damage in umbilical cord were similar among the groups. Newborns of diabetic mothers had increased expression of BER mRNA (APE1, POLβ and FEN1) and proteins (hOGG1, APE1, POLβ and FEN1). A diabetes-like environment was unable to induce apoptosis in the umbilical cord blood cells. Conclusions: Our data show relevant asymmetry between maternal and fetal blood cell susceptibility to DNA damage and apoptosis induction. Maternal cells seem to be more predisposed to changes in an adverse glucose environment. This may be due to differential ability in upregulating multiple genes involved in the activation of DNA repair response, especially the BER mechanism. However if this study shows a more effective adaptive response by the fetal organism, it also calls for further studies to determine the limit of this response that definitely changes the fate of a fetus under these conditions of cellular stress.
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Affiliation(s)
- Jusciele B Moreli
- 1. Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University / UNESP, São Paulo, Brazil
| | - Janine H Santos
- 2. Laboratory of Molecular Carcinogenesis, National Institute of Environmental Health Sciences / NIEHS, North Carolina, USA
| | - Aline Rodrigues Lorenzon-Ojea
- 3. Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo / USP, São Paulo, Brazil
| | - Simone Corrêa-Silva
- 1. Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University / UNESP, São Paulo, Brazil.; 3. Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo / USP, São Paulo, Brazil
| | - Rodrigo S Fortunato
- 4. Laboratory of Molecular Radiobiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro / UFRJ, Rio de Janeiro, Brazil
| | - Clarissa Ribeiro Rocha
- 5. DNA Repair Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo / USP, São Paulo, Brazil
| | - Marilza V Rudge
- 1. Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University / UNESP, São Paulo, Brazil
| | - Débora C Damasceno
- 1. Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University / UNESP, São Paulo, Brazil
| | - Estela Bevilacqua
- 3. Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo / USP, São Paulo, Brazil
| | - Iracema M Calderon
- 1. Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University / UNESP, São Paulo, Brazil
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91
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Gabory A, Chavatte-Palmer P, Vambergue A, Tarrade A. [Impact of maternal obesity and diabetes on placental function]. Med Sci (Paris) 2016; 32:66-73. [PMID: 26850609 DOI: 10.1051/medsci/20163201011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Located at the feto-maternal interface, the placenta is involved in exchange, endocrine and immune functions, which impact fetal development. In contact with the maternal environment, this organ is sensitive to metabolic disorders as over-nutrition, obesity or diabetes. The alteration of blood parameters associated with these pathologies affects placental histology, vascularization and nutrient transfers and, according to the types of troubles, induces local inflammation or hypoxia. These placental changes lead to disturbance of development and fetal growth, which increase the risk of pathologies in offspring in adulthood. The placenta thus appears as a crucial player in the fetal programming.
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Affiliation(s)
- Anne Gabory
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France
| | - Pascale Chavatte-Palmer
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France - Fondation PremUp, 4, avenue de l'Observatoire, F-75006 Paris, France
| | - Anne Vambergue
- Hôpital Claude Huriez, CHRU Lille, université Lille2, EA 4489 environnement périnatal et croissance, Faculté de médecine, place de Verdun, F-59000 Lille, France
| | - Anne Tarrade
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France - Fondation PremUp, 4, avenue de l'Observatoire, F-75006 Paris, France
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92
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Camprubi Robles M, Campoy C, Garcia Fernandez L, Lopez-Pedrosa JM, Rueda R, Martin MJ. Maternal Diabetes and Cognitive Performance in the Offspring: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0142583. [PMID: 26566144 PMCID: PMC4643884 DOI: 10.1371/journal.pone.0142583] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/24/2015] [Indexed: 12/02/2022] Open
Abstract
Objective Diabetes during gestation is one of the most common pregnancy complications associated with adverse health effects for the mother and the child. Maternal diabetes has been proposed to negatively affect the cognitive abilities of the child, but experimental research assessing its impact is conflicting. The main aim of our study was to compare the cognitive function in children of diabetic and healthy pregnant women. Methods A systematic review and meta-analysis was conducted through a literature search using different electronic databases from the index date to January 31, 2015. We included studies that assessed the cognitive abilities in children (up to 14 years) of diabetic and non-diabetic mothers using standardized and validated neuropsychological tests. Results Of 7,698 references reviewed, 12 studies involving 6,140 infants met our inclusion criteria and contributed to meta-analysis. A random effect model was used to compute the standardized mean differences and 95% confidence interval (CI) were calculated. Infants (1–2 years) of diabetic mothers had significantly lower scores of mental and psychomotor development compared to control infants. The effect size for mental development was -0.41 (95% CI -0.59, -0.24; p<0.0001) and for psychomotor development was -0.31 (95% CI -0.55, -0.07; p = 0.0125) with non-significant heterogeneity. Diabetes during pregnancy could be associated with decreased intelligence quotient scores in school-age children, although studies showed significant heterogeneity. Conclusion The association between maternal diabetes and deleterious effects on mental/psychomotor development and overall intellectual function in the offspring must be taken with caution. Results are based on observational cohorts and a direct causal influence of intrauterine hyperglycemia remains uncertain. Therefore, more trials that include larger populations are warranted to elucidate whether gestational diabetes mellitus (GDM) has a negative impact on offspring central nervous system (CNS).
