251
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Zhu G, Qian X, Qi L, Xia C, Ming Y, Zeng Z, Liu Y, Yang Y, Zhang M, Zhang H. The intention to undertake physical activity in pregnant women using the theory of planned behaviour. J Adv Nurs 2020; 76:1647-1657. [PMID: 32153052 DOI: 10.1111/jan.14347] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
AIM To identify the intention of Chinese pregnant women to undertake physical activity (PA) using the theory of planned behaviour. DESIGN A cross-sectional survey. METHODS From April - October 2017, a cross-sectional questionnaire was completed by 746 pregnant women from the Health Birth Cohort in Wuhan, China. The theory of planned behaviour variables as well as sociodemographic characteristics was recorded, and the Pregnancy PA Questionnaire was together used to assess their PA during pregnancy. RESULTS Only 11.3% of the women met the international guideline. The intention to undertake PA was found it to be positive in 63.9% of pregnant women. Structural equation modelling analysis revealed that behavioural attitudes, subjective norms, and perceived behavioural control (PBC) influenced PA by directly influencing the behaviour intention. Both behavioural attitude and subjective norms influenced PA by indirectly affecting the behaviour. Overall, the model described 60% variance of the behavioural intention to undertake PA during pregnancy. CONCLUSION PBC was confirmed to be a prominent factor in determining behavioural intention to undertake PA during pregnancy. Pregnant women should be helped and appropriately guided by health providers to overcome barriers to PA. EFFECT This study investigates the effect of perceived behavioural control (PBC) on the intention to undertake physical activity (PA). The findings suggest that nurses' and midwives' attention should be focused on how to promote the improvement of perceived behavioural control ability of pregnant women to improve pregnant women's PA intention. The attitude of pregnant women on taking up PA and their ability to control behaviours can be improved with support from family or healthcare providers.
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Affiliation(s)
- Gangjiao Zhu
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Xiangzi Qian
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Ling Qi
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Chang Xia
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Yu Ming
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Zhi Zeng
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Yuanxia Liu
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Yan Yang
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Mengtian Zhang
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Hongling Zhang
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
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252
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You H, Lei A, Xiang J, Wang Y, Luo B, Hu J. Effects of breastfeeding education based on the self-efficacy theory on women with gestational diabetes mellitus: A CONSORT-compliant randomized controlled trial. Medicine (Baltimore) 2020; 99:e19643. [PMID: 32311936 PMCID: PMC7220535 DOI: 10.1097/md.0000000000019643] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) face big challenges of breastfeeding. In order to improve breastfeeding self-efficacy and breastfeeding rate of them, we formulated perinatal individualized interventions based on self-efficacy theory and conducted a randomized controlled trial to verify the effectiveness. METHODS We conducted a randomized controlled trial. The perinatal individualized interventions based on the self-efficacy theory including 4 phases were led by the International Board Certified Lactation Consultant (IBCLC). Women allocated to the control group received usual care for lactation support during the antenatal and postnatal period. Data collection occurred at admission, discharge, 6 weeks postpartum, 4 months postpartum, and 6 months postpartum. RESULTS We enrolled 226 women with GDM, 113 in the intervention group and 113 in the control group. The scores of breastfeeding self-efficacy in the intervention group were significantly higher than those in the control group at discharge, at 6 weeks, 4 months, and 6 months postpartum (P < .05). We found higher rates of exclusive and any breastfeeding in the intervention group at discharge (Exclusive: 25.2% vs 13.5%, P < .05; Any: 94.4% vs 89.4%, P > .05), at 6 weeks postpartum (Exclusive: 75.5% vs 62.5%, P < .05; Any: 100.0% vs 96.2%, P > .05), at 4 months postpartum (Exclusive: 68.9% vs 43.3%, P < .05; Any: 94.3% vs 83.7%, P < .05) and at 6 months postpartum (Exclusive: 55.8% vs 36.9%, P < .05; Any: 88.5% vs 64.1%, P < .05). CONCLUSION Perinatal individualized breastfeeding education based on the self-efficacy theory had positive effects on breastfeeding self-efficacy and breastfeeding rate of women with GDM.
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Affiliation(s)
- Huaxuan You
- Department of Obstetrics and Gynecology
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University)
| | - Anjiang Lei
- Department of Obstetrics and Gynecology
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University)
| | - Jie Xiang
- Department of Obstetrics and Gynecology
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University)
| | - Yan Wang
- Department of Obstetrics and Gynecology
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University)
| | - Biru Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University)
- Department of Nursing
| | - Juan Hu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University)
- Department of Emergency, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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253
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Dong B, Zhi M, Han M, Yu H, Lin H, Li L. Early menarche is associated with insulin resistance in advanced maternal age before delivery. Gynecol Endocrinol 2020; 36:341-345. [PMID: 31478751 DOI: 10.1080/09513590.2019.1658731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: With the wide implementation of the universal two-child policy in China, the number of pregnant women in advanced maternal age (AMA) will increase gradually. We aimed to assess the association between age at menarche (AAM) and insulin resistance (IR) before delivery in AMA. Methods: A total of 80 pregnant women in AMA were consecutively enrolled before delivery in Zhongda hospital. Pregnant women were stratified into early menarche group and late menarche group according to the age of regular menstruation (about 13 years). At delivery, serum glucose and lipid levels were measured. IR was calculated by the method of homeostasis model assessment 2(HOMA2). Results: The fasting blood insulin (17.68(9.72-36.71) and 10.35(7.76-15.10), respectively; p = .006) and HOMA-IR (2.08(1.18-4.37) and 1.24(0.89-1.78), respectively; p = .005) were higher in early menarche group than in late menarche group. AAM was inversely associated with HOMA-IR in AMA (r= -0.27, p = .014). In the multivariable analysis, AAM in late menarche group was negatively related to the level of HOMA-IR compared to those in early menarche group (β= -2.275, p≤.0001). Conclusions: Taken together, our findings suggest that AAM was inversely associated with HOMA-IR in AMA. Furthermore, pregnant women in AMA with early menarche might have higher HOMA-IR levels than those with late menarche. Clinical trial registration: Chinese Clinical Trial Registry (No. ChiCTR-RRC-16008714), retrospectively registered.
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Affiliation(s)
- Beibei Dong
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Pancreatic Research Institute, Southeast University, Nanjing, China
| | - Mengmeng Zhi
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Pancreatic Research Institute, Southeast University, Nanjing, China
| | - Manman Han
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Pancreatic Research Institute, Southeast University, Nanjing, China
| | - Hong Yu
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hao Lin
- Pancreatic Research Institute, Southeast University, Nanjing, China
- Department of Clinical Science and Research, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ling Li
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Pancreatic Research Institute, Southeast University, Nanjing, China
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254
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Xiao Y, Ding J, Shi Y, Lin L, Huang W, Shen D, Wang W. MiR-330-3p contributes to INS-1 cell dysfunction by targeting glucokinase in gestational diabetes mellitus. J Obstet Gynaecol Res 2020; 46:864-875. [PMID: 32202040 DOI: 10.1111/jog.14249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/21/2020] [Accepted: 03/07/2020] [Indexed: 12/16/2022]
Abstract
AIMS High-expressed miR-330-3p in gestational diabetes mellitus (GDM) patients was reported. However, the role and mechanism of miR-330-3p in GDM are rarely reported. In this research, we aim to investigate the effects of miR-330-3p on GDM. METHODS MiR-330-3p expression in the GDM patients' blood was determined by q-PCR. Blood glucose of blood samples was detected using blood glucose detection kits. Glucokinase (GCK) was confirmed to be a target gene of miR-330-3p by bioinformatics and luciferase analysis. Correlations between miR-330-3p with GCK and blood glucose were analyzed by Pearson correlation analysis. After INS-1 cells were treated with glucose and transfected with mimic, inhibitor or siGCK, GCK expression was detected by western blot, and q-PCR, enzyme-linked immunosorbent assays, cell counting kit-8 and Annexin-V/propidium iodide were conducted to examine the expression of insulin, cell viability and apoptosis. RESULTS MiR-330-3p was high-expressed in GDM patients' blood, while GCK was low-expressed. The miR-330-3p expression level positively correlated with blood glucoseand and it was highly expressed in glucose-treated INS-1 cells (11 and 22 mmol/L), while miR-330-3p expression negatively correlated with GCK expression. GCK expression was inhibited by miR-330-3p mimic and enhanced by the miR-330-3p inhibitor. MiR-330-3p mimic inhibited INS-1 cells' insulin expression, cell viability and induced apoptosis. Yet miR-330-3p inhibitor and siGCK exhibited opposite effects which miR-330-3p mimic and GCK played on INS-1 cells. In addition, siGCK reversed the effect of miR-330-3p inhibitor on INS-1 cells. CONCLUSION Our findings proved that miR-330-3p targeting GCK lead to the dysfunction of INS-1 cells in GDM, and could become a therapeutic target for GDM treatment.
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Affiliation(s)
- Yuping Xiao
- Department of Pediatrics, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou, People's Republic of China.,Department of Pediatrics, Zhejiang University Hospital, Hangzhou, People's Republic of China
| | - Jingchao Ding
- Department of Pediatrics, Shaoxing Hospital of Zhejiang University, Shaoxing, People's Republic of China
| | - Yulan Shi
- Department of Pediatrics, Zhenyuan County People's Hospital, Guizhou, Qiandongnan Autonomous Prefecture, People's Republic of China
| | - Long Lin
- Department of Pediatrics, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou, People's Republic of China
| | - Wenyuan Huang
- Department of Pediatrics, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou, People's Republic of China
| | - Dongxia Shen
- Department of Pediatrics, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou, People's Republic of China
| | - Weiqun Wang
- Department of Pediatrics, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou, People's Republic of China
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255
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Seo Y, Kim EM, Choi JS, Park CY. Using a Mobile-based Nutritional Intervention Application Improves Glycemic Control but Reduces the Intake of Some Nutrients in Patients with Gestational Diabetes Mellitus: A Case Series Study. Clin Nutr Res 2020; 9:73-79. [PMID: 32095450 PMCID: PMC7015723 DOI: 10.7762/cnr.2020.9.1.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
The prevalence of gestational diabetes mellitus (GDM) has been increasing worldwide, as has the economic cost associated with this condition. GDM threatens the health of the mother and child, and thus proper monitoring and management are essential. Mobile healthcare services have been applied to manage some diseases, particularly chronic diseases. We aimed to evaluate the utility of a mobile application in nutritional intervention by observing cases of a mobile application in a series of patients with GDM. We provided a mobile-based intervention to GDM patients and collected biochemical and nutritional information. The mobile-based nutritional intervention was effective in controlling carbohydrate intake and improving blood glucose level for patients with GDM.
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Affiliation(s)
- Yeonkyung Seo
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul 03181, Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul 03181, Korea
| | - Jin Sun Choi
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul 03181, Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
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256
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Meertens LJE, Scheepers HCJ, van Kuijk SMJ, Roeleveld N, Aardenburg R, van Dooren IMA, Langenveld J, Zwaan IM, Spaanderman MEA, van Gelder MMHJ, Smits LJM. External validation and clinical utility of prognostic prediction models for gestational diabetes mellitus: A prospective cohort study. Acta Obstet Gynecol Scand 2020; 99:891-900. [PMID: 31955406 PMCID: PMC7317858 DOI: 10.1111/aogs.13811] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 11/14/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Abstract
Introduction We performed an independent validation study of all published first trimester prediction models, containing non‐invasive predictors, for the risk of gestational diabetes mellitus. Furthermore, the clinical potential of the best performing models was evaluated. Material and methods Systemically selected prediction models from the literature were validated in a Dutch prospective cohort using data from Expect Study I and PRIDE Study. The predictive performance of the models was evaluated by discrimination and calibration. Clinical utility was assessed using decision curve analysis. Screening performance measures were calculated at different risk thresholds for the best model and compared with current selective screening strategies. Results The validation cohort included 5260 women. Gestational diabetes mellitus was diagnosed in 127 women (2.4%). The discriminative performance of the 12 included models ranged from 68% to 75%. Nearly all models overestimated the risk. After recalibration, agreement between the observed outcomes and predicted probabilities improved for most models. Conclusions The best performing prediction models showed acceptable performance measures and may enable more personalized medicine‐based antenatal care for women at risk of developing gestational diabetes mellitus compared with current applied strategies.
