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Sagedal LR, Vistad I, Øverby NC, Bere E, Torstveit MK, Lohne-Seiler H, Hillesund ER, Pripp A, Henriksen T. The effect of a prenatal lifestyle intervention on glucose metabolism: results of the Norwegian Fit for Delivery randomized controlled trial. BMC Pregnancy Childbirth 2017; 17:167. [PMID: 28577545 PMCID: PMC5457543 DOI: 10.1186/s12884-017-1340-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/23/2017] [Indexed: 12/03/2022] Open
Abstract
Background The effectiveness of prenatal lifestyle intervention to prevent gestational diabetes and improve maternal glucose metabolism remains to be established. The Norwegian Fit for Delivery (NFFD) randomized, controlled trial studied the effect of a combined lifestyle intervention provided to a general population, and found significantly lower gestational weight gain among intervention participants but no improvement in obstetrical outcomes or the proportion of large infants. The aim of the present study is to examine the effect of the NFFD intervention on glucose metabolism, including an assessment of the subgroups of normal-weight and overweight/obese participants. Methods Healthy, non-diabetic women expecting their first child, with pre-pregnancy body mass index (BMI) ≥19 kg/m2, age ≥ 18 years and a singleton pregnancy of ≤20 gestational-weeks were enrolled from healthcare clinics in southern Norway. Gestational weight gain was the primary endpoint. Participants (n = 606) were individually randomized to intervention (two dietary consultations and access to twice-weekly exercise groups) or control group (routine prenatal care). The effect of intervention on glucose metabolism was a secondary endpoint, measuring glucose (fasting and 2-h following 75-g glucose load), insulin, homeostatic assessment of insulin resistance (HOMA-IR) and leptin levels at gestational-week 30. Results Blood samples from 557 (91.9%) women were analyzed. For the total group, intervention resulted in reduced insulin (adj. Mean diff −0.91 mU/l, p = 0.045) and leptin levels (adj. Mean diff -207 pmol/l, p = 0.021) compared to routine care, while glucose levels were unchanged. However, the effect of intervention on both fasting and 2-h glucose was modified by pre-pregnancy BMI (interaction p = 0.030 and p = 0.039, respectively). For overweight/obese women (n = 158), intervention was associated with increased risk of at least one glucose measurement exceeding International Association of Pregnancy and Diabetes Study Group thresholds (33.7% vs. 13.9%, adj. OR 3.89, p = 0.004). Conclusions The Norwegian Fit for Delivery intervention lowered neither glucose levels nor GDM incidence, despite reductions in insulin and leptin. Prenatal combined lifestyle interventions designed for a general population may be unsuited to reduce GDM risk, particularly among overweight/obese women, who may require earlier and more targeted interventions. Trial registration ClinicalTrials.gov ID NCT01001689, registered July 2, 2009, confirmed completed October 26, 2009 (retrospectively registered).
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Affiliation(s)
- Linda R Sagedal
- Department of Obstetrics and Gynecology/Department of Research, Sørlandet Hospital, Postbox 416, 4604, Kristiansand, Norway.
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology/Department of Research, Sørlandet Hospital, Postbox 416, 4604, Kristiansand, Norway
| | - Nina C Øverby
- Department of Public Health, Sports and Nutrition, University of Agder, Postbox 422, 4604, Kristiansand, Norway
| | - Elling Bere
- Department of Public Health, Sports and Nutrition, University of Agder, Postbox 422, 4604, Kristiansand, Norway
| | - Monica K Torstveit
- Department of Public Health, Sports and Nutrition, University of Agder, Postbox 422, 4604, Kristiansand, Norway
| | - Hilde Lohne-Seiler
- Department of Public Health, Sports and Nutrition, University of Agder, Postbox 422, 4604, Kristiansand, Norway
| | - Elisabet R Hillesund
- Department of Public Health, Sports and Nutrition, University of Agder, Postbox 422, 4604, Kristiansand, Norway
| | - Are Pripp
- Department of Biostatistics and Epidemiology, Oslo University Hospital, Postbox 4950, Nydalen, 0424, Oslo, Norway
| | - Tore Henriksen
- Section of Obstetrics, Women and Children's Division, Oslo University Hospital and University of Oslo, Postbox 4950, Nydalen, 0424, Oslo, Norway
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Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes. Oncotarget 2017; 8:61048-61056. [PMID: 28977845 PMCID: PMC5617405 DOI: 10.18632/oncotarget.17824] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/05/2017] [Indexed: 01/11/2023] Open
Abstract
Pregnancies complicated by pre-gestational diabetes (PGD) are associated with a higher rate of adverse outcomes, including an increased rage of preterm delivery, pregnancy-induced hypertension, pre-eclampsia, caesarean section, perinatal mortality, stillbirth, shoulder dystocia, macrosomia, small for gestational age, large for gestational age, low birth weight, neonatal hypoglycemia, neonatal death, low Apgar score, NICU admission, jaundice and respiratory distress. In the past two decades, numerous reports have been published regarding associations between PGD and risk of adverse outcomes. However, study results are inconsistent. To provide a synopsis of the current understanding of PGD for risk of adverse pregnancy outcomes, a random-effects meta-analysis over 40 million subjects from 100 studies was performed to calculate the pooled ORs. Potential sources of heterogeneity were systematically explored by multiple strata analyses and meta-regression. Overall, PGD were significantly associated with increased risk of preterm delivery (OR=3.48), LGA (OR=3.90), perinatal mortality (OR=3.39), stillbirth (OR=3.52), pre-eclampsia (OR=3.48), caesarean section (OR=3.52), NICU admission (OR=3.92), and neonatal hypoglycemia (OR=26.62). Significant results were also observed for 7 adverse outcomes with OR range from 1.54 to 2.82, while no association was found for SGA and respiratory distress after Bonferroni correction. We found that women with T1DM had higher risks for most of adverse pregnancy outcomes compared with women with T2DM. When stratified by study design, sample size, type of diabetes, geographic region, and study quality, significant associations remains. Our findings demonstrated that PGD is a strong risk-conferring factor for adverse maternal, perinatal and neonatal outcomes.
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Feng H, Zhu WW, Yang HX, Wei YM, Wang C, Su RN, Hod M, Hadar E. Relationship between Oral Glucose Tolerance Test Characteristics and Adverse Pregnancy Outcomes among Women with Gestational Diabetes Mellitus. Chin Med J (Engl) 2017; 130:1012-1018. [PMID: 28469094 PMCID: PMC5421169 DOI: 10.4103/0366-6999.204928] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Hyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test (OGTT) results on adverse perinatal outcomes. METHODS This retrospective cohort study included data from 15 hospitals in Beijing from June 20, 2013 to November 30, 2013. Women with gestational diabetes mellitus (GDM) were categorized according to the number and distribution of abnormal OGTT values, and the characteristics of adverse pregnancy outcomes were evaluated. Chi-square test and logistic regression analysis were used to determine the associations. RESULTS In total, 14,741 pregnant women were included in the study population, 2927 (19.86%) of whom had GDM. As the number of hyperglycemic values in the OGTT increased, the risk of cesarean delivery, preterm births, large-for-gestational age (LGA), macrosomia, and neonatal complications significantly increased. Fasting hyperglycemia had clear associations with macrosomia (odds ratios [OR s]:1.84, 95% confidence intervals [CI s]: 1.39-2.42,P < 0.001), LGA (OR: 1.70, 95% CI: 1.29-2.25,P < 0.001), and cesarean delivery (OR: 1.33, 95% CI: 1.15-1.55,P < 0.001). The associations were stronger as fasting glucose increased. GDM diagnosed by hyperglycemia at OGTT-2 h was more likely to lead to preterm birth (OR: 1.50, 95% CI: 1.11-2.03,P < 0.01). CONCLUSIONS Various characteristics of OGTTs are associated with different adverse outcomes. A careful reconsideration of GDM with hierarchical and individualized management according to OGTT characteristics is needed.
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Affiliation(s)
- Hui Feng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Wei-Wei Zhu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
- Exchange and Cooperation Division, National Institute of Hospital Administration, Beijing 100191, China
| | - Hui-Xia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Yu-Mei Wei
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Chen Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Ri-Na Su
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Tel-Aviv 6997801, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Tel-Aviv 6997801, Israel
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Villarroel C, Salinas A, López P, Kohen P, Rencoret G, Devoto L, Codner E. Pregestational type 2 diabetes and gestational diabetes exhibit different sexual steroid profiles during pregnancy. Gynecol Endocrinol 2017; 33:212-217. [PMID: 27898283 DOI: 10.1080/09513590.2016.1248933] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Higher androgen levels are observed in non-pregnant women with diabetes. Whether this hormonal profile is found during pregnancy is unknown. The aim of this study was to determine the sexual steroids levels in pregnant women with pregestational type 2 (T2D) and gestational diabetes (GD) compared to healthy control (C) pregnant women during the second half of pregnancy. A prospective study of 69 pregnant women with T2D (n = 21), GD (n = 24) and control (C, n = 24) was followed up during the second half of gestation. Clinical assessments and blood samples were collected at 26.7 (25-27.8); 34 (32-34.9) and 37.5 (37-40) weeks of gestation. Androgens, sex hormone-binding globulin (SHBG), estrogens, estradiol/testosterone (E/T) ratio, insulin, glucose, HOMA-IR, were measured. Testosterone, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) levels were higher in T2D compared with C at each sampling point during pregnancy, even after adjusting for BMI and age. Estrogens levels and estradiol/testosterone ratio were lower in T2D and GD compared with C. Hyperandrogenemia, and higher insulin resistance is observed in T2D, but not in GD during pregnancy. Decreased estrogen and E/T ratio found in T2D and GD suggests a diminished aromatase activity during gestation. T2D and GD are associated with specific changes in sexual steroids and insulin resistance levels during pregnancy.
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Affiliation(s)
- Claudio Villarroel
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| | - Abril Salinas
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| | - Patricia López
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
- b Hospital Clínico San Borja Arriarán, Servicio de Salud Centro, Ministerio de Salud , Santa Rosa 1234, Santiago , Chile , and
| | - Paulina Kohen
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| | - Gustavo Rencoret
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
- c School of Medicine, University of Chile , Independencia 1027, Santiago , Chile
| | - Luigi Devoto
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| | - Ethel Codner
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
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Jamilian M, Samimi M, Ebrahimi FA, Hashemi T, Taghizadeh M, Razavi M, Sanami M, Asemi Z. The effects of vitamin D and omega-3 fatty acid co-supplementation on glycemic control and lipid concentrations in patients with gestational diabetes. J Clin Lipidol 2017; 11:459-468. [PMID: 28502503 DOI: 10.1016/j.jacl.2017.01.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study was performed to evaluate the effects of vitamin D and omega-3 fatty acids co-supplementation on glucose metabolism and lipid concentrations in gestational diabetes (GDM) patients. METHODS This randomized double-blind placebo-controlled clinical trial was done among 140 GDM patients. Participants were randomly divided into 4 groups to receive: (1) 1000 mg omega-3 fatty acids containing 360 mg eicosapentaenoic acid and 240 mg docosahexaenoic acid (DHA) twice a day + vitamin D placebo (n = 35); (2) 50,000 IU vitamin D every 2 weeks + omega-3 fatty acids placebo (n = 35); (3) 50,000 IU vitamin D every 2 weeks + 1000 mg omega-3 fatty acids twice a day (n = 35), and (4) vitamin D placebo + omega-3 fatty acids placebo (n = 35) for 6 weeks. RESULTS After 6 weeks of intervention, patients who received combined vitamin D and omega-3 fatty acids supplements compared with vitamin D, omega-3 fatty acids, and placebo had significantly decreased fasting plasma glucose (-7.3 ± 7.8, -6.9 ± 6.6, -4.0 ± 2.5, and +1.0 ± 11.4 mg/dL, respectively, P < .001), serum insulin levels (-1.9 ± 1.9, -1.3 ± 6.3, -0.4 ± 6.3, and +2.6 ± 6.5 μIU/mL, respectively, P = .005), homeostatic model of assessment for insulin resistance (-0.7 ± 0.6, -0.5 ± 1.4, -0.2 ± 1.5, and +0.6 ± 1.5, respectively, P < .001) and increased quantitative insulin sensitivity check index (+0.01 ± 0.01, +0.008 ± 0.02, +0.002 ± 0.02, and -0.005 ± 0.02, respectively, P = .001). In addition, changes in serum triglycerides (-8.2 ± 41.0, +7.6 ± 31.5, +3.6 ± 29.9, and +20.1 ± 29.6 mg/dL, respectively, P = .006) and very low-density lipoprotein cholesterol (-1.6 ± 8.2, +1.5 ± 6.3, +0.8 ± 6.0, and +4.0 ± 5.9 mg/dL, respectively, P = .006) in the vitamin D plus omega-3 fatty acids group were significantly different from the changes in these indicators in the vitamin D, omega-3 fatty acids, and placebo groups. CONCLUSION Overall, vitamin D and omega-3 fatty acids co-supplementation for 6 weeks among GDM patients had beneficial effects on fasting plasma glucose, serum insulin levels, homeostatic model of assessment for insulin resistance, quantitative insulin sensitivity check index, serum triglycerides, and very low-density lipoprotein cholesterol levels.
