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Mackin ST, Nelson SM, Wild SH, Colhoun HM, Wood R, Lindsay RS. Factors associated with stillbirth in women with diabetes. Diabetologia 2019; 62:1938-1947. [PMID: 31353418 PMCID: PMC6731193 DOI: 10.1007/s00125-019-4943-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS Stillbirth risk is increased in pregnancy complicated by diabetes. Fear of stillbirth has major influence on obstetric management, particularly timing of delivery. We analysed population-level data from Scotland to describe timing of stillbirths in women with diabetes and associated risk factors. METHODS A retrospective cohort of singleton deliveries to mothers with type 1 (n = 3778) and type 2 diabetes (n = 1614) from 1 April 1998 to 30 June 2016 was analysed using linked routine care datasets. Maternal and fetal characteristics, HbA1c data and delivery timing were compared between stillborn and liveborn groups. RESULTS Stillbirth rates were 16.1 (95% CI 12.4, 20.8) and 22.9 (95% CI 16.4, 31.8) per 1000 births in women with type 1 (n = 61) and type 2 diabetes (n = 37), respectively. In women with type 1 diabetes, higher HbA1c before pregnancy (OR 1.03 [95% CI 1.01, 1.04]; p = 0.0003) and in later pregnancy (OR 1.06 [95% CI 1.04, 1.08]; p < 0.0001) were associated with stillbirth, while in women with type 2 diabetes, higher maternal BMI (OR 1.07 [95% CI 1.01, 1.14]; p = 0.02) and pre-pregnancy HbA1c (OR 1.02 [95% CI 1.00, 1.04]; p = 0.016) were associated with stillbirth. Risk was highest in infants with birthweights <10th centile (sixfold higher born to women with type 1 diabetes [n = 5 stillbirths, 67 livebirths]; threefold higher for women with type 2 diabetes [n = 4 stillbirths, 78 livebirths]) compared with those in the 10th-90th centile (n = 20 stillbirths, 1685 livebirths). Risk was twofold higher in infants with birthweights >95th centile born to women with type 2 diabetes (n = 15 stillbirths, 402 livebirths). A high proportion of stillborn infants were male among mothers with type 2 diabetes (81.1% vs 50.5% livebirths, p = 0.0002). A third of stillbirths occurred at term, with highest rates in the 38th week (7.0 [95% CI 3.7, 12.9] per 1000 ongoing pregnancies) among mothers with type 1 diabetes and in the 39th week (9.3 [95% CI 2.4, 29.2]) for type 2 diabetes. CONCLUSIONS/INTERPRETATION Maternal blood glucose levels and BMI are important modifiable risk factors for stillbirth in diabetes. Babies at extremes of weight centiles are at most risk. Many stillbirths occur at term and could potentially be prevented by change in routine care and delivery policies.
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Affiliation(s)
- Sharon T Mackin
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | | | - Sarah H Wild
- Usher Institute of Population Health Science and Informatics, University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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152
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Dandjinou M, Sheehy O, Bérard A. Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case-control study. BMJ Open 2019; 9:e025908. [PMID: 31575566 PMCID: PMC6830475 DOI: 10.1136/bmjopen-2018-025908] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the association between antidepressant (AD) classes, types and duration of use during pregnancy and the risk of gestational diabetes mellitus (GDM). DESIGN AND SETTING A nested case-control study was conducted within the Quebec Pregnancy Cohort (QPC), a Canadian provincial database which includes data on all pregnancies and children in Quebec from January 1998 to December 2015. PRIMARY OUTCOME MEASURES Gestational diabetes mellitus. PARTICIPANTS Cases of GDM were identified after week 20 of pregnancy and randomly matched 1:10 to controls on gestational age at index date (ie, calendar date of GDM) and year of pregnancy. AD exposure was assessed by filled prescriptions between the beginning of pregnancy (first day of last menstrual period) and index date. Conditional logistic regression models were used to estimate crude and adjusted odds ratios (aOR). RESULTS Among 20 905 cases and 209 050 matched controls, 9741 (4.2%) women were exposed to ADs. When adjusting for potential confounders, AD use was associated with an increased risk of GDM (aOR 1.19, 95% CI 1.08 to 1.30); venlafaxine (aOR 1.27, 95% CI 1.09 to 1.49) and amitriptyline (aOR 1.52, 95% CI 1.25 to 1.84) were also associated with an increased risk of GDM. Moreover, the risk of GDM was increased with longer duration of AD use, specifically for serotonin norepinephrine reuptake inhibitors, tricyclic ADs and combined use of two AD classes. No statistically significant association was observed for selective serotonin reuptake inhibitors. CONCLUSION The findings suggest that ADs-and specifically venlafaxine and amitriptyline-were associated with an increased risk of GDM.
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Affiliation(s)
- Maëlle Dandjinou
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Odile Sheehy
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Anick Bérard
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
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153
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Lipscombe LL, Delos-Reyes F, Glenn AJ, de Sequeira S, Liang X, Grant S, Thorpe KE, Price JAD. The Avoiding Diabetes After Pregnancy Trial in Moms Program: Feasibility of a Diabetes Prevention Program for Women With Recent Gestational Diabetes Mellitus. Can J Diabetes 2019; 43:613-620. [PMID: 31669188 DOI: 10.1016/j.jcjd.2019.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/12/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Our aim in this study was to evaluate the feasibility of a home-based diabetes prevention program, delivered by interdisciplinary certified diabetes educators (CDEs), and customized for postpartum women with recent gestational diabetes mellitus (GDM). METHODS This pilot randomized trial recruited women with GDM from 24 to 40 weeks gestation from 4 centres, and trained 10 CDEs in behaviour coaching, physical activity (PA) and low glycemic index education. Women were randomized after 3 months postpartum to standard care (1 visit) or 1 of 3 24-week coaching interventions (1 visit and 12 telephone calls): i) PA and diet, ii) PA only or iii) diet only. Feasibility outcomes included recruitment, retention, adherence and satisfaction. RESULTS Of 1,342 eligible patients, 392 were actively invited (29.3%) and 227 (16.9%) consented. Of these, 149 (65.6%) were randomized postpartum, of whom 131 (87.9%) started the program and 105 (70.5%) attended the final assessment. Intervention arm participants completed a median 75% (interquartile range, 50% to 92%) of telephone calls. Visit and call duration were a mean 71.4 (standard deviation, 13.8) and 18.1 (standard deviation, 6.5) minutes, respectively. Participants reported excellent/very good satisfaction 73% of the time, and 87% would recommend the program to others. CONCLUSIONS A home-based diabetes prevention program customized for postpartum women with GDM can be feasibly delivered by CDEs, and it is associated with >70% retention, adherence and satisfaction.
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Affiliation(s)
- Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Faith Delos-Reyes
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea J Glenn
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie de Sequeira
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Xinyun Liang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shannan Grant
- Department of Applied Human Nutrition, Mount St Vincent's University, Halifax, Nova Scotia, Canada; Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jennifer A D Price
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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154
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Kwong W, Ray JG, Wu W, Feig DS, Lowe J, Lipscombe LL. Perinatal Outcomes Among Different Asian Groups With Gestational Diabetes Mellitus in Ontario: A Cohort Study. Can J Diabetes 2019; 43:606-612. [PMID: 31492620 DOI: 10.1016/j.jcjd.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether perinatal outcomes differ between Caucasian and Asian subgroups of women with gestational diabetes mellitus (GDM) through use of standard vs ethnicity-specific birthweight curves. METHODS This retrospective cohort study included 537 women with GDM, within the ethnically diverse province of Ontario, Canada. Study outcomes included large-for-gestational-age (LGA) and small-for-gestational-age (SGA) birthweights in newborns of women from prevalent Asian ethnic groups compared with newborns of Caucasian women. Odds ratios were adjusted for maternal age, parity, prepregnancy body mass index, gestational weight gain and insulin use in pregnancy. RESULTS Of the 537 women participing in the study, 228 (35.8%) were Caucasian, 109 (17.1%) South Asian, 141 (22.1%) East Asian and 59 (9.3%) Filipino. Using standard birthweight curves, compared with Caucasian women, the risk of LGA was lower among South Asian (adjusted odds ratio [aOR], 0.065; 95% confidence interval [CI], 0.01 to 0.49) and East Asian (aOR, 0.36; 95% CI, 0.14 to 0.95) women. The aOR for SGA was notably higher among South Asian women (aOR, 2.96; 95% CI, 1.24 to 7.09). Significant effects were not seen among Filipino women. Use of ethnicity-specific birthweight curves largely attenuated these associations, except for LGA in South Asian mothers (aOR, 0.27; 95% CI, 0.09 to 0.81). CONCLUSION South Asian women with GDM are at lower risk of having an LGA newborn, even after accounting for maternal risk factors or the use of an ethnicity-specific birthweight curve.
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Affiliation(s)
- Wilson Kwong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sinai Health System, Toronto, Ontario, Canada
| | - Julia Lowe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
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Abstract
PURPOSE OF REVIEW Diabetes affects an increasing number of pregnancies. Regular exercise is recommended for pregnant women without diabetes, but whether exercise during pregnancy also benefits women with gestational diabetes (GDM) or preexisting (type 1 or type 2) diabetes or if these women have any specific risks is unclear. RECENT FINDINGS Recent evidence suggests that low- to moderate-intensity exercise improves blood glucose and may delay insulin initiation for women with GDM. Exercise is also safe, with no reports of increased maternal or neonatal complications. Few studies evaluated exercise as adjunct therapy for pregnant women with preexisting diabetes, precluding a thorough assessment in this population. Low- to moderate-intensity exercise during pregnancy safely improves glycemic control among women with GDM. More studies are needed to evaluate the impact of exercise in pregnant women with preexisting diabetes. Whether a specific type, volume, or timing of activity is most effective is not known.