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Affiliation(s)
| | - Cristina Campoy
- Department of Pediatrics, School of Medicine, University of Granada, Granada, Spain
| | | | | | - Ricardo Rueda
- Abbott Nutrition, Research and Development, Granada, Spain
| | - Maria J. Martin
- Abbott Nutrition, Research and Development, Granada, Spain
- * E-mail:
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93
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Zhang L, Li Z, Zhang B, He H, Bai Y. PPIA is a novel adipogenic factor implicated in obesity. Obesity (Silver Spring) 2015; 23:2093-100. [PMID: 26347493 DOI: 10.1002/oby.21208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/26/2015] [Accepted: 06/08/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the role of peptidyl-prolyl cis/trans isomerase a (PPIA) in adipogenesis and obesity. METHODS Fat mass and adipocyte sizes of PPIA-/- and wild-type mice were compared. The role of PPIA in adipocyte differentiation of 3T3L1 and MEFs cells was analyzed by gene silencing and overexpression. The roles of PPIA in obesity were observed on a high-fat diet obesity model and a gestational diabetes obesity model. RESULTS PPIA-/- mice had significantly less fat than PPIA+/+ mice. The adipocyte size of PPIA-/- mice was significantly smaller than wild type. Silencing PPIA in 3T3L1 cells significantly impaired its adipocyte differentiation ability. Similarly, MEFs from PPIA-/- mice differentiated less than wild type, while their differentiation ability was restored by PPIA overexpression. PPIA-silenced 3T3L1 cells had significantly lower expression of PPARG, C/EBPA, and C/EBPB at late stage of adipocyte differentiation, which was the same in PPIA-/- MEFs. When fed a high-fat diet, PPIA-/- mice gained significantly less weight than wild type, accompanied by reduced PPARG, C/EBPA, and C/EBPB expression. PPIA expression was significantly higher in adipose tissue of gestational diabetes rat offspring, which had higher inguinal fat/body weight ratios than normal rat offspring. CONCLUSIONS PPIA was a novel adipogenic factor important in obesity.
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Affiliation(s)
- Lihong Zhang
- Department of Medical Genetics, Third Military Medical University, Chongqing, People's Republic of China
- Department of Gynecology and Obstetrics, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Zhen Li
- Department of Gynecology and Obstetrics, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Bo Zhang
- Department of Medical Genetics, Third Military Medical University, Chongqing, People's Republic of China
| | - Haiyang He
- Institute of Immunology, Third Military Medical University, Chongqing, People's Republic of China
| | - Yun Bai
- Department of Medical Genetics, Third Military Medical University, Chongqing, People's Republic of China
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94
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Laiosa MD, Tate ER. Fetal Hematopoietic Stem Cells Are the Canaries in the Coal Mine That Portend Later Life Immune Deficiency. Endocrinology 2015; 156:3458-65. [PMID: 26241066 PMCID: PMC4588830 DOI: 10.1210/en.2015-1347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Disorders of the blood system are a significant and growing global health concern and include a spectrum of diseases ranging from aplastic anemia and leukemias to immune suppression. This array of hematological disorders is attributed to the fact that the blood system undergoes a perpetual cycle of turn over with aged and exhausted red and white blood cells undergoing daily replacement. The foundational cells of this replenishment process are comprised of rare hematopoietic stem cells (HSCs) located in the bone marrow that possess the dual function of long-term self-renewal and multilineage differentiation. This constant turnover makes the hematopoietic system uniquely vulnerable to changes in the environment that impact multilineage differentiation, self-renewal, or both. Notably, environmental endocrine-disrupting exposures occurring during development, when HSCs are first emerging, can lead to alterations in HSC programming that impacts the blood and immune systems throughout life. In this review, we describe the process of fetal hematopoiesis and provide an overview of the intrauterine environmental and endocrine-disrupting compounds that disrupt this process. Finally, we describe research opportunities for fetal HSCs as potential sentinels of later-life blood and immune system disorders.
