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Gammeltoft TM, Nguyen TA, Dung TK, Thi Dang NA, Phuong Nguyen TM, Nguyen VT, Bygbjerg IC. The pioneers of Vietnam's epidemiological transition: an ethnographic study of pregnant women's experiences of gestational diabetes. Glob Health Action 2024; 17:2341521. [PMID: 38693861 PMCID: PMC11067556 DOI: 10.1080/16549716.2024.2341521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/07/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is an abnormal glucose metabolism diagnosed during pregnancy that can have serious adverse consequences for mother and child. GDM is an exceptional health condition, as its management serves not only as treatment but also as prevention, reducing the risk of future diabetes in mother and child. OBJECTIVES This qualitative study aimed to explore how pregnant women experience and respond to GDM, focusing particularly on the role of the family environment in shaping women's experiences. METHODS The research was carried out in Vietnam's Thái Bình province in April-May 2023. We conducted in-depth ethnographic interviews with 21 women with GDM, visiting them in their homes. Our theoretical starting point was phenomenological anthropology, and the data were analysed using a thematic analysis approach. RESULTS At the centre of women's experiences was the contrast between GDM as a biomedical and a social condition. Whereas GDM was biomedically diagnosed and managed in the healthcare system, it was often deemed insignificant or non-existent by family members. This made GDM a biomedically present but socially absent health condition. This paradox posed challenges to women's GDM self-care, placing them in pioneering social positions. CONCLUSIONS The biomedical presence yet social absence of GDM turned women into pioneers at biomedical, digital, epidemiological, and family frontiers. This article calls for appreciation of pregnant women's pioneering roles and for health systems action to involve women and families in the development of GDM policies and programmes at a time of sweeping global health changes.
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Affiliation(s)
- Tine M. Gammeltoft
- Department of Anthropology, University of Copenhagen, København, Denmark
| | - Thi Ai Nguyen
- Department of Health Management & Organization, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Thi Kim Dung
- Department of Epidemiology, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Ngoc-Anh Thi Dang
- Department of Environmental Health, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Thi Minh Phuong Nguyen
- Department of Health Sociology, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Van Tien Nguyen
- Department of Health Management & Organization, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Ib C. Bygbjerg
- Department of Public Health, Global Health Section, University of Copenhagen, København, Denmark
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Tsoi KY, Chan RCM, Zhang C, Tam WH, Ma RCW. A randomized controlled trial to evaluate the effects of an early postnatal lifestyle modification program on diet, adiposity and metabolic outcome in mothers with gestational diabetes mellitus. Int J Gynaecol Obstet 2024; 166:1170-1182. [PMID: 38651286 DOI: 10.1002/ijgo.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/01/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of a 12-month early postnatal lifestyle intervention program in women with gestational diabetes in a recent pregnancy. METHODS This study was a prospective randomized intervention study conducted at a diabetes center in Hong Kong. Chinese women aged 18-45 years, who developed gestational diabetes mellitus (GDM) in their most recent pregnancy, were invited. Eligible women were randomized in 1:1 ratio at baseline (6-12 weeks postpartum), to standard care or lifestyle intervention (diet and physical activity) groups for 12 months. A standardized biochemistry assessment including oral glucose tolerance test, blood lipids, complete blood count, renal and liver functions, were measured at baseline and at 12-month. Anthropometry assessment and lifestyle questionnaire were performed at various timepoints. RESULTS A total of 103 women were randomized at baseline and a total of 79 women (standard care, n = 39, intervention, n = 40) completed the assessment. After the 12-month study period, women in the intervention group had significantly lower energy intake (intervention, -497.6 ± 488.3 kcal; standard, -222.0 ± 390.0 kcal, P < 0.01) compared to the standard care group, and a trend towards greater weight reduction (intervention, -0.93 ± 4.68 kg; standard, -0.01 ± 3.12 kg, P = 0.36). CONCLUSION The lifestyle intervention implemented within 3 months postpartum appeared to promote postpartum weight loss. The early postnatal lifestyle intervention program may provide an opportunity to reduce the long-term risk of diabetes in this high-risk population.
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Affiliation(s)
- Kit Ying Tsoi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruth C M Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Cuilin Zhang
- Global Center for Asian Women's Health & Bia-Echo Asia Center for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynecology, National University of Singapore, Singapore
| | - Wing Hung Tam
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Chinese University of Hong Kong, Hong Kong, China
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McGovern L, O'Toole L, Houshialsadat Z, O'Reilly SL. Women's perspectives on mHealth behavior change interventions for the management of overweight, obesity, or gestational diabetes: A qualitative meta-synthesis. Obes Rev 2024; 25:e13761. [PMID: 38733067 DOI: 10.1111/obr.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 05/13/2024]
Abstract
mHealth interventions play an increasingly important role in health behavior change for gestational diabetes or peripartum obesity management. This qualitative systematic review and meta-synthesis aims to explore women's perceptions of mHealth behavior change interventions for gestational diabetes and/or overweight/obesity management during pregnancy and the postpartum period. Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, Excerpta Medica Database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Psychological Information Database (PsycINFO) databases were searched using a Sample, Phenomenon of Interest, Design, Evaluation and Research type (SPIDER) concept framework through to February 2024. Included studies were quality assessed using the Critical Appraisal Skills Programme checklist. Study findings were evaluated using reflexive thematic analysis and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQual) checklist. We identified 29 studies, representing 604 women's views from one upper middle-income and nine high-income countries. Two themes were generated: mHealth as a supportive tool; and mHealth as a personalizable tool. Women highlighted the importance of self-monitoring, information trustworthiness, peer support, motivational tools (goal setting, risk awareness, and problem solving) and convenience in achieving behavior change using mHealth technology. They suggest mHealth programs incorporate these elements to support user engagement and improved health outcomes. Understanding what women want as mHealth users is particularly important for effective interventions in gestational diabetes, weight management, and chronic disease prevention. Creating a better, more woman-centered experience by addressing central engagement issues should result in improved maternal health outcomes.