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Affiliation(s)
- Tricia M Peters
- Lady Davis Research Institute, Centre for Clinical Epidemiology, and Division of Endocrinology, Jewish General Hospital, 3755 Côte Ste-Catherine, H-450, Montreal, QC, H3T 1E2, Canada.
| | - Anne-Sophie Brazeau
- McGill University School of Human Nutrition, Sainte-Anne-de-Bellevue, QC, Canada
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156
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Vézina-Im LA, Nicklas TA, Baranowski T. Intergenerational Effects of Health Issues Among Women of Childbearing Age: a Review of the Recent Literature. Curr Nutr Rep 2019; 7:274-285. [PMID: 30259413 DOI: 10.1007/s13668-018-0246-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the latest scientific evidence, primarily from systematic reviews/meta-analyses and large cohort studies, on the impact of health issues among women of childbearing age and their effect on their offspring during pregnancy and from birth to adulthood. RECENT FINDINGS Women of childbearing age with overweight/obesity, diabetes, and hypertension prior to pregnancy are at increased risk for adverse outcomes during pregnancy, such as excessive gestational weight gain, gestational diabetes mellitus, and hypertensive disorders of pregnancy. These adverse outcomes could complicate delivery and put their offspring at risk of developing overweight/obesity, diabetes, and hypertension (i.e., intergenerational transmission of health issues). Interventions should target women of childbearing age, especially those who wish to conceive, in order to possibly stop the transmission of women's health issues to the offspring and favor a healthy pregnancy from the start. This could be one of the best strategies to promote both maternal and child health.
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Affiliation(s)
- Lydi-Anne Vézina-Im
- Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030, USA.
| | - Theresa A Nicklas
- Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030, USA
| | - Tom Baranowski
- Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030, USA
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157
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Neimark E, Wainstock T, Sheiner E, Fischer L, Pariente G. Long-term cardiovascular hospitalizations of small for gestational age (SGA) offspring born to women with and without gestational diabetes mellitus (GDM) ‡. Gynecol Endocrinol 2019; 35:518-524. [PMID: 30626227 DOI: 10.1080/09513590.2018.1541233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess whether delivery of small for gestational age (SGA) neonates to mothers with gestational diabetes mellitus (GDM) increases the risk of long-term cardiovascular offspring hospitalizations compared to SGA neonates born to mothers without GDM. STUDY DESIGN This is a population-based retrospective cohort study. The study group was SGA offspring born to mothers with GDM (n = 259), while the control group was SGA offspring born to mothers without GDM (n = 9053). The main factor evaluated was offspring cardiovascular hospitalizations up to the age of 18 years. Kaplan-Meier survival curve was used to estimate cumulative incidence of cardiovascular hospitalizations. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for cardiovascular hospitalizations. RESULTS SGA children born to mothers with GDM had significantly higher rates of cardiovascular-related hospitalizations (1.9% vs. 0.7%, p = .026). A Kaplan-Meier survival curve demonstrated that SGA children born to GDM mothers had a higher cumulative incidence of cardiovascular hospitalizations (log-rank p = .037). The Cox regression model, while controlling for confounders, demonstrated that delivery of SGA neonates to mothers with GDM is independently associated with long-term cardiovascular offspring hospitalizations (adjusted HR =2.6; 95% CI 1.02-6.55 p = .045). CONCLUSION Delivery of SGA neonates born to mothers with GDM is independently associated with long-term cardiovascular offspring hospitalizations.
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Affiliation(s)
- Eli Neimark
- a Department of Obstetrics and Gynecology , Soroka University Medical, Center Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Tamar Wainstock
- b Department of Public Health Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Eyal Sheiner
- a Department of Obstetrics and Gynecology , Soroka University Medical, Center Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Laura Fischer
- a Department of Obstetrics and Gynecology , Soroka University Medical, Center Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Gali Pariente
- a Department of Obstetrics and Gynecology , Soroka University Medical, Center Ben-Gurion University of the Negev , Beer-Sheva , Israel
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158
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Berger H, Melamed N, Murray-Davis B, Hasan H, Mawjee K, Barrett J, McDonald SD, Geary M, Ray JG. Prevalence of Pre-Pregnancy Diabetes, Obesity, and Hypertension in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1579-1588.e2. [PMID: 30914233 DOI: 10.1016/j.jogc.2019.01.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Pre-existing diabetes mellitus (D), obesity (O), and chronic hypertension (H) can each alter the natural course of pregnancy, especially when they cluster together. Because the prevalence of various combinations of D, O, and H is unknown, the current study was undertaken. METHODS This population-based cross-sectional study included 506 483 singleton and twin live birth and stillbirth deliveries in Ontario, occurring at ≥20 weeks gestation. All hospital births from 2012 to 2016 were identified in the Better Outcomes Registry and Network information system. The prevalence per 1000 births (95% confidence interval [CI]) of D, O, and H and their combinations were calculated. Prevalence estimates were stratified by twin and singleton gestations, maternal age, parity, and ethnicity (Canadian Task Force Classification II-2). RESULTS During the study period, 5493 women (10.8 per 1000 births; 95% CI 10.6-11.1) had D, 90,177 (178.2; 95% CI 177.0-179.3) had O, and 5667 (11.2; 95% CI 10.9-11.5) had H. The prevalence per 1000 of DO was 4.8, DH 1.0, and OH 5.5, whereas 359 women (0.71 per 1000) had all three. D and H each linearly increased with rising maternal age, along with their combinations, and to some degree with higher parity. The combination of O and H was highest among women of Black ancestry (14.5 per 1000) and lowest among those of Asian ancestry (3.0 per 1000). CONCLUSION D, O, and H are common conditions in pregnancy, both alone and in various combinations. These data can be used to assess the impact of each state on perinatal health.
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Affiliation(s)
- Howard Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON.
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Beth Murray-Davis
- Department of Obstetrics and Gynecology, Midwifery Education Program, McMaster University, Hamilton, ON
| | - Haroon Hasan
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON
| | - Karizma Mawjee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Jon Barrett
- Department of Obstetrics and Gynecology, Midwifery Education Program, McMaster University, Hamilton, ON
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON; Department of Radiology, McMaster University, Hamilton, ON; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON
| | - Michael Geary
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Joel G Ray
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON; Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, ON
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159
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Hildén K, Hanson U, Persson M, Magnuson A, Simmons D, Fadl H. Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden. Diabet Med 2019; 36:151-157. [PMID: 30698864 PMCID: PMC6590111 DOI: 10.1111/dme.13843] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate the interaction effects of gestational diabetes (GDM) with obesity on perinatal outcomes. METHODS A population-based cohort study in Sweden excluding women without pre-gestational diabetes with a singleton birth between 1998 and 2012. Logistic regression was performed to evaluate the potential independent associations of GDM and BMI with adverse perinatal outcomes as well as their interactions. Main outcome measures were malformations, stillbirths, perinatal mortality, low Apgar score, fetal distress, prematurity and Erb's palsy. RESULTS Some 1,294,006 women were included, with a GDM prevalence of 1% (n = 14,833). The rate of overweight/obesity was 67.7% in the GDM-group and 36.1% in the non-GDM-group. No significant interaction existed. Offspring of women with GDM had significantly increased risk of malformations, adjusted odds ratio (aOR) 1.16 (95% confidence intervals 1.06-1.26), prematurity, aOR 1.86 (1.76-1. 98), low Apgar score, aOR 1.36 (1.10-1.70), fetal distress, aOR 1.09 (1.02-1.16) and Erb's palsy aOR 2.26 (1.79-2.86). No risk for stillbirth or perinatal mortality was seen. Offspring of overweight (BMI 25-29.9 kg/m2 ), obese (BMI 30-34.9 kg/m2 ) and severely obese women (BMI ≥ 35.0 kg/m2 ) had significantly increased risks of all outcomes including stillbirth 1.51 (1.40-1.62) to 2.85 (2.52-3.22) and perinatal mortality 1.49 (1.40-1.59) to 2.83 (2.54-3.15). CONCLUSIONS There is no interaction effect between GDM and BMI for the studied outcomes. Higher BMI and GDM are major independent risk factors for most serious adverse perinatal outcomes. More effective pre-pregnancy and antenatal interventions are required to prevent serious adverse pregnancy outcomes among women with either GDM or high BMI.
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Affiliation(s)
- K. Hildén
- Department of Obstetrics & GynaecologySchool of Medical SciencesÖrebro UniversityÖrebroSweden
| | - U. Hanson
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - M. Persson
- Department of MedicineClinical Epidemiology UnitKarolinska UniversitetssjukhusetSolnaSweden
| | - A. Magnuson
- Clinical Epidemiology and BiostatisticsSchool of Medical SciencesÖrebro UniversityÖrebroSweden
| | - D. Simmons
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- School of MedicineWestern Sydney UniversityCampbelltownNSWAustralia
| | - H. Fadl
- Department of Obstetrics & GynaecologySchool of Medical SciencesÖrebro UniversityÖrebroSweden
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160
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The Ethics of Perinatal Care for Black Women: Dismantling the Structural Racism in "Mother Blame" Narratives. J Perinat Neonatal Nurs 2019; 33:108-115. [PMID: 31021935 DOI: 10.1097/jpn.0000000000000394] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Perinatal and neonatal nurses have a critical role to play in effectively addressing the disproportionate prevalence of adverse pregnancy outcomes experienced by black childbearing families. Upstream inequities in maternal health must be better understood and addressed to achieve this goal. The importance of maternal health before, during, and after pregnancy is illustrated with the growing and inequitable prevalence of 2 common illnesses, pregestational diabetes and chronic hypertension, and 2 common conditions during and after pregnancy, gestational diabetes and preterm birth. New care models are needed and must be structured on appropriate ethical principles for serving black families in partnership with nurses. The overarching purpose of this article is to describe the ethics of perinatal care for black women; to discuss how social determinants of health, health disparities, and health inequities affecting women contribute to poor outcomes among their children; and to provide tools to dismantle structural racism specific to "mother blame" narratives." Finally, strategies are presented to enhance the provision of ethical perinatal care for black women by nurses.