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Affiliation(s)
- Mehri Jamilian
- Endocrinology and Metabolism Research Center, Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mansooreh Samimi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Faraneh Afshar Ebrahimi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Teibeh Hashemi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Mohsen Taghizadeh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Maryamalsadat Razavi
- Department of Gynecology and Obstetrics, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Marzieh Sanami
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran.
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Singh A, Kujur A. Single-Step First Trimester Screening "Sooner the Better". J Obstet Gynaecol India 2016; 66:77-81. [PMID: 27651582 DOI: 10.1007/s13224-015-0785-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 08/30/2015] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate the role of single-step universal screening in first trimester and its effectiveness. MATERIALS AND METHODS Three thousand women attending antenatal clinic of Pt JNM Medical College, Raipur, were screened with 75 gm OGTT in their first trimester irrespective of their last meal, and those who were screened negative were again subjected to OGTT at 24-28 weeks. The women were followed throughout pregnancy till delivery. Any maternal or perinatal complications were noted. RESULT Overall incidence of GDM was 5.2 %. About 61.54 % women screened positive in first trimester. At 24-28 weeks, 38.46 % women were diagnosed with GDM. Women diagnosed in first trimester showed significantly low incidence of cesarean section rate (20.83 %), PIH (2.08 %), and macrosomia (14.44 %), in comparison to women diagnosed later in pregnancy. CONCLUSION The role of first trimester screening was found effective in reducing adverse maternal and perinatal outcomes in GDM.
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Affiliation(s)
- Abha Singh
- Department of Obstetrics & Gynaecology, Pt. J.N.M. Medical College, E-8, Shankar Nagar, Raipur, Chhattisgarh India
| | - Avinashi Kujur
- Department of Obstetrics & Gynaecology, Pt. J.N.M. Medical College, A-12, Maruti Residency, Amlidih, Raipur, Chhattisgarh India
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Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, Dunne F, Lawlor DA. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ 2016; 354:i4694. [PMID: 27624087 PMCID: PMC5021824 DOI: 10.1136/bmj.i4694] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To assess the association between maternal glucose concentrations and adverse perinatal outcomes in women without gestational or existing diabetes and to determine whether clear thresholds for identifying women at risk of perinatal outcomes can be identified. DESIGN Systematic review and meta-analysis of prospective cohort studies and control arms of randomised trials. DATA SOURCES Databases including Medline and Embase were searched up to October 2014 and combined with individual participant data from two additional birth cohorts. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies including pregnant women with oral glucose tolerance (OGTT) or challenge (OGCT) test results, with data on at least one adverse perinatal outcome. APPRAISAL AND DATA EXTRACTION Glucose test results were extracted for OGCT (50 g) and OGTT (75 g and 100 g) at fasting and one and two hour post-load timings. Data were extracted on induction of labour; caesarean and instrumental delivery; pregnancy induced hypertension; pre-eclampsia; macrosomia; large for gestational age; preterm birth; birth injury; and neonatal hypoglycaemia. Risk of bias was assessed with a modified version of the critical appraisal skills programme and quality in prognostic studies tools. RESULTS 25 reports from 23 published studies and two individual participant data cohorts were included, with up to 207 172 women (numbers varied by the test and outcome analysed in the meta-analyses). Overall most studies were judged as having a low risk of bias. There were positive linear associations with caesarean section, induction of labour, large for gestational age, macrosomia, and shoulder dystocia for all glucose exposures across the distribution of glucose concentrations. There was no clear evidence of a threshold effect. In general, associations were stronger for fasting concentration than for post-load concentration. For example, the odds ratios for large for gestational age per 1 mmol/L increase of fasting and two hour post-load glucose concentrations (after a 75 g OGTT) were 2.15 (95% confidence interval 1.60 to 2.91) and 1.20 (1.13 to 1.28), respectively. Heterogeneity was low between studies in all analyses. CONCLUSIONS This review and meta-analysis identified a large number of studies in various countries. There was a graded linear association between fasting and post-load glucose concentration across the whole glucose distribution and most adverse perinatal outcomes in women without pre-existing or gestational diabetes. The lack of a clear threshold at which risk increases means that decisions regarding thresholds for diagnosing gestational diabetes are somewhat arbitrary. Research should now investigate the clinical and cost-effectiveness of applying different glucose thresholds for diagnosis of gestational diabetes on perinatal and longer term outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013004608.
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Affiliation(s)
- Diane Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD9 6RJ, UK Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
| | - Maria Bryant
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD9 6RJ, UK Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | | | | | - Su Golder
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Fidelma Dunne
- Galway Diabetes Research Centre (GDRC) and School of Medicine, National University of Ireland, Republic of Ireland
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol BS8 2BN, UK School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Roeckner JT, Sanchez-Ramos L, Jijon-Knupp R, Kaunitz AM. Single abnormal value on 3-hour oral glucose tolerance test during pregnancy is associated with adverse maternal and neonatal outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2016; 215:287-97. [PMID: 27133007 DOI: 10.1016/j.ajog.2016.04.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE DATA The purpose of this study was to determine whether women with 1 abnormal value on 3-hour 100-g oral glucose tolerance test are at an increased risk for adverse pregnancy outcomes. STUDY Gestational diabetes mellitus is diagnosed by a 2-step method, with a 3-hour, 100-g oral glucose tolerance test that is reserved for women with an abnormal 1-hour, 50-g glucose challenge test. Although the increased maternal-fetal morbidity with gestational diabetes mellitus is well established, controversy remains about the risk that is associated with an isolated abnormal value during a 3-hour, 100-g oral glucose tolerance test. STUDY APPRAISAL AND SYNTHESIS METHODS Prospective and retrospective studies that evaluated the maternal and perinatal impact of 1 abnormal glucose value during a 3-hour, 100-g oral glucose tolerance test were identified with the use of computerized databases. Data were extracted and quantitative analyses were performed. RESULTS Twenty-five studies (7 prospective and 18 retrospective) that met criteria for metaanalysis included 4466 women with 1 abnormal glucose value on oral glucose tolerance test. Patients with 1 abnormal glucose value had significantly worse pregnancy outcomes compared with women with zero abnormal values with the following pooled odds ratios: macrosomia, 1.59 (95% confidence interval, 1.16-2.19); large for gestational age, 1.38 (95% confidence interval, 1.09-1.76); increased mean birthweight, 44.5 g (95% confidence interval, 8.10-80.80 g); neonatal hypoglycemia, 1.88 (95% confidence interval, 1.05-3.38); total cesarean delivery, 1.69 (95% confidence interval, 1.40-2.05); pregnancy-induced hypertension, 1.55 (95% confidence interval, 1.31-1.83), and Apgar score of <7 at 5 minutes, 6.10 (95% confidence interval, 2.65-14.02). There was also an increase in neonatal intensive care unit admission and respiratory distress syndrome. Similar results were seen that compared 1 abnormal glucose value to a population with a normal 1-hour 50-g glucose challenge test (normal glucose screen). With the exception of birthweight, outcomes of patients with 1 abnormal glucose value were similar to outcomes of patients with gestational diabetes mellitus. CONCLUSION Women with 1 abnormal value on 3-hour, 100-g oral glucose tolerance test have a significantly increased risk for poor outcomes comparable with women who have gestational diabetes mellitus.
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Imam-Fulani AO, Bamikole OK, Owoyele BV. Effects of Caffeine Administration on Brain Sodium-Potassium ATPase Activity in Healthy and Streptozotocin-Induced Diabetic Female Wistar Rats. JOURNAL OF CAFFEINE RESEARCH 2016. [DOI: 10.1089/jcr.2015.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Daly N, Carroll C, Flynn I, Harley R, Maguire PJ, Turner MJ. Evaluation of point-of-care maternal glucose measurements for the diagnosis of gestational diabetes mellitus. BJOG 2016; 124:1746-1752. [DOI: 10.1111/1471-0528.14255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- N Daly
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - C Carroll
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - I Flynn
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - R Harley
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - PJ Maguire
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - MJ Turner
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
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Abstract
Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes, with risks not only associated with more severe forms of GDM, but milder forms of GDM as well. Treatment of mild GDM with dietary intervention and insulin when necessary has proven to be effective in reducing the risks of several, but not all, adverse perinatal outcomes. Less is known about the long-term benefits of mild GDM treatment. This article will review the benefits of mild GDM treatment, and related risk factors, on short-term and long-term maternal and neonatal/child outcomes, with an emphasis on research conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
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Affiliation(s)
- Madeline Murguia Rice
- George Washington University Biostatistics Center, 6110 Executive Boulevard, Suite 750, Rockville, MD 20852.
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Hildén K, Hanson U, Persson M, Fadl H. Overweight and obesity: a remaining problem in women treated for severe gestational diabetes. Diabet Med 2016; 33:1045-51. [PMID: 27172974 PMCID: PMC5089567 DOI: 10.1111/dme.13156] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 01/21/2023]
Abstract
AIM To analyse the impact of overweight and obesity on the risk of adverse maternal outcomes and fetal macrosomia in pregnancies of women treated for severe gestational diabetes. METHODS This was a population-based cohort study including all singleton pregnancies in Sweden without pre-existing diabetes in the period 1998-2012. Only mothers with an early- pregnancy BMI of ≥ 18.5 kg/m² were included. Logistic regression analysis was used to determine odds ratios with 95% CIs for maternal outcomes and fetal growth. Analyses were stratified by maternal gestational diabetes/non-gestational diabetes to investigate the impact of overweight/obesity in each group. RESULTS Of 1 249 908 singleton births, 13 057 were diagnosed with gestational diabetes (1.0%). Overweight/obesity had the same impact on the risks of caesarean section and fetal macrosomia in pregnancies with and without gestational diabetes, but the impact of maternal BMI on the risk of preeclampsia was less pronounced in women with gestational diabetes. Normal-weight women with gestational diabetes had an increased risk of caesarean section [odds ratio 1.26 (95% CI 1.16-1.37)], preeclampsia [odds ratio 2.03 (95% CI 1.71-2.41)] and large-for-gestational-age infants [odds ratio 2.25 (95% CI 2.06-2.46)]. Risks were similar in the overweight group without gestational diabetes, caesarean section [odds ratio 1.34 (1.33-1.36)], preeclampsia odds ratio [1.76 (95% CI 1.72-1.81)], large-for-gestational-age [odds ratio 1.76 (95% CI 1.74-1.79)]. CONCLUSIONS Maternal overweight and obesity is associated with similar increments in risks of adverse maternal outcomes and delivery of large-for-gestational-age infants in women with and without gestational diabetes. Obese women with gestational diabetes are defined as a high-risk group. Normal-weight women with gestational diabetes have similar risks of adverse outcomes to overweight women without gestational diabetes.