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Affiliation(s)
- Liz McGovern
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
| | - Laura O'Toole
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland
| | - Zeinab Houshialsadat
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
- Ecole Hautes Etudes en Santé Publique, Paris, France
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
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Zhang X, Wu H, Lau ESH, Fan B, Tsoi KY, Tam CHT, Yang A, Shi M, Chow E, Kong APS, Chan JCN, Tam WH, Luk AOY, Ma RCW. Health impacts of new-onset diabetes in women post-gestational diabetes mellitus: Insights from Hong Kong's territory-wide data. J Diabetes Investig 2024; 15:772-781. [PMID: 38456720 PMCID: PMC11143414 DOI: 10.1111/jdi.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
AIMS/INTRODUCTION To determine the population health burden attributable to the development of diabetes among women with a history of gestational diabetes mellitus (GDM). MATERIALS AND METHODS We conducted a retrospective analysis of women with a history of GDM attending the Hong Kong Hospital Authority between 2000 and 2019. The time-varying population attributable fraction was calculated. RESULTS A total of 76,181 women with a history of gestational diabetes mellitus were included, 6,606 of them developed diabetes during a median follow-up of 8.6 years. The respective hazard ratios (95% confidence interval) among women with GDM who developed diabetes vs those with GDM only were 2.8 (2.2, 3.7) for cardiovascular disease (CVD), 4.8 (3.0, 7.7) for end-stage kidney disease (ESKD), 2.2 (1.9, 2.6) for infection-related hospitalization, and 1.8 (1.3, 2.4) for all-cause mortality. The development of diabetes was associated with 1.3 (0.8, 1.7), 0.6 (0.3, 0.8), 3.2 (2.4, 4.0), and 0.5 (0.2, 0.9) additional incident cases per 1,000 person-years, accounting for 24.0% (13.2%, 35.9%), 42.0% (22.5%, 58.8%), 10.8% (7.1%, 14.9%), and 6.0% (-3.1%, 16.1%) of absolute number of CVD, ESKD, infection-related hospitalization, and all-cause mortality over 20 years after GDM, respectively. CONCLUSIONS Diabetes is a significant contributor to the population health burden of some clinical outcomes in women with a history of gestational diabetes mellitus, but other risk factors need to be considered.
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Affiliation(s)
- Xinge Zhang
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Hongjiang Wu
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Eric SH Lau
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Baoqi Fan
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Kit Ying Tsoi
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Claudia HT Tam
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Aimin Yang
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Mai Shi
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Elaine Chow
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Alice PS Kong
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Juliana CN Chan
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Wing Hung Tam
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Andrea OY Luk
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - Ronald CW Ma
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
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Golshan-Tafti M, Bahrami R, Dastgheib SA, Karimi-Zarchi M, Azizi S, Marzbanrad Z, Hajizadeh N, Aghasipour M, Yeganegi M, Shiri A, Aghili K, Neamatzadeh H. Comprehensive data on the relationship between KCNJ11 polymorphisms and gestational diabetes mellitus predisposition: a meta-analysis. J Diabetes Metab Disord 2024; 23:475-486. [PMID: 38932913 PMCID: PMC11196507 DOI: 10.1007/s40200-024-01428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/24/2024] [Indexed: 06/28/2024]
Abstract
Purpose The genetic aspect of gestational diabetes mellitus (GDM) is influenced by multiple causal genetic variants, each with different effect sizes. The KCNJ11 gene is particularly noteworthy as a potential contributor to the risk of GDM due to its role in regulating glucose-induced insulin secretion. To evaluate the association between KCNJ11 polymorphisms and GDM, a comprehensive meta-analysis was conducted to review the existing literature and quantitatively assess the correlation. Methods A thorough search was performed on the PubMed, EMBASE, Scopus, and CNKI databases until December 25, 2023, using precise terms and keywords related to Gestational Diabetes, KCNJ11 gene, and polymorphism. Odds ratios and 95% confidence intervals were used to evaluate the relationships. The statistical analysis was conducted using Comprehensive Meta-Analysis software, and the Cochrane risk of bias assessment tool was used to determine bias presence. Results The meta-analysis comprised 9 studies with 3108 GDM cases and 5374 controls for the rs5219 polymorphism, and 3 studies with 1209 GDM cases and 1438 controls for the rs5210 polymorphism. The pooled data indicated a noteworthy link between the rs5219 polymorphism and GDM globally and among various ethnic groups, notably in Caucasian and Asian populations. However, no substantial association was observed between the rs5210 polymorphism and GDM. Conclusions Pooled data showed a correlation between the KCNJ11 rs5219 polymorphism and GDM susceptibility, but no association was found for the rs5210 polymorphism. Future research with larger sample sizes and more diverse populations is needed to improve result generalizability. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01428-0.