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Affiliation(s)
- Linda J E Meertens
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert Aardenburg
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Ivo M A van Dooren
- Department of Obstetrics and Gynecology, Sint Jans Gasthuis Weert, Weert, The Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Iris M Zwaan
- Department of Obstetrics and Gynecology, Laurentius Hospital, Roermond, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marleen M H J van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luc J M Smits
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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257
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Dong Y, Zhai Y, Wang J, Chen Y, Xie X, Zhang C, Liu J, Lu Y, Tang G, Han L, Li L, Cao Z. Glycated albumin in pregnancy: reference intervals establishment and its predictive value in adverse pregnancy outcomes. BMC Pregnancy Childbirth 2020; 20:12. [PMID: 31900124 PMCID: PMC6942295 DOI: 10.1186/s12884-019-2704-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022] Open
Abstract
Background Many efforts have been focused on the alternative glycemic marker glycated albumin (GlyA) and its application in pregnancy during which profound physiological changes take place. Our objective was to determine the reference intervals (RIs) of GlyA in healthy Chinese pregnant women and to assess the predictive value of serum GlyA in adverse pregnancy outcomes. Methods Totally 421 healthy subjects including 137 in the first trimester, 152 in the second trimester, and 132 in the third trimester were enrolled from March to July 2019, for the purpose of establishing the trimester-specific RIs of GlyA. In addition, 67 pregnant women diagnosed with GDM were enrolled at 24–28 weeks of gestation. The diagnostic value of GlyA for GDM patients was evaluated and compared with that of fasting plasma glucose (FPG) at 24–28 weeks of gestation. The association between GlyA in the late pregnancy and the adverse pregnancy outcomes was analyzed with the data collected from January to June 2018 at our hospital. Results The estimated RIs of GlyA in present study were 11.26–15.10%, 10.04–13.50%, and 9.76–13.09% in the first, second, and third trimesters respectively. The areas under receiver operating characteristic (ROC) curves were 0.503 for GlyA and 0.705 for FPG. More importantly, the GlyA level in the third trimester was not more elevated in the patients with adverse pregnancy outcomes including large for gestational age (LGA), preterm delivery, hypertension and preeclampsia (PE). The exception was made with the GDM patients who suffered from postpartum hemorrhage and had significantly higher GlyA levels than the control group. Conclusions Our results showed that the GlyA was continuously decreased as the gestational age went up. The GlyA testing has limited value in diagnosing GDM and predicting adverse pregnancy outcomes.
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Affiliation(s)
- Ying Dong
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Yanhong Zhai
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Jing Wang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Yi Chen
- Obstetrical Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xin Xie
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Chunhong Zhang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Jingrui Liu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Yifan Lu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Guodong Tang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China.,Prenatal Diagnosis Center, Beijing Haidian Maternal and Child Health Hospital, Beijing, China
| | - Lican Han
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China
| | - Lin Li
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zheng Cao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China.
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258
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Huang Q, Wang Y, Gu B, Xu Y. Whether the risk of gestational diabetes mellitus is affected by TNF-α, IL-6, IL-10 or ADIPOQ polymorphisms: a meta-analysis. Diabetol Metab Syndr 2020; 12:81. [PMID: 32963590 PMCID: PMC7499992 DOI: 10.1186/s13098-020-00582-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Whether polymorphisms in tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10) or adiponectin (ADIPOQ) influence the risk of gestational diabetes mellitus (GDM) or not remain inconclusive. Therefore, the authors conducted a meta-analysis to robustly assess relationships between polymorphisms in TNF-α, IL-6, IL-10 or ADIPOQ and the risk of GDM by merging the results of eligible publications. METHODS A through literature searching in Medline, Embase, Wanfang, VIP and CNKI was conducted by the authors to identify eligible publications, and twenty-two publications were finally found to be eligible for merged quantitative analyses. RESULTS The merged quantitative analyses revealed that ADIPOQ + 45T/G (rs2241766) polymorphism was significantly associated with the risk of GDM in overall population (dominant comparison: OR = 0.70, p < 0.001; recessive comparison: OR = 1.95, p < 0.001; over-dominant comparison: OR = 1.18, p = 0.03; allele comparison: OR = 0.71, p < 0.001) and Asians (dominant comparison: OR = 0.70, p < 0.001; recessive comparison: OR = 1.94, p < 0.001; allele comparison: OR = 0.72, p < 0.001). Nevertheless, we did not observe any positive results for TNF-α - 238G/A (rs361525), TNF-α - 308G/A (rs1800629), IL6 - 174G/C (rs1800795), IL-10 - 819C/T (rs1800871), IL-10 - 592C/A (rs1800872), IL-10 - 1082A/G (rs1800896) and ADIPOQ + 276G/T (rs1501299) polymorphisms. CONCLUSIONS The present meta-analysis shows that among investigated TNF-α, IL-6, IL-10 or ADIPOQ polymorphisms, only ADIPOQ + 45T/G (rs2241766) polymorphism may affect the risk of GDM.
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Affiliation(s)
- Qiqi Huang
- Department of Nutrition, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Yi Wang
- Department of Nutrition, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Binbin Gu
- Department of Nutrition, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Yanwen Xu
- Department of Endocrinology, Huzhou Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, No.315 of South Chaoyang Street, Huzhou, 313000 China
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259
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Quaresima P, Visconti F, Chiefari E, Mirabelli M, Borelli M, Caroleo P, Foti D, Puccio L, Venturella R, Di Carlo C, Brunetti A. Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia. J Diabetes Res 2020; 2020:5393952. [PMID: 33015192 PMCID: PMC7520011 DOI: 10.1155/2020/5393952] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Screening strategies for gestational diabetes mellitus (GDM) earlier than 24-28 weeks of gestation should be considered to prevent adverse pregnancy outcomes. Nonetheless, there is uncertainty about which women would benefit most from early screening and which screening strategies should be offered to women with GDM. The Italian National Healthcare Service (NHS) recommendations on selective screening for GDM at 16-18 weeks of gestation are effective in preventing fetal macrosomia in high-risk (HR) women, but the appropriateness of timing and effectiveness of these recommendations in medium- (MR) and low-risk (LR) women are still controversial. Patients and Methods. We retrospectively enrolled 769 consecutive singleton pregnant women who underwent both anomaly scan at 19-21 weeks of gestation and screening for GDM at 16-18 and/or 24-28 weeks of gestation, in agreement with the NHS recommendations and risk stratification criteria. Comparison of maternal characteristics, fetal biometric parameters at anomaly scan (head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)), and neonatal birth weight (BW) percentile among risk groups was examined. RESULTS 219 (28.5%) women were diagnosed with GDM, while 550 (71.5%) were normal glucose-tolerant women. Out of 164 HR women, only 62 (37.8%) underwent the recommended early screening for GDM at 16-18 weeks of gestation. AC and EFW percentiles, as well as neonates' BW percentiles, were significantly higher in HR women diagnosed with GDM at 24-28 weeks of gestation with respect to normal glucose-tolerant women, as well as MR and LR women who tested positive for GDM. Comparative analysis between MR and LR women with GDM and women with normal glucose tolerance revealed significant differences in both AC and EFW percentiles (P < 0.05), while there was no significant difference in neonatal BW percentiles. CONCLUSION In MR and LR women with GDM, a mild acceleration of fetal growth can be detected at the time of anomaly scan. However, in these at-risk categories, the NHS recommendations for screening and treatment of GDM at 24-28 weeks of gestation are still effective in normalizing BW and preventing fetal macrosomia, thus supporting a risk factor-based selective screening program for GDM.
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Affiliation(s)
- Paola Quaresima
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Federica Visconti
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Mirabelli
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Massimo Borelli
- UMG School of PhD Programmes Life Sciences and Technologies, University “Magna Græcia” of Catanzaro, Italy
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Italy
| | - Patrizia Caroleo
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Viale Pio X, 88100 Catanzaro, Italy
| | - Daniela Foti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Viale Pio X, 88100 Catanzaro, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Costantino Di Carlo
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
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He Y, Wu N, Yu W, Li L, OuYang H, Liu X, Qian M, Al-Mureish A. Research Progress on the Experimental Animal Model of Gestational Diabetes Mellitus. Diabetes Metab Syndr Obes 2020; 13:4235-4247. [PMID: 33204130 PMCID: PMC7665513 DOI: 10.2147/dmso.s270935] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022] Open
Abstract
Gestational diabetes mellitus (GDM) refers to different degrees of abnormal glucose metabolism during pregnancy, where blood glucose levels do not reach the level of overt diabetes, accounting for 80-90% of pregnancy with hyperglycemia. Hyperglycemia affects the pregnancy process, leading to a series of adverse maternal outcomes that have a profound impact on the future of the offspring. The establishing of an appropriate GDM model will provide theoretical basis for study GDM pathogenesis involves, the choice of resonable drugs and the observation the disease trends and outcomes. At present, there are many methods for establishing experimental GDM animal models and animal choices. This paper examines the different GDM models and their induction methods.
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Affiliation(s)
- Yujing He
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
- Correspondence: Na WuDepartment of Endocrinology, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang, Liaoning Province110004, People’s Republic of ChinaTel +86 18940258445 Email
| | - Wenshu Yu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Ling Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Hong OuYang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Xinyan Liu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Meichen Qian
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - A Al-Mureish
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
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261
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Dong B, Zhi M, Han M, Lin H, Yu H, Li L. The relationship between vitamin D and insulin resistance before delivery in advanced maternal age. Reprod Biol Endocrinol 2019; 17:108. [PMID: 31849339 PMCID: PMC6918560 DOI: 10.1186/s12958-019-0555-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/12/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND With the widely implementation of universal two-child policy, the number of pregnant women in advanced maternal age (AMA) will increase gradually. We aimed to assess the association of vitamin D levels and insulin resistance (IR) during the late pregnancy in AMA. METHODS A total of 80 pregnant women were consecutively enrolled in the cross-sectional study before delivery from the August 2016 to June 2017 at the department of gynecology and obstetrics in the hospital of ZhongDa, affiliated to Southeast University. At delivery, serum 25(OH) D and metabolism parameters including glucose and lipid levels were measured. IR was calculated by the method of homeostasis model assessment 2(HOMA2). RESULTS Pregnant women in AMA with vitamin D deficiency have higher fasting insulin (14.70(8.76-34.65) and 10.89(7.15-16.12), respectively, P = 0.031) and HOMA-IR indices (1.78(1.07-4.14) and 1.30(0.83-1.89), respectively, P = 0.024) than those with vitamin D non-deficiency. Serum 25(OH) D levels were inversely associated with HOMA-IR indices (r = - 0.25, P = 0.025). In multivariable analysis for adjusting confounder factors, vitamin D non-deficiency was also negatively correlated with HOMA-IR compared to vitamin D deficiency (β = - 1.289, P = 0.026). CONCLUSIONS Taken together, our findings suggest that serum 25(OH) D levels were inversely associated with HOMA-IR in AMA. Furthermore, pregnant women in AMA with vitamin D deficiency might have higher HOMA-IR levels than those with vitamin D non-deficiency. TRIAL REGISTRATION Chinese Clinical Trial Registry (No. ChiCTR-RRC-16008714). retrospectively registered.
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Affiliation(s)
- Beibei Dong
- Department of Endocrinology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu Province, China
- Pancreatic Research Institute, Southeast University, Nanjing, China
| | - Mengmeng Zhi
- Department of Endocrinology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu Province, China
- Pancreatic Research Institute, Southeast University, Nanjing, China
| | - Manman Han
- Department of Endocrinology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu Province, China
- Pancreatic Research Institute, Southeast University, Nanjing, China
| | - Hao Lin
- Pancreatic Research Institute, Southeast University, Nanjing, China
- Department of Clinical Science and Research, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hong Yu
- Department of Obstetrics and Gynecology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Ling Li
- Department of Endocrinology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu Province, China.
- Pancreatic Research Institute, Southeast University, Nanjing, China.
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262
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miR-657 Promotes Macrophage Polarization toward M1 by Targeting FAM46C in Gestational Diabetes Mellitus. Mediators Inflamm 2019; 2019:4851214. [PMID: 31915414 PMCID: PMC6930733 DOI: 10.1155/2019/4851214] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 02/08/2023] Open
Abstract
MicroRNA (miRNA) has been widely suggested to play a vital role of in the pathogenesis of gestational diabetes mellitus (GDM). We have previously demonstrated that miR-657 can regulate macrophage inflammatory response in GDM. However, the role of miR-657 on M1/M2 macrophage polarization in GDM pathogenesis is not clear yet. This study is aimed at elucidating this issue and identifying novel potential GDM therapeutic targets based on miRNA network. miR-657 is found to be upregulated in placental macrophages demonstrated by real-time PCR, which can enhance macrophage proliferation and migration in vitro. Luciferase reporter assay shows the evidence that FAM46C is a target of miR-657. In addition, miR-657 can promote macrophage polarization toward the M1 phenotype by downregulating FAM46C in macrophages. The present study strongly suggests miR-657 is involved in GDM pathogenesis by regulating macrophage proliferation, migration, and polarization via targeting FAM46C. miR-657/FAM46C may serve as promising targets for GDM diagnosis and treatment.
