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Wegler C, Saleh A, Lindqvist A, Nordeng H, Smeraglia J, Baranczewski P. Simple and rapid quantification of cetirizine, venlafaxine, and O-desmethylvenlafaxine in human breast milk, and metformin in human milk and plasma with UHPLC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1205:123340. [PMID: 35732105 DOI: 10.1016/j.jchromb.2022.123340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
The majority of women have health problems that require medication after giving birth. Complications such as allergies, postpartum depression, and diabetes are often treated with drugs such as cetirizine, venlafaxine, and metformin, respectively. These treatments are considered safe during lactation, but information of the transfer of drugs to breast milk and possible effects on the infant is scarce. Therefore, this needs to be systematically investigated in larger populations. To enable the determination of drug transfer, we here describe the validation of two rapid, sensitive, and high-throughput analysis methods for 1) simultaneous quantification of cetirizine, venlafaxine, and O-desmethylvenlafaxine in human breast milk, and 2) metformin in human breast milk and plasma. In both methods, a simple protein precipitation protocol with acetonitrile and benchtop-centrifugation was used prior to compound analysis with liquid-chromatography tandem mass spectrometry. The methods had linear ranges between 0.39 - 194.5 ng/mL for cetirizine, 0.28 - 138.7 ng/mL for venlafaxine, 0.26 - 131.7 ng/mL for O-desmethylvenlafaxine, in milk, and 0.65 - 193.7 ng/mL for metformin in both milk and plasma. Intra-run and inter-run precision and accuracy were ≤ 9% for cetirizine, venlafaxine, and O-desmethylvenlafaxine in milk, and ≤ 7% for metformin in milk and plasma. Cetirizine was measured to median milk concentrations of 13 ng/mL (range: 0.65 - 65 ng/mL) in 228 donor samples from breast-feeding women.
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Affiliation(s)
- Christine Wegler
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden
| | - Aljona Saleh
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden
| | - Annika Lindqvist
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - John Smeraglia
- Development Sciences, Translational Biomarkers and Bioanalysis, UCB BioPharma SPRL, B-1420 Braine-l'Alleud, Belgium
| | - Pawel Baranczewski
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden.
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Begum R, Roy S, Banik S. The prevalence of gestational diabetes mellitus in Bangladesh: a systematic review and meta-analysis. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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She L, Li W, Guo Y, Zhou J, Liu J, Zheng W, Dai A, Chen X, Wang P, He H, Zhang P, Zeng J, Xiang B, Li S, Wang L, Dai Q, Yang M. Association of glucokinase gene and glucokinase regulatory protein gene polymorphisms with gestational diabetes mellitus: A case-control study. Gene X 2022; 824:146378. [PMID: 35276241 DOI: 10.1016/j.gene.2022.146378] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association of glucokinase (GCK) gene, glucokinase regulatory protein (GCKR) gene polymorphisms with the susceptibility to GDM in Chinese population. RESEARCH DESIGN AND METHODS This case-control study included 835 GDM patients and 870 non-diabetic pregnant women who had their prenatal examinations at 24-28 gestational weeks at the Maternal and Child Health Hospital of Hubei Province from January 15, 2018 to March 31, 2019. The nurses were trained to collect clinical information and blood samples. The candidate single nucleotide polymorphism (SNPs, GCK rs1799884, rs4607517, rs10278336, rs2268574, rs730497 and GCKR rs780094, rs1260326) were genotyped on Sequenom Massarray platform. Statistical analysis including independent sample t test, chi-square test, logistic regression and one-way ANOVA were performed to evaluate the differences in allele and genotype distributions and their correlations with the odds of GDM. RESULTS There were statistically significant differences in age, pre-gestational BMI, education level and family history of diabetes between case and control group (P < 0.05). After adjusting for these confounders, GCK rs1799884 was still significantly associated with GDM (P < 0.05), but there were no significant associations between rs4607517, rs10278336 and rs2268574, rs780094 and rs1260326 polymorphisms and GDM odds (P > 0.05). In addition, the pregnant women with rs4607517 TT genotype had the significantly higher fasting blood glucose level than CC genotype (P < 0.05). CONCLUSION GCK rs1799884 mutation is associated with higher GDM odds in Chinese population. Further larger studies are needed to explore the association between GCK and GCKR polymorphisms and GDM susceptibility.
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Affiliation(s)
- Lu She
- School of Medicine, Wuhan University of Science and Technology, No.947, Heping Road, Wuhan, China
| | - Wei Li
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No.745 Wuluo Road, Wuhan, China
| | - Yan Guo
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Jia Zhou
- Maternal and Child Health Hospital of Chongqing Yubei, No. 71 ShuanghuZhi Road, Chongqing, China
| | - Jianqiong Liu
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No.745 Wuluo Road, Wuhan, China
| | - Wenpei Zheng
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No.745 Wuluo Road, Wuhan, China
| | - Anna Dai
- School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, China
| | - Xiaohong Chen
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No.745 Wuluo Road, Wuhan, China
| | - Ping Wang
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No.745 Wuluo Road, Wuhan, China
| | - Hua He
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No.745 Wuluo Road, Wuhan, China
| | - Pei Zhang
- School of Medicine, Wuhan University of Science and Technology, No.947, Heping Road, Wuhan, China
| | - Jing Zeng
- School of Medicine, Wuhan University of Science and Technology, No.947, Heping Road, Wuhan, China
| | - Bing Xiang
- School of Medicine, Wuhan University of Science and Technology, No.947, Heping Road, Wuhan, China
| | - Shiyu Li
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No.745 Wuluo Road, Wuhan, China
| | - Liang Wang
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Qiong Dai
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No.745 Wuluo Road, Wuhan, China.
| | - Mei Yang
- School of Medicine, Wuhan University of Science and Technology, No.947, Heping Road, Wuhan, China.
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Gestational weight gain influences neonatal outcomes in women with obesity and gestational diabetes. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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La Verde M, Torella M, Riemma G, Narciso G, Iavarone I, Gliubizzi L, Palma M, Morlando M, Colacurci N, De Franciscis P. Incidence of gestational diabetes mellitus before and after the Covid-19 lockdown: A retrospective cohort study. J Obstet Gynaecol Res 2022; 48:1126-1131. [PMID: 35199420 PMCID: PMC9115303 DOI: 10.1111/jog.15205] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 01/04/2023]
Abstract
AIM To evaluate whether the first Covid-19 lockdown for Italian citizens (March to July 2021) might have altered the incidence of gestational diabetes mellitus (GDM). METHODS A retrospective single-center study in a tertiary referral center. Primary outcome was the incidence of GDM among pregnant women. GDM incidence, from June 11, 2019 to December 4, 2020, was compared by dividing the study time as follows: from the beginning of the study to before Covid-19 lockdown (from June 11, 2019, to March 9, 2020) and lockdown period (from March 10, 2020, to December 4, 2020). GDM was diagnosed with a 75-g, 2-h oral glucose tolerance test (OGTT) at 24-28 gestational weeks. RESULTS Concerning 1295 women, GDM incidence increased during the lockdown period (9.3% vs. 3.4%, p < 0.001). Higher pregnancy weight gain with an increased body mass index (BMI) at the delivery was reported during the lockdown (31.3 vs. 28.4 kg/m2 , p = 0.02 and mean weight gain of 9.3 vs. 6.6 kg, p = 0.007). There was no difference in other comorbidity incidence and OGTT values between the two groups. CONCLUSIONS Pregnant women during the Covid-19 lockdown might have experienced higher BMI and pregnancy weight gain with increased GDM diagnoses. This may be related to physical limitations and emotional distress experienced during the lockdown. However, evidence is limited due to restricted study duration and random variations of outcomes across time. More studies are needed to understand the dietary patterns and the physical activity changes during the Covid-19 lockdown and its impact on fetal outcomes.
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Affiliation(s)
- Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Giuliana Narciso
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Irene Iavarone
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Ligia Gliubizzi
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Marica Palma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
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Yan Q, Qiu D, Liu X, Xing Q, Liu R, Hu Y. The incidence of gestational diabetes mellitus among women with polycystic ovary syndrome: a meta-analysis of longitudinal studies. BMC Pregnancy Childbirth 2022; 22:370. [PMID: 35488240 PMCID: PMC9055740 DOI: 10.1186/s12884-022-04690-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Previous studies have shown that polycystic ovary syndrome is a predictor of gestational diabetes mellitus, but we do not know exactly how many polycystic ovary syndrome patients may develop gestational diabetes mellitus. Currently, the incidence of gestational diabetes mellitus among women with polycystic ovary syndrome varies greatly across studies, ranged from 4.12% to 59.50%. Besides, many factors have been found to be related to the incidence of gestational diabetes mellitus among women with polycystic ovary syndrome, but the results among different studies are not consistent. The possible causes of inconsistencies between the current estimates were unclear. This review aimed at exploring the pooled incidence of gestational diabetes mellitus among women with polycystic ovary syndrome, summarizing possible causes of the inconsistencies in the current estimates, try to provide a reference for prevention of gestational diabetes mellitus and polycystic ovary syndrome in the future. METHODS Systematic searches of different databases (including EMBASE, Web of Science, MEDLINE, The Cochrane Library, CNKI and PubMed) were conducted for studies published until 31 May 2021. Statistical analyses were performed using R software, the pooled incidence of gestational diabetes mellitus among polycystic ovary syndrome patients was combined using random effects model. Cochrane's "Tool to Assess Risk of Bias in Cohort Studies" was used for quality assessment. RESULTS Twenty-two longitudinal studies were included. A total of 24,574 women with polycystic ovary syndrome were identified in the 22 articles, of which 4478 were reported with gestational diabetes mellitus. The pooled incidence of gestational diabetes mellitus among women with polycystic ovary syndrome was 20.64%, with a 95% CI of 14.64% to 28.30%. In the meta-regression model, several variables including age, area, quality score and sample size were suggested as significant sources of heterogeneity, accounted for 77.57% of the heterogeneity across studies. CONCLUSIONS Evidence in this review suggests that gestational diabetes mellitus were common among women with polycystic ovary syndrome. More research is needed to found effective interventions for preventing gestational diabetes mellitus among women with polycystic ovary syndrome.
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Affiliation(s)
- Qingzi Yan
- Department of Pharmacy, Xiangtan Central Hospital, Hunan, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Xiang Liu
- Department of Pharmacy, Xiangtan Central Hospital, Hunan, China
| | - Qichang Xing
- Department of Pharmacy, Xiangtan Central Hospital, Hunan, China
| | - Renzhu Liu
- Department of Pharmacy, Xiangtan Central Hospital, Hunan, China
| | - Yixiang Hu
- Department of Pharmacy, Xiangtan Central Hospital, Hunan, China
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Zhong W, Li C, Liu J, Zhou J, Xiao Z, Li C, Wu H. Effect and Significance of High-Quality Nursing on Blood Glucose, Pregnancy Outcome, and Neonatal Complications of Patients with Gestational Diabetes Mellitus. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2426417. [PMID: 35516455 PMCID: PMC9064497 DOI: 10.1155/2022/2426417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the role of high-quality nursing on blood glucose, pregnancy outcome, and neonatal complications in patients with gestational diabetes mellitus. Methods Altogether, 148 patients with GDM admitted to our hospital were selected as the research participants, 83 of whom received high-quality nursing as the observation group (OG). Another 65 patients received only routine care as the control group (CG). The blood sugar level, blood pressure value, and adverse pregnancy outcomes of the OG and the CG of patients after intervention were compared. The changes of psychological state and nursing satisfaction of the OG and the CG of patients were observed. The blood lipid level and neonatal complications of the OG and the CG were detected. Results The blood sugar level of the OG was lower than that of the CG (P < 0.05). The systolic pressure and diastolic pressure of patients in the OG were lower than those in the CG after nursing intervention (P < 0.05). The abnormal delivery rate in the CG was evidently higher than that in the OG (P < 0.05). After intervention, SAS and SDS scores in the OG were lower than those in the CG (P < 0.05). The number of people who needed improvement and were dissatisfied in the OG was evidently lower than that in the CG (P < 0.05). TG and LDL-C in the OG were lower than those in the CG (P < 0.05). The total incidence of complications in the CG was evidently higher than that in the OG (P < 0.05). Conclusion High-quality nursing can reduce blood sugar and blood pressure of GDM patients and has a great protective effect on maternal and infant health, which is worthy of clinical practice.