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161
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Britton LE, Berry DC, Hussey JM. Comorbid hypertension and diabetes among U.S. women of reproductive age: Prevalence and disparities. J Diabetes Complications 2018; 32:1148-1152. [PMID: 30291018 PMCID: PMC6289742 DOI: 10.1016/j.jdiacomp.2018.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/23/2018] [Indexed: 12/11/2022]
Abstract
AIMS Diabetes is associated with significant pregnancy complications, which can be further exacerbated by comorbid hypertension. Racial/ethnic differentials in the burden of comorbid hypertension and diabetes among women of reproductive age have not been described. METHODS Using Wave IV of the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health), we analyzed survey and biological data from 6576 non-pregnant women who were aged 24-32 in 2007-2008. Hypertension and diabetes were identified by self-report of diagnosis and biological measurements taken during in-home interviews. We used logistic regression models to predict the presence of comorbid hypertension and diabetes and whether each was diagnosed. RESULTS Over a third (36.0%) of women with diabetes had comorbid hypertension. Compared to non-Hispanic white women, more non-Hispanic black women had comorbid hypertension and diabetes (adjusted odds ratio (aOR) 5.93, 95% CI 3.84-9.16), and, if comorbid, were less likely to have a diabetes diagnosis (aOR 0.03, 95% CI 0.007-0.1) or hypertension diagnosis (aOR 0.22, 95% CI 0.08-0.65). CONCLUSION Comorbid hypertension and diabetes are more common among non-Hispanic black women and less likely to be diagnosed, signaling disparities threatening maternal and child health among women with diabetes.
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Affiliation(s)
- Laura E Britton
- University of North Carolina at Chapel Hill, School of Nursing, Campus Box 7460, Chapel Hill, North Carolina 27599-7460, United States.
| | - Diane C Berry
- University of North Carolina at Chapel Hill, School of Nursing, Campus Box 7460, Chapel Hill, North Carolina 27599-7460, United States.
| | - Jon M Hussey
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Campus Box 7445, Chapel Hill, North Carolina 27599-7445, United States.
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163
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Pintaudi B, Fresa R, Dalfrà M, Dodesini AR, Vitacolonna E, Tumminia A, Sciacca L, Lencioni C, Marcone T, Lucisano G, Nicolucci A, Bonomo M, Napoli A. The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study. Acta Diabetol 2018; 55:1261-1273. [PMID: 30221320 DOI: 10.1007/s00592-018-1208-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/06/2018] [Indexed: 01/10/2023]
Abstract
AIMS To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. METHODS Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. RESULTS Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59-3.87), large for gestational age (OR 3.99, 95% CI 2.40-6.63), fetal malformation (OR 2.66, 95% CI 1.00-7.18), and respiratory distress (OR 4.33, 95% CI 1.33-14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00-2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04-3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02-2.27) and obesity (OR 1.62, 95% CI 1.04-2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21-2.33 for obese; OR 1.38 95% CI 1.03-1.87 for overweight). CONCLUSIONS A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity.
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Affiliation(s)
- Basilio Pintaudi
- SSD Diabetes Unit, Niguarda Cà Granda Hospital, 20162, Milan, Italy.
| | - Raffaella Fresa
- Endocrinology and Diabetes Unit, ASL Salerno, Salerno, Italy
| | | | | | - Ester Vitacolonna
- Department of Medicine and Aging, D'Annunzio University, Chieti-Pescara, Italy
| | - Andrea Tumminia
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
| | - Laura Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
| | | | | | | | | | - Matteo Bonomo
- SSD Diabetes Unit, Niguarda Cà Granda Hospital, 20162, Milan, Italy
| | - Angela Napoli
- S. Andrea Hospital, Sapienza University, Rome, Italy
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164
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Buse JD, Donovan LE, Naugler CT, Sadrzadeh SMH, de Koning L. Intervention to Reduce Unnecessary Glucose Tolerance Testing in Pregnant Women. J Appl Lab Med 2018; 3:418-428. [PMID: 33636922 DOI: 10.1373/jalm.2018.026047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/04/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) can be diagnosed in pregnant women by increased fasting plasma glucose alone, which eliminates the need for performing a 75 g oral glucose tolerance test (OGTT). If whole blood glucose meters are used to triage fasting samples in order to decide whether to give the glucose drink, a cutpoint with appropriate sensitivity and specificity for elevated fasting plasma glucose is needed. METHODS The number of GDM diagnoses by increased fasting plasma glucose alone was determined from specimens collected and tested at core laboratories in urban hospitals, rural health centers, and from specimens collected at patient phlebotomy service centers (PSCs) for plasma testing at a central laboratory. The number of glucose drinks avoided was counted after implementing the diagnostic cutoff of ≥95 mg/dL (5.3 mmol/L) at urban hospitals and rural health centers, which have on-site plasma testing, and after selecting a PSC meter fasting venous whole blood glucose cutpoint after calculating sensitivity and specificity for plasma glucose ≥95 mg/dL (5.3 mmol/L) using logistic regression. RESULTS Among 4850 OGTTs, there were 1315 GDM diagnoses annually, of which 409 were from increased fasting plasma glucose. Ninety-one percent of OGTTs were performed at PSCs. If a fasting plasma glucose cutpoint of ≥95 mg/dL (5.3 mmol/L) was implemented at urban hospitals and rural health centers and a meter fasting venous whole blood glucose cutpoint of ≥108 mg/dL (6.0 mmol/L) (25% sensitivity, 99.9% specificity) was implemented at PSCs, the drink would be appropriately avoided by 145 patients/year, and inappropriately avoided by 3 patients/year. After implementing these cutpoints, the drink was appropriately avoided in 91 patients during a 36-week period, with none inappropriately avoiding it. CONCLUSION Modifying fasting glucose cutpoints reduced unnecessary diagnostic OGTTs in pregnant women.
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Affiliation(s)
- Joshua D Buse
- Department of Analytical Toxicology, Calgary Laboratory Services, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lois E Donovan
- Diabetes in Pregnancy Clinic, Calgary Zone, Alberta Health Services Division of Endocrinology and Metabolism, and the Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher T Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S M Hossein Sadrzadeh
- Department of Analytical Toxicology, Calgary Laboratory Services, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence de Koning
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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165
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Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational Diabetes Mellitus: Mechanisms, Treatment, and Complications. Trends Endocrinol Metab 2018; 29:743-754. [PMID: 30297319 DOI: 10.1016/j.tem.2018.09.004] [Citation(s) in RCA: 416] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy. The prevalence is rising and correlates with the increase in maternal obesity over recent decades. The etiology of GDM is complex, with genetic and environmental factors implicated in mechanistic and epidemiological studies. GDM begets important short- and long-term health risks for the mother, developing fetus, and offspring. This includes the high likelihood of subsequent maternal type 2 diabetes (T2DM), and possible adverse cardiometabolic phenotypes in the offspring. The most clinically and cost-effective methods of screening for GDM remain uncertain. Whilst treatments with lifestyle and pharmacological interventions have demonstrated short-term benefits, the long-term impact for the offspring of intrauterine exposure to antidiabetic medication remains unclear.
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MESH Headings
- Diabetes Complications/etiology
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/drug therapy
- Diabetes, Gestational/etiology
- Female
- Humans
- Hypertension, Pregnancy-Induced/etiology
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Infant, Newborn
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/pathology
- Infant, Newborn, Diseases/physiopathology
- Obstetric Labor Complications/etiology
- Pregnancy
- Prenatal Exposure Delayed Effects/chemically induced
- Prenatal Exposure Delayed Effects/metabolism
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Affiliation(s)
- Emma C Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK; BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.
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166
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Zipori Y, Lauterbach R, Matanes E, Beloosesky R, Weiner Z, Weissman A. Vaginal progesterone for the prevention of preterm birth and the risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2018; 230:6-9. [DOI: 10.1016/j.ejogrb.2018.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/20/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
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167
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McCarthy EA, Williamson R, Shub A. Pregnancy outcomes for women with pre‐pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review. Aust N Z J Obstet Gynaecol 2018; 59:183-194. [DOI: 10.1111/ajo.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Elizabeth A. McCarthy
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
- Department of Perinatal MedicineMercy Hospital for Women Melbourne Victoria Australia
| | - Rebecca Williamson
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
| | - Alexis Shub
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
- Mercy Hospital for Women Melbourne Victoria Australia
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168
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Beyerlein A, Lack N, von Kries R. No further improvement in pregnancy-related outcomes in the offspring of mothers with pre-gestational diabetes in Bavaria, Germany, between 2001 and 2016. Diabet Med 2018; 35:1420-1424. [PMID: 29797595 DOI: 10.1111/dme.13691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/27/2022]
Abstract
AIMS To investigate whether there has been further improvement in the risk of adverse outcomes in pregnancies in women with diabetes during 2008-2016 in Bavaria, Germany. METHODS Using cross-sectional data on all 1716 170 deliveries in Bavarian hospitals between 2001 and 2016, we assessed the risks of stillbirth, early neonatal death, preterm delivery, large for gestational age, malformations, low Apgar score and low umbilical cord pH by maternal group with diabetes (gestational, pre-gestational, or none) separately for 2001-2007 and 2008-2016. We also investigated the associations of specific risk factors such as maternal smoking with respect to early mortality and malformations in each group with diabetes during 2008-2016. RESULTS No further reduction in the risk for any adverse outcome in mothers with pre-gestational diabetes and their offspring during 2008-2016 was observed. Maternal smoking, multiple delivery and substandard antenatal care were the strongest additional predictors of both early perinatal mortality and malformations for mothers with pre-gestational diabetes. The respective risks were lower and also decreased over time for mothers with gestational diabetes. CONCLUSIONS No significant improvement has been achieved in the management of pregnancies affected by pre-gestational diabetes during the last decade. The apparent risk reductions in women with gestational diabetes may partly be due to a change in diagnostic criteria over time. Women with pre-gestational diabetes who smoke, carry more than one child, or are not regularly seen during pregnancy, may need particular attention.
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Affiliation(s)
- A Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - N Lack
- German Bavarian Quality Assurance Institute for Medical Care, Munich, Germany
| | - R von Kries
- Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Munich, Germany
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169
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Keely E, Berger H, Feig DS. New Diabetes Canada Clinical Practice Guidelines for Diabetes and Pregnancy - What's Changed? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1484-1489. [PMID: 30274918 DOI: 10.1016/j.jogc.2018.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/23/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, ON; The Ottawa Hospital, Ottawa, ON.
| | - Howard Berger
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Maternal Fetal Medicine, St. Michael's Hospital, Toronto, ON
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, On, Canada; Mount Sinai Hospital, Toronto, ON
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170
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Abstract
Diabetes is a common chronic condition in women of reproductive age. Preconception care is crucial to reducing the risk of adverse maternal and fetal outcomes, such as hypertensive disorders, abnormal fetal growth, traumatic delivery and stillbirth, associated with poor glycemic control. Insulin is the preferred medication to optimize glucose control in women with pregestational diabetes. Frequent dose adjustments are needed during pregnancy to achieve glycemic goals, and team-based multidisciplinary care may help. Postpartum care should include lactation support, counseling on contraceptive options, and transition to primary care.