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263
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Molecular Modelling of Islet β-Cell Adaptation to Inflammation in Pregnancy and Gestational Diabetes Mellitus. Int J Mol Sci 2019; 20:ijms20246171. [PMID: 31817798 PMCID: PMC6941051 DOI: 10.3390/ijms20246171] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM), a metabolic disease that develops with the increase in insulin resistance during late pregnancy, is currently one of the most common complications affecting pregnancy. The polygenic nature of GDM, together with the interplay between different genetic variants with nutritional and environmental factors has hindered the full understanding of the etiology of this disease. However, an important genetic overlap has been found with type 2 diabetes mellitus (T2DM) and, as in the case of T2DM, most of the identified loci are associated with β-cell function. Early detection of GDM and adequate interventions to control the maternal glycemia are necessary to avoid the adverse outcomes for both the mother and the offspring. The in utero exposure to the diabetic milieu predispose these children for future diseases, among them T2DM, originating a vicious circle implicated in the increased prevalence of both GDM and T2DM. The involvement of inflammatory processes in the development of GDM highlights the importance of pancreatic β-cell factors able to favor the adaptation processes required during gestation, concomitantly with the protection of the islets from an inflammatory milieu. In this regard, two members of the Pax family of transcription factors, PAX4 and PAX8, together with the chromatin remodeler factor HMG20A, have gained great relevance due to their involvement in β-cell mass adaptation together with their anti-inflammatory properties. Mutations in these factors have been associated with GDM, highlighting these as novel candidates for genetic screening analysis in the identification of women at risk of developing GDM.
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Relationship between Size of the Foveal Avascular Zone and Carbohydrate Metabolic Disorders during Pregnancy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3261279. [PMID: 31781611 PMCID: PMC6874923 DOI: 10.1155/2019/3261279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/11/2019] [Accepted: 10/03/2019] [Indexed: 11/18/2022]
Abstract
Aim To determine whether the area of the foveal avascular zone (FAZ), as a morphological indicator of the microcirculation of the perifoveal capillary network, changes in the carbohydrate metabolism disorders during pregnancy (the gestational age of patients with gestational diabetes mellitus (GDM) and preexisting diabetes (PexD)). Methods Ten normal individuals and 41 eyes of 41 patients, 28 with GDM and 13 with PexD, were studied. A 3 × 3 mm area of the FAZ of the superficial capillary plexus layer (SCP) and the deep capillary plexus layer (DCP) was determined by optical coherence tomography angiography (OCTA; RS-3000 Advance, NIDEK). The significance of the correlation between the size of the FAZ and the weeks of pregnancy was determined. Results The area of the FAZ of the SCP was 0.38 ± 0.11 mm2 (normal eyes), 0.41 ± 0.16 mm2 (GDM), and 0.43 ± 0.10 mm2 (PexD). The area of the FAZ of the DCP was 0.78 ± 0.23 mm2 (normal eyes), 0.69 ± 0.16 mm2 (GDM), and 0.79 ± 0.25 mm2 (PexD). No significant difference in the FAZ sizes was observed between the groups. The average number of weeks of pregnancy was 24.1 ± 8.2 weeks in the eyes with GDM and 23.3 ± 11.4 weeks in the eyes with PexD (P > 0.05). Significant correlations were found between the size of the FAZ of the SCP and the number of weeks (r = 0.37, P=0.04 for GDM, and r = 0.49, P=0.04 for PexD, Spearman's rank-order correlation coefficient). Conclusions For GDM and PexD under established glycemic control, the area of the FAZ is not affected, but vascular changes occurred at the early phase of pregnancy.
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265
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Specialized pro-resolving mediators in diabetes: novel therapeutic strategies. Clin Sci (Lond) 2019; 133:2121-2141. [DOI: 10.1042/cs20190067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023]
Abstract
AbstractDiabetes mellitus (DM) is an important metabolic disorder characterized by persistent hyperglycemia resulting from inadequate production and secretion of insulin, impaired insulin action, or a combination of both. Genetic disorders and insulin receptor disorders, environmental factors, lifestyle choices and toxins are key factors that contribute to DM. While it is often referred to as a metabolic disorder, modern lifestyle choices and nutrient excess induce a state of systemic chronic inflammation that results in the increased production and secretion of inflammatory cytokines that contribute to DM. It is chronic hyperglycemia and the low-grade chronic-inflammation that underlies the development of microvascular and macrovascular complications leading to damage in a number of tissues and organs, including eyes, vasculature, heart, nerves, and kidneys. Improvements in the management of risk factors have been beneficial, including focus on intensified glycemic control, but most current approaches only slow disease progression. Even with recent studies employing SGLT2 inhibitors demonstrating protection against cardiovascular and kidney diseases, kidney function continues to decline in people with established diabetic kidney disease (DKD). Despite the many advances and a greatly improved understanding of the pathobiology of diabetes and its complications, there remains a major unmet need for more effective therapeutics to prevent and reverse the chronic complications of diabetes. More recently, there has been growing interest in the use of specialised pro-resolving mediators (SPMs) as an exciting therapeutic strategy to target diabetes and the chronic complications of diabetes.
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266
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Wang CY, Su MT, Cheng HL, Kuo PL, Tsai PY. Fetuin-A Inhibits Placental Cell Growth and Ciliogenesis in Gestational Diabetes Mellitus. Int J Mol Sci 2019; 20:ijms20205207. [PMID: 31640125 PMCID: PMC6829213 DOI: 10.3390/ijms20205207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a type of unbalanced glucose tolerance that occurs during pregnancy, which affects approximately 10% of pregnancies worldwide. Fetuin-A is associated with insulin resistance, and the concentration of circulating fetuin-A increases in women with GDM, however, the role of fetuin-A in the placenta remains unclear. In this study, we enrolled placental samples from twenty pregnant women with GDM and twenty non-GDM pregnant women and found that the abundance of fetuin-A was upregulated in terms of mRNA and protein levels. Fetuin-A inhibited placental cell growth by inducing apoptosis and inhibiting S phase entry. Irregular alignment of mitotic chromosomes and aberrant mitotic spindle poles were observed. In addition, centrosome amplification was induced by fetuin-A treatment, and these amplified centrosomes nucleated microtubules with disorganized microtubule arrays in placental cells. Furthermore, fetuin-A inhibited autophagy, and thus blocked the growth of the primary cilium, a cellular antenna that regulates placenta development and differentiation. Thus, our study uncovered the novel function of fetuin-A in regulating placental cell growth and ciliogenesis.
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Affiliation(s)
- Chia-Yih Wang
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
| | - Mei-Tsz Su
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
| | - Hui-Ling Cheng
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
| | - Pei-Yin Tsai
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
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267
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Kang X, Liang Y, Wang S, Hua T, Cui J, Zhang M, Ding Y, Chen L, Xiao J. Prediction model comparison for gestational diabetes mellitus with macrosomia based on risk factor investigation. J Matern Fetal Neonatal Med 2019; 34:2481-2490. [PMID: 31575301 DOI: 10.1080/14767058.2019.1668922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To establish a feasible prediction model for gestational diabetes mellitus (GDM) with macrosomia based on risk factors analysis. METHODS A total of 1981 GDM pregnant women with macrosomia were enrolled in this retrospective study. The potential risk factors were revealed between the GDM women with and without macrosomia based on questionnaire and clinical data analysis. Then, prediction models including logistic regression (LR), decision tree (DT), support vector machine (SVM) and artificial neural networks (ANN) were constructed using these risk factors. Effect evaluation was performed based on model forecasting ability and model practicability such as accuracy, true positive (TP) rate, false positive (FP) rate, recall, F-measure, and receiver operating characteristic curve (ROC). RESULTS The risk factors analysis showed that factors such as triglyceride (TG), high-density lipoprotein-cholesterol (HDL-c) and ketone body were risk factors for GDM with macrosomia. Then, the forecasting model was constructed, respectively. Based on these risk factors as variables, the overall classification accuracy of the four forecasting models was 86%. DT model had the highest overall classification accuracy. SVM model had advantages over the other three models in terms of TP rate. Among the comparison parameters including overall ROC curve, ANN model was the highest, followed by LR model. CONCLUSION Among four forecasting models, ANN might be the optimal predication model, which had a certain practical value for the clinical screening of GDM women combined with macrosomia. Furthermore, HDL-c, TG, and ketone body might be potential risk factors for GDM with macrosomia.
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Affiliation(s)
- Xinyi Kang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Yuanyuan Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China
| | - Shiyu Wang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China
| | - Tianqi Hua
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China
| | - Jiawen Cui
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Mingjin Zhang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Yunjunyu Ding
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Liping Chen
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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268
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Rosik J, Szostak B, Machaj F, Pawlik A. The role of genetics and epigenetics in the pathogenesis of gestational diabetes mellitus. Ann Hum Genet 2019; 84:114-124. [DOI: 10.1111/ahg.12356] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Jakub Rosik
- Department of Physiology Pomeranian Medical University Szczecin Poland
| | - Bartosz Szostak
- Department of Physiology Pomeranian Medical University Szczecin Poland
| | - Filip Machaj
- Department of Physiology Pomeranian Medical University Szczecin Poland
| | - Andrzej Pawlik
- Department of Physiology Pomeranian Medical University Szczecin Poland
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Visconti F, Quaresima P, Chiefari E, Caroleo P, Arcidiacono B, Puccio L, Mirabelli M, Foti DP, Di Carlo C, Vero R, Brunetti A. First Trimester Combined Test (FTCT) as a Predictor of Gestational Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193654. [PMID: 31569431 PMCID: PMC6801433 DOI: 10.3390/ijerph16193654] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 01/27/2023]
Abstract
Background—The first trimester combined test (FTCT) is an effective screening tool to estimate the risk of fetal aneuploidy. It is obtained by the combination of maternal age, ultrasound fetal nuchal translucency (NT) measurement, and the maternal serum markers free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein A (PAPP-A). However, conflicting data have been reported about the association of FTCT, β-hCG, or PAPP-A with the subsequent diagnosis of gestational diabetes mellitus (GDM). Research design and methods—2410 consecutive singleton pregnant women were retrospectively enrolled in Calabria, Southern Italy. All participants underwent examinations for FTCT at 11–13 weeks (plus 6 days) of gestation, and screening for GDM at 16–18 and/or 24–28 weeks of gestation, in accordance with current Italian guidelines and the International Association Diabetes Pregnancy Study Groups (IADPSG) glycemic cut-offs. Data were examined by univariate and logistic regression analyses. Results—1814 (75.3%) pregnant women were normal glucose tolerant, while 596 (24.7%) were diagnosed with GDM. Spearman univariate analysis demonstrated a correlation between FTCT values and subsequent GDM diagnosis (ρ = 0.048, p = 0.018). The logistic regression analysis showed that women with a FTCT <1:10000 had a major GDM risk (p = 0.016), similar to women with a PAPP-A <1 multiple of the expected normal median (MoM, p = 0.014). Conversely, women with β-hCG ≥2.0 MoM had a reduced risk of GDM (p = 0.014). Conclusions—Our findings indicate that GDM susceptibility increases with fetal aneuploidy risk, and that FTCT and its related maternal serum parameters can be used as early predictors of GDM.
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Affiliation(s)
- Federica Visconti
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Paola Quaresima
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Patrizia Caroleo
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Biagio Arcidiacono
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Maria Mirabelli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Daniela P Foti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Costantino Di Carlo
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Raffaella Vero
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Antonio Brunetti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
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270
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Bao LX, Shi WT, Han YX. Metformin versus insulin for gestational diabetes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:2741-2753. [PMID: 31558075 DOI: 10.1080/14767058.2019.1670804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Metformin is increasingly used in clinical practice for the treatment of gestational diabetes mellitus. However, its safety and long-term effects on fetuses exposed to metformin in uterus remain controversial. METHODS We systematically searched PubMed, Embase, and the Cochrane database (last search was updated on 1 May 2019) for randomized controlled trials comparing metformin with insulin. Two reviewers extracted the data and calculated pooled estimates by use of a random-effects model. RESULTS Twenty-four studies were included. Among these, seventeen RCTs (N = 2828 participants) were included for quantitative analyses and seven studies were included only for qualitative synthesis. Metformin lowered the risk of pregnancy-induced hypertension (p = .03; risk ratio (RR) = 0.64; confidence interval (95%CI) [0.44, 0.95]), large for gestational age babies (p = .04; RR = 0.82; 95% CI [0.68, 0.99]), macrosomia (p = .01; RR = 0.63; 95%CI [0.45, 0.90]), neonatal hypoglycemia (p = .001; RR = 0.72; 95%CI [0.59, 0.88]), and neonatal intensive care unit admission (p = .01; RR = 0.74; 95%CI [0.58, 0.94]). Metformin did not increase premature delivery (p = .11; RR = 1.28; 95%CI [0.95, 1.73]), preeclampsia (p = .45; RR = 0.89; 95%CI [0.65, 1.21]), caesarean delivery (p = .20; RR = 0.94; 95%CI [0.85, 1.04]), small for gestational age babies (p = .95; RR = 0.99; 95%CI [0.69, 1.42]). The long-term results seemed to have no adverse effect, but the information was still limited. CONCLUSIONS According to our review, metformin may have potential benefits for pregnant women and newborns with no obvious adverse effects. However, even more studies are needed to provide evidence for the future use of metformin.
