Management of Gestational Diabetes Mellitus

The role of machine learning algorithms in detection of gestational diabetes; a narrative review of current evidence

Gestational Diabetes Mellitus (GDM) poses significant health risks to mothers and infants. Early prediction and effective management are crucial to improving outcomes. Machine learning techniques have emerged as powerful tools for GDM prediction. This review compiles and analyses the available studies to highlight key findings and trends in the application of machine learning for GDM prediction. A comprehensive search of relevant studies published between 2000 and September 2023 was conducted. Fourteen studies were selected based on their focus on machine learning for GDM prediction. These studies were subjected to rigorous analysis to identify common themes and trends. The review revealed several key themes. Models capable of predicting GDM risk during the early stages of pregnancy were identified from the studies reviewed. Several studies underscored the necessity of tailoring predictive models to specific populations and demographic groups. These findings highlighted the limitations of uniform guidelines for diverse populations. Moreover, studies emphasised the value of integrating clinical data into GDM prediction models. This integration improved the treatment and care delivery for individuals diagnosed with GDM. While different machine learning models showed promise, selecting and weighing variables remains complex. The reviewed studies offer valuable insights into the complexities and potential solutions in GDM prediction using machine learning. The pursuit of accurate, early prediction models, the consideration of diverse populations, clinical data, and emerging data sources underscore the commitment of researchers to improve healthcare outcomes for pregnant individuals at risk of GDM.

Prevalence and Risk Factors of Confirmed Gestational Diabetes Mellitus Among Pregnant Women With Prior Positive Screening: A Case-Control Study

BACKGROUND

 Saudi Arabia has a higher rate of gestational diabetes mellitus (GDM) than most other countries. There is a paucity of data on the risk factors for GDM, particularly positive screening for diabetes in the initial period of pregnancy.

OBJECTIVES

 The aim of this study was to determine the prevalence of confirmed GDM in pregnant women who initially screened positive for GDM, as well as to identify its association with age, nationality, and clinical risk factors.

PATIENTS AND METHODS

 This case-control study was conducted retrospectively at a tertiary referral center in Jeddah, Saudi Arabia. It included pregnant women who were referred between January 2019 and December 2022 after having tested positive on a 50 g oral glucose tolerance test (OGTT). They subsequently underwent a 75 g or 100 g confirmatory OGTT at our center. The sociodemographic and clinical characteristics of those with confirmed GDM (cases) and those with negative confirmatory OGTT (controls) were compared.

RESULTS

 The majority of participants (75.4%) had confirmed GDM. However, there were no significant differences between cases and controls with regard to age, nationality, or clinical or pregnancy-related factors. Of note, the cohort was characterized by high gravidity and high parity, which may indicate susceptibility to GDM.

CONCLUSION

 The study findings support the usefulness of the 50 g OGTT for the screening of pregnant women at high risk for GDM. In addition, high gravidity and parity may also be risk factors for GDM, warranting closer monitoring for GDM and further research in a high-natality population such as that of Saudi Arabia.

Gestational diabetes mellitus and COVID-19: The epidemic during the pandemic

During the global coronavirus disease 2019 (COVID-19) pandemic, people worldwide have experienced an unprecedented rise in psychological distress and anxiety. In addition to this challenging situation, the prevalence of diabetes mellitus (DM), a hidden epidemic, has been steadily increasing in recent years. Lower-middle-income countries have faced significant barriers in providing accessible prenatal care and promoting a healthy diet for pregnant women, and the pandemic has made these challenges even more difficult to overcome. Pregnant women are at a higher risk of developing complications such as hyper-tension, preeclampsia, and gestational diabetes, all of which can have adverse implications for both maternal and fetal health. The occurrence of gestational diabetes has been on the rise, and it is possible that the pandemic has worsened its prevalence. Although data is limited, studies conducted in Italy and Canada suggest that the pandemic has had an impact on gestational diabetes rates, especially among women in their first trimester of pregnancy. The significant disruptions to daily routines caused by the pandemic, such as limited exercise options, indicate a possible link between COVID-19 and an increased likelihood of experiencing higher levels of weight gain during pregnancy. Notably, individuals in the United States with singleton pregnancies are at a significantly higher risk of excessive gestational weight gain, making this association particularly important to consider. Although comprehensive data is currently lacking, it is important for clinical researchers to explore the possibility of establishing correlations between the stress experienced during the pandemic, its consequences such as gestational gain weight, and the increasing incidence of gestational DM. This knowledge would contribute to better preventive measures and support for pregnant individuals during challenging times.