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Affiliation(s)
| | - Reza Bahrami
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Karimi-Zarchi
- Department of Gynecologic Oncology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Azizi
- Shahid Akbarabadi Clinical Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Marzbanrad
- Department of Obstetrics and Gynecology, Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nazanin Hajizadeh
- Prevention Gynecology Research Center, Imam Hossein hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Aghasipour
- Department of Cancer Biology, College of Medicine, University of Cincinnati, Cincinnati, OH USA
| | - Maryam Yeganegi
- Department of Obstetrics and Gynecology, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Amirmasoud Shiri
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kazem Aghili
- Department of Radiology, School of Medicine, Shahid Rahnamoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Mother and Newborn Health Research Center, School of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Nørmark LP, McAuliffe F, Maindal HT, O'Reilly S, Davies A, Burden C, Skinner TC, Vrangbæk K, Callander E. Protocol for cost-effectiveness analysis of a randomised trial of mHealth coaching (Bump2Baby and Me) compared with usual care for healthy gestational weight gain and postnatal outcomes in at-risk women and their offspring in the UK, Australia, Ireland and Spain. BMJ Open 2024; 14:e080823. [PMID: 38772891 PMCID: PMC11110546 DOI: 10.1136/bmjopen-2023-080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Gestational diabetes mellitus and overweight are associated with an increased likelihood of complications during birth and for the newborn baby. These complications lead to increased immediate and long-term healthcare costs as well as reduced health and well-being in women and infants. This protocol presents the health economic evaluation to investigate the cost-effectiveness of Bump2Baby and Me (B2B&Me), which is a health coaching intervention delivered via smartphone to women at risk of gestational diabetes. METHODS AND ANALYSIS Using data from the B2B&Me randomised controlled trial, this economic evaluation compares costs and health effects between the intervention and control group as an incremental cost-effectiveness ratio. Direct healthcare costs, costs of pharmaceuticals and intervention costs will be included in the analysis, body weight and quality-adjusted life-years for the mother will serve as the effect outcomes. To investigate the long-term cost-effectiveness of the trial, a Markov model will be employed. Deterministic and probabilistic sensitivity analysis will be employed. ETHICS AND DISSEMINATION The National Maternity Hospital Human Research and Ethics Committee was the primary approval site (EC18.2020) with approvals from University College Dublin HREC-Sciences (LS-E-20-150-OReilly), Junta de Andalucia CEIM/CEI Provincial de Granada (2087-M1-22), Monash Health HREC (RES-20-0000-892A) and National Health Service Health Research Authority and Health and Care Research Wales (HCRW) (21/WA/0022). The results from the analysis will be disseminated in scientific papers, through conference presentations and through different channels for communication within the project. TRIAL REGISTRATION NUMBER ACTRN12620001240932.
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Affiliation(s)
- Laura Pirhonen Nørmark
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, University College Dublin, Dublin, Ireland
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | | | - Sharleen O'Reilly
- Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Christy Burden
- University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Timothy C Skinner
- Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, UK
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Carneiro MM. Obesity, diabetes & women's health: the perfect storm looming in the horizon? Women Health 2024; 64:365-368. [PMID: 38804119 DOI: 10.1080/03630242.2024.2360185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- Márcia Mendonça Carneiro
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- ORIGEN Center for Reproductive Medicine, Belo Horizonte, Brazil
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Schieren A, Koch S, Pecht T, Simon MC. Impact of Physiological Fluctuations of Sex Hormones During the Menstrual Cycle on Glucose Metabolism and the Gut Microbiota. Exp Clin Endocrinol Diabetes 2024; 132:267-278. [PMID: 38382644 PMCID: PMC11093651 DOI: 10.1055/a-2273-5602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
Diabetes mellitus is one of the most prevalent chronic diseases. Previous studies have shown differences in glucose metabolism between males and females. Moreover, difficulties in medication adherence have been reported in females with type 2 diabetes. These observations are believed to be caused by fluctuations in sex hormone concentrations during the menstrual cycle. Furthermore, gut microbiota is linked to female host metabolism and sex hormone production. Understanding the interactions between fluctuating hormone concentrations during the menstrual cycle, gut microbiota, and glucose metabolism in humans is significant because of the increasing prevalence of diabetes and the consequent need to expand preventive efforts. A literature search was performed to determine and summarize the existing evidence, deduce future research needs to maintain female health, and investigate the relationship between the physiological menstrual cycle and glucose metabolism. Studies from 1967 to 2020 have already examined the relationship between variations during the menstrual cycle and glucose metabolism in healthy female subjects using an oral-glucose tolerance test or intravenous glucose tolerance test. However, the overall number of studies is rather small and the results are contradictory, as some studies detected differences in glucose concentrations depending on the different cycle phases, whereas others did not. Some studies reported lower glucose levels in the follicular phase than in the luteal phase, whereas another study detected the opposite. Data on gut microbiota in relation to the menstrual cycle are limited. Conflicting results exist when examining the effect of hormonal contraceptives on the gut microbiota and changes in the course of the menstrual cycle. The results indicate that the menstrual cycle, especially fluctuating sex hormones, might impact the gut microbiota composition.The menstrual cycle may affect the gut microbiota composition and glucose metabolism. These results indicate that glucose tolerance may be the greatest in the follicular phase; however, further well-conducted studies are needed to support this assumption.