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Affiliation(s)
- Wenjuan Zhong
- Pediatrics, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430063, China
| | - Chunxia Li
- Department of Obstetrics and Gynecology, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Jing Liu
- Nursing Department, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Jinman Zhou
- Nursing Department, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Zhong Xiao
- Department of Obstetrics and Gynecology, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Cuimei Li
- General Surgery, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Hui Wu
- General Surgery, Wuhan Wuchang Hospital, Wuhan 430063, China
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van Hoorn EGM, van Dijk PR, Prins JR, Lutgers HL, Hoogenberg K, Erwich JJHM, Kooy A. Pregnancy Outcomes: Effects of Metformin (POEM) study: a protocol for a long-term, multicentre, open-label, randomised controlled trial in gestational diabetes mellitus. BMJ Open 2022; 12:e056282. [PMID: 35354633 PMCID: PMC8968576 DOI: 10.1136/bmjopen-2021-056282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a common disorder of pregnancy with health risks for mother and child during pregnancy, delivery and further lifetime, possibly leading to type 2 diabetes mellitus (T2DM). Current treatment is focused on reducing hyperglycaemia, by dietary and lifestyle intervention and, if glycaemic targets are not reached, insulin. Metformin is an oral blood glucose lowering drug and considered safe during pregnancy. It improves insulin sensitivity and has shown advantages, specifically regarding pregnancy-related outcomes and patient satisfaction, compared with insulin therapy. However, the role of metformin in addition to usual care is inconclusive and long-term outcome of metformin exposure in utero are lacking. The primary aim of this study is to investigate the early addition of metformin on pregnancy and long-term outcomes in GDM. METHODS AND ANALYSIS The Pregnancy Outcomes: Effects of Metformin study is a multicentre, open-label, randomised, controlled trial. Participants include women with GDM, between 16 and 32 weeks of gestation, who are randomised to either usual care or metformin added to usual care, with insulin rescue in both groups. Metformin is given up to 1 year after delivery. The study consists of three phases (A-C): A-until 6 weeks after delivery; B-until 1 year after delivery; C-observational study until 20 years after delivery. During phase A, the primary outcome is a composite score consisting of: (1) pregnancy-related hypertension, (2) large for gestational age neonate, (3) preterm delivery, (4) instrumental delivery, (5) caesarean delivery, (6) birth trauma, (7) neonatal hypoglycaemia, (8) neonatal intensive care admission. During phase B and C the primary outcome is the incidence of T2DM and (weight) development in mother and child. ETHICS AND DISSEMINATION The study was approved by the Central Committee on Research Involving Human Subjects in the Netherlands. Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02947503.
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Affiliation(s)
- Eline G M van Hoorn
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Peter R van Dijk
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jelmer R Prins
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Helen L Lutgers
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | - Klaas Hoogenberg
- Department of Internal Medicine, Martini Hospital, Groningen, Netherlands
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Adriaan Kooy
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Bethesda Diabetes Research Center, Hoogeveen, Netherlands
- Department of Internal Medicine, Treant Care Group, Hoogeveen, Netherlands
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Rockliffe L, Peters S, Smith DM, Heal C, Heazell AEP. Investigating the utility of the COM-B and TM model to explain changes in eating behaviour during pregnancy: A longitudinal cohort study. Br J Health Psychol 2022; 27:1077-1099. [PMID: 35297131 PMCID: PMC9541598 DOI: 10.1111/bjhp.12590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/25/2022] [Indexed: 12/04/2022]
Abstract
Objectives Pregnancy has been described as a ‘teachable moment’ for behaviour change, which presents an important opportunity for health promotion within antenatal care settings. However, no pregnancy‐specific model has been developed or tested in the context of health behaviour change during pregnancy. This study aimed to investigate and compare the utility of the Capability‐Opportunity‐Motivation Behaviour (COM‐B) and Teachable Moments (TM) models, to explain health behaviour change during pregnancy, within the context of eating behaviour. Design Longitudinal cohort study. Methods Five hundred and sixteen women completed a survey at between 12–16 weeks gestation (T1). Follow‐up data were collected at 20–24 weeks (T2), 36–40 weeks (T3), and 6–12 weeks postnatally (T4). The primary outcome was eating behaviour. To assess the utility of the COM‐B model, perceived capability, opportunity, and motivation to eat healthily were measured. To assess the utility of the TM model, risk perceptions, self‐image, and affective response were measured. Results Overall, the COM‐B model explained 18.4% of the variance in eating behaviour, whilst the TM model explained 9%. Both models explained the most variance in eating behaviour at T1 and T3, compared with T2 and T4. Small changes were observed in eating behaviour and the model constructs over the time period studied, although these were not clinically meaningful. Conclusions Neither the COM‐B nor TM model provide a satisfactory explanation of eating behaviour during pregnancy, however the findings suggest that certain stages of pregnancy may create more salient opportunities for behaviour change. The findings also support claims that motivation may not play a key role in directing eating behaviour during pregnancy. Further research is needed to explore the role of timing in antenatal behaviour change. The development of a pregnancy‐specific model is necessary to optimise understanding of pregnancy as a teachable moment for behaviour change.
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Affiliation(s)
- Lauren Rockliffe
- Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, UK
| | - Sarah Peters
- Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, UK
| | - Debbie M Smith
- Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, UK
| | - Calvin Heal
- Faculty of Biology, Medicine and Health, Centre for Biostatistics, University of Manchester, UK
| | - Alexander E P Heazell
- Faculty of Biology, Medicine and Health, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Asselmann E, Garthus-Niegel S, Knappe S, Martini J. Physical and mental health changes in the five years before and five years after childbirth: A population-based panel study in first-time mothers and fathers from Germany. J Affect Disord 2022; 301:138-144. [PMID: 35032504 DOI: 10.1016/j.jad.2022.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND The transition to parenthood is characterized by far-reaching changes in life. However, little prospective-longitudinal evidence from general population samples exists on changes of general physical and mental health in the years around the birth of a child among mothers and fathers. METHODS Using data from the German Socio-Economic Panel Study (SOEP), this study examined continuous and discontinuous short- and long-term changes of general physical and mental health from five years before until five years after the birth of the first child in women (N = 1,912) and men (N = 1,742). Whether a child was born was assessed annually throughout the study. Physical and mental health was assessed biannually from 2002 to 2018 with the SF-12v2. RESULTS Multilevel analyses revealed that women experienced a considerable decrease of physical health during pregnancy, which remitted after delivery. On average, women's mental health increased in the last year before and first year after delivery. These mental health improvements were stronger in older vs. younger mothers and remained largely stable in the years after childbirth. In contrast, little evidence for changes of general physical or mental health in (expectant) fathers was found. LIMITATIONS Physical and mental health was assessed with a short questionnaire only (SF-12v2). CONCLUSIONS On average, women's mental health tends to improve before and after the birth of the first child. Men seem to be much less affected by the birth of a child than many previous studies suggest.
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Affiliation(s)
- Eva Asselmann
- Department of Psychology, HMU Health and Medical University, Olympischer Weg 1, Potsdam, Germany.
| | - Susan Garthus-Niegel
- Department of Medicine, Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany; Evangelische Hochschule Dresden (ehs), University of Applied Sciences for Social Work, Education and Nursing, Dresden Germany
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Fagninou A, Nekoua MP, Fiogbe SEM, Moutaïrou K, Yessoufou A. Predictive Value of Immune Cells in the Risk of Gestational Diabetes Mellitus: A Pilot Study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:819164. [PMID: 36992781 PMCID: PMC10012146 DOI: 10.3389/fcdhc.2022.819164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/06/2022] [Indexed: 01/04/2023]
Abstract
AimsImmunological and biochemical parameters are gaining more and more importance in the prognosis of diabetes and its complications. Here, we assessed the predictive power of immune cells correlated with biochemical parameters in gestational diabetes mellitus (GDM).Materials and MethodsImmune cells and serum biochemical parameters were determined in women with GDM and pregnant controls. Receiver operating characteristics (ROC) curve analyses were conducted to assess the optimal cutoff and value of ratios of immune cells to biochemical parameters for predicting GDM.ResultsBlood glucose, total cholesterol, LDL-cholesterol and triglycerides were significantly increased whereas HDL-cholesterol decreased in women with GDM compared to pregnant controls. Glycated hemoglobin, creatinine, transaminase activities did not significantly differ between both groups. Total leukocyte, lymphocyte and platelet numbers were significantly high in women with GDM. Correlation tests showed that ratios of lymphocyte/HDL-C, monocyte/HDL-C and granulocyte/HDL-C were significantly higher in women with GDM than in pregnant controls (p = 0.001; p = 0.009 and p = 0.004 respectively). Women with a lymphocyte/HDL-C ratio greater than 3.66 had a 4-fold increased risk of developing GDM than those with lower ratios (odds ratio 4.00; 95% CI: 1.094 – 14.630; p=0.041).ConclusionOur study showed that ratios of lymphocyte, monocyte and granulocyte to HDL-C might represent valuable biomarkers for GDM and in particular, lymphocyte/HDL-C ratio exhibited a strong predictive power for GDM risk.
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Affiliation(s)
- Adnette Fagninou
- Laboratory of Cell Biology, Physiology and Immunology, Department of Biochemistry and Cellular Biology, Faculty of Sciences and Technology (FAST), Institute of Applied Biomedical Sciences (ISBA), University of Abomey-Calavi (UAC), Cotonou, Benin
- Unité de Recherche sur les Maladies Non Transmissibles et le Cancer (UR-MNTC), Laboratory of Research in Applied Biology (LARBA), Ecole Polytechnique d’Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin
| | - Magloire Pandoua Nekoua
- Laboratory of Cell Biology, Physiology and Immunology, Department of Biochemistry and Cellular Biology, Faculty of Sciences and Technology (FAST), Institute of Applied Biomedical Sciences (ISBA), University of Abomey-Calavi (UAC), Cotonou, Benin
| | - Salomon Ezéchiel M. Fiogbe
- Unité de Recherche sur les Maladies Non Transmissibles et le Cancer (UR-MNTC), Laboratory of Research in Applied Biology (LARBA), Ecole Polytechnique d’Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin
| | - Kabirou Moutaïrou
- Laboratory of Cell Biology, Physiology and Immunology, Department of Biochemistry and Cellular Biology, Faculty of Sciences and Technology (FAST), Institute of Applied Biomedical Sciences (ISBA), University of Abomey-Calavi (UAC), Cotonou, Benin
| | - Akadiri Yessoufou
- Laboratory of Cell Biology, Physiology and Immunology, Department of Biochemistry and Cellular Biology, Faculty of Sciences and Technology (FAST), Institute of Applied Biomedical Sciences (ISBA), University of Abomey-Calavi (UAC), Cotonou, Benin
- *Correspondence: Akadiri Yessoufou,
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Toft JH, Bleskestad IH, Skadberg Ø, Gøransson LG, Økland I. Glycated albumin in pregnancy: LC-MS/MS-based reference interval in healthy, nulliparous Scandinavian women and its diagnostic accuracy in gestational diabetes mellitus. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:123-131. [PMID: 35148229 DOI: 10.1080/00365513.2022.2033827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Glycated albumin (GA) may be a useful biomarker of glycemia in pregnancy. The aim of this study was to establish the reference interval (RI) for GA, analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS), in healthy, nulliparous pregnant women. In addition, we assessed the accuracy of GA and glycated hemoglobin A1c (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM). Finally, we explored the prevalence of GDM in healthy nulliparas, comparing three diagnostic guidelines (WHO-1999, WHO-2013 and the Norwegian guideline). The study was carried out at Stavanger University Hospital, Norway, and included a study population of 147 pregnant nulliparous women. An oral glucose tolerance test (OGTT) was performed and used as the gold standard for GDM diagnosis. Blood samples for analysis of GA and HbA1c were collected at pregnancy week 24-28. A nonparametric approach was chosen for RI calculation, and receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of GA and HbA1c. The established RI for GA in 121 pregnant women was 7.1-11.6%. The area under the ROC curves (AUCs) were 0.531 (GA) and 0.627 (HbA1c). According to the WHO-1999, WHO-2013 and the Norwegian guideline, respectively, 24 (16%), 36 (24%) and 21 (14%) women were diagnosed with GDM. Only nine women (6%) fulfilled the GDM-criteria of all guidelines. In conclusion, we established the first LC-MS/MS-based RI for GA in pregnant women. At pregnancy weeks 24-28, neither GA nor HbA1c discriminated between those with and without GDM. Different women were diagnosed with GDM using the three guidelines.
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Affiliation(s)
- Johanne Holm Toft
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Øyvind Skadberg
- Department of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Lasse Gunnar Gøransson
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Inger Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.,Department of Caring and Ethics, University of Stavanger, Stavanger, Norway
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63
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Mora-Janiszewska O, Faryniak-Zuzak A, Darmochwał-Kolarz D. Epigenetic Links between Microbiota and Gestational Diabetes. Int J Mol Sci 2022; 23:1831. [PMID: 35163753 PMCID: PMC8837149 DOI: 10.3390/ijms23031831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is considered a significant and increasing worldwide problem. The growing body of evidence on this topic has allowed us to point out that a hostile intrauterine environment in mothers with GDM via epigenetic mechanisms induces "diabetogenic" and "obesogenic" changes in an offspring's DNA. This sets a vicious intergenerational cycle of metabolic diseases in motion, gradually deteriorating the health of the human population. One of the most important participants of this process seems to be altered microbiota. There is a chance that the identification of specific epigenetic marks may provide a key for future diagnostic, prognostic and therapeutic solutions in the field of personalised medicine. Given the reversibility of most epigenetic changes, there is an opportunity to improve the long-term health of the human population. In this manuscript, we aim to summarise available data on epigenetic changes among women suffering from GDM and their progeny, in association with alterations in the microbiome.
