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Ma S, Hu S, Liang H, Xiao Y, Tan H. Metabolic effects of breastfeed in women with prior gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Res Rev 2019; 35:e3108. [PMID: 30513131 PMCID: PMC6590118 DOI: 10.1002/dmrr.3108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
This study was undertaken to provide comprehensive analyses of current research developments in the field of breastfeed (BF) and metabolic-related outcomes among women with prior gestational diabetes mellitus (GDM). Database PubMed, Embase, BIOSIS Previews, Web of Science, and Cochrane Library were searched through December 3, 2017. Odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) were pooled by random-effects model using Stata version 12.0. Twenty-three observational studies were included in quantitative synthesis. Reduced possibility of progression to type 2 diabetes mellitus (T2DM; OR = 0.79; 95% CI, 0.68-0.92) and pre-DM (OR = 0.66; 95% CI, 0.51-0.86) were found among women with longer BF of any intensity after GDM pregnancy. The positive effect of longer BF on progression to T2DM gradually became prominent with the extension of follow-up period. Compared with women with shorter BF, those with longer BF manifested more favourable metabolic parameters, including significant lower body mass index, fasting glucose, triglyceride, and higher insulin sensitivity index. The findings support that BF may play an important role in protection against the development of T2DM-related outcomes in midlife of women with prior GDM. However, further studies are needed to reveal the etiological mechanism.
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Affiliation(s)
- Shujuan Ma
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Shimin Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Huiling Liang
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Yanni Xiao
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
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Shen Y, Leng J, Li W, Zhang S, Liu H, Shao P, Wang P, Wang L, Tian H, Zhang C, Yang X, Yu Z, Hou L, Tuomilehto J, Hu G. Lactation intensity and duration to postpartum diabetes and prediabetes risk in women with gestational diabetes. Diabetes Metab Res Rev 2019; 35:e3115. [PMID: 30548991 PMCID: PMC6442676 DOI: 10.1002/dmrr.3115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/29/2018] [Accepted: 12/11/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the association of lactation intensity and duration with postpartum diabetes and prediabetes risks among Chinese women with a history of gestational diabetes (GDM). METHODS We included 1260 women with a history of GDM who participated in the whole population's GDM universal screening survey by using the 1999 World Health Organization's criteria. Lactation intensity and lactation duration were collected by a standardized questionnaire. Postpartum diabetes and prediabetes risk were confirmed by an oral glucose tolerance test. RESULTS During a mean postpartum period of 3.65 years, we identified 114 cases of diabetes and 417 cases of prediabetes. The multivariable-adjusted hazard ratios based on different lactation intensity (exclusive formula, mixed feeding, and exclusive lactation) were 1.00, 0.68, 0.45 for diabetes (Ptrend = 0.008), and 1.00, 0.74, and 0.61 for prediabetes (Ptrend = 0.006), respectively. The multivariable-adjusted hazard ratios associated with different lactation duration (none, 0-6 months, 6-12 months, 12-18 months, and ≥18 months) were 1.00, 0.66, 0.42, 0.66, and 0.25 for diabetes (Ptrend = 0.013), and 1.00, 0.82, 0.62, 0.67, and 0.63 for prediabetes (Ptrend = 0.021), respectively. A restricted cubic spline curve showed a graded inverse association of lactation duration with the risks of diabetes and prediabetes (Ptrend < 0.001). CONCLUSIONS Higher-lactation intensity and longer-lactation duration were significantly associated with lower risks of postpartum diabetes and prediabetes among Chinese women with a history of GDM.
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Affiliation(s)
- Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, LA
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Six People’s Hospital, Shanghai, China
| | - Junhong Leng
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Weiqin Li
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Huikun Liu
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Ping Shao
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Peng Wang
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Huiguang Tian
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Xilin Yang
- Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhijie Yu
- Population Cancer Research program, Dalhousie University, Halifax, NS, Canada
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA
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Ma Y, Wang N, Gu L, Wei X, Ren Q, Huang Q, Zhang A, Zhang J, Peng Y, Wang Y. Postpartum assessment of the beta cell function and insulin resistance for Chinese women with previous gestational diabetes mellitus. Gynecol Endocrinol 2019; 35:174-178. [PMID: 30182781 DOI: 10.1080/09513590.2018.1512094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Gestational diabetes mellitus (GDM) imparts a high risk of developing postpartum diabetes and is considered to be an early stage of type 2 diabetes mellitus (T2DM). In this study, a 75-g oral glucose tolerance test was performed on 472 women with GDM at 6-8 weeks after delivery. The clinical and metabolic characteristics were compared between the patients with normal glucose tolerance (NGT) and abnormal glucose metabolism (AGM). These data were then compared between pre-diabetic and diabetic patients. A total of 37.7% of the women with GDM continued to have abnormal glucose levels after delivery. Compared with the women who reverted to normal, HOMA-IR was significantly higher in AGM. A multiple stepwise regression analysis revealed that age, the postpartum body mass index (BMI), low density lipoprotein-cholesterol (LDL-C), 2 h glucose load plasma glucose (2 h PG), triglycerides (TG), hemoglobin A1c (HbA1c), 1 h glucose load plasma insulin (INS) level, and 2 h INS level were independent risk factors for the development of insulin resistance after delivery. This study has identified a high prevalence of AGM after GDM. Insulin resistance appears to be the major contributor. Any treatment to reduce the postpartum BMI and lipids level may be beneficial to decrease insulin resistance.
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Affiliation(s)
- Yuhang Ma
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Nian Wang
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Liping Gu
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Xiaohui Wei
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Qian Ren
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Qianfang Huang
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Aifang Zhang
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Jiarong Zhang
- b Department of Obstetrics and Gynecology , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Yongde Peng
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
| | - Yufan Wang
- a Department of Endocrinology and Metabolism , Shanghai General Hospital Shanghai Jiao Tong University , Shanghai , China
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Firneisz G, Rosta K, Al-Aissa Z, Hadarits O, Harreiter J, Nádasdi Á, Bancher-Todesca D, Németh L, Igaz P, Rigó J, Sziller I, Kautzky-Willer A, Somogyi A. The MTNR1B rs10830963 Variant in Interaction with Pre-Pregnancy BMI is a Pharmacogenetic Marker for the Initiation of Antenatal Insulin Therapy in Gestational Diabetes Mellitus. Int J Mol Sci 2018; 19:E3734. [PMID: 30477160 PMCID: PMC6321391 DOI: 10.3390/ijms19123734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 11/26/2022] Open
Abstract
The rs10830963 variant of the Melatonin Receptor 1B (MTNR1B) gene is associated with the development of gestational diabetes mellitus (GDM). We hypothesized that carrying the rs10830963/G risk allele had effect on antenatal insulin therapy (AIT) initiation in GDM in a body mass index (BMI)-dependent manner. Design: In this post hoc analysis the MTNR1B rs10830963 genotype and the clinical data of 211 Caucasian GDM patients were assessed. As a first step, a pre-pregnancy BMI threshold was determined where the effect of MTNR1B rs10830963/G allele carrying on AIT initiation was the most significant using logistic regression. Maternal age adjusted real-life odds ratios (OR) values were calculated. The chi-square test was also used to calculate the p value and 10.000 bootstrap simulations were performed in each case to re-assess the statistical power and the OR. Carrying the MTNR1B rs10830963/G allele increased the odds of AIT initiation (OR = 5.2, p = 0.02 [χ² test], statistical power = 0.53) in GDM patients with pre-pregnancy BMI ≥ 29 kg/m². The statistical power reached 0.77, when the pre-pregnancy BMI cutoff of 27 kg/m² was used and the genetic effect on AIT initiation was still significant, but only using the logistic regression model. Carrying the MTNR1B rs10830963/G risk allele-in interaction with pre-pregnancy BMI-is likely be considered as a candidate pharmacogenetic marker of antenatal insulin therapy initiation and should be further assessed in precision medicine trials in GDM.
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Affiliation(s)
- Gábor Firneisz
- 2nd Department of Internal Medicine, Semmelweis University, H-1088 Budapest, Hungary.
- MTA-SE Molecular Medicine Research Group, Hungarian Academy of Sciences⁻Semmelweis University, H-1088 Budapest, Hungary.
| | - Klara Rosta
- Department of Obstetrics and Gynecology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Obstetrics and Gynecology, Semmelweis University, H-1088 Budapest, Hungary.
| | - Zahra Al-Aissa
- 2nd Department of Internal Medicine, Semmelweis University, H-1088 Budapest, Hungary.
| | - Orsolya Hadarits
- Department of Obstetrics and Gynecology, Semmelweis University, H-1088 Budapest, Hungary.
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Ákos Nádasdi
- 2nd Department of Internal Medicine, Semmelweis University, H-1088 Budapest, Hungary.
| | - Dagmar Bancher-Todesca
- Department of Obstetrics and Gynecology, Medical University of Vienna, A-1090 Vienna, Austria.
| | - László Németh
- Department of Probability Theory and Statistics, Eötvös Loránd University, H-1088 Budapest, Hungary.
| | - Péter Igaz
- 2nd Department of Internal Medicine, Semmelweis University, H-1088 Budapest, Hungary.
- MTA-SE Molecular Medicine Research Group, Hungarian Academy of Sciences⁻Semmelweis University, H-1088 Budapest, Hungary.
| | - János Rigó
- Department of Obstetrics and Gynecology, Semmelweis University, H-1088 Budapest, Hungary.
| | - István Sziller
- Department of Obstetrics and Gynecology, Szent Imre Teaching Hospital, H-1088 Budapest, Hungary.
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, A-1090 Vienna, Austria.
| | - Anikó Somogyi
- 2nd Department of Internal Medicine, Semmelweis University, H-1088 Budapest, Hungary.
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55
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Marshall NE, Lau B, Purnell JQ, Thornburg KL. Impact of maternal obesity and breastfeeding intention on lactation intensity and duration. MATERNAL AND CHILD NUTRITION 2018; 15:e12732. [PMID: 30345729 DOI: 10.1111/mcn.12732] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/01/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022]
Abstract
Exclusive breastfeeding (EBF) has numerous maternal health benefits. However, EBF rates are lower in mothers with obesity. We sought to better understand whether maternal body composition measurements in early pregnancy are also predictive of lower rates of EBF. Healthy pregnant women with prepregnancy body mass index (BMI) of 17.5-51 kg/m2 underwent determination of percent body fat (% body fat) in early (12-16 weeks) and late (37 weeks) gestation. Intent and duration of EBF were determined by surveys completed at 6 weeks and 6 months postpartum (PP). Unadjusted and adjusted analyses were performed to compare EBF rates and weaning by maternal BMI and % body fat. Increasing BMI and % body fat in early pregnancy were significantly associated with lower rates of EBF among women intending EBF. Women with BMI ≥ 25 were less likely to be EBF at 6 weeks and 6 months PP compared with women of normal BMI (67 and 37% vs. 91 and 79%, P value 0.005 and 0.001, respectively). Among primiparous women intending EBF, 100% of women in the lowest two body fat quartiles in early pregnancy were EBF at 6 weeks PP compared with 66.7 and 63.6% of women in the higher quartiles (P = 0.03). Lactation cessation by 6 months PP was higher with increasing maternal BMI (P = 0.001). Maternal obesity in early gestation is associated with lower EBF rates among women intending EBF and earlier weaning. Excess adiposity in early pregnancy may impede EBF.