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Affiliation(s)
- Alina Schieren
- University of Bonn, Institute of Nutrition and Food Sciences, Nutrition
and Microbiota, Bonn, Germany
| | - Sandra Koch
- University of Bonn, Institute of Nutrition and Food Sciences, Nutrition
and Microbiota, Bonn, Germany
| | - Tal Pecht
- University of Bonn, Life & Medical Sciences (LIMES) Institute,
Department for Genomics and Immunoregulation, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Systems Medicine,
Bonn, Germany
| | - Marie-Christine Simon
- University of Bonn, Institute of Nutrition and Food Sciences, Nutrition
and Microbiota, Bonn, Germany
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Wu R, Duan M, Zong D, Li Z. Effect of arsenic on the risk of gestational diabetes mellitus: a systematic review and meta-analysis. BMC Public Health 2024; 24:1131. [PMID: 38654206 PMCID: PMC11041030 DOI: 10.1186/s12889-024-18596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a complication of pregnancy associated with numerous adverse outcomes. There may be a potential link between GDM and arsenic (As) exposure, but this hypothesis remains controversial. This meta-analysis summarizes the latest studies evaluating the association between As and GDM. METHODS A comprehensive search of the PubMed, Embase, and Scopus databases up to September 2023 was performed. The pooled estimates with 95% CIs were presented using forest plots. Estimates were calculated with random effects models, and subgroup and sensitivity analyses were conducted to address heterogeneity. RESULTS A total of 13 eligible studies involving 2575 patients with GDM were included in this meta-analysis. The results showed that women exposed to As had a significantly increased risk of GDM (OR 1.47, 95% CI: 1.11 to 1.95, P = 0.007). Subgroup analyses suggested that the heterogeneity might be attributed to the years of publication. In addition, sensitivity analysis confirmed the robust and reliable results. CONCLUSIONS This analysis suggested that women exposed to As have a greater risk of GDM. However, the significant heterogeneity across studies requires careful interpretation. REGISTRATION The PROSPERO registration ID is CRD42023461820.
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Affiliation(s)
- Rui Wu
- School of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, China
| | - Min Duan
- School of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, China
| | - Dongsheng Zong
- School of Medical Devices, Shenyang Pharmaceutical University, Shenyang, China.
| | - Zuojing Li
- School of Medical Devices, Shenyang Pharmaceutical University, Shenyang, China.
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Wang X, Lan Y, Li N, Gao J, Meng D, Miao S. Associations of education attainment with gestational diabetes mellitus and the mediating effects of obesity: A Mendelian randomization study. Heliyon 2024; 10:e29000. [PMID: 38601611 PMCID: PMC11004574 DOI: 10.1016/j.heliyon.2024.e29000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
We aim to assess the causal association between educational attainment and gestational diabetes mellitus, and the mediating effect of obesity on this association. We estimated the causal effects of educational attainment on gestational diabetes mellitus using European ancestry genome-wide association study summary data with two-sample univariate Mendelian randomization (UVMR) approach. Two-stage Mendelian randomization analysis was performed to assess the potential mediating role of obesity traits in this association and to calculate the mediating proportion. UVMR analysis demonstrated that higher educational attainment was associated with a reduced risk of GDM (OR 0.76, 95% CI 0.67-0.86; p < 0.01). EA has also been associated with decreased obesity in women. Mediation Mendelian randomization results indicated that body mass index (BMI) was the most significant mediating factor in the relationship between educational attainment and GDM, accounting for 42.52% (95% CI 37.75-55.44%) of the effect, followed by waist-to-hip ratio (WHR) at 34.35% (95% CI 29.82-46.41%), body fat percentage at 28.95% (95% CI 35.99-46.81%), and WHR adjusted for BMI (WHRadjBMI) at 12.51% (95% CI 36.2-58.5%). educational attainment exerts a potential causal protective effect against gestational diabetes mellitus, and obesity-related risk factors play a mediating role. Attention should be paid to the educational attainment of women, and obese women with lower educational attainment may represent a higher risk group for GDM than those with higher educational attainment.