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Affiliation(s)
- Le-Xin Bao
- Affiliated Hospital of Qingdao, University, Qingdao University, Qingdao, People's Republic of China
| | - Wan-Ting Shi
- Affiliated Hospital of Qingdao, University, Qingdao University, Qingdao, People's Republic of China
| | - Yu-Xin Han
- Affiliated Hospital of Qingdao, University, Qingdao University, Qingdao, People's Republic of China
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271
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Badakhsh M, Daneshi F, Abavisani M, Rafiemanesh H, Bouya S, Sheyback M, Rezaie Keikhaie K, Balouchi A. Prevalence of gestational diabetes mellitus in Eastern Mediterranean region: a systematic review and meta-analysis. Endocrine 2019; 65:505-514. [PMID: 31376101 DOI: 10.1007/s12020-019-02026-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is one of the costly challenges in the health field. Despite the individual studies in the Eastern Mediterranean, there is no comprehensive study in this regard. The aim of this study was to determine the prevalence of GDM in the Eastern Mediterranean region. METHODS In this meta-analysis and systematic review, three international databases (PubMed, Web of science and Scopus) were searched from inception until 30 December 2018. The Hui tool was used to assess the quality of the included studies. RESULTS Thirty-three studies performed on 887166 participants were included in the meta-analysis. Based on the results of random effect method, the overall prevalence of GDM was 11.7%. Between six country with have three or more study, pooled prevalence for Saudi Arabi it was 3.6 times more than Israel (17.6 vs. 4.9%), and for Pakistan, Qatar, Bahrain and Iran were 15.3%, 14.7%, 12.2%, and 8.6%, respectively. CONCLUSION Despite the high diversity of methods, the results of the present study indicate a high prevalence of GDM in the Eastern Mediterranean region, indicating more policymakers' interest in timely screening and proper management.
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Affiliation(s)
- Mahin Badakhsh
- Department of Midwifery, School of Nursing and Midwifery, Zabol University of Medical Science, Zabol, Iran
| | - Fereshteh Daneshi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Mahnaz Abavisani
- MSc of Medical Surgical Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hosien Rafiemanesh
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salehoddin Bouya
- Clinical Immunology Research Center, Ali-ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | | | - Abbas Balouchi
- Student Research Committee, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran
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Abreu LRS, Shirley MK, Castro NP, Euclydes VV, Bergamaschi DP, Luzia LA, Cruz AM, Rondó PHC. Gestational diabetes mellitus, pre-pregnancy body mass index, and gestational weight gain as risk factors for increased fat mass in Brazilian newborns. PLoS One 2019; 14:e0221971. [PMID: 31465493 PMCID: PMC6715169 DOI: 10.1371/journal.pone.0221971] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/15/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common complication of pregnancy. It may predispose offspring to increased fat mass (FM) and the development of obesity, however few data from Latin America exist. OBJECTIVE To investigate the influence of GDM on newborn FM in mother-newborn pairs recruited from a public maternity care center in São Paulo, Brazil. METHODS Data were collected cross-sectionally in 2013-2014 from 72 mothers diagnosed with GDM, and 211 mothers with normal glucose tolerance (NGT). Newborn FM was evaluated by air-displacement plethysmography (PEA POD), and relevant demographic and obstetric data were collected from hospital records. Associations between maternal GDM status and newborn FM were investigated by multiple linear regression analysis, with adjustment for maternal age, pre-pregnancy BMI, gestational weight gain, type of delivery, sex of the child, and gestational age. RESULTS FM was greater in GDM versus NGT newborns in a bivariable model (Median (IQR), GDM: 0.35 (0.3) kg vs. NGT: 0.27 (0.2) kg, p = 0.02), however GDM status was not a significant predictor of FM with adjustment for other variables. Rather, pre-pregnancy BMI (coefficient (β) 1.46; 95% confidence interval (CI) 0.66, 2.27), gestational weight gain (β 1.32; 95% CI 0.49, 2.15), and male sex (β -17.8; 95% CI -27.2, -8.29) predicted newborn FM. Analyzing GDM and NGT groups separately, pre-pregnancy BMI (β 6.75; 95% CI 2.36, 11.1) and gestational weight gain (β 5.64; 95% CI 1.16, 10.1) predicted FM in the GDM group, while male sex alone predicted FM in the NGT group (β -12.3; 95% CI -18.3, -6.34). CONCLUSIONS Combined model results suggest that in our cohort, pre-pregnancy BMI and gestational weight gain are more important risk factors for increased neonatal FM than GDM. However, group-specific model results suggest that GDM status may contribute to variation in the relationship between maternal/offspring factors and FM. Our use of a binary GDM variable in the combined model may have precluded clearer results on this point. Prospective cohort studies including data on maternal pre-pregnancy BMI, GWG, and glycemic profile are needed to better understand associations among these variables and their relative influence on offspring FM.
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Affiliation(s)
- Laísa R. S. Abreu
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Meghan K. Shirley
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Natália P. Castro
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Verônica V. Euclydes
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Denise P. Bergamaschi
- Epidemiology Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Liania A. Luzia
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Ana M. Cruz
- Geraldo de Paula Souza Health Center, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Patrícia H. C. Rondó
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
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273
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Zhuang Y, Zhang J, Li Y, Gu H, Zhao J, Sun Y, Wang R, Zhang C, Chen W, Weng J, Qi L, Lu H, Zhang J, Liu Q, He Y, Xu X. B Lymphocytes Are Predictors of Insulin Resistance in Women with Gestational Diabetes Mellitus. Endocr Metab Immune Disord Drug Targets 2019; 19:358-366. [PMID: 30621567 PMCID: PMC7040503 DOI: 10.2174/1871530319666190101130300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/12/2018] [Accepted: 11/16/2018] [Indexed: 12/11/2022]
Abstract
Backgroud: The present study aimed to investigate the association between immune cells and gestational diabetes mellitus (GDM) and identify a reasonable predictor of insulin resistance in women with GDM. Objective: The clinical and biochemical characteristics of 124 women with GDM and 168 healthy pregnant women were compared. Methods: The percentage of immune cells in the blood of the subjects was analyzed by flow cytometry. Pearson’s correlation analysis revealed the correlation between the percentage of B lymphocytes and insulin resistance. A cutoff point was determined for the percentage of B lymphocytes, based on insulin resistance, using receiver operating characteristic (ROC) curves. Results: Compared to the healthy pregnant women, the percentages of B lymphocytes and IgA produced by B-cells were significantly different in women with GDM. The percentage of B lymphocytes was positively related to insulin resistance.The number of 14.05% of B lymphocytes was an optimal cutoff point that predicted the insulin resistance in women with GDM. Conclusion: The percentage of B lymphocytes was positively associated with insulin resistance, and hence, might serve as an appropriate predictor of insulin resistance in women with GDM.
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Affiliation(s)
- Yan Zhuang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Jin Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Yiwei Li
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Hongqin Gu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Jinyan Zhao
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Ya Sun
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Rencheng Wang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Chunyan Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China.,Department of Obstetrics and Gynecology, Shangyou Maternal and Child Care Service Center, No.9 Shuinan Avenue, Ganzhou City, Jiangxi Province 341200, China
| | - Wen Chen
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China.,Department of Obstetrics and Gynecology, Fuluan Maternal and Child Care Service Center, No.2 Kaiyuan Road, Jingdezhen City, Jiangxi Province 333400, China
| | - Jianrong Weng
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Lan Qi
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Huifang Lu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Jiarong Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Qin Liu
- The Wistar Institution, 19104, Philadelphia, United States
| | - Yinyan He
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
| | - Xianming Xu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai 200080, China
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274
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Xiong T, Zhong C, Sun G, Zhou X, Chen R, Li Q, Wu Y, Gao Q, Huang L, Hu X, Xiao M, Yang X, Hao L, Yang N. Early maternal circulating alkaline phosphatase with subsequent gestational diabetes mellitus and glucose regulation: a prospective cohort study in China. Endocrine 2019; 65:295-303. [PMID: 31115769 DOI: 10.1007/s12020-019-01954-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/08/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE Emerging clinical evidence has implied that alkaline phosphatase (ALP) may contribute to gestational diabetes mellitus (GDM). However, there were no studies to reveal the independent and prospective associations between ALP and GDM. Our aim was to explore the independent and prospective associations between early maternal ALP level and GDM risk and glucose regulation. METHODS In a prospective cohort study with 2073 singleton mothers at four maternity units in China, maternal serum ALP levels were measured before 20 gestational weeks. Using logistic regression, we analyzed the relationship between maternal ALP level and risk of GDM. We further explored the relationships of ALP level to fasting blood glucose (FBG), 1-h and 2-h post-load blood glucose (1-h, 2-h PBG) with multiple linear regression. Finally, we analyzed the association between maternal ALP level and isolated impaired fasting glucose (i-IFG) and isolated impaired glucose tolerance (i-IGT) risk. RESULTS The maximum value of maternal ALP level was 90 U/L, within the normal range. After adjustment for confounding factors, the odds ratio (ORs) of GDM increased linearly with ALP level (p for overall association = 0.002, p for nonlinear association = 0.799), with the OR comparing the highest versus lowest quartile of 2.47 (95% CI 1.47, 4.15). Moreover, each additional of 10 U/L ALP level was associated with a 2% higher FBG (p = 0.043) and a 12% higher 1-h PBG (p = 0.004). Higher ALP level also increased the risk of i-IFG (OR 3.73, 95% CI 1.17-11.86) and i-IGT (OR 2.03, 95% CI 1.07-3.84). CONCLUSIONS Even within the upper limit of normal, higher early maternal ALP level could increase the risk of GDM. Moreover, both FBG and PBG were increased with early maternal ALP.
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Affiliation(s)
- Ting Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Chunrong Zhong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Guoqiang Sun
- Hubei Maternal and Child Health Hospital, Wuhan, Hubei, 430070, People's Republic of China
| | - Xuezhen Zhou
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Renjuan Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Qian Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Yuanjue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Qin Gao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Li Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Xingwen Hu
- Hubei Maternal and Child Health Hospital, Wuhan, Hubei, 430070, People's Republic of China
| | - Mei Xiao
- Hubei Maternal and Child Health Hospital, Wuhan, Hubei, 430070, People's Republic of China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China.
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People's Republic of China.
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275
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Nwose EU, Mogbusiaghan M, Bwititi PT, Adoh G, Agofure O, Igumbor EO. Barriers in determining prevalence of type 2 diabetes mellitus among postpartum GDM: The research and retraining needs of healthcare professionals. Diabetes Metab Syndr 2019; 13:2533-2539. [PMID: 31405673 DOI: 10.1016/j.dsx.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/08/2019] [Indexed: 11/20/2022]
Abstract
AIM A large percentage of gestational diabetes (GDM) are undiagnosed, and prevalence of postpartum type 2 diabetes (T2DM) is unknown, especially in developing countries. This study assessed barriers to GDM diagnosis and postpartum follow-up; to determine educational needs. MATERIALS AND METHODS This was a clinical observational study of records and procedures of antenatal services at two hospitals. Laboratory and medical records were reviewed for availability of data on anthropometrics, blood glucose, gestational age, urinalysis, and lipid profile for GDM register. Antenatal clinic protocol was observed for GDM diagnosis. BMI was derived and data were analyzed using SPSS version 20. RESULTS Critical barriers attributable to health systems included lack of screening for blood sugar as part of routine antenatal protocol, and lack of GDM registers at both facilities. There was 6.5% registration of pregnancies in first trimester, 22% pre-pregnancy obesity, and 2.6% high blood pressure. Positive glucosuria cases were not followed-up for GDM diagnosis. CONCLUSIONS There is neither concerted effort to diagnose GDM, nor systematic records of screening and postpartum follow-up. The gap in diabetology knowledge and practice calls for re-training of antenatal healthcare professionals. GDM screening checklist needs to be established and positive results entered into GDM registers for proper management during and after delivery.