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Affiliation(s)
- Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Bernard Lau
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan Q Purnell
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Kent L Thornburg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
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56
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Di Cianni G, Lacaria E, Lencioni C, Resi V. Preventing type 2 diabetes and cardiovascular disease in women with gestational diabetes - The evidence and potential strategies. Diabetes Res Clin Pract 2018; 145:184-192. [PMID: 29684619 DOI: 10.1016/j.diabres.2018.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 02/01/2023]
Abstract
Gestational Diabetes Mellitus is a condition strongly related to the development of type 2 diabetes later in life, although the risk and the onset have not been fully identified yet. Although glucose tolerance returns to normal levels after delivery in the majority of women with GDM, this condition represents an early stage in the natural history of T2DM. In addition, women with previous GDM exhibit an increased cardiovascular risk profile and a raised incidence of cardiovascular diseases. Lifestyle changes and pharmacological interventions might be able to reduce the incidence of type 2 diabetes in pGDM women, although results are still not conclusive. Long term continuous programs specifically addressed to women with pGDM should be implemented, with the ambitious target to encourage them to regularly check glucose tolerance, lipid profile and other parameters related to cardiovascular diseases, aimed at improving women's health. In this paper, we review the relationship between type 2 diabetes, cardiovascular diseases and a history of GDM.
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Affiliation(s)
- Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Livorno, Italy.
| | - Emilia Lacaria
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Livorno, Italy
| | - Cristina Lencioni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Lucca Hospital, Lucca, Italy
| | - Veronica Resi
- Diabetes Service, Unit of Endocrinology, IRCCS Cà Granda-Ospedale Maggiore Policlinico Foundation and Department of Medical Sciences, University of Milan, Milan, Italy
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57
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Retnakaran R. Hyperglycemia in pregnancy and its implications for a woman's future risk of cardiovascular disease. Diabetes Res Clin Pract 2018; 145:193-199. [PMID: 29679623 DOI: 10.1016/j.diabres.2018.04.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/04/2018] [Indexed: 01/13/2023]
Abstract
It is well established that gestational diabetes mellitus (GDM) identifies a population of women who are at risk of ultimately developing type 2 diabetes (T2DM) later in life. Moreover, this relationship extends across the full spectrum of hyperglycemia in pregnancy, with lesser degrees of gestational dysglycemia identifying a proportionate gradient of future risk of T2DM. Importantly, a growing body of evidence suggests that an analogous relationship exists between hyperglycemia in pregnancy and a woman's long-term risk of cardiovascular disease (CVD), as well. Indeed, as compared to their peers, woman who had GDM have a higher risk of major cardiovascular events, which first manifests within the first decade after the index pregnancy. Although the absolute incidence of such events remains low in young women of child-bearing age, the identification of future risk of CVD at this early point in its natural history may provide the unique opportunity for timely intervention and ideally disease prevention. Thus, in this review, we discuss the emerging concept of hyperglycemia in pregnancy as an indicator of the future risk of CVD in young women and its implications for research and clinical practice.
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Affiliation(s)
- Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada; Division of Endocrinology, University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
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58
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Abstract
The prevalence of gestational diabetes in the developed world is increased and parallels that of obesity. Apart from the maternal and fetal complications occurring during pregnancy, GDM is characterized by a high subsequent risk of type 2 diabetes, metabolic syndrome, and cardiovascular disease. In this paper, we outline the different factors to consider in assessing the future risk of diabetes developing in women with a history of GDM. Looking at the modifiable risk factors, it is worth noting that promoting a healthy diet and lifestyle before (physical activity), during and after pregnancy (breast feeding) in women of fertile age are fundamental to the success of efforts to reduce the burden of diabetes in these young people.
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Affiliation(s)
- Silvia Burlina
- Department of Medicine, DIMED University of Padova, Via Giustiniani n 2, Padova, Italy
| | - Maria Grazia Dalfrà
- Department of Medicine, DIMED University of Padova, Via Giustiniani n 2, Padova, Italy
| | - Annunziata Lapolla
- Department of Medicine, DIMED University of Padova, Via Giustiniani n 2, Padova, Italy.
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59
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Mecacci F, Ottanelli S, Petraglia F. Mothers with HIP - The short term and long-term impact, what is new? Diabetes Res Clin Pract 2018; 145:146-154. [PMID: 29730389 DOI: 10.1016/j.diabres.2018.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/26/2018] [Indexed: 01/13/2023]
Abstract
Hyperglycemia is one of the most common medical conditions that women encounter during pregnancy and it is due to gestational diabetes (GDM) in the majority of cases (International Diabetes Federation, 2015) [1]. GDM is associated with a higher incidence of maternal morbidity in pregnancy in term of hypertensive disorders/preclampsia and higher rate of cesarean delivery but also with long-term risk of type 2 diabetes and cardiovascular disease. Pregnancy can therefore be considered a stress test; diagnosis of HIP can unmask a preexisting susceptibility and consequently a future risk for type 2 diabetes and can be a useful marker of future cardiovascular risk. Postpartum follow up provides an excellent opportunity to implement healthy lifestyle behaviors to prevent or delay the development of diabetes or cardiovascular disease. The aim of the current review is to focus on short and long term maternal morbidity of HIP.
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Affiliation(s)
- Federico Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Serena Ottanelli
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy.
| | - Felice Petraglia
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
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Pineros-Leano M, Tabb KM, Simonovich SD, Wang Y, Meline B, Huang H. Racial Differences in Breastfeeding Initiation Among Participants in a Midwestern Public Health District. Health Equity 2018; 2:296-303. [PMID: 30364880 PMCID: PMC6198273 DOI: 10.1089/heq.2018.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Although variations in breastfeeding initiation are well documented, the contributing role of maternal race remains poorly understood, especially among the multiracial—two or more races—population. The purpose of this study is to examine differences in breastfeeding initiation among a racially and ethnically diverse population of low-income women. Methods: Participants for this study (n=1010) were enrolled in the supplemental nutrition program for women, infant, and children and concurrently enrolled in a perinatal depression registry at a public health clinic in the Midwest. Race was obtained from medical records. Breastfeeding initiation was gathered through a clinical interview during the first postpartum visit. Logistic regression was conducted using STATA 14.2. Results: Sixty-eight percent of study participants reported breastfeeding initiation. The bivariate analysis demonstrated that there were significant differences in rates of breastfeeding initiation by race/ethnicity. The logistic regression models showed that after adjusting for maternal education, age, income, nativity, parity, body mass index, and antenatal smoking, Black (odds ratio [OR] 0.47; confidence interval [95% CI] 0.34–0.66), multiracial (OR 0.21; 95% CI 0.07–0.65), and Latina women (OR 0.48; 95% CI 0.26–0.86) were significantly less likely to initiate breastfeeding compared with White women. Conclusion: These findings highlight the need for further understanding of the underlying barriers to the initiation of breastfeeding among low-income Black, multiracial, and Latina women. Moreover, breastfeeding should remain a priority for intervention and policy development, particularly among racially and ethnically diverse low-income women.
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Affiliation(s)
- Maria Pineros-Leano
- School of Social Work, Boston College, Chestnut Hill, Massachusetts.,IDEA Research Team, University of Illinois, Urbana, Illinois
| | - Karen M Tabb
- IDEA Research Team, University of Illinois, Urbana, Illinois.,School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Shannon D Simonovich
- IDEA Research Team, University of Illinois, Urbana, Illinois.,School of Nursing, College of Science & Health, DePaul University, Chicago, Illinois
| | - Yang Wang
- IDEA Research Team, University of Illinois, Urbana, Illinois.,School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Brandon Meline
- IDEA Research Team, University of Illinois, Urbana, Illinois.,Maternal and Child Health Division, Champaign-Urbana Public Health District, Champaign, Illinois
| | - Hsiang Huang
- IDEA Research Team, University of Illinois, Urbana, Illinois.,Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
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Early-life origins of disparities in chronic diseases among Indigenous youth: pathways to recovering health disparities from intergenerational trauma. J Dev Orig Health Dis 2018; 10:115-122. [PMID: 30223914 DOI: 10.1017/s2040174418000661] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Indigenous women and children experience some of the most profound health disparities globally. These disparities are grounded in historical and contemporary trauma secondary to colonial atrocities perpetuated by settler society. The health disparities that exist for chronic diseases may have their origins in early-life exposures that Indigenous women and children face. Mechanistically, there is evidence that these adverse exposures epigenetically modify genes associated with cardiometabolic disease risk. Interventions designed to support a resilient pregnancy and first 1000 days of life should abrogate disparities in early-life socioeconomic status. Breastfeeding, prenatal care and early child education are key targets for governments and health care providers to start addressing current health disparities in cardiometabolic diseases among Indigenous youth. Programmes grounded in cultural safety and co-developed with communities have successfully reduced health disparities. More works of this kind are needed to reduce inequities in cardiometabolic diseases among Indigenous women and children worldwide.
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Kondo M, Nagao Y, Mahbub MH, Tanabe T, Tanizawa Y. Factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus: decision-curve analysis. Diabet Med 2018; 35:1111-1117. [PMID: 29706019 DOI: 10.1111/dme.13657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 02/05/2023]
Abstract
AIMS To identify factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus, using decision-curve analysis. METHODS A retrospective cohort study was performed. The participants were 123 Japanese women with gestational diabetes who underwent 75-g oral glucose tolerance tests at 8-12 weeks after delivery. They were divided into a glucose intolerance and a normal glucose tolerance group based on postpartum oral glucose tolerance test results. Analysis of the pregnancy oral glucose tolerance test results showed predictive factors for postpartum glucose intolerance. We also evaluated the clinical usefulness of the prediction model based on decision-curve analysis. RESULTS Of 123 women, 78 (63.4%) had normoglycaemia and 45 (36.6%) had glucose intolerance. Multivariable logistic regression analysis showed insulinogenic index/fasting immunoreactive insulin and summation of glucose levels, assessed during pregnancy oral glucose tolerance tests (total glucose), to be independent risk factors for postpartum glucose intolerance. Evaluating the regression models, the best discrimination (area under the curve 0.725) was obtained using the basic model (i.e. age, family history of diabetes, BMI ≥25 kg/m2 and use of insulin during pregnancy) plus insulinogenic index/fasting immunoreactive insulin <1.1. Decision-curve analysis showed that combining insulinogenic index/fasting immunoreactive insulin <1.1 with basic clinical information resulted in superior net benefits for prediction of postpartum glucose intolerance. CONCLUSIONS Insulinogenic index/fasting immunoreactive insulin calculated using oral glucose tolerance test results during pregnancy is potentially useful for predicting early postpartum glucose intolerance in Japanese women with gestational diabetes.