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Affiliation(s)
- Xiaoyan Wang
- Department of Clinical Nutrition, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
| | - Ying Lan
- Department of Intensive Care Unit, Affiliated Hospital of Chengdu University &Clinical Medical College, Chengdu, Sichuan Province, China
| | - Na Li
- Department of Maternity, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
| | - Jinfeng Gao
- Department of Clinical Nutrition, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
| | - Dejiao Meng
- Department of Clinical Nutrition, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
| | - Shuchuan Miao
- Department of Neurosurgery, Chengdu Seventh People's Hospital, Sichuan Province, China
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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Wainstock T, Yoles I, Sergienko R, Sheiner E. Maternal diabetes following gestational diabetes: Does multiple gestation multiply the risk? Int J Gynaecol Obstet 2024; 164:1047-1052. [PMID: 37698085 DOI: 10.1002/ijgo.15090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To assess whether the risk for future diabetes is higher among women diagnosed with gestational diabetes (GD) during twin versus singleton gestations. METHOD A retrospective cohort study was performed including all women who delivered at a tertiary medical center between the years 1991 and 2021 and had at least one GD diagnosis. The first GD diagnosis per women was defined as the index pregnancy. Women diagnosed with GD during multiple gestations were compared with women diagnosed with GD during singleton gestations. The outcomes included first hemoglobin A1C (Hba1C) level > 6.4 mg/dL post partum, and the highest level measured during the follow-up period of up to 30 years. Multivariable logistic and Cox proportional analysis were used to compare the risk between the two groups while adjusting for confounding variables. RESULTS The current study included 13 770 mothers, with 458 patients (3.3%) diagnosed with GD during twin gestations and 13 312 (96.7%) during singleton gestations. The mean follow-up was 12.25 ± 9.3 years. Mothers of both groups did not differ in age at index pregnancy; however, mothers of twins were more likely to conceive following fertility treatments. Incidence of diabetes and prediabetes (defined as Hba1C > 6.4 and >5.7, respectively) were lower among the twin-gestation group, both during the 6-month postpartum period (for diabetes: 15.5% vs 22.1%; odds ratio [OR], 0.65 [95% confidence interval (CI), 0.46-0.91]) and during the long-term follow-up (for diabetes: 31.8% vs 40.7%; OR, 0.68 [95% CI, 0.52-0.88]). These results remained significant in the multivariable analysis, while accounting for age, ethnicity, and fertility treatments. CONCLUSION GD diagnosis during multiple versus singleton gestations is associated with a lower risk for future diabetes.
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Affiliation(s)
- Tamar Wainstock
- Department of Public Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Israel Yoles
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Toivonen E, Taurio K, Kortelainen E, Havulinna AS, Jääskeläinen T, Laivuori H. Validation of the Finnish Care register for Health Care diagnoses for preeclampsia, gestational diabetes and preterm delivery. Pregnancy Hypertens 2024; 35:26-29. [PMID: 38091805 DOI: 10.1016/j.preghy.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Centrally collected Finnish national health register data on adverse pregnancy outcomes are available for research, but the validity of the data is largely unknown. Our aim was to compare the diagnoses of preeclampsia (PE), gestational diabetes (GDM), and preterm delivery from hospital records with the registry based diagnoses from the Finnish Care Register for Health Care (FCR). Data on gestational age at delivery from the Medical Birth Registry (MBR) was also studied. METHODS The Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) Study cohort was used as a data source. Each diagnosis was ascertained from electronic hospital records. The validity of diagnoses obtained by record linkage of FCR and MBR was assessed against the classification previously confirmed independently by a research nurse and a study physician. RESULTS Sensitivity of PE diagnoses in FCR was 80.3 % (95 % CI 78.3 % to 82.2 %) andspecificity 95.3 % (95 % CI 93.9 % to 96.4 %). Sensitivity for GDM was 64.1 % (95 % CI: 58.7 % - 69.3 %) and specificity 98.5 % (95 % CI: 97.9 % - 98.9 %), whereas sensitivity and specificity for preterm delivery were 32.4 % (95 % CI: 29.0 % - 36.0 %) and 99.7 % (95 % CI: 99.3 % - 99.9 %). Sensitivity of preterm delivery in the MBR was 99.1 % and specificity 99.9 %. CONCLUSIONS FCR registry diagnoses for PE have satisfactory sensitivity and high specificity. Diagnoses for GDM and preterm delivery have lower sensitivity limiting their use in studies, and data from MBR should be preferred when studying preterm deliveries.
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Affiliation(s)
- Elli Toivonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, PO Box 2000, Tampere 33521, Finland; Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampereen yliopisto, PO Box 100, Tampere 33014, Finland.
| | - Kirsi Taurio
- Department of Obstetrics and Gynecology, Tampere University Hospital, PO Box 2000, Tampere 33521, Finland; Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampereen yliopisto, PO Box 100, Tampere 33014, Finland.
| | - Eija Kortelainen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, University of Helsinki, PO Box 63, Helsinki 00014, Finland.
| | - Aki S Havulinna
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, University of Helsinki, PO Box 4, Helsinki 00014, Finland; Finnish Institute for Health and Welfare, PO Box 30, Helsinki 00271, Finland.
| | - Tiina Jääskeläinen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, University of Helsinki, PO Box 63, Helsinki 00014, Finland; Department of Food and Nutrition, University of Helsinki, PO Box 66, Helsinki 00014, Finland.