Gestational diabetes mellitus: The optimal time of delivery

Gestational diabetes mellitus (GDM) is a common pregnancy complication strongly associated with poor maternal-fetal outcomes. Its incidence and prevalence have been increasing in recent years. Women with GDM typically give birth through either vaginal delivery or cesarean section, and the maternal-fetal outcomes are related to several factors such as cervical level, fetal lung maturity, the level of glycemic control still present, and the mode of treatment for the condition. We categorized women with GDM based on the latter two factors. GDM that is managed without medication when it is responsive to nutrition- and exercise-based therapy is considered diet- and exercise-controlled GDM, or class A1 GDM, and GDM managed with medication to achieve adequate glycemic control is considered class A2 GDM. The remaining cases in which neither medical nor nutritional treatment can control glucose levels or patients who do not control their blood sugar are categorized as class A3 GDM. We investigated the optimal time of delivery for women with GDM according to the classification of the condition. This review aimed to address the benefits and harms of giving birth at different weeks of gestation for women with different classes of GDM and attempted to provide an analytical framework and clearer advice on the optimal time for labor.

Feto-placental endothelial dysfunction in Gestational Diabetes Mellitus under dietary or insulin therapy

OBJECTIVE

Gestational diabetes mellitus (GDM) is a serious complication in pregnancy. Despite controlling the plasma glucose levels with dietary intervention (GDM-D) or insulin therapy (GDM-I), children born of diabetic mothers suffer more long-term complications from childhood to early adulthood. Placental circulation and nutrient exchange play a vital role in fetal development. Additionally, placental endothelial function is an indicator of vascular health, and plays an important role in maintaining placental circulation for nutrient exchange. This study was conducted to assess changes in fetal endothelial dysfunction in GDM under different interventions during pregnancy.

METHODS

The primary human umbilical vein endothelial cells (HUVECs) were obtained from normal pregnant women (n = 11), GDM-D (n = 14), and GDM-I (n = 12) patients. LC-MS/MS was used to identify differentially expressed proteins in primary HUVECs among the three groups, after which Bioinformatics analysis was performed. Glucose uptake, ATP level, apoptosis, and differentially expressed proteins were assessed to investigate changes in energy metabolism.

RESULTS

A total of 8174 quantifiable proteins were detected, and 142 differentially expressed proteins were identified after comparing patients with GDM-D/GDM-I and healthy controls. Of the 142, 64 proteins were upregulated while 77 were downregulated. Bioinformatics analysis revealed that the differentially expressed proteins were involved in multiple biological processes and signaling pathways related to cellular processes, biological regulation, and metabolic processes. According to the results from KEGG analysis, there were changes in the PI3K/AKT signaling pathway after comparing the three groups. In addition, there was a decrease in glucose uptake in the GDM-I (P < 0.01) group. In GDM-I, there was a significant decrease in the levels of glucose transporter 1 (GLUT1) and glucose transporter 3 (GLUT3). Moreover, glucose uptake was significantly decreased in GDM-I, although in GDM-D, there was only a decrease in the levels of GLUT1. ATP levels decreased in GDM-I (P < 0.05) and apoptosis occurred in both the GDM-D and GDM-I groups. Compared to the normal controls, the levels of phosphate AKT and phosphate AMPK over total AKT and AMPK were reduced in the GDM-I group.

CONCLUSION

In summary, endothelial dysfunction occurred in pregnancies with GDM even though the plasma glucose levels were controlled, and this dysfunction might be related to the degree of glucose tolerance. The energy dysfunction might be related to the regulation of the AKT/AMPK/mTOR signaling pathway.