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Affiliation(s)
- Ronan Sugrue
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Chloe Zera
- Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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171
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Emeruwa UN, Zera C. Optimal Obstetric Management for Women with Diabetes: the Benefits and Costs of Fetal Surveillance. Curr Diab Rep 2018; 18:96. [PMID: 30194499 DOI: 10.1007/s11892-018-1058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To elaborate on the risks and benefits associated with antenatal fetal surveillance for stillbirth prevention in women with diabetes. RECENT FINDINGS Women with pregestational diabetes have a 3- to 5-fold increased odds of stillbirth compared to women without diabetes. The stillbirth risk in women with gestational diabetes (GDM) is more controversial; while recent data suggest the odds for stillbirth are approximately 50% higher in women with GDM at term (37 weeks and beyond) than in those without GDM, it is unclear if this risk is seen in women with optimal glycemic control. Current professional society guidelines are broad with respect to fetal testing strategies and delivery timing in women with diabetes. The data supporting strategies to reduce the risk of stillbirth in women with diabetes are limited. Antepartum fetal surveillance should be performed to reduce stillbirth rates; however, the optimal test, frequency of testing, and delivery timing are not yet clear. Future studies of obstetric management for women with diabetes should consider not just individual but also system level costs and benefits associated with antenatal surveillance.
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Affiliation(s)
- Ukachi N Emeruwa
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, ASB 1-3, Boston, MA, 02115, USA.
| | - Chloe Zera
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
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172
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Pitchika A, Vehik K, Hummel S, Norris JM, Uusitalo UM, Yang J, Virtanen SM, Koletzko S, Andrén Aronsson C, Ziegler AG, Beyerlein A. Associations of Maternal Diabetes During Pregnancy with Overweight in Offspring: Results from the Prospective TEDDY Study. Obesity (Silver Spring) 2018; 26:1457-1466. [PMID: 30226003 PMCID: PMC6146413 DOI: 10.1002/oby.22264] [Citation(s) in RCA: 16] [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: 04/04/2018] [Accepted: 07/02/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to determine the relationship between different forms of, and potential pathways between, maternal diabetes and childhood obesity at different ages. METHODS Prospective cohort data from The Environmental Determinants of Diabetes in the Young (TEDDY) study, which was composed of 5,324 children examined from 0.25 to 6 years of age, were analyzed. Cross-sectional and longitudinal analyses taking into account potential confounders and effect modifiers such as maternal prepregnancy BMI and birth weight z scores were performed. RESULTS Offspring of mothers with gestational diabetes mellitus (GDM) or type 1 diabetes mellitus (T1DM) showed a higher BMI standard deviation score and increased risk for overweight and obesity at 5.5 years of age than offspring of mothers without diabetes. While these associations could be substantially explained by maternal prepregnancy BMI in offspring of mothers with GDM, significant associations disappeared after adjustment for birth weight z scores in offspring of T1DM mothers. Furthermore, overweight risk became stronger with increasing age in offspring of mothers with diabetes compared with offspring of mothers without diabetes. CONCLUSIONS Maternal diabetes is associated with increased risk of offspring overweight, and the association appears to get stronger as children grow older. Indeed, intrauterine exposure to maternal T1DM may predispose children to later obesity through increased birth weight, while maternal BMI is more important in children exposed to GDM.
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Affiliation(s)
- Anitha Pitchika
- Institute of Diabetes Research, Helmhtoltz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V, Helmhtoltz Zentrum München, Munich, Germany
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Sandra Hummel
- Institute of Diabetes Research, Helmhtoltz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V, Helmhtoltz Zentrum München, Munich, Germany
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ulla M Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Suvi M Virtanen
- Unit of Nutrition, National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Sibylle Koletzko
- Dr. v. Hauner Children's Hospital, University Medical Center, LMU, Munich, Germany
| | - Carin Andrén Aronsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital SUS, Malmö, Sweden
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmhtoltz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V, Helmhtoltz Zentrum München, Munich, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmhtoltz Zentrum München, Munich, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V, Helmhtoltz Zentrum München, Munich, Germany
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173
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Murphy HR. Intensive Glycemic Treatment During Type 1 Diabetes Pregnancy: A Story of (Mostly) Sweet Success! Diabetes Care 2018; 41:1563-1571. [PMID: 29936423 DOI: 10.2337/dci18-0001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 02/03/2023]
Abstract
Studies from Scotland and Canada confirm large increases in the incidence of pregnancies complicated by pregestational type 1 diabetes (T1D). With this increased antenatal workload comes more specialization and staff expertise, which may be important as diabetes technology use increases. While euglycemia remains elusive and obstetrical intervention (earlier delivery, increased operative deliveries) is increasing, there have been some notable successes in the past 5-10 years. These include a decline in the rates of congenital anomaly (Canada) and stillbirths (U.K.) and substantial reductions in both maternal hypoglycemia (both moderate and severe) across many countries. However, pregnant women with T1D still spend ∼30-45% of the time (8-11 h/day) hyperglycemic during the second and third trimesters. The duration of maternal hyperglycemia appears unchanged in routine clinical care over the past decade. This ongoing fetal exposure to maternal hyperglycemia likely explains the persistent rates of large for gestational age (LGA), neonatal hypoglycemia, and neonatal intensive care unit (NICU) admissions in T1D offspring. The Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found that pregnant women using real-time continuous glucose monitoring (CGM) spent 5% less time (1.2 h/day) hyperglycemic during the third trimester, with clinically relevant reductions in LGA, neonatal hypoglycemia, and NICU admissions. This article will review the progress in our understanding of the intensive glycemic treatment of T1D pregnancy, focusing in particular on the recent technological advances in CGM and automated insulin delivery. It suggests that even with advanced diabetes technology, optimal maternal dietary intake is needed to minimize the neonatal complications attributed to postprandial hyperglycemia.
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Affiliation(s)
- Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, U.K. .,Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K. .,Department of Women & Children's Health, King's College London, London, U.K.
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174
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Assalino M, Podetta M, Demuylder-Mischler S, Francini K, Pernin N, Randin JP, Bosco D, Andres A, Berney T. Successful pregnancy and delivery after simultaneous islet-kidney transplantation. Am J Transplant 2018; 18:2075-2078. [PMID: 29673064 DOI: 10.1111/ajt.14884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 01/25/2023]
Abstract
Allogeneic islet of Langerhans transplantation is a recognized beta-cell replacement therapy for patients affected by type 1 diabetes mellitus. Type 1 diabetes mellitus is a condition associated with an increased risk of adverse outcomes for pregnant women and fetuses. We report the case of a 29-year-old woman with type 1 diabetes mellitus, who underwent successful allogeneic islet transplantation with simultaneous kidney transplantation. She achieved durable insulin independence after 2 islet infusions. Pregnancy was desired and planned 2 years after the last islet infusion. Multidisciplinary monitoring of pregnancy was carried out and the immunosuppressive regimen was adapted. Euglycemia was maintained throughout pregnancy without the need for exogenous insulin. After an uneventful pregnancy, she delivered on term an otherwise healthy male child with imperforate anus that was immediately surgically corrected. In conclusion, allogeneic islet transplantation is a suitable treatment for women of childbearing age with complicated type 1 diabetes mellitus, allowing physiologic glycemic control during pregnancy with a low risk of graft loss. This target can be achieved only by a tight multidisciplinary follow-up, including immunosuppressive therapy adaptation and adequate diabetes and obstetrical monitoring.
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Affiliation(s)
- Michela Assalino
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Michele Podetta
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Katyuska Francini
- Departement "Femme-Mère-Enfant", Lausanne University Hospital, Lausanne, Switzerland
| | - Nadine Pernin
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva School of Medicine, Geneva, Switzerland
| | | | - Domenico Bosco
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva School of Medicine, Geneva, Switzerland
| | - Axel Andres
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Thierry Berney
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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175
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Muñoz MP, Valdés M, Muñoz-Quezada MT, Lucero B, Rubilar P, Pino P, Iglesias V. Urinary Inorganic Arsenic Concentration and Gestational Diabetes Mellitus in Pregnant Women from Arica, Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071418. [PMID: 29976896 PMCID: PMC6069383 DOI: 10.3390/ijerph15071418] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/25/2022]
Abstract
Introduction: The association of total arsenic exposure with impaired glucose tolerance and gestational diabetes has been shown; however, evidence regarding urinary inorganic arsenic in pregnant women is still limited. Our aim was to evaluate the association between urinary inorganic arsenic concentration and gestational diabetes among pregnant women living in Arica, Chile. Methods: Cross-sectional study of pregnant women receiving care at primary health centers in urban Arica. The exposure was urinary inorganic arsenic concentration, while gestational diabetes was the outcome. The association was evaluated using multiple logistic regression models adjusted by age, education level, ethnicity, and pre-pregnancy body mass index. Results: 244 pregnant women were surveyed. The median urinary inorganic arsenic was 14.95 μg/L, and the prevalence of gestational diabetes was 8.6%. After adjusting, we did not find a significant association between gestational diabetes and inorganic arsenic exposure tertiles (Odds ratio (OR) 2.98, 95% CI = 0.87–10.18), (OR 1.07, 95% CI = 0.26–4.33). Conclusion: This study did not provide evidence on the relationship between urinary inorganic arsenic concentration and gestational diabetes. Further research is needed to elucidate the factors underlying this association.
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Affiliation(s)
- María Pía Muñoz
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, 8380453 Santiago, Chile.
| | - Macarena Valdés
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, 8380453 Santiago, Chile.
| | | | - Boris Lucero
- Facultad de Ciencias de la Salud, Universidad Católica del Maule, 3480112 Talca, Chile.
| | - Paola Rubilar
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, 8380453 Santiago, Chile.
| | - Paulina Pino
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, 8380453 Santiago, Chile.
| | - Verónica Iglesias
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, 8380453 Santiago, Chile.