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, PO Box 2000, Tampere 33521, Finland; Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampereen yliopisto, PO Box 100, Tampere 33014, Finland; Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, University of Helsinki, PO Box 63, Helsinki 00014, Finland; Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, University of Helsinki, PO Box 4, Helsinki 00014, Finland.
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13
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Che X, Hong X, Gross S, Pearson C, Bartell T, Wang X, Wang G. Maternal Mediterranean-Style Diet Adherence during Pregnancy and Metabolomic Signature in Postpartum Plasma: Findings from the Boston Birth Cohort. J Nutr 2024; 154:846-855. [PMID: 38278216 PMCID: PMC10942856 DOI: 10.1016/j.tjnut.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND The health benefits of a Mediterranean-style diet (MSD) are well observed, but the underlying mechanisms are unclear. Metabolomic profiling offers a systematic approach for identifying which metabolic biomarkers and pathways might be affected by an MSD. OBJECTIVES This study aimed to identify postpartum plasma metabolites that are associated with MSD adherence during pregnancy and to further test whether these identified metabolites may vary by maternal characteristics. METHODS We analyzed data from 1410 mothers enrolled in the Boston Birth Cohort (BBC). A maternal food frequency questionnaire (FFQ) was administered and epidemiologic information was obtained via an in-person standard questionnaire interview within 24-72 h postpartum. Maternal clinical information was extracted from electronic medical records. A Mediterranean-style diet score (MSDS) was calculated using responses to the FFQ. Metabolomic profiling in postpartum plasma was conducted by liquid chromatography-MS. Linear regression models were used to assess the associations of each metabolite with an MSDS, adjusting for covariates. RESULTS Among the 380 postpartum plasma metabolites analyzed, 24 were associated with MSDS during pregnancy (false discovery rate < 0.05). Of 24 MSDS-associated metabolites, 19 were lipids [for example, triacylglycerols, phosphatidylcholines (PCs), PC plasmalogen, phosphatidylserine, and phosphatidylethanolamine]; others were amino acids (methionine sulfoxide and threonine), tropane (nor-psi-tropine), vitamin (vitamin A), and nucleotide (adenosine). The association of adenosine and methionine sulfoxide with MSDS differed by race (P-interaction = 0.033) and maternal overweight or obesity status (P-interaction = 0.021), respectively. CONCLUSIONS In the BBC, we identified 24 postpartum plasma metabolites associated with MSDS during pregnancy. The associations of the 2 metabolites varied by maternal race and BMI. This study provides a new insight into dietary effects on health under the skin. More studies are needed to better understand the metabolic pathways underlying the short- and long-term health benefits of an MSD during pregnancy.
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Affiliation(s)
- Xiaoyu Che
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Susan Gross
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Colleen Pearson
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Tami Bartell
- Patrick M. Magoon Institute for Healthy Communities, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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14
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Wambua S, Singh M, Okoth K, Snell KIE, Riley RD, Yau C, Thangaratinam S, Nirantharakumar K, Crowe FL. Association between pregnancy-related complications and development of type 2 diabetes and hypertension in women: an umbrella review. BMC Med 2024; 22:66. [PMID: 38355631 PMCID: PMC10865714 DOI: 10.1186/s12916-024-03284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension, previous umbrella reviews have only examined a single pregnancy complication. Here we have synthesised evidence from systematic reviews and meta-analyses on the associations of a wide range of pregnancy-related complications with risk of developing T2DM and hypertension. METHODS Medline, Embase and Cochrane Database of Systematic Reviews were searched from inception until 26 September 2022 for systematic reviews and meta-analysis examining the association between pregnancy complications and risk of T2DM and hypertension. Screening of articles, data extraction and quality appraisal (AMSTAR2) were conducted independently by two reviewers using Covidence software. Data were extracted for studies that examined the risk of T2DM and hypertension in pregnant women with the pregnancy complication compared to pregnant women without the pregnancy complication. Summary estimates of each review were presented using tables, forest plots and narrative synthesis and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. RESULTS Ten systematic reviews were included. Two pregnancy complications were identified. Gestational diabetes mellitus (GDM): One review showed GDM was associated with a 10-fold higher risk of T2DM at least 1 year after pregnancy (relative risk (RR) 9.51 (95% confidence interval (CI) 7.14 to 12.67) and although the association differed by ethnicity (white: RR 16.28 (95% CI 15.01 to 17.66), non-white: RR 10.38 (95% CI 4.61 to 23.39), mixed: RR 8.31 (95% CI 5.44 to 12.69)), the between subgroups difference were not statistically significant at 5% significance level. Another review showed GDM was associated with higher mean blood pressure at least 3 months postpartum (mean difference in systolic blood pressure: 2.57 (95% CI 1.74 to 3.40) mmHg and mean difference in diastolic blood pressure: 1.89 (95% CI 1.32 to 2.46) mmHg). Hypertensive disorders of pregnancy (HDP): Three reviews showed women with a history of HDP were 3 to 6 times more likely to develop hypertension at least 6 weeks after pregnancy compared to women without HDP (meta-analysis with largest number of studies: odds ratio (OR) 4.33 (3.51 to 5.33)) and one review reported a higher rate of T2DM after HDP (hazard ratio (HR) 2.24 (1.95 to 2.58)) at least a year after pregnancy. One of the three reviews and five other reviews reported women with a history of preeclampsia were 3 to 7 times more likely to develop hypertension at least 6 weeks postpartum (meta-analysis with the largest number of studies: OR 3.90 (3.16 to 4.82) with one of these reviews reporting the association was greatest in women from Asia (Asia: OR 7.54 (95% CI 2.49 to 22.81), Europe: OR 2.19 (95% CI 0.30 to 16.02), North and South America: OR 3.32 (95% CI 1.26 to 8.74)). CONCLUSIONS GDM and HDP are associated with a greater risk of developing T2DM and hypertension. Common confounders adjusted for across the included studies in the reviews were maternal age, body mass index (BMI), socioeconomic status, smoking status, pre-pregnancy and current BMI, parity, family history of T2DM or cardiovascular disease, ethnicity, and time of delivery. Further research is needed to evaluate the value of embedding these pregnancy complications as part of assessment for future risk of T2DM and chronic hypertension.