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Affiliation(s)
- K Hildén
- Department of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - U Hanson
- Department of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Persson
- Department of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - H Fadl
- Department of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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63
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Berger H, Gagnon R, Sermer M. Archivée: Le diabète pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:680-694.e2. [DOI: 10.1016/j.jogc.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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64
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Temming LA, Tuuli MG, Stout MJ, Macones GA, Cahill AG. Maternal and Perinatal Outcomes in Women with Insulin Resistance. Am J Perinatol 2016; 33:776-80. [PMID: 26906185 PMCID: PMC4919204 DOI: 10.1055/s-0036-1572434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective This study aims to estimate the risks of adverse maternal and perinatal outcomes in women with insulin resistance below the threshold of gestational diabetes mellitus (GDM). Methods This was a retrospective cohort study of 5,983 women with singleton pregnancies undergoing universal GDM screening between 24 and 28 weeks gestation. Subjects were divided into those with a normal 1-hour glucose challenge test (GCT), those with an elevated GCT with all normal values on a 3-hour glucose tolerance test (GTT), and those with an elevated GCT with one abnormal value on GTT. Outcomes included macrosomia, pregnancy-induced hypertension (PIH), cesarean section and operative delivery, shoulder dystocia, indicated-preterm birth, and other neonatal outcomes. Logistic regression was performed to compare outcomes among groups. Results The risk of macrosomia was increased for those with an elevated GCT and all normal values on GTT (adjusted odds ratio [aOR], 1.71; 95% confidence interval [CI]: 1.12, 1.97), and for those with an elevated GCT and one abnormal value (aOR, 2.69; 95% CI: 1.49, 4.83). Risks of PIH, cesarean section, and indicated-preterm birth were also increased in those with an elevated 1-hour GCT and no GDM. Conclusion There are increased risks of macrosomia, PIH, indicated-preterm birth, and cesarean section among those with insulin resistance even in the absence of GDM.
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Affiliation(s)
- Lorene A. Temming
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Molly J. Stout
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - George A. Macones
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
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65
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Jeffery T, Petersen R, Quinlivan J. Does cardiotocography have a role in the antenatal management of pregnancy complicated by gestational diabetes mellitus? Aust N Z J Obstet Gynaecol 2016; 56:358-63. [PMID: 27353715 DOI: 10.1111/ajo.12487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Controversy surrounds the role of fetal cardiotocography (CTG) in the antenatal management of pregnancy complicated with gestational diabetes mellitus (GDM). AIM The aim was to investigate whether antenatal CTG aids management in pregnancy complicated by GDM. MATERIALS AND METHODS A prospective audit of 1404 consecutive antenatal CTG in women diagnosed with GDM. Outcomes for all CTG were audited to determine whether CTG altered pregnancy management. RESULTS In women requiring combination therapy (diet and medication), 43 CTG were required to change management of a pregnancy. In women managed by diet alone with a secondary pregnancy complication, 161 CTG were required to change management. In women managed by diet alone with no secondary pregnancy complication, CTG did not change management. CONCLUSIONS Antenatal CTG is not recommended in women with GDM managed by diet alone with no secondary pregnancy complication. Antenatal CTG is recommended in women with GDM who require combination therapy (diet and medication). The role of CTG in women managed by diet alone with a secondary pregnancy complication should be based upon the nature of the complication.
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Affiliation(s)
- Timothy Jeffery
- Department of Obstetrics & Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Rodney Petersen
- Women's and Babies Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia.,Discipline of Obstetrics and Gynaecology, Faculty of Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Julie Quinlivan
- Department of Obstetrics & Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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66
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Sahin Ersoy G, Altun Ensari T, Subas S, Giray B, Simsek EE, Cevik O. WISP1 is a novel adipokine linked to metabolic parameters in gestational diabetes mellitus. J Matern Fetal Neonatal Med 2016; 30:942-946. [DOI: 10.1080/14767058.2016.1192118] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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67
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Berger H, Gagnon R, Sermer M, Basso M, Bos H, Brown RN, Bujold E, Cooper SL, Gagnon R, Gouin K, McLeod NL, Menticoglou SM, Mundle WR, Roggensack A, Sanderson FL, Walsh JD. Diabetes in Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:667-679.e1. [PMID: 27591352 DOI: 10.1016/j.jogc.2016.04.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This guideline reviews the evidence relating to the diagnosis and obstetrical management of diabetes in pregnancy. OUTCOMES The outcomes evaluated were short- and long-term maternal outcomes, including preeclampsia, Caesarean section, future diabetes, and other cardiovascular complications, and fetal outcomes, including congenital anomalies, stillbirth, macrosomia, birth trauma, hypoglycemia, and long-term effects. EVIDENCE Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary (MeSH terms "diabetes" and "pregnancy"). Where appropriate, results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). SUMMARY STATEMENTS Recommendations It is recognized that the use of different diagnostic thresholds for the "preferred" and "alternative" strategies could cause confusion in certain settings. Despite this, the committee has identified the importance of remaining aligned with the current Canadian Diabetes Association 2013 guidelines as being a priority. It is thus recommended that each care centre strategically align with 1 of the 2 strategies and implement protocols to ensure consistent and uniform reporting of test results.
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68
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Mulla WR. Carbohydrate Content in the GDM Diet: Two Views: View 2: Low-Carbohydrate Diets Should Remain the Initial Therapy for Gestational Diabetes. Diabetes Spectr 2016; 29:89-91. [PMID: 27182177 PMCID: PMC4865384 DOI: 10.2337/diaspect.29.2.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IN BRIEF The appropriate dietary intervention for gestational diabetes mellitus (GDM) is not clear. Traditionally, a low-carbohydrate diet has been prescribed. Recently, there has been a movement to prescribe a diet higher in nutrient-dense carbohydrate as the initial treatment for GDM. At this time, there is insufficient outcome data to support this type of diet.
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Affiliation(s)
- Wadia R Mulla
- Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA
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69
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Harper LM, Mele L, Landon MB, Carpenter MW, Ramin SM, Reddy UM, Casey B, Wapner RJ, Varner MW, Thorp JM, Sciscione A, Catalano P, Harper M, Saade G, Caritis SN, Sorokin Y, Peaceman AM, Tolosa JE. Carpenter-Coustan Compared With National Diabetes Data Group Criteria for Diagnosing Gestational Diabetes. Obstet Gynecol 2016; 127:893-898. [PMID: 27054932 PMCID: PMC4840065 DOI: 10.1097/aog.0000000000001383] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Use of Carpenter-Coustan compared with National Diabetes Data Group criteria increases the number of women diagnosed with gestational diabetes mellitus (GDM) by 30-50%, but whether treatment of this milder GDM reduces adverse outcomes is unknown. We explored the effects of the diagnostic criteria used on the benefits of GDM treatment. METHODS This was a secondary analysis of a randomized trial for treatment of mild GDM diagnosed using Carpenter-Coustan criteria. We evaluated the effect of treatment within two mutually exclusive diagnostic groups: 1) women who met the stricter National Diabetes Data Group as well as Carpenter-Coustan criteria (National Diabetes Data Group), and 2) those diagnosed by Carpenter-Coustan but not meeting National Diabetes Data Group criteria (Carpenter-Coustan only). Maternal outcomes examined were pregnancy-induced hypertension, shoulder dystocia, maternal weight gain, and cesarean delivery. Neonatal outcomes were large for gestational age, macrosomia (greater than 4,000 g), fat mass, small for gestational age, and a composite outcome of perinatal death, birth injury, hypoglycemia, hyperbilirubinemia, and hyperinsulinemia. Analysis of variance or the Breslow-Day test, as appropriate, was used to test for the interaction between diagnostic criteria and GDM treatment on the outcomes of interest. RESULTS Of 958 patients, 560 (58.5%) met National Diabetes Data Group criteria and 398 (41.5%) met Carpenter-Coustan only. Compared with untreated women, the direction of treatment effect did not differ by diagnostic criteria used and was consistent with the original trial. The P value for interaction between diagnostic criteria and treatment status was not significant for any outcome. CONCLUSION The overall beneficial treatment effect on pregnancy-induced hypertension, shoulder dystocia, cesarean delivery, and macrosomia was seen in patients diagnosed by the higher National Diabetes Data Group and by the lower thresholds of the Carpenter-Coustan criteria.
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Affiliation(s)
- Lorie M Harper
- Departments of Obstetrics and Gynecology, the University of Alabama at Birmingham, Birmingham, Alabama, The Ohio State University, Columbus, Ohio, Brown University, Providence, Rhode Island, the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, the University of Texas Southwestern Medical Center, Dallas, Texas, Columbia University, New York, New York, the University of Utah, Salt Lake City, Utah, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Drexel University, Philadelphia, Pennsylvania, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio, Wake Forest University Health Sciences, Winston-Salem, North Carolina, the University of Texas Medical Branch, Galveston, Texas; the University of Pittsburgh, Pittsburgh, Pennsylvania; Wayne State University, Detroit, Michigan, Northwestern University, Chicago, Illinois, and Oregon Health & Science University, Portland, Oregon; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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70
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Cade WT, Tinius RA, Reeds DN, Patterson BW, Cahill AG. Maternal Glucose and Fatty Acid Kinetics and Infant Birth Weight in Obese Women With Type 2 Diabetes. Diabetes 2016; 65:893-901. [PMID: 26861786 PMCID: PMC4806655 DOI: 10.2337/db15-1061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/25/2016] [Indexed: 11/13/2022]
Abstract
The objectives of this study were 1) to describe maternal glucose and lipid kinetics and 2) to examine the relationships with infant birth weight in obese women with pregestational type 2 diabetes during late pregnancy. Using stable isotope tracer methodology and mass spectrometry, maternal glucose and lipid kinetic rates during the basal condition were compared in three groups: lean women without diabetes (Lean, n = 25), obese women without diabetes (OB, n = 26), and obese women with pregestational type 2 diabetes (OB+DM, n = 28; total n = 79). Glucose and lipid kinetics during hyperinsulinemia were also measured in a subset of participants (n = 56). Relationships between maternal glucose and lipid kinetics during both conditions and infant birth weight were examined. Maternal endogenous glucose production (EGP) rate was higher in OB+DM than OB and Lean during hyperinsulinemia. Maternal insulin value at 50% palmitate Ra suppression (IC50) for palmitate suppression with insulinemia was higher in OB+DM than OB and Lean. Maternal EGP per unit insulin and plasma free fatty acid concentration during hyperinsulinemia most strongly predicted infant birth weight. Our findings suggest maternal fatty acid and glucose kinetics are altered during late pregnancy and might suggest a mechanism for higher birth weight in obese women with pregestational diabetes.