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64
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Melov SJ, White L, Simmons M, Kirby A, Stulz V, Padmanabhan S, Alahakoon TI, Pasupathy D, Cheung NW. The BLIiNG Study - Breastfeeding length and intensity in gestational diabetes and metabolic effects in a subsequent pregnancy: A cohort study. Midwifery 2022; 107:103262. [DOI: 10.1016/j.midw.2022.103262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/01/2022]
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Mnatzaganian G, Woodward M, McIntyre HD, Ma L, Yuen N, He F, Nightingale H, Xu T, Huxley RR. Trends in percentages of gestational diabetes mellitus attributable to overweight, obesity, and morbid obesity in regional Victoria: an eight-year population-based panel study. BMC Pregnancy Childbirth 2022; 22:95. [PMID: 35105311 PMCID: PMC8809044 DOI: 10.1186/s12884-022-04420-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes in Australia with rates trebling over the past decades partially explained by rising obesity rates and maternal age among childbearing women. Percentage of GDM attributable to obesity has been documented, mostly focusing on metropolitan populations. In parts of regional (areas outside capital cities) and rural Australia where overweight, obesity and morbid obesity are more prevalent, intertwined with socioeconomic disadvantage and higher migrant communities, trends over time in adjusted percentages of GDM attributed to obesity are unknown. METHODS In this population-based retrospective panel study, women, without pre-existing diabetes, delivering singletons between 2010 and 2017 in a tertiary regional hospital that serves 26% of Victoria's 6.5 million Australian population were eligible for inclusion. Secular trends in GDM by body mass index (BMI) and age were evaluated. The percentage of GDM that would have been prevented each year with the elimination of overweight or obesity was estimated using risk-adjusted regression-based population attributable fractions (AFp). Trends in the AFp over time were tested using the augmented Dickey-Fuller test. RESULTS Overall 7348 women, contributing to 10,028 births were included. The age of expecting mothers, their BMI, proportion of women born overseas, and GDM incidence significantly rose over time with GDM rising from 3.5% in 2010 to 13.7% in 2017, p < 0.001, increasing in all BMI categories. The incidence was consistently highest among women with obesity (13.8%) and morbid obesity (21.6%). However, the highest relative increase was among women with BMI < 25 kg/m2, rising from 1.4% in 2010 to 7.0% in 2017. Adjusting for age, country of birth, socioeconomic status, comorbidities, antenatal and intrapartum factors, an estimated 8.6% (confidence interval (CI) 6.1-11.0%), 15.6% (95% CI 12.2-19.0%), and 19.5% (95% CI 15.3-23.6%) of GDM would have been prevented by eliminating maternal overweight, obesity, and morbid obesity, respectively. However, despite the rise in obesity over time, percentages of GDM attributable to overweight, obesity, and morbid obesity significantly dropped over time. Scenario analyses supported these findings. CONCLUSIONS Besides increasing prevalence of obesity over time, this study suggests that GDM risk factors, other than obesity, are also increasing over time.
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Affiliation(s)
- George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
| | - Mark Woodward
- The George Institute for Global Health, Imperial College, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - H David McIntyre
- Obstetric Medicine, Mater Health Services, University of Queensland, Brisbane, Queensland, Australia
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Nicola Yuen
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Fan He
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia
| | - Helen Nightingale
- Rural Department of Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Tingting Xu
- Department of Health Policy and Management, School of Public Health, Capital Medical University, Beijing, China
| | - Rachel R Huxley
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
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66
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Groot EL, Huet RA, Bloemenkamp KW, Boer JH, Ossewaarde‐van Norel J. Idiopathic multifocal choroiditis and punctate inner choroidopathy: an evaluation in pregnancy. Acta Ophthalmol 2022; 100:82-88. [PMID: 34009733 PMCID: PMC9291166 DOI: 10.1111/aos.14898] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/18/2021] [Indexed: 01/26/2023]
Abstract
Purpose To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during pregnancy. Methods Patients with MFC or PIC and a pregnancy in 2011–2019 from two academic centres were enrolled. For the most recent pregnancy, data on best‐corrected visual acuity (BCVA) before and after pregnancy, relapse rate in pregnancy and postpartum period and obstetric, maternal and neonatal outcomes were collected. Treatment regimens consisted of a wait‐and‐see regime and an immunosuppressive treatment regime with systemic corticosteroids and/or azathioprine, both combined with intravitreal antivascular endothelial growth factor injections when indicated. Results Sixteen women (26 affected eyes) were included. Median Snellen BCVA was 20/19 before pregnancy and 20/18 after delivery. In seven pregnancies a wait‐and‐see regime and in nine pregnancies an immunosuppressive treatment regime was carried out. Fourteen intravitreal anti‐VEGF injections were given in six pregnancies. The relapse rate during pregnancy was 44% and in the postpartum period 31%. Maternal/obstetrical and fetal complications occurred in 31% and 13% of the pregnancies, respectively. Fifteen healthy children were born and one pregnancy ended in a stillbirth in a patient with a complicated obstetrical history. One patient treated with azathioprine developed intrahepatic cholestasis of pregnancy (ICP). Conclusions Among women with MFC and PIC BCVA remained stable during pregnancy despite a relapse rate of 44% in pregnancy. No major maternal, obstetric and fetal complications occurred in pregnant patients treated with systemic corticosteroids, azathioprine or intravitreal anti‐VEGF injections, though one patient developed ICP while treated with azathioprine.
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Affiliation(s)
- Evianne L. Groot
- Department of Ophthalmology University Medical Center Utrecht Utrecht the Netherlands
| | - Ramon A.C. Huet
- Department of Ophthalmology Radboud University Medical Center Nijmegen the Netherlands
| | - Kitty W.M. Bloemenkamp
- Department of Obstetrics Birth Center Wilhelmina’s Children Hospital University Medical Center Utrecht Utrecht the Netherlands
| | - Joke H. Boer
- Department of Ophthalmology University Medical Center Utrecht Utrecht the Netherlands
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Aleknaviciute J, Evans TE, Aribas E, de Vries MW, Steegers EAP, Ikram MA, Tiemeier H, Kavousi M, Vernooij MW, Kushner SA. Long-term association of pregnancy and maternal brain structure: the Rotterdam Study. Eur J Epidemiol 2022; 37:271-281. [PMID: 34989970 PMCID: PMC9110529 DOI: 10.1007/s10654-021-00818-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
The peripartum period is the highest risk interval for the onset or exacerbation of psychiatric illness in women’s lives. Notably, pregnancy and childbirth have been associated with short-term structural and functional changes in the maternal human brain. Yet the long-term effects of pregnancy on maternal brain structure remain unknown. We investigated a large population-based cohort to examine the association between parity and brain structure. In total, 2,835 women (mean age 65.2 years; all free from dementia, stroke, and cortical brain infarcts) from the Rotterdam Study underwent magnetic resonance imaging (1.5 T) between 2005 and 2015. Associations of parity with global and lobar brain tissue volumes, white matter microstructure, and markers of vascular brain disease were examined using regression models. We found that parity was associated with a larger global gray matter volume (β = 0.14, 95% CI = 0.09–0.19), a finding that persisted following adjustment for sociodemographic factors. A non-significant dose-dependent relationship was observed between a higher number of childbirths and larger gray matter volume. The gray matter volume association with parity was globally proportional across lobes. No associations were found regarding white matter volume or integrity, nor with markers of cerebral small vessel disease. The current findings suggest that pregnancy and childbirth are associated with robust long-term changes in brain structure involving a larger global gray matter volume that persists for decades. Future studies are warranted to further investigate the mechanism and physiological relevance of these differences in brain morphology.
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Affiliation(s)
- Jurate Aleknaviciute
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - Tavia E Evans
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands
| | - Merel W de Vries
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Child Psychiatry, Sophia Children's Hospital, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands.
| | - Steven A Kushner
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
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Huang X, Zha B, Zhang M, Li Y, Wu Y, Zhang R, Sheng L, Xu J, Yu Z, Gao C, Chen Z, Ding H, Ma L, Zhang Y, Zang S, Zhang TN, Liu J. Decreased Monocyte Count Is Associated With Gestational Diabetes Mellitus Development, Macrosomia, and Inflammation. J Clin Endocrinol Metab 2022; 107:192-204. [PMID: 34478541 DOI: 10.1210/clinem/dgab657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT The immune system plays a central role in the pathophysiology of gestational diabetes mellitus (GDM). Monocytes, the main innate immune cells, are especially important in the maintenance of a normal pregnancy. OBJECTIVE Here, we investigated the potential effect of monocytes in GDM. METHODS Monocyte count was monitored throughout pregnancy in 214 women with GDM and 926 women without in a case-control and cohort study. Circulating levels of inflammatory cytokines, placenta-derived macrophages, and their products were measured. RESULTS Throughout pregnancy, monocyte count was significantly decreased in women with GDM, and was closely associated with glucose level, insulin resistance, and newborn weight. First-trimester monocyte count outperformed that of the second and third trimester as a risk factor and diagnostic predictor of GDM and macrosomia both in the case-control and cohort study. In addition, our cohort study showed that as first-trimester monocyte count decreased, GDM and macrosomia incidence, glucose level, and newborn weight increased in a stepwise manner. Risk of GDM started to decrease rapidly when first-trimester monocyte count exceeded 0.48 × 109/L. Notably, CD206 and interleukin 10 (IL-10) were significantly lower, whereas CD80, CD86, tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) were higher both in GDM placental tissue and peripheral blood. First-trimester monocyte count was positively related to IL-10 and CD206, but negatively related to CD80, CD86, TNF-α, and IL-6. CONCLUSION Decreased monocyte count throughout pregnancy was closely associated with the development of GDM, macrosomia, and the chronic inflammatory state of GDM. First-trimester monocyte count has great potential as an early diagnostic marker of GDM.
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Affiliation(s)
- Xinmei Huang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Bingbing Zha
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Manna Zhang
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yue Li
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Yueyue Wu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Rui Zhang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Li Sheng
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Jiong Xu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Zhiyan Yu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Cuijun Gao
- Department of Obstetrics, Wujing Hospital, Shanghai 200241, China
| | - Zaoping Chen
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Heyuan Ding
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Ling Ma
- Department of Obstetrics, Wujing Hospital, Shanghai 200241, China
| | - Yanquan Zhang
- Department of Obstetrics, Wujing Hospital, Shanghai 200241, China
| | - Shufei Zang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Tie-Ning Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jun Liu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
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Vorobjova T, Tagoma A, Talja I, Janson H, Kirss A, Uibo R. FABP4 and I-FABP Levels in Pregnant Women Are Associated with Body Mass Index but Not Gestational Diabetes. J Diabetes Res 2022; 2022:1089434. [PMID: 35647197 PMCID: PMC9142318 DOI: 10.1155/2022/1089434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) is glucose intolerance detected initially during pregnancy. GDM poses an increased risk for the development of diabetes later in life. Fatty acid-binding protein 4 (FABP4) is a regulator of lipid metabolism and is associated with obesity, insulin resistance, and type 2 diabetes. Increased level of intestinal fatty acid-binding protein (I-FABP) may indicate impaired intestinal permeability, which may be an important contributor to the pathogenesis of type 1 diabetes and GDM. We aimed to compare FABP4 and I-FABP levels in pregnant women with GDM and in healthy pregnant controls, taking into consideration their prepregnancy body mass index (BMI), past exposures to enteroviruses (EV), and adipokine and cytokine levels, which have been shown to decrease insulin sensitivity. Material and Methods. Forty patients with GDM (median age 30.5) and 40 pregnant healthy controls (median age 31.1) were divided on the basis of their prepregnancy BMI into two groups: normal weight (BMI < 25, n = 20) and overweight (BMI ≥ 25, n = 20). FABP4 and I-FABP were measured from serum samples using commercial ELISA kits. RESULTS FABP4 and I-FABP levels did not differ between women with GDM and healthy pregnant controls (p > 0.05 for both comparisons). However, both levels were associated with BMI (p < 0.001 for both comparisons). Median I-FABP level was the highest in healthy controls with lower BMI (<25) (p = 0.0009). FABP4 levels correlated with BMI and C-peptide values in both groups (p < 0.001). Anti-EV antibody levels did not correlate with FABP4 or I-FABP levels. FABP4 and adiponectin levels were negatively correlated in controls (r = -0.61, p = 0.0009), while I-FABP correlated positively with adiponectin (r = 0.58, p = 0.04) and resistin (r = 0.67, p = 0.04) levels in the GDM group. CONCLUSION FABP4 and I-FABP levels were not dependent on the diagnosis of GDM, but rather on BMI. The correlation of I-FABP with adiponectin and resistin levels in women with GDM may suggests the importance of lipid metabolism in GDM-associated changes in intestinal permeability.
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Affiliation(s)
- Tamara Vorobjova
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Estonia
| | - Aili Tagoma
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Estonia
| | - Ija Talja
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Estonia
| | - Helis Janson
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Estonia
| | - Anne Kirss
- Women's Clinic, Tartu University Hospital, L. Puusepa 8, Tartu 51014, Estonia
| | - Raivo Uibo
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Estonia
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Lee KW, Tan SF, Omar A, Nasir NH, Ching SM, Mohd Noor MK, Masdor NA, Lee YS, Noordin S, Mohamed H. Effectiveness of system-based intervention in reducing incidence of type 2 diabetes and to improve the postnatal metabolic profiles in women with gestational diabetes mellitus: a randomized controlled study. Gynecol Endocrinol 2022; 38:55-62. [PMID: 34636710 DOI: 10.1080/09513590.2021.1988561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIM The objective of this study was to determine the effectiveness of system-based intervention in reducing the incidence of diabetes and to improve the postnatal metabolic profiles among women with gestational diabetes mellitus (GDM). MATERIALS AND METHODS For women in the intervention arm (n = 130), they received one session of individualized health education at 36 gestational weeks, a booklet of diabetes prevention, five-session of postpartum booster educational program which were conducted including 1 session of dietary and exercise counseling by dietician and physiotherapist at 6 weeks postpartum. For women in the control group (n = 168), standard treatment whereby they had received group therapy on diet and physical activity modification by dietician and staff nurses during the antenatal period. RESULTS There were no significant differences in baseline characteristics between groups for most of the variables examined except for educational level which the control group had a higher education than the intervention group. The women assigned to system-based intervention have a significant difference to GDM women who were assigned to the control group for LDL and HDL but not in anthropometric measurements, blood pressure, glucose index, total cholesterol, and triglyceride. In addition, it was found that the incidence of Type 2 diabetes mellitus (T2DM) 2 years after delivery was 20% in the intervention arm compared to 17% in the control arm. CONCLUSION The system-based intervention was not statistically superior to the control intervention as there is no difference in terms of incidence of T2DM between the intervention and control group. We, therefore, suggested that more intensive interventions are needed to prevent GDM from developing into T2DM.