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Affiliation(s)
- M Kondo
- Division of Endocrinology, Metabolism, Haematological Sciences and Therapeutics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Y Nagao
- Division of Internal Medicine, Yamaguchi Red Cross Hospital, Yamaguchi-City, Yamaguchi, Japan
| | - M H Mahbub
- Division of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - T Tanabe
- Division of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Y Tanizawa
- Division of Endocrinology, Metabolism, Haematological Sciences and Therapeutics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Barriers to Exclusive Breastfeeding Among Women With Gestational Diabetes Mellitus in the United States. J Obstet Gynecol Neonatal Nurs 2018; 47:301-315. [DOI: 10.1016/j.jogn.2018.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/24/2022] Open
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Feng L, Xu Q, Hu Z, Pan H. Lactation and progression to type 2 diabetes in patients with gestational diabetes mellitus: A systematic review and meta-analysis of cohort studies. J Diabetes Investig 2018; 9:1360-1369. [PMID: 29575786 PMCID: PMC6215952 DOI: 10.1111/jdi.12838] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/28/2018] [Accepted: 03/11/2018] [Indexed: 12/26/2022] Open
Abstract
Aims/Introduction To explore the association between lactation and type 2 diabetes incidence in women with prior gestational diabetes. Materials and Methods We searched PubMed, Embase and the Cochrane Library for cohort studies published through 12 June 2017 that evaluated the effect of lactation on the development of type 2 diabetes in women with prior gestational diabetes. A random effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs). Results A total of 13 cohort studies were included in the meta‐analysis. The pooled result suggested that compared with no lactation, lactation was significantly associated with a lower risk of type 2 diabetes (RR 0.66, 95% CI 0.48–0.90, I2 = 72.8%, P < 0.001). This relationship was prominent in a study carried out in the USA (RR 0.66, 95% CI 0.43–0.99), regardless of study design (prospective design RR 0.56, 95% CI 0.41–0.76; retrospective design RR 0.63, 95% CI 0.40–0.99), smaller sample size (RR 0.52, 95% CI 0.30–0.92, P = 0.024) and follow‐up duration >1 years (RR 0.75, 95% CI 0.56–1.00), and the study used adjusted data (RR 0.69, 95% CI 0.50–0.94). Finally, by pooling data from three studies, we failed to show that compared with no lactation, long‐term lactation (>1 to 3 months postpartum) was associated with the type 2 diabetes risk (RR 0.69, 95% CI 0.41–1.17). Conclusions The present meta‐analysis showed that lactation was associated with a lower risk of type 2 diabetes in women with prior gestational diabetes. Furthermore, no significant relationship between long‐term lactation and type 2 diabetes risk was detected. The impact of long‐term lactation and the risk of type 2 diabetes should be verified in further large‐scale studies.
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Affiliation(s)
- Lijun Feng
- Department of Nutrition, Sir Run Run Shaw Hospital, School of Medicine Zhejiang University, Hangzhou, China
| | - Qunli Xu
- Department of Nursing, Sir Run Run Shaw Hospital, School of Medicine Zhejiang University, Hangzhou, China
| | - Zhefang Hu
- Department of Nutrition, Sir Run Run Shaw Hospital, School of Medicine Zhejiang University, Hangzhou, China
| | - Hongying Pan
- Department of Nursing, Sir Run Run Shaw Hospital, School of Medicine Zhejiang University, Hangzhou, China
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Huvinen E, Koivusalo SB, Meinilä J, Valkama A, Tiitinen A, Rönö K, Stach-Lempinen B, Eriksson JG. Effects of a Lifestyle Intervention During Pregnancy and First Postpartum Year: Findings From the RADIEL Study. J Clin Endocrinol Metab 2018; 103:1669-1677. [PMID: 29409025 DOI: 10.1210/jc.2017-02477] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/26/2018] [Indexed: 02/04/2023]
Abstract
CONTEXT Women with a history of gestational diabetes (GDM) have a sevenfold risk of developing type 2 diabetes. OBJECTIVE To assess the effects of a lifestyle intervention during pregnancy and first postpartum year on glucose regulation, weight retention, and metabolic characteristics among women at high GDM risk. DESIGN In the Finnish Gestational Diabetes Prevention study, trained study nurses provided lifestyle counseling in each trimester and 6 weeks, 6 months, and 12 months postpartum. SETTING Three maternity hospitals in the Helsinki area and one in Lappeenranta. PATIENTS In total, 269 women with previous GDM and/or a prepregnancy body mass index ≥30 kg/m2 were enrolled before 20 gestational weeks and allocated to either a control or an intervention group. This study includes the 200 participants who attended study visits 6 weeks and/or 12 months postpartum. INTERVENTION The lifestyle intervention followed Nordic diet recommendations and at least 150 minutes of moderate exercise was recommended weekly. MAIN OUTCOME MEASURE The incidence of impaired glucose regulation (impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes) during the first postpartum year. RESULTS Impaired glucose regulation was present in 13.3% of the women in the control and in 2.7% in the intervention group [age-adjusted odds ratio, 0.18 (95% confidence interval, 0.05 to 0.65), P = 0.009] during the first postpartum year. There were no differences between the groups in weight retention, physical activity, or diet at 12 months postpartum. CONCLUSIONS A lifestyle intervention during pregnancy and the first postpartum year successfully reduced the incidence of postpartum impairment in glucose regulation.
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Affiliation(s)
- Emilia Huvinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jelena Meinilä
- Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anita Valkama
- Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
| | - Johan G Eriksson
- Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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Gunderson EP, Lewis CE, Lin Y, Sorel M, Gross M, Sidney S, Jacobs DR, Shikany JM, Quesenberry CP. Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years: The 30-Year CARDIA Study. JAMA Intern Med 2018; 178:328-337. [PMID: 29340577 PMCID: PMC5885916 DOI: 10.1001/jamainternmed.2017.7978] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/20/2017] [Indexed: 11/14/2022]
Abstract
Importance Lactation duration has shown weak protective associations with incident diabetes (3%-15% lower incidence per year of lactation) in older women based solely on self-report of diabetes, studies initiated beyond the reproductive period are vulnerable to unmeasured confounding or reverse causation from antecedent biochemical risk status, perinatal outcomes, and behaviors across the childbearing years. Objective To evaluate the association between lactation and progression to diabetes using biochemical testing both before and after pregnancy and accounting for prepregnancy cardiometabolic measures, gestational diabetes (GD), and lifestyle behaviors. Design, Setting, and Participants For this US multicenter, community-based 30-year prospective cohort study, there were 1238 women from the Coronary Artery Risk Development in Young Adults (CARDIA) study of young black and white women ages 18 to 30 years without diabetes at baseline (1985-1986) who had 1 or more live births after baseline, reported lactation duration, and were screened for diabetes up to 7 times during 30 years after baseline (1986-2016). Exposures Time-dependent lactation duration categories (none, >0 to 6 months, >6 to <12 months, and ≥12 months) across all births since baseline through 30 years. Main Outcomes and Measures Diabetes incidence rates per 1000 person-years and adjusted relative hazards (RH) with corresponding 95% CIs, as well as proportional hazards regression models adjusted for biochemical, sociodemographic, and reproductive risk factors, as well as family history of diabetes, lifestyle, and weight change during follow-up. Results Overall 1238 women were included in this analysis (mean [SD] age, 24.2 [3.7] years; 615 black women). There were 182 incident diabetes cases during 27 598 person-years for an overall incidence rate of 6.6 cases per 1000 person-years (95% CI, 5.6-7.6); and rates for women with GD and without GD were 18.0 (95% CI, 13.3-22.8) and 5.1 (95% CI, 4.2-6.0), respectively (P for difference < .001). Lactation duration showed a strong, graded inverse association with diabetes incidence: adjusted RH for more than 0 to 6 months, 0.75 (95% CI, 0.51-1.09); more than 6 months to less than 12 months, 0.52 (95% CI, 0.31-0.87), and 12 months or more 0.53 (0.29-0.98) vs none (0 days) (P for trend = .01). There was no evidence of effect modification by race, GD, or parity. Conclusions and Relevance This study provides longitudinal biochemical evidence that lactation duration is independently associated with lower incidence of diabetes. Further investigation is required to elucidate mechanisms that may explain this relationship.
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Affiliation(s)
| | - Cora E. Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Ying Lin
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Mike Sorel
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Myron Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham
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Kugishima Y, Yasuhi I, Yamashita H, Sugimi S, Umezaki Y, Suga S, Fukuda M, Kusuda N. Risk factors associated with the development of postpartum diabetes in Japanese women with gestational diabetes. BMC Pregnancy Childbirth 2018; 18:19. [PMID: 29310607 PMCID: PMC5759797 DOI: 10.1186/s12884-017-1654-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/29/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although the onset of gestational diabetes (GDM) is known to be a significant risk factor for the future development of type 2 diabetes, this risk specifically in women with GDM diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria has not yet been thoroughly investigated. This study was performed to investigate the risk factors associated with the development of postpartum diabetes in Japanese women with a history of GDM, and the effects of the differences in the previous Japanese criteria and the IADPSG criteria. METHODS This retrospective cohort study included Japanese women with GDM who underwent at least one postpartum oral glucose tolerance test (OGTT) between 2003 and 2014. Cases with overt diabetes in pregnancy were excluded. We investigated the risk factors including maternal baseline and pregnancy characteristics associated with the development of postpartum diabetes. RESULTS Among 354 women diagnosed with GDM during the study period, 306 (86%) (116/136 [85.3%] and 190/218 [87.2%] under the previous criteria and the IADPSG criteria, respectively) who underwent at least 1 follow-up OGTT were included in the study. Thirty-two women (10.1%) developed diabetes within a median follow-up period of 57 weeks (range, 6-292 weeks). Eleven (9.5%) and 21 (11.1%) were diagnosed as GDM during pregnancy based on the previous Japanese criteria and the IADPSG criteria, respectively, which did not significantly differ between those criteria. A multivariate logistic regression analysis revealed that HbA1c and 2-h plasma glucose (PG) at the time of the diagnostic OGTT during pregnancy were independent predictors of the development of diabetes after adjusting for confounders. The adjusted relative risk of HbA1c ≥5.6% for the development of diabetes was 4.67 (95% confidence interval, 1.53-16.73), while that of 2-h PG ≥183 mg/dl was 7.02 (2.51-20.72). CONCLUSIONS A modest elevation of the HbA1c and 2-h PG values at the time of the diagnosis of GDM during pregnancy are independent predictors of the development of diabetes during the postpartum period in Japanese women with a history of GDM. The diagnostic criteria did not affect the incidence of postpartum diabetes.
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Affiliation(s)
- Yukari Kugishima
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan.