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176
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Borsari L, Malagoli C, Werler MM, Rothman KJ, Malavolti M, Rodolfi R, De Girolamo G, Nicolini F, Vinceti M. Joint Effect of Maternal Tobacco Smoking and Pregestational Diabetes on Preterm Births and Congenital Anomalies: A Population-Based Study in Northern Italy. J Diabetes Res 2018; 2018:2782741. [PMID: 30050951 PMCID: PMC6046136 DOI: 10.1155/2018/2782741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 12/21/2022] Open
Abstract
Smoking and pregestational diabetes (PGD) are recognized risk factors for adverse pregnancy outcomes, but to date, no population-based study has investigated their joint effects. Using hospital discharges, we identified all women with PGD delivering in Emilia-Romagna region during 2007-2010 matched 1 : 5 with parturients without diabetes. Our study endpoints were preterm births and congenital anomalies. We measured interaction between PGD and maternal smoking, by calculating excess prevalence and prevalence ratio due to interaction, relative excess risk due to interaction (RERI), attributable proportion (AP), and the synergy index (S). Analyses were performed in the overall study population and in the subgroup whose PGD was validated through diabetes registers. The study included 992 women with PGD (10.5% smokers) and 4788 comparison women (11.9% smokers). The effects of PGD and maternal tobacco smoking were greater than additive for both preterm birth (excess prevalence due to interaction = 11.7%, excess ratio due to interaction = 1.5, RERI = 2.39, AP = 0.51, S = 2.82) and congenital anomalies (excess prevalence due to interaction = 2.2%, excess ratio due to interaction = 1.3, RERI = 1.33, AP = 0.49, S = 5.03). Joint effect on both endpoints was confirmed in the subgroup whose PGD status was validated. In conclusion, we found that maternal tobacco smoking and PGD intensify each other's effect on preterm birth and congenital anomalies.
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Affiliation(s)
- Lucia Borsari
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Carlotta Malagoli
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Martha M. Werler
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Kenneth J. Rothman
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Research Triangle Institute, Research Triangle Park, NC 27709, USA
| | - Marcella Malavolti
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Rossella Rodolfi
- Local Health Authority of Reggio Emilia, Reggio Emilia 42122, Italy
| | - Gianfranco De Girolamo
- Department of Public Health, Unit of Epidemiology and Risk Communication, Local Health Authority of Modena, Modena 41126, Italy
| | - Fausto Nicolini
- Local Health Authority of Reggio Emilia, Reggio Emilia 42122, Italy
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia, Modena 41125, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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177
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Amed S, Islam N, Sutherland J, Reimer K. Incidence and prevalence trends of youth-onset type 2 diabetes in a cohort of Canadian youth: 2002-2013. Pediatr Diabetes 2018; 19:630-636. [PMID: 29280255 DOI: 10.1111/pedi.12631] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/23/2017] [Accepted: 11/22/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Youth-onset type 2 diabetes is an emerging disease. We estimated incidence and prevalence trends of youth-onset type 2 diabetes between 2002 and 2013 in the Canadian province of British Columbia. METHODS This population-based cohort study used a validated diabetes case-finding definition and algorithm to differentiate type 2 from type 1 diabetes to identify youth <20 years with type 2 diabetes within linked population-based administrative data. Age-standardized incidence and prevalence were calculated. JoinPoint regression and double exponential smooth modeling were used. RESULTS From 2002/2003 to 2012/2013, the incidence of youth-onset type 2 diabetes increased from 3.45 (95% confidence interval, CI: 2.43, 4.80) to 5.16 (95% CI: 3.86, 6.78)/100 000. The annual percent change (APC) in incidence was 3.74 (95% CI: 1.61, 5.92; P = 0.003) overall, while it was 5.94 (95% CI: 1.84, 10.20; P = 0.009) and 0.53 (95% CI: -5.04, 6.43; P = 0.837) in females and males, respectively. The prevalence increased from 0.009% (95% CI: 0.007, 0.011) in 2002/2003 to 0.021% (95% CI: 0.018, 0.024) in 2012/2013 with an APC of 7.89 (95% CI: 6.41, 9.40; P < 0.0001). In females, it increased from 0.012% (95% CI: 0.009, 0.015) to 0.027% (95% CI: 0.023, 0.032) and in males from 0.007% (95% CI: 0.005, 0.009) to 0.015% (95% CI: 0.012, 0.019). By 2030, we forecast a prevalence of 0.046% (95% CI: 0.043, 0.048). CONCLUSIONS Youth-onset type 2 diabetes is increasing with higher rates in females vs males. If these rates continue, in 2030, the number of cases will increase by 5-fold. These data are needed to set priorities for diabetes prevention in youth.
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Affiliation(s)
- Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jenny Sutherland
- Population Health Surveillance & Epidemiology, BC Ministry of Health, Victoria, Canada
| | - Kim Reimer
- Population Health Surveillance & Epidemiology, BC Ministry of Health, Victoria, Canada
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178
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Zamstein O, Sheiner E, Wainstock T, Landau D, Walfisch A. Maternal gestational diabetes and long-term respiratory related hospitalizations of the offspring. Diabetes Res Clin Pract 2018; 140:200-207. [PMID: 29626584 DOI: 10.1016/j.diabres.2018.03.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/05/2018] [Accepted: 03/29/2018] [Indexed: 01/17/2023]
Abstract
AIMS To assess the implications of gestational diabetes mellitus (GDM) on long-term respiratory related hospitalizations of the offspring. METHODS A population-based cohort analysis including singleton pregnancies delivered between the years 1991 to 2014 in a tertiary referral hospital was conducted. Incidence of hospitalizations (up to age 18 years) due to various respiratory diseases was compared between offspring of GDM-complicated pregnancies and normoglycemic pregnancies. Kaplan-Meyer curves were used to assess cumulative hospitalization incidence. Cox proportional hazards model was used to control for baseline selected confounders. RESULTS During the study period 216,197 deliveries met the inclusion criteria. Of those, 4.7% (n = 10,184) were complicated by GDM. In most of the investigated respiratory diseases, no significant differences were found between offspring of both groups. Nonetheless, obstructive sleep apnea-related hospitalization rate was higher among the GDM group, an association which proved to be independent of potential confounders with an adjusted hazard ratio of 1.26 (95% CI 1.02-1.55; p = 0.036). CONCLUSION Gestational diabetes mellitus does not appear to be associated with long-term respiratory hospitalizations of the offspring other than obstructive sleep apnea-related hospitalizations.
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Affiliation(s)
- Omri Zamstein
- Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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179
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Lipscombe LL, Hwee J, Webster L, Shah BR, Booth GL, Tu K. Identifying diabetes cases from administrative data: a population-based validation study. BMC Health Serv Res 2018; 18:316. [PMID: 29720153 PMCID: PMC5932874 DOI: 10.1186/s12913-018-3148-0] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/25/2018] [Indexed: 12/16/2022] Open
Abstract
Background Health care data allow for the study and surveillance of chronic diseases such as diabetes. The objective of this study was to identify and validate optimal algorithms for diabetes cases within health care administrative databases for different research purposes, populations, and data sources. Methods We linked health care administrative databases from Ontario, Canada to a reference standard of primary care electronic medical records (EMRs). We then identified and calculated the performance characteristics of multiple adult diabetes case definitions, using combinations of data sources and time windows. Results The best algorithm to identify diabetes cases was the presence at any time of one hospitalization or physician claim for diabetes AND either one prescription for an anti-diabetic medication or one physician claim with a diabetes-specific fee code [sensitivity 84.2%, specificity 99.2%, positive predictive value (PPV) 92.5%]. Use of physician claims alone performed almost as well: three physician claims for diabetes within one year was highly specific (sensitivity 79.9%, specificity 99.1%, PPV 91.4%) and one physician claim at any time was highly sensitive (sensitivity 93.6%, specificity 91.9%, PPV 58.5%). Conclusions This study identifies validated algorithms to capture diabetes cases within health care administrative databases for a range of purposes, populations and data availability. These findings are useful to study trends and outcomes of diabetes using routinely-collected health care data. Electronic supplementary material The online version of this article (10.1186/s12913-018-3148-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B1, Canada. .,Department of Medicine, University of Toronto, Suite RFE 3-805, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - Jeremiah Hwee
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Lauren Webster
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Suite RFE 3-805, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.,Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Suite RFE 3-805, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Karen Tu
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.,Department of Community and Family Medicine, University of Toronto, 5th Floor, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.,University Health Network, R. Fraser Elliot Building, 1st Floor, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
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180
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Wang H, Yang J, Du H, Xu L, Liu S, Yi J, Qian X, Chen Y, Jiang Q, He G. Perfluoroalkyl substances, glucose homeostasis, and gestational diabetes mellitus in Chinese pregnant women: A repeat measurement-based prospective study. ENVIRONMENT INTERNATIONAL 2018; 114:12-20. [PMID: 29459131 DOI: 10.1016/j.envint.2018.01.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/07/2018] [Accepted: 01/26/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Exposure to perfluoroalkyl substances (PFASs) can affect glucose homeostasis and has been suggested as a potential risk of diabetes mellitus, but data are limited for pregnant women. OBJECTIVES We aimed to explore the associations of exposure to PFASs with glucose homeostasis and gestational diabetes mellitus (GDM) in Chinese pregnant women. METHODS The current study was conducted in Hebei Province of Northern China between 2013 and 2014 and 560 pregnant women were recruited in their early term of pregnancy and two representative serum PFASs, perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS), were measured. In 385 pregnant women who completed oral glucose tolerance test (OGTT), the associations of serum PFOA and PFOS concentrations with fasting blood glucose (FBG), fasting insulin (FIns), and homeostasis model assessment of insulin resistance (HOMA-IR) in the early, middle, and late terms of pregnancy and occurrence of GDM were examined using linear and Cox proportional hazard regression models. The reproducibility of serum PFASs during pregnancy was assessed in 230 pregnant women. RESULTS The intraclass correlation coefficients of serum PFASs, covariates, and outcomes based on averaged repeat measurement (0.35-0.96) were higher than those based on single measurement (0.16-0.92). Serum PFOA was positively associated with averaged FIns and HOMA-IR in the early, middle, and late terms of pregnancy and averaged blood glucose level at 1 h and 2 h of OGTT, but serum PFOS tended to be negatively associated with averaged FBG and OGTT blood glucose. The adjusted hazard ratios of GDM associated with serum PFOA and PFOS were 1.98 (95% confidence interval: 0.70-5.57; p-value: 0.197) and 0.71 (0.29-1.75; 0.453), respectively. CONCLUSIONS Our data raised a possibility that exposure to PFASs might have different influences on glucose homeostasis and GDM in Chinese pregnant women. More lab and human studies are needed to further test the hypothesis and investigate potential mechanisms.