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Affiliation(s)
- Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Siow Foon Tan
- Klinik Kesihatan Pelabuhan Klang, Ministry of Health Malaysia, Klang, Malaysia
| | - Azahadi Omar
- National Institute of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | | | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Noor Azreen Masdor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Yeow Siong Lee
- Klinik Kesihatan Selayang Baru, Ministry of Health Malaysia, Batu Caves, Malaysia
| | - Salmah Noordin
- Klinik Kesihatan Cheras Batu 9, Ministry of Health Malaysia, Cheras, Malaysia
| | - Hazlin Mohamed
- Klinik Kesihatan Teluk Panglima Garang, Ministry of Health Malaysia, Teluk Panglima Garang, Malaysia
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Pérez-Martín SM, Quintero-Prado R, Lara-Barea A, López-Tinoco C, Torrejón R, Bugatto F. Fetal cerebral three-dimensional power Doppler vascularization indices and their relationships with maternal glucose levels in pregnancies complicated with gestational diabetes. Diab Vasc Dis Res 2022; 19:14791641221078109. [PMID: 35236142 PMCID: PMC8907605 DOI: 10.1177/14791641221078109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to evaluate fetal cerebral circulation using three-dimensional power Doppler (3DPD) vascular indices and to study their relationships with maternal lipid and glycaemic profiles. METHODS Case-control study in women with and without gestational diabetes mellitus (GDM) at 28-32 weeks in which feto-maternal Doppler study and 3DPD cerebral vascularization indices (FI, VI and VFI) were determined. Maternal lipid and glycaemic profiles were also analysed. Both groups were compared and the correlations of the 3DPD indices with studied variables were analysed. RESULTS There were significant differences between groups in cerebral FI (p= 0.02), mean maternal Uterine artery PI (p= 0.009) and glucose levels (p= 0.001), being higher in the GDM group. Significant negative correlations were found in GDM group between VFI and MCA PI (p = 0.02) and between VI and MCA PI (p= 0.01). In the GDM group we found a negative significant correlation between FI, VI, VFI and maternal glucose (r= -0.52, p<0.001; r= -0.32, p=0.03 and r= -0.36, p= 0.01, respectively). CONCLUSIONS Fetal cerebral FI values were higher in GDM pregnancies. All 3DPD vascular indices showed an inverse correlation with maternal glucose levels. These findings support the view that GDM may also represent a fetal vascular disorder influencing fetal neurodevelopment.
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Affiliation(s)
- Sara M Pérez-Martín
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Rocío Quintero-Prado
- Department of Obstetrics and
Gynaecology, Puerto Real University
Hospital, Puerto Real, Cádiz, Spain & Ginemed Clínicas, San
Fernando, Cádiz, Spain
| | - Almudena Lara-Barea
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Cristina López-Tinoco
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
- Biomedical Research and Innovation
Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Rafael Torrejón
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
| | - Fernando Bugatto
- Division of Maternal-Fetal
Medicine, Obstetrics and Gynaecology Department, Puerta del Mar University
Hospital, Cádiz, Spain
- Department of Endocrinology and
Nutrition, Puerta del Mar University
Hospital, Cádiz, Spain
- Fernando Bugatto, Obstetrics and
Gynaecology Department, Puerta del Mar University Hospital, Avda, Ana de Viya,
21, Cádiz 11009, Spain.
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García-Moreno RM, Benítez-Valderrama P, Barquiel B, González Pérez-de-Villar N, Hillman N, Lora Pablos D, Herranz L. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Diabet Med 2022; 39:e14703. [PMID: 34564868 DOI: 10.1111/dme.14703] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/21/2021] [Indexed: 12/22/2022]
Abstract
AIMS This systematic review aims to evaluate the effect of continuous glucose monitoring (CGM) on maternal and neonatal outcomes in gestational diabetes mellitus (GDM). METHODS Two authors conducted a systematic search using PubMed, Embase, CENTRAL, CINAHL, Scopus, Web of Science, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. The inclusion criteria for the systematic review were randomized clinical trials that compared the effects of CGM and blood glucose monitoring (BGM) in women with GDM. A restricted maximum likelihood random-effects model was used for the meta-analysis. The measures of effect were risk ratios for categorical data and mean differences for continuous data. RESULTS Of the 457 studies reviewed, six randomized clinical trials met the inclusion criteria. A total of 482 patients were included in the meta-analysis. The use of CGM was associated with lower HbA1c levels at the end of pregnancy (mean difference: -0.22; 95%CI -0.42 to -0.03) compared to BGM. Women using CGM also had less gestational weight gain (mean difference: -1.17, 95%CI -2.15 to -0.19), and their children had lower birth weight (mean difference: -116.26, 95%CI -224.70 to -7.81). No differences were observed in the other outcomes evaluated. CONCLUSION Women with GDM using CGM may achieve lower average blood glucose levels, lower maternal weight gain and infant birth weight than women using BGM. Nevertheless, current evidence is limited by the low number of studies and the small sample sizes of these studies. Larger clinical trials are needed to better understand the effects of CGM in GDM. REGISTRATION PROSPERO registration ID CRD42021225651.
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Affiliation(s)
- Rosa M García-Moreno
- Department of Endocrinology and Nutrition, La Paz University Hospital, Madrid, Spain
| | | | - Beatriz Barquiel
- Department of Endocrinology and Nutrition, La Paz University Hospital, Madrid, Spain
| | | | - Natalia Hillman
- Department of Endocrinology and Nutrition, La Paz University Hospital, Madrid, Spain
| | - David Lora Pablos
- Clinical Research Unit, Hospital 12 de Octubre Research Institute (imas12), Madrid, Spain
- Faculty of Statistics, Complutense University of Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucrecia Herranz
- Department of Endocrinology and Nutrition, La Paz University Hospital, Madrid, Spain
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Paulo MS, Abdo NM, Bettencourt-Silva R, Al-Rifai RH. Gestational Diabetes Mellitus in Europe: A Systematic Review and Meta-Analysis of Prevalence Studies. Front Endocrinol (Lausanne) 2021; 12:691033. [PMID: 34956073 PMCID: PMC8698118 DOI: 10.3389/fendo.2021.691033] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/17/2021] [Indexed: 01/14/2023] Open
Abstract
Background Gestational Diabetes Mellitus (GDM) is defined as the type of hyperglycemia diagnosed for the first-time during pregnancy, presenting with intermediate glucose levels between normal levels for pregnancy and glucose levels diagnostic of diabetes in the non-pregnant state. We aimed to systematically review and meta-analyze studies of prevalence of GDM in European countries at regional and sub-regional levels, according to age, trimester, body weight, and GDM diagnostic criteria. Methods Systematic search was conducted in five databases to retrieve studies from 2014 to 2019 reporting the prevalence of GDM in Europe. Two authors have independently screened titles and abstracts and full text according to eligibility using Covidence software. A random-effects model was used to quantify weighted GDM prevalence estimates. The National Heart, Lung, and Blood Institute criteria was used to assess the risk of bias. Results From the searched databases, 133 research reports were deemed eligible and included in the meta-analysis. The research reports yielded 254 GDM-prevalence studies that tested 15,572,847 pregnant women between 2014 and 2019. The 133 research reports were from 24 countries in Northern Europe (44.4%), Southern Europe (27.1%), Western Europe (24.1%), and Eastern Europe (4.5%). The overall weighted GDM prevalence in the 24 European countries was estimated at 10.9% (95% CI: 10.0-11.8, I2 : 100%). The weighted GDM prevalence was highest in the Eastern Europe (31.5%, 95% CI: 19.8-44.6, I2 : 98.9%), followed by in Southern Europe (12.3%, 95% CI: 10.9-13.9, I2 : 99.6%), Western Europe (10.7%, 95% CI: 9.5-12.0, I2 : 99.9%), and Northern Europe (8.9%, 95% CI: 7.9-10.0, I2 : 100). GDM prevalence was 2.14-fold increased in pregnant women with maternal age ≥30 years (versus 15-29 years old), 1.47-fold if the diagnosis was made in the third trimester (versus second trimester), and 6.79- fold in obese and 2.29-fold in overweight women (versus normal weight). Conclusions In Europe, GDM is significant in pregnant women, around 11%, with the highest prevalence in pregnant women of Eastern European countries (31.5%). Findings have implications to guide vigilant public health awareness campaigns about the risk factors associated with developing GDM. Systematic Review Registration PROSPERO [https://www.crd.york.ac.uk/PROSPERO/], identifier CRD42020161857.
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Affiliation(s)
- Marília Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Noor Motea Abdo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rita Bettencourt-Silva
- Department of Endocrinology and Nutrition, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
- Department of Endocrinology, Hospital Lusíadas Porto, Porto, Portugal
| | - Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Wang J, Lv B, Chen X, Pan Y, Chen K, Zhang Y, Li Q, Wei L, Liu Y. An early model to predict the risk of gestational diabetes mellitus in the absence of blood examination indexes: application in primary health care centres. BMC Pregnancy Childbirth 2021; 21:814. [PMID: 34879850 PMCID: PMC8653559 DOI: 10.1186/s12884-021-04295-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the critical causes of adverse perinatal outcomes. A reliable estimate of GDM in early pregnancy would facilitate intervention plans for maternal and infant health care to prevent the risk of adverse perinatal outcomes. This study aims to build an early model to predict GDM in the first trimester for the primary health care centre. Methods Characteristics of pregnant women in the first trimester were collected from eastern China from 2017 to 2019. The univariate analysis was performed using SPSS 23.0 statistical software. Characteristics comparison was applied with Mann-Whitney U test for continuous variables and chi-square test for categorical variables. All analyses were two-sided with p < 0.05 indicating statistical significance. The train_test_split function in Python was used to split the data set into 70% for training and 30% for test. The Random Forest model and Logistic Regression model in Python were applied to model the training data set. The 10-fold cross-validation was used to assess the model’s performance by the areas under the ROC Curve, diagnostic accuracy, sensitivity, and specificity. Results A total of 1,139 pregnant women (186 with GDM) were included in the final data analysis. Significant differences were observed in age (Z=−2.693, p=0.007), pre-pregnancy BMI (Z=−5.502, p<0.001), abdomen circumference in the first trimester (Z=−6.069, p<0.001), gravidity (Z=−3.210, p=0.001), PCOS (χ2=101.024, p<0.001), irregular menstruation (χ2=6.578, p=0.010), and family history of diabetes (χ2=15.266, p<0.001) between participants with GDM or without GDM. The Random Forest model achieved a higher AUC than the Logistic Regression model (0.777±0.034 vs 0.755±0.032), and had a better discrimination ability of GDM from Non-GDMs (Sensitivity: 0.651±0.087 vs 0.683±0.084, Specificity: 0.813±0.075 vs 0.736±0.087). Conclusions This research developed a simple model to predict the risk of GDM using machine learning algorithm based on pre-pregnancy BMI, abdomen circumference in the first trimester, age, PCOS, gravidity, irregular menstruation, and family history of diabetes. The model was easy in operation, and all predictors were easily obtained in the first trimester in primary health care centres.
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Affiliation(s)
- Jingyuan Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bohan Lv
- School of Nursing, Qingdao University, Qingdao, China
| | - Xiujuan Chen
- Department of Nursing, The Affiliated Hospital of Qingdao University, #16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Yueshuai Pan
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Chen
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Zhang
- Department of Nursing, The Affiliated Hospital of Qingdao University, #16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Qianqian Li
- Department of Nursing, The Affiliated Hospital of Qingdao University, #16 Jiangsu Road, Qingdao, 266003, Shandong Province, China
| | - Lili Wei
- Department of Nursing, The Affiliated Hospital of Qingdao University, #16 Jiangsu Road, Qingdao, 266003, Shandong Province, China.
| | - Yan Liu
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
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Lapolla A, Dalfrà MG, Burlina S. Vaccination against COVID-19 infection: the need of evidence for diabetic and obese pregnant women. Acta Diabetol 2021; 58:1581-1585. [PMID: 34181082 PMCID: PMC8236746 DOI: 10.1007/s00592-021-01764-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022]
Abstract
AIM The recent availability of vaccines against COVID-19 has sparked national and international debate on the feasibility of administering them to pregnant and lactating women, given that these vaccines have not been tested to assess their safety and efficacy in such women. As concerns the risks of COVID-induced disease, published data show that pregnant women who develop COVID-19 have fewer symptoms than patients who are not pregnant, but they are more likely to need hospitalization in intensive care, and neonatal morbidity. Aim of the present perspective paper is to analyze the current literature regarding the use of the vaccine against COVID-19 infection, in terms of safety and protection, in high risk pregnant women as those affected by diabetes and obesity. METHODS Analysis of literature about vaccination against COVID-19 infection in pregnancy. RESULTS The main health organizations and international scientific societies, emphasize that-although data regarding the use of COVID vaccines during pregnancy and lactation are still lacking-vaccination should not be contraindicated. It should be considered for pregnant women at high risk of exposure to COVID-19. For such women, the potential benefits and risks should be assessed by the healthcare professionals caring for them. A recent prospective study to test the immunogenicity and reactogenicity of vaccination with COVID-19 mRNA in pregnant and lactating women, has showed that SARS-CoV-2 mRNA vaccination triggers a robust humoral immunity in pregnant and lactating women; there was also evidence of an immune transfer to their newborn. CONCLUSIONS We urgently need data on the effect of COVID-19 vaccination, in terms of maternal and fetal outcomes and vaccine related symptoms in high risk women during pregnancy and breastfeeding. It is important to run campaigns to promote vaccination, in particular in pregnant women at high risk to have severe COVID infection as those diabetics and/or obese.