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Affiliation(s)
- E U Nwose
- School of Community Health, Charles Sturt University, Orange, Australia; Department of Public & Community Health, Novena University, Ogume, Nigeria.
| | - M Mogbusiaghan
- Department of Public & Community Health, Novena University, Ogume, Nigeria
| | - P T Bwititi
- School of Biomedical Sciences, Charles Sturt University, Orange, Australia
| | - G Adoh
- Department of Public & Community Health, Novena University, Ogume, Nigeria
| | - O Agofure
- Department of Public & Community Health, Novena University, Ogume, Nigeria
| | - E O Igumbor
- Department of Public & Community Health, Novena University, Ogume, Nigeria
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276
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Pascual-Morena C, Martínez-Vizcaíno V, Álvarez-Bueno C, Pozuelo-Carrascosa DP, Notario-Pacheco B, Saz-Lara A, Fernández-Rodriguez R, Cavero-Redondo I. Exercise vs metformin for gestational diabetes mellitus: Protocol for a network meta-analysis. Medicine (Baltimore) 2019; 98:e16038. [PMID: 31232936 PMCID: PMC6636956 DOI: 10.1097/md.0000000000016038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The purpose of this protocol is to provide a network meta-analysis methodology that compares the effects of metformin and physical exercise in the prevention and treatment of gestational diabetes mellitus (GDM) and its associated fetal and maternal morbidity. METHODS AND ANALYSIS This protocol conforms to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the recommendations of the Cochrane Collaboration Handbook. An electronic search will be conducted in MEDLINE, EMBASE, Web of Science and the Cochrane Library, from the inception until July 2019. There will be no language restrictions. The Cochrane Collaboration tool for assessing risk of bias (RoB2) and the quality assessment tool for quantitative studies will be used. The Grading of Recommendations, Assessment, Development and Evaluation scale will be used to evaluate the strength of the evidence. A Bayesian network meta-analysis will be carried out, which allows direct and indirect comparison of the interventions, for the risk of GDM, prematurity, caesarean section, macrosomia, hypertensive disorders, insulin requirement, and differences in basal glucose, maternal weight, and weight of the newborn. DISCUSSION With this protocol, a methodology is established that resolves the limitations of previous meta-analysis. It will be possible to determine the difference of effect between physical exercise and metformin in the main outcomes of the GDM, as well as the type and intensity of the exercise, and the dose of metformin, more effective. ETHICS AND DISSEMINATION The data included in the network meta-analysis will be obtained from trials that meet accepted ethical standards and the Declaration of Helsinki. The results will be published in a peer-reviewed journal. The evidence obtained could be included in the guidelines of clinical practice in pregnancy. STRENGTHS AND LIMITATIONS A comprehensive methodology is established for the analysis, through network meta-analysis, of the comparative efficacy of metformin and physical exercise in gestational diabetes mellitus. The results obtained could help medical professionals by establishing the best evidence-based interventions which may be recommended for these population groups. REGISTRATION NUMBER PROSPERO CRD42019121715.
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Affiliation(s)
- Carlos Pascual-Morena
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Celia Álvarez-Bueno
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | | | | | - Alicia Saz-Lara
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | | | - Iván Cavero-Redondo
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
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277
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Bellos I, Fitrou G, Pergialiotis V, Perrea DN, Daskalakis G. Serum levels of adipokines in gestational diabetes: a systematic review. J Endocrinol Invest 2019; 42:621-631. [PMID: 30392100 DOI: 10.1007/s40618-018-0973-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the difference of serum levels of 10 adipokines (apelin, chemerin, fatty acid-binding protein-4, fibroblast growth factor-21, monocyte chemoattractant protein-1, nesfatin-1, omentin-1, resistin, vaspin, and visfatin) among women with gestational diabetes and healthy pregnant controls. MATERIALS AND METHODS Literature search was conducted using the Medline (1966-2018), Scopus (2004-2018), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2018), Clinicaltrials.gov (2008-2018) and Google Scholar (2004-2018) databases, along with the reference list of the included studies. RESULTS Ninety-one studies were included in the present review, with a total number of 11,074 pregnant women. A meta-analysis was not conducted due to the high inter-study heterogeneity. Current evidence suggests that fatty acid-binding protein-4 levels are significantly increased in pregnancies complicated with gestational diabetes, while no association of serum apelin and monocyte chemoattractant protein-1 with the disease can be supported. Data regarding the rest adipokines are conflicting, since the available studies did not unanimously indicate a significant change of their levels in gestational diabetes. CONCLUSIONS The findings of the present systematic review suggest the promising role of fatty acid-binding protein-4 in the prediction of gestational diabetes, while inconsistent evidence exists regarding the rest novel adipokines. Future cohorts are needed to assess their predictive efficacy and fully elucidate their contribution in the disease.
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Affiliation(s)
- I Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, 15Β, Ag. Thoma str., 115 27, Athens, Greece.
| | - G Fitrou
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, 15Β, Ag. Thoma str., 115 27, Athens, Greece
| | - V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, 15Β, Ag. Thoma str., 115 27, Athens, Greece
| | - D N Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, 15Β, Ag. Thoma str., 115 27, Athens, Greece
| | - G Daskalakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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278
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Song H, Xu Y, Yang X, Rong X, Wang Y, Wei N. Tertiary butylhydroquinone alleviates gestational diabetes mellitus in C57BL/KsJ-Lep db/+ mice by suppression of oxidative stress. J Cell Biochem 2019; 120:15310-15319. [PMID: 31050362 DOI: 10.1002/jcb.28798] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/14/2022]
Abstract
Gestational diabetes mellitus (GDM) is a common disorder characterized by abnormal glucose metabolism during pregnancy, affecting 2% to 5% of pregnant women. Currently, clinical treatment for GDM is very limited. The present study was designed to investigate the effect and underlying molecular mechanism of tertiary butylhydroquinone (TBHQ) in a pregnant C57BL/KsJ-Lep db/+ (referred to as db+) GDM mouse model. The results showed that nonpregnant db/+ mice did not show a diabetic phenotype, and TBHQ had no effect on glucose and insulin tolerance in these mice. Moreover, in db/+ pregnant mice exhibiting typical diabetes symptoms, such as hyperglycemia and hypoinsulinemia, TBHQ could remarkably decrease the blood glucose level, increase insulin level, and improve glucose and insulin intolerance. The results also revealed that TBHQ could inhibit oxidative stress in pregnant db/+ mice. Furthermore, TBHQ greatly improved offspring survival rate, glucose metabolism, and insulin tolerance. In addition, TBHQ inhibited oxidative stress by reducing malondialdehyde (MDA) and reactive oxygen species (ROS) levels and increased superoxide dismutase (SOD), and glutathione peroxidase (GPx) activities. Moreover, we found that TBHQ activated the nuclear factor erythroid 2-related factor 2 (Nrf2), thereby increasing the levels of Nrf2, and ultimately upregulating the expression of heme oxygenase 1 (NO-1) and superoxide dismutase 2 (SOD2). In conclusion, our findings demonstrated that TBHQ alleviated GDM via Nrf2 activation.
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Affiliation(s)
- Hongbi Song
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Yin Xu
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Xiaowu Yang
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Xiaoting Rong
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Ying Wang
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Na Wei
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
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279
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Zhu H, Chen B, Cheng Y, Zhou Y, Yan YS, Luo Q, Jiang Y, Sheng JZ, Ding GL, Huang HF. Insulin Therapy for Gestational Diabetes Mellitus Does Not Fully Protect Offspring From Diet-Induced Metabolic Disorders. Diabetes 2019; 68:696-708. [PMID: 30696708 DOI: 10.2337/db18-1151] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/18/2019] [Indexed: 11/13/2022]
Abstract
Gestational diabetes mellitus (GDM) is associated with an increased risk of metabolic disorders in offspring in later life. Although mounting evidence suggests that therapy for GDM could improve neonatal health, whether the therapy confers long-term metabolic benefits to offspring in their later adult lives is not known. Here, using a mouse model of diabetes in the latter half of pregnancy to mimic human GDM, we find that the efficient insulin therapy for GDM confers significant protection against glucose intolerance and obesity in offspring fed a normal chow diet. However, the therapy fails to protect offspring when challenged with a high-fat diet, especially for male offspring. Genome-wide DNA methylation profiling of pancreatic islets from male offspring identified hypermethylated regions in several genes that regulate insulin secretion, including Abcc8, Cav1.2, and Cav2.3 that encode KATP or Ca2+ channels, which are associated with reduced gene expression and impaired insulin secretion. This finding suggests a methylation-mediated epigenetic mechanism for GDM-induced intergenerational glucose intolerance. It highlights that even efficient insulin therapy for GDM is insufficient to fully protect adult offspring from diet-induced metabolic disorders.
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Affiliation(s)
- Hong Zhu
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bin Chen
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi Cheng
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pathology and Pathophysiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yin Zhou
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi-Shang Yan
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Jiang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Zhong Sheng
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Pathology and Pathophysiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guo-Lian Ding
- The International Peace Maternity and Child Health Hospital, Institute of Embryo-Fetal Original Adult Disease, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - He-Feng Huang
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The International Peace Maternity and Child Health Hospital, Institute of Embryo-Fetal Original Adult Disease, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
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280
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Trojnar M, Patro-Małysza J, Kimber-Trojnar Ż, Leszczyńska-Gorzelak B, Mosiewicz J. Associations between Fatty Acid-Binding Protein 4⁻A Proinflammatory Adipokine and Insulin Resistance, Gestational and Type 2 Diabetes Mellitus. Cells 2019; 8:cells8030227. [PMID: 30857223 PMCID: PMC6468522 DOI: 10.3390/cells8030227] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/03/2019] [Accepted: 03/03/2019] [Indexed: 12/12/2022] Open
Abstract
There is ample scientific evidence to suggest a link between the fatty acid-binding protein 4 (FABP4) and insulin resistance, gestational (GDM), and type 2 (T2DM) diabetes mellitus. This novel proinflammatory adipokine is engaged in the regulation of lipid metabolism at the cellular level. The molecule takes part in lipid oxidation, the regulation of transcription as well as the synthesis of membranes. An involvement of FABP4 in the pathogenesis of obesity and insulin resistance seems to be mediated via FABP4-dependent peroxisome proliferator-activated receptor γ (PPARγ) inhibition. A considerable number of studies have shown that plasma concentrations of FABP4 is increased in obesity and T2DM, and that circulating FABP4 levels are correlated with certain clinical parameters, such as body mass index, insulin resistance, and dyslipidemia. Since plasma-circulating FABP4 has the potential to modulate the function of several types of cells, it appears to be of extreme interest to try to develop potential therapeutic strategies targeting the pathogenesis of metabolic diseases in this respect. In this manuscript, representing a detailed review of the literature on FABP4 and the abovementioned metabolic disorders, various mechanisms of the interaction of FABP4 with insulin signaling pathways are thoroughly discussed. Clinical aspects of insulin resistance in diabetic patients, including women diagnosed with GDM, are analyzed as well.
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Affiliation(s)
- Marcin Trojnar
- Chair and Department of Internal Medicine, Medical University of Lublin, 20-081 Lublin, Poland.
| | - Jolanta Patro-Małysza
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Żaneta Kimber-Trojnar
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | | | - Jerzy Mosiewicz
- Chair and Department of Internal Medicine, Medical University of Lublin, 20-081 Lublin, Poland.
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281
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Kang J, Liu CH, Lee CN, Li HY, Yang CW, Huang SC, Lin SY, Jou TS. Novel Interleukin-10 Gene Polymorphism Is Linked to Gestational Diabetes in Taiwanese Population. Front Genet 2019; 10:89. [PMID: 30873205 PMCID: PMC6401599 DOI: 10.3389/fgene.2019.00089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/29/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: The association of interleukin-10 (IL-10) polymorphism with diabetes and its complication was recently established, while there were few researches considering the potential role of IL-10 in gestational diabetes (GDM). This study aimed to investigate the association between IL-10 gene rs1800896 (−1082 A/G), rs1800871 (−819 T/C), rs1800872 (−592 A/C), and rs3021094 (3388 A/C) single nucleotide polymorphisms (SNPs) and GDM susceptibility. Methods: This study included 72 GDM patients and 100 healthy pregnant women. Direct sequencing of the products from polymerase chain reactions of the extracted genomic DNA from study subjects were conducted for analyzing IL-10 gene polymorphism and further genotype frequencies were compared. Plasma IL-10 concentration was measured by ELISA method. Results: The results revealed no significant difference in −592 A/C, −819 T/C, and −1082 A/G genotypes. Significantly increased prevalence of A allele (P = 0.028, OR = 1.69, 95% CI = 1.081–2.64) and A/A genotype (P = 0.031, OR = 2.881, 95% CI = 1.145–7.250) at a previously un-characterized rs3021094 SNP were discovered in the GDM group. Increased IL-10 levels and insulin resistance were also related to the genotype of rs3021094. The risk of GDM was increased when IL-10 level was over 6.5 pg/ml. Conclusion: Our study demonstrated that A allele and A/A genotype of rs3021094 SNP in IL-10 gene were linked to increased risk for GDM, IL-10 plasma level and insulin resistance, which could be potential targets for early screening and detection of GDM.