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Masashi Fukuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Nobuko Kusuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
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Hummel S, Beyerlein A, Pfirrmann M, Hofelich A, Much D, Hivner S, Bunk M, Herbst M, Peplow C, Walter M, Kohn D, Hummel N, Kratzsch J, Hummel M, Füchtenbusch M, Hasford J, Ziegler AG. Efficacy of vildagliptin for prevention of postpartum diabetes in women with a recent history of insulin-requiring gestational diabetes: A phase II, randomized, double-blind, placebo-controlled study. Mol Metab 2018; 9:168-175. [PMID: 29396374 PMCID: PMC5869734 DOI: 10.1016/j.molmet.2017.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/14/2017] [Accepted: 12/24/2017] [Indexed: 01/22/2023] Open
Abstract
Objective Women with insulin-requiring gestational diabetes mellitus (GDM) are at high risk of developing diabetes within a few years postpartum. We implemented this phase II study to test the hypothesis that vildagliptin, a dipeptidyl peptidase-4 inhibitor, is superior to placebo in terms of reducing the risk of postpartum diabetes. Methods Women with insulin-requiring GDM were randomized to either placebo or 50 mg vildagliptin twice daily for 24 months followed by a 12-month observation period (EudraCT: 2007-000634-39). Both groups received lifestyle counseling. The primary efficacy outcomes were the diagnosis of diabetes (American Diabetes Association (ADA) criteria) or impaired fasting glucose (IFG)/impaired glucose tolerance (IGT). Results Between 2008 and 2015, 113 patients (58 vildagliptin, 55 placebo) were randomized within 2.2–10.4 (median 8.6) months after delivery. At the interim analysis, nine diabetic events and 28 IFG/IGT events had occurred. Fifty-two women withdrew before completing the treatment phase. Because of the low diabetes rate, the study was terminated. Lifestyle adherence was similar in both groups. At 24 months, the cumulative probability of postpartum diabetes was 3% and 5% (hazard ratio: 1.03; 95% confidence interval: 0.15–7.36) and IFG/IGT was 43% and 22% (hazard ratio: 0.55; 95% confidence interval: 0.26–1.19) in the placebo and vildagliptin groups, respectively. Vildagliptin was well tolerated with no unexpected adverse events. Conclusions The study did not show significant superiority of vildagliptin over placebo in terms of reducing the risk of postpartum diabetes. However, treatment was safe and suggested some improvements in glycemic control, insulin resistance, and β-cell function. The study identified critical issues in performing clinical trials in the early postpartum period in women with GDM hampering efficacy assessments. With this knowledge, we have set a basis for which properly powered trials could be performed in women with recent GDM. Trial registration number at ClinicalTrials.gov NCT01018602. Treatment with vildagliptin suggested positive effects on β-cell function and HbA1c. Treatment with vildagliptin was safe. Contraindication of vildagliptin during lactation led to exclusion of women with early postpartum diabetes. Slow enrolment and high drop-out rates are major challenges in studies of women with GDM.
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Affiliation(s)
- Sandra Hummel
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377 München, Germany
| | - Anna Hofelich
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Daniela Much
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Susanne Hivner
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Melanie Bunk
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Melanie Herbst
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Claudia Peplow
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Markus Walter
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Denise Kohn
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377 München, Germany
| | - Nadine Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Jürgen Kratzsch
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Uniklinikum Leipzig, Paul-List-Str. 13/15, 04103 Leipzig, Germany
| | - Michael Hummel
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Martin Füchtenbusch
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377 München, Germany
| | - Anette-G Ziegler
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany.
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Iliadou M, Lykeridou K, Prezerakos P, Swift EM, Tziaferi SG. Measuring the Effectiveness of a Midwife-led Education Programme in Terms of Breastfeeding Knowledge and Self-efficacy, Attitudes Towards Breastfeeding, and Perceived Barriers of Breastfeeding Among Pregnant Women. Mater Sociomed 2018; 30:240-245. [PMID: 30936785 PMCID: PMC6377922 DOI: 10.5455/msm.2018.30.240-245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Exclusive breastfeeding is the optimal mode of feeding for the first six months of a child’s life. Modifiable factors associated with increased breastfeeding, may be addressed through antenatal breastfeeding education. In Greece, the rates of exclusive breastfeeding remain rather low. Aim: The aim of the current study was to evaluate the effectiveness of a structured in-hospital midwife-led antenatal breastfeeding educational programme on breastfeeding knowledge and self-efficacy, attitudes towards breastfeeding and perceived-barriers of breastfeeding. Patients and Methods: This was a quasi-experimental study with two study groups: an intervention group (following a four-hour midwife-led antenatal breastfeeding programme) and a control group. All nulliparous women attending antenatal care at the tertiary hospital in Athens, Greece during May 2016–January 2017 were invited to participate, of which 203 nulliparous pregnant women took part. Demographic data forms, the Breastfeeding Self-efficacy Scale, the Iowa Infant Feeding Attitude Scale, the Breast Feeding Knowledge Questionnaire and the Perceived Breast Feeding Barriers Questionnaire were used for data collection. Results: Post-intervention, women in the intervention group had a more positive attitude towards breastfeeding (73.5% versus 66.1%, p<0.001), greater knowledge (14.6% versus 13.1%, p<0.001) and more breastfeeding self-efficacy (51.4% versus 45.6%, p<0.001) compared to the control group. Furthermore, they had significantly less perceived barriers regarding breastfeeding (27.4% versus 31.0%, p<0.001). Conclusion: The four-hour antenatal breastfeeding education intervention which occurred and was evaluated for the first time in the Greek female population was effective in increasing breastfeeding knowledge, self-efficacy and a positive attitude towards breastfeeding. The intervention was furthermore effective in lowering perceived breastfeeding barriers. This midwife-led antenatal breastfeeding education programme could be suitable for integration to routine antenatal care in health care services in Greece.
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Affiliation(s)
- Maria Iliadou
- Department of Nursing, Laboratory of Integrated Health Care, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparti, Greece.,Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Katerina Lykeridou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Panagiotis Prezerakos
- Department of Nursing, Laboratory of Integrated Health Care, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparti, Greece
| | - Emma Marie Swift
- Faculty of Nursing, Department of Midwifery, University of Iceland, Reykjavik, Iceland
| | - Styliani G Tziaferi
- Department of Nursing, Laboratory of Integrated Health Care, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparti, Greece
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Yasuhi I, Soda T, Yamashita H, Urakawa A, Izumi M, Kugishima Y, Umezaki Y. The effect of high-intensity breastfeeding on postpartum glucose tolerance in women with recent gestational diabetes. Int Breastfeed J 2017; 12:32. [PMID: 28725256 PMCID: PMC5513345 DOI: 10.1186/s13006-017-0123-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/03/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although breastfeeding is expected to reduce the incidence of diabetes in women with gestational diabetes, the effect has not been clearly confirmed. We examined whether or not high-intensity breastfeeding reduces the incidence of abnormal glucose tolerance and investigated the effect of high-intensity breastfeeding on insulin resistance during the first year postpartum in Japanese women with current gestational diabetes. METHODS In this retrospective study, we included women with gestational diabetes who underwent postpartum 75 g oral glucose tolerance test during the first year (12-14 months) postpartum from 2009 to 2011 at a single tertiary perinatal care center in Japan. High-intensity breastfeeding was defined as the condition in which infants were fed by breastfeeding alone or 80% or more of the volume. We investigated the effect of high-intensity breastfeeding on the prevalence of postpartum abnormal glucose tolerance and the postpartum homeostasis model of assessment of insulin resistance (HOMA-IR), after controlling for confounders, including prepregnancy obesity and weight changes during pregnancy and postpartum. RESULTS Among 88 women with gestational diabetes, 46 (52%) had abnormal glucose tolerance during the postpartum period. High-intensity breastfeeding women (n = 70) were significantly less likely to have abnormal glucose tolerance than non-high-intensity breastfeeding women (n = 18) (46% vs. 78%, p = 0.015). High-intensity breastfeeding was also associated with a lower HOMA-IR at 12-14 months postpartum than non-high-intensity breastfeeding (1.41 ± 1.02 vs. 2.28 ± 1.05, p = 0.035). Those associations remained significant after controlling for confounders. At least six months of high-intensity breastfeeding had a significant effect on lowering both the abnormal glucose tolerance prevalence and HOMA-IR compared with non-high-intensity breastfeeding. CONCLUSIONS In Japanese women with gestational diabetes, high-intensity breastfeeding ≥6 months had a protective effect against the development of abnormal glucose tolerance during the first year postpartum through improving insulin resistance, independent of obesity and postpartum weight change.
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Affiliation(s)
- Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Tomoko Soda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Atsuko Urakawa
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Mihoko Izumi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Yukari Kugishima
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
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Infant and young child feeding patterns in Kuwait: results of a cross-sectional survey. Public Health Nutr 2017; 20:2201-2207. [PMID: 28676134 DOI: 10.1017/s1368980017001094] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The beneficial role of breast-feeding for maternal and child health is now well established. Its possible role in helping to prevent diabetes and obesity in children in later life means that more attention must be given to understanding how patterns of infant feeding are changing. The present study describes breast-feeding profiles and associated factors in Kuwait. Design/Setting/Subjects Interviews with 1484 recent mothers were undertaken at immunisation clinics across Kuwait. Descriptive analysis and binary logistic regression of results were performed. RESULTS Rates of breast-feeding initiation in Kuwait were high (98·1 %) but by the time of discharge from hospital, only 36·5 % of mothers were fully breast-feeding, 37·0 % were partially breast-feeding and 26·5 % were already fully formula-feeding. Multiple social and health reasons were given for weaning the child, with 87·6 % of mothers who had stopped breast-feeding completely doing so within 3 months postpartum. Nationality (P<0·001), employment status 6 months prior to delivery (P<0·001), mode of delivery (P=0·01), sex of the child (P=0·026) and breast-feeding information given by nurses (P=0·026) were all found to be significantly associated with breast-feeding. Few women (5·6 %) got information on infant nutrition and feeding from nursing staff, but those who did were 2·54 times more likely to be still breast-feeding at discharge from hospital. Over 70 % of mothers had enjoyed breast-feeding and 74 % said they would be very likely to breast-feed again. CONCLUSIONS In Kuwait where the prevalence of both obesity and type 2 diabetes is growing rapidly, the public health role of breast-feeding must be recognised and acted upon more than it has in the past.
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Breastfeeding Initiation Associated With Reduced Incidence of Diabetes in Mothers and Offspring. Obstet Gynecol 2017; 128:1095-1104. [PMID: 27741196 DOI: 10.1097/aog.0000000000001689] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine associations between breastfeeding initiation and subsequent diabetes among First Nations (indigenous people in Canada who are not Métis or Inuit) and non-First Nations mothers and their offspring with and without gestational diabetes mellitus (GDM). METHODS This retrospective database study included 334,553 deliveries (1987-2011) in Manitoba with up to 24 years of follow-up for diabetes using population-based databases. Information of breastfeeding initiation before hospital discharge was obtained from hospital abstracts recorded by nurses in postpartum wards. Cox proportional hazard models were applied to examine the association between breastfeeding initiation and risk of diabetes in mothers and their offspring. RESULTS Breastfeeding initiation was recorded in 83% of non-First Nations mothers and 56% of First Nations mothers (P<.001). Breastfeeding initiation was associated with a reduced risk of incident (later developed) diabetes in non-First Nations mothers without GDM (hazard ratio [HR] 0.73 [or -27% of risk], 95% confidence interval [CI] 0.68-0.79), non-First Nations mothers with GDM (HR 0.78 or -22% of risk, CI 0.69-0.89), First Nations mothers without GDM (HR 0.89 or -11% of risk, CI 0.81-0.98), and First Nations mothers with GDM (HR 0.82 or -18% of risk, CI 0.73-0.92) with 24 years of follow-up or less. With 24 years of follow-up or less, breastfeeding initiation was associated with a 17% lower risk of youth-onset type 2 diabetes in offspring (HR 0.83, CI 0.69-0.99, P=.038). The association between breastfeeding initiation and subsequent diabetes in mothers and offspring was independent of family income, rural residence, First Nations status, GDM, parity, gestational hypertension, and age of the mother. CONCLUSION Breastfeeding initiation is associated with a reduced risk of diabetes among women and their offspring in Manitoba. The results suggest that breastfeeding might be a potentially modifiable factor to reduce the risk of diabetes in both First Nations and non-First Nations women and children.