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Affiliation(s)
- W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rachel A Tinius
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Dominic N Reeds
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Bruce W Patterson
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
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71
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Tyrrell J, Richmond RC, Palmer TM, Feenstra B, Rangarajan J, Metrustry S, Cavadino A, Paternoster L, Armstrong LL, De Silva NMG, Wood AR, Horikoshi M, Geller F, Myhre R, Bradfield JP, Kreiner-Møller E, Huikari V, Painter JN, Hottenga JJ, Allard C, Berry DJ, Bouchard L, Das S, Evans DM, Hakonarson H, Hayes MG, Heikkinen J, Hofman A, Knight B, Lind PA, McCarthy MI, McMahon G, Medland SE, Melbye M, Morris AP, Nodzenski M, Reichetzeder C, Ring SM, Sebert S, Sengpiel V, Sørensen TI, Willemsen G, de Geus EJC, Martin NG, Spector TD, Power C, Järvelin MR, Bisgaard H, Grant SF, Nohr EA, Jaddoe VW, Jacobsson B, Murray JC, Hocher B, Hattersley AT, Scholtens DM, Smith GD, Hivert MF, Felix JF, Hyppönen E, Lowe WL, Frayling TM, Lawlor DA, Freathy RM. Genetic Evidence for Causal Relationships Between Maternal Obesity-Related Traits and Birth Weight. JAMA 2016; 315:1129-40. [PMID: 26978208 PMCID: PMC4811305 DOI: 10.1001/jama.2016.1975] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Neonates born to overweight or obese women are larger and at higher risk of birth complications. Many maternal obesity-related traits are observationally associated with birth weight, but the causal nature of these associations is uncertain. OBJECTIVE To test for genetic evidence of causal associations of maternal body mass index (BMI) and related traits with birth weight. DESIGN, SETTING, AND PARTICIPANTS Mendelian randomization to test whether maternal BMI and obesity-related traits are potentially causally related to offspring birth weight. Data from 30,487 women in 18 studies were analyzed. Participants were of European ancestry from population- or community-based studies in Europe, North America, or Australia and were part of the Early Growth Genetics Consortium. Live, term, singleton offspring born between 1929 and 2013 were included. EXPOSURES Genetic scores for BMI, fasting glucose level, type 2 diabetes, systolic blood pressure (SBP), triglyceride level, high-density lipoprotein cholesterol (HDL-C) level, vitamin D status, and adiponectin level. MAIN OUTCOME AND MEASURE Offspring birth weight from 18 studies. RESULTS Among the 30,487 newborns the mean birth weight in the various cohorts ranged from 3325 g to 3679 g. The maternal genetic score for BMI was associated with a 2-g (95% CI, 0 to 3 g) higher offspring birth weight per maternal BMI-raising allele (P = .008). The maternal genetic scores for fasting glucose and SBP were also associated with birth weight with effect sizes of 8 g (95% CI, 6 to 10 g) per glucose-raising allele (P = 7 × 10(-14)) and -4 g (95% CI, -6 to -2 g) per SBP-raising allele (P = 1×10(-5)), respectively. A 1-SD ( ≈ 4 points) genetically higher maternal BMI was associated with a 55-g higher offspring birth weight (95% CI, 17 to 93 g). A 1-SD ( ≈ 7.2 mg/dL) genetically higher maternal fasting glucose concentration was associated with 114-g higher offspring birth weight (95% CI, 80 to 147 g). However, a 1-SD ( ≈ 10 mm Hg) genetically higher maternal SBP was associated with a 208-g lower offspring birth weight (95% CI, -394 to -21 g). For BMI and fasting glucose, genetic associations were consistent with the observational associations, but for systolic blood pressure, the genetic and observational associations were in opposite directions. CONCLUSIONS AND RELEVANCE In this mendelian randomization study, genetically elevated maternal BMI and blood glucose levels were potentially causally associated with higher offspring birth weight, whereas genetically elevated maternal SBP was potentially causally related to lower birth weight. If replicated, these findings may have implications for counseling and managing pregnancies to avoid adverse weight-related birth outcomes.
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Affiliation(s)
- Jessica Tyrrell
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
- European Centre for Environment and Human Health, University of Exeter, The Knowledge Spa, Truro, TR1 3HD
| | - Rebecca C. Richmond
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Tom M. Palmer
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Janani Rangarajan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Sarah Metrustry
- Department of Twin Research, King’s College London, St. Thomas’ Hospital, London, UK
| | - Alana Cavadino
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Population, Policy and Practice, UCL Institute of Child Health, University College London, UK
| | - Lavinia Paternoster
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Loren L. Armstrong
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine
| | - N. Maneka G. De Silva
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Andrew R. Wood
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Momoko Horikoshi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Frank Geller
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Ronny Myhre
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Jonathan P. Bradfield
- Center for Applied Genomics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eskil Kreiner-Møller
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark & Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Denmark
| | - Ville Huikari
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Jodie N. Painter
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Herston, Qld 4029, Australia
| | - Jouke-Jan Hottenga
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Biological Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Catherine Allard
- Department of Mathematics, Universite de Sherbrooke, QC, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Diane J. Berry
- Population, Policy and Practice, UCL Institute of Child Health, University College London, UK
| | - Luigi Bouchard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- ECOGENE-21 and Lipid Clinic, Chicoutimi Hospital, Saguenay, QC, Canada
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Shikta Das
- Department of Primary Care and Public Health, Imperial College London
| | - David M. Evans
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M. Geoffrey Hayes
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine
| | - Jani Heikkinen
- FIMM Institute for Molecular Medicine Finland, Helsinki University Helsinki, FI-00014, Finland
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Bridget Knight
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Penelope A. Lind
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Herston, Qld 4029, Australia
| | - Mark I. McCarthy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - George McMahon
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Sarah E. Medland
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Herston, Qld 4029, Australia
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrew P. Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GA, UK
| | - Michael Nodzenski
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Christoph Reichetzeder
- Institute of Nutritional Science, University of Potsdam, Germany
- Center for Cardiovascular Research / Charité, Berlin, Germany
| | - Susan M. Ring
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Sylvain Sebert
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, School of Public Health, Medical Research Council-Health Protection Agency Centre for Environment and Health, Faculty of Medicine, Imperial College London, UK
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Sahgrenska University Hospital, Gothenburg, Sweden
| | - Thorkild I.A. Sørensen
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg University Hospital, Capital Region, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gonneke Willemsen
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Biological Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Eco J. C. de Geus
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Biological Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Nicholas G. Martin
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Herston, Qld 4029, Australia
| | - Tim D. Spector
- Department of Twin Research, King’s College London, St. Thomas’ Hospital, London, UK
| | - Christine Power
- Population, Policy and Practice, UCL Institute of Child Health, University College London, UK
| | - Marjo-Riitta Järvelin
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, School of Public Health, Medical Research Council-Health Protection Agency Centre for Environment and Health, Faculty of Medicine, Imperial College London, UK
- Department of Children and Young People and Families, National Institute for Health and Welfare, Aapistie 1, Box 310, FI-90101 Oulu, Finland
- Biocenter Oulu, University of Oulu,Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Kajaanintie 50, P.O.Box 20, FI-90220 Oulu, 90029 OYS, Finland
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark & Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Denmark
| | - Struan F.A. Grant
- Center for Applied Genomics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ellen A. Nohr
- Research Unit of Obstetrics & Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Vincent W. Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Bo Jacobsson
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Sahgrenska University Hospital, Gothenburg, Sweden
| | | | - Berthold Hocher
- Institute of Nutritional Science, University of Potsdam, Germany
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Andrew T. Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Denise M. Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA
- Diabetes Center, Massachussetts General Hospital, Boston, MA
- Department of Medicine, Universite de Sherbrooke, QC, Canada
| | - Janine F. Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Elina Hyppönen
- Population, Policy and Practice, UCL Institute of Child Health, University College London, UK
- Centre for Population Health Research, School of Health Sciences, and Sansom Institute, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - William L. Lowe
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine
| | - Timothy M. Frayling
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Debbie A. Lawlor
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Rachel M. Freathy
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
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72
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Assaf-Balut C, Familiar C, García de la Torre N, Rubio MA, Bordiú E, del Valle L, Lara M, Ruiz T, Ortolá A, Crespo I, Duran A, Herraiz MA, Izquierdo N, Perez N, Torrejon MJ, Runkle I, Montañez C, Calle-Pascual AL. Gestational diabetes mellitus treatment reduces obesity-induced adverse pregnancy and neonatal outcomes: the St. Carlos gestational study. BMJ Open Diabetes Res Care 2016; 4:e000314. [PMID: 28074143 PMCID: PMC5220275 DOI: 10.1136/bmjdrc-2016-000314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 09/23/2016] [Accepted: 10/19/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Obesity and gestational diabetes mellitus (GDM) increase the morbidity of the mother and newborn, which could increase further should they coexist. We aimed to determine the risk of adverse pregnancy and neonatal outcomes associated with excess weight (EW), and within this group identify potential differences between those with and without GDM. METHODS We carried out a post-hoc analysis of the St. Carlos Gestational Study which included 3312 pregnant women, arranged in 3 groups: normal-weight women (NWw) (2398/72.4%), overweight women (OWw) (649/19.6%) and obese women (OBw) (265/8%). OWw and OBw were grouped as EW women (EWw). We analyzed variables related to adverse pregnancy and neonatal outcomes. RESULTS The relative risk (95% CI) for GDM was 1.82 (1.47 to 2.25; p<0.0001) for OWw, and 3.26 (2.45 to 4.35; p<0.0001) in OBw. Univariate analysis showed associations of EW to higher rates of prematurity, birth weight >90th centile, newborns admitted to neonatal intensive care unit (NICU), instrumental delivery and cesarean delivery (all p<0.005). Multivariate analysis, adjusted for parity and ethnicity, showed that EW increased the risk of prematurity, admission to NICU, cesarean and instrumental delivery, especially in EWw without GDM. NWw with GDM had a significantly lower risk of admission to NICU and cesarean delivery, compared with NWw without GDM. CONCLUSIONS EW is detrimental for pregnancy and neonatal outcomes, and treatment of GDM contributes to lowering the risk in EWw and NWw. Applying the same lifestyle changes to all pregnant women, independent of their weight or GDM condition, could improve these outcomes.
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Affiliation(s)
- Carla Assaf-Balut
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Miguel A Rubio
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
| | - Elena Bordiú
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
| | - Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Miriam Lara
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Teresa Ruiz
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana Ortolá
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Irene Crespo
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandra Duran
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
| | - Miguel A Herraiz
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
- Gynecology and Obstetrics Department, Madrid, Spain
| | - Nuria Izquierdo
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
- Gynecology and Obstetrics Department, Madrid, Spain
| | - Noelia Perez
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
- Gynecology and Obstetrics Department, Madrid, Spain
| | - Maria J Torrejon
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Clinical Laboratory Department, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
| | - Carmen Montañez
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain
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73
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Huvinen E, Grotenfelt NE, Eriksson JG, Rönö K, Klemetti MM, Roine R, Pöyhönen-Alho M, Tiitinen A, Andersson S, Laivuori H, Knip M, Valkama A, Meinilä J, Kautiainen H, Stach-Lempinen B, Koivusalo SB. Heterogeneity of maternal characteristics and impact on gestational diabetes (GDM) risk-Implications for universal GDM screening? Ann Med 2016; 48:52-8. [PMID: 26745028 DOI: 10.3109/07853890.2015.1131328] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To study the incidence of gestational diabetes mellitus (GDM) in relation to phenotypic characteristics and gestational weight gain (GWG) among women at high risk for GDM. MATERIALS AND METHODS This is a secondary analysis of a GDM prevention study (RADIEL), a randomized controlled trial conducted in Finland. 269 women with a history of GDM and/or a pre-pregnancy body mass index (BMI) ≥ 30 kg/m(2) were enrolled before 20 weeks of gestation and divided into four groups according to parity, BMI and previous history of GDM. The main outcome was incidence of GDM. RESULTS There was a significant difference in incidence of GDM between the groups (p < 0.001). Women with a history of GDM and BMI <30 kg/m(2) showed the highest incidence (35.9%). At baseline they had fewer metabolic risk factors and by the second trimester they gained more weight. There was no interaction between GWG and GDM outcome and no significant difference in the prevalence of diabetes-associated antibodies. CONCLUSION Despite a healthier metabolic profile at baseline the non-obese women with a history of GDM displayed a markedly higher cumulative incidence of GDM. GWG and the presence of diabetes-associated antibodies were not associated with GDM occurrence among these high-risk women. Key message Despite a healthier metabolic profile at baseline the non-obese women with previous gestational diabetes mellitus display a markedly higher cumulative incidence of gestational diabetes mellitus.
