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Abstract
The review presents some renewed data on the problem of optimal time and modes of delivery for women with various types of diabetes mellitus (DM 1 and 2, gestational diabetes). The necessity of making the universal delivery strategy algorithm for women with DM comes out of adverse outcomes high frequency, where the main cases are fetal macrosomia, fetal shoulder dystocia and perinatal mortality. Despite significant interest for this issue, there is still no common delivery tactics in the world for pregnant women with carbohydrate metabolism disorders. The main obstacle is evidence-based tests and meta-analysis insufficiency. So far, further studies are necessary to obtain high quality data concerning optimal terms and modes of delivery for women with DM.
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Affiliation(s)
- Roman Kapustin
- Department of Obstetrics, Division of Maternal-Fetal Medicine, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Olga Arzhanova
- Department of Obstetrics, Division of Maternal-Fetal Medicine, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Elena Alekseenkova
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Adrey Glotov
- Department of Genetics, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia
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Pereda J, Bove I, Pineyro MM. Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay. Front Endocrinol (Lausanne) 2020; 11:588443. [PMID: 33224106 PMCID: PMC7669744 DOI: 10.3389/fendo.2020.588443] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the risk of macrosomia in newborns from women with gestational diabetes, pregestational diabetes, overweight, and obesity in Uruguay in 2012, as well as its association with prolonged pregnancy, maternal age, multiparity, and excessive gestational weight gain (EGWG). METHODS We performed a cross-sectional study of 42,663 pregnant women. The risk of macrosomia was studied using logistic regression. RESULTS Mean maternal age was 26.7 ± 6.8 years. Pregestational overweight and obesity was present in 20.9% and 10.7% of women, respectively. There were 28.1% and 19.8% of women overweight and obese at the end of the pregnancy, respectively. Furthermore, 0.5% had pregestational diabetes and 8.5% were multiparous. Twenty two percent developed gestational diabetes and 44.9% had EGWG. The prevalence of macrosomia was 7.9%, significantly more prevalent in males (10.0% vs. 5.5%, p<0.005). Univariate analysis showed that obesity and overweight pre-pregnancy, obesity and overweight at the end of pregnancy, EGWG, pregestational diabetes, gestational diabetes, multiparity, prolonged pregnancy, and male newborn were strongly associated with macrosomia (p<0.0001). Maternal age >35 years did not increase the risk of macrosomia. After multiple logistic regression macrosomia was more likely in pre-gestational obese women (OR 1.24; CI 1.07-1.44), overweight women at the end of pregnancy (OR 1.66; CI 1.46-1.87), obese women at the end of pregnancy (OR 2.21; CI 1.90-2.58), women with EGWG (OR 1.78; CI 1.59-1.98), pregestational diabetes (OR 1.75; CI 1.15-2.69), gestational diabetes (OR 1.39; CI 1.25-1.53), prolonged pregnancy (OR 2.67; CI 2.28-3.12), multiparity (OR 1.24; CI 1.04-1.48), and male newborn (OR 1.89; CI 1.72-2.08). CONCLUSION Maternal overweight, obesity, EGWG, and gestational diabetes are prevalent in Uruguay, increasing the risk of macrosomia. Efforts to implement strategies to decrease the prevalence of overweight and obesity among women of reproductive age are essential to improve maternal and neonatal outcomes.
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Affiliation(s)
- Jimena Pereda
- Clinica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Isabel Bove
- Departamento de Ciencias Cognitivas y de la Salud, Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Maria M. Pineyro
- Clinica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- *Correspondence: Maria M. Pineyro, ; orcid.org/0000-0003-2083-7839
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Hashim M, Radwan H, Hasan H, Obaid RS, Al Ghazal H, Al Hilali M, Rayess R, Chehayber N, Mohamed HJJ, Naja F. Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort. BMC Pregnancy Childbirth 2019; 19:463. [PMID: 31795984 PMCID: PMC6892062 DOI: 10.1186/s12884-019-2621-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nutritional status of women during pregnancy has been considered an important prognostic indicator of pregnancy outcomes. Objectives To investigate the pattern of gestational weight gain (GWG) and gestational diabetes mellitus (GDM) and their risk factors among a cohort of Emirati and Arab women residing in the United Arab Emirates (UAE). A secondary objective was to investigate pre-pregnancy body mass index (BMI) and its socio-demographic correlates among study participants. Methods Data of 256 pregnant women participating in the cohort study, the Mother-Infant Study Cohort (MISC) were used in this study. Healthy pregnant mothers with no history of chronic diseases were interviewed during their third trimester in different hospitals in UAE. Data were collected using interviewer-administered multi-component questionnaires addressing maternal sociodemographic and lifestyle characteristics. Maternal weight, weight gain, and GDM were recorded from the hospital medical records. Results Among the study participants, 71.1% had inadequate GWG: 31.6% insufficient and 39.5% excessive GWG. 19.1% reported having GDM and more than half of the participants (59.4%) had a pre-pregnancy BMI ≥ 25 kg/m2. The findings of the multiple multinomial logistic regression showed that multiparous women had decreased odds of excessive gain as compared to primiparous [odds ratio (OR): 0.17; 95% CI: 0.05–0.54]. Furthermore, women with a pre-pregnancy BMI ≥ 25 kg/m2 had increased odds of excessive gain (OR: 2.23; 95%CI: 1.00–5.10) as compared to those with pre-pregnancy BMI < 25 kg/m2. Similarly, women who had a pre-pregnancy BMI ≥ 25 kg/m2 were at higher risk of having GDM (OR: 2.37; 95%CI: 1.10–5.12). As for the associations of women’s characteristics with pre-pregnancy BMI, age and regular breakfast consumption level were significant predictors of higher pre-pregnancy BMI. Conclusions This study revealed alarming prevalence rates of inadequate, mainly excessive, GWG and GDM among the MISC participants. Pre-pregnancy BMI was found a risk factor for both of these conditions (GWG and GDM). In addition, age and regular breakfast consumption were significant determinants of pre-pregnancy BMI. Healthcare providers are encouraged to counsel pregnant women to maintain normal body weight before and throughout pregnancy by advocating healthy eating and increased physical activity in order to reduce the risk of excessive weight gain and its associated complications.
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Affiliation(s)
- Mona Hashim
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hayder Hasan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Reyad Shaker Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hessa Al Ghazal
- Family Health Promotion Center, Sharjah, United Arab Emirates
| | - Marwa Al Hilali
- Al Qassimi Hospital, Ministry of Health and Prevention, Sharjah, United Arab Emirates
| | - Rana Rayess
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Noor Chehayber
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | | | - Farah Naja
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon.
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Vander Wyst KB, Vercelli ME, O’Brien KO, Cooper EM, Pressman EK, Whisner CM. A social media intervention to improve nutrition knowledge and behaviors of low income, pregnant adolescents and adult women. PLoS One 2019; 14:e0223120. [PMID: 31647852 PMCID: PMC6812786 DOI: 10.1371/journal.pone.0223120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022] Open
Abstract
Pregnant adolescents are at increased risk of adverse pregnancy outcomes compared to adult women, necessitating a need for early and comprehensive health care. This study aimed to evaluate the effectiveness of a social media intervention (i.e. weekly prenatal health messages) on improving diet quality, and health beliefs and knowledge. Participants (10 adolescents and 12 adults) completed pre-post intervention interviews, nutrition knowledge and health belief questionnaires, and 24-hour diet recalls. Participants entering pregnancy as overweight or obese were more likely to experience excessive GWG during the intervention. The adults had greater participation during the study despite high levels of social media access among both groups. Participants were able to identify sugar-sweetened foods and acknowledged the benefits of whole grains; however, overall knowledge of MyPlate Guidelines was limited. Social media-based education was well received by participants but did not result in large changes in dietary intake and knowledge. Although larger studies are needed, social media appears to have the potential to reach high-risk women.
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Affiliation(s)
- Kiley B. Vander Wyst
- College of Health Solutions, Arizona State University, Phoenix, Arizona, United States of America
| | - Megan E. Vercelli
- College of Health Solutions, Arizona State University, Phoenix, Arizona, United States of America
| | - Kimberly O. O’Brien
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Elizabeth M. Cooper
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, United States of America
- University of Rochester Medical Center Midwifery Group, Rochester, New York, United States of America
| | - Eva K. Pressman
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, United States of America
| | - Corrie M. Whisner
- College of Health Solutions, Arizona State University, Phoenix, Arizona, United States of America
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
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Fan Y, Li W, Liu H, Wang L, Zhang S, Li W, Liu H, Leng J, Shen Y, Tuomilehto J, Yu Z, Yang X, Liu M, Hu G. Effects of obesity and a history of gestational diabetes on the risk of postpartum diabetes and hyperglycemia in Chinese women: Obesity, GDM and diabetes risk. Diabetes Res Clin Pract 2019; 156:107828. [PMID: 31472162 PMCID: PMC6858564 DOI: 10.1016/j.diabres.2019.107828] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the independent or combined effects of gestational diabetes (GDM) and pre-pregnancy and postpartum BMI on the odds of postpartum diabetes and hyperglycemia. METHODS The study samples included 1263 women with prior GDM and 705 women without GDM. Postpartum 1-7 years diabetes was diagnosed by the standard oral glucose tolerance test. RESULTS The multivariable-adjusted odds ratios among women with prior GDM, compared with those without it, were 7.52 for diabetes and 2.27 for hyperglycemia. The multivariable-adjusted odds ratios at different postpartum BMI levels (<24, 24-27.9, and ≥ 28 kg/m2) were 1.00, 2.80, and 8.08 for diabetes (Ptrend < 0.001), and 1.00, 2.10, and 4.42 for hyperglycemia (Ptrend < 0.001), respectively. Women with high body fat (≥31.9%) or abdominal obesity (≥85 cm) had a 2.7-6.9-fold higher odds ratio for diabetes or hyperglycemia. Women with both obesity and prior GDM had the highest risk of diabetes or hyperglycemia compared with non-obese women without GDM. Non-obese women with prior GDM had the same risk of diabetes and hyperglycemia as non-GDM women with obesity. When using Cox regression models, the results were very close to those using logistic regression models. CONCLUSIONS Maternal prior GDM and pre-pregnancy or postpartum obesity contribute equally to postpartum diabetes and hyperglycemia risk.
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Affiliation(s)
- Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China; Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Wei Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Hongyan Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, LA, USA; Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Six People's Hospital, Shanghai, China
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Xilin Yang
- Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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de la Garza Puentes A, Martí Alemany A, Chisaguano AM, Montes Goyanes R, Castellote AI, Torres-Espínola FJ, García-Valdés L, Escudero-Marín M, Segura MT, Campoy C, López-Sabater MC. The Effect of Maternal Obesity on Breast Milk Fatty Acids and Its Association with Infant Growth and Cognition-The PREOBE Follow-Up. Nutrients 2019; 11:nu11092154. [PMID: 31505767 PMCID: PMC6770754 DOI: 10.3390/nu11092154] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 02/02/2023] Open
Abstract
This study analyzed how maternal obesity affected fatty acids (FAs) in breast milk and their association with infant growth and cognition to raise awareness about the programming effect of maternal health and to promote a healthy prenatal weight. Mother–child pairs (n = 78) were grouped per maternal pre-pregnancy body mass index (BMI): normal-weight (BMI = 18.5–24.99), overweight (BMI = 25–29.99) and obese (BMI > 30). Colostrum and mature milk FAs were determined. Infant anthropometry at 6, 18 and 36 months of age and cognition at 18 were analyzed. Mature milk exhibited lower arachidonic acid (AA) and docosahexaenoic acid (DHA), among others, than colostrum. Breast milk of non-normal weight mothers presented increased saturated FAs and n6:n3 ratio and decreased α-linolenic acid (ALA), DHA and monounsaturated FAs. Infant BMI-for-age at 6 months of age was inversely associated with colostrum n6 (e.g., AA) and n3 (e.g., DHA) FAs and positively associated with n6:n3 ratio. Depending on the maternal weight, infant cognition was positively influenced by breast milk linoleic acid, n6 PUFAs, ALA, DHA and n3 LC-PUFAs, and negatively affected by n6:n3 ratio. In conclusion, this study shows that maternal pre-pregnancy BMI can influence breast milk FAs and infant growth and cognition, endorsing the importance of a healthy weight in future generations.
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Affiliation(s)
- Andrea de la Garza Puentes
- Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
- Institut de Recerca en Nutrició i Seguretat Alimentària UB (INSA-UB), 08921 Barcelona, Spain.