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Abstract
PURPOSE Low birth weight (BW) and low ponderal index (PI) are associated with increased risk of type 2 diabetes mellitus. This study has two purposes: first to investigate the influence of PI on the risk of gestational diabetes mellitus (GDM); second, to study the association between glucose metabolism and BW in women with previous GDM. METHODS GDM cohort: 185 women with GDM in 1978-1996, attending a follow-up study in 2000-2002. Control cohort: 1137 women from a population-based diabetes screening study (Inter99) in a neighbouring county in 1999-2001. BW and birth length were collected from the original midwifery records. BW and PI were stratified into tertiles for analysis. RESULTS PI in the lower tertiles was associated with an increased risk of GDM [odds ratio 1.59 (95% confidence interval 1.07-2.36, p = 0.021)]. Among women with previous GDM, the area under the curve (AUC) for plasma levels of glucose and insulin during an OGTT was highest for the lower tertiles of BW (for AUCglucose p = 0.048, for AUCinsulin p = 0.047 adjusted for age and BMI). CONCLUSIONS Lower PI is associated with increased risk of GDM. In women with previous GDM, lower BW is associated with a more severe impairment of glucose metabolism one to two decades after the pregnancy complicated by GDM.
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Tanase‐Nakao K, Arata N, Kawasaki M, Yasuhi I, Sone H, Mori R, Ota E. Potential protective effect of lactation against incidence of type 2 diabetes mellitus in women with previous gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Res Rev 2017; 33:e2875. [PMID: 28072911 PMCID: PMC5434910 DOI: 10.1002/dmrr.2875] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 12/16/2022]
Abstract
Lactation may protect women with previous gestational diabetes mellitus (GDM) from developing type 2 diabetes mellitus, but the results of existing studies are inconsistent, ranging from null to beneficial. We aimed to conduct a systematic review to gather available evidence. Databases MEDLINE, CINAHL, PubMed, and EMBASE were searched on December 15, 2015, without restriction of language or publication year. A manual search was also conducted. We included observational studies (cross-sectional, case-control, and cohort study) with information on lactation and type 2 diabetes mellitus incidence among women with previous GDM. We excluded case studies without control data. Data synthesis was conducted by random-effect meta-analysis. Fourteen reports of 9 studies were included. Overall risk of bias using RoBANS ranged from low to unclear. Longer lactation for more than 4 to 12 weeks postpartum had risk reduction of type 2 diabetes mellitus compared with shorter lactation (OR 0.77, 95% CI 0.01-55.86; OR 0.56, 95% CI 0.35-0.89; OR 0.22, 95% CI 0.13-0.36; type 2 diabetes mellitus evaluation time < 2 y, 2-5 y, and >5 y, respectively). Exclusive lactation for more than 6 to 9 weeks postpartum also had lower risk of type 2 diabetes mellitus compared with exclusive formula (OR 0.42, 95% CI 0.22-0.81). The findings support the evidence that longer and exclusive lactation may be beneficial for type 2 diabetes mellitus prevention in women with previous GDM. However, the evidence relies only on observational studies. Therefore, further studies are required to address the true causal effect.
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Affiliation(s)
- Kanako Tanase‐Nakao
- Division of Maternal Medicine, Center for Maternal‐Fetal, Neonatal and Reproductive MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Naoko Arata
- Division of Maternal Medicine, Center for Maternal‐Fetal, Neonatal and Reproductive MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Maki Kawasaki
- Department of Health PolicyNational Center for Child Health and DevelopmentTokyoJapan
| | - Ichiro Yasuhi
- Department of Obstetrics and GynecologyNational Hospital Organization Nagasaki Medical CenterNagasakiJapan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
| | - Rintaro Mori
- Department of Health PolicyNational Center for Child Health and DevelopmentTokyoJapan
| | - Erika Ota
- Department of Health PolicyNational Center for Child Health and DevelopmentTokyoJapan
- Department of Global Health Nursing, Graduate School of Nursing SciencesSt. Luke's International UniversityTokyoJapan
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Developmental origins of type 2 diabetes: a perspective from China. Eur J Clin Nutr 2017; 71:870-880. [PMID: 28378847 DOI: 10.1038/ejcn.2017.48] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/04/2017] [Indexed: 12/20/2022]
Abstract
There has been a marked increase in the prevalence of diabetes in Asia, including China, over the last few decades. While the increased prevalence of diabetes has often been attributed to the nutritional transition associated with recent economic development, emerging data suggest that early-life exposures also play a major role in shaping developmental trajectories, and contributes to alter an individual's susceptibility to diabetes and other non-communicable diseases (NCDs). Early-life exposures such as in utero exposure to undernutrition has been consistently linked with later risk of diabetes and obesity. Furthermore, in utero exposure to maternal hyperglycemia, maternal obesity and excess gestational weight gain are all linked with increased childhood obesity and later risk of diabetes. Emerging data have also highlighted the potential link between early-feeding practices, the role of one-carbon metabolism in metabolic programming and endocrine disrupting chemicals (EDCs) with later risk of diabetes. These different developmental exposures may all be highly relevant to the current epidemic of diabetes in China. For example, the prevalence of gestational diabetes has increased markedly over the last two decades, and may contribute to the diabetes epidemic by driving macrosomia, childhood obesity and later risk of diabetes. In order to address the current burden of diabetes, a lifecourse perspective, incorporating multisectoral efforts from public health policy down to the individuals, will be needed. Several major initiatives have been launched in China as part of its national plans for NCD prevention and treatment, and the experience from these efforts would be invaluable.
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Bajaj H, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, Retnakaran R. Prior lactation reduces future diabetic risk through sustained postweaning effects on insulin sensitivity. Am J Physiol Endocrinol Metab 2017; 312:E215-E223. [PMID: 27965206 DOI: 10.1152/ajpendo.00403.2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 11/22/2022]
Abstract
Breastfeeding for ≥12 mo is recommended for optimal infant nutrition but may hold maternal benefits as well. Indeed, lactation has been associated with lower long-term risk of diabetes in the mother, but the mechanism by which it imparts sustained postweaning effects on glucose tolerance remains unclear. In this context, we postulated that lactation could potentially induce postweaning beneficial effects on glucose tolerance by modifying the natural history of insulin sensitivity and/or pancreatic β-cell function over time. Thus, in this study, we evaluated the relationships between duration of lactation [≤3 mo (n = 70), 3-12 mo (n = 140), and ≥12 mo (n = 120)] and trajectories of insulin sensitivity/resistance, β-cell function, and glycemia over the first 3 yr postpartum in a cohort of 330 women comprising the full spectrum of glucose tolerance in pregnancy, who underwent serial metabolic characterization, including oral glucose tolerance tests, at 3 mo, 1 yr, and 3 yr postpartum. The prevalence of dysglycemia (pre-diabetes/diabetes) at 3 yr postpartum was lower in women who breastfed for ≥12 mo (12.5%) than in those who breastfed for ≤3 mo (21.4%) or for 3-12 mo (25.7%)(overall P = 0.028). On logistic regression analysis, lactation for ≥12 mo independently predicted a lower likelihood of prediabetes/diabetes at 3 yr postpartum (OR = 0.37, 95% CI 0.18-0.78, P = 0.009). Notably, lactation for ≥12 mo predicted lesser worsening of insulin sensitivity/resistance (P < 0.0001), fasting glucose (P < 0.0001), and 2-h glucose (P = 0.011) over 3 yr compared with lactation ≤3 mo but no differences in β-cell function (P ≥ 0.37). It has thus emerged that adherence to current breastfeeding recommendations reduces future diabetic risk through sustained postweaning effects on insulin sensitivity/resistance but not β-cell function.
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Affiliation(s)
- Harpreet Bajaj
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Chang Ye
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anthony J Hanley
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Philip W Connelly
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mathew Sermer
- Division of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; and
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada;
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Kautzky-Willer A, Harreiter J, Bancher-Todesca D, Berger A, Repa A, Lechleitner M, Weitgasser R. [Gestational diabetes mellitus]. Wien Klin Wochenschr 2017; 128 Suppl 2:S103-12. [PMID: 27052232 DOI: 10.1007/s00508-015-0941-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and offspring. Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes (glucose: fasting > 126 mg/dl, spontaneous > 200 mg/dl or HbA1c > 6.5 % before 20 weeks of gestation). GDM is diagnosed by an oral glucose tolerance test (OGTT) or fasting glucose concentrations (> 92 mg/dl). Screening for undiagnosed type 2 diabetes at the first prenatal visit (Evidence level B) is recommended in women at increased risk using standard diagnostic criteria (high risk: history of GDM or pre-diabetes (impaired fasting glucose or impaired glucose tolerance); malformation, stillbirth, successive abortions or birth weight > 4,500 g in previous pregnancies; obesity, metabolic syndrome, age > 45 years, vascular disease; clinical symptoms of diabetes (e. g. glucosuria)). Performance of the OGTT (120 min; 75 g glucose) may already be indicated in the first trimester in some women but is mandatory between 24 and 28 gestational weeks in all pregnant women with previous non-pathological glucose metabolism (Evidence level B). Based on the results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study GDM is defined, if fasting venous plasma glucose exceeds 92 mg/dl or 1 h 180 mg/dl or 2 h 153 mg/dl after glucose loading (OGTT; international consensus criteria). In case of one pathological value a strict metabolic control is mandatory. This diagnostic approach was recently also recommended by the WHO. All women should receive nutritional counseling and be instructed in blood glucose self-monitoring and to increase physical activity to moderate intensity levels- if not contraindicated. If blood glucose levels cannot be maintained in the normal range (fasting < 95 mg/dl and 1 h after meals < 140 mg/dl) insulin therapy should be initiated as first choice. Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. After delivery all women with GDM have to be reevaluated as to their glucose tolerance by a 75 g OGTT (WHO criteria) 6-12 weeks postpartum and every 2 years in case of normal glucose tolerance (Evidence level B). All women have to be instructed about their (sevenfold increased relative) risk of type 2 diabetes at follow-up and possibilities for diabetes prevention, in particular weight management and maintenance/increase of physical activity. Monitoring of the development of the offspring and recommendation of healthy lifestyle of the children and family is recommended.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Gender Medicine Unit, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| | - Jürgen Harreiter
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Gender Medicine Unit, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Dagmar Bancher-Todesca
- Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Angelika Berger
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Andreas Repa
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Monika Lechleitner
- Abteilung für Innere Medizin, Landeskrankenhaus Hochzirl - Natters, Hochzirl, Österreich
| | - Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
- Universitätsklinik für Innere Medizin I, Landeskrankenhaus Salzburg - Universitätsklinikum, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
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78
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Moon JH, Kwak SH, Jang HC. Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus. Korean J Intern Med 2017; 32:26-41. [PMID: 28049284 PMCID: PMC5214732 DOI: 10.3904/kjim.2016.203] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023] Open
Abstract
Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.