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Affiliation(s)
- Hexing Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Jiaqi Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Hongyi Du
- Department of Maternal, Child and Adolescent Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Linji Xu
- Maternal and Child Health Care Hospital, Tangshan Municipality, Tangshan 063000, Hebei province, China
| | - Shuping Liu
- Maternal and Child Health Care Hospital, Tangshan Municipality, Tangshan 063000, Hebei province, China
| | - Jianping Yi
- Maternal and Child Health Care Hospital, Tangshan Municipality, Tangshan 063000, Hebei province, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1G5Z3, Canada
| | - Qingwu Jiang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Gengsheng He
- Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China.
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181
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Sacks DA, Feig DS. Caring for pregnant women whose diabetes antedates pregnancy: is there room for improvement? Diabetologia 2018; 61:1022-1026. [PMID: 29411042 DOI: 10.1007/s00125-018-4565-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Affiliation(s)
- David A Sacks
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA, 91101, USA.
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
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182
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Feig DS. Type 2 diabetes after gestational diabetes: Can the progression be prevented? Diabetes Metab Res Rev 2018; 34:e2988. [PMID: 29430798 DOI: 10.1002/dmrr.2988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/26/2018] [Indexed: 01/11/2023]
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183
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The Maternal Nutritional Milieu and Neonatal Outcomes: Connecting the Dots. J Pediatr 2018; 195:9-11. [PMID: 29398061 DOI: 10.1016/j.jpeds.2017.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
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184
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Feig DS, Murphy HR. Continuous glucose monitoring in pregnant women with Type 1 diabetes: benefits for mothers, using pumps or pens, and their babies. Diabet Med 2018; 35:430-435. [PMID: 29352491 DOI: 10.1111/dme.13585] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 12/16/2022]
Abstract
AIMS To review the current literature on the use of continuous glucose monitoring during pregnancy in women with Type 1 diabetes. METHODS We searched the literature for randomized controlled trials using continuous glucose monitoring during pregnancy in women with Type 1 diabetes. RESULTS Three randomized trials were found and discussed in this review. One UK study found a reduction in large-for-gestational-age infants; however, only masked continuous glucose monitoring was used in that study. A Danish study used intermittent real-time continuous glucose monitoring and found no differences. The present authors conducted the CONCEPTT trial, in which pregnant women and women planning pregnancy were randomized to receive continuous glucose monitoring or standard care. We found a greater drop in HbA1c , more time spent in the target range, and a reduction in some adverse neonatal outcomes in women using continuous glucose monitoring. Numbers-needed-to-treat to prevent a large-for-gestational-age infant, a neonatal intensive care unit admission for >24 h, and a neonatal hypoglycaemia event were low. These findings were seen in both injection and pump users and across all countries. Possible reasons for differences in study findings are discussed. In addition, several issues need further study. Glycaemic variability and differences in dietary intake may also have played a role. Despite excellent glycaemic control, babies continue to be large. More research is needed to understand the role of glucose targets and the dynamic placental processes involved in fetal growth. CONCLUSIONS The use of continuous glucose monitoring in women with Type 1 diabetes in pregnancy is associated with improved glycaemic control and neonatal outcomes. Further research examining the glycaemic and non-glycaemic variables involved in fetal growth and the cost-benefit of using continuous glucose monitoring in pregnancy is warranted.
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Affiliation(s)
- D S Feig
- Sinai Health System, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - H R Murphy
- Cambridge University Hospitals NHS Foundation Trust, Cambridge
- Department of Women and Children's Health, King's College London, London
- Department of Medicine, University of East Anglia, Norwich, UK
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185
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Sobierajski FM, Purdy GM, Usselman CW, Skow RJ, James MA, Chari RS, Khurana R, Stickland MK, Davidge ST, Devolin M, Steinback CD, Davenport MH. Maternal Physical Activity Is Associated With Improved Blood Pressure Regulation During Late Pregnancy. Can J Cardiol 2018; 34:485-491. [DOI: 10.1016/j.cjca.2018.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/16/2022] Open
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186
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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187
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Weisman A, Fazli GS, Johns A, Booth GL. Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review. Can J Cardiol 2018; 34:552-564. [PMID: 29731019 DOI: 10.1016/j.cjca.2018.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 02/07/2023] Open
Abstract
Currently, the global prevalence of diabetes is 8.8%. This figure is expected to increase worldwide, with the largest changes projected to occur in low- and middle-income countries. The aging of the world's population and substantial increases in obesity have contributed to the rise in diabetes. Global shifts in lifestyles have led to the adoption of unhealthy behaviours such as physical inactivity and poorer-quality diets. Correspondingly, diabetes is a rapidly-increasing problem in higher- as well as lower-income countries. In Canada, the prevalence of diabetes increased approximately 70% in the past decade. Although diabetes-related mortality rates have decreased in Canada, the number of people affected by diabetes has continued to grow because of a surge in the number of new diabetes cases. Non-European ethnic groups and individuals of lower socioeconomic status have been disproportionately affected by diabetes and its risk factors. Clinical trials have proven efficacy in reducing the onset of diabetes in high-risk populations through diet and physical activity interventions. However, these findings have not been broadly implemented into the Canadian health care context. In this article we review the evolving epidemiology of type 2 diabetes, with regard to trends in occurrence rates and prevalence; the role of risk factors including those related to ethnicity, obesity, diet, physical activity, socioeconomic status, prediabetes, and pregnancy; and the identification of critical windows for lifestyle intervention. Identifying high-risk populations and addressing the upstream determinants and risk factors of diabetes might prove to be effective diabetes prevention strategies to curb the current diabetes epidemic.
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Affiliation(s)
- Alanna Weisman
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ghazal S Fazli
- The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Johns
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Gillian L Booth
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
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188
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Harmon QE, Basso O, Weinberg CR, Wilcox AJ. Two denominators for one numerator: the example of neonatal mortality. Eur J Epidemiol 2018. [PMID: 29516296 DOI: 10.1007/s10654-018-0373-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Preterm delivery is one of the strongest predictors of neonatal mortality. A given exposure may increase neonatal mortality directly, or indirectly by increasing the risk of preterm birth. Efforts to assess these direct and indirect effects are complicated by the fact that neonatal mortality arises from two distinct denominators (i.e. two risk sets). One risk set comprises fetuses, susceptible to intrauterine pathologies (such as malformations or infection), which can result in neonatal death. The other risk set comprises live births, who (unlike fetuses) are susceptible to problems of immaturity and complications of delivery. In practice, fetal and neonatal sources of neonatal mortality cannot be separated-not only because of incomplete information, but because risks from both sources can act on the same newborn. We use simulations to assess the repercussions of this structural problem. We first construct a scenario in which fetal and neonatal factors contribute separately to neonatal mortality. We introduce an exposure that increases risk of preterm birth (and thus neonatal mortality) without affecting the two baseline sets of neonatal mortality risk. We then calculate the apparent gestational-age-specific mortality for exposed and unexposed newborns, using as the denominator either fetuses or live births at a given gestational age. If conditioning on gestational age successfully blocked the mediating effect of preterm delivery, then exposure would have no effect on gestational-age-specific risk. Instead, we find apparent exposure effects with either denominator. Except for prediction, neither denominator provides a meaningful way to define gestational-age-specific neonatal mortality.
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Affiliation(s)
- Quaker E Harmon
- National Institute of Environmental Health Sciences, P.O. Box 12233, Durham, NC, 27709, USA.
| | - Olga Basso
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Allen J Wilcox
- National Institute of Environmental Health Sciences, P.O. Box 12233, Durham, NC, 27709, USA
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189
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Jiang TT, Zhao L, Lin Y, Zhou D, Wang L, Sun GQ, Xiao M. Effects of gestational diabetes mellitus on time to delivery and pregnancy outcomes in full-term pregnancies with dinoprostone labor induction. Clin Exp Hypertens 2018; 41:44-48. [PMID: 29473764 DOI: 10.1080/10641963.2018.1441859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the effects of gestational diabetes mellitus (GDM) on time to delivery and perinatal outcomes in full-term pregnancies underwent dinoprostone-induced labor. METHODS GDM patients that underwent labor induction with dinoprostone vaginal inserts were retrospectively recruited. Full-term pregnancies with normal glucose tolerance (NGT) that underwent labor induction at the same period were recruited as control. Time to delivery and perinatal outcomes were compared between the two groups. RESULTS A total of 1555 pregnancies with 226 GDM and 1329 NGT were recruited. GDM pregnancies had older ages, lower gestational age, higher body mass index (BMI) and abortion history, and more multigravida than NGT pregnancies (P< 0.05). Univariate analysis showed no significant difference in time to delivery and delivery rates between the two groups. However, after adjusted in a multivariate analysis model, the delivery rates of GDM women delivered within 12, 24, 36 or 48 h and those vaginally delivered within 12 or 36 h were significantly lower than those in the NGT group (P< 0.05). Perinatal outcomes were clinically similar between the two groups. CONCLUSION GDM did not affect the time to delivery, cesarean delivery and other perinatal outcomes in Chinese women underwent dinoprostone-induced labor. However, it may be associated with the lower rates of delivery within different time intervals.