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi, Spain.
| | - Adrià Martí Alemany
- Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain
| | - Aida Maribel Chisaguano
- Nutrition, Faculty of Health Sciences, University of San Francisco de Quito, 170157 Quito, Ecuador
| | - Rosa Montes Goyanes
- Food Research and Analysis Institute, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain
| | - Ana I Castellote
- Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain
- Institut de Recerca en Nutrició i Seguretat Alimentària UB (INSA-UB), 08921 Barcelona, Spain
- CIBER Physiopathology of Obesity and Nutrition CIBERobn, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Franscisco J Torres-Espínola
- Centre of Excellence for Paediatric Research EURISTIKOS, University of Granada, 18071 Granada, Spain
- Department of Paediatrics, University of Granada, 18071 Granada, Spain
| | - Luz García-Valdés
- Centre of Excellence for Paediatric Research EURISTIKOS, University of Granada, 18071 Granada, Spain
- Department of Paediatrics, University of Granada, 18071 Granada, Spain
| | - Mireia Escudero-Marín
- Centre of Excellence for Paediatric Research EURISTIKOS, University of Granada, 18071 Granada, Spain
- Department of Paediatrics, University of Granada, 18071 Granada, Spain
| | - Maria Teresa Segura
- Centre of Excellence for Paediatric Research EURISTIKOS, University of Granada, 18071 Granada, Spain
- Department of Paediatrics, University of Granada, 18071 Granada, Spain
| | - Cristina Campoy
- Centre of Excellence for Paediatric Research EURISTIKOS, University of Granada, 18071 Granada, Spain
- Department of Paediatrics, University of Granada, 18071 Granada, Spain
- CIBER Epidemiology and Public Health CIBEResp, Institute of Health Carlos III, 28029 Madrid, Spain
| | - M Carmen López-Sabater
- Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
- Institut de Recerca en Nutrició i Seguretat Alimentària UB (INSA-UB), 08921 Barcelona, Spain.
- CIBER Physiopathology of Obesity and Nutrition CIBERobn, Institute of Health Carlos III, 28029 Madrid, Spain.
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Huang A, Xiao Y, Hu H, Zhao W, Yang Q, Ma W, Wang L. Gestational Weight Gain Charts by Gestational Age and Body Mass Index for Chinese Women: A Population-Based Follow-up Study. J Epidemiol 2019; 30:345-353. [PMID: 31474675 PMCID: PMC7348073 DOI: 10.2188/jea.je20180238] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Establishment of an unbiased association between gestational weight gain (GWG) and perinatal health is urgently needed in China, which has the largest population in the world. Our study aimed to create weight-gain-for-gestational-age charts using early pregnancy body mass index (BMI) to present selected percentiles of GWG in China. Methods A population-based follow-up study was conducted based on the Maternal and Newborn Health Monitoring System, which recruited 132,835 pregnant women between October 2013 and September 2016 in 12 districts/counties of 6 provinces in China. Multilevel analyses and restricted cubic splines were performed to model the longitudinal repeated maternal weight gain measurements and obtain smoothed curves for GWG. The internal and external validation of each model was also assessed. Results To develop models of GWG, 34,288 women were included. Smoothed percentiles of GWG in the 3rd, 10th, 50th, 90th, and 97th percentiles were estimated for each week of gestation. The median figures for GWG were 15.0 kg, 14.4 kg, 13.5 kg, and 12.1 kg in underweight, normal weight, overweight, and obese women, respectively, at 40 weeks. Of all the weight measurements, more than 70% and 95% fell within the expected 1 to 2 standard deviations, respectively. To accomplish external validation of the models, 20,458 women were included. The specificities of measurements in the 5th, 10th, 15th, 25th, 75th, 85th, 90th, and 95th percentiles in four BMI categories were between 90% and 100%. Conclusions The population-based gestational weight gain Z-score charts performed well in providing guidance regarding expected gestational weight gain in Chinese women.
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Affiliation(s)
- Aiqun Huang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention
| | - Yanhui Xiao
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center
| | - Huanqing Hu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention
| | - Qi Yang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention
| | - Weixiao Ma
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention
| | - Linlin Wang
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center
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Ijäs H, Koivunen S, Raudaskoski T, Kajantie E, Gissler M, Vääräsmäki M. Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: A register-based study. PLoS One 2019; 14:e0221549. [PMID: 31465425 PMCID: PMC6715199 DOI: 10.1371/journal.pone.0221549] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/09/2019] [Indexed: 12/03/2022] Open
Abstract
AIMS Gestational diabetes (GDM) is often accompanied by maternal overweight. Our aim was to evaluate the separate and concomitant effects of GDM and maternal overweight/obesity on perinatal outcomes. METHODS We used the Finnish Medical Birth Register to identify all 24,577 women with a singleton pregnancy who delivered in 2009 in Finland and underwent an oral glucose tolerance test (OGTT). Women were divided into groups according to the result of OGTT (GDM/no GDM) and pre-pregnancy body mass index (BMI): normal weight (≤24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). Primary outcomes included macrosomia, caesarean delivery, and treatment at neonatal ward. Normal weight women without GDM constituted the reference group. RESULTS Compared to reference group, overweight or obese women without GDM had an increased risk of macrosomia [odds ratio adjusted for age, parity, smoking and socio-economic status (aOR)1.18 (95% CI 1.09-1.28) and 1.50 (95% CI 1.19-1.88)], and caesarean delivery [aORs 1.17 (95% CI 1.07-1.28) and 1.52 (95% CI 1.37-1.69)], respectively. In normal weight GDM women the risk of macrosomia [aOR 1.17 (95% CI 0.85-1.62)] and caesarean delivery [aOR 1.10 (95% CI 0.96-1.27)] was not significantly increased as compared to normal weight women without GDM. GDM increased the risk of treatment at neonatal ward in all BMI categories and maternal obesity without GDM was also a risk factor for treatment at neonatal ward. Interaction p values between BMI and GDM on these outcomes were <0.001. CONCLUSIONS Maternal overweight and obesity without GDM increased the risk of macrosomia and caesarean delivery when compared to the reference group. These risks were amplified when overweight/obesity was accompanied by GDM. Obesity without GDM was a risk factor for treatment at neonatal ward; GDM increased this risk in all BMI categories. Our results suggest that especially maternal obesity should be considered as a risk factor for adverse pregnancy outcomes and GDM further amplifies this risk.
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Affiliation(s)
- Hilkka Ijäs
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
| | - Sanna Koivunen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
| | - Tytti Raudaskoski
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mika Gissler
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
- Karolinska Institute, Stockholm, Sweden
| | - Marja Vääräsmäki
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
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Xu Q, Ge Z, Hu J, Shen S, Bi Y, Zhu D. THE ASSOCIATION OF GESTATIONAL WEIGHT GAIN AND ADVERSE PREGNANCY OUTCOMES IN WOMEN WITH GESTATIONAL DIABETES MELLITUS. Endocr Pract 2019; 25:1137-1150. [PMID: 31414907 DOI: 10.4158/ep-2019-0011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To explore the association of excessive gestational weight gain (GWG) defined by the Institute of Medicine (IOM) targets and adverse perinatal outcomes in gestational diabetes mellitus (GDM) pregnancies, and whether a modified target might be related to a lower rate of adverse perinatal outcomes for GDM. Methods: This retrospective cohort study involved 1,138 women of normal glucose tolerance (NGT) and 1,200 women with GDM. Based on the IOM target, pregnancies were classified to appropriate GWG (aGWG), inadequate GWG, and excessive GWG (eGWG). Modified GWG targets included: upper limit of IOM target minus 1 kg (IOM-1) or 2 kg (IOM-2), both upper and lower targets minus 1 kg (IOM-1-1) or 2 kg (IOM-2-2). Results: The proportions of women achieving eGWG were 26.3% in NGT and 31.2% in GDM (P = .036); in comparison, for aGWG NGT, the risks of large for gestational age (LGA) were significantly higher in eGWG NGT (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.02 to 2.13), aGWG GDM (adjusted OR 1.42; 95% CI 1.03 to 1.95), and eGWG GDM (adjusted OR 2.70; 95% CI 1.92 to 3.70). GDM pregnancies gaining aGWG based on the modified GWG targets (IOM-2, IOM-1-1, and IOM-2-2) had a lower prevalence of LGA and macrosomia delivery than that for similar pregnancies using the original IOM target (all P<.05). Conclusion: For aGWG GDM according to the IOM target, adhering to a more stringent weight control was associated with decreased adverse outcomes. A tighter IOM target might help to reduce the prevalence of adverse pregnancy outcomes. Abbreviations: aGWG = appropriate gestational weight gain; BG = blood glucose; BMI = body mass index; CI = confidence interval; eGWG = excessive gestational weight gain; GDM = gestational diabetes mellitus; GW = gestational weeks; GWG = gestational weight gain; HbA1c = hemoglobin A1c; iGWG = inadequate gestational weight gain; IOM = Institute of Medicine; LGA = large for gestational age; NGT = normal glucose tolerance; NICU = neonatal intensive care unit; OGTT = oral glucose tolerance test; OR = odds ratio; PARp = partial population attributable risks; SGA = small for gestational age.
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Can a Simple Dietary Screening in Early Pregnancy Identify Dietary Habits Associated with Gestational Diabetes? Nutrients 2019; 11:nu11081868. [PMID: 31405206 PMCID: PMC6722606 DOI: 10.3390/nu11081868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/04/2019] [Accepted: 08/09/2019] [Indexed: 12/05/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is predominantly a lifestyle disease, with diet being an important modifiable risk factor. A major obstacle for the prevention in clinical practice is the complexity of assessing diet. In a cohort of 1651 Icelandic women, this study examined whether a short 40-item dietary screening questionnaire administered in the 1st trimester could identify dietary habits associated with GDM. The dietary variables were aggregated into predefined binary factors reflecting inadequate or optimal intake and stepwise backward elimination was used to identify a reduced set of factors that best predicted GDM. Those binary factors were then aggregated into a risk score (range: 0–7), that was mostly characterised by frequent consumption of soft drinks, sweets, cookies, ice creams and processed meat. The women with poor dietary habits (score ≥ 5, n = 302), had a higher risk of GDM (RR = 1.38; 95%CI = 3, 85) compared with women with a more optimal diet (score ≤ 2, n = 407). In parallel, a pilot (n = 100) intervention was conducted among overweight and obese women examining the effect of internet-based personalized feedback on diet quality. Simple feedback was given in accordance with the answers provided in the screening questionnaire in 1st trimester. At the endpoint, the improvements in diet quality were observed by, as an example, soft drink consumption being reduced by ~1 L/week on average in the intervention group compared to the controls. Our results suggest that a simple dietary screening tool administered in the 1st trimester could identify dietary habits associated with GMD. This tool should be easy to use in a clinical setting, and with simple individualized feedback, improvements in diet may be achieved.
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Larqué E, Labayen I, Flodmark CE, Lissau I, Czernin S, Moreno LA, Pietrobelli A, Widhalm K. From conception to infancy - early risk factors for childhood obesity. Nat Rev Endocrinol 2019; 15:456-478. [PMID: 31270440 DOI: 10.1038/s41574-019-0219-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 12/25/2022]
Abstract
Maternal lifestyle during pregnancy, as well as early nutrition and the environment infants are raised in, are considered relevant factors for the prevention of childhood obesity. Several models are available for the prediction of childhood overweight and obesity, yet most have not been externally validated. Moreover, the factors considered in the models differ among studies as the outcomes manifest after birth and depend on maturation processes that vary between individuals. The current Review examines and interprets data on the early determinants of childhood obesity to provide relevant strategies for daily clinical work. We evaluate a selection of prenatal and postnatal factors associated with child adiposity. Actions to be considered for preventing childhood obesity include the promotion of healthy maternal nutrition and weight status at reproductive age and during pregnancy, as well as careful monitoring of infant growth to detect early excessive weight gain. Paediatricians and other health-care professionals should provide scientifically validated, individual nutritional advice to families to counteract excessive adiposity in children. Based on systematic reviews, original papers and scientific reports, we provide information to help with setting up public health strategies to prevent overweight and obesity in childhood.
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Affiliation(s)
- Elvira Larqué
- Department of Physiology, University of Murcia, Murcia, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD) and Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Carl-Erik Flodmark
- Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
| | - Inge Lissau
- Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
- Clinical Research Centre, University Hospital Copenhagen, Hvidovre, Denmark
| | - Sarah Czernin
- Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research Group, Universidad de Zaragoza, Zaragoza, Spain.