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Affiliation(s)
- Steven Wambua
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Megha Singh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kym I E Snell
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Richard D Riley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Christopher Yau
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3 Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
- Health Data Research, London, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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15
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Carcel C, Haupt S, Arnott C, Yap ML, Henry A, Hirst JE, Woodward M, Norton R. A life-course approach to tackling noncommunicable diseases in women. Nat Med 2024; 30:51-60. [PMID: 38242981 DOI: 10.1038/s41591-023-02738-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
Women's health has been critically underserved by a failure to look beyond women's sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of death for women. Among these, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these conditions exist at each stage of women's lives, but recognition of the unique needs of women for the prevention and management of noncommunicable diseases is relatively recent and still emerging. Once they are diagnosed, treatments for these diseases are often costly and noncurative. Therefore, we call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic approach to women's health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational approach to advancing health equity for women, with ultimate benefits for society as a whole.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | - Sue Haupt
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Clare Arnott
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, South-West Sydney Local Health District, Sydney, New South Wales, Australia
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), South-Western Sydney Clinical School, Ingham Institute, UNSW, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Amanda Henry
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Discipline of Women's Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW, Sydney, New South Wales, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - Jane E Hirst
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Robyn Norton
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
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16
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Huang J, Wu Y, Li H, Cui H, Zhang Q, Long T, Zhang Y, Li M. Weight Management during Pregnancy and the Postpartum Period in Women with Gestational Diabetes Mellitus: A Systematic Review and Summary of Current Evidence and Recommendations. Nutrients 2023; 15:5022. [PMID: 38140280 PMCID: PMC10746048 DOI: 10.3390/nu15245022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Weight management during pregnancy and the postpartum period is an important strategy that can be utilized to reduce the risk of short- and long-term complications in women with gestational diabetes mellitus (GDM). We conducted a systematic review to assess and synthesize evidence and recommendations on weight management during pregnancy and the postpartum period in women with GDM to provide evidence-based clinical guidance. METHODS Nine databases and eighteen websites were searched for clinical decisions, guidelines, recommended practices, evidence summaries, expert consensus, and systematic reviews. RESULTS A total of 12,196 records were retrieved and fifty-five articles were included in the analysis. Sixty-nine pieces of evidence were summarized, sixty-two of which focused on pregnancy, including benefits, target population, weight management goals, principles, weight monitoring, nutrition assessment and counseling, energy intake, carbohydrate intake, protein intake, fat intake, fiber intake, vitamin and mineral intake, water intake, dietary supplements, sugar-sweetened beverages, sweeteners, alcohol, coffee, food safety, meal arrangements, dietary patterns, exercise assessment and counseling, exercise preparation, type of exercise, intensity of exercise, frequency of exercise, duration of exercise, exercise risk prevention, and pregnancy precautions, and seven focused on the postpartum period, including target population, benefits, postpartum weight management goals, postpartum weight monitoring, dietary recommendations, exercise recommendations, and postpartum precautions. CONCLUSIONS Healthcare providers can develop comprehensive pregnancy and postpartum weight management programs for women with GDM based on the sixty-nine pieces of evidence. However, because of the paucity of evidence on postpartum weight management in women with GDM, future guidance documents should focus more on postpartum weight management in women with GDM.
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Affiliation(s)
- Jing Huang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Yi Wu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Hua Li
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Hangyu Cui
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Qi Zhang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Tianxue Long
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Yiyun Zhang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
| | - Mingzi Li
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (J.H.)