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76
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Lupattelli A, Barone-Adesi F, Nordeng H. Association between antidepressant use in pregnancy and gestational diabetes mellitus: Results from the Norwegian Mother, Father and Child Cohort Study. Pharmacoepidemiol Drug Saf 2021; 31:247-256. [PMID: 34817916 DOI: 10.1002/pds.5388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/27/2021] [Accepted: 11/18/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE This study sought to determine the association between gestational diabetes mellitus (GDM) and antidepressant exposure during early-mid pregnancy, overall and according to antidepressant affinity to the histamine-1 (H1 ) receptor. METHODS Data originate from the nation-wide, Norwegian Mother, Father and Child Cohort Study conducted in 1999-2008, linked to the national Medical Birth Registry. The study included 6647 pregnancies within women with depressive/anxiety disorders during and/or 6 months prior to pregnancy. Pregnancies exposed in early-mid gestation to antidepressants having low (group 1, n = 814) or high (group 2, n = 77) affinity to the H1 receptor were compared to non-medicated (n = 5756). We fit crude and weighted modified Poisson regression models using inverse probability of treatment weighting (IPTW). RESULTS Overall, 84 (1.3%) of the pregnancies developed GDM. Relative to non-medicated pregnancies, the risk of GDM was slightly lower in antidepressant group 1 exposed (1.3% vs 1.1%), but more elevated in those exposed to group 2 antidepressants (3.9%). In the weighted analysis, there was no evidence for an association between antidepressant group 1 exposure in early-mid pregnancy and risk of GDM [relative risk (RR): 0.69, 95% confidence interval: 0.31-1.51]. CONCLUSIONS Gestational use of antidepressants with low H1 receptor affinity, mainly SSRIs and SNRIs, does not pose a substantial risk of GDM in women with depressive/anxiety disorders in pregnancy, compared to no use.
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Affiliation(s)
- Angela Lupattelli
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | | | - Hedvig Nordeng
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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77
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Şahin M, Görkem Ü, Bilgi A, Dikker O. Comparison of the effectiveness of screening methods for the diagnosis of gestational diabetes mellitus in pregnant women: A cross-sectional study. Int J Clin Pract 2021; 75:e14857. [PMID: 34516039 DOI: 10.1111/ijcp.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The methods and criteria used for gestational diabetes mellitus (GDM) screening in pregnant women are updated by the relevant organisations in certain periods. We aimed to compare the efficiency of GDM screening tests in pregnant women and to investigate the reasons of different prevalence values reported in the literature. MATERIALS AND METHODS In this retrospective cross-sectional study, a total of 2406 pregnant women who were admitted to the obstetric outpatient clinic for screening GDM, were included. All pregnant women were randomly screened between 24 and 28 gestational weeks, using one-step (75 gr glucose loading) or two-step (50 gr and 100 gr glucose loading) methods. The demographic, clinical and biochemical parameters of the study population were analysed. RESULTS In our study, 680 pregnant women were screened by one-step method and 1726 by two-step method. The average age of the one-step and two-step groups was 28.3 ± 5.7 and 28.1 ± 5.1, respectively, and no statistically significant difference was found between the ages of the two groups (P = .647). Other baseline characteristics, including maternal age, maternal weight, height, body mass index, gestational week, multiparity, systolic blood pressure, diastolic blood pressure, pulse, fasting plasma glucose were not significantly different between the two groups (P > .05, for all). The prevalence of GDM was significantly higher in the one-step group than that in the two-step group: 158/680 (23.2%) versus 143/1683 (8.5%), respectively. A statistically significant difference was found between the prevalence of the two groups (P < .001). CONCLUSION The reason for the different prevalence values obtained in GDM screening studies may be because of the preferred method. Considering the advantages and disadvantages of both methods, studies are needed in which international organisations will revise their diagnostic criteria. We think it would be more appropriate to use the two-step screening method until international professional organisations develop a new methodology and new cut-off values.
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Affiliation(s)
- Mustafa Şahin
- Department of Medical Biochemistry, Hitit University Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Ümit Görkem
- Department of Obstetrics and Gynecology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Ahmet Bilgi
- Department of Obstetrics and Gynecology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Okan Dikker
- Department of Medical Biochemistry, Okmeydanı Training and Research Hospital, Istanbul, Turkey
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Evans JMM, Ireland AV, Cameron DM, Clarke KM, Eades CE. Postpartum opportunistic advice in primary care for women who have had gestational diabetes: a qualitative study of health care professionals' views. BMC FAMILY PRACTICE 2021; 22:209. [PMID: 34666697 PMCID: PMC8527649 DOI: 10.1186/s12875-021-01558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women who have had gestational diabetes during pregnancy are at very high risk of developing type 2 diabetes later in life, but their understanding of the risks is often limited. In this study we explored the views of health care professionals regarding offering brief opportunistic advice to women after their pregnancy, during unrelated consultations in primary care, relating to reducing diabetes risk. METHODS The study took place in three Health Boards in Scotland. We conducted semi-structured one-to-one interviews (either face-to-face or telephone) with two health visitors, three practice nurses, two GPs, two diabetes consultants and two obstetricians. A focus group with five health visitors was also held. A topic guide was followed, covering the feasibility and acceptability of delivering brief opportunistic advice during a routine consultation, the optimal way to identify and recall women with previous gestational diabetes, and the possible content and timing of any such intervention. A thematic approach was used to analyse the qualitative data generated. RESULTS The interviews/discussion lasted from 15 to 51 min. There was widespread support from all participants for offering opportunistic advice, and general consensus that health visitors would be best placed to do this as part of the Universal Health Visiting Pathway in Scotland. Thematic analysis generated three significant points of discussion: implications for training of health visitors, the need for a systematic approach to identifying women with gestational diabetes, and the optimal timing of delivery. Despite an already demanding schedule of providing advice and education to women, health visitors were confident that they could offer educational advice, provided that they received appropriate training to do so. However, there would need to be a watertight system for identifying women in their care who had had gestational diabetes. In terms of timing, later visits around 6-8 months after delivery were considered most suitable. CONCLUSIONS There is support from health care professionals, and most pertinently from health visitors, that the frequency of routine visits with women during the Universal Health Visiting Pathway programme in Scotland provides potential opportunities for education around future diabetes risk to women who have had gestational diabetes.
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Affiliation(s)
- Josie M. M. Evans
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland FK9 4LA UK
| | - Aileen V. Ireland
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland FK9 4LA UK
| | - Dawn M. Cameron
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, G72 OLH UK
| | - Kate M. Clarke
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland FK9 4LA UK
| | - Claire E. Eades
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland FK9 4LA UK
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Lis-Kuberka J, Orczyk-Pawiłowicz M. Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910409. [PMID: 34639709 PMCID: PMC8508017 DOI: 10.3390/ijerph181910409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022]
Abstract
Gestational diabetes mellitus (GDM) is a multifaceted disease and is associated with complications for newborns and mothers. The aim of the study was to assess Polish women’s knowledge concerning GDM and their attitude to breastfeeding. As a research tool, an anonymous online survey that included 33 questions, grouped into three main sections—sociodemographic and obstetric variables, risk factors for GDM and neonatal adverse outcomes, and knowledge about breastfeeding—was used and administered online. A total of 410 women aged from 18 to 45 participated in this study. Based on the survey, it was demonstrated that the women had moderate knowledge concerning the maternal risk factors and adverse neonatal outcomes associated with GDM and, additionally, the short- and long-term effects of breastfeeding. Significantly deeper knowledge about GDM, including breastfeeding by GDM mothers, was observed among hyperglycemic mothers in comparison to normoglycemic mothers. However, knowledge concerning the health benefits of breastfeeding was not related to the mothers’ glycemic status. In conclusion, educational programs must include pre-pregnancy education of women and place emphasis on explaining the mechanism of development of GDM and the transformation of GDM to type 2 diabetes. This is crucial for changing the public’s perception of GDM as a temporary, reversible clinical entity.
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Barani M, Sargazi S, Mohammadzadeh V, Rahdar A, Pandey S, Jha NK, Gupta PK, Thakur VK. Theranostic Advances of Bionanomaterials against Gestational Diabetes Mellitus: A Preliminary Review. J Funct Biomater 2021; 12:54. [PMID: 34698244 PMCID: PMC8544389 DOI: 10.3390/jfb12040054] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 12/18/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is the most frequent complication during pregnancy. This complex disease is characterized by glucose intolerance and consequent hyperglycemia that begins or is first diagnosed in pregnancy, and affects almost 7% of pregnant women. Previous reports have shown that GDM is associated with increased pregnancy complications and might cause abnormal fetal development. At present, treatments are not suitable for the prevention and management of these patients. As an alternative therapeutic opportunity and a leading scientific technique, nanotechnology has helped enlighten the health of these affected women. Theranostic nanomaterials with unique properties and small sizes (at least <100 nm in one of their dimensions) have been recently engineered for clinics and pharmaceutics. Reducing materials to the nanoscale has successfully changed their properties and enabled them to uniquely interact with cell biomolecules. Several biosensing methods have been developed to monitor glucose levels in GDM patients. Moreover, cerium oxide nanoparticles (NPs), selenium NPs, polymeric NPs, and drug-loaded NPs loaded with therapeutic agents have been used for GDM treatment. Still, there are some challenges associated with the detection limits and toxicity of such nanomaterials. This preliminary review covers the aspects from a fast-developing field to generating nanomaterials and their applications in GDM diagnosis and treatment.
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Affiliation(s)
- Mahmood Barani
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman 7616913555, Iran;
| | - Saman Sargazi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan 9816743463, Iran;
| | - Vahideh Mohammadzadeh
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Science, Mashhad 1313199137, Iran;
| | - Abbas Rahdar
- Department of Physics, Faculty of Science, University of Zabol, Zabol 53898615, Iran
| | - Sadanand Pandey
- Department of Chemistry, College of Natural Science, Yeungnam University, 280 Daehak-ro, Gyeongsan 38541, Gyeongbuk, Korea;
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India;
| | - Piyush Kumar Gupta
- Department of Life Sciences, School of Basic Sciences and Research, Sharda University, Greater Noida 201310, India
| | - Vijay Kumar Thakur
- Biorefining and Advanced Materials Research Centre, SRUC, Edinburgh EH9 3JG, UK
- Department of Mechanical Engineering, School of Engineering, Shiv Nadar University, Noida 201314, India
- School of Engineering, University of Petroleum & Energy Studies (UPES), Dehradun 248007, India
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Application of machine learning algorithm for predicting gestational diabetes mellitus in early pregnancy†. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To study the application of a machine learning algorithm for predicting gestational diabetes mellitus (GDM) in early pregnancy.
Methods
This study identified indicators related to GDM through a literature review and expert discussion. Pregnant women who had attended medical institutions for an antenatal examination from November 2017 to August 2018 were selected for analysis, and the collected indicators were retrospectively analyzed. Based on Python, the indicators were classified and modeled using a random forest regression algorithm, and the performance of the prediction model was analyzed.
Results
We obtained 4806 analyzable data from 1625 pregnant women. Among these, 3265 samples with all 67 indicators were used to establish data set F1; 4806 samples with 38 identical indicators were used to establish data set F2. Each of F1 and F2 was used for training the random forest algorithm. The overall predictive accuracy of the F1 model was 93.10%, area under the receiver operating characteristic curve (AUC) was 0.66, and the predictive accuracy of GDM-positive cases was 37.10%. The corresponding values for the F2 model were 88.70%, 0.87, and 79.44%. The results thus showed that the F2 prediction model performed better than the F1 model. To explore the impact of sacrificial indicators on GDM prediction, the F3 data set was established using 3265 samples (F1) with 38 indicators (F2). After training, the overall predictive accuracy of the F3 model was 91.60%, AUC was 0.58, and the predictive accuracy of positive cases was 15.85%.
Conclusions
In this study, a model for predicting GDM with several input variables (e.g., physical examination, past history, personal history, family history, and laboratory indicators) was established using a random forest regression algorithm. The trained prediction model exhibited a good performance and is valuable as a reference for predicting GDM in women at an early stage of pregnancy. In addition, there are certain requirements for the proportions of negative and positive cases in sample data sets when the random forest algorithm is applied to the early prediction of GDM.