- Instituto Agroalimentario de Aragón (IA2) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kurt Widhalm
- Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria
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Pre-pregnancy BMI, gestational weight gain and birth outcomes in Lebanon and Qatar: Results of the MINA cohort. PLoS One 2019; 14:e0219248. [PMID: 31265481 PMCID: PMC6605672 DOI: 10.1371/journal.pone.0219248] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Accumulating evidence has highlighted the role of maternal nutritional status on fetal development, birth outcomes and child health. The Mother and Infant Nutritional Assessment (MINA) cohort is a 3-year follow-up study of pregnant women and their children in Qatar and Lebanon. This study reports on the characteristics and determinants of pre-pregnancy BMI and Gestational Weight Gain (GWG) of MINA particiants, as well as birth outcomes. A total of 272 pregnant women were recruited during their first trimester from primary healthcare centers as well as private clinics in Beirut (n = 194) and Doha (n = 147). During the first visit, data collection included pre-pregnancy weight, sociodemographic and lifestyle characteristics. The weight before delivery and neonatal outcomes were extracted from the medical records. GWG was calculated as the difference between weight before delivery and pre-pregnancy weight and was classified into insufficient, adequate, and excessive, as per the IOM criteria. Overall, 42.1% of women had a pre-pregnancy BMI≥25 Kg/m2 (58% in Qatar vs 30.8% in Lebanon, p<0.001). Only 30.2% of women had adequate GWG, while 25.7% and 44.1% of women had insufficient and excessive GWG, respectively. In the cohort 68.7% of infants had a weight adequate-for-gestational age (AGA), 6.7% were SGA and 24.6% were LGA. The proportions of LGA were higher with greater GWG (p<0.05). After adjustment, Qatari women were 3 times more likely to be overweight or obese before pregnancy while a higher education level was associated with significantly lower odds of pre-pregnancy BMI≥25 Kg/m2. Pre-pregnancy BMI≥25 Kg/m2 and regular breakfast consumption were predictors of excessive GWG (OR: 3.20, CI: 1.48–6.91; OR: 2.84, CI: 1.15–7.02, respectively). The high prevalence of pre-pregnancy overweight and excessive GWG among MINA participants underscores the need for culture-specific intervention programs to promote healthy body weight in women of childbearing age, and prevent excessive weight gain during pregnancy.
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Tabrizi R, Asemi Z, Lankarani KB, Akbari M, Khatibi SR, Naghibzadeh-Tahami A, Sanjari M, Alizadeh H, Afshari M, Khodadost M, Moosazadeh M. Gestational diabetes mellitus in association with macrosomia in Iran: a meta-analysis. J Diabetes Metab Disord 2019; 18:41-50. [PMID: 31275873 PMCID: PMC6582006 DOI: 10.1007/s40200-019-00388-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/24/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE This meta-analysis aimed to estimate the association between gestational diabetes mellitus (GDM) and occurrence of macrosomia for the first time among Iranian population. METHODS A systematic review was done of national and international databases. Lists of relevant articles were checked to increase sensitivity of the search reference. Also, access to unpublished articles and documents were accessed by negotiation with related individuals and research centers. These published epidemiological studies (cross-sectional, case-control and cohort studies) were used for comparisons to determine whether GDM was associated with macrosomia. Finally, the Mantel-Haenszel method and the fixed and random-effect models based on heterogeneity of the primary studies were used according to pool results and estimate the odds ratio of macrosomia in women with GDM. RESULTS Of 1870 articles, thirty relevant articles were eligible for the current meta-analysis. Our findings showed that 335 of 2524 women with GDM had macrosomia while only 775 of 26,592 women without GDM had macrosomia. Using random-effect model, the pooled odds ratio (OR) relation between GDM and occurrence of macrosomia was estimated as of 5.49 (95% CI: 4.27-7.04). Subgroup analysis showed no difference regarding different study designs and definitions of macrosomia. There was no evidence of publication bias based on the result of Egger's test (β = 0.1, P = 0.70). CONCLUSIONS This meta-analysis shows that GDM is directly associated with the risk of macrosomia in the Iranian population. This confirms the findings of previous studies in the wider scientific literature.
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Affiliation(s)
- Reza Tabrizi
- Health Policy Research Center, Institute of Health, Clinical Neurology Research Center, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Kamran B. Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Akbari
- Health Policy Research Center, Institute of Health, Clinical Neurology Research Center, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Seyed Reza Khatibi
- Department of Epidemiology, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Ahmad Naghibzadeh-Tahami
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mojgan Sanjari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Hosniyeh Alizadeh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahdi Afshari
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Mahmoud Khodadost
- Gastroenterology and Liver Diseases Research Center, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
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Abstract
BACKGROUND Women who had delivered a macrosomic newborn will have a higher risk to deliver another macrosomia. We aimed to examine the recurrence risk of macrosomia in the subsequent pregnancy and the implications in long-term child health. METHODS Data from the Collaborative Perinatal Project, a longitudinal birth cohort with 54,371 singleton births, were used. 401 recurrent macrosomic infants (macro-macro) and 1327 normal weight babies with a macrosomia in the last pregnancy (macro-normal) were selected to explore risk factors for recurrent macrosomia. Furthermore, 768 newly onset macrosomia with normal birthweight infant in previous pregnancies (normal-macro) were identified to examine long-term health effects of recurrent macrosomia. RESULTS The recurrent rate of macrosomia was 23.2% [95% confidence interval (CI) 21.2%, 25.2%]. White race, higher pre-pregnant body mass index (BMI), more gestational weight gain, male infant and more prior macrosomic infants were significant risk factors for recurrent macrosomia. At 4 years of age, recurrent macrosomic infants had a higher BMI (16.7 vs. 16.1 kg/m2, adjusted β: 0.36, 95% CI: 0.12, 0.60) and a higher risk of overweight and obesity (adjusted OR: 1.56, 95% CI: 1.10, 2.23) than infants with normal birthweight after a previous macrosomic sibling. There was no significant difference between recurrent macrosomia and newly onset macrosomia in child outcomes after adjustment for covariates. CONCLUSIONS Fetal macrosomia has a high recurrence rate in the following pregnancy. Higher maternal pre-pregnant BMI and gestational weight gain are still important risk factors for recurrence of macrosomia, which in turn increases the risk for childhood obesity.
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Association of trimester-specific gestational weight gain with birth weight and fetal growth in a large community-based population. Arch Gynecol Obstet 2019; 300:313-322. [PMID: 31144024 DOI: 10.1007/s00404-019-05188-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 05/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies showed that the association of gestational weight gain (GWG) with fetal birthweight and offspring developmental growth was unclear. The aim of this study is to investigate the respective effect of 1 kg of GWG during three trimesters on birthweight and offspring growth from birth to 3 years of age. METHODS We extracted the decoded information from the Maternal and Child Health Information Management System of Zhoushan Maternal and Child Health Hospital in Zhejiang, China from October 2001 to March 2015, and used multiple linear and logistic regression models. RESULTS This study included 20,232 women with a full-term singleton birth and 15,557 newborns who took regular health check-ups. Compared to that in the 2nd and 3rd trimester, 1 kg GWG increasing in the 1st trimester had the strongest positive association with higher birthweight, body weight, and height from 1 to 36 months. Their associations with BMI after birth were similar among the three trimesters. In addition, some positive dose-response effects found between quartiles of GWG in the 1st trimester and offspring body weight, as well as BMI. The 1 kg GWG in 1st trimester played the strongest role in contributing to birth weight and benefiting to body growth among children aged up to 3 years. CONCLUSION The 1 kg GWG in 1st trimester contributed more to birth weight and body development from birth to 3 years compared to the 2nd and 3rd trimesters. The possible beneficial effects of GWG in the 1st trimester on birthweight and offspring development in under/normal weight mothers are found.
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67
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Price SA, Sumithran P, Nankervis A, Permezel M, Proietto J. Preconception management of women with obesity: A systematic review. Obes Rev 2019; 20:510-526. [PMID: 30549166 DOI: 10.1111/obr.12804] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Abstract
The prevalence of women of child-bearing age with obesity continues to rise at an alarming rate. This has significant implications for both the short-term and long-term health of mother and offspring. Given the paucity of evidence-based literature in this field, the preconception management of women with obesity is highly variable both between institutions and around the world. This systematic review aims to evaluate studies that inform us about the role of preconception weight loss in the fertility and pregnancy outcomes of women with obesity. Current therapeutic interventions are discussed, with a specific focus on the suitability of weight loss interventions for women with obesity planning pregnancy. There are significant knowledge gaps in the current literature; these are discussed and areas for future research are explored.
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Affiliation(s)
- Sarah A Price
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
| | | | - Michael Permezel
- Department of Obstetrics and Gynaecology (Mercy Hospital for Women), University of Melbourne, Heidelberg, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
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Abstract
To determine the longitude lipid profiles in women with and without gestational diabetes mellitus (GDM), and to investigate the relationship between lipid disturbances in the 1st trimester and GDM.Blood samples were collected from 1283 normal pregnant women and 300 women with GDM. Serum lipids which include total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured and the TG/HDL-C ratio was calculated in the 1st, 2nd, and 3rd trimesters of pregnancy and then we got the longitudinal lipid profiles. We compared the differences of lipid profiles between patients with GDM and normal pregnant women using 2-way repeated measures analysis of variance. Also additional propensity-based subgroup analyses were performed. The logistic regression analysis was used to determine the relationship between the lipid disturbances in the 1st trimester and GDM.TG, TC, LDL-C concentrations, and TG/HDL-C ratio increased progressively throughout pregnancy; while HDL-C amounts increased from the 1st to the 2nd trimester with a slight decrease in the 3rd trimester. The GDM group showed higher TG concentrations, higher TG/HDL-C ratio, and lower HDL-C concentrations throughout pregnancy. There were no significant differences in TC and LDL-C concentrations in the 1st, 2nd, and 3rd trimesters (P > .05), between the GDM group and the control group. Logistic regression analysis showed that maternal age, prepregnancy body mass index (BMI), and TG/HDL ratio in the 1st trimester were associated with an increased risk of GDM.The lipid profile alters significantly in patients with GDM, and maternal age, prepregnancy BMI, and TG/HDL ratio in the 1st trimester were associated with an increased risk of GDM.
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Mañé L, Flores-Le Roux JA, Benaiges D, Chillarón JJ, Prados M, Pedro-Botet J, Llauradó G, Gortazar L, Payà A. Impact of overt diabetes diagnosed in pregnancy in a multi-ethnic cohort in Spain. Gynecol Endocrinol 2019; 35:332-336. [PMID: 30328728 DOI: 10.1080/09513590.2018.1521387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Overt diabetes (ODM) is defined as women without diabetes meeting the criteria for diabetes at the first antenatal visit. The risk of obstetric complications increases linearly with maternal glycemia and poorer maternal-fetal outcomes than in gestational diabetes (GDM) may be expected. Studies focusing on ODM pregnancy outcomes are lacking. We aimed to analyze maternal characteristics and pregnancy outcomes in ODM women compared with those with GDM. A retrospective cohort study of women giving birth between January 2010 and April 2013 was conducted. Participants with pre-gestational diabetes were excluded. All women underwent screening for GDM at the 24th-28th weeks of gestation or at the first prenatal visit in those with risk factors. HbA1c and a fasting glucose were measured in GDM women to rule out ODM. Of the 5,633 women included, 572 (10%) were diagnosed with GDM and 50 (0.88%) with ODM. Almost 95% of ODM women were from ethnic minorities. After adjustment for confounding factors, ODM women showed increased rates of premature birth (23.1% vs. 6.7%, p < .001), emergent cesarean section (41.0% vs. 19.5%, p = .049), preeclampsia (22% vs. 3.7%, p < .001) and large-for-gestational-age babies (40.0% vs. 14.8%, p = .008) compared with GDM. In conclusion, ODM is associated with poorer obstetric outcomes than GDM and affects mainly women from ethnic minorities.