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Affiliation(s)
- Joon Ho Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hak C. Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Nouhjah S, Shahbazian H, Shahbazian N, Jahanshahi A, Jahanfar S, Cheraghian B. Incidence and Contributing Factors of Persistent Hyperglycemia at 6-12 Weeks Postpartum in Iranian Women with Gestational Diabetes: Results from LAGA Cohort Study. J Diabetes Res 2017; 2017:9786436. [PMID: 28491872 PMCID: PMC5405388 DOI: 10.1155/2017/9786436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/19/2017] [Accepted: 01/29/2017] [Indexed: 12/31/2022] Open
Abstract
Background. A history of gestational diabetes is an important predictor of many metabolic disturbances later in life. Method. Life after gestational diabetes Ahvaz Study (LAGAs) is an ongoing population-based cohort study. Up to February 2016, 176 women with gestational diabetes underwent a 75 g oral glucose tolerance test (OGTT) at 6-12 weeks postpartum in Ahvaz (southwestern of Iran). Gestational diabetes was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and the American Diabetes Association (ADA) criteria applied for diagnosis of postpartum prediabetes and diabetes. Univariate and multivariate regression analysis were done. Results. Overall incidence of early postpartum glucose intolerance was 22.2% (95% CI, 16.3-29.0), 17.6% prediabetes (95% CI, 12.3-24.1) and 4.5% diabetes (95% CI, 2.0-8.8%). Independent risk factors for glucose intolerance were FPG ≥ 100 at the time of OGTT (OR 3.86; 95% CI; 1.60-9.32), earlier diagnosis of GDM (OR 0.92; 95% CI; 0.88-0.97), systolic blood pressure (OR 1.02; 95% CI; 1.002-1.04), and insulin or metformin therapy (OR 3.14; 95% CI; 1.20-8.21). Conclusion. Results determined a relatively high rate of glucose intolerance at 6-12 weeks after GDM pregnancy. Early postpartum screening of type 2 diabetes is needed particularly in women at high risk of type 2 diabetes.
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Affiliation(s)
- Sedigheh Nouhjah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- *Hajieh Shahbazian:
| | - Nahid Shahbazian
- Department of Obstetrics and Gynecology, Fertility, Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Jahanshahi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Internal Medicine Ward, Golestan Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shayesteh Jahanfar
- School of Health Sciences, Central Michigan University, Building 2212, Room 2239, Mount Pleasant, MI 48859, USA
| | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Stuebe AM, Bonuck K, Adatorwovor R, Schwartz TA, Berry DC. A Cluster Randomized Trial of Tailored Breastfeeding Support for Women with Gestational Diabetes. Breastfeed Med 2016; 11:504-513. [PMID: 27782758 PMCID: PMC5165668 DOI: 10.1089/bfm.2016.0069] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) and their infants are at increased risk of developing metabolic disease; however, longer breastfeeding is associated with a reduction in these risks. We tested an intervention to increase breastfeeding duration among women with GDM. MATERIALS AND METHODS We conducted a cluster randomized trial to determine the efficacy of a breastfeeding education and support program for women with GDM. Women were enrolled between 22 and 36 weeks of pregnancy and cluster randomized to an experimental lifestyle intervention or wait-list control group. Breastfeeding duration and intensity were prespecified secondary outcomes of the trial. Duration of exclusive and any breastfeeding was assessed at 6 weeks and at 4, 7, and 10 months postpartum. We quantified differences in breastfeeding rates using Kaplan-Meier estimates, log-rank tests, and Cox regression models. RESULTS We enrolled 100 women, of whom 52% were African American, 31% non-Hispanic white, 11% Hispanic, 9% American Indian or Alaskan Native, 2% Asian, 2% other, and 4% more than one race. In models accounting for within-cluster correlation and adjusted for study site, breastfeeding intention, and African American race, women allocated to the intervention group were less likely to stop breastfeeding (adjusted hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.21-0.74) or to introduce formula (adjusted HR 0.50, 95% CI 0.34-0.72). CONCLUSION Our results suggest that targeted breastfeeding education for women with GDM is feasible and efficacious. CLINICAL TRIALS REGISTRATION http://clinicaltrials.gov/ct2/show/NCT01809431.
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Affiliation(s)
- Alison M Stuebe
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine , Chapel Hill, North Carolina.,2 Department of Maternal and Child Health, Carolina Global Breastfeeding Institute , Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Karen Bonuck
- 3 Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, New York
| | - Reuben Adatorwovor
- 3 Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, New York
| | - Todd A Schwartz
- 4 Department of Biostatistics, Gillings School of Global Public Health , Chapel Hill, North Carolina.,5 School of Nursing, University of North Carolina , Chapel Hill, North Carolina
| | - Diane C Berry
- 5 School of Nursing, University of North Carolina , Chapel Hill, North Carolina
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81
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Much D, Beyerlein A, Kindt A, Krumsiek J, Stückler F, Rossbauer M, Hofelich A, Wiesenäcker D, Hivner S, Herbst M, Römisch-Margl W, Prehn C, Adamski J, Kastenmüller G, Theis F, Ziegler AG, Hummel S. Lactation is associated with altered metabolomic signatures in women with gestational diabetes. Diabetologia 2016; 59:2193-202. [PMID: 27423999 DOI: 10.1007/s00125-016-4055-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/20/2016] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Lactation for >3 months in women with gestational diabetes is associated with a reduced risk of type 2 diabetes that persists for up to 15 years postpartum. However, the underlying mechanisms are unknown. We examined whether in women with gestational diabetes lactation for >3 months is associated with altered metabolomic signatures postpartum. METHODS We enrolled 197 women with gestational diabetes at a median of 3.6 years (interquartile range 0.7-6.5 years) after delivery. Targeted metabolomics profiles (including 156 metabolites) were obtained during a glucose challenge test. Comparisons of metabolite concentrations and ratios between women who lactated for >3 months and women who lactated for ≤3 months or not at all were performed using linear regression with adjustment for age and BMI at the postpartum visit, time since delivery, and maternal education level, and correction for multiple testing. Gaussian graphical modelling was used to generate metabolite networks. RESULTS Lactation for >3 months was associated with a higher total lysophosphatidylcholine/total phosphatidylcholine ratio; in women with short-term follow-up, it was also associated with lower leucine concentrations and a lower total branched-chain amino acid concentration. Gaussian graphical modelling identified subgroups of closely linked metabolites within phosphatidylcholines and branched-chain amino acids that were affected by lactation for >3 months and have been linked to the pathophysiology of type 2 diabetes in previous studies. CONCLUSIONS/INTERPRETATION Lactation for >3 months in women with gestational diabetes is associated with changes in the metabolomics profile that have been linked to the early pathogenesis of type 2 diabetes.
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Affiliation(s)
- Daniela Much
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Alida Kindt
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jan Krumsiek
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Ferdinand Stückler
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michaela Rossbauer
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Anna Hofelich
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - David Wiesenäcker
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Pediatrics, Kinderklinik München Schwabing, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Susanne Hivner
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Melanie Herbst
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Werner Römisch-Margl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Cornelia Prehn
- Genome Analysis Center, Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jerzy Adamski
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Genome Analysis Center, Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany
| | - Gabi Kastenmüller
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Fabian Theis
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
- Forschergruppe Diabetes e.V., Neuherberg, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
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Shi M, Liu ZL, Steinmann P, Chen J, Chen C, Ma XT, Han SH. Medical nutrition therapy for pregnant women with gestational diabetes mellitus—A retrospective cohort study. Taiwan J Obstet Gynecol 2016; 55:666-671. [DOI: 10.1016/j.tjog.2016.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 01/11/2023] Open
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Ingram ER, Robertson IK, Ogden KJ, Dennis AE, Campbell JE, Corbould AM. Utility of antenatal clinical factors for prediction of postpartum outcomes in women with gestational diabetes mellitus (GDM). Aust N Z J Obstet Gynaecol 2016; 57:272-279. [DOI: 10.1111/ajo.12514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/05/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Emily R. Ingram
- School of Medicine and School of Health Sciences; Faculty of Health; University of Tasmania; Launceston Tasmania Australia
| | - Iain K. Robertson
- School of Medicine and School of Health Sciences; Faculty of Health; University of Tasmania; Launceston Tasmania Australia
| | - Kathryn J. Ogden
- School of Medicine and School of Health Sciences; Faculty of Health; University of Tasmania; Launceston Tasmania Australia
| | - Amanda E. Dennis
- School of Medicine and School of Health Sciences; Faculty of Health; University of Tasmania; Launceston Tasmania Australia
- Women's and Children's Service; Launceston General Hospital; Launceston Tasmania Australia
| | - Joanne E. Campbell
- John Morris Diabetes Centre; Launceston General Hospital; Launceston Tasmania Australia
| | - Anne M. Corbould
- School of Medicine and School of Health Sciences; Faculty of Health; University of Tasmania; Launceston Tasmania Australia
- John Morris Diabetes Centre; Launceston General Hospital; Launceston Tasmania Australia
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84
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Köhler M, Ziegler AG, Beyerlein A. Development of a simple tool to predict the risk of postpartum diabetes in women with gestational diabetes mellitus. Acta Diabetol 2016; 53:433-7. [PMID: 26482741 DOI: 10.1007/s00592-015-0814-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
AIMS Women with gestational diabetes mellitus (GDM) have an increased risk of diabetes postpartum. We developed a score to predict the long-term risk of postpartum diabetes using clinical and anamnestic variables recorded during or shortly after delivery. METHODS Data from 257 GDM women who were prospectively followed for diabetes outcome over 20 years of follow-up were used to develop and validate the risk score. Participants were divided into training and test sets. The risk score was calculated using Lasso Cox regression and divided into four risk categories, and its prediction performance was assessed in the test set. RESULTS Postpartum diabetes developed in 110 women. The computed training set risk score of 5 × body mass index in early pregnancy (per kg/m(2)) + 132 if GDM was treated with insulin (otherwise 0) + 44 if the woman had a family history of diabetes (otherwise 0) - 35 if the woman lactated (otherwise 0) had R (2) values of 0.23, 0.25, and 0.33 at 5, 10, and 15 years postpartum, respectively, and a C-Index of 0.75. Application of the risk score in the test set resulted in observed risk of postpartum diabetes at 5 years of 11 % for low risk scores ≤140, 29 % for scores 141-220, 64 % for scores 221-300, and 80 % for scores >300. CONCLUSIONS The derived risk score is easy to calculate, allows accurate prediction of GDM-related postpartum diabetes, and may thus be a useful prediction tool for clinicians and general practitioners.