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Affiliation(s)
- Emilia Huvinen
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | | | - Johan Gunnar Eriksson
- b Folkhälsan Research Centre, Helsinki, University of Helsinki , Helsinki , Finland ;,c Department of Chronic Disease Prevention , National Institute for Health and Welfare , Helsinki , Finland ;,d Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kristiina Rönö
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Miira Marjuska Klemetti
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,e Department of Obstetrics and Gynecology , South-Karelia Central Hospital , Lappeenranta , Finland ;,f Medical Genetics, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Risto Roine
- g Department of Health and Social Management , University of Eastern Finland , Kuopio , Finland ;,h Group Administration, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Maritta Pöyhönen-Alho
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Aila Tiitinen
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Sture Andersson
- j Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hannele Laivuori
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,f Medical Genetics, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,i Institute for Molecular Medicine Finland , Helsinki , Finland
| | - Mikael Knip
- b Folkhälsan Research Centre, Helsinki, University of Helsinki , Helsinki , Finland ;,j Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,k Research Programs Unit, Diabetes and Obesity, University of Helsinki , Helsinki , Finland ;,l Tampere Centre for Child Health Research, Tampere University Hospital , Tampere , Finland
| | - Anita Valkama
- b Folkhälsan Research Centre, Helsinki, University of Helsinki , Helsinki , Finland ;,d Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Jelena Meinilä
- d Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hannu Kautiainen
- d Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,m Department of General Practice and Primary Health Care , University of Eastern Finland , Joensuu , Finland
| | - Beata Stach-Lempinen
- e Department of Obstetrics and Gynecology , South-Karelia Central Hospital , Lappeenranta , Finland
| | - Saila Birgitta Koivusalo
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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74
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Koivusalo SB, Rönö K, Klemetti MM, Roine RP, Lindström J, Erkkola M, Kaaja RJ, Pöyhönen-Alho M, Tiitinen A, Huvinen E, Andersson S, Laivuori H, Valkama A, Meinilä J, Kautiainen H, Eriksson JG, Stach-Lempinen B. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes Care 2016. [PMID: 26223239 DOI: 10.2337/dc15-0511] [Citation(s) in RCA: 276] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether gestational diabetes mellitus (GDM) can be prevented by a moderate lifestyle intervention in pregnant women who are at high risk for the disease. RESEARCH DESIGN AND METHODS Two hundred ninety-three women with a history of GDM and/or a prepregnancy BMI of ≥30 kg/m(2) were enrolled in the study at <20 weeks of gestation and were randomly allocated to the intervention group (n = 155) or the control group (n = 138). Each subject in the intervention group received individualized counseling on diet, physical activity, and weight control from trained study nurses, and had one group meeting with a dietitian. The control group received standard antenatal care. The diagnosis of GDM was based on a 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. RESULTS A total of 269 women were included in the analyses. The incidence of GDM was 13.9% in the intervention group and 21.6% in the control group ([95% CI 0.40-0.98%]; P = 0.044, after adjustment for age, prepregnancy BMI, previous GDM status, and the number of weeks of gestation). Gestational weight gain was lower in the intervention group (-0.58 kg [95% CI -1.12 to -0.04 kg]; adjusted P = 0.037). Women in the intervention group increased their leisure time physical activity more and improved their dietary quality compared with women in the control group. CONCLUSIONS A moderate individualized lifestyle intervention reduced the incidence of GDM by 39% in high-risk pregnant women. These findings may have major health consequences for both the mother and the child.
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Affiliation(s)
- Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, and Kätilöopisto Maternity Hospital, Helsinki, Finland
| | - Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, and Kätilöopisto Maternity Hospital, Helsinki, Finland
| | - Miira M Klemetti
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland Medical Genetics and Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto P Roine
- University of Eastern Finland, Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, Kuopio, Finland Helsinki and Uusimaa Hospital District, Helsinki, Finland Kuopio University Hospital, Kuopio, Finland
| | - Jaana Lindström
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Maijaliisa Erkkola
- Division of Nutrition, Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Risto J Kaaja
- Turku University Hospital and Turku University, Turku, Finland
| | - Maritta Pöyhönen-Alho
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, Espoo, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland
| | - Emilia Huvinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, Espoo, Finland
| | - Sture Andersson
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannele Laivuori
- Medical Genetics and Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Anita Valkama
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Folkhälsan Research Centre, Helsinki, University of Helsinki, Helsinki, Finland
| | - Jelena Meinilä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Department of General Practice and Primary Health Care, University of Eastern Finland, Kuopio, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Folkhälsan Research Centre, Helsinki, University of Helsinki, Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
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75
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Hernández Núñez J, Valdés Yong M, Suñol Vázquez YDLC, López Quintana MDLC. [Maternal and perinatal risk factors for neonatal morbidity: a narrative literature review]. Medwave 2015; 15:e6182. [PMID: 26247448 DOI: 10.5867/medwave.2015.06.6182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022] Open
Abstract
Newborn diseases increase neonatal mortality rates, so a literature review was conducted to establish the risk factors related to maternal and peripartum morbidity affecting the newborn. We searched the following electronic databases: Cumed, EBSCO, LILACS, IBECS and PubMed/MEDLINE. We used specific terms and Boolean operators in Spanish, Portuguese and English. We included longitudinal and cross-sectional descriptive studies, as well as case-control and cohort studies, systematic reviews and meta-analysis, spanning from 2010 to 2015 that responded the topic of interest. The included studies show that multiple maternal and perinatal conditions are risk factors for significant increase of neonatal morbidity, which are described in this narrative review.
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Affiliation(s)
- Jónathan Hernández Núñez
- Departamento de Obstetricia y Ginecología, Hospital "Alberto Fernández Valdés", Mayabeque, Cuba. Address: Av. 9na entre 24 y 26, Zona de Desarrollo, Santa Cruz del Norte, Mayabeque, Cuba.
| | - Magel Valdés Yong
- Departamento de Obstetricia y Ginecología, Hospital "Dr. Luis Díaz Soto", La Habana, Cuba
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76
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Daly N, Stapleton M, O'Kelly R, Kinsley B, Daly S, Turner MJ. The role of preanalytical glycolysis in the diagnosis of gestational diabetes mellitus in obese women. Am J Obstet Gynecol 2015; 213:84.e1-84.e5. [PMID: 25772210 DOI: 10.1016/j.ajog.2015.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/14/2015] [Accepted: 03/10/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this prospective observational study was to determine whether the preanalytical management of maternal plasma glucose samples had a significant effect on glucose measurements in obese pregnant women. STUDY DESIGN Based on the accurate calculation of body mass index in the first trimester, obese women were recruited at their convenience. In 1 cohort, fasting glucose level was measured in early pregnancy; in the other cohort, an oral glucose tolerance test was performed at 24-28 weeks' gestation. Paired samples were taken from all women in both cohorts. The first sample was transferred to the laboratory in iced water for immediate analysis (fast-tracked analysis). The second sample was not placed on ice and transferred according to established hospital practices (hospital-tracked analysis). RESULTS Of the 24 women who had a fasting glucose test in early pregnancy, the result was abnormal (≥5.1 mmol/L) in 7 women (29%) with hospital-tracked analysis compared with 16 women (67%) with fast-tracked analysis (P < .01). The mean phlebotomy-analysis interval was 119 minutes for the hospital-tracked samples compared with 23 minutes for the fast-tracked samples (P < .001). Of the 24 women who had a glucose tolerance test, the fasting glucose level was abnormal in 4 women (17%) after hospital-tracked analysis compared with 13 women (54%) after fast-tracked analysis (P < .01). The hospital-tracked phlebotomy-analysis interval for the fasting sample of the 24-28 week oral glucose tolerance test cohort was 166 minutes compared with 25 minutes for the fast-tracked samples (P < .001). CONCLUSION Unless maternal fasting glucose samples are transported on ice and analyzed immediately in the laboratory, gestational diabetes mellitus will be underdiagnosed in obese women.
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Affiliation(s)
- Niamh Daly
- University College Dublin Centre for Human Reproduction, Dublin, Ireland.
| | - Mary Stapleton
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ruth O'Kelly
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Brendan Kinsley
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Sean Daly
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael J Turner
- University College Dublin Centre for Human Reproduction, Dublin, Ireland
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77
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Mutlu N, Esra H, Begum A, Fatma D, Arzu Y, Yalcin H, Fatih K, Selahattin K. Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome. Afr Health Sci 2015; 15:523-31. [PMID: 26124799 DOI: 10.4314/ahs.v15i2.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the relationship between maternal vitamin D status and glucose intolerance, and its impact on pregnant women and their newborns. METHODS A cohort of pregnant women were divided into three groups: women with gestational diabetes mellitus, ones with normal results both after the 50 gr and 100 gr OGTT (CG-1) and ones having a positive result after the 50 gr OGTT screening but negative results for gestational diabetes mellitus (GDM) after the 100 gr OGTT (CG-2). RESULTS The newborn length in CG-1 was greater than in GDM and CG-2 (p= 0.002 and p= 0.02). Fasting blood glucose and insulin resistance (IR) were negatively correlated with length of the newborns (r=-0.3, p=0.03 and r=-0.3, p=0.01). The newborns of women with GDM had lower APGAR-1 and 5 scores than those of CG-1 and CG-2 (APGAR-1 p= 0.001 and p= 0.004, APGAR-5 p=0.005 and p=0.007, respectively). APGAR scores were correlated negatively with IR (APGAR-1 r=-0.32, p=0.01, APGAR-5 r=-0.3, p=0.03) and positively with 25OHD levels (APGAR-1 r=0.3, p=0.01, APGAR-5 r=0.3, p=0.02). CONCLUSION Vitamin D deficiency, gestational diabetes and insulin resistance are interrelated. Severe vitamin D deficiency during pregnancy is associated with poor pregnancy and neonatal outcome.
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78
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Martin KE, Grivell RM, Yelland LN, Dodd JM. The influence of maternal BMI and gestational diabetes on pregnancy outcome. Diabetes Res Clin Pract 2015; 108:508-13. [PMID: 25796512 DOI: 10.1016/j.diabres.2014.12.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/21/2014] [Accepted: 12/28/2014] [Indexed: 01/04/2023]
Abstract
AIMS To evaluate the effect of maternal body mass index (BMI) on gestational diabetes (GDM) and the risk of adverse pregnancy outcomes in women who are overweight or obese. METHODS A prospective cohort study nested within the LIMIT randomised controlled trial. A total of 1030 women were recruited between 10 and 20 weeks' gestation, with a BMI≥25 kg/m(2), and were grouped into BMI subclasses utilising World Health Organisation criteria. Women underwent a fasting oral glucose tolerance test at 26-28 weeks' gestation, and a diagnosis of GDM was made if fasting blood glucose was ≥5.5 mmol/L or ≥7.8 mmol/L after 2h. Maternal and neonatal health outcomes were evaluated. RESULTS The prevalence of GDM increased with increasing maternal BMI (6.74% overweight vs 13.42% obese subclass 1 vs 12.79% obese subclass 2 vs 20.00% obese subclass 3). Women who were diagnosed with GDM were significantly less likely to give birth to an infant with birth weight above 4 kg (RR 0.60; 95% CI 0.36 to 1.00; p=0.05). The need for caesarean delivery (RR 1.27; 95% CI 1.07 to 1.50; p=0.006) and incidence of birth weight >90% (RR 1.38; 95% CI 1.07 to 1.77; p=0.01) was significantly increased in women who were obese, independent of GDM. CONCLUSION Increasing maternal BMI is a significant risk factor for the development of GDM, and our findings demonstrate a considerably higher prevalence than has been previously described. Raised maternal BMI is a risk factor for high infant birth weight, which may be modified by lifestyle intervention.