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Affiliation(s)
- Laura Mañé
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Juana Antonia Flores-Le Roux
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - David Benaiges
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Juan José Chillarón
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Montse Prados
- c Department of Endocrinology , Hospital de Martorell , Martorell , Spain
| | - Juan Pedro-Botet
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Gemma Llauradó
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
| | - Lucía Gortazar
- a Department of Endocrinology and Nutrition , Hospital del Mar , Barcelona , Spain
| | - Antonio Payà
- b Department of Medicine , Universitat Autònoma de Barcelona, Campus del mar , Barcelona , Spain
- d Department of Gynecology and Obstetrics , Hospital del Mar , Barcelona , Spain
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Aiken CEM, Hone L, Murphy HR, Meek CL. Improving outcomes in gestational diabetes: does gestational weight gain matter? Diabet Med 2019; 36:167-176. [PMID: 29932243 DOI: 10.1111/dme.13767] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 01/24/2023]
Abstract
AIM Excessive gestational weight gain increases risk of gestational diabetes mellitus (GDM) but it remains unclear whether weight control after GDM diagnosis improves outcomes. We assessed whether: (1) total gestational weight gain during pregnancy (0-36 weeks); (2) early gestational weight gain (0-28 weeks, before GDM diagnosis); or (3) late gestational weight gain (28-36 weeks, after diagnosis) are associated with maternal-fetal outcomes. METHODS Some 546 women with GDM who delivered viable singleton infants at a single UK obstetric centre (October 2014 to March 2017) were included in this retrospective observational study. RESULTS Higher total gestational weight gain was associated with Caesarean section [n = 376; odds ratio (OR) 1.05; confidence intervals (CI) 1.02-1.08, P < 0.001] and large for gestational age (OR 1.08; CI 1.03-1.12, P < 0.001). Higher late gestational weight gain (28-36 weeks; n = 144) was associated with large for gestational age (OR 1.17; CI 1.01-1.37, P < 0.05), instrumental deliveries (OR 1.26; CI 1.03-1.55, P < 0.01), higher total daily insulin doses (36 weeks; beta coefficient 4.37; CI 1.92-6.82, P < 0.001), and higher post-partum 2-h oral glucose tolerance test concentrations (beta coefficient 0.12; CI 0.01-0.22, P < 0.05). Women who avoided substantial weight gain after GDM diagnosis had 0.7 mmol/l lower postnatal 2-h glucose and needed half the amount of insulin/day at 36 weeks compared with women with substantial weight gain after diagnosis. There were no significant associations between early gestational weight gain (0-28 weeks) and pregnancy outcomes. CONCLUSIONS These findings suggest that controlling gestational weight gain should be a priority following GDM diagnosis to optimize pregnancy outcomes and improve maternal postnatal glucose homeostasis. The period after diagnosis of GDM (often 28 weeks gestation) is not too late to offer lifestyle advice or intervention to improve weight management and pregnancy outcomes.
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Affiliation(s)
- C E M Aiken
- Department of Obstetrics, Cambridge University Hospitals, Rosie Hospital, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - L Hone
- University of Cambridge, Cambridge, UK
| | - H R Murphy
- Wolfson Diabetes and Endocrinology Clinic, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - C L Meek
- Wolfson Diabetes and Endocrinology Clinic, Cambridge, UK
- Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
- Department of Clinical Biochemistry, Cambridge University Hospitals, Cambridge, UK
- Department of Chemistry, Peterborough City Hospital, Peterborough, UK
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Silva L, Plösch T, Toledo F, Faas MM, Sobrevia L. Adenosine kinase and cardiovascular fetal programming in gestational diabetes mellitus. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165397. [PMID: 30699363 DOI: 10.1016/j.bbadis.2019.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is a detrimental condition for human pregnancy associated with endothelial dysfunction and endothelial inflammation in the fetoplacental vasculature and leads to increased cardio-metabolic risk in the offspring. In the fetoplacental vasculature, GDM is associated with altered adenosine metabolism. Adenosine is an important vasoactive molecule and is an intermediary and final product of transmethylation reactions in the cell. Adenosine kinase is the major regulator of adenosine levels. Disruption of this enzyme is associated with alterations in methylation-dependent gene expression regulation mechanisms, which are associated with the fetal programming phenomenon. Here we propose that cellular and molecular alterations associated with GDM can dysregulate adenosine kinase leading to fetal programming in the fetoplacental vasculature. This can contribute to the cardio-metabolic long-term consequences observed in offspring after exposure to GDM.
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Affiliation(s)
- Luis Silva
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), Groningen 9700 RB, the Netherlands.
| | - Torsten Plösch
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Fernando Toledo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Basic Sciences, Faculty of Sciences, Universidad del Bío-Bío, Chillán 3780000, Chile
| | - Marijke M Faas
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), Groningen 9700 RB, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, 4029, Queensland, Australia.
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Wen L, Liu X, Wang L, Zheng Y, Li J, Tong C, Qi H, Saffery R, Baker P. Correlation between second trimester weight gain and perinatal outcomes in dichorionic twin pregnancies: The LoTiS cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 233:64-69. [PMID: 30580225 DOI: 10.1016/j.ejogrb.2018.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/08/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate how second trimester gestational weight gain relates to perinatal outcomes in twin pregnancies of the LoTiS cohort in Chongqing, China. METHODS A cohort study was conducted among women with dichorionic twin pregnancies; pregnancies that culminated in delivery at ≥20 gestational weeks were included in the analysis (n = 177). Data were collected through the Longitudinal Twin Study (LoTiS). The second trimester was divided into two periods: 12-20 and 21-28 gestational weeks. Correlations between maternal weight gain and perinatal outcomes were estimated using linear or logistic regression models; the crude OR and adjusted OR were calculated. RESULTS The average total gestational weight gain for the whole pregnancy was 17.71 ± 4.98 kg and average gestational weight gains during 12-20 gestational weeks and 20-28 gestational weeks were 5.11 ± 1.81 kg and 5.84 ± 2.05 kg, respectively. Insufficient gestational weight gain was associated with higher risk of preterm birth (OR = 0.92, 95% CI 0.86-0.99) and spontaneous preterm birth (OR = 0.89, 95% CI 0.82-0.97). Reduced gestational weight gain during 12-20 gestational weeks was associated with higher risk of small for gestational age. Additionally, the mean birth weight of a twin pair increased by 45.78 g or 13.03 g when gestational weight gain during 12-20 weeks or total gestational weight gain increased by 1 kg. CONCLUSION Maternal weight gain in the early second trimester was correlated with birth weight in dichorionic twins.
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Affiliation(s)
- Li Wen
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; International Collaborative Jointed Laboratory of Maternal and Fetal Medicine, Ministry of Education, Chongqing Medical University, Chongqing 400016, China; Sate Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
| | - Xiyao Liu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; International Collaborative Jointed Laboratory of Maternal and Fetal Medicine, Ministry of Education, Chongqing Medical University, Chongqing 400016, China; Sate Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
| | - Lan Wang
- Department of Obstetrics, Chongqing Women and Children's Health Center, Chongqing 401147, China
| | - Yangxi Zheng
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; International Collaborative Jointed Laboratory of Maternal and Fetal Medicine, Ministry of Education, Chongqing Medical University, Chongqing 400016, China; Sate Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
| | - Jie Li
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; International Collaborative Jointed Laboratory of Maternal and Fetal Medicine, Ministry of Education, Chongqing Medical University, Chongqing 400016, China; Sate Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China
| | - Chao Tong
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; International Collaborative Jointed Laboratory of Maternal and Fetal Medicine, Ministry of Education, Chongqing Medical University, Chongqing 400016, China; Sate Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China.
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; International Collaborative Jointed Laboratory of Maternal and Fetal Medicine, Ministry of Education, Chongqing Medical University, Chongqing 400016, China; Sate Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing 400016, China.
| | - Richard Saffery
- Cancer, Disease and Developmental Epigenetics, Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Parkville Victoria 3052, Australia
| | - Philip Baker
- International Collaborative Jointed Laboratory of Maternal and Fetal Medicine, Ministry of Education, Chongqing Medical University, Chongqing 400016, China; College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK
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Suliga E, Rokita W, Adamczyk-Gruszka O, Pazera G, Cieśla E, Głuszek S. Factors associated with gestational weight gain: a cross-sectional survey. BMC Pregnancy Childbirth 2018; 18:465. [PMID: 30509248 PMCID: PMC6276162 DOI: 10.1186/s12884-018-2112-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/22/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The aim of this study was to describe the dietary patterns in pregnant women and determine the association between diet factors, pre-pregnancy body mass index, socio-demographic characteristics and gestational weight gain. METHODS The analysis was conducted on a group of 458 women. Cut-off values of gestational weight gain adequacy were based on recommendations published by the US Institute of Medicine and were body mass index-specific. Logistic regression analysis was used to assess the risk of the occurrence of inadequate or excessive gestational weight gain. Dietary patterns were identified by factor analysis. RESULTS Three dietary patterns characteristic of pregnant women in Poland were identified: 'unhealthy', 'varied' and 'prudent'. The factor associated with increased risk of inadequate gestational weight gain was being underweight pre-pregnancy (OR = 2.61; p = 0.018). The factor associated with increased risk of excessive weight gain were being overweight or obese pre-pregnancy (OR = 7.00; p = 0.031) and quitting smoking (OR = 7.32; p = 0.019). The risk of excessive weight gain was decreased by being underweight pre-pregnancy (OR = 0.20; p = 0.041), being in the third or subsequent pregnancy compared to being in the first (OR = 0.37; p = 0.018), and having a high adherence to a prudent dietary pattern (OR = 0.47; p = 0.033). CONCLUSIONS Women who were overweight or obese pre-pregnancy and those who quit smoking at the beginning of pregnancy should be provided with dietary guidance to prevent excessive gestational weight gain.
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Affiliation(s)
- Edyta Suliga
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland.
| | - Wojciech Rokita
- Department of Gynecological and Obstetric Prophylaxis, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Olga Adamczyk-Gruszka
- Department of Gynecological and Obstetric Prophylaxis, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Grażyna Pazera
- Clinic of Neonatology at the Regional Polyclinic Hospital, Kielce, Poland
| | - Elżbieta Cieśla
- Department of Developmental Age Research, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Głuszek
- Department of Surgery and Surgical Nursing with the Scientific Research Laboratory, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Hashemipour S, Haji Seidjavadi E, Maleki F, Esmailzadehha N, Movahed F, Yazdi Z. Level of maternal triglycerides is a predictor of fetal macrosomia in non-obese pregnant women with gestational diabetes mellitus. Pediatr Neonatol 2018; 59:567-572. [PMID: 29398554 DOI: 10.1016/j.pedneo.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 09/20/2017] [Accepted: 01/02/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The role of maternal serum triglycerides (TGs) in the development of fetal macrosomia in different subgroups of body mass index (BMI) has received little attention. The aim of this study was to determine the association between the level of maternal TGs and fetal macrosomia in Iranian pregnant women of different BMI subgroups with gestational diabetes mellitus (GDM). METHODS This cohort study was conducted on 305 pregnant women with GDM referred for glucose control to Kowsar Hospital in Qazvin, Iran. Level of TGs was measured on the 24th-28th weeks of pregnancy. The ROC curve of the level of TGs was depicted in BMI subgroups to predict fetal macrosomia. Logistic regression analysis was used to determine the risk of macrosomia per 1-SD increase in the level of TGs. RESULTS The prevalence of hypertriglyceridemia did not significantly differ across BMI subgroups. Macrosomia was more prevalent in obese women (32.2%) than overweight (19.1%) and normal weight (11.1%) women (P < 0.05). A 1-SD increase in the level of TG was associated with 4.2 and 1.9 times increased risk of macrosomia in normal weight (P < 0.01) and overweight (P < 0.01) women, respectively. Serum level of TGs was not associated with macrosomia in any adjustment models in obese women. The area under the curve of the level of TGs for macrosomia was 0.828 (95% CI: 0.712-0.911, P < 0.001) and 0.711 (95% CI: 0.639-0.775, P < 0.001) in normal weight and overweight women, respectively. CONCLUSION Hypertriglyceridemia was a predictor of macrosomia in non-obese women. More studies on different ethnicities and lifestyles are necessary to determine the association between the level of maternal TG and fetal macrosomia in BMI subgroups.
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Affiliation(s)
- Sima Hashemipour
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Firoozeh Maleki
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Farideh Movahed
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zohreh Yazdi
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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C-Reactive Protein Levels at the Midpregnancy Can Predict Gestational Complications. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1070151. [PMID: 30533423 PMCID: PMC6247639 DOI: 10.1155/2018/1070151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/25/2018] [Indexed: 12/18/2022]
Abstract
Although essential for a successful pregnancy, a growing body of evidence suggests that maternal inflammation, when dysregulated, may represent a risk factor for both maternal and neonatal outcomes. Here, we assessed the accuracy of maternal C-reactive protein (CRP) concentrations at the middle phase of pregnancy in the identification of maternal adverse outcomes (MAO) until delivery. A correlation between CRP and a complicated pregnancy including both maternal and neonatal adverse outcomes has been investigated, too. In this retrospective study, conducted at the Diabetology Unit of IRCCS Ospedale Policlinico San Martino, Genoa (Italy), 380 outpatient pregnant women have been enrolled at the prenatal visit before performing a 75 g oral glucose tolerance test at 24th-26th gestational week for gestational diabetes mellitus (GDM) screening. Demographic, medical, and reproductive history has been obtained by verbal interview. Data about pregnancy and delivery have been retrieved from medical records. The median value of maternal baseline serum CRP was 3.25 μg/mL. Women experiencing MAO were older, more frequently suffering from hypertension, and showed higher CRP concentrations, with a cutoff value >1.86 μg/mL found by a ROC curve analysis to be accurately predictive for MAO. By a logistic regression analysis, serum CRP levels >1.86 μg/mL have been found to predict MAO also considering maternal age, hypertension, and GDM. Maternal CRP levels have been positively associated with overall pregnancy adverse outcomes (maternal and neonatal), too. In conclusion, in pregnant women serum levels of CRP can early recognize subjects at higher risk for maternal and neonatal complications needing a more stringent follow-up.