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Affiliation(s)
- Jessica Kang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hsiung Liu
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Wen Yang
- Graduate Institute of Molecular Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzuu-Shuh Jou
- Graduate Institute of Molecular Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Precision Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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282
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Zhang Y, Chen Y, Qu H, Wang Y. Methylation of HIF3A promoter CpG islands contributes to insulin resistance in gestational diabetes mellitus. Mol Genet Genomic Med 2019; 7:e00583. [PMID: 30743315 PMCID: PMC6465726 DOI: 10.1002/mgg3.583] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/16/2018] [Accepted: 12/28/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance during pregnancy, and will lead to high risk of diabetes even after pregnancy. Hypoxia-inducible factor (HIF) family proteins are transcriptional factors that are highly correlated with methylation, which might be involved in the regulation of GDM. METHODS Baseline clinical characteristics of the GDM patients and healthy women were analyzed. Omental tissue from GDM patients and control groups were collected and detected for the expression levels of HIF1A, HIF2A, and HIF3A. The CpG islands of HIF3A promoter were predicted by "methprimer" software, and the methylation level of CpG islands was detected by bisulfite sequencing PCR. RESULTS HIF3A was downregulated in the omental tissue from GDM patients, whereas HIF1A and HIF2A were not affected. Furthermore, HIF3A expression was positively correlated with levels of estrogen receptor α (ESR1) and solute carrier family 2 member 4 (SLC2A4). Moreover, CpG islands of HIF3A promoter were highly methylated in GDM patients. In addition, methylation level of CpG islands could be upregulated by Estradiol (E2) treatment, since high dose of E2 reduced HIF3A mRNA expression in 3T3-L1 adipocytes. CONCLUSION Our findings demonstrate that the expression level of HIF3A, but not HIF1A or HIF2A, is downregulated in GDM patients. The methylation status of HIF3A promoter region is highly correlated with GDM, which could be a novel therapeutic target for GDM treatment.
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Affiliation(s)
- Yinghong Zhang
- Department of Obstetrics, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yangyang Chen
- Department of Obstetrics, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Hongmei Qu
- Department of Obstetrics, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yuanli Wang
- Department of Obstetrics, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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283
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Karamali M, Nasiri N, Taghavi Shavazi N, Jamilian M, Bahmani F, Tajabadi-Ebrahimi M, Asemi Z. The Effects of Synbiotic Supplementation on Pregnancy Outcomes in Gestational Diabetes. Probiotics Antimicrob Proteins 2019; 10:496-503. [PMID: 28786012 DOI: 10.1007/s12602-017-9313-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Synbiotics are known to exert multiple beneficial effects, including anti-inflammatory and antioxidative actions. This study was designed to evaluate the effects of synbiotic administration on biomarkers of inflammation, oxidative stress, and pregnancy outcomes among gestational diabetic (GDM) women. This randomized, double-blind, placebo-controlled clinical trial was carried out among 60 subjects with GDM who were not on oral hypoglycemic agents. Patients were randomly assigned to consume either one synbiotic capsule containing Lactobacillus acidophilus strain T16 (IBRC-M10785), L. casei strain T2 (IBRC-M10783), and Bifidobacterium bifidum strain T1 (IBRC-M10771) (2 × 109 CFU/g each) plus 800 mg inulin (HPX) (n = 30) or placebo (n = 30) for 6 weeks. Compared with the placebo, synbiotic supplementation significantly decreased serum high-sensitivity C-reactive protein (hs-CRP) (- 1.9 ± 4.2 vs. +1.1 ± 3.5 mg/L, P = 0.004), plasma malondialdehyde (MDA) (- 0.1 ± 0.6 vs. + 0.3 ± 0.7 μmol/L, P = 0.02), and significantly increased total antioxidant capacity (TAC) (+ 70.1 ± 130.9 vs. - 19.7 ± 124.6 mmol/L, P = 0.009) and total glutathione (GSH) levels (+ 28.7 ± 61.5 vs. - 14.9 ± 85.3 μmol/L, P = 0.02). Supplementation with synbiotic had a significant decrease in cesarean section rate (16.7 vs. 40.0%, P = 0.04), lower incidence of hyperbilirubinemic newborns (3.3 vs. 30.0%, P = 0.006), and newborns' hospitalization (3.3 vs. 30.0%, P = 0.006) compared with the placebo. Synbiotic supplementation did not affect plasma nitric oxide (NO) levels and other pregnancy outcomes. Overall, synbiotic supplementation among GDM women for 6 weeks had beneficial effects on serum hs-CRP, plasma TAC, GSH, and MDA; cesarean section; incidence of newborn's hyperbilirubinemia; and newborns' hospitalization but did not affect plasma NO levels and other pregnancy outcomes. http://www.irct.ir : www.irct.ir : IRCT201704205623N108.
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Affiliation(s)
- Maryam Karamali
- Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nabiollah Nasiri
- Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Naemeh Taghavi Shavazi
- Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehri Jamilian
- Endocrinology and Metabolism Research Center, Arak University of Medical Sciences, Arak, Iran
| | - Fereshteh Bahmani
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R, Iran
| | - Maryam Tajabadi-Ebrahimi
- Faculty member of Science department, science faculty, Islamic Azad University, Tehran Central branch, Tehran, Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R, Iran.
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284
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Mahmoud M, Abu-Shahba N, Azmy O, El-Badri N. Impact of Diabetes Mellitus on Human Mesenchymal Stromal Cell Biology and Functionality: Implications for Autologous Transplantation. Stem Cell Rev Rep 2019; 15:194-217. [DOI: 10.1007/s12015-018-9869-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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285
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Gestational diabetes and pre-existing diabetes – an approach from the metformin perspective. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.26.4.2019.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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286
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Wang K, Chen Q, Feng Y, Yang H, Wu W, Zhang P, Wang Y, Ko J, Zhao F, Du W, Yang F, Han T, Wang S, Zhang Y. Single Nucleotide Polymorphisms in CDKAL1 Gene Are Associated with Risk of Gestational Diabetes Mellitus in Chinese Population. J Diabetes Res 2019; 2019:3618103. [PMID: 31098383 PMCID: PMC6487100 DOI: 10.1155/2019/3618103] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/11/2019] [Accepted: 03/04/2019] [Indexed: 01/05/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a growing public health concern for many reasons, and its etiology remains unclear. Due to the similarity of its pathophysiology with type 2 diabetes (T2DM), we evaluated the relationship between published T2DM susceptibility genes and the risk of GDM. A total of 303 SNPs from genes including IRS1, IGF2BP2, CDKAL1, GCK, TCF7L2, KCNQ1, and KCNJ11 and the risk of GDM were examined in a nested case-control study with 321 GDM cases and 316 controls. The odds ratios (ORs) and their 95% confidence interval (95% CI) were estimated by unconditional logistical regression as a measure of the associations between genotypes and GDM in additive, recessive, dominant, and codominant models adjusting for maternal age, maternal BMI, parity, and family history of diabetes. At the gene level, CDKAL1 was associated with GDM risk. SNPs in the CDKAL1 gene including rs4712527, rs7748720, rs9350276, and rs6938256 were associated with reduced GDM risk. However, SNPs including rs9295478, rs6935599, and rs7747752 were associated with elevated GDM risk. After adjusting for multiple comparisons, rs9295478 and rs6935599 were still significant across the additive, recessive, and codominant models; rs7748720 and rs6938256 were significant in dominant and codominant models; and rs4712527 was only significant in the codominant model. Our study provides evidence for an association between the CDKAL1 gene and risk of GDM. However, its role in the GDM pathogenesis still needs to be verified by further studies.
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Affiliation(s)
- Keke Wang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Qiong Chen
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
- Office for Cancer Prevention and Research, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou 450008, China
| | - Yongliang Feng
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Hailan Yang
- Department of Obstetrics, the First Affiliated Hospital, Shanxi Medical University, Taiyuan 030001, China
| | - Weiwei Wu
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Ping Zhang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Ying Wang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Jamie Ko
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, 06520 CT, USA
| | - Feng Zhao
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Wenqiong Du
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Feifei Yang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Tianbi Han
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Suping Wang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Yawei Zhang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
- Department of Surgery, Yale University School of Medicine, New Haven 06520, USA
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, 06520 CT, USA
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287
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Zhang J, Ma S, Wu S, Guo C, Long S, Tan H. Effects of Probiotic Supplement in Pregnant Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Diabetes Res 2019; 2019:5364730. [PMID: 31583250 PMCID: PMC6748202 DOI: 10.1155/2019/5364730] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/11/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous studies showed that probiotics could improve glycemic control and attenuate some of the adverse effects of type 2 diabetes. However, whether the effects are generalizable to gestational diabetes mellitus (GDM) remains uncertain. OBJECTIVE We conducted a systematic review and meta-analysis to evaluate the effects of probiotic supplement in GDM. METHOD PubMed, EMBASE, the Cochrane Library, and EBSCO were systematically searched for relevant literature published through January 2019. Randomized controlled trials (RCTs) assessing the effects of probiotic supplement on one or more of the following in GDM were included: pregnancy outcome (the primary outcome), glycemic control, blood lipid profile, and inflammation and oxidative stress. Two reviewers independently extracted data and assessed the risk of bias in studies. Meta-analysis was conducted by using the fixed effects model unless substantial heterogeneity was found among studies. RESULTS Eleven randomized trials involving 719 participants were included for analysis. Eight of the trials were from Iran. Probiotics were given alone in eight trials and synbiotics in three trials. Though the components of probiotics varied, Lactobacillus was included in all trials and Bifidobacterium in all except one. The duration of intervention ranged from 4 to 8 weeks. Almost all trials (10/11) had a low risk of bias. Probiotic supplementation reduced the risk of a newborn's hyperbilirubinemia by 74% and improved four biomarkers for glycemic control (fasting blood glucose, fasting serum insulin, homeostasis model assessment insulin resistance, and quantitative insulin sensitivity check index), two biomarkers for lipid profile (triglycerides and HDL-cholesterol), and four biomarkers for inflammation and oxidative stress (total glutathione, malondialdehyde, nitric oxide, and total antioxidant capacity). But significant heterogeneity was observed in the meta-analyses on the four biomarkers related to glycemic control and on triglycerides, which could not be explained by prespecified subgroup analyses according to the mean age of participants and intervention type (i.e., probiotics or synbiotics). The effects on the risk of preterm delivery, macrosomia and a newborns' hypoglycemia, gestational age, total cholesterol, and LDL-cholesterol were not statistically significant. CONCLUSION Probiotic supplementation seemed to be able to reduce the risk of a newborn's hyperbilirubinemia and improve glycemic control, blood lipid profiles and inflammation and oxidative stress in pregnant women with GDM. However, due to the heterogeneity among existing studies, the surrogate nature of outcomes, and/or the fact that most studies were from Iran, the clinical significance and generalizability of the above findings remain uncertain. Further studies are warranted to address the limitations of existing evidence and better inform the management of GDM.
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Affiliation(s)
- Jiayue Zhang
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shujuan Ma
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shilan Wu
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Chuhao Guo
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Sisi Long
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hongzhuan Tan
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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288
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Chen Q, Feng Y, Yang H, Wu W, Zhang P, Wang K, Wang Y, Ko J, Shen J, Guo L, Zhao F, Du W, Ru S, Wang S, Zhang Y. A Vitamin Pattern Diet Is Associated with Decreased Risk of Gestational Diabetes Mellitus in Chinese Women: Results from a Case Control Study in Taiyuan, China. J Diabetes Res 2019; 2019:5232308. [PMID: 31089473 PMCID: PMC6476050 DOI: 10.1155/2019/5232308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/28/2018] [Accepted: 01/17/2019] [Indexed: 01/01/2023] Open
Abstract
Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM. Therefore, we examined the dietary nutrient patterns and evaluated their relationship with GDM risk in a Chinese population using a case control study design. A total of 1,464 GDM cases and 8,092 non-GDM controls were included in the final analysis. Dietary intake was assessed using a 33-item food frequency questionnaire, and nutrients were estimated using the Chinese Standard Tables of Food Consumption. Dietary nutrient patterns were identified using factor analysis, and their associations with GDM risk were evaluated using unconditional logistic regression models adjusting for total energy intake, maternal age, high blood pressure, education, maternal body mass index (BMI), parity, and family history of diabetes. A "vitamin" nutrient pattern was characterized as the consumption of diet rich in vitamin A, carotene, vitamin B2, vitamin B6, vitamin C, dietary fiber, folate, calcium, and potassium. For every quartile increase in the vitamin factor score during one year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk decreased by 9% (OR: 0.91, 95%CI: 0.86-0.96), 9% (OR: 0.91, 95%CI: 0.86-0.96), and 10% (OR: 0.90, 95%CI: 0.85-0.95), respectively. The significant reduced GDM risk was seen in women regardless of age and parity, and slightly stronger effect was found in women whose age ≤ 30 and women who are nulliparous across the three time periods. The significant association was also found in women whose BMI ≤ 24 with similar effect size across the three time periods. Our study suggests that the vitamin nutrient pattern diet is associated with decreased GDM risk. Additional studies are necessary to explore the underlying mechanism of this relationship.