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Affiliation(s)
- Kate E Martin
- The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia.
| | - Rosalie M Grivell
- The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia
| | - Lisa N Yelland
- The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia
| | - Jodie M Dodd
- The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia
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79
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Vigod SN, Gomes T, Wilton AS, Taylor VH, Ray JG. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study. BMJ 2015; 350:h2298. [PMID: 25972273 PMCID: PMC4430156 DOI: 10.1136/bmj.h2298] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate maternal medical and perinatal outcomes associated with antipsychotic drug use in pregnancy. DESIGN High dimensional propensity score (HDPS) matched cohort study. SETTING Multiple linked population health administrative databases in the entire province of Ontario, Canada. PARTICIPANTS Among women who delivered a singleton infant between 2003 and 2012, and who were eligible for provincially funded drug coverage, those with ≥ 2 consecutive prescriptions for an antipsychotic medication during pregnancy, at least one of which was filled in the first or second trimester, were selected. Of these antipsychotic drug users, 1021 were matched 1:1 with 1021 non-users by means of a HDPS algorithm. MAIN OUTCOME MEASURES The main maternal medical outcomes were gestational diabetes, hypertensive disorders of pregnancy, and venous thromboembolism. The main perinatal outcomes were preterm birth (<37 weeks), and a birth weight <3rd or >97th centile. Conditional Poisson regression analysis was used to generate rate ratios and 95% confidence intervals, adjusting for additionally prescribed non-antipsychotic psychotropic medications. RESULTS Compared with non-users, women prescribed an antipsychotic medication in pregnancy did not seem to be at higher risk of gestational diabetes (rate ratio 1.10 (95% CI 0.77 to 1.57)), hypertensive disorders of pregnancy (1.12 (0.70 to 1.78)), or venous thromboembolism (0.95 (0.40 to 2.27)). The preterm birth rate, though high among antipsychotic users (14.5%) and matched non-users (14.3%), was not relatively different (rate ratio 0.99 (0.78 to 1.26)). Neither birth weight <3rd centile or >97th centile was associated with antipsychotic drug use in pregnancy (rate ratios 1.21 (0.81 to 1.82) and 1.26 (0.69 to 2.29) respectively). CONCLUSIONS Antipsychotic drug use in pregnancy had minimal evident impact on important maternal medical and short term perinatal outcomes. However, the rate of adverse outcomes is high enough to warrant careful assessment of maternal and fetal wellbeing among women prescribed an antipsychotic drug in pregnancy.
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Affiliation(s)
- Simone N Vigod
- Women's College Research Institute; Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1B2, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5 Department of Psychiatry, Women's College Hospital; University of Toronto, Toronto, Ontario
| | - Tara Gomes
- Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5
| | - Andrew S Wilton
- Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5
| | - Valerie H Taylor
- Women's College Research Institute; Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1B2, Canada Department of Psychiatry, Women's College Hospital; University of Toronto, Toronto, Ontario
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5 Departments of Medicine and Obstetrics and Gynaecology, St Michael's Hospital, University of Toronto, Toronto, Ontario M5B 1W8
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March MI, Modest AM, Ralston SJ, Hacker MR, Gupta M, Brown FM. The effect of adopting the IADPSG screening guidelines on the risk profile and outcomes of the gestational diabetes population. J Matern Fetal Neonatal Med 2015; 29:1141-5. [PMID: 25958989 PMCID: PMC4776727 DOI: 10.3109/14767058.2015.1038513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To compare characteristics and outcomes of women diagnosed with gestational diabetes mellitus (GDM) by the newer one-step glucose tolerance test and those diagnosed with the traditional two-step method. Research design and methods: This was a retrospective cohort study of women with GDM who delivered in 2010–2011. Data are reported as proportion or median (interquartile range) and were compared using a Chi-square, Fisher's exact or Wilcoxon rank sum test based on data type. Results: Of 235 women with GDM, 55.7% were diagnosed using the two-step method and 44.3% with the one-step method. The groups had similar demographics and GDM risk factors. The two-step method group was diagnosed with GDM one week later [27.0 (24.0–29.0) weeks versus 26.0 (24.0–28.0 weeks); p = 0.13]. The groups had similar median weight gain per week before diagnosis. After diagnosis, women in the one-step method group had significantly higher median weight gain per week [0.67 pounds/week (0.31–1.0) versus 0.56 pounds/week (0.15–0.89); p = 0.047]. In the one-step method group more women had suspected macrosomia (11.7% versus 5.3%, p = 0.07) and more neonates had a birth weight >4000 g (13.6% versus 7.5%, p = 0.13); however, these differences were not statistically significant. Other pregnancy and neonatal complications were similar. Conclusions: Women diagnosed with the one-step method gained more weight per week after GDM diagnosis and had a non-statistically significant increased risk for suspected macrosomia. Our data suggest the one-step method identifies women with at least equally high risk as the two-step method.
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Affiliation(s)
- Melissa I March
- a Department of Obstetrics and Gynecology and.,b Division of Maternal Fetal Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA .,c Department of Obstetrics, Gynecology and Reproductive Biology , Harvard Medical School , Boston , MA , USA
| | | | - Steven J Ralston
- a Department of Obstetrics and Gynecology and.,b Division of Maternal Fetal Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA .,c Department of Obstetrics, Gynecology and Reproductive Biology , Harvard Medical School , Boston , MA , USA
| | - Michele R Hacker
- a Department of Obstetrics and Gynecology and.,c Department of Obstetrics, Gynecology and Reproductive Biology , Harvard Medical School , Boston , MA , USA
| | - Munish Gupta
- d Department of Neonatology , Beth Israel Deaconess Medical Center , Boston , MA , USA .,e Department of Pediatrics , Harvard Medical School , Boston , MA , USA
| | - Florence M Brown
- f Department of Internal Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA .,g Joslin Diabetes Center , Boston , MA , USA , and.,h Department of Medicine , Harvard Medical School , Boston , MA , USA
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81
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Bashshur RL, Shannon GW, Smith BR, Woodward MA. The empirical evidence for the telemedicine intervention in diabetes management. Telemed J E Health 2015; 21:321-54. [PMID: 25806910 PMCID: PMC4432488 DOI: 10.1089/tmj.2015.0029] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and diabetic retinopathy. The impetus derives from the confluence of high prevalence of these diseases, increasing incidence, and rising costs, while telemedicine promises to ameliorate, if not prevent, type 2 diabetes and its complications. MATERIALS AND METHODS A purposeful review of the literature identified relevant publications from January 2005 to December 2013. These were culled to retain only credible research articles for detailed review and analysis. The search yielded approximately 17,000 articles with no date constraints. Of these, 770 appeared to be research articles within our time frame. A review of the abstracts yielded 73 articles that met the criteria for inclusion in the final analysis. Evidence is organized by research findings regarding feasibility/acceptance, intermediate outcomes (e.g., use of service, and screening compliance), and health outcomes (control of glycemic level, lipids, body weight, and physical activity.) RESULTS Definitions of telediabetes varied from study to study vis-à-vis diabetes subtype, setting, technology, staffing, duration, frequency, and target population. Outcome measures also varied. Despite these vagaries, sufficient evidence was obtained from a wide variety of research studies, consistently pointing to positive effects of telemonitoring and telescreening in terms of glycemic control, reduced body weight, and increased physical exercise. The major contributions point to telemedicine's potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated. CONCLUSIONS Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2 and gestational diabetes as well as effective screening and monitoring of diabetic retinopathy.
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Affiliation(s)
- Rashid L. Bashshur
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary W. Shannon
- Department of Geography, University of Kentucky, Lexington, Kentucky
| | - Brian R. Smith
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Maria A. Woodward
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Son KH, Lim NK, Lee JW, Cho MC, Park HY. Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes. Diabet Med 2015; 32:477-86. [PMID: 25472691 PMCID: PMC4407911 DOI: 10.1111/dme.12656] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. METHODS Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes. RESULTS Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups. CONCLUSIONS The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications.
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Affiliation(s)
- K H Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Centre, Gachon UniversityIncheon, Korea
| | - N-K Lim
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
| | - J-W Lee
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
| | - M-C Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National UniversityChungju, Korea
| | - H-Y Park
- Division of Cardiovascular and Rare Disease, Korea National Institute of HealthChungbuk, Korea
- Correspondence to: Hyun-Young Park. E-mail:
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Perinatal outcomes associated with the diagnosis of gestational diabetes made by the international association of the diabetes and pregnancy study groups criteria. Obstet Gynecol 2015; 124:571-578. [PMID: 25162258 DOI: 10.1097/aog.0000000000000412] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess perinatal outcomes with Carpenter-Coustan criteria for gestational diabetes mellitus (GDM), those with normal glucose testing, and those who would be added to GDM by The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODS This was a retrospective cohort study of women who underwent screening and diagnostic testing for GDM. Patients were divided into nonoverlapping groups: GDM by Carpenter-Coustan (Carpenter-Coustan), IADPSG GDM criteria but not Carpenter-Coustan (IADPSG), and normal GDM screening or testing (control). Outcomes included newborn birth weight, birth weight z-score, Ponderal Index, and large for gestational age. Data were analyzed with one-way analysis of variance, t tests, or χ. RESULTS There were 8,390 women who met inclusion criteria: 338 Carpenter-Coustan; 281 IADPSG; and 7,771 women in the control group. Mean birth weight (3,411 compared with 3,240 g, P<.01), birth weight z-score (0.477 compared with 0.059, P<.01), Ponderal Index (2.79 compared with 2.73 g/cm, P=.014), and large for gestational age (19.9% compared with 8.8%, relative risk 2.25, 95% confidence interval [CI] 1.76-2.88) were higher in IADPSG compared with women in the control group. The IADPSG group had greater birth weight (3,411 compared with 3,288 g, P<.01) than Carpenter-Coustan neonates with no difference in large for gestational age (19.9% compared with 16.0%, relative risk 1.25 95% CI 0.88-1.75), Ponderal Index (2.78 compared with 2.79 g/cm, P=1), or birth weight z-score (0.477 compared with 0.330, P=.30). CONCLUSIONS Newborns of women who would be added to the diagnosis of GDM by IADPSG criteria have greater measures of fetal overgrowth than those in the control group and greater birth weight in comparison with Carpenter-Coustan GDM neonates. LEVEL OF EVIDENCE II.