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Bianchi C, de Gennaro G, Romano M, Aragona M, Battini L, Del Prato S, Bertolotto A. Pre-pregnancy obesity, gestational diabetes or gestational weight gain: Which is the strongest predictor of pregnancy outcomes? Diabetes Res Clin Pract 2018; 144:286-293. [PMID: 30189224 DOI: 10.1016/j.diabres.2018.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/16/2018] [Accepted: 08/30/2018] [Indexed: 11/19/2022]
Abstract
AIMS Both obesity and gestational diabetes (GDM) are risk factors for adverse pregnancy outcomes. The aim of our study is to ascertain the independent role of prepregnancy BMI (pp-BMI), gestational weight gain (GWG), and GDM on pregnancy outcomes. METHODS We analyzed data of 1198 pregnant women, who underwent selective screening for GDM. Data on pregnancy outcomes was collected from hospital discharge records. RESULTS Cesarean section (CS) was comparable in GDM and NGT women. Prevalence of fetal macrosomia was 5.9%, with no difference between GDM and normal glucose tolerance (NGT), neonatal hyperbilirubinemia were more frequent in newborns of GDM women (63.3% vs. 52.2%; p < 0.01). Offspring of women with excessive GWG weighed more than those of women with regular GWG (3405 ± 510 g vs. 3287 ± 524 g; p < 0.01). On a logistic regression analysis, GWG was an independent risk factor for macrosomia (OR 1.08, 95% CI 1.02-1.13; p < 0.01) and delivery at a gestational age <37 weeks (OR 0.29, 95% CI 0.16-0.53; p < 0.0001). GDM and pp-BMI were not independent risk factors for adverse outcomes in this cohort. CONCLUSIONS GWG rather than GDM is associated with adverse pregnancy outcomes. These findings call for an early education and implementation of a healthy lifestyle in women planning a pregnancy.
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Affiliation(s)
| | | | - Matilde Romano
- Maternal-Infant Department, University Hospital of Pisa, Italy
| | | | - Lorella Battini
- Maternal-Infant Department, University Hospital of Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Wang J, Liu E, Wang Y, Qiao Y, Zhang T, Li B, Zhang Z, Li N, Hu G. Association of early pregnancy body mass index and children's birth weight with risk of being overweight in childhood. Am J Hum Biol 2018; 30:e23174. [PMID: 30207617 PMCID: PMC6193846 DOI: 10.1002/ajhb.23174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 06/24/2018] [Accepted: 07/26/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To examine the potential effects of mothers' early pregnancy body mass index (BMI) and children's birth weight on childhood overweight/obesity at 1-6 years of age. METHODS We performed a cohort study in Tianjin, China, using the health care records from the Tianjin maternal and child health care system with 36 719 mother-child pairs from early pregnancy to children at 6 years of age. Logistic regression analyses were used to assess the single and joint associations of maternal early pregnancy BMI and children's birth weight with the risks of children being overweight at 1-6 years of age in multivariable-adjusted models. RESULTS Both maternal early pregnancy BMI and children's birth weight were positively associated with the risk of children being overweight at 1-6 years of age. Compared with children who were born to normal weight mothers and had low or normal birth weight (NBW; birth BMI < 85%), higher risks of being overweight at 1-6 years were found among children with low or NBW who were born to overweight mothers, and children with high NBW (BMI ≥ 85%) or macrosomia who were born to normal weight or overweight mothers. Lower risks of being overweight were found among those with low birth weight who were born to normal weight mothers. CONCLUSIONS Maternal early pregnancy BMI may play a more important role than children's birth weight in the risk of being overweight from 4 to 6 years of age. Children with high or NBW need to be given more attention to prevent excessive weight gain.
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Affiliation(s)
- Jing Wang
- Tianjin Women’s and Children’s Health Center, Tianjin, China, 300070
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA, 70808
| | - Enqing Liu
- Tianjin Women’s and Children’s Health Center, Tianjin, China, 300070
| | - Yue Wang
- Tianjin Women’s and Children’s Health Center, Tianjin, China, 300070
| | - Yijuan Qiao
- Tianjin Women’s and Children’s Health Center, Tianjin, China, 300070
| | - Tao Zhang
- Tianjin Women’s and Children’s Health Center, Tianjin, China, 300070
| | - Baojuan Li
- Tianjin Women’s and Children’s Health Center, Tianjin, China, 300070
| | - Zhiwei Zhang
- Tianjin Women’s and Children’s Health Center, Tianjin, China, 300070
| | - Nan Li
- Tianjin Women’s and Children’s Health Center, Tianjin, China, 300070
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA, 70808
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Wang N, Ding Y, Wu J. Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight in women with gestational diabetes mellitus. Early Hum Dev 2018; 124:17-21. [PMID: 30081354 DOI: 10.1016/j.earlhumdev.2018.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 05/17/2018] [Accepted: 07/23/2018] [Indexed: 01/09/2023]
Abstract
AIM To study the impact of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on neonatal birth weight in women with gestational diabetes mellitus (GDM). METHODS This was a prospective cohort study of 622 singleton pregnant women diagnosed with GDM recruited from 1 April 2014 and 30 December 2014 in a university teaching hospital in China. Binary logistic regression was used to analyze the factors influencing macrosomia. RESULTS Pre-pregnancy BMI categories were: underweight (10.6%), normal (65.6%), overweight (18.0%) and obese (5.8%). Mean GWG was 14.4 ± 4.8 kg and birth weight 3353.1 ± 467.3 g. The incidence of macrosomia was 7.8% and low birth weight 2.3%. Logistic regression analysis showed that pre-pregnancy BMI was not associated with macrosomia. However, excessive GWG was a risk factor for macrosomia (odds ratio (OR) 2.884, 95% confidence interval (CI) 1.385-6.004, p < 0.01). In addition, high maternal fasting plasma glucose (FPG) (OR 1.933, 95% CI 1.126-3.316) and serum triglyceride (TG) (OR 1.235, 95% CI 1.053-1.449) in the third trimester of pregnancy were risk factors for macrosomia. CONCLUSIONS Patients with GDM can be advised that excessive GWG and uncontrolled hyperglycaemia influence their chances for macrosomia.
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Affiliation(s)
- Na Wang
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China.
| | - Jiangnan Wu
- Department of Clinical Epidemiology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
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Hosseini E, Janghorbani M. Systematic review and meta-analysis of diagnosing gestational diabetes mellitus with one-step or two-step approaches and associations with adverse pregnancy outcomes. Int J Gynaecol Obstet 2018; 143:137-144. [PMID: 30101526 DOI: 10.1002/ijgo.12644] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/27/2018] [Accepted: 08/09/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is an ongoing discussion about the optimal diagnostic strategy for gestational diabetes mellitus (GDM). OBJECTIVE To assess the magnitude of the association between GDM diagnosed with the one-step (International Association of Diabetes and Pregnancy Study Groups criteria) or two-step (Carpenter and Coustan criteria) approach and selected adverse pregnancy outcomes. SEARCH STRATEGY Five electronic databases were searched up to October 2017 using Medical Subject Headings for each adverse outcome combined with the term "gestational diabetes." SELECTION CRITERIA Observational studies assessing the one-step versus the two-step diagnostic approach in GDM. DATA COLLECTION AND ANALYSIS Relative risks were extracted and random-effects models were used to estimate pooled relative risks (RRs). MAIN RESULTS A total of 41 663 participants from nine studies were included. Gestational diabetes mellitus was significantly associated with pre-eclampsia (RR 1.68 vs RR 1.77), cesarean delivery (RR 1.28 vs RR 1.33), and large for gestational age (RR 1.44 vs RR 1.68) when diagnosed with the one-step versus the two-step approach. A one-step diagnosis also increased the risks of neonatal intensive care unit admission and gestational hypertension, whereas a two-step diagnosis increased the incidence of macrosomia. CONCLUSIONS Women with GDM diagnosed with either the one-step or the two-step approach were at increased risk for selected adverse pregnancy outcomes. The associations with the two-step method were slightly stronger.
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Affiliation(s)
- Elham Hosseini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Janghorbani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kashyap H, Sharma D, Gala A, Pratap OT, Murki S. Effect of second trimester and third trimester weight gain on immediate outcomes in neonates born to mothers with gestational diabetes: a retrospective observational study from India. J Matern Fetal Neonatal Med 2018; 32:4133-4138. [PMID: 29804503 DOI: 10.1080/14767058.2018.1482270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Aim: To evaluate the effect of second trimester and third trimester rate of weight gain on immediate outcomes in neonates born to mothers with Gestational Diabetes Mellitus (GDM).Method and material: This retrospective observational study enrolled 593 eligible mothers. The records of all pregnant women booked before 24 weeks and screened for diabetes were eligible if they were diagnosed with Gestational Diabetes Mellitus (GDM) anytime during pregnancy. All the necessary maternal and neonatal details were collected from hospital database. The rate of weight gain was calculated at 18-24 weeks, 28-30 weeks, and that before delivery. The enrolled women were categorized into: poor weight gain, normal weight gain, and increased weight.Results and discussion: The mean birth weight, length, and head circumference of neonates were significantly lower in women who had poor rate of weight gain in comparison with normal weight gain group. The mean prepregnancy BMI was significantly high in women with increased rate of weight gain when compared to normal weight gain women in second and third trimester. Regression analysis done to evaluate the independent effect of weight gain on C section and neonatal complications, showed that the independent predictors for cesarean section were previous cesarean section or 12.5 (95% CI 6.7-23) and conception by assisted reproductive technologies or 1.75 (95% CI 1.01-4.3), and the neonatal complications were influenced by birth weight or 1.5 (95% CI 1.1-2.2) and weight gain during second trimester or 1.26 (95% CI 1-1.6).Conclusion: In women with GDM, reduced weight gain during pregnancy is associated with small for gestational age neonates. Caesarean section is predicted by previous C-section, and mode of conception whereas neonatal complications were predicted by birth weight and maternal weight gain during second trimester.
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Affiliation(s)
- Harish Kashyap
- Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, India
| | - Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, India
| | - Anisha Gala
- Department of Obstetrics, Fernandez Hospital, Hyderguda, Hyderabad, India
| | - Oleti Tejo Pratap
- Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, India
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Badon SE, Littman AJ, Chan KCG, Williams MA, Enquobahrie DA. Maternal sedentary behavior during pre-pregnancy and early pregnancy and mean offspring birth size: a cohort study. BMC Pregnancy Childbirth 2018; 18:267. [PMID: 29945548 PMCID: PMC6020429 DOI: 10.1186/s12884-018-1902-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sedentary behavior is associated with adverse health outcomes in the general population. Whether sedentary behavior during pregnancy is associated with newborn outcomes, such as birth size, is not established, and previous studies have been inconsistent. While previous research suggests that male and female fetuses respond differently to maternal behaviors, such as physical activity, the role of infant sex in sedentary behavior-birth size associations has not been examined. METHODS Participants in the Omega study, a cohort in Washington State (1996-2008), reported leisure time sedentary behavior (non-work time spent sitting), light intensity physical activity, and moderate/vigorous leisure time physical activity duration in the year before pregnancy (N = 1373) and in early pregnancy (N = 1535, mean 15 weeks). Offspring birth size was abstracted from delivery records. Non-parametric calibration weighting was used to assign adjustment weight (matching the distribution of sociodemographic and medical characteristics of the full cohort (N = 4128)) to participants with available sedentary behavior data. Weighted linear regression models were used to estimate mean differences in offspring birthweight, head circumference, and ponderal index (birthweight/length3) associated with leisure time sedentary behavior. Regression models were run overall and stratified by offspring sex. Isotemporal substitution modeling was used to determine mean differences in birthweight associated with replacing sedentary behavior with light or moderate/vigorous physical activity. RESULTS On average, women spent 2.3 and 2.6 h/day in leisure time sedentary behavior during pre- and early pregnancy, respectively. There were no associations of pre-pregnancy leisure time sedentary behavior with mean birthweight, head circumference, or ponderal index (adjusted β = - 12, 95% CI: -28, 4.1; β = 0.0, 95% CI: -0.04, 0.1; and β = 0.1, 95% CI: -0.2, 0.4, respectively). Early pregnancy sedentary behavior was not associated with mean birth size. Associations of sedentary behavior with mean birth size did not differ by offspring sex. Replacing sedentary time with light or moderate/vigorous physical activity was not associated with mean birthweight. CONCLUSIONS We did not observe associations of maternal sedentary behavior during pre- or early pregnancy with mean offspring birth size. Pre-pregnancy and early pregnancy sedentary behavior may have important adverse effects on maternal health, but our results do not support associations with mean offspring birth size.