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Affiliation(s)
- M Köhler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - A G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes e.V., Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - A Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
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85
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Schmidt MI, Duncan BB, Castilhos C, Wendland EM, Hallal PC, Schaan BD, Drehmer M, Costa E Forti A, Façanha C, Nunes MA. Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil): study protocol for a multicenter randomized controlled trial. BMC Pregnancy Childbirth 2016; 16:68. [PMID: 27029489 PMCID: PMC4812654 DOI: 10.1186/s12884-016-0851-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 03/17/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM), a hyperglycemic state detected during pregnancy, is an established risk factor for diabetes. However, treatment during pregnancy in and of itself is not able to eliminate this risk, and a considerable fraction of women with GDM will develop frank diabetes in the decade following pregnancy. Our aim is to conduct a multicenter randomized controlled trial to investigate the effectiveness of a lifestyle intervention program implemented after a pregnancy complicated by GDM in delaying or preventing the development of type 2 diabetes. METHODS Women aged 18 or older identified as having recent GDM are recruited and followed by telephone to assess eligibility for the trial. To be eligible, women must have used insulin during pregnancy or present intermediate hyperglycemia postpartum. Women are encouraged to enter the trial as early as 10 weeks, and are permitted to do so up to 2 years after a pregnancy with GDM. An estimated 740 women will be randomized to either conventional care or to coach-based interventions focused on breastfeeding, weight loss, healthy eating, and increased physical activity, and predominantly delivered by telephone. Women are followed annually to detect new onset diabetes, the primary outcome, and additional secondary outcomes which include reversion to normoglycemia, weight loss, physical activity and fitness, and insulin resistance. DISCUSSION Though previous studies have demonstrated that type 2 diabetes can be delayed or prevented, no study has yet demonstrated the feasibility and effectiveness of similar interventions implemented in the postpartum period for women with recent GDM. If shown to be successful, this approach could become an important means of preventing diabetes in primary care settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02327286; Registered 23 December 2014.
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Affiliation(s)
- Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil. .,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Eliana Márcia Wendland
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Department of Collective Health, Federal University of Health Sciences, Porto Alegre, RS, Brazil
| | - Pedro C Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Beatriz D'Agord Schaan
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Studies Program in Endocrinology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Michele Drehmer
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Adriana Costa E Forti
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Integrated Center for Diabetes and Hypertension, Ceará State Health Department, Fortaleza, Ceará, Brazil
| | - Cristina Façanha
- Integrated Center for Diabetes and Hypertension, Ceará State Health Department, Fortaleza, Ceará, Brazil.,School of Medicine, Centro Universitário Unichristus, Fortaleza, Ceará, Brazil
| | - Maria Angélica Nunes
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil
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86
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Bedeutung des Stillens für diabetische Mütter und ihre Kinder. DIABETOLOGE 2016. [DOI: 10.1007/s11428-015-0053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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87
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Choi MJ, Chung CW. Patterns of Diagnosis and Risk Factors for Type 2 Diabetes in Women with a History of Gestational Diabetes Mellitus. ACTA ACUST UNITED AC 2016. [DOI: 10.16952/pns.2016.13.1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mi Jin Choi
- Graduate Student, College of Nursing, Seoul National University, Seoul, Korea
| | - Chae Weon Chung
- Professor, College of Nursing, Seoul National University, Seoul, Korea
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Jonas W, Woodside B. Physiological mechanisms, behavioral and psychological factors influencing the transfer of milk from mothers to their young. Horm Behav 2016; 77:167-81. [PMID: 26232032 DOI: 10.1016/j.yhbeh.2015.07.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 07/12/2015] [Accepted: 07/23/2015] [Indexed: 12/13/2022]
Abstract
This article is part of a Special Issue "Parental Care".Producing milk to support the growth of their young is a central element of maternal care in mammals. In spite of the facts that ecological constraints influence nursing frequency, length of time until weaning and the composition of milk, there is considerable similarity in the anatomy and physiology of milk production and delivery across mammalian species. Here we provide an overview of cross species variation in nursing patterns and milk composition as well as the mechanisms underlying mammary gland development, milk production and letdown. Not all women breastfeed their infants, thus in later sections we review studies of factors that facilitate or impede the initiation and duration of breastfeeding. The results of these investigations suggest that the decisions to initiate and maintain breastfeeding are influenced by an array of personal, social and biological factors. Finally, studies comparing the development of breastfed and formula fed infants as well as those investigating associations between breastfeeding, maternal health and mother/infant interaction are reviewed. Leading health agencies including the World Health Organization and CDC advocate breastfeeding for at least the first 6months postpartum. To achieve these rates will require not only institutional support but also a focus on individual mother/infant dyads and their experience.
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Affiliation(s)
- Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Fraser Mustard Institute of Human Development, University of Toronto, Toronto, Canada
| | - Barbara Woodside
- Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada.
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Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, Dewey KG, Azevedo RA, Young S, Fox G, Elmasian CC, Salvador N, Lum M, Sternfeld B, Quesenberry CP. Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study. Ann Intern Med 2015; 163:889-98. [PMID: 26595611 PMCID: PMC5193135 DOI: 10.7326/m15-0807] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain. OBJECTIVE To evaluate lactation and the 2-year incidence of DM after GDM pregnancy. DESIGN Prospective, observational cohort of women with recent GDM. (ClinicalTrials.gov: NCT01967030). SETTING Integrated health care system. PARTICIPANTS 1035 women diagnosed with GDM who delivered singletons at 35 weeks' gestation or later and enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy from 2008 to 2011. MEASUREMENTS Three in-person research examinations from 6 to 9 weeks after delivery (baseline) and annual follow-up for 2 years that included 2-hour, 75-g oral glucose tolerance testing; anthropometry; and interviews. Multivariable Weibull regression models evaluated independent associations of lactation measures with incident DM adjusted for potential confounders. RESULTS Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years later; 113 (11.8%) developed incident DM. There were graded inverse associations for lactation intensity at baseline with incident DM and adjusted hazard ratios of 0.64, 0.54, and 0.46 for mostly formula or mixed/inconsistent, mostly lactation, and exclusive lactation versus exclusive formula feeding, respectively (P trend = 0.016). Time-dependent lactation duration showed graded inverse associations with incident DM and adjusted hazard ratios of 0.55, 0.50, and 0.43 for greater than 2 to 5 months, greater than 5 to 10 months, and greater than 10 months, respectively, versus 0 to 2 months (P trend = 0.007). Weight change slightly attenuated hazard ratios. LIMITATION Randomized design is not feasible or desirable for clinical studies of lactation. CONCLUSION Higher lactation intensity and longer duration were independently associated with lower 2-year incidences of DM after GDM pregnancy. Lactation may prevent DM after GDM delivery. PRIMARY FUNDING SOURCE National Institute of Child Health and Human Development.
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Affiliation(s)
- Erica P. Gunderson
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Shanta R. Hurston
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Xian Ning
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Joan C. Lo
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Yvonne Crites
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - David Walton
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Kathryn G. Dewey
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Robert A. Azevedo
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Stephen Young
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Gary Fox
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Cathie C. Elmasian
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Nora Salvador
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Michael Lum
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Barbara Sternfeld
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
| | - Charles P. Quesenberry
- From Kaiser Permanente Northern California and the Permanente Medical Group, Oakland, and University of California, Davis, Davis, California
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Stuebe A. Associations Among Lactation, Maternal Carbohydrate Metabolism, and Cardiovascular Health. Clin Obstet Gynecol 2015; 58:827-39. [PMID: 26457850 PMCID: PMC4968698 DOI: 10.1097/grf.0000000000000155] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In mammalian reproductive physiology, lactation follows pregnancy; growing evidence suggests that disruption of this physiology affects a woman's lifetime risk of metabolic disease. These differences may reflect lactation-induced mobilization of fat stores and modulation of maternal stress reactivity. In addition, confounders may play a role: women who breastfeed for long durations are more likely to engage in other healthy behaviors, and obesity and insulin resistance may interfere with breastfeeding physiology. These findings underscore the importance of evidenced-based care to enable women to achieve their infant feeding goals.
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Affiliation(s)
- Alison Stuebe
- *Maternal-Fetal Medicine, University of North Carolina School of Medicine †Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, North Carolina
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91
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Fallon A, Dunne F. Breastfeeding practices that support women with diabetes to breastfeed. Diabetes Res Clin Pract 2015; 110:10-17. [PMID: 26278351 DOI: 10.1016/j.diabres.2015.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 12/01/2022]
Abstract
The aim of this literature review was to identify breastfeeding practices that support women with diabetes to breastfeed. A search was undertaken of CINAHL and Medline databases to identify studies that inform breastfeeding practice for women with diabetes. This resulted in 14 studies (19 records). Most studies focused on women with GDM and T1D with some consideration of T2D. The review has been organised using Maslow's Hierarchy of Needs, to enable a clear focus on the needs of women while identifying supportive practices. The key findings of this review are that breastfeeding as the first feed and exclusive breastfeeding are beneficial to meeting physiological needs. Preparations such as having food nearby and having someone to call on can help meet the woman's safety and security needs. A sense of love and belonging is supported by the practice of an early first breastfeed, but antenatal breast milk expression is currently not recommended. The woman's self-esteem can be enhanced through informed multidisciplinary support. Finally, self-actualisation or success with breastfeeding has been achieved by women with diabetes. Common breastfeeding concerns rather than diabetes have been identified as reasons for cessation of breastfeeding. Practices that support women deal with these concerns are recommended.
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Affiliation(s)
- Anne Fallon
- School of Nursing and Midwifery, Aras Moyola, National University of Ireland Galway, Galway, Ireland.
| | - Fidelma Dunne
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland; Galway Diabetes Research Centre (GDRC), National University of Ireland Galway, Galway, Ireland.
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92
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Bardenheier BH, Imperatore G, Gilboa SM, Geiss LS, Saydah SH, Devlin HM, Kim SY, Gregg EW. Trends in Gestational Diabetes Among Hospital Deliveries in 19 U.S. States, 2000-2010. Am J Prev Med 2015; 49:12-9. [PMID: 26094225 PMCID: PMC4532269 DOI: 10.1016/j.amepre.2015.01.026] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/23/2015] [Accepted: 01/30/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Diabetes is one of the most common and fastest-growing comorbidities of pregnancy. Temporal trends in gestational diabetes mellitus (GDM) have not been examined at the state level. This study examines GDM prevalence trends overall and by age, state, and region for 19 states, and by race/ethnicity for 12 states. Sub-analysis assesses trends among GDM deliveries by insurance type and comorbid hypertension in pregnancy. METHODS Using the Agency for Healthcare Research and Quality's National and State Inpatient Databases, deliveries were identified using diagnosis-related group codes for GDM and comorbidities using ICD-9-CM diagnosis codes among all community hospitals. General linear regression with a log-link and binomial distribution was used in 2014 to assess annual change in GDM prevalence from 2000 through 2010. RESULTS The age-standardized prevalence of GDM increased from 3.71 in 2000 to 5.77 per 100 deliveries in 2010 (relative increase, 56%). From 2000 through 2010, GDM deliveries increased significantly in all states (p<0.01), with relative increases ranging from 36% to 88%. GDM among deliveries in 12 states reporting race and ethnicity increased among all groups (p<0.01), with the highest relative increase in Hispanics (66%). Among GDM deliveries in 19 states, those with pre-pregnancy hypertension increased significantly from 2.5% to 4.1% (relative increase, 64%). The burden of GDM delivery payment shifted from private insurers (absolute decrease of 13.5 percentage points) to Medicaid/Medicare (13.2-percentage point increase). CONCLUSIONS Results suggest that GDM deliveries are increasing. The highest rates of increase are among Hispanics and among GDM deliveries complicated by pre-pregnancy hypertension.