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Rai AS, Sletner L, Jenum AK, Øverby NC, Stafne SN, Lekva T, Pripp AH, Sagedal LR. Identifying women with gestational diabetes based on maternal characteristics: an analysis of four Norwegian prospective studies. BMC Pregnancy Childbirth 2021; 21:615. [PMID: 34496778 PMCID: PMC8427855 DOI: 10.1186/s12884-021-04086-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/29/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is still no worldwide agreement on the best diagnostic thresholds to define gestational diabetes (GDM) or the optimal approach for identifying women with GDM. Should all pregnant women perform an oral glucose tolerance test (OGTT) or can easily available maternal characteristics, such as age, BMI and ethnicity, indicate which women to test? The aim of this study was to assess the prevalence of GDM by three diagnostic criteria and the predictive accuracy of commonly used risk factors. METHODS We merged data from four Norwegian cohorts (2002-2013), encompassing 2981 women with complete results from a universally offered OGTT. Prevalences were estimated based on the following diagnostic criteria: 1999WHO (fasting plasma glucose (FPG) ≥7.0 or 2-h glucose ≥7.8 mmol/L), 2013WHO (FPG ≥5.1 or 2-h glucose ≥8.5 mmol/L), and 2017Norwegian (FPG ≥5.3 or 2-h glucose ≥9 mmol/L). Multiple logistic regression models examined associations between GDM and maternal factors. We applied the 2013WHO and 2017Norwegian criteria to evaluate the performance of different thresholds of age and BMI. RESULTS The prevalence of GDM was 10.7, 16.9 and 10.3%, applying the 1999WHO, 2013WHO, and the 2017Norwegian criteria, respectively, but was higher for women with non-European background when compared to European women (14.5 vs 10.2%, 37.7 vs 13.8% and 27.0 vs 7.8%). While advancing age and elevated BMI increased the risk of GDM, no risk factors, isolated or in combination, could identify more than 80% of women with GDM by the latter two diagnostic criteria, unless at least 70-80% of women were offered an OGTT. Using the 2017Norwegian criteria, the combination "age≥25 years or BMI≥25 kg/m2" achieved the highest sensitivity (96.5%) with an OGTT required for 93% of European women. The predictive accuracy of risk factors for identifying GDM was even lower for non-European women. CONCLUSIONS The prevalence of GDM was similar using the 1999WHO and 2017Norwegian criteria, but substantially higher with the 2013WHO criteria, in particular for ethnic non-European women. Using clinical risk factors such as age and BMI is a poor pre-diagnostic screening method, as this approach failed to identify a substantial proportion of women with GDM unless at least 70-80% were tested.
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Affiliation(s)
- Anam Shakil Rai
- Department of Research, Sorlandet Hospital, 4604, Kristiansand, Norway.
| | - Line Sletner
- Department of Pediatric and Adolescents Medicine, Akershus University Hospital, Akershus, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- Department of General Medicine, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Services, St.Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Tove Lekva
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Linda Reme Sagedal
- Department of Research, Sorlandet Hospital, 4604, Kristiansand, Norway
- Department of Obstetrics and Gynaecology, Sorlandet Hospital, Kristiansand, Norway
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83
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Bagger S, Maindal HT, Nielsen KK, Vrå AG, Aagaard-Hansen J. Perceptions of risk and motivation for healthy living among immigrants from non-western countries with prior gestational diabetes mellitus living in Denmark. Health Psychol Behav Med 2021; 9:761-777. [PMID: 34484976 PMCID: PMC8409963 DOI: 10.1080/21642850.2021.1969235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark. Design Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women were recruited through a public hospital and other health services and nongovernmental organisations. The theoretical approach was inspired by Arthur Kleinman’s Explanatory Models. Data were analysed using qualitative content analysis. Results A diagnosis of GDM entailed great worry for the future. Participants’ fears were primarily linked to the potential later development of type 2 diabetes (T2D) and poor health. Women’s perceptions of GDM reflected their experiences with T2D-related complications and even death among relatives. The risk perception of GDM was also influenced by participants’ challenges and trauma unrelated to diabetes. Their motivation for healthy living was strengthened by their experiences with T2D among relatives, while unrelated challenges and trauma generally reduced their capacity for healthier behaviours. Conclusion Among women with a non-western immigrant background and prior GDM living in Denmark, experiences with T2D among family members and their close communities affect their perceptions of risk and motivation to prevent the development of T2D. Furthermore, the challenges of daily life and past trauma were critical factors in their levels of available resources for health. Health promotion in this population should address health in a holistic way by integrating mental and social health with interventions aimed at preventing the development of T2D.
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Affiliation(s)
- Stine Bagger
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Section for Health Promotion, Aarhus University, Aarhus, Denmark
| | | | | | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Faculty of Health Sciences, SA MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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84
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Mmasa KN, Powis K, Sun S, Makhema J, Mmalane M, Kgole S, Masasa G, Moyo S, Gerschenson M, Mohammed T, Legbedze J, Abrams EJ, Kurland IJ, Geffner ME, Jao J. Gestational diabetes in women living with HIV in Botswana: lower rates with dolutegravir- than with efavirenz-based antiretroviral therapy. HIV Med 2021; 22:715-722. [PMID: 34003565 PMCID: PMC8373729 DOI: 10.1111/hiv.13120] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND There are few data on the prevalence of gestational diabetes (GDM) in pregnant women living with HIV (WLHIV) in sub-Saharan Africa, particularly those using integrase strand transfer inhibitors such as dolutegravir (DTG). METHODS We prospectively enrolled pregnant WLHIV and pregnant women without HIV ≥18 years old in Gaborone, Botswana, excluding those with pre-existing diabetes. We screened for GDM using a 75 g oral glucose tolerance test (OGTT) performed at 24-28 weeks' gestation or at the earliest prenatal visit for those presenting after 28 weeks. Logistic regression models were fitted to assess the association between maternal HIV infection and GDM. Subgroup analyses were performed among WLHIV to assess the association between maternal antiretroviral therapy (ART) in pregnancy [DTG vs. efavirenz (EFV) with tenofovir/emtricitabine] and GDM. RESULTS Of 486 pregnant women, 66.5% were WLHIV, and they were older than women without HIV (median age 30 vs. 25 years, P < 0.01). Among WLHIV, 97.8% had an HIV-1 RNA level < 400 copies/mL at enrolment. Overall, 8.4% had GDM with similar rates between WLHIV and those without HIV (9.0% vs. 7.4%). The WLHIV receiving DTG-based ART had a 60% lower risk for GDM compared with those on EFV-based ART (adjusted odds ratio = 0.40, 95% CI: 0.18-0.92) after adjusting for confounders. CONCLUSIONS Pregnant WLHIV on ART in Botswana were not at increased risk of GDM compared with women without HIV. Among WLHIV, the risk of GDM was lower with DTG- than with EFV-based ART. Further studies with larger cohorts are warranted to confirm these findings.
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Affiliation(s)
- K N Mmasa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - K Powis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, MA, USA
| | - S Sun
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - J Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - M Mmalane
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - S Kgole
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - G Masasa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - S Moyo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, MA, USA
| | - M Gerschenson
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - T Mohammed
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - J Legbedze
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - E J Abrams
- ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - I J Kurland
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M E Geffner
- The Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - J Jao
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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85
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Population-based study on birth outcomes among women with hypertensive disorders of pregnancy and gestational diabetes mellitus. Sci Rep 2021; 11:17391. [PMID: 34462468 PMCID: PMC8405617 DOI: 10.1038/s41598-021-96345-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
To evaluate birth outcomes in women with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), we used insurance data of Taiwan to evaluate 11 adverse neonatal outcomes of infants born to women with HDP (N = 7775) and with both HDP and GDM (HDP/GDM) (N = 1946), comparing to women with neither disorder (N = 19,442), matched by age. The impacts of preeclampsia/eclampsia were also evaluated. Results showed that Caesarean section delivery was near 1.7-fold greater in the HDP/GDM and HDP groups than in comparisons. The preterm delivery rates were more than threefold greater in HDP/GDM group and HDP group than in comparisons with adjusted odds ratios (aORs) of 4.84 (95% confidence interval (CI) 4.34–5.40) and 3.92 (95% CI 3.65–4.21), respectively, followed by jaundice (aORs 2.95 (95% CI 2.63–3.33) and 1.90 (95% CI 1.76–2.06)), and small gestation age (SGA) (aORs 6.57 (95% CI 5.56–7.75) and 5.81 (95% CI 5.15–6.55)). Incidence rates of birth trauma, patent ductus arteriosus, atrial septal defect, respiratory distress syndrome, and neonatal hypoglycemia were also higher in the HDP/GDM and HDP groups than in the comparison group. Most adverse outcomes increased further in women with preeclampsia or eclampsia. In conclusion, women with HDP are at elevated risks of adverse neonatal outcomes. Risks of most adverse outcomes increase further for women with both HDP and GDM. Preeclampsia or eclampsia may also contribute to these outcomes to higher risk levels. Every pregnant woman with these conditions deserves specialized prenatal care.
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86
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Loo EXL, Zhang Y, Yap QV, Yu G, Soh SE, Loy SL, Lau HX, Chan SY, Shek LPC, Luo ZC, Yap FKP, Tan KH, Chong YS, Zhang J, Eriksson JG. Comparative epidemiology of gestational diabetes in ethnic Chinese from Shanghai birth cohort and growing up in Singapore towards healthy outcomes cohort. BMC Pregnancy Childbirth 2021; 21:566. [PMID: 34407778 PMCID: PMC8375167 DOI: 10.1186/s12884-021-04036-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has been associated with adverse health outcomes for mothers and offspring. Prevalence of GDM differs by country/region due to ethnicity, lifestyle and diagnostic criteria. We compared GDM rates and risk factors in two Asian cohorts using the 1999 WHO and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODS The Shanghai Birth Cohort (SBC) and the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort are prospective birth cohorts. Information on sociodemographic characteristics and medical history were collected from interviewer-administered questionnaires. Participants underwent a 2-h 75-g oral glucose tolerance test at 24-28 weeks gestation. Logistic regressions were performed. RESULTS Using the 1999 WHO criteria, the prevalence of GDM was higher in GUSTO (20.8%) compared to SBC (16.6%) (p = 0.046). Family history of hypertension and alcohol consumption were associated with higher odds of GDM in SBC than in GUSTO cohort while obesity was associated with higher odds of GDM in GUSTO. Using the IADPSG criteria, the prevalence of GDM was 14.3% in SBC versus 12.0% in GUSTO. A history of GDM was associated with higher odds of GDM in GUSTO than in SBC, while being overweight, alcohol consumption and family history of diabetes were associated with higher odds of GDM in SBC. CONCLUSIONS We observed several differential risk factors of GDM among ethnic Chinese women living in Shanghai and Singapore. These findings might be due to heterogeneity of GDM reflected in diagnostic criteria as well as in unmeasured genetic, lifestyle and environmental factors.
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Affiliation(s)
- Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore. .,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Yuqing Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Qai Ven Yap
- Department of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Guoqi Yu
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - See Ling Loy
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Hui Xing Lau
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhong-Cheng Luo
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, Canada
| | - Fabian Kok Peng Yap
- Duke-NUS Medical School, Singapore, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Public Health, Guilin Medical College, Guilin, Guangxi, China
| | - Johan Gunnar Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.,Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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A Glimpse at the Size of the Fetal Liver-Is It Connected with the Evolution of Gestational Diabetes? Int J Mol Sci 2021; 22:ijms22157866. [PMID: 34360631 PMCID: PMC8346004 DOI: 10.3390/ijms22157866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/17/2021] [Accepted: 07/22/2021] [Indexed: 12/17/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as an impairment of glucose tolerance, manifested by hyperglycemia, which occurs at any stage of pregnancy. GDM is more common in the third trimester of pregnancy and usually disappears after birth. It was hypothesized that the glycemic status of the mother can modulate liver development and growth early during the pregnancy. The simplest modality to monitor the evolution of GDM employs noninvasive techniques. In this category, routinely obstetrical ultrasound (OUS) examinations (simple or 2D/3D) can be employed for specific fetal measurements, such as fetal liver length (FLL) or volume (FLV). FLL and FLV may emerge as possible predictors of GDM as they positively relate to the maternal glycated hemoglobin (HbA1c) levels and to the results of the oral glucose tolerance test. The aim of this review is to offer insight into the relationship between GDM and fetal nutritional status. Risk factors for GDM and the short- and long-term outcomes of GDM pregnancies are also discussed, as well as the significance of different dietary patterns. Moreover, the review aims to fill one gap in the literature, investigating whether fetal liver growth can be used as a predictor of GDM evolution. To conclude, although studies pointed out a connection between fetal indices and GDM as useful tools in the early detection of GDM (before 23 weeks of gestation), additional research is needed to properly manage GDM and offspring health.