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Affiliation(s)
- Sylvia E. Badon
- Department of Epidemiology, University of Washington, Box 357236, Health Sciences Building, 1959 NE Pacific Street, Seattle, WA 98195-7236 USA
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Alyson J. Littman
- Department of Epidemiology, University of Washington, Box 357236, Health Sciences Building, 1959 NE Pacific Street, Seattle, WA 98195-7236 USA
- Seattle Epidemiologic Research and Information Center, Box 358280, VA Puget Sound, 1660 S Columbian Way, Seattle, WA 98108 USA
| | - K. C. Gary Chan
- Department of Biostatistics, University of Washington, Box 357232, Health Sciences Building, 1705 NE Pacific Street, Seattle, WA 98195-7232 USA
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Kresge Building, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Daniel A. Enquobahrie
- Department of Epidemiology, University of Washington, Box 357236, Health Sciences Building, 1959 NE Pacific Street, Seattle, WA 98195-7236 USA
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O’Higgins AC, Doolan A, McCartan T, Mullaney L, O’Connor C, Turner MJ. Is birth weight the major confounding factor in the study of gestational weight gain?: an observational cohort study. BMC Pregnancy Childbirth 2018; 18:218. [PMID: 29879924 PMCID: PMC5992630 DOI: 10.1186/s12884-018-1843-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Much interest has been focussed on both maternal obesity and gestational weight gain (GWG), particularly on their role in influencing birth weight (BW). Several large reviews have reported that excessive GWG is associated with an increase in BW. However recent large, well-designed, randomized controlled trials studying interventions aimed at reducing GWG have all consistently failed to show a reduction in BW despite achieving a reduction in GWG. The aim of this longitudinal prospective study was to examine the relationship between GWG and birth weight in women where GWG and Body Mass Index (BMI) were measured accurately in a strictly standardized way. METHODS Women were enrolled at their convenience before 18 weeks gestation. Height and weight were measured accurately at the first antenatal visit and BMI calculated. Maternal weight was measured again after 37 weeks gestation. The weight of the baby was measured at birth. Relationships were tested using linear regression analysis, chi-squared tests and t-tests as appropriate. RESULTS Of the 522 women studied, the mean BMI was 25.3 kg/m2 and 15.7% were obese. The mean BW at term was 3576 g (2160-5120) and 2.7% (n = 14) weighed ≥4500 g. The mean GWG overall was 12.3 kg (4.6 to 28.4) and GWG decreased as BMI increased. The mean GWG was less in obese women, at 8.7 kg (- 4.6 to 23.4), compared to non-obese,13.0 kg (0.6-28.4) (p < 0.001). Mean BW in obese women was 3630 g vs 3565 g in non-obese (p = 0.27). The total GWG correlated positively with BW (p < 0.001). When BW was subtracted from total GWG, GWG no longer correlated with BW (p = 0.12). CONCLUSIONS The positive correlation between GWG in pregnancy and BW can be accounted for by the contribution of fetal weight to GWG antenatally without a contribution from increased maternal adiposity. There was a wide range of BW irrespective of the degree of GWG and obese women had a lower GWG than non-obese women. These findings help explain why Randomized Controlled Trials (RCTs) designed to reduce GWG have failed to decrease BW and suggest there is no causative link between excessive GWG and increased BW.
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Affiliation(s)
- Amy C. O’Higgins
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Anne Doolan
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Thomas McCartan
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Laura Mullaney
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Clare O’Connor
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Michael J. Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
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83
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Muñoz‐Muñoz E, Krause BJ, Uauy R, Casanello P. LGA‐newborn from patients with pregestational obesity present reduced adiponectin‐mediated vascular relaxation and endothelial dysfunction in fetoplacental arteries. J Cell Physiol 2018; 233:6723-6733. [DOI: 10.1002/jcp.26499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/24/2018] [Indexed: 12/21/2022]
Affiliation(s)
| | - Bernardo J. Krause
- Division of Pediatrics, School of Medicine Pontificia Universidad Católica de Chile Santiago Chile
| | - Ricardo Uauy
- Division of Pediatrics, School of Medicine Pontificia Universidad Católica de Chile Santiago Chile
| | - Paola Casanello
- Division of Pediatrics, School of Medicine Pontificia Universidad Católica de Chile Santiago Chile
- Division of Obstetrics and Gynecology, School of Medicine Pontificia Universidad Católica de Chile Santiago Chile
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84
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Rys PM, Ludwig-Slomczynska AH, Cyganek K, Malecki MT. Continuous subcutaneous insulin infusion vs multiple daily injections in pregnant women with type 1 diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials and observational studies. Eur J Endocrinol 2018; 178:545-563. [PMID: 29545258 DOI: 10.1530/eje-17-0804] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/13/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Randomised controlled trials (RCTs) have shown an advantage of continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) in the general type 1 diabetes mellitus (T1DM) population. RCT data on T1DM management in pregnancy remain limited. OBJECTIVE We performed a systematic review of both RCTs and non-RCTs evaluating CSII vs MDI in T1DM-complicated pregnancy. STUDY DESIGN Electronic databases were searched for studies comparing CSII with MDI in T1DM-complicated pregnancy. METHODS A meta-analysis provided point estimates with 95% confidence intervals (CI). Continuous outcomes were reported as weighted mean differences (WMD) or standardised mean differences (SMD), and dichotomous data as relative risk (RR). RESULTS The search identified 47 studies, including 43 non-RCTs, reporting on 7824 pregnancies. The meta-analysis showed a lower HbA1c level with CSII vs MDI in the first trimester (WMD: -0.45%; 95%CI: -0.62, -0.27). This difference decreased in subsequent trimesters. Compared to MDI, therapy with CSII resulted in higher gestational weight gain (GWG) (WMD: 1.02 kg; 95%CI: 0.41, 1.62), and lower daily insulin dose requirements in the first (SMD: -0.46; 95%CI: -0.68, -0.24) and subsequent trimesters. Moreover, infants from the CSII group were more likely to be large for gestational age (LGA) (RR: 1.16; 95%CI: 1.07, 1.24) and less likely to be small for gestational age (SGA) (RR: 0.66; 95%CI: 0.45; 0.97). CONCLUSIONS In T1DM-complicated pregnancy, CSII compared to MDI therapy resulted in better first trimester glycaemic control; this difference decreased in subsequent trimesters. CSII therapy was associated with lower insulin requirements, higher GWG and altered risk for infants being LGA and SGA.
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Affiliation(s)
| | | | | | - Maciej T Malecki
- University HospitalKrakow, Poland
- Department of Metabolic DiseasesJagiellonian University Medical College, Krakow, Poland
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85
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Wang X, Guan Q, Zhao J, Yang F, Yuan Z, Yin Y, Fang R, Liu L, Zuo C, Gao L. Association of maternal serum lipids at late gestation with the risk of neonatal macrosomia in women without diabetes mellitus. Lipids Health Dis 2018; 17:78. [PMID: 29642923 PMCID: PMC5896067 DOI: 10.1186/s12944-018-0707-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/12/2018] [Indexed: 01/06/2023] Open
Abstract
Background Macrosomia is a serious public health problem worldwide due to its increasing prevalence and adverse influences on maternal and neonatal outcomes. Maternal dyslipidemia exerts potential and adverse impacts on pregnant women and newborns. However, the association between maternal serum lipids and the risk of macrosomia has not yet been clearly elucidated. We explored the association between the maternal lipids profile at late gestation and the risk of having macrosomia among women without diabetes mellitus (DM). Methods The medical records of 5407 pregnant women giving birth to single live babies at term were retrospectively analyzed. Subjects with DM, hypertension, thyroid disorders and fetal malformation were excluded. Maternal fasting serum lipids were measured during late pregnancy. Logistic regression analysis was used to analyze the variables associated with the risk of macrosomia. Results Maternal serum triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels were related to macrosomia; each 1 mmol/L increase in TG resulted in a 27% increase in macrosomia risk, while each 1 mmol/L increase in HDL-C level resulted in a 37% decrease in macrosomia risk, even after adjusting for potential confounders. Notably, the risk of macrosomia increased progressively with increased maternal serum TG levels and decreased HDL-C levels. Compared with women with serum TG levels < 2.5 mmol/L, women with TG levels greater than 3.92 mmol/L had an approximately 2.8-fold increased risk of macrosomia. Compared with women with serum HDL-C levels above 2.23 mmol/L, women with HDL-C levels of less than 1.62 mmol/L had a 1.9-fold increased risk of giving birth to an infan with macrosomia. In addition, a higher risk of macrosomia was observed in women with simultaneous hypertriglyceridemia and low serum HDL-C levels (odds ratio [OR] 2.400, 95% confidence interval [CI]: 1.760–3.274) compared to those with hypertriglyceridemia or low serum HDL-C alone (OR 2.074, 95% CI: 1.609–2.673 and OR 1.363, 95% CI: 1.028–1.809, respectively). Conclusions Maternal serum TG levels and HDL-C levels at late gestation are independent predictors of macrosomia in women without DM. Electronic supplementary material The online version of this article (10.1186/s12944-018-0707-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiangxiang Wang
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China.,Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 544, Jing 4 Rd, Jinan, Shandong, 250021, China
| | - Qingbo Guan
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China.,Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 544, Jing 4 Rd, Jinan, Shandong, 250021, China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China.,Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 544, Jing 4 Rd, Jinan, Shandong, 250021, China
| | - Feifei Yang
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China.,Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 544, Jing 4 Rd, Jinan, Shandong, 250021, China
| | - Zhongshang Yuan
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, 250012, China
| | - Yongchao Yin
- Department of Scientific Research, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Rui Fang
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China.,Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 544, Jing 4 Rd, Jinan, Shandong, 250021, China
| | - Lingwei Liu
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China.,Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 544, Jing 4 Rd, Jinan, Shandong, 250021, China
| | - Changting Zuo
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.
| | - Ling Gao
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, 544, Jing 4 Rd, Jinan, Shandong, 250021, China. .,Scientific Center, Shandong Provincial Hospital affiliated to Shandong University, 544, Jing 4 Rd, Jinan, Shandong, 250021, China.
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86
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McGrath RT, Glastras SJ, Scott ES, Hocking SL, Fulcher GR. Outcomes for Women with Gestational Diabetes Treated with Metformin: A Retrospective, Case-Control Study. J Clin Med 2018. [PMID: 29522471 PMCID: PMC5867576 DOI: 10.3390/jcm7030050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Metformin is increasingly being used a therapeutic option for the management of gestational diabetes mellitus (GDM). The aim of this study was to compare the maternal characteristics and perinatal outcomes of women with GDM treated with metformin (with or without supplemental insulin) with those receiving other management approaches. A retrospective, case-control study was carried out and 83 women taking metformin were matched 1:1 with women receiving insulin or diet and lifestyle modification alone. Women managed with diet and lifestyle modification had a significantly lower fasting plasma glucose (p < 0.001) and HbA1c (p < 0.01) at diagnosis of GDM. Furthermore, women managed with metformin had a higher early pregnancy body mass index (BMI) compared to those receiving insulin or diet and lifestyle modification (p < 0.001). There was no difference in mode of delivery, birth weight or incidence of large- or small-for-gestational-age neonates between groups. Women receiving glucose lowering therapies had a higher rate of neonatal hypoglycaemia (p < 0.05). The incidence of other adverse perinatal outcomes was similar between groups. Despite their greater BMI, women with metformin-treated GDM did not have an increased risk of adverse perinatal outcomes. Metformin is a useful alternative to insulin in the management of GDM.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- Northern Clinical School, University of Sydney, Sydney NSW 2065, Australia.
- Kolling Institute of Medical Research, St Leonards, Sydney NSW 2065, Australia.