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Affiliation(s)
- Ting-Ting Jiang
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Lei Zhao
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Ying Lin
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Dong Zhou
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Ling Wang
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Guo-Qiang Sun
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
| | - Mei Xiao
- a Department of Obstetric , Hubei Maternity and Child Health Hospital , Wuhan , China
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McLaughlin K, Audette MC, Parker JD, Kingdom JC. Mechanisms and Clinical Significance of Endothelial Dysfunction in High-Risk Pregnancies. Can J Cardiol 2018; 34:371-380. [PMID: 29571421 DOI: 10.1016/j.cjca.2018.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 10/18/2022] Open
Abstract
The maternal cardiovascular system undergoes critical anatomic and functional adaptations to achieve a successful pregnancy outcome which, if disrupted, can result in complications that significantly affect maternal and fetal health. Complications that involve the maternal cardiovascular system are among the most common disorders of pregnancy, including gestational hypertension, preeclampsia, gestational diabetes, and impaired fetal growth. As a central feature, maternal endothelial dysfunction is hypothesized to play a predominant role in mediating the pathogenesis of these high-risk pregnancies, and as such, might proceed and precipitate the clinical presentation of these pregnancy disorders. Improving or normalizing maternal endothelial function in high-risk pregnancies might be an effective therapeutic strategy to ameliorate maternal and fetal clinical outcomes.
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Affiliation(s)
- Kelsey McLaughlin
- Department of Medicine, Division of Cardiology, Sinai Health System, University of Toronto, Toronto, Ontario, Canada; The Centre for Women's and Infant's Health at the Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Melanie C Audette
- The Centre for Women's and Infant's Health at the Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - John D Parker
- Department of Medicine, Division of Cardiology, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - John C Kingdom
- The Centre for Women's and Infant's Health at the Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada.
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Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF, Asztalos E, Barrett JFR, Sanchez JJ, de Leiva A, Hod M, Jovanovic L, Keely E, McManus R, Hutton EK, Meek CL, Stewart ZA, Wysocki T, O'Brien R, Ruedy K, Kollman C, Tomlinson G, Murphy HR. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 2017; 390:2347-2359. [PMID: 28923465 PMCID: PMC5713979 DOI: 10.1016/s0140-6736(17)32400-5] [Citation(s) in RCA: 400] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 07/31/2017] [Accepted: 08/08/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. METHODS In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. FINDINGS Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference -0·19%; 95% CI -0·34 to -0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). INTERPRETATION Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. FUNDING Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.
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Affiliation(s)
- Denice S Feig
- Department of Medicine, Sinai Health System, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Lois E Donovan
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rosa Corcoy
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau CIBER-BBN, Barcelona, Spain
| | - Kellie E Murphy
- Department of Obstetrics & Gynecology, Sinai Health System, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie A Amiel
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Katharine F Hunt
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK; Diabetes Service, Devision of Urgent Care, Planned Care and Allied Critical Services, King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Alberto de Leiva
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau CIBER-BBN, Barcelona, Spain
| | - Moshe Hod
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah, Tikvah, Israel
| | - Lois Jovanovic
- Division of Endocrinology, University of Southern California, Los Angeles, CA, USA; Department of Chemistry, University of California, Santa Barbara, CA, USA
| | - Erin Keely
- Department of Medicine, University of Ottawa, and The Ottawa Hospital, Ottawa, ON, Canada
| | - Ruth McManus
- Department of Medicine, St Joseph Health Care London, ON, Canada; Department of Medicine, University of Western ON, London, ON, Canada
| | - Eileen K Hutton
- Department of Obstetrics & Gynecology, McMaster University Hamilton, ON, Canada
| | - Claire L Meek
- Wolfson Diabetes and Endocrine Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zoe A Stewart
- Wolfson Diabetes and Endocrine Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tim Wysocki
- Nemours Children's Health System, Jacksonville, FL, USA
| | | | | | | | - George Tomlinson
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Helen R Murphy
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK; Wolfson Diabetes and Endocrine Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Medicine, University of East Anglia, Norwich, UK
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Lin SF, Kuo CF, Chiou MJ, Chang SH. Maternal and fetal outcomes of pregnant women with type 1 diabetes, a national population study. Oncotarget 2017; 8:80679-80687. [PMID: 29113335 PMCID: PMC5655230 DOI: 10.18632/oncotarget.20952] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/26/2017] [Indexed: 01/30/2023] Open
Abstract
Pregnancy in women with type 1 diabetes is associated with poor maternal and neonatal outcomes. However, the risk of these outcomes has never been evaluated in an Asian national population. In this work, we report the maternal and fetal outcomes of pregnant women with type 1 diabetes in Taiwan. A total of 2,350,339 pregnancy records created between 2001 and 2012 were obtained from the National Health Insurance database and analyzed. Here, 630 pregnancy records were identified in women having type 1 diabetes. Compared with pregnant women without type 1 diabetes, pregnant women with the disease showed increased risk of multiple adverse outcomes, including preeclampsia, eclampsia, cesarean delivery, adult respiratory distress syndrome, pulmonary edema, sepsis, chorioamnionitis, pregnancy-related hypertension, puerperal cerebrovascular disorders, acute renal failure, and shock. Fetuses of type 1 diabetic mothers were at increased risk of stillbirth, premature birth, large for gestational age, low birth weight, and low Apgar score. Of the studied endpoints, only preeclampsia showed an improvement in the late period (2011-2012) when compared with the early period (2001-2010). These findings reveal that pregnant women with type 1 diabetes are at significantly increased risk of developing many adverse maternal and fetal outcomes. Therefore, pregnancy outcomes in women with type 1 diabetes should be improved.
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Affiliation(s)
- Shu-Fu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, Taoyuan, Taiwan
| | - Meng-Jiun Chiou
- Office for Big Data Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Hung Chang
- Office for Big Data Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, Taoyuan, Taiwan
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Di Cianni G, Gualdani E, Berni C, Meucci A, Roti L, Lencioni C, Lacaria E, Seghieri G, Francesconi P. Screening for gestational diabetes in Tuscany, Italy. A population study. Diabetes Res Clin Pract 2017; 132:149-156. [PMID: 28863332 DOI: 10.1016/j.diabres.2017.08.003] [Citation(s) in RCA: 14] [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: 05/08/2017] [Revised: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 11/24/2022]
Abstract
AIMS According to current Italian guidelines, only women at higher risk of gestational diabetes (GDM) are eligible for receiving a glucose tolerance test (OGTT) during pregnancy. This study evaluates the compliance to national guidelines, additionally proposing an algorithm able to identify women with GDM. METHODS The study included 23,270 pregnant women aged >15yr, resident in Tuscany, a region in central Italy, delivering in year 2015, identified by certificates of care at delivery. Eligibility to screening was evaluated by fulfillment to regional guidelines recommending a 2-h-75g-OGTT only in presence of risk factors. Additionally, a validated algorithm is proposed to diagnose GDM from regional administrative databases. RESULTS Glucose tolerance was tested in 79.2% of women. Eligibility criteria were fulfilled in 55.6% of OGTT performers and in 40.2% of those who didn't perform any OGTT. Performers' rate increased with age, body weight, higher education degree and in those followed by a well defined clinical setting. Housewives and students had a lower chance of receiving an OGTT. Algorithm identified GDM in 11% of women, ranging from 14% among eligible and 7% among non-eligible ones. CONCLUSION Selective screening for GDM is not being currently applied in Tuscany. Despite the percentage of eligible women by national guidelines was 55%, the rate of those who performed the screening was about 80%, with a 40% of low risk women continuing to be screened. Moreover, GDM rate, calculated by algorithm, was relatively large (7%) among non-eligible women, suggesting the need of universal glucose screening to adequately capture all GDM cases.
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Affiliation(s)
- Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Italy
| | - Elisa Gualdani
- Epidemiology Unit, Agenzia Regionale Sanità, Florence, Italy
| | | | | | - Lorenzo Roti
- Direzione Sanità Regione Toscana, Florence, Italy
| | - Cristina Lencioni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Italy
| | - Emilia Lacaria
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Italy
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Wander PL, Boyko EJ, Hevner K, Parikh VJ, Tadesse MG, Sorensen TK, Williams MA, Enquobahrie DA. Circulating early- and mid-pregnancy microRNAs and risk of gestational diabetes. Diabetes Res Clin Pract 2017; 132:1-9. [PMID: 28783527 PMCID: PMC5623075 DOI: 10.1016/j.diabres.2017.07.024] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/14/2017] [Accepted: 07/17/2017] [Indexed: 12/19/2022]
Abstract
AIMS Epigenetic regulators, including microRNAs (miRNAs), are implicated in type 2 diabetes, but evidence linking circulating miRNAs in pregnancy and risk of gestational diabetes (GDM) is sparse. Potential modifiers, including pre-pregnancy overweight/obesity and offspring sex, are unexamined. We hypothesized that circulating levels of early-mid-pregnancy (range 7-23weeks of gestation) candidate miRNAs are related to subsequent development of GDM. We also hypothesized that miRNA-GDM associations might vary by pre-pregnancy body-mass index (ppBMI) or offspring sex. METHODS In a case-control analysis (36GDM cases/80 controls) from the Omega study, a prospective cohort study of pregnancy complications, we measured early-mid-pregnancy plasma levels of 10miRNAs chosen for potential roles in pregnancy course and complications (miR-126-3p, -155-5p, -21-3p, -146b-5p, -210-3p, -222-3p, -223-3p, -517-5p, -518a-3p, and 29a-3p) using qRT-PCR. Logistic regression models adjusted for gestational age at blood draw (GA) were fit to compare circulating miRNAs between cases and controls. We repeated analyses among overweight/obese (ppBMI≥25kg/m2) or lean (ppBMI<25kg/m2) women, and women with male or female offspring separately. RESULTS Mean age was 34.3years (cases) and 32.9years (controls). GA-adjusted miR-155-5p (β=0.260/p=0.028) and -21-3p (β=0.316/p=0.005) levels were positively associated with GDM. MiR-146b-5p (β=0.266/p=0.068) and miR-517-5p (β=0.196/p=0.074) were borderline. Associations of miR-21-3p and miR-210-3p with GDM were observed among overweight/obese but not lean women. Associations of six miRNAs (miR-155-5p, -21-3p, -146b-5p, -223-3p, -517-5p, and -29a-3p) with GDM were present only among women carrying male fetuses (all p<0.05). CONCLUSIONS Circulating early-mid-pregnancy miRNAs are associated with GDM, particularly among women who are overweight/obese pre-pregnancy or pregnant with male offspring. This area has potential to clarify mechanisms underlying GDM pathogenesis and identify at-risk mothers earlier in pregnancy.