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Affiliation(s)
- Michael D Laiosa
- Joseph J. Zilber School of Public Health, University of Wisconsin, Milwaukee, Wisconsin 53211
| | - Everett R Tate
- Joseph J. Zilber School of Public Health, University of Wisconsin, Milwaukee, Wisconsin 53211
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95
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Placental DNA methylation of peroxisome-proliferator-activated receptor-γ co-activator-1α promoter is associated with maternal gestational glucose level. Clin Sci (Lond) 2015; 129:385-94. [PMID: 25875376 DOI: 10.1042/cs20140688] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Among all the participants, the maternal gestational glucose level was positively correlated with placental DNA methylation. The correlation between gestational 2-h post-OGTT glycaemia and CpG site-specific methylation in placenta was stronger in the gestational diabetes group.
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96
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Lee HY, Lu CL, Chen HF, Su HF, Li CY. Perinatal and childhood risk factors for early-onset type 1 diabetes: a population-based case-control study in Taiwan. Eur J Public Health 2015; 25:1024-9. [PMID: 25841034 DOI: 10.1093/eurpub/ckv059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Certain factors originating from the perinatal and childhood periods are suspected of contributing to the recent increasing trend of childhood type 1 diabetes (T1D) incidence. This study sought to investigate the relationships between various perinatal and childhood risk factors and T1D incidence in young children (<10 years). METHODS We used a nested case-control design based on 1,478,573 live births born in 2000-05 in Taiwan. Cases were 632 incident cases of T1D between 2000 and 2008. Ten matched controls for each case were randomly selected. Information on various perinatal risk factors was also identified from claim data. Multiple conditional logistic regression was employed to estimate odds ratio (OR) and 95 confidence interval (CI) of T1D. RESULTS Childhood infection was significantly associated with an increased risk of T1D (OR = 1.46, 95% CI = 1.23-1.73). Increased risk of T1D was also noted in children born to younger mothers (<25 years) (OR = 1.94, 95% CI = 1.34-2.81), older fathers (>30 years) (OR = 1.56 (95% CI = 1.16-2.10) to 1.57 (95% CI = 1.19-2.05), mothers with Caesarean section (CS) (OR = 2.35, 95% CI = 1.52-3.64), and mothers with gestational diabetes mellitus (OR = 4.36, 95% CI = 2.76-7.77). Fathers with T1D (OR = 7.36, 95% CI = 1.02-57.21) or type 2 diabetes (OR = 1.54, 95% CI = 1.04-2.26) were observed to substantially increase the risk of offspring T1D. CONCLUSIONS Certain modifiable perinatal factors such as infection and CS may predispose incidence of T1D in young children.