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- Northern Clinical School, University of Sydney, Sydney NSW 2065, Australia.
- Kolling Institute of Medical Research, St Leonards, Sydney NSW 2065, Australia.
| | - Emma S Scott
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Sydney NSW 2050, Australia.
| | - Samantha L Hocking
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- Boden Institute, Charles Perkins Centre, University of Sydney, Camperdown, Sydney NSW 2006, Australia.
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- Northern Clinical School, University of Sydney, Sydney NSW 2065, Australia.
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87
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Barquiel B, Herranz L, Meneses D, Moreno Ó, Hillman N, Burgos MÁ, Bartha JL. Optimal Gestational Weight Gain for Women with Gestational Diabetes and Morbid Obesity. Matern Child Health J 2018; 22:1297-1305. [PMID: 29497985 DOI: 10.1007/s10995-018-2510-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Our aim was to investigate the greatest gestational weight gain (GWG) without adverse pregnancy complications in women with gestational diabetes mellitus (GDM) and morbid obesity. METHODS An observational retrospective study including 3284 patients with single pregnancies and GDM was completed. Of the patients, 131 (4.0%) were classified as having pre-pregnancy morbid obesity (BMI ≥ 35 kg/m2). Perinatal complications were compared among BMI groups. In the group with morbid obesity, GWG threshold values to predict outcomes were examined based on sensitivity and specificity values under the receiver operating characteristic curve. RESULTS GWG was higher in mothers with morbid obesity and macrosomic neonates: 11.3 (4.4-15.7) versus 4.8 (1.5-8.2) kg (p = 0.033). The GWG and neonatal ponderal index were positively correlated (r = 0.305, p = 0.001). The GWG was 7.0 (2.9-11.6) kg in women with hypertensive disorder versus 4.5 (1.0-7.5) kg in normotensive women (p = 0.017). A GWG above 5 kg was a risk factor for macrosomia (87.8% sensitivity, 54.7% specificity) and hypertensive disorder (70.0% sensitivity, 48.4% specificity). GWG associations were maintained after controlling for glycemic control, maternal and gestational age, parity, smoking and neonatal sex. CONCLUSIONS FOR PRACTICE A GWG below 5 kg is recommended for women with GDM and morbid obesity. In these women, adequate GWG may prevent macrosomia, fetal overgrowth and hypertensive disorder.
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Affiliation(s)
- Beatriz Barquiel
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain.
| | - Lucrecia Herranz
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Diego Meneses
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Óscar Moreno
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Natalia Hillman
- Diabetes and Pregnancy Unit, Division of Diabetes, La Paz University Hospital, Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Mª Ángeles Burgos
- Diabetes and Pregnancy Unit, Department of Obstetrics, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Diabetes and Pregnancy Unit, Department of Obstetrics, La Paz University Hospital, Madrid, Spain
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88
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de Medeiros TS, Bernardi JR, de Brito ML, Bosa VL, Goldani MZ, da Silva CH. Caffeine Intake During Pregnancy in Different Intrauterine Environments and its Association with Infant Anthropometric Measurements at 3 and 6 Months of Age. Matern Child Health J 2018; 21:1297-1307. [PMID: 28110387 DOI: 10.1007/s10995-016-2230-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective To investigate the association between maternal caffeine intake during pregnancy and infant anthropometric measurements at age 3 and 6 months. Methods Longitudinal observational study of mother-child pairs stratified into five groups: diabetic women (DM), hypertensive women (HYP), smoking mothers (SMO), mothers of infants small for gestational age (SGA), and controls (CTL). Pairs were recruited from three public hospitals in Porto Alegre, Brazil, from 2011 to 2015, using a convenience sampling strategy. The Food Frequency Questionnaire (FFQ) was administered on postpartum day 7 to evaluate maternal caffeine intake during pregnancy. The anthropometric measurements of interest (weight, length, and skinfold thickness) were assessed at birth and at age 3 and 6 months. Linear regression was used to analyze the interaction between caffeine intake and skinfold thickness. Results Overall, 272 mother-child pairs were investigated (41 DM, 26 HYP, 68 SMO, 25 SGA, and 112 CTL). There were no differences in anthropometric measurements between infants born to mothers who had and had not consumed caffeine during pregnancy (P > 0.05). Children of mothers in the DM group had the highest adjusted average skinfold thicknesses at 3 months. An interaction between maternal caffeine intake during pregnancy and the sum of skinfolds at age 3 months was found in the DM and CTL groups (P < 0.05). However, significant differences were not observed at 6 months. Conclusions Maternal caffeine intake influenced infants skinfold thickness measurements at 3 months of age. This parameter was reduced in infants born to mothers with DM and increased in those born to healthy control mothers.
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Affiliation(s)
- Thamíris Santos de Medeiros
- Master of Sciences in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Center for the Study of Child and Adolescent Health, Hospital de Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2nd floor, 2350, CEP 90035-903, Porto Alegre, RS, Brazil.
| | - Juliana Rombaldi Bernardi
- Department of Nutrition, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Pediatrics and Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Center for the Study of Child and Adolescent Health, Hospital de Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2nd floor, 2350, CEP 90035-903, Porto Alegre, RS, Brazil
| | - Mariana Lopes de Brito
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Center for the Study of Child and Adolescent Health, Hospital de Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2nd floor, 2350, CEP 90035-903, Porto Alegre, RS, Brazil
| | - Vera Lucia Bosa
- Department of Nutrition, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Center for the Study of Child and Adolescent Health, Hospital de Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2nd floor, 2350, CEP 90035-903, Porto Alegre, RS, Brazil
| | - Marcelo Zubaran Goldani
- Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Pediatrics and Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Center for the Study of Child and Adolescent Health, Hospital de Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2nd floor, 2350, CEP 90035-903, Porto Alegre, RS, Brazil
| | - Clécio Homrich da Silva
- Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Pediatrics and Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Center for the Study of Child and Adolescent Health, Hospital de Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2nd floor, 2350, CEP 90035-903, Porto Alegre, RS, Brazil
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89
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Al-Rifai RH, Ali N, Barigye ET, Al Haddad AHI, Loney T, Al-Maskari F, Ahmed LA. Maternal and birth cohort studies in the Gulf Cooperation Council countries: protocol for a systematic review and narrative evaluation. BMJ Open 2018; 8:e019843. [PMID: 29374677 PMCID: PMC5829589 DOI: 10.1136/bmjopen-2017-019843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cohort studies have revealed that genetic, socioeconomic, communicable and non-communicable diseases, and environmental exposures during pregnancy may influence the mother and her pregnancy, birth delivery and her offspring. Numerous studies have been conducted in the Gulf Cooperation Council (GCC) countries to examine maternal and birth health. The objectives of this protocol for a systematic review are to systematically review and characterise the exposures and outcomes that have been examined in the mother and birth cohort studies in the GCC region, and to summarise the strength of association between key maternal exposures during pregnancy (ie, body mass index) and different health-related outcomes (ie, mode of birth delivery). The review will then synthesise and characterise the consequent health implications and will serve as a platform to help identify areas that are overlooked, point out limitations of studies and provide recommendations for future cohort studies. METHODS AND ANALYSIS Medline, Embase, Cochrane Library and Web of Science electronic databases will be comprehensively searched. Two reviewers will independently screen each study for eligibility, and where discrepancies arise they will be discussed and resolved; otherwise a third reviewer will be consulted. The two reviewers will also independently extract data into a predefined Excel spreadsheet. The included studies will be categorised on the basis of whether the participant is a mother, infant or mother-infant dyad. Outcome variables will be divided along two distinctions: mother or infant. Exposure variables will be divided into six domains: psychosocial, biological, environmental, medical/medical services, maternal/reproductive and perinatal/child. Studies are expected to be of heterogeneous nature; therefore, quantitative syntheses might be limited. ETHICS AND DISSEMINATION There is no primary data collection; therefore, ethical review is not necessary. The findings of this review will be disseminated in a peer-reviewed journal and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42017068910.
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Affiliation(s)
- Rami H Al-Rifai
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Nasloon Ali
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Esther T Barigye
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amal H I Al Haddad
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Fatima Al-Maskari
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Luai A Ahmed
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
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90
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White V, Jawerbaum A, Mazzucco MB, Gauster M, Desoye G, Hiden U. IGF2 stimulates fetal growth in a sex- and organ-dependent manner. Pediatr Res 2018; 83:183-189. [PMID: 28910276 DOI: 10.1038/pr.2017.221] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/31/2017] [Indexed: 11/09/2022]
Abstract
BackgroundInsulin-like growth factor 2 (IGF2) is a key determinant of fetal growth, and the altered expression of IGF2 is implicated in fetal growth disorders and maternal metabolic derangements including gestational diabetes. Here we studied how increased levels of IGF2 in late pregnancy affect fetal growth.MethodsWe employed a rat model of repeated intrafetal IGF2 administration in late pregnancy, i.e., during GD19-GD21, and measured the consequences on fetal organ weight and expression of insulin/IGF-axis components.ResultsIGF2 treatment tended to increase fetal weight, but only weight increase of the fetal stomach reached significance (+33±9%; P<0.01). Sex-dependent data analysis revealed a sexual dimorphism of IGF2 action. In male fetuses, IGF2 administration significantly increased fetal weight (+13±3%; P<0.05) and weight of fetal stomach (+42±10%; P<0.01), intestine (+26±5%; P<0.05), liver (+13±4%; P<0.05), and pancreas (+25±8%; P<0.05). Weights of heart, lungs, and kidneys were unchanged. In female fetuses, IGF2 increased only stomach weight (+26±9%; P<0.05). Furthermore, gene expression of insulin/IGF axis in the heart, lungs, liver, and stomach was more sensitive toward IGF2 treatment in male than in female fetuses.ConclusionData suggest that elevated circulating IGF2 in late pregnancy predominantly stimulates organ growth of the digestive system, and male fetuses are more susceptible toward the IGF2 effects than female fetuses.
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Affiliation(s)
- Veronica White
- Laboratory of Reproduction and Metabolism, Center for Pharmacological and Botanical Studies, CEFyBO-CONICET, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alicia Jawerbaum
- Laboratory of Reproduction and Metabolism, Center for Pharmacological and Botanical Studies, CEFyBO-CONICET, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Maria Belen Mazzucco
- Laboratory of Reproduction and Metabolism, Center for Pharmacological and Botanical Studies, CEFyBO-CONICET, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Martin Gauster
- Institute of Cell Biology, Histology and Embryology, Medical University of Graz, Graz, Austria
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Ursula Hiden
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
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91
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Ersoy AÖ, Öztaş E, Özler S, Ersoy E, Topçu HO, Fındık RB, Taşçı Y. The evaluation of the low risk pregnant women who gave birth to macrosomic infants. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2017. [DOI: 10.5799/jcei.382414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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92
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Laine MK, Kautiainen H, Gissler M, Raina M, Aahos I, Järvinen K, Pennanen P, Eriksson JG. Gestational diabetes in primiparous women-impact of age and adiposity: a register-based cohort study. Acta Obstet Gynecol Scand 2017; 97:187-194. [PMID: 29194561 DOI: 10.1111/aogs.13271] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/25/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Data on risk factors for gestational diabetes mellitus (GDM) in primiparous women is limited. The aim of this study was to assess the prevalence of GDM and simultaneously evaluate the impact of age and adiposity in primiparous women at risk of GDM risk. MATERIAL AND METHODS This observational register-based cohort study from the city of Vantaa, Finland, included all 7750 primiparous women giving birth between 2009 and 2015 without previously diagnosed diabetes mellitus. RESULTS In primiparous women the prevalence of GDM was 16.5% and mean age was 28.2 years (5.2 SD). Primiparous women aged ≥35 years had a significantly higher risk for GDM than women aged <25 years [odds ratio (OR) 2.67, 95% confidence interval (CI) 2.13-3.34]. Primiparous women with a pre-pregnancy body mass index (BMI) ≥30.0 kg/m2 had a significantly higher risk for GDM than women with a pre-pregnancy BMI <25 kg/m2 (OR 5.36, 95% CI 4.53-6.36). The risk of developing GDM showed an increasing trend with increasing age in all BMI categories except the category BMI ≥35 kg/m2 . Normal weight women (BMI 20.0-24.9 kg/m2 ) aged 40 years had a significantly higher risk for GDM than normal weight women aged 28 years (OR 1.48, 95% CI 1.01-2.19). CONCLUSIONS The prevalence of GDM is high in primiparous women. Both age and degree of adiposity influenced the risk for GDM. To reduce GDM risk, adiposity should be prevented already in childhood and primiparity should be encouraged at a younger age.