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Affiliation(s)
- Pandora L Wander
- Department of Medicine, University of Washington, Seattle, WA, USA; VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Edward J Boyko
- Department of Medicine, University of Washington, Seattle, WA, USA; VA Puget Sound Health Care System, Seattle, WA, USA
| | - Karin Hevner
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
| | - Viraj J Parikh
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mahlet G Tadesse
- Department of Mathematics and Statistics, Georgetown University, Washington, DC, USA
| | - Tanya K Sorensen
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel A Enquobahrie
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
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Brown FM, Wyckoff J. Application of One-Step IADPSG Versus Two-Step Diagnostic Criteria for Gestational Diabetes in the Real World: Impact on Health Services, Clinical Care, and Outcomes. Curr Diab Rep 2017; 17:85. [PMID: 28799123 PMCID: PMC5552830 DOI: 10.1007/s11892-017-0922-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to summarize the impact of the one-step International Association of Diabetes and Pregnancy Study Groups (IADPSG) versus the two-step gestational diabetes mellitus (GDM) criteria with regard to prevalence, outcomes, healthcare delivery, and long-term maternal metabolic risk. RECENT FINDINGS Studies demonstrate a 1.03-3.78-fold rise in the prevalence of GDM with IADPSG criteria versus baseline criteria. Women with GDM by IADPSG criteria have more adverse pregnancy outcomes than women with normal glucose tolerance (NGT). Treatment of GDM by IADPSG criteria may be cost effective. Use of the fasting glucose as a screen before the 75-g oral glucose tolerance test to rule out GDM with fasting plasma glucose (FPG) < 4.4 (80 mg/dl) and rule in GDM with FPG ≥ 5.1 mmol/l (92 mg/dl) reduces the need for OGTT by 50% and its cost and inconvenience. The prevalence of postpartum abnormal glucose metabolism is higher for women with GDM diagnosed by IADPSG criteria versus that for women with NGT. Data support the use of IADPSG criteria, if the cost of diagnosis and treatment can be controlled and if lifestyle can be optimized to reduce the risk of future diabetes.
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Affiliation(s)
- Florence M Brown
- Joslin Diabetes Center, 1 Joslin Pl, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, USA.
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Maternal Diabetes, Birth Weight, and Neonatal Risk of Congenital Heart Defects in Norway, 1994-2009. Obstet Gynecol 2017; 128:1116-1125. [PMID: 27741197 DOI: 10.1097/aog.0000000000001694] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between pregestational or gestational diabetes and offspring risk of congenital heart defects and the association between large-for-gestational-age birth weight and risk of cardiac defects in offspring of diabetic women. METHODS Information on pregestational and gestational diabetes, cardiac defects, and birth weight among all births in Norway in 1994-2009 was ascertained from the Medical Birth Registry of Norway, national health registries, and the Cardiovascular Disease in Norway project. The relative risk (RR) compared offspring risk of cardiac defects for maternal diabetes with offspring risk in nondiabetic mothers adjusted for year of birth, maternal age, and parity. RESULTS Among 914,427 births (live births, stillbirths, terminated pregnancies), 5,618 (0.61%) were complicated by maternal pregestational diabetes and 9,726 (1.06%) by gestational diabetes. Congenital heart defects were identified in 10,575 offspring. The prevalence of cardiac defects differed between groups: 344 of 10,000 births to women with pregestational diabetes, 172 of 10,000 to women with gestational diabetes, and 114 of 10,000 in women without diabetes (adjusted RRs 2.92, 95% confidence interval [CI] 2.54-3.36 and 1.47, 95% CI 1.26-1.71). During the study period, the adjusted RRs for congenital heart defects did not change. The risk of cardiac defects in neonates very large for gestational age (birth weight greater than 3 standard deviations above the mean) was compared with neonates with birth weight appropriate for gestational age. For pregestational diabetes, the prevalences of offspring cardiac defects were 561 compared with 248 per 10,000 births (adjusted RR 2.23, 95% CI 1.39-3.59) and for gestational diabetes 388 compared with 132 per 10,000 (adjusted RR 2.73, 95% CI 1.53-4.85). CONCLUSION The increased risk of having a child with a congenital heart defect has not changed for diabetic women in Norway since 1994. Among women with pregestational or gestational diabetes, having a large-for-gestational-age neonate was associated with a two- to threefold increased risk of cardiac defects compared with neonates with normal birth weight.
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Booth GL, Luo J, Park AL, Feig DS, Moineddin R, Ray JG. Influence of environmental temperature on risk of gestational diabetes. CMAJ 2017; 189:E682-E689. [PMID: 28507087 PMCID: PMC5433869 DOI: 10.1503/cmaj.160839] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cold-induced thermogenesis is known to improve insulin sensitivity, which may become increasingly relevant in the face of global warming. The aim of this study was to examine the relation between outdoor air temperature and the risk of gestational diabetes mellitus. METHODS We identified all births in the Greater Toronto Area from 2002 to 2014 using administrative health databases. Generalized estimating equations were used to examine the relation between the mean 30-day outdoor air temperature before the time of gestational diabetes mellitus screening and the likelihood of diagnosis of gestational diabetes mellitus based on a validated algorithm using hospital records and physician service claims. RESULTS Over the 12-year period, there were 555 911 births among 396 828 women. Prevalence of gestational diabetes mellitus was 4.6% among women exposed to extremely cold mean outdoor air temperatures (≤ -10°C) in the 30-day period before screening and increased to 7.7% among those exposed to hot mean 30-day temperatures (≥ 24°C). Each 10°C increase in mean 30-day temperature was associated with a 1.06 (95% confidence interval [CI] 1.04-1.07) times higher odds of gestational diabetes mellitus, after adjusting for maternal age, parity, neighbourhood income quintile, world region and year. A similar effect was seen for each 10°C rise in outdoor air temperature difference between 2 consecutive pregnancies for the same woman (adjusted odds ratio 1.06, 95% CI 1.03-1.08). INTERPRETATION In our setting, there was a direct relation between outdoor air temperature and the likelihood of gestational diabetes mellitus. Future climate patterns may substantially affect global variations in the prevalence of diabetes, which also has important implications for the prevention and treatment of gestational diabetes mellitus.
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Affiliation(s)
- Gillian L Booth
- Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont.
| | - Jin Luo
- Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont
| | - Alison L Park
- Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont
| | - Denice S Feig
- Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont
| | - Rahim Moineddin
- Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont
| | - Joel G Ray
- Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont
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Léveillé P, Rouxel C, Plourde M. Diabetic pregnancy, maternal and fetal docosahexaenoic acid: a review of existing evidence. J Matern Fetal Neonatal Med 2017; 31:1358-1363. [PMID: 28423959 DOI: 10.1080/14767058.2017.1314460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Docosahexaenoic acid (DHA) is vital for fetal development especially during the third trimester of gestation when the speed of fetal brain growth is at its peak. Diabetes modifies the maternal fatty acid profile, which may in turn change the quantity and/or quality of lipids transferred to the fetus. Neonates born to diabetic mothers might be more vulnerable to DHA deficiency leading to lower cognitive scores together with lower overall intellectual quotients when compared to control. We reviewed the influence of type 1 or type 2 pre-gestational (PGD) and gestational diabetes mellitus (GDM) on maternal and fetal DHA levels. METHOD We searched MEDLINE articles about PGD and/or GDM and DHA published before October 2016. RESULTS Maternal blood DHA level seems higher in those with diabetes than those without diabetes. However, DHA in cord plasma of neonates born to PGD and/or GDM mothers seem lower compared to neonates born to nondiabetic mothers. CONCLUSIONS Altogether, these results suggest that the transfer of DHA from the mother to the fetus may be deficient or dysregulated in diabetic pregnancies. What remains to be understood is how placental lipid transport is regulated and whether there is a link with clinical neurodevelopmental phenotypes in the newborns.
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Affiliation(s)
- Pauline Léveillé
- a Faculté de médecine et des sciences de la santé, Université de Sherbrooke , Sherbrooke , Canada.,b Research Center on Aging, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke.,c Institute of Nutrition and Functional Foods, Laval University , Québec , Canada
| | - Clémence Rouxel
- b Research Center on Aging, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke
| | - Mélanie Plourde
- a Faculté de médecine et des sciences de la santé, Université de Sherbrooke , Sherbrooke , Canada.,b Research Center on Aging, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke.,c Institute of Nutrition and Functional Foods, Laval University , Québec , Canada
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Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A, Jacqueminet S. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017; 60:636-644. [PMID: 28197657 PMCID: PMC6518373 DOI: 10.1007/s00125-017-4206-6] [Citation(s) in RCA: 313] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/20/2016] [Indexed: 11/05/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort. METHODS All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated. RESULTS The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother-infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]). CONCLUSIONS/INTERPRETATION GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes.
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Affiliation(s)
- Cécile Billionnet
- Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France
| | - Delphine Mitanchez
- Division of Neonatology, Department of Perinatology, Armand Trousseau Hospital, APHP, Paris, France
- Sorbonne University, UPMC Univ Paris 06, Paris, France
| | - Alain Weill
- Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France
| | - Jacky Nizard
- Sorbonne University, UPMC Univ Paris 06, Paris, France
- Department of Obstetrics and Gynaecology, Groupe Hospitalier Pitié-Salpêtrière, APHP CNRS UMR 7222, Inserm U1150, Paris, France
| | - François Alla
- Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France
| | - Agnès Hartemann
- Sorbonne University, UPMC Univ Paris 06, Paris, France
- Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
- Diabetes and Metabolic Diseases Department, Pitié-Salpêtrière Hospital, 83 boulevard de l'Hôpital, 75013, Paris, France
| | - Sophie Jacqueminet
- Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
- Diabetes and Metabolic Diseases Department, Pitié-Salpêtrière Hospital, 83 boulevard de l'Hôpital, 75013, Paris, France.
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