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88
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Scavini M, Formoso G, Festa C, Sculli MA, Succurro E, Sciacca L, Torlone E. Follow-up of women with a history of gestational diabetes in Italy: Are we missing an opportunity for primary prevention of type 2 diabetes and cardiovascular disease? Diabetes Metab Res Rev 2021; 37:e3411. [PMID: 32979283 DOI: 10.1002/dmrr.3411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/29/2020] [Accepted: 08/26/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Marina Scavini
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Gloria Formoso
- Department of Medicine and Aging Sciences, Centre for Advanced Studies and Technology (CAST, Ex CeSIMet) G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Camilla Festa
- Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Maria Angela Sculli
- Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Laura Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy
| | - Elisabetta Torlone
- Department of Internal Medicine Endocrine and Metabolic Sciences, University of Perugia, Perugia, Italy
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89
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Li F, Hu Y, Zeng J, Zheng L, Ye P, Wei D, Chen D. Analysis of risk factors related to gestational diabetes mellitus. Taiwan J Obstet Gynecol 2021; 59:718-722. [PMID: 32917324 DOI: 10.1016/j.tjog.2020.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE With the rapid rising prevalence, gestational diabetes mellitus (GDM) has become one of the leading causes of maternal and child mortality and morbidity worldwide. The present study aimed to analyze GDM-related risk factors for early intervention. MATERIALS AND METHODS From January to June 2018, a total of 250 pregnant women from Chengdu Second People's Hospital were enrolled in the study. According to the diagnostic criteria for GDM, they were assigned into GDM group (n = 48) and non-GDM group (n = 202). The clinical data and biochemical indicators were compared between GDM group and non-GDM group, and Logistic regression analysis was performed to analyze the risk factors of GDM. RESULTS GDM group was significantly higher than non-GDM group in the age, pregnancy times, pre-pregnancy body mass index (BMI), low-density lipoprotein cholesterol (LDL-C) level, history of diabetes mellitus in first-degree relatives, incidence of subclinical hypothyroidism (SCH) and the positive rate of thyroid peroxidase antibody (TPOAb) (P < 0.05), whereas was conspicuously lower than non-GDM group in the education level above junior college (P < 0.05). The results of Logistic regression analysis revealed that the age [odds ratios (OR) = 1.125, 95% confidential interval (CI) = 1.019-1.241, P = 0.020], pre-pregnancy BMI (OR = 1.280, 95%CI = 1.118-1.466, P < 0.001), history of diabetes mellitus in first-degree relatives (OR = 4.938, 95%CI = 1.418-17.196, P = 0.012) and TPOAb (+) (OR = 4.849, 95%CI = 1.742-13.501, P = 0.003) were the risk factors of GDM. CONCLUSIONS Advanced age, pre-pregnancy BMI overweight, history of diabetes mellitus in first-degree relatives and TPOAb (+) are associated with an increased risk of GDM.
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Affiliation(s)
- Fang Li
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, 610017, Sichuan, China.
| | - Ying Hu
- Department of Nuclear Medicine, Chengdu Second People's Hospital, Chengdu 610017, Sichuan, China.
| | - Jing Zeng
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, 610017, Sichuan, China
| | - Li Zheng
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, 610017, Sichuan, China
| | - Peng Ye
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, 610017, Sichuan, China
| | - Dong Wei
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, 610017, Sichuan, China
| | - Dongmei Chen
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, 610017, Sichuan, China
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Eckstein ML, Moser O, Rössler A, Moertl MG, Jantscher A, Papousek I, Wagner J, Schmid-Zalaudek K, Sourij H, Treiber G, Lackner HK. Differences in Hemodynamic, Hormonal and Heart Rate Variability Parameters in Complication-Free Pregnancies Compared to Individuals with Gestational Diabetes Mellitus and Preeclampsia: An Observational Retrospective Analysis. Life (Basel) 2021; 11:life11070626. [PMID: 34209500 PMCID: PMC8306108 DOI: 10.3390/life11070626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/16/2022] Open
Abstract
To investigate differences in hemodynamic, hormonal and heart rate variability parameters in women following complication-free pregnancies (healthy), preeclampsia and gestational diabetes mellitus (GDM) after giving childbirth. Data of 60 women (healthy: n = 29, age 32.7 ± 4.5 years, BMI 24.2 ± 4.3 kg/m2; preeclampsia: n = 16, age 35.3 ± 4.4 years, 28.5 ± 6.4 kg/m2; GDM, n = 15, age 32.3 ± 6.0 years, BMI 26.4 ± 6.2 kg/m2) were included. Two visits were conducted 16 and 48 weeks after giving childbirth. Hair samples were taken for analysis of cortisol and testosterone. ECG and blood pressure were recorded at each visit. Data were analyzed via RM-ANOVA and post-hoc testing (p ≤ 0.05). Heart rate increased from visit 1 to visit 2, whereas SDNN decreased (both p = 0.03). RMSSD showed an increased trend for groups (p = 0.06). Testosterone in the GDM group was significantly higher compared to the other groups (p = 0.002). Cortisol levels were significantly higher following post-hoc testing GDM was different compared to healthy individuals (p = 0.02). Hemodynamic changes from week 16 to week 48 did not differ between groups (p > 0.05). No differences between individuals with preeclampsia and healthy individuals were found for all hemodynamic parameters (p > 0.05). The study showed higher levels of chronic stress indicators in GDM measured via heart rate variability and cortisol compared to women with a history of preeclampsia and healthy women.
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Affiliation(s)
- Max L. Eckstein
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany;
| | - Othmar Moser
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany;
- Correspondence: ; Tel.: +49-(0)921-55-3465
| | - Andreas Rössler
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, 8036 Graz, Austria; (A.R.); (A.J.); (J.W.); (K.S.-Z.); (H.K.L.)
| | - Manfred G. Moertl
- Clinical Center Klagenfurt, Department of Obstetrics and Gynecology, 9020 Klagenfurt, Austria;
| | - Andreas Jantscher
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, 8036 Graz, Austria; (A.R.); (A.J.); (J.W.); (K.S.-Z.); (H.K.L.)
| | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, 9020 Graz, Austria;
| | - Johann Wagner
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, 8036 Graz, Austria; (A.R.); (A.J.); (J.W.); (K.S.-Z.); (H.K.L.)
| | - Karin Schmid-Zalaudek
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, 8036 Graz, Austria; (A.R.); (A.J.); (J.W.); (K.S.-Z.); (H.K.L.)
| | - Harald Sourij
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (H.S.); (G.T.)
| | - Gerlies Treiber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (H.S.); (G.T.)
| | - Helmut K. Lackner
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, 8036 Graz, Austria; (A.R.); (A.J.); (J.W.); (K.S.-Z.); (H.K.L.)
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91
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Pre-Gestational Consumption of Ultra-Processed Foods and Risk of Gestational Diabetes in a Mediterranean Cohort. The SUN Project. Nutrients 2021; 13:nu13072202. [PMID: 34206854 PMCID: PMC8308322 DOI: 10.3390/nu13072202] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 12/18/2022] Open
Abstract
We aimed to investigate the relationship between the pre-gestational consumption of ultra-processed foods (UPF) and the risk of gestational diabetes (GDM). We carried out a prospective study among 3730 Spanish women of the SUN cohort who reported at least one pregnancy after baseline recruitment. Cases of GDM were identified among women with a confirmed diagnosis of GDM. UPF consumption was assessed through a validated, semi-quantitative food frequency questionnaire and the frequency of UPF consumption was categorized in tertiles. We identified 186 cases of GDM. In the pooled sample, we did not observe a significant association of UPF with the risk of GDM. When we stratified by age, the multivariate OR for the third tertile of UPF consumption compared with the lowest one was 2.05 (95% CI 1.03, 4.07) in women aged ≥30 years at baseline (Ptrend = 0.041). The association remained significant in a sensitivity analysis after changing many of our assumptions and adjusting for additional confounders. No association between a higher UPF consumption and GDM risk was observed in women aged 18–29 years. The pre-gestational UPF consumption may be a risk factor for GDM, especially in women aged 30 years or more. Confirmatory studies are needed to validate these findings.
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92
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Feleke BE, Feleke TE, Kassahun MB, Adane WG, Achenefe D, Genetu A, Nigussie AA, Engedaw HA. Progression of pregnancy induced diabetes mellitus to type two diabetes mellitus, an ambidirectional cohort study. Prim Care Diabetes 2021; 15:596-600. [PMID: 33323352 DOI: 10.1016/j.pcd.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/16/2020] [Accepted: 11/29/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Diabetes mellitus (DM) is a metabolic disorder characterized by elevated level of blood glucose. It affects more than 422 million people globally. In resource limited settings, the progression of gestational diabetes (GDM) to DM was not well investigated and this research work was conducted to estimate the incidence of DM after GDM and their predictors in resource limited settings. METHODS A retrospective and prospective cohort studies were used from January 2010 until December 2019. The data were collected using patients chart review, interview and collecting blood sample. Initially, baseline data were collected from GDM and GDM free women and update data were collected every 3 month. Clinical nurses were used to extract the necessary data from medical charts and to collect the data using patient interview. Laboratory technologists were used to measure the blood glucose level of the study participants. The study was conducted in pregnant women presenting themselves in the referral hospitals of Amhara regional state. The sample size was calculated using Epi-info software. Descriptive statistics were used to describe the profile of study participants. Kaplan Meier survival curve and life-table were used to estimate the survivals of study participants. Incidence density was used to estimate the incidence of DM. Cox regression was used to identify the predictors DM. RESULTS A total of 4892 women were followed giving for the response rate of 88.62%. The mean age of study participants at the start of the study was 28.34 years with standard deviation [SD] ±7.48 years. DM was associated with gestational diabetes mellitus [AHR (adjusted hazard ratio); 2.53, 95% CI: 2.14-2.99], frequency of breastfeeding [AHR; 0.72, 95% CI: 0.69-0.74], age [AHR; 1.04, 95% CI: 1.03-1.05], parity [AHR; 1.14, 95% CI: 1.07-1.21], regular physical exercise [AHR; 0.45, 95% CI: 0.37-0.55], family history of DM [AHR; 2.04, 95% CI: 1.76-2.37], stillbirth [AHR; 1.67: 95% CI: 1.34-2.07], abortion [AHR; 2.64, 95% CI: 2.25-3.09]. CONCLUSION The progression of GDM to DM was very high and special follow up should be implemented for women with a history of abortion, stillbirth, and family history of DM.
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Affiliation(s)
- Berhanu Elfu Feleke
- Department of Epidemiology and Biostatistics, University of Bahir Dar, Bahir Dar, Ethiopia.
| | - Teferi Elfu Feleke
- Department of Pediatrics and Child Health Wolkite University, Butajira General Hospital, Ethiopia
| | | | | | - Desalegn Achenefe
- Department of Internal Medicine, University of Bahir Dar, Bahir Dar, Ethiopia
| | - Abere Genetu
- Department of Internal Medicine, University of Bahir Dar, Bahir Dar, Ethiopia
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93
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Cauldwell M, van-de-L'Isle Y, Watt Coote I, Steer PJ. Seasonal and SARS-CoV-2 pandemic changes in the incidence of gestational diabetes. BJOG 2021; 128:1881-1887. [PMID: 34047455 PMCID: PMC8209849 DOI: 10.1111/1471-0528.16779] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
Objective To test the hypothesis that there is seasonal variation in the rates of gestational diabetes (GDM) diagnosed using a 2‐hour oral glucose tolerance test. Design Monthly assessment of the percentage of women screened from 1 April 2016 to the 31 December 2020 who were diagnosed as having gestational diabetes. Setting London teaching hospital. Population 28 128 women receiving antenatal care between 1 April 2016 and 31 December 2020. Methods Retrospective study of prospectively collected data. Main outcome measures Proportion of women screened diagnosed as having gestational diabetes. Results The mean (SD) percentage of women diagnosed with GDM was 14.78 (2.24) in summer (June, July, August) compared with 11.23 (1.62) in winter (P < 0.001), 12.13 (1.94) in spring (P = 0.002) and 11.88 (2.67) in autumn (P = 0.003). There was a highly significant positive correlation of the percentage testing positive for GDM with the mean maximum monthly temperature (R2 = 0.248, P < 0.001). There was a statistically significant 33.8% increase in the proportion of GDM diagnoses from June 2020 onwards, possibly related to a reduction in exercise secondary to the Covid‐19 pandemic. Conclusions There is a 23.3% higher rate of GDM diagnoses in the warmer summer months. There has been a 33.8% rise in GDM diagnoses associated with the Covid‐19 pandemic. Tweetable abstract Rates of GDM are higher in summer and since the onset of the Covid‐19 pandemic. Rates of GDM are higher in summer and since the onset of the Covid‐19 pandemic.
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Affiliation(s)
- M Cauldwell
- Department of Obstetrics, Maternal Medicine Service, St George's University Hospital, London, UK
| | - Y van-de-L'Isle
- Department of Obstetrics, Maternal Medicine Service, St George's University Hospital, London, UK
| | - I Watt Coote
- Department of Obstetrics, Maternal Medicine Service, St George's University Hospital, London, UK
| | - P J Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
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94
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Liu Q, Wei S, Lei J, Luo L, Wang F. Periconceptional folate and gestational diabetes mellitus: a systematic review and meta-analysis of cohort studies. J Matern Fetal Neonatal Med 2021; 35:6884-6893. [PMID: 34034602 DOI: 10.1080/14767058.2021.1929158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the relationship between periconceptional folate exposure and risk of gestational diabetes mellitus (GDM). METHODS Several electronic databases, including PubMed, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), and Cochrane Library, were searched for all relevant cohort studies by January 2021. Studies on relationship between folate exposure (intake or status) and GDM risk were included. Quality of included studies was assessed using Newcastle-Ottawa Scale. Random effects meta-analysis was performed to estimate overall odds ratio (OR) and 95% confidence intervals (CIs) by Stata software (Stata Corp., College Station, TX). RESULTS Ten cohort studies with 40,244 pregnancies were eligible for quantitative meta-analysis. Significant association was observed between folate exposure and risk of GDM (OR = 1.24, p=.036, 95% CI: 1.01-1.52). Subgroup analysis revealed that periconceptional folate exposure of population in China (OR = 1.35, 95% CI: 1.09-1.67) but not in western countries, folate exposure during pregnancy (OR = 1.49, 95% CI: 1.22-1.81) but not before pregnancy, and internal folate exposure (OR = 1.36, 95% CI: 1.10-1.67), were significantly associated with increased GDM risk. CONCLUSIONS Overall, periconceptional folate exposure is positively associated with GDM risk, especially the exposure during pregnancy and exposure in Chinese populations.