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Affiliation(s)
- Hsin-Yu Lee
- 1 Department and Graduate Institute of Public Health, College of Medical, National Cheng-Kung University, Tainan, Taiwan
| | - Chin-Li Lu
- 1 Department and Graduate Institute of Public Health, College of Medical, National Cheng-Kung University, Tainan, Taiwan 2 Department of Medical Research, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Hua-Fen Chen
- 3 Department of Endocrinology, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hui-Fang Su
- 4 Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Yi Li
- 1 Department and Graduate Institute of Public Health, College of Medical, National Cheng-Kung University, Tainan, Taiwan 5 Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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97
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Peiris HN, Lappas M, Georgiou HM, Vaswani K, Salomon C, Rice GE, Mitchell MD. Myostatin in the placentae of pregnancies complicated with gestational diabetes mellitus. Placenta 2014; 36:1-6. [PMID: 25443639 DOI: 10.1016/j.placenta.2014.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/05/2014] [Accepted: 11/12/2014] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is characterised by maternal glucose intolerance and insulin resistance during pregnancy. Myostatin, initially identified as a negative regulator of muscle development may also function in the regulation of placental development and glucose uptake. Myostatin expression in placentae of GDM complicated pregnancies is unknown. However, higher myostatin levels occur in placentae of pregnancies complicated with preeclampsia. We hypothesise that myostatin will be differentially expressed in GDM complicated pregnancies. METHODS Myostatin concentrations (ELISA) were evaluated in plasma of presymptomatic women who later developed GDM and compared to plasma of normal glucose tolerant (NGT) women. Furthermore, myostatin protein expression (Western blot) was studied in placentae of pregnant women with GDM (treated with diet or insulin) compared to placentae of NGT women. RESULTS No significant difference in myostatin concentration was seen in plasma of pre-symptomatic GDM women compared to NGT women. In placenta significant differences in myostatin protein expressions (higher precursor; p < 0.05and lower dimer: p < 0.005) were observed in GDM complicated compared to NGT pregnancies. Furthermore, placentae of GDM women treated with insulin compared to diet have higher dimer (p < 0.005) and lower precursor (p < 0.05). Compared to lean women, placentae of obese NGT women were lower in myostatin dimer expression (p < 0.05). DISCUSSION Myostatin expression in placental tissue is altered under stress conditions (e.g. obesity and abnormal glucose metabolism) found in pregnancies complicated with GDM. We hypothesise that myostatin is active in these placentae and could affect glucose homoeostasis and/or cytokine production thereby altering the function of the placenta.
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Affiliation(s)
- H N Peiris
- The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - M Lappas
- Department of Obstetrics & Gynaecology, The University of Melbourne, Mercy Hospital, Heidelberg, 3084, Victoria, Australia; Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - H M Georgiou
- Department of Obstetrics & Gynaecology, The University of Melbourne, Mercy Hospital, Heidelberg, 3084, Victoria, Australia
| | - K Vaswani
- The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - C Salomon
- The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - G E Rice
- The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - M D Mitchell
- The University of Queensland Centre for Clinical Research, Brisbane, Australia.
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Moreli JB, Santos JH, Rocha CR, Damasceno DC, Morceli G, Rudge MV, Bevilacqua E, Calderon IMP. DNA damage and its cellular response in mother and fetus exposed to hyperglycemic environment. BIOMED RESEARCH INTERNATIONAL 2014; 2014:676758. [PMID: 25197655 PMCID: PMC4147359 DOI: 10.1155/2014/676758] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 02/02/2023]
Abstract
The increased production of reactive oxygen species (ROS) plays a key role in pathogenesis of diabetic complications. ROS are generated by exogenous and endogenous factors such as during hyperglycemia. When ROS production exceeds the detoxification and scavenging capacity of the cell, oxidative stress ensues. Oxidative stress induces DNA damage and when DNA damage exceeds the cellular capacity to repair it, the accumulation of errors can overwhelm the cell resulting in cell death or fixation of genome mutations that can be transmitted to future cell generations. These mutations can lead to and/or play a role in cancer development. This review aims at (i) understanding the types and consequences of DNA damage during hyperglycemic pregnancy; (ii) identifying the biological role of DNA repair during pregnancy, and (iii) proposing clinical interventions to maintain genome integrity. While hyperglycemia can damage the maternal genetic material, the impact of hyperglycemia on fetal cells is still unclear. DNA repair mechanisms may be important to prevent the deleterious effects of hyperglycemia both in mother and in fetus DNA and, as such, prevent the development of diseases in adulthood. Hence, in clinical practice, maternal glycemic control may represent an important point of intervention to prevent the deleterious effects of maternal hyperglycemia to DNA.
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Affiliation(s)
- Jusciele Brogin Moreli
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University (UNESP), SP, Brazil
| | - Janine Hertzog Santos
- Laboratory of Molecular Carcinogenesis, National Institute of Environmental Health Sciences (NIEHS), NC, USA
| | - Clarissa Ribeiro Rocha
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo (USP), SP, Brazil
| | - Débora Cristina Damasceno
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University (UNESP), SP, Brazil
| | - Glilciane Morceli
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University (UNESP), SP, Brazil
| | - Marilza Vieira Rudge
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University (UNESP), SP, Brazil
| | - Estela Bevilacqua
- Department of Cell and Developmental Biology, Institute of Biomedical Sciences, USP, University of São Paulo, São Paulo, Brazil
| | - Iracema Mattos Paranhos Calderon
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University (UNESP), SP, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, São Paulo State University (UNESP), Distrito de Rubião Jr. s/n, 18618-000 Botucatu, SP, Brazil
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