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Hiersch L, Yogev Y. Management of diabetes and pregnancy – When to start and what pharmacological agent to choose? Best Pract Res Clin Obstet Gynaecol 2015; 29:225-36. [DOI: 10.1016/j.bpobgyn.2014.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 04/13/2014] [Indexed: 12/16/2022]
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Ethnic differences translate to inadequacy of high-risk screening for gestational diabetes mellitus in an Asian population: a cohort study. BMC Pregnancy Childbirth 2014; 14:345. [PMID: 25273851 PMCID: PMC4190487 DOI: 10.1186/1471-2393-14-345] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 09/23/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Universal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated. Few studies have assessed GDM screening in Asian populations and even fewer have compared Asian ethnic groups in a single multi-ethnic population. METHODS 1136 pregnant women (56.7% Chinese, 25.5% Malay and 17.8% Indian) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study were screened for GDM by 75-g oral glucose tolerance test (OGTT) at 26-28 weeks of gestation. GDM was defined using the World Health Organization (WHO) criteria. High-risk screening is based on the guidelines of the UK National Institute for Health and Clinical Excellence. RESULTS Universal screening detected significantly more cases than high-risk screening [crude OR 2.2 (95% CI 1.7-2.8)], particularly for Chinese women [crude OR = 3.5 (95% CI 2.5-5.0)]. Pre-pregnancy BMI > 30 kg/m2 (adjusted OR = 3.4, 95% CI 1.5-7.9) and previous GDM history (adjusted OR = 6.6, 95% CI 1.2-37.3) were associated with increased risk of GDM in Malay women while GDM history was the only significant risk factor for GDM in Chinese women (adjusted OR = 4.7, 95% CI 2.0-11.0). CONCLUSION Risk factors used in high-risk screening do not sufficiently predict GDM risk and failed to detect half the GDM cases in Asian women. Asian women, particularly Chinese, should be screened to avoid under-diagnosis of GDM and thereby optimize maternal and fetal outcomes.
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McIntyre HD, Colagiuri S, Roglic G, Hod M. Diagnosis of GDM: a suggested consensus. Best Pract Res Clin Obstet Gynaecol 2014; 29:194-205. [PMID: 25242583 DOI: 10.1016/j.bpobgyn.2014.04.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/13/2014] [Indexed: 01/27/2023]
Abstract
Despite recent attempts at building consensus, an internationally consistent definition of gestational diabetes mellitus (GDM) remains elusive. Within and between countries, there is disagreement between obstetric, medical, and endocrine groups as to the diagnosis and management of GDM. The current article aims to discuss the background to the controversy of GDM diagnosis and to address issues related to the detection and treatment of GDM in low-, middle-, and high-resource settings. The criteria recommended by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG), the American Diabetes Association (ADA), and the World Health Organization (WHO) are endorsed. We also wish to put into perspective the importance of GDM, both during and after pregnancy, in terms of its relationship to overall women's health.
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Affiliation(s)
- Harold David McIntyre
- University of Queensland and Mater Health Services, South Brisbane, QLD 4101, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition & Exercise, G89 Medical Foundation Building K25, Sydney Medical School, The University of Sydney, NSW 2000, Australia.
| | - Gojka Roglic
- Department of Management of Noncommunicable Chronic Diseases, World Health Organization, Geneva, Switzerland.
| | - Moshe Hod
- Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah-Tiqva 49100, Israel.
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Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: a systematic review. Diabet Med 2014; 31:319-31. [PMID: 24528230 DOI: 10.1111/dme.12357] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/05/2013] [Accepted: 10/08/2013] [Indexed: 01/22/2023]
Abstract
AIMS To assess different diagnostic thresholds for gestational diabetes on outcomes for mothers and their offspring in the absence of treatment for gestational diabetes. This information was used to inform a National Institutes of Health consensus conference on diagnosing gestational diabetes. METHODS We searched 15 electronic databases from 1995 to May 2012. Study selection was conducted independently by two reviewers. Randomized controlled trials or cohort studies were eligible if they involved women without known pre-existing diabetes mellitus and who did not undergo treatment for gestational diabetes. One reviewer extracted, and a second reviewer verified, data for accuracy. Two reviewers independently assessed methodological quality. RESULTS Thirty-eight studies were included. Three large, methodologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of Caesarean section and macrosomia. When data were examined categorically (i.e. women meeting or not meeting specific diagnostic thresholds), women with gestational diabetes across all glucose criteria had significantly more Caesarean sections, shoulder dystocia, macrosomia (except for International Association of Diabetes in Pregnancy Study Groups' criteria) and large for gestational age. Higher glucose thresholds did not consistently demonstrate greater risk for all outcomes. CONCLUSIONS Higher glucose thresholds did not consistently demonstrate greater risk, possibly because studies did not compare mutually exclusive groups of women. A pragmatic approach for diagnosis of gestational diabetes using Hyperglycemia and Adverse Pregnancy Outcome Study odds ratio 2.0 thresholds warrants further consideration until additional analysis of the data comparing mutually exclusive groups of women is provided and large randomized controlled trials investigating different diagnostic and treatment thresholds are completed.
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Affiliation(s)
- L Hartling
- Alberta Research Center for Health Evidence and the University of Alberta Evidence-Based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Rönö K, Stach-Lempinen B, Klemetti MM, Kaaja RJ, Pöyhönen-Alho M, Eriksson JG, Koivusalo SB. Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL). BMC Pregnancy Childbirth 2014; 14:70. [PMID: 24524674 PMCID: PMC3928878 DOI: 10.1186/1471-2393-14-70] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/10/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Maternal overweight, obesity and consequently the incidence of gestational diabetes are increasing rapidly worldwide. The objective of the study was to assess the efficacy and cost-effectiveness of a combined diet and physical activity intervention implemented before, during and after pregnancy in a primary health care setting for preventing gestational diabetes, later type 2 diabetes and other metabolic consequences. METHODS RADIEL is a randomized controlled multi-center intervention trial in women at high risk for diabetes (a previous history of gestational diabetes or prepregnancy BMI ≥30 kg/m2). Participants planning pregnancy or in the first half of pregnancy were parallel-group randomized into an intervention arm which received lifestyle counseling and a control arm which received usual care given at their local antenatal clinics. All participants visited a study nurse every three months before and during pregnancy, and at 6 weeks, 6 and 12 months postpartum. Measurements and laboratory tests were performed on all participants with special focus on dietary and exercise habits and metabolic markers.Of the 728 women [mean age 32.5 years (SD 4.7); median parity 1 (range 0-9)] considered to be eligible for the study 235 were non-pregnant and 493 pregnant [mean gestational age 13 (range 6 to 18) weeks] at the time of enrollment. The proportion of nulliparous women was 29.8% (n = 217). Out of all participants, 79.6% of the non-pregnant and 40.4% of the pregnant women had previous gestational diabetes and 20.4% of the non-pregnant and 59.6% of the pregnant women were recruited because of a prepregnancy BMI ≥30 kg/m2. Mean BMI at first visit was 30.1 kg/m2 (SD 6.2) in the non-pregnant and 32.7 kg/m2 (SD 5.6) in the pregnant group. DISCUSSION To our knowledge, this is the first randomized lifestyle intervention trial, which includes, besides the pregnancy period, both the prepregnancy and the postpartum period. This study design also provides an opportunity to focus upon the health of the next generation. The study is expected to produce novel information on the optimal timing and setting of interventions and for allocating resources to prevent obesity and diabetes in women of reproductive age.
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Affiliation(s)
- Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Miira M Klemetti
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Risto J Kaaja
- Satakunta Central Hospital, Pori, Finland
- University of Turku, Turku, Finland
| | - Maritta Pöyhönen-Alho
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 Helsinki, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Helsingfors Universitet, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 Helsinki, Finland
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Fong A, Serra A, Herrero T, Pan D, Ogunyemi D. Pre-gestational versus gestational diabetes: a population based study on clinical and demographic differences. J Diabetes Complications 2014; 28:29-34. [PMID: 24094665 PMCID: PMC3887473 DOI: 10.1016/j.jdiacomp.2013.08.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 12/30/2022]
Abstract
AIMS To assess the clinical and demographic differences in patients with pre-gestational diabetes mellitus (PGDM) compared to those with gestational diabetes (GDM). METHODS Using the 2001-2007 California Health Discharge Database, we identified 22,331 cases of PGDM and 147,097 cases of GDM via ICD-9-CM codes after excluding cases which were missing race or age data or with extremes of age. Data analyzed included demographics, pre-existing medical conditions, antepartum complications, and intrapartum complications. Logistic regression was used to adjust for potential confounders. RESULTS Both PGDM and GDM incidences increased during the study period. Advancing age was associated with increased prevalence of both diseases. Although Asians were found to have the highest prevalence of GDM, they, along with Caucasians, were found have the lowest prevalence of PGDM. Conditions with increased frequency in PGDM versus GDM included chronic hypertension, renal disease, thyroid dysfunction, fetal CNS malformation, fetal demise, pyelonephritis, and eclampsia. Subjects with PGDM were more likely than those with GDM to have a shoulder dystocia, failed induction of labor, or undergo cesarean delivery. CONCLUSIONS We have demonstrated clinical morbidities and demographic factors which differ in patients with PGDM compared to patients with GDM. Our findings suggest PGDM to be associated with significantly higher morbidity when compared to GDM. Our findings also suggest that races with the highest tendency for GDM during pregnancy may not necessarily have the highest tendency for PGDM outside of pregnancy.
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Affiliation(s)
- Alex Fong
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA.
| | - Allison Serra
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA
| | - Tiffany Herrero
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Deyu Pan
- Charles Drew University of Medicine and Science, Research Life Sciences Institute, Los Angeles, CA
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Youngwanichsetha S, Phumdoung S. Association between neonatal hypoglycaemia and prediabetes in postpartum women with a history of gestational diabetes. J Clin Nurs 2013; 23:2181-5. [PMID: 24372900 DOI: 10.1111/jocn.12488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To determine the association between hypoglycaemia among neonates born to mothers with gestational diabetes mellitus and their postpartum prediabetes. BACKGROUND Infants born to mothers with diabetes who experienced hyperglycaemia are more likely to develop hypoglycaemia. DESIGN A prospective-descriptive research was conducted in three tertiary hospitals in southern Thailand. METHODS One hundred and fifty matched pairs of mothers and their newborns were included in the study. Data were analysed using descriptive statistic, odds ratio, Spearman's rho correlation and binary logistic regression. RESULTS The incidence of neonatal hypoglycaemia was 42·37% and odds ratio was 0·30. The findings showed the significant association between neonatal hypoglycaemia and postpartum blood sugar levels of women with a history of gestational diabetes mellitus. CONCLUSIONS Neonatal hypoglycaemia was associated with maternal hyperglycaemia and prediabetes. RELEVANCE TO CLINICAL PRACTICE Neonatal hypoglycaemia might be used to predict prediabetes of postpartum women with a history of gestational diabetes mellitus.
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Abstract
The insulin/insulin-like growth factor (IGF) pathways and glucose metabolism act as mediators of human ovarian function and female fertility. In normal insulin action, insulin binds to its own receptors in the ovary to mediate steroidogenesis and act as a co-gonadotropin. Insulin with other factors may influence ovarian growth and cyst formation. The IGF pathway also seems to influence normal ovarian function. Insulin signaling affects reproductive function. Dysregulation of this pathway leads to altered puberty, ovulation, and fertility. Better understanding of the normal physiology and pathophysiology of insulin, IGF, and glucose effects on the human reproductive system will allow for better outcomes.