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Affiliation(s)
- Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Vantaa Health Center, Vantaa, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - Marko Raina
- Vantaa Health Center, Vantaa, Finland.,Apotti, Helsinki, Finland
| | | | | | | | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland.,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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93
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Maternal pre-pregnancy obesity and the risk of macrosomia: a meta-analysis. Arch Gynecol Obstet 2017; 297:139-145. [DOI: 10.1007/s00404-017-4573-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
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94
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Iwama N, Sugiyama T, Metoki H, Kusaka H, Maki J, Nishigori H, Yaegashi N, Sagawa N, Hiramatsu Y, Toyoda N. Maternal body mass index is a better indicator of large-for-gestational-age infants compared with a 75-g oral glucose tolerance test in early pregnancy: The JAGS trial. Diabetes Res Clin Pract 2017; 132:10-18. [PMID: 28783528 DOI: 10.1016/j.diabres.2017.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 07/07/2017] [Indexed: 11/17/2022]
Abstract
AIMS There is no previous study comparing the predictive ability of maternal pre-pregnancy body mass index (BMI) versus a 75-g oral glucose tolerance test (OGTT) in early pregnancy for large-for-gestational-age (LGA) infants. METHODS This multi-institutional prospective cohort study included 966 pregnant Japanese women. A multiple logistic regression model was applied to compare the effect size of pre-pregnancy BMI, fasting plasma glucose (PG), and 1- and 2-h PG levels after a 75-g OGTT performed before 22weeks gestation for LGA. After these variables were included separately into the model as per continuous variables 1 standard deviation (SD) increase, they were included simultaneously. RESULTS When pre-pregnancy BMI, fasting PG, and 1- and 2-h PG after a 75-g OGTT were separately included in the model, the adjusted odds ratios (ORs) for LGA per 1 SD increase in pre-pregnancy BMI, fasting, and 1- and 2-h PG were 1.55 (95% confidence interval [CI]: 1.26-1.91), 1.26 (95% CI: 1.03-1.54), 0.99 (95% CI: 0.78-1.25), and 1.17 (95% CI: 0.93-1.49), respectively. When these variables were included simultaneously, the adjusted ORs per 1 SD increase in pre-pregnancy BMI, fasting, and 1- and 2-h PG were 1.52 (95% CI: 1.23-1.88), 1.19 (95% CI: 0.96-1.46), 0.77 (95% CI: 0.57-1.03), and 1.30 (95% CI: 0.96-1.76), respectively. CONCLUSIONS Maternal pre-pregnancy BMI was more strongly associated with LGA compared with a 75-g OGTT in early pregnancy. Health-care providers should recognize that women with a higher pre-pregnancy BMI carry a higher risk for having LGA infants regardless of the results of a 75-g OGTT.
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Affiliation(s)
- Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Obstetrics and Gynecology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical Pharmaceutical University, Sendai, Miyagi, Japan
| | - Hideto Kusaka
- Department of Obstetrics and Gynecology, National Hospital Organization Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hidekazu Nishigori
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Norimasa Sagawa
- Department of Obstetrics and Gynecology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Yuji Hiramatsu
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Okayama, Japan
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95
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Maternal Habitual Midday Napping Duration and Frequency are Associated with High Birthweight. Sci Rep 2017; 7:10564. [PMID: 28874688 PMCID: PMC5585221 DOI: 10.1038/s41598-017-09683-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/28/2017] [Indexed: 12/03/2022] Open
Abstract
Habitual midday napping is a common habit in China, especially for pregnant women. The purpose of this study was to examine whether duration and frequency of maternal habitual midday napping were associated with high birthweight (HBW). A total of 10,482 participants from Healthy Baby Cohort were include in our analysis. The information of the mothers and their infants were abstracted from medical records, or obtained from questionnaire. Logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of habitual midday napping duration and frequency with HBW. Of the participants, 8,705 (83.0%) reported having habitual midday napping. Duration and frequency of napping had a positive association with HBW without adjustment. After controlling for potential confounders, increasing risk of HBW was observed in participants who napped 1.5–2 hours (OR, 1.50, 95% CI, 1.14, 1.98), and ≥2 hours (OR, 1.35, 95% CI, 1.03, 1.78) compared with no habitual midday napping. Participants who took naps ≥5 days/week had a higher risk of HBW (OR, 1.37, 95% CI, 1.07, 1.77) compared with the women without naps. This suggests that longer (≥1.5 hours) and more frequent (≥5 days/week) maternal habitual midday napping were associated with an increased risk of HBW.
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96
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Pirjani R, Shirzad N, Qorbani M, Phelpheli M, Nasli-Esfahani E, Bandarian F, Hemmatabadi M. Gestational diabetes mellitus its association with obesity: a prospective cohort study. Eat Weight Disord 2017; 22:445-450. [PMID: 27747467 DOI: 10.1007/s40519-016-0332-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/04/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the association between pre-pregnancy body mass index (BMI) and gestational diabetes mellitus (GDM). METHODS This prospective study was conducted on 256 pregnant women without diabetes referred for prenatal care in the first trimester of pregnancy to two referral University Hospitals (Shariati and Arash Hospitals) during the years 2012 and 2013. Eligible participants were selected consecutively and were followed until delivery and 6 weeks after that. Body weight and fasting plasma glucose were measured in each trimester, and BMI was calculated. Incidence of GDM was recorded, and BMI in this group was compared with those without GDM. RESULTS Mean age of women was 28.70 ± 5.57 years and among them, 78 women (30.5 %) developed GDM of which 21 were obese (52.5 %), 25 overweight (27.8 %), and 32 (25.4 %) were normal weight (p = 0.004). Pre-pregnancy obesity (OR 2.74, 95 % CI 1.28-5.88, p = 0.009), family history of diabetes (OR 2.01, 95 % CI 1.13-3.56, p = 0.016), and maternal age more than 30 years (OR 2.20, 95 % CI 1.25-3.88, p = 0.006) were three independent predictors for GDM, and pre-pregnancy obesity was the most potent predictor of GDM. CONCLUSION Women with high BMI and obesity have a significantly higher risk for developing GDM. Pre-pregnancy obesity, family history of diabetes, and age more than 30 years are three independent risk factors for GDM.
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Affiliation(s)
- Reihaneh Pirjani
- Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Shirzad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th Floor, Shariati Hospital, North Kargar Ave., Tehran, Iran. .,Department of Endocrinology, Vali-Asr Hospital, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mina Phelpheli
- Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bandarian
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Hemmatabadi
- Department of Endocrinology, Vali-Asr Hospital, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
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97
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Olmos PR, Borzone GR. Basal-bolus insulin therapy reduces maternal triglycerides in gestational diabetes without modifying cholesteryl ester transfer protein activity. J Obstet Gynaecol Res 2017; 43:1397-1404. [DOI: 10.1111/jog.13403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/28/2017] [Accepted: 04/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Pablo R. Olmos
- Departments of Nutrition, Diabetes & Metabolism, College of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
- Departments of Obstetrics & Gynecology, College of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Gisella R. Borzone
- Departments of Respiratory Diseases, College of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
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98
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Abstract
Suspected fetal macrosomia is encountered commonly in obstetric practice. As birth weight increases, the likelihood of labor abnormalities, shoulder dystocia, birth trauma, and permanent injury to the neonate increases. The purpose of this document is to quantify those risks, address the accuracy and limitations of methods for estimating fetal weight, and suggest clinical management for a pregnancy with suspected fetal macrosomia.
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99
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Gao X, Yan Y, Xiang S, Zeng G, Liu S, Sha T, He Q, Li H, Tan S, Chen C, Li L, Yan Q. The mutual effect of pre-pregnancy body mass index, waist circumference and gestational weight gain on obesity-related adverse pregnancy outcomes: A birth cohort study. PLoS One 2017; 12:e0177418. [PMID: 28575041 PMCID: PMC5456032 DOI: 10.1371/journal.pone.0177418] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/26/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the mutual effect of pre-pregnancy body mass index (BMI), waist circumference (WC) and gestational weight gain (GWG) on obesity-related adverse pregnancy outcomes. METHODS This birth cohort study was conducted in three Streets in Changsha, China, including a total of 976 mother-child pairs. All data was collected within 15 days after deliveries from a self-administered questionnaire, maternal health manual and perinatal health care information system. Multivariate logistic regression models were conducted to estimate the effects of maternal pre-pregnancy BMI, WC and GWG on obesity-related adverse pregnancy outcomes including gestational diabetes mellitus (GDM), primary cesarean section (P-CS), large for gestational age (LGA) and composite outcome (one or more adverse pregnancy outcomes). RESULTS After controlling for all confounders, both maternal pre-pregnancy overweight/obesity and central adiposity contributed to increased risks of GDM [ORs 95% CIs = 2.19 (1.02-4.76) and 2.26 (1.11-4.60), respectively], P-CS [ORs 95% CIs = 1.66 (1.05-2.65) and 1.71 (1.11-2.63), respectively], LGA [ORs 95% CIs = 1.93 (1.07-3.50) and 2.14 (1.21-3.75), respectively] and composite outcome [ORs 95% CIs = 1.82 (1.15-2.87) and 1.98 (1.30-3.01), respectively] compared with mothers with normal pre-pregnancy weight and normal WC. Excessive GWG was found to be associated with an increased risk of LGA [OR 95% CI = 1.74 (1.05-2.89)], but was not significantly related to higher risks of GDM, P-CS and composite outcome [ORs 95% CIs = 0.90 (0.47-1.72), 1.08 (0.77-1.52), and 1.30 (0.94-1.79), respectively]. In terms of the joint effect of maternal pregestational BMI and WC on obesity-related composite outcome, mothers with both pre-pregnancy overweight and central adiposity had the highest risk of composite outcome [OR 95% CI = 3.96 (2.40-6.54)], compared with mothers without pre-pregnancy overweight or central adiposity. CONCLUSIONS The results of this study suggest that maternal pre-pregnancy overweight/obesity and central adiposity may contribute to multiple obesity-related adverse pregnancy outcomes, excessive weight gain during pregnancy is associated with an increased risk of LGA. Healthcare providers should carry out health education, and guide women to keep an ideal BMI and WC prior to pregnancy and help them gain optimal weight during pregnancy based on their pre-pregnancy BMI and WC.
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Affiliation(s)
- Xiao Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
- * E-mail:
| | - Shiting Xiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Guangyu Zeng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Shiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Tingting Sha
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Hongyan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Shan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Cheng Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Ling Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qiang Yan
- Department of Maternal and Child Health, Kaifu District Health Bureau, Changsha, China
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100
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Liu YQ, Liu Y, Hua Y, Chen XL. Effect of diet and exercise intervention in Chinese pregnant women on gestational weight gain and perinatal outcomes: A quasi-experimental study. Appl Nurs Res 2017; 36:50-56. [PMID: 28720239 DOI: 10.1016/j.apnr.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/21/2017] [Accepted: 05/20/2017] [Indexed: 01/23/2023]
Abstract
Aim To determine the effect of a diet and exercise intervention in pregnant women on total gestational weight gain, weekly weight gain, 42-days postpartum weight retention, mode of delivery, and infant birth weight. METHODS One hundred and one eligible Chinese pregnant women whose pre-pregnancy body mass index ranged from 18.5 to 24.9 were recruited between June 2013 and June 2014 from a tertiary hospital. Ninety participants, 45 in each group, completed the study. Intervention women received three face-to-face interventions and three follow-up phone calls which were developed based on the Transtheoretical Model. Gestational weight was measured at each prenatal check. Mode of delivery and infant birth weight were collected from the medical record. The 42-days postpartum weight was measured during the postpartum visits. RESULTS (1) The total gestational weight gain and mean weight gain per week in the intervention group were significantly less than the control group (P=0.045 and P=0.008 respectively). (2) Infant birth weight was significantly lower in the intervention group (P=0.012). (3) Postpartum weight retention was significantly less in the intervention group (P=0.001). 4) There were not significant differences in mode of delivery. 5) Infant birth weight was significantly less than the control group (P=0.012). CONCLUSIONS The lifestyle intervention significantly reduced gestational weight gain, optimized infant weight and lowered postpartum weight retention. Promotion of gestational weight management is needed and cultural health beliefs about pregnancy and postpartum practices should be considered when developing the intervention plan.
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Affiliation(s)
- Yan Qun Liu
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
| | - Yun Liu
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
| | - Yun Hua
- Wuhan Women and Children Medical Care Center, 100 Xianggang Road, Hankou, Wuhan, Hubei Province, China.
| | - Xiao Li Chen
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
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