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Affiliation(s)
- Qiong Chen
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
- Office for Cancer Prevention and Research, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou 450008, China
| | - Yongliang Feng
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Hailan Yang
- Department of Obstetrics, The First Affiliated Hospital, Shanxi Medical University, Taiyuan 030001, China
| | - Weiwei Wu
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Ping Zhang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Keke Wang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Ying Wang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Jamie Ko
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, 06520 CT, USA
| | - Jiaxin Shen
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Lingling Guo
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Feng Zhao
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Wenqiong Du
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Shouhang Ru
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Suping Wang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
| | - Yawei Zhang
- Department of Epidemiology, Shanxi Medical University School of Public Health, Taiyuan 030001, China
- Department of Surgery, Yale University School of Medicine, New Haven 06520, USA
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, 06520 CT, USA
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289
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Zhu B, Huang K, Yan S, Hao J, Zhu P, Chen Y, Ye A, Tao F. VDR Variants rather than Early Pregnancy Vitamin D Concentrations Are Associated with the Risk of Gestational Diabetes: The Ma'anshan Birth Cohort (MABC) Study. J Diabetes Res 2019; 2019:8313901. [PMID: 31341914 PMCID: PMC6613005 DOI: 10.1155/2019/8313901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/14/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022] Open
Abstract
AIM This study investigated the associations among early pregnancy vitamin D concentrations, seasonality, and vitamin D metabolic gene variants and how these variables related alone and in interaction with the risk of gestational diabetes mellitus (GDM). METHODS Research participants were women from the Ma'anshan birth cohort study in China. The overall study included 3110 women to explore the association between early pregnancy vitamin D concentrations and the risk of GDM. In the current analysis, a nested case-control study of 274 GDM cases and 380 controls was conducted to investigate seven vitamin D metabolic gene variants and the risk of GDM. Vitamin D concentrations were measured by radioimmunoassay. Genotypes were determined by improved multiple ligase detection reaction. Interactions between genetic variants and vitamin D as predictors of the risk of GDM were evaluated by a pair-wise analysis under a multiplicative interaction model. RESULTS Vitamin D concentrations were not significantly associated with the risk of GDM (OR = 0.79, 95% CI = 0.55-1.13) after adjusting for seasonality. Fall-winter conceptions had a 37% decreased risk of GDM compared with spring-summer conceptions (OR = 0.63, 95% CI = 0.49-0.81), independent of vitamin D concentrations. Two VDR gene variants rs1544410 (OR = 2.03, 95% CI = 1.17-3.51 for CT versus CC) and rs731236 (OR = 2.42, 95% CI = 1.29-4.55 for GA versus AA) were significantly associated with the risk of GDM. No interactions among genetic variants and vitamin D concentrations were detected. CONCLUSION Early pregnancy vitamin D insufficiency or deficiency was not significantly associated with the risk of GDM. The results of this study emphasize the importance of genetic variants in VDR and conception season as factors that affect the risk of GDM.
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Affiliation(s)
- Beibei Zhu
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Care Center, Ma'anshan, China
| | - Jiahu Hao
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Yao Chen
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Aoxing Ye
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
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Celentano C, Matarrelli B, Pavone G, Vitacolonna E, Mattei PA, Berghella V, Liberati M. The influence of different inositol stereoisomers supplementation in pregnancy on maternal gestational diabetes mellitus and fetal outcomes in high-risk patients: a randomized controlled trial. J Matern Fetal Neonatal Med 2018; 33:743-751. [PMID: 30558466 DOI: 10.1080/14767058.2018.1500545] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: To identify the effects of different dietary inositol stereoisomers on insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk for this disorder.Design: A preliminary, prospective, randomized, placebo controlled clinical trial.Participants: Nonobese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.Intervention: Supplementation with myo-inositol, d-chiro-inositol, combined myo- and d-chiro-inositol or placebo.Main outcome measure: Development of GDM on a 75 grams oral glucose tolerance test at 24-28 weeks' gestation. Secondary outcome measures were increase in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.Results: The group of women allocated to receive myo-inositol alone had a lower incidence of abnormal oral glucose tolerance test (OGTT). Nine women in the control group (C), one of the myo-inositol (MI), five in d-chiro-inositol (DCI), three in the myo-inositol/D-chiro-inositol group (MI/DCI) required insulin (p = .134). Basal, 1-hour, and 2 hours glycemic controls were significantly lower in exposed groups (p < .001, .011, and .037, respectively). The relative risk reduction related to primary outcome was 0.083, 0.559, and 0.621 for MI, DCI, and MI/DCI groups.Conclusions: This study compared the different inositol stereoisomers in pregnancy to prevent GDM. Noninferiority analysis demonstrated the largest benefit in the myo-inositol group. The relevance of our findings is mainly related to the possibility of an effective approach in GDM. Our study confirmed the efficacy of inositol supplementation in pregnant women at risk for GDM.
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Affiliation(s)
- Claudio Celentano
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Barbara Matarrelli
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Giulia Pavone
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Science of Aging, University of Chieti, Chieti, Italy
| | - Peter A Mattei
- ITAB Institute of Advanced Biomedical Technologies, University of Chieti, Chieti, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marco Liberati
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
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291
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Quaresima P, Visconti F, Chiefari E, Puccio L, Foti DP, Venturella R, Vero R, Brunetti A, Di Carlo C. Barriers to Postpartum Glucose Intolerance Screening in an Italian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2853. [PMID: 30558120 PMCID: PMC6313594 DOI: 10.3390/ijerph15122853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 01/17/2023]
Abstract
Background: Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus (T2D) and the postpartum period is crucial for early treatment in at-risk women. However, despite recommendations, only a fraction of women undergo a postpartum screening for glucose intolerance (ppOGTT). The present study aims to verify the reason(s) for poor adherence in our population. Research design and methods: This retrospective study includes 451 women in which GDM was diagnosed between 2015⁻2016. During 2017, we verified by phone interview how many women underwent ppOGTT at 6⁻12 weeks postpartum, as recommended by the Italian guidelines. The non-compliant women were asked about the reason(s) for failing to screen. The non-parametric Mann-Whitney test and the 2-tailed Fisher exact test were used to compare continuous and categorical features, respectively, among women performing or non-performing ppOGTT. Results: Out of 451 women with GDM diagnosis, we recorded information from 327. Only 97 (29.7%) performed ppOGTT. The remaining 230 women (70.3%) provided the following explanation for non-compliance: (1) newborn care (30.4%); (2) misunderstood importance (28.3%); (3) oversight (13.0%); (4) unavailability of test reservation in the nearest centers (10.4%); (5) normal glycemic values at delivery (8.3%); (6) discouragement by primary care physician (5.6%). Conclusions: In our population, most women with recent GDM failed to perform ppOGTT. Our results indicated that the prominent barriers could potentially be overcome.
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Affiliation(s)
- Paola Quaresima
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Federica Visconti
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Daniela P Foti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Roberta Venturella
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Raffaella Vero
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
| | - Antonio Brunetti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
| | - Costantino Di Carlo
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia'' of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
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292
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Pleskacova A, Bartakova V, Chalasova K, Pacal L, Kankova K, Tomandl J. Uric Acid and Xanthine Levels in Pregnancy Complicated by Gestational Diabetes Mellitus-The Effect on Adverse Pregnancy Outcomes. Int J Mol Sci 2018; 19:ijms19113696. [PMID: 30469427 PMCID: PMC6274971 DOI: 10.3390/ijms19113696] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022] Open
Abstract
Uric acid (UA) levels are associated with many diseases including those related to lifestyle. The aim of this study was to evaluate the influence of clinical and anthropometric parameters on UA and xanthine (X) levels during pregnancy and postpartum in women with physiological pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM), and to evaluate their impact on adverse perinatal outcomes. A total of 143 participants were included. Analyte levels were determined by HPLC with ultraviolet detection (HPLC-UV). Several single-nucleotide polymorphisms (SNPs) in UA transporters were genotyped using commercial assays. UA levels were higher within GDM women with pre-gestational obesity, those in high-risk groups, and those who required insulin during pregnancy. X levels were higher in the GDM group during pregnancy and also postpartum. Positive correlations between UA and X levels with body mass index (BMI) and glycemia levels were found. Gestational age at delivery was negatively correlated with UA and X levels postpartum. Postpartum X levels were significantly higher in women who underwent caesarean sections. Our data support a possible link between increased UA levels and a high-risk GDM subtype. UA levels were higher among women whose glucose tolerance was severely disturbed. Mid-gestational UA and X levels were not linked to adverse perinatal outcomes.
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Affiliation(s)
- Anna Pleskacova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
- Department of Biochemistry, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Vendula Bartakova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Katarina Chalasova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Lukas Pacal
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Katerina Kankova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Josef Tomandl
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
- Department of Biochemistry, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
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293
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Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci 2018; 19:E3342. [PMID: 30373146 PMCID: PMC6274679 DOI: 10.3390/ijms19113342] [Citation(s) in RCA: 789] [Impact Index Per Article: 131.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/15/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a serious pregnancy complication, in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation. In most cases, this hyperglycemia is the result of impaired glucose tolerance due to pancreatic β-cell dysfunction on a background of chronic insulin resistance. Risk factors for GDM include overweight and obesity, advanced maternal age, and a family history or any form of diabetes. Consequences of GDM include increased risk of maternal cardiovascular disease and type 2 diabetes and macrosomia and birth complications in the infant. There is also a longer-term risk of obesity, type 2 diabetes, and cardiovascular disease in the child. GDM affects approximately 16.5% of pregnancies worldwide, and this number is set to increase with the escalating obesity epidemic. While several management strategies exist-including insulin and lifestyle interventions-there is not yet a cure or an efficacious prevention strategy. One reason for this is that the molecular mechanisms underlying GDM are poorly defined. This review discusses what is known about the pathophysiology of GDM, and where there are gaps in the literature that warrant further exploration.
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Affiliation(s)
- Jasmine F Plows
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Joanna L Stanley
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand.
| | - Philip N Baker
- University of Leicester, University Road, Leicester LE1 7RH, UK.
| | - Clare M Reynolds
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand.
| | - Mark H Vickers
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand.
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294
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Liu X, Zhang L, Li J, Meng G, Chi M, Li T, Zhao Y, Wu Y. A nested case-control study of the association between exposure to polybrominated diphenyl ethers and the risk of gestational diabetes mellitus. ENVIRONMENT INTERNATIONAL 2018; 119:232-238. [PMID: 29980046 DOI: 10.1016/j.envint.2018.06.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is rapidly increasing worldwide. Exposure to endocrine-disrupting chemicals such as polybrominated diphenyl ethers (PBDEs) is thought to be a contributor to GDM, independent of diet and physical activity. OBJECTIVE The prospective association between PBDEs body burden in early pregnancy and GDM risk was investigated. METHODS A nested case-control study of 439 pregnant women was conducted between 2013 and 2015 in Beijing, China. Seven predominant PBDE congeners were measured in first trimester maternal serum by gas chromatography-high resolution mass spectrometry. Pregnant women were screened for GDM at 24-28 weeks of gestation using the oral glucose tolerance test. GDM was defined based on the diagnostic criteria set by China Ministry of Health. Conditional logistic and linear regression were used to estimate the association between PBDEs exposure and GDM risk, and PBDEs exposure and glucose level, respectively. RESULTS A total of 77 (17.5%) women developed GDM in this study. Median concentrations of PBDEs were higher in women with GDM. Analyses parameterizing PBDE concentrations as continuous variables suggested significant associations between BDE-153, -154, -183 and GDM risk with an estimated odds ratio of 4.04 (95%CI: 1.92, 8.52), 1.88 (95%CI: 1.15, 3.09) and 1.91 (95%CI: 1.31, 2.08), respectively. In the quartile analyses, a significant increase in the odds ratio of GDM was associated with the highest levels of BDE-153 (OR = 3.42 95%CI: 1.49, 7.89) and BDE-183 (OR = 3.70, 95%CI: 1.58, 8.65), whereas, BDE-154 demonstrated an inverted U-shaped association with GDM. In addition, BDE-153 and -154 were significantly positively associated with fasting glucose, and both 1 h and 2 h glucose level (p < 0.05). CONCLUSIONS These results suggest that exposure to PBDEs disturbs maternal glucose homeostasis and increases the risk of GDM. These findings should be replicated in future studies with a larger population and wider range of exposure.