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Affiliation(s)
- Anindita Nandi
- Division of Endocrinology and Metabolism, Beth Israel Medical Center, Albert Einstein College of Medicine, 317 East 17th Street, 7th Floor, New York, NY 10003, USA
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Wang P, Lu MC, Yan YH. Abnormal glucose tolerance is associated with preterm labor and increased neonatal complications in Taiwanese women. Taiwan J Obstet Gynecol 2013; 52:479-84. [DOI: 10.1016/j.tjog.2013.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 11/25/2022] Open
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Persson M, Fadl H, Hanson U, Pasupathy D. Disproportionate body composition and neonatal outcome in offspring of mothers with and without gestational diabetes mellitus. Diabetes Care 2013; 36:3543-8. [PMID: 24159180 PMCID: PMC3816875 DOI: 10.2337/dc13-0899] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/21/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Population-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998-2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm(3)) was ≤90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0-3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes. RESULTS The risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09-1.30]) and hypoglycemia (1.23 [1.11-1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section. CONCLUSIONS The risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA.
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94
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Tsai PJS, Roberson E, Dye T. Gestational diabetes and macrosomia by race/ethnicity in Hawaii. BMC Res Notes 2013; 6:395. [PMID: 24083634 PMCID: PMC3849973 DOI: 10.1186/1756-0500-6-395] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/24/2013] [Indexed: 12/14/2022] Open
Abstract
Background Gestational diabetes (GDM) has been shown to have long-term sequelae for both the mother and infant. Women with GDM are at increased risk of macrosomia, which predisposes the infant to birth injuries. Previous studies noted increased rates of GDM in Asian and Pacific Islander (API) women; however, the rate of macrosomia in API women with GDM is unclear. The objective of this study was to examine the relationship between ethnicity, gestational diabetes (GDM), and macrosomia in Hawaii. Methods A retrospective cohort study was performed using Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS) data. Data from 2009–2011, linked with selected items from birth certificates, were used to examine GDM and macrosomia by ethnicity. SAS-callable SUDAAN 10.0 was used to generate odds ratios, point estimates and standard errors. Results Data from 4735 respondents were weighted to represent all pregnancies resulting in live births in Hawaii from 2009–2011. The overall prevalence of GDM in Hawaii was 10.9%. The highest prevalence of GDM was in Filipina (13.1%) and Hawaiian/Pacific Islander (12.1%) women. The lowest prevalence was in white women (7.4%). Hawaiian/Pacific Islander, Filipina, and other Asian women all had an increased risk of GDM compared to white women using bivariate analysis. Adjusting for obesity, age, maternal nativity, and smoking, Asian Pacific Islander (API) women, which includes Hawaiian/Pacific Islander, Filipina, and other Asian women, had a 50% increased odds of having GDM compared to white women when compared using multivariate analysis. Among women with GDM, the highest prevalence of macrosomia was in white women (14.5%) while the lowest was in Filipina (5.3%) women. Conclusions API women in Hawaii have increased rates of GDM compared to white women. Paradoxically, this elevated GDM risk in API women is not associated with an increased rate of macrosomia. This suggests the relationship between GDM and macrosomia is more complex in this population.
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Affiliation(s)
- Pai-Jong Stacy Tsai
- John A Burns School of Medicine, University of Hawaii, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA.
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Cisse O, Fajardy I, Dickes-Coopman A, Moitrot E, Montel V, Deloof S, Rousseaux J, Vieau D, Laborie C. Mild gestational hyperglycemia in rat induces fetal overgrowth and modulates placental growth factors and nutrient transporters expression. PLoS One 2013; 8:e64251. [PMID: 23691181 PMCID: PMC3653871 DOI: 10.1371/journal.pone.0064251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 04/14/2013] [Indexed: 12/30/2022] Open
Abstract
Mild gestational hyperglycemia is often associated with fetal overgrowth that can predispose the offspring to metabolic diseases later in life. We hypothesized that unfavorable intrauterine environment may compromise the development of placenta and contribute to fetal overgrowth. Therefore, we developed a rat model and investigated the effects of maternal dysglycemia on fetal growth and placental gene expression. Female rats were treated with single injection of nicotinamide plus streptozotocin (N-STZ) 1-week before mating and were studied at gestational day 21. N-STZ pregnant females displayed impaired glucose tolerance that is associated with a lower insulin secretion. Moderate hyperglycemia induced fetal overgrowth in 40% of newborns, from pregnancies with 10 to 14 pups. The incidence of macrosomia was less than 5% in the N-STZ pregnancies when the litter size exceeds 15 newborns. We found that placental mass and the labyrinthine layer were increased in macrosomic placentas. The expression of genes involved in placental development and nutrient transfer was down regulated in the N-STZ placentas of macrosomic and normosomic pups from pregnancies with 10 to 14 ones. However, we observed that lipoprotein lipase 1 (LPL1) gene expression was significantly increased in the N-STZ placentas of macrosomic pups. In pregnancies with 15 pups or more, the expression of IGFs and glucose transporter genes was also modulated in the control placentas with no additional effect in the N-STZ ones. These data suggest that placental gene expression is modulated by gestational conditions that might disrupt the fetal growth. We described here a new model of maternal glucose intolerance that results in fetal overgrowth. We proposed that over-expression of LPL1 in the placenta may contribute to the increased fetal growth in the N-STZ pregnancies. N-STZ model offers the opportunity to determinate whether these neonatal outcomes may contribute to developmental programming of metabolic diseases in adulthood.
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Affiliation(s)
- Ouma Cisse
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
| | - Isabelle Fajardy
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
- Pôle de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie, Lille, France
| | - Anne Dickes-Coopman
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
| | - Emmanuelle Moitrot
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
- Pôle de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie, Lille, France
| | - Valérie Montel
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
| | - Sylvie Deloof
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
| | - Jean Rousseaux
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
- Pôle de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie, Lille, France
| | - Didier Vieau
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
| | - Christine Laborie
- Unité Environnement Périnatal et Croissance, EA 4489, Université Lille Nord de France, Lille, France
- * E-mail:
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Reif P, Panzitt T, Moser F, Resch B, Haas J, Lang U. Short-term neonatal outcome in diabetic versus non-diabetic pregnancies complicated by non-reassuring foetal heart rate tracings. J Matern Fetal Neonatal Med 2013; 26:1500-5. [DOI: 10.3109/14767058.2013.789845] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Reece EA, Moore T. The diagnostic criteria for gestational diabetes: to change or not to change? Am J Obstet Gynecol 2013; 208:255-9. [PMID: 23123381 DOI: 10.1016/j.ajog.2012.10.887] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/22/2012] [Accepted: 10/26/2012] [Indexed: 01/21/2023]
Abstract
The different screening and diagnostic methods for gestational diabetes mellitus (GDM) currently in clinical use have led the National Institutes of Health Office of Disease Prevention to organize a consensus conference to better understand the potential ramifications of changing the current screening and diagnostic criteria in the United States vs keeping current practices in place. Research has demonstrated that even mild forms of hyperglycemia potentially pose significant adverse health consequences for pregnant women and their children. Thus, it is anticipated that lowering the diagnostic criteria for GDM will significantly reduce morbidity and health care costs in the long term. However, such a change would dramatically increase the number of women identified as having this disease and place a significantly greater burden on an already overburdened primary health care system. Although several cost-benefit analyses suggest that such a change will improve health outcomes for mothers and babies, at least 1 study found that these anticipated public health benefits will not occur unless a higher level of care is devoted to these newly diagnosed patients. There also is a distinct possibility that changing the diagnostic criteria for GDM will increase cesarean delivery rates, which might offset many of the public health gains engendered by diagnosing more women with this condition. The scientific dilemma to change or not to change, thus, requires a rigorous analysis of the scientific, economic, practice, and legal pros and cons to achieve a satisfactory answer.
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Chon SJ, Kim SY, Cho NR, Min DL, Hwang YJ, Mamura M. Association of variants in PPARγ², IGF2BP2, and KCNQ1 with a susceptibility to gestational diabetes mellitus in a Korean population. Yonsei Med J 2013; 54:352-7. [PMID: 23364967 PMCID: PMC3575978 DOI: 10.3349/ymj.2013.54.2.352] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Patients with gestational diabetes mellitus (GDM) have been reported to exhibit the same genetic susceptibility as that observed in those with type 2 diabetes mellitus (T2DM). Recent polymorphism studies have shown that several genes are related to T2DM and GDM. The aim of this study was to examine whether certain candidate genes, previously shown to be associated with T2DM, also offer a specific genetic predisposition to GDM. MATERIALS AND METHODS The current study was conducted in 136 Korean pregnant women, who gave birth at Gil Hospital, from October 2008 to May 2011. These study subjects included 95 subjects with GDM and 41 non-diabetic controls. We selected the specific genes of PPARγ², IGF2BP2, and KCNQ1 for study and amplified them using the polymerase chain reaction. This was followed by genotyping for single nucleotide polymorphisms. We then compared the genotype frequencies between patients with GDM and non-diabetic controls using the χ² test. We obtained and analyzed clinical information using Student's t-test, and statistical analyses were conducted using logistic regression with SPSS Statistics software, version 19.0. RESULTS Significant differences were observed in maternal age, body mass index, weight gain and weight at time of delivery between the groups compared. Among pregnant women, polymorphisms in PPARγ² and IGF2BP2 were shown to be highly correlated with GDM occurrence, whereas no correlation was found for KCNQ1 polymorphisms. CONCLUSION Our results indicated that genetic polymorphisms could also be of value in predicting the occurrence and diagnosis of GDM.
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Affiliation(s)
- Seung Joo Chon
- Department of Obstetrics & Gynecology, Gil Hospital, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Suk Young Kim
- Department of Obstetrics & Gynecology, Gil Hospital, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Nu Ree Cho
- Department of Obstetrics & Gynecology, Gil Hospital, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Dle Lae Min
- Department of Obstetrics & Gynecology, Gil Hospital, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Yu Jin Hwang
- Division of Biological Science, Gil Hospital, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Mizuko Mamura
- Lab of Immunology, Gil Hospital, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
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Hokkanen L, Launes J, Michelsson K. The Perinatal Adverse events and Special Trends in Cognitive Trajectory (PLASTICITY) - pre-protocol for a prospective longitudinal follow-up cohort study. F1000Res 2013; 2:50. [PMID: 24358867 PMCID: PMC3790606 DOI: 10.12688/f1000research.2-50.v1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 01/12/2023] Open
Abstract
Prospective follow-up studies on long term effects of pre- and perinatal adverse conditions in adulthood are rare. We will continue to follow the prospective cohort of initially 1196 subjects with predefined at-delivery risk factors out of 22,359 consecutive deliveries during 1971-74 at a single maternity hospital. The risk cohort and 93 controls have been followed up with a comprehensive clinical program at 5, 9, and 16 years of age and by questionnaire at the age of 30 years. Major medical events known to affect the development and growth of the brain, or cognitive functions and personality have been documented. Here we present a pre-protocol for the project, which we will call PLASTICITY, whose aim is to follow consenting subjects and controls into mid-adulthood and beyond, and to explore how the neonatal risk factors modulate neurodevelopmental and neurodegenerative processes such as learning disabilities, ADHD, aging, early onset mild cognitive impairment and even dementia. Our first focus is on the neurological and cognitive outcomes at age 40 years, using detailed neurological, neuropsychological, neuroimaging, genetic, blood chemistry and registry based methods. Results will be expected to offer information on the risk of neurological, psychiatric, metabolic and other medical consequences as well as the need for health and social services at the brink of middle age, when new degenerative phenomena are known to emerge. The evaluation at age 40 years will serve as a baseline for later aging studies. We welcome all comments and suggestions, which we will apply in finalizing details and inviting collaboration.
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Affiliation(s)
- Laura Hokkanen
- Faculty of Behavioural Sciences, Division of Cognitive and Neuropsychology, University of Helsinki, Helsinki, Finland
| | - Jyrki Launes
- Faculty of Medicine, Department of Neurology, University of Helsinki, Helsinki, 00029, Finland
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