Effect of cognitive behavior therapy (CBT) on lowering of blood glucose levels in gestational diabetes mellitus (GDM) patients: study protocol for a prospective, open-label, randomized controlled trial

BACKGROUND

Gestational diabetes mellitus (GDM) is a common perinatal condition. Convincing evidence has shown that hyperglycemia and other chronic comorbidities of diabetes during the prenatal period increase maternal and fetal risk. Several guidelines have identified lifestyle management as the first-line therapy in GDM patients. To improve the efficacy of lifestyle intervention, cognitive behavior therapy (CBT) is proposed as a solution to improve clinical outcomes. The objective of this trial is to determine the efficacy in treating hyperglycemia of mobile-based CBT interventions in GDM patients, compared with conventional face-to-face interventions.  METHODS: This trial is designed as a prospective randomized controlled trial, which enrolled the patients diagnosed with GDM in First People's Hospital of Kunshan affiliated with Jiangsu University from September 2021 to March 2023 with a 3-month follow-up. The specific randomization method was established and implemented through the central randomization system of EDC clinical trials. The percentage of all blood glucose levels collected within the normal range between the two groups at baseline, during the intervention period, and postpartum infant and maternal outcomes will be measured. Summary statistics for continuous variables will include the number of subjects, mean, median, SD, or the standard error, minimum, and maximum. The chi-square test, t test, and paired-sample t test were used for statistical analysis of differences between groups.

DISCUSSION

This trial investigates the effects of mobile-based CBT intervention on blood glucose levels in GDM patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2100048527) [registered: 2021/07/09].

Is overweight associated with periodontitis in pregnant women? Systematic review and meta-analysis

This systematic review and meta-analysis aimed to generate pooled evidence for the association between excessive weight and pregnancy induced periodontitis. EMBASE, SCOPUS, PubMed/MEDLINE, Web of Science, BVS/LILACS, Cochrane Library and SCIELO databases were accessed. Eligibility criteria were: human clinical studies published between year 2000 and 2021. Newcastle-Ottawa scale was used to evaluate risk of bias of the studies. Meta-analysis was performed using MedCalc® Statistical Software. Eleven studies were included, evaluating 2152 pregnant women (743 with overweight/obesity and 1409 with normal body mass index - BMI), with a mean age of 29.62 years. Most studies had low risk of bias. A positive association between overweight/obesity and periodontitis was found, with an average of 61.04% of women with overweight/obesity and periodontitis, showing the overall random-effects relative risk and 95% CI of 2.21 (1.53–3.17) (p < 0.001). Arterial hypertension, gestational diabetes mellitus and excessive gestational weight gain were the most common adverse effects of maternal obesity that may have been linked to periodontitis induced pro-inflammatory state. In conclusion, a positive association was found between overweight/obesity and periodontitis during pregnancy. However, the high heterogeneity between the studies related to sample size, periodontal classification and the cutoff-points for BMI are the main limitation.

Effects of Probiotic Supplementation during Pregnancy on the Future Maternal Risk of Metabolic Syndrome

Probiotics are live microorganisms that induce health benefits in the host. Taking probiotics is generally safe and well tolerated by pregnant women and their children. Consumption of probiotics can result in both prophylactic and therapeutic effects. In healthy adult humans, the gut microbiome is stable at the level of the dominant taxa: Bacteroidetes, Firmicutes and Actinobacteria, and has a higher presence of Verrucomicrobia. During pregnancy, an increase in the number of Proteobacteria and Actinobacteria phyla and a decrease in the beneficial species Roseburia intestinalis and Faecalibacterium prausnitzii are observed. Pregnancy is a "window" to the mother's future health. The aim of this paper is to review studies assessing the potentially beneficial effects of probiotics in preventing the development of diseases that appear during pregnancy, which are currently considered as risk factors for the development of metabolic syndrome, and consequently, reducing the risk of developing maternal metabolic syndrome in the future. The use of probiotics in gestational diabetes mellitus, preeclampsia and excessive gestational weight gain is reviewed. Probiotics are a relatively new intervention that can prevent the development of these disorders during pregnancy, and thus, would reduce the risk of metabolic syndrome resulting from these disorders in the mother's future.