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Affiliation(s)
- Qingyun Liu
- Department of Clinical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Shanshan Wei
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jiafan Lei
- Central Laboratory, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Liangping Luo
- Medical Imaging Center,The First Affiliated Hospital of Jinan University, Guangzhou, China.,Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, Guangzhou, China
| | - Feng Wang
- Department of Clinical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
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95
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Aubry EM, Raio L, Oelhafen S. Effect of the IADPSG screening strategy for gestational diabetes on perinatal outcomes in Switzerland. Diabetes Res Clin Pract 2021; 175:108830. [PMID: 33895193 DOI: 10.1016/j.diabres.2021.108830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate the impact adoption of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria on prevalence of gestational diabetes mellitus (GDM) and risks of perinatal outcomes. METHODS Retrospectively, 155,103 women screened with selective two step criteria in Switzerland in period 1 (2005-2010) were compared to 170,427 women screened with IADPSG criteria in period 2 (2012-2017). GDM prevalence over time was established and multivariable regression used to assess variation in risks for GDM related events and perinatal outcomes. RESULTS GDM prevalence increased steadily over both study periods from 1.8% to 9.0%. A risk reduction of GDM-related events was shown only for women with one or two risk factors for GDM present (relative risk (95% confidence interval)): (0.93 (0.90,0.97), 0.90 (0.83,0.96)). The comparison of perinatal outcomes between the two study periods revealed a significant lower risk for newborns large for gestational age (LGA) (0.93 (0.91-0.95)), pre-term delivery (0.94 (0.92-0.97)) and neonatal hypoglycemia (0.83 (0.77-0.90)) in period 2. CONCLUSION The introduction of the IADPSG criteria for the screening of GDM increased prevalence by threefold with no substantial improvements in GDM related events for women without risk factors but reduced the risks for LGA, neonatal hypoglycemia and preterm birth.
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Affiliation(s)
- Evelyne M Aubry
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland.
| | - Luigi Raio
- Department of Obstetrics and Gynecology. Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Oelhafen
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland
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96
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Azeez TA, Abo-Briggs T, Adeyanju AS. A systematic review and meta-analysis of the prevalence and determinants of gestational diabetes mellitus in Nigeria. Indian J Endocrinol Metab 2021; 25:182-190. [PMID: 34760670 PMCID: PMC8547393 DOI: 10.4103/ijem.ijem_301_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with onset or first diagnosis in pregnancy. GDM has numerous potential complications and it is important to estimate its burden and risk factors. The objective of the meta-analysis was to determine the pooled prevalence of GDM in Nigeria and identify its determinants. METHODS The study design was a meta-analysis; therefore the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases (African Journal Online, PubMed, SCOPUS, and Google Scholar) and the gray literature were systematically searched. Statistical analysis was done with MetaXL using the random effect model. Heterogeneity was determined using the I2 statistic and the publication bias was checked with the Doi plot. RESULTS The total sample size was 46 210. The prevalence of GDM in Nigeria was 0.5 - 38% and the pooled prevalence was 11.0% (95% CI 8-13). The I2 statistic was 99%. The Doi plot suggested some degree of bias. The most frequently reported determinants of GDM were previous macrosomic babies, maternal obesity, family history of diabetes, previous miscarriage, and advanced maternal age. CONCLUSION The prevalence of GDM in Nigeria is high and efforts should be geared at modifying its risk factors so as to reduce its prevalence and prevent the associated complications.
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Affiliation(s)
| | - Tamunosaki Abo-Briggs
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
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97
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Wang W, Meng H, Liu Y, Yin W, Li Z, Wan M, Zou L, Zhang D. Effects of sleep duration and sleep quality in early pregnancy and their interaction on gestational diabetes mellitus. Sleep Breath 2021; 26:489-496. [PMID: 33929688 DOI: 10.1007/s11325-021-02391-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the association of sleep duration and quality in early pregnancy with gestational diabetes mellitus (GDM), and explore their interaction effect on GDM. METHODS Participants from 2 hospitals were enrolled in this case-control study between April 2018 and November 2020. Sleep duration and quality were measured using the Pittsburg Sleep Quality Index (PSQI). RESULTS A total of 1300 participants (396 GDM and 904 controls) were included. After adjusting for potential confounders, higher global PSQI scores or poor sleep quality were associated with GDM with odds ratios of 1.13 (95% CI 1.07, 1.19, p < 0.001) and 1.75 (95% CI 1.29, 2.38, p < 0.001), respectively; sleep duration < 7 h, 9-9.9 h and ≥ 10 h were all associated with increased GDM with odds ratios of 4.28 (95% CI 2.51, 7.31, p < 0.001), 1.69 (95% CI 1.20, 2.39, p = 0.003), and 4.42 (95% CI 3.01, 6.50, p < 0.001), respectively. In the stratified analysis based on sleep duration, the effect of poor sleep quality on GDM in the < 7 h group (OR 5.47, 95% CI 2.57, 11.64, p < 0.001) was much stronger than that in the 7-8.9 h group (OR 1.24, 95% CI 0.81, 1.91, p = 0.327), and the p value of the interaction was 0.011. CONCLUSIONS Poor sleep quality and short or long sleep duration in early pregnancy were all associated with GDM, and an interaction effect between short sleep duration and poor sleep quality on GDM was noted.
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Affiliation(s)
- Weiye Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong, 266021, People's Republic of China
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Haozhe Meng
- Department of Biomedical Engineering, School of Mechanical and Electrical Engineering, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Yiwa Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Wei Yin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Zetong Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Mengting Wan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Linbing Zou
- Department of Obstetrics, Anhui Women and Children Health Hospital, 15 Yimin Road, Hefei, Anhui, 230001, People's Republic of China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong, 266021, People's Republic of China.
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Gortazar L, Flores-Le Roux JA, Benaiges D, Sarsanedas E, Navarro H, Payà A, Mañé L, Pedro-Botet J, Goday A. Trends in Prevalence of Diabetes among Twin Pregnancies and Perinatal Outcomes in Catalonia between 2006 and 2015: The DIAGESTCAT Study. J Clin Med 2021; 10:1937. [PMID: 33946383 PMCID: PMC8125732 DOI: 10.3390/jcm10091937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022] Open
Abstract
The aims of our study were to evaluate the trends in the prevalence of diabetes among twin pregnancies in Catalonia, Spain between 2006 and 2015, to assess the influence of diabetes on perinatal outcomes of twin gestations and to ascertain the interaction between twin pregnancies and glycaemic status. A population-based study was conducted using the Spanish Minimum Basic Data Set. Cases of gestational diabetes mellitus (GDM) and pre-existing diabetes were identified using ICD-9-CM codes. Data from 743,762 singleton and 15,956 twin deliveries between 2006 and 2015 in Catalonia was analysed. Among twin pregnancies, 1088 (6.82%) were diagnosed with GDM and 83 (0.52%) had pre-existing diabetes. The prevalence of GDM among twin pregnancies increased from 6.01% in 2006 to 8.48% in 2015 (p < 0.001) and the prevalence of pre-existing diabetes remained stable (from 0.46% to 0.27%, p = 0.416). The risk of pre-eclampsia was higher in pre-existing diabetes (15.66%, p = 0.015) and GDM (11.39%, p < 0.001) than in normoglycaemic twin pregnancies (7.55%). Pre-existing diabetes increased the risk of prematurity (69.62% vs. 51.84%, p = 0.002) and large-for-gestational-age (LGA) infants (20.9% vs. 11.6%, p = 0.001) in twin gestations. An attenuating effect on several adverse perinatal outcomes was found between twin pregnancies and the presence of GDM and pre-existing diabetes. As a result, unlike in singleton pregnancies, diabetes did not increase the risk of all perinatal outcomes in twins and the effect of pre-existing diabetes on pre-eclampsia and LGA appeared to be attenuated. In conclusion, prevalence of GDM among twin pregnancies increased over the study period. Diabetes was associated with a higher risk of pre-eclampsia, prematurity and LGA in twin gestations. However, the impact of both, pre-existing diabetes and GDM, on twin pregnancy outcomes was attenuated when compared with its impact on singleton gestations.
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Affiliation(s)
- Lucia Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (L.G.); (J.A.F.-L.R.); (H.N.); (L.M.); (J.P.-B.); (A.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Juana Antonia Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (L.G.); (J.A.F.-L.R.); (H.N.); (L.M.); (J.P.-B.); (A.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (L.G.); (J.A.F.-L.R.); (H.N.); (L.M.); (J.P.-B.); (A.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
- Consorci Sanitari de l’Alt Penedès Garraf, 08720 Vilafranca del Penedès, Spain
| | - Eugènia Sarsanedas
- Health Information Management Department, Hospital del Mar, 08003 Barcelona, Spain;
| | - Humberto Navarro
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (L.G.); (J.A.F.-L.R.); (H.N.); (L.M.); (J.P.-B.); (A.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Antonio Payà
- Department of Gynecology and Obstetrics, Hospital del Mar, 08003 Barcelona, Spain;
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (L.G.); (J.A.F.-L.R.); (H.N.); (L.M.); (J.P.-B.); (A.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (L.G.); (J.A.F.-L.R.); (H.N.); (L.M.); (J.P.-B.); (A.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
| | - Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (L.G.); (J.A.F.-L.R.); (H.N.); (L.M.); (J.P.-B.); (A.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
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Kunysz M, Mora-Janiszewska O, Darmochwał-Kolarz D. Epigenetic Modifications Associated with Exposure to Endocrine Disrupting Chemicals in Patients with Gestational Diabetes Mellitus. Int J Mol Sci 2021; 22:ijms22094693. [PMID: 33946662 PMCID: PMC8124363 DOI: 10.3390/ijms22094693] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
Gestational diabetes mellitus (GDM) remains a significant clinical and public health issue due to its increasing prevalence and the possibility for numerous short- and long-term complications. The growing incidence of GDM seems to coincide with the widespread use of endocrine disrupting chemicals (EDCs). The extensive production and common use of these substances in everyday life has resulted in constant exposure to harmful substances from the environment. That may result in epigenetic changes, which may manifest themselves also after many years and be passed on to future generations. It is important to consider the possible link between environmental exposure to endocrine disrupting chemicals (EDCs) during pregnancy, epigenetic mechanisms and an increased risk for developing gestational diabetes mellitus (GDM). This manuscript attempts to summarize data on epigenetic changes in pregnant women suffering from gestational diabetes in association with EDCs. There is a chance that epigenetic marks may serve as a tool for diagnostic, prognostic, and therapeutic measures.
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Kousta E, Kontogeorgi A, Robinson S, Johnston DG. Long-Term Metabolic Consequences in Patients with a History of Gestational Diabetes. Curr Pharm Des 2021; 26:5564-5572. [PMID: 33155900 DOI: 10.2174/1381612826666201106092423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/15/2020] [Indexed: 11/22/2022]
Abstract
Gestational diabetes mellitus is a common metabolic complication of pregnancy. Universal guidelines on gestational diabetes have been impeded by the long-term controversies on its definition and screening strategies. The prevalence of gestational diabetes is rising all over the world, is significantly influenced by ethnicity and its rise is mainly attributed to increasing maternal obesity and age. Gestational diabetes mellitus has important long-term implications, including gestational diabetes recurrence, increased risk for developing type 2 diabetes, metabolic syndrome and cardiovascular disease for the mother. Gestational diabetes mellitus may be viewed as a chronic metabolic disorder that is identified in women during gestation and may provide a unique opportunity for the early identification and primary prevention of type 2 diabetes mellitus and cardiovascular disease in these women. In this mini-review, the evolution of screening tests for gestational diabetes and guidelines are briefly described and metabolic and cardiovascular long-term consequences of women with a history of gestational diabetes are summarized. A summary of our own St. Mary's Hospital-UK Research series on long-term metabolic consequences of 368 women with a history of gestational diabetes of 3 different ethnic groups and 482 control women is also included. We found that approximately 2 years following delivery, 37% of women with a history of gestational diabetes had abnormal glucose concentrations, but, most importantly, even those who were normoglycaemic, postpartum displayed metabolic abnormalities on detailed testing. Future research needs to focus on the prevention of gestational diabetes long-term complications, but also in identification of pre-pregnancy predictors and risk reduction before conception.
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Affiliation(s)
- Eleni Kousta
- Research in Female Reproduction Postgraduate Course, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Adamantia Kontogeorgi
- Research in Female Reproduction Postgraduate Course, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Stephen Robinson
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom
| | - Desmond G Johnston
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom
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