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Affiliation(s)
- Xin Liu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China
| | - Lei Zhang
- The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China
| | - Jingguang Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China.
| | - Guimin Meng
- Beijing Fengtai Hospital Obstetrics and Gynecology, Beijing, China
| | - Min Chi
- School of Food Science and Technology, Nanchang University, Nanchang, China
| | - Tiantian Li
- Department of Environmental Health Risk Assessment, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunfeng Zhao
- The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China
| | - Yongning Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China
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295
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Kimber-Trojnar Ż, Patro-Małysza J, Skórzyńska-Dziduszko KE, Oleszczuk J, Trojnar M, Mierzyński R, Leszczyńska-Gorzelak B. Ghrelin in Serum and Urine of Post-Partum Women with Gestational Diabetes Mellitus. Int J Mol Sci 2018; 19:ijms19103001. [PMID: 30275385 PMCID: PMC6213416 DOI: 10.3390/ijms19103001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022] Open
Abstract
Women with a previous history of gestational diabetes mellitus (GDM) have a significantly increased risk of developing type 2 diabetes, obesity, and cardiovascular diseases in the future. The aim of the study was to evaluate ghrelin concentrations in serum and urine in the GDM group in the early post-partum period, with reference to laboratory results, body composition, and hydration status. The study subjects were divided into two groups, that is, 28 healthy controls and 26 patients with diagnosed GDM. The maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. The concentrations of ghrelin in the maternal serum and urine were determined via enzyme-linked immunosorbent assay (ELISA). The laboratory and BIA results of the mothers with GDM were different from those without GDM. Urine ghrelin positively correlated with serum ghrelin and high-density lipoprotein cholesterol (HDL) levels in healthy mothers. There were direct correlations between urine ghrelin and HDL as well as triglycerides levels in the GDM group. Neither the lean tissue index nor body cell mass index were related to the serum ghrelin concentrations in this group. Only the urine ghrelin of healthy mothers correlated with the fat tissue index. Our results draw attention to urine as an easily available and appropriable biological material for further studies.
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Affiliation(s)
- Żaneta Kimber-Trojnar
- Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin 20-090, Poland.
| | - Jolanta Patro-Małysza
- Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin 20-090, Poland.
| | | | - Jan Oleszczuk
- Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin 20-090, Poland.
| | - Marcin Trojnar
- Department of Internal Medicine, Medical University of Lublin, Lublin 20-081, Poland.
| | - Radzisław Mierzyński
- Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin 20-090, Poland.
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296
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Ruth Gründahl F, Hammer K, Braun J, Oelmeier de Murcia K, Köster HA, Möllers M, Steinhard J, Klockenbusch W, Schmitz R. Fetal brain development in diabetic pregnancies and normal controls. J Perinat Med 2018; 46:797-803. [PMID: 30150484 DOI: 10.1515/jpm-2017-0341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/25/2018] [Indexed: 01/11/2023]
Abstract
Abstract
Objective:
To compare the fetal brain structures assessed in routine sonographic scans during the second and third trimesters in diabetic and normal pregnancies.
Methods:
In this retrospective study, we measured the head circumference (HC), the transversal diameter of the cerebellum (TCD) and the sizes of the cisterna magna (CM), the cavum septi pellucidi (CSP) and the lateral ventricles (LV) in stored sonographic scans between 20 and 41 weeks of gestation. We compared 231 fetuses of diabetic mothers (diabetic group) to 231 fetuses of normal pregnancies (control group) matched by gestational age. The diabetic group was divided into three subgroups: pre-existing maternal diabetes, diet-controlled gestational diabetes and insulin-dependent gestational diabetes.
Results:
The mean widths of the CSP and LV were larger in fetuses of diabetic mothers in comparison with the controls (P<0.001, P<0.001; respectively). The sizes of HC, CM and TCD were similar in both groups. These results were consistent across the three subgroups.
Conclusions:
Diabetes is associated with altered fetal brain development. We would like to introduce the increased widths of CSP and LV as potential markers for gestational diabetes.
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Affiliation(s)
- Friederike Ruth Gründahl
- Department of Obstetrics and Gynecology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany, Phone: +49-16095211934, Fax +49-2518348210.,Department of Obstetrics and Gynecology, St. Franziskus-Hospital Münster, Münster, Germany
| | - Kerstin Hammer
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | | | - Helen Ann Köster
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Johannes Steinhard
- Department of Fetal Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Walter Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
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297
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Hyperglycemia induces inflammatory mediators in the human chorionic villous. Cytokine 2018; 111:41-48. [PMID: 30114628 DOI: 10.1016/j.cyto.2018.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 05/21/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022]
Abstract
This study was based on the hypothesis that IL-1β and its central regulator, the inflammasome, may play a role in the inflammatory condition exhibited by placental tissues from mothers with different gestational hyperglycemia levels. Pregnant women were classified according to the glycemic reference as non-diabetic (n = 15), mild gestational hyperglycemia (n = 15), gestational diabetes mellitus (n = 15) and type 2 diabetes mellitus (n = 15). We investigated levels of pro-inflammatory factors in maternal plasma and placental tissues (by ELISA or immunohistochemistry) and, NFKB activity (by electrophoretic mobility shift assay) and inflammasome protein expression (by Western blot) in chorionic villous. Maternal plasma and placental levels of inflammatory factors (IL-1β, IL-6, and MCP-1) were increased during all hyperglycemic conditions. Villous stroma cells showed strong immunoreactivity to CD68. In addition, with syncytiotrophoblast, the villous stroma cells were also stained to detect iNOS, MCP-1, TLR2, and TLR4. Although the levels of protein had fluctuated in the groups, NLRP1, NLRP3, ASC, and Caspase 1 were up-regulated in all hyperglycemic groups suggesting the inflammasome may be assembled in these pregnant women. The NFKB activity also exhibited higher levels in hyperglycemic groups, which might imply in pro-inflammatory cytokines production. In summary, increased maternal glucose levels during pregnancy changed systemic and placental inflammatory patterns, which occurred in parallel with the expression of inflammasome factors and processing and secretion of the pro-inflammatory cytokine IL-1β. These results suggest an inflammatory condition in all gestational hyperglycemic conditions, even in hyperglycemia that is less severe than gestational or overt diabetes, likely associated with inflammasome activation and inflammatory cytokine secretion. Inflammasome activation as a possible source of inflammatory factors may be an important target to be considered while managing hyperglycemia and preventing adverse pregnancy outcomes.
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298
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Fraticelli F, Celentano C, Zecca IA, Di Vieste G, Pintaudi B, Liberati M, Franzago M, Di Nicola M, Vitacolonna E. Effect of inositol stereoisomers at different dosages in gestational diabetes: an open-label, parallel, randomized controlled trial. Acta Diabetol 2018; 55:805-812. [PMID: 29774465 DOI: 10.1007/s00592-018-1157-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/06/2018] [Indexed: 12/20/2022]
Abstract
AIMS Gestational diabetes mellitus (GDM) is the most common metabolic disorder of pregnancy. The aim of the study is to compare the effect of different dosages of inositol stereoisomers supplementation on insulin resistance levels and several maternal-fetal outcomes in GDM women. METHODS Participants were randomly allocated to receive daily: 400 mcg folic acid (control treatment), 4000 mg myo-inositol plus 400 mcg folic acid (MI treatment), 500 mg D-chiro-inositol plus 400 mcg folic acid (DCI treatment) or 1100/27.6 mg myo/D-chiro-inositol plus 400 mcg folic acid (MI plus DCI treatment). The homeostasis model assessment of insulin resistance (HOMA-IR) was measured at the diagnosis of GDM and after 8 weeks of treatment. Secondary outcomes, obstetric outcomes and any maternal or fetal complication at delivery were also collected. RESULTS Eighty GDM women were assigned to one of the four arms of study (20 per arm). A significant delta decrease in HOMA-IR index was found in subjects of MI group without insulin therapy compared to control group (p < 0.001). A lower variation in average weight gain (at delivery vs pre-pregnancy and OGTT period) was detected in MI group vs control group (p = 0.001 and p = 0.019, respectively). Moreover, women exposed to MI and MI plus DCI required a significantly lower necessity of an intensified insulin treatment. Women of the control group had newborns with higher birth weight compared with women treated with inositol (p = 0.032). CONCLUSIONS Our study provides interesting but preliminary results about the potential role of inositol stereoisomers supplementation in the treatment of GDM on insulin resistance levels and several maternal-fetal outcomes. Further studies are required to examine the optimal and effective dosages of different inositol supplements. CLINICAL TRIAL REG. NO.: NCT02097069, ClinicalTrial.gov.
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Affiliation(s)
- Federica Fraticelli
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Claudio Celentano
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Isaia Al Zecca
- Department of Medicine and Science of Ageing, School of Hygiene and Preventive Medicine, "G. D'Annunzio" University Chieti-Pescara, Chieti, Italy
| | | | | | - Marco Liberati
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Marica Franzago
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University Chieti-Pescara, Chieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy.
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299
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Guo Y, Han Z, Guo L, Liu Y, Li G, Li H, Zhang J, Bai L, Wu H, Chen B. Identification of urinary biomarkers for the prediction of gestational diabetes mellitus in early second trimester of young gravidae based on iTRAQ quantitative proteomics. Endocr J 2018; 65:727-735. [PMID: 29760307 DOI: 10.1507/endocrj.ej17-0471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) has brought great harm to maternal and fetus. Up to now, only a few plasma biomarkers for its early diagnosis have been reported; nevertheless, there is no report about identification of urinary biomarkers for prediction of GDM. Thus, it is necessary to correct this deficiency. In our study, urine samples were collected from 889 healthy young gravidae at the early second trimester (15 to 20 weeks), 69 of whom were subsequently diagnosed with GDM at 24 to 28 weeks. iTRAQ (the isobaric tags for relative and absolute quantification) quantitative proteomics was conducted on sixteen GDM (trial group) and an equal number of matched healthy young gravidae (control group). Validation was performed in 40 cases of each group by ELISA. A total of 1,901 proteins were identified in this study, including 119 significantly differential proteins (fold change ≧1.2 or ≦0.83 and p < 0.05). Compared with control group, 83 differential proteins were increased and 36 proteins were decreased in GDM group. The validation for expression of CD59 and IL1RA showed significant difference and the area under the receiver operating characteristic curve was 0.729 and 0.899, respectively (p < 0.05). The two candidate protein biomarkers (CD59 and IL1RA) in urine could be an early, noninvasive diagnostic predictors of young pravidae with GDM, and IL1RA is stronger diagnostic power than CD59.
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Affiliation(s)
- Ying Guo
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- Department of Obstetrics and Gynecology, Maternity and Child Health Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, China
| | - Zhonghou Han
- Department of Obstetrics and Gynecology, Maternity and Child Health Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, China
| | - Li Guo
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Yu Liu
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Gang Li
- Department of Obstetrics and Gynecology, Maternity and Child Health Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, China
| | - Huiqing Li
- Department of Obstetrics and Gynecology, Maternity and Child Health Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, China
| | - Jie Zhang
- Department of Obstetrics and Gynecology, Maternity and Child Health Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, China
| | - Liwei Bai
- Department of Obstetrics and Gynecology, Maternity and Child Health Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, China
| | - Hongli Wu
- Department of Obstetrics and Gynecology, Maternity and Child Health Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, China
| | - Biliang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
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Hyer S, Balani J, Shehata H. Metformin in Pregnancy: Mechanisms and Clinical Applications. Int J Mol Sci 2018; 19:E1954. [PMID: 29973490 PMCID: PMC6073429 DOI: 10.3390/ijms19071954] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/12/2018] [Accepted: 06/29/2018] [Indexed: 01/27/2023] Open
Abstract
Metformin use in pregnancy is increasing worldwide as randomised controlled trial (RCT) evidence is emerging demonstrating its safety and efficacy. The Metformin in Gestational Diabetes (MiG) RCT changed practice in many countries demonstrating that metformin had similar pregnancy outcomes to insulin therapy with less maternal weight gain and a high degree of patient acceptability. A multicentre RCT is currently assessing the addition of metformin to insulin in pregnant women with type 2 diabetes. RCT evidence is also available for the use of metformin in pregnancy for women with Polycystic Ovarian Syndrome and for nondiabetic women with obesity. No evidence of an increase in congenital malformations or miscarriages has been observed even when metformin is started before pregnancy and continued to term. Body composition and metabolic outcomes at two, seven, and nine years have now been reported for the offspring of mothers treated in the MiG study. In this review, we will briefly discuss the action of metformin and then consider the evidence from the key clinical trials.
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Affiliation(s)
- Steve Hyer
- Department of Endocrinology, Epsom and St. Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton SM5 1AA, Surrey, UK.
| | - Jyoti Balani
- Department of Endocrinology, Epsom and St. Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton SM5 1AA, Surrey, UK.
| | - Hassan Shehata
- Department of Maternal Medicine, Epsom and St. Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton SM5 1AA, Surrey, UK.
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