- School of Nursing, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China
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17
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O'Reilly SL, McAuliffe FM, Geraghty AA, Burden C, Davies A. Implementing weight management during and after pregnancy to reduce diabetes and CVD risk in maternal and child populations. Proc Nutr Soc 2023:1-12. [PMID: 38037711 DOI: 10.1017/s0029665123004883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Maintaining a healthy weight during pregnancy is critical for both women's and children's health. Excessive gestational weight gain (GWG) can lead to complications such as gestational diabetes, hypertension and caesarean delivery. Insufficient GWG can cause fetal growth restriction and increase infant mortality risk. Additionally, postpartum weight retention raises risk of obesity, type 2 diabetes and other chronic diseases for both mother and child. This review seeks to identify current obstacles in weight management research during and after pregnancy and explore evidence-based strategies to overcome them. Pregnancy offers a window of opportunity for health behaviour changes as women are more receptive to education and have regular contact with health services. Staying within Institute of Medicine's recommended GWG ranges is associated with better maternal and fetal outcomes. Systematic review evidence supports structured diet and physical activity pregnancy interventions, leading to reduced GWG and fewer complications. Health economic evaluation indicates significant returns from implementation, surpassing investment costs due to decreased perinatal morbidity and adverse events. However, the most effective way to implement interventions within routine antenatal care remains unclear. Challenges increase in the postpartum period due to competing demands on women physically, mentally and socially, hindering intervention reach and retention. Flexible, technology-supported interventions are needed, requiring frameworks such as penetration-implementation-participation-effectiveness and template-for-intervention-description-and-replication for successful implementation. Greater research efforts are necessary to inform practice and investigate fidelity aspects through pragmatic implementation trials during the pregnancy and postpartum periods. Understanding the best ways to deliver interventions will empower women to maintain a healthy weight during their reproductive years.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin College of Health Sciences, Dublin, Ireland
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Aisling A Geraghty
- School of Agriculture and Food Science, University College Dublin College of Health Sciences, Dublin, Ireland
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Christy Burden
- Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Davies
- Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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18
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Nguyen-Hoang L, Smith GN, Bergman L, McAuliffe FM, Poon LC. FIGO pregnancy passport: A useful tool for women and their healthcare providers on health risks following pregnancy complications. Int J Gynaecol Obstet 2023; 162:787-791. [PMID: 37485783 DOI: 10.1002/ijgo.15029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Affiliation(s)
- Long Nguyen-Hoang
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Graeme N Smith
- Obstetrics & Gynecology, Department of Obstetrics & Gynecology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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19
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Ikoh Rph CL, Tang Tinong R. The Incidence and Management of Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus. Cureus 2023; 15:e44468. [PMID: 37664380 PMCID: PMC10471197 DOI: 10.7759/cureus.44468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
Gestational diabetes mellitus (GDM) refers to a transient state of impaired glucose tolerance that develops during pregnancy, affecting a significant proportion of expectant mothers globally. This review aimed to comprehensively examine the subsequent incidence and management of type 2 diabetes mellitus (T2DM) in women who have previously experienced GDM. The transition from GDM to T2DM is a well-recognized continuum, with affected women facing an increased risk of developing T2DM postpartum. Several studies have demonstrated that women with a history of GDM face a substantially higher risk of developing T2DM compared to normoglycemic pregnant women. The long-term consequences of developing T2DM following GDM are significant, as it not only affects the health of the mother but also poses risks to the offspring. The most common risk factors associated with the progression of GDM to T2DM include pregnancy at an advanced age, insulin treatment during pregnancy, and delivering an overweight baby. As GDM women are at higher risk of developing T2DM, effective management strategies such as lifestyle changes, postpartum care, breastfeeding, screening tests, and gaining awareness of risk are crucial to mitigate the risk of T2DM in this population. The current review was conducted to guide healthcare providers and women with a history of GDM about the potential risks of T2DM and management strategies to prevent the condition. This review provides a summary of evidence on the incidence rate of T2DM in GDM patients, its associated risk factors, and approaches to mitigate this challenge.
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Affiliation(s)
- Chinyere L Ikoh Rph
- Endocrinology, Diabetes and Metabolism, John F. Kennedy University of Medicine Curacao, Willemstad, CUW
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Ahuja M. Changing Care in Changing World - Reproductive Marker of Cardiovascular Disease Risk in Women. J Midlife Health 2023; 14:149-151. [PMID: 38312768 PMCID: PMC10836438 DOI: 10.4103/jmh.jmh_248_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Maninder Ahuja
- Editor in Chief JMH, Faridabad, Haryana, India
- Director, Ahuja Health Care Services, Faridabad, Haryana, India
- President SMLM (Society of Meaningful Life Management), Faridabad, Haryana, India E-mail:
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21
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Balsarkar G. Pregnancy as an Opportunity to the Obstetricians to Improve Long-Term Maternal Health. J Obstet Gynaecol India 2023; 73:1-2. [PMID: 37063474 PMCID: PMC9984658 DOI: 10.1007/s13224-023-01741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Geetha Balsarkar
- Seth G.S. Medical College, Nowrosjee Wadia Maternity Hospital, Mumbai, India
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