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Affiliation(s)
- Barbara H Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion.
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Suzanne M Gilboa
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Linda S Geiss
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Sharon H Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Heather M Devlin
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Shin Y Kim
- Division for Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
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93
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Interventions to modify the progression to type 2 diabetes mellitus in women with gestational diabetes: a systematic review of literature. Curr Opin Obstet Gynecol 2015; 26:476-86. [PMID: 25333677 DOI: 10.1097/gco.0000000000000127] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Gestational diabetes mellitus (GDM) increases the lifetime risk of developing type 2 diabetes mellitus (T2DM) in the mother. We undertook a systematic review to assess the effectiveness of interventions that delay or prevent the onset of T2DM in women with previous gestational diabetes. RECENT FINDINGS Diet and lifestyle interventions show differing effects on women with GDM and their long-term risk of T2DM. Pharmacological interventions, such as metformin, appear to have a beneficial role. Breastfeeding may have a protective role by reducing the risk of progression to T2DM. The findings were limited by the small number of heterogeneous studies that varied in their population, intervention, outcome and duration of follow-up. SUMMARY Women with GDM should be informed about the future risk of T2DM and the potential benefit with lifestyle interventions. Further studies are needed prior to routine use of metformin as a preventive strategy for T2DM in women with GDM.
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94
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Stuebe AM. Does breastfeeding prevent the metabolic syndrome, or does the metabolic syndrome prevent breastfeeding? Semin Perinatol 2015; 39:290-5. [PMID: 26187772 PMCID: PMC4516665 DOI: 10.1053/j.semperi.2015.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In mammalian physiology, lactation follows pregnancy. Disruption of this physiology is associated with long-term adverse maternal health outcomes, including higher risks of later-life obesity, type 2 diabetes, metabolic syndrome, hypertension, and cardiovascular disease. Multiple mechanisms likely contribute to these associations, including the metabolic demands of breastfeeding, modulation of stress reactivity, and confounding by other health behaviors. At the same time, evidence suggests that maternal metabolic health entering pregnancy affects lactation performance. In this paradigm, adverse lactation outcomes may be a marker for underlying maternal disease risk. Understanding these relationships has important clinical and policy implications for women's health.
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Morrison M, Collins C, Lowe J, Giglia R. Factors associated with early cessation of breastfeeding in women with gestational diabetes mellitus. Women Birth 2015; 28:143-7. [DOI: 10.1016/j.wombi.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/04/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022]
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96
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Valizadeh M, Alavi N, Mazloomzadeh S, Piri Z, Amirmoghadami H. The risk factors and incidence of type 2 diabetes mellitus and metabolic syndrome in women with previous gestational diabetes. Int J Endocrinol Metab 2015; 13:e21696. [PMID: 25892996 PMCID: PMC4386229 DOI: 10.5812/ijem.21696] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/19/2014] [Accepted: 12/20/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) affects nearly 5% of pregnancies. Significant proportion of the women with previous GDM develops type 2 diabetes mellitus (T2DM) in the next years, which indicates a higher risk in them than in the general population. OBJECTIVES We conducted this study to determine the risk factors and incidence of abnormal glucose level and metabolic syndrome (MetS) in women with a history of GDM in a long period after delivery in our region. PATIENTS AND METHODS We extracted the demographic characteristics of 110 women with GDM who had delivered during 2004 - 2010 in three main hospitals of Zanjan City, Iran. The patients were recalled to perform oral glucose tolerance test (OGTT) and other necessary tests for MetS diagnosis. Anthropometric measurements were recorded of all the participants. RESULTS In this study, 110 women with a history of GDM were studied at one to six years since delivery. Among these women, 36 (32.7%) developed T2DM and 11 (10%) had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Moreover, 22 women (20%) had developed MetS. among those with abnormal results in glycemic test, 93.6% had fasting blood sugar (FBS) ≥ 95 mg/dL (≥ 5.27 mmol/L)at the time of GDM diagnosis in the index pregnancy that was significantly higher than the normal glycemic test (NGT) group with 42.9% being affected (OR, 19.55; P < 0.0001). There was a significant difference between those with abnormal results and NGT group in interval between delivery and performing laboratory tests (27 ± 18.8 and 18.5 ± 17.7 months, respectively; OR, 1.02; P = 0.02). No insulin use during pregnancy was discovered as a protective factor in women with a history of GDM (OR, 0.35; P = 0.01). Those with abnormal results were significantly different from NGT group in the number of parities (2.61 ± 1.4 vs. 2.05 ± 1.1, respectively; OR, 1.4; P = 0.03). The most common component of MetS among women with a history of GDM was FBS > 100 mg/dL (> 5.55 mmol/L). CONCLUSIONS Regarding the high incidence of the T2DM and MetS among women with a history of GDM, they should be screened at a regular interval for diabetes and other cardiovascular risk factors.
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Affiliation(s)
- Majid Valizadeh
- Metabolic Disease Research Center, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Nooshin Alavi
- Metabolic Disease Research Center, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Saeideh Mazloomzadeh
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Zahra Piri
- Student Research Committee, Zanjan University of Medical Sciences, Zanjan, IR Iran
- Corresponding author: Zahra Piri, Student Research Committee, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, IR Iran. Tel: +98-9128205320, E-mail:
| | - Hamidreza Amirmoghadami
- Medical Laboratory ,Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, IR Iran
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97
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Su Y, Zhang Y. Identification of biological processes and genes for gestational diabetes mellitus. Arch Gynecol Obstet 2015; 292:635-40. [PMID: 25736406 DOI: 10.1007/s00404-015-3649-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/03/2015] [Indexed: 01/03/2023]
Abstract
AIM Gestational diabetes mellitus (GDM) is one of the most usual complications of pregnancy, while the correlations between genes and their known biological processes need to be further elucidated. METHODS In the current study, microarray data GSE2956 containing a list of 435 significantly modified genes (differentially expressed genes, DEGs) were used. Genes that correspond to official gene symbols were chosen and were functional annotated for Gene Ontology (GO) and pathway analyses (p ≤ 0.05). Then, the protein-protein interaction (PPI) network and the sub network were constructed and analyzed (combined score ≥0.4). RESULTS A total of 405 DEGs including 239 up-regulated and 166 down-regulated genes were screened, and they were found mainly related to adhesion and motion, stimulus-response, and wound healing, etc. Besides, a PPI network containing 217 nodes and 644 lines was obtained. Hub genes including fibronectin 1 (FN1) and insulin-like growth factor 1 (IGF1) were down-regulated, and leptin (LEP) and calmodulin 1 (CALM1) were up-regulated. Three modules in the PPI network were mined and similar functional terms enriched by DEGs of these modules were obtained. CONCLUSION GO terms relevant to translation and metabolic process and their related genes CREB1, ribosomal proteins and LEP, still the inflammation-related proteins (e.g., IGF1 and CALM1) and cell adhesion-related protein FN1 may work together and be essential for GDM. This study provides insight into the cooperative interactions of metabolism and immune responses and the pathogenesis of GDM.
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Affiliation(s)
- Yile Su
- Department of Obstetrics and gynecology, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, Wuhan, 430071, China
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98
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Hod M, Hadar E, Cabero-Roura L. Prevention of type 2 diabetes among women with prior gestational diabetes mellitus. Int J Gynaecol Obstet 2015; 131 Suppl 1:S16-8. [PMID: 26433497 DOI: 10.1016/j.ijgo.2015.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The morbidity and mortality rates related to diabetes are constantly rising, as well as those for other noncommunicable diseases. The epidemic is spreading throughout the world, in both low- and high-resource countries. Prevention is a key aspect in the battle against the disease and obstetricians play a critical role in the fight. Prevention starts in utero-for the diabetic mother, her infant, and future generations. The postpartum period should not be neglected because it provides another window of opportunity to address prevention. Data on the prevention of type 2 diabetes among women diagnosed with gestational diabetes are discussed.
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Affiliation(s)
- Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Luis Cabero-Roura
- Department of Obstetrics, Hospital Universitari Valld'Hebron, Universitat Autonoma, Barcelona, Spain.
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99
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Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. [Endocrinologic diseases management during breastfeeding]. Med Clin (Barc) 2015; 144:73-9. [PMID: 25073822 DOI: 10.1016/j.medcli.2014.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/16/2014] [Accepted: 04/24/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Pilar Serrano Aguayo
- Unidad de Endocrinología y Nutrición, IBCLC, Hospital Virgen del Rocío, Sevilla, España
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100
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Park S, Kim SH. Women with rigorously managed overt diabetes during pregnancy do not experience adverse infant outcomes but do remain at serious risk of postpartum diabetes. Endocr J 2015; 62:319-27. [PMID: 25735969 DOI: 10.1507/endocrj.ej14-0529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We retrospectively detected overt diabetes during pregnancy (ODMP) using a modified IADPSG definition and assessed whether ODMP increases the risk of developing maternal and neonatal complications and postpartum diabetes in Korean pregnant women. According to the definition of IADPSG, ODMP pregnant women were defined and 71 ODMP, 1781 gestational diabetes mellitus (GDM) and and 463 non-GDM pregnant women were included in a hospital-based study. Their blood glucose levels were tightly regulated by modifying lifestyles and insulin treatment. The pregnancy outcomes and postpartum glucose tolerances were determined among the non-GDM, GDM and ODMP groups. The ODMP women had higher plasma glucose levels after overnight-fasting and at 2 h after 100 g OGTT challenge as well as higher overnight-fasted plasma insulin and HbA1c levels than GDM women. HbA1c levels at delivery were close to the normal range in both GDM and ODMP groups. Most pregnancy outcomes such as Apgar score and the rate of preterm delivery were not significantly different among three groups. Only the rate of large for gestational age (LGA) was greater in the ODMP group than other groups. However, about 73% of ODMP women remained diabetic at 6-8 week postpartum as compared to 4.3% of GDM. The development of postpartum diabetes was also associated with postpartum waist circumferences and duration of breast feeding. In conclusion, ODMP women in this study maintained tight control of glucose homeostasis and did not experience serious adverse outcomes except for LGA infants; however most ODMP women still had postpartum glucose dysregulation.
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Affiliation(s)
- Sunmin Park
- Department of Food & Nutrition, Hoseo University, Asan 336-795, Korea
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