A self-efficacy-enhancing physical activity intervention in women with high-risk factors for gestational diabetes mellitus: study protocol for a randomized clinical trial

BACKGROUND

Gestational diabetes mellitus (GDM) is one of the most common medical disorders in pregnancy. Evidence has demonstrated that moderate-intensity physical activity may reduce the risk of gestational diabetes. However, women at risk of GDM spend most of their time performing sedentary behaviors. Although researchers identified self-efficacy as a mediator to overcome physical activity barriers, exercise intervention during pregnancy based on self-efficacy theory has not been discussed so far. Furthermore, there is conflicting evidence regarding the effects of a physical exercise intervention on the incidence of GDM and other maternal or neonatal outcomes in women at higher risk for GDM.

METHODS/DESIGN

A single-center, parallel, randomized controlled trial will be conducted in a maternal-child health care center. A total of 244 pregnant women at high risk for GDM will be randomized into a study group receiving a self-efficacy-enhancing physical activity intervention or a control group receiving the usual care. The intervention will consist of four group sessions and everyday reminders by WeChat (Tencent, Shenzhen, China). The program will begin at approximately 13-14+6 gestational weeks and end at 36+6 gestational weeks. The primary outcomes will include the incidence of GDM, blood sugar values, and physical activity. The secondary outcomes will include physical activity self-efficacy, gestational weight gain, maternal outcomes, and neonatal outcomes.

DISCUSSION

The findings of this research will contribute toward understanding the effects of a self-efficacy theory-oriented physical activity program on the incidence of GDM, blood sugar values, physical activity level, gestational weight gain, physical activity self-efficacy, maternal outcomes, and neonatal outcomes.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (CHiCTR) ChiCTR2200056355 . Registered on February 4, 2022.

WHO criteria for diabetes in pregnancy: a retrospective cohort

BACKGROUND

Recognizing that hyperglycemia in pregnancy can impact both individually a patient's health and collectively the healthcare system and that different levels of hyperglycemia incur different consequences, we aimed to evaluate the differences and similarities between patients who met the diagnostic criteria for gestational diabetes mellitus (GDM) or diabetes in pregnancy (DIP) according to the World Health Organization diagnostic criteria based on the 75 g oral glucose tolerance test (OGTT).

METHODS

This retrospective study included a cohort of 1064 women followed-up at the Gestational Diabetes Unit of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (Sao Paulo, Brazil). Patients were classified into GDM and DIP groups, according to their OGTT results. Their electronic charts were reviewed to obtain clinical and laboratory data for all participants.

RESULTS

Women in the DIP group had a higher pre-pregnancy body mass index (30.5 vs 28.1 kg/m², odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.11), more frequently experienced GDM in a previous pregnancy (25% vs. 11%, OR 2.71, 95% CI 1.17-6.27), and were more likely to have chronic hypertension (43.1% vs. 23.5%, OR 2.46, 95% CI 1.47-4.11), a current twin pregnancy (10.8% vs. 2.9%, OR 4.04, 95% CI 1.70-9.61), or require insulin (46.1% vs. 14.3%, OR 5.14, 95% CI 3.06-8.65) than those in the GDM group. Patients in the DIP group also had a higher frequency of large-for-gestational-age infants (12.3% vs. 5.1%, OR 2.78, 95% CI 1.23-6.27) and abnormal postpartum OGTT (45.9% vs. 12.6%, OR 5.91, 95% CI 2.93-11.90) than those in the GDM group. Nevertheless, in more than half of the DIP patients, glucose levels returned to normal after birth.

CONCLUSIONS

Diabetes in pregnancy is associated with an increased risk of adverse perinatal outcomes but does not equate to a diagnosis of diabetes post-pregnancy. It is necessary to identify and monitor these women more closely during and after pregnancy. Keeping patients with hyperglycemia in pregnancy engaged in healthcare is essential for accurate diagnosis and prevention of complications related to abnormal glucose metabolism.

Optimal delivery time for patients with diet-controlled gestational diabetes mellitus: a single-center real-world study

Background

To determine the optimal delivery time for women with diet-controlled gestational diabetes mellitus by comparing differences in adverse maternal–fetal outcome and cesarean section rates.

Methods

This real-world retrospective study included 1,050 patients with diet-controlled gestational diabetes mellitus who delivered at 35–42 weeks’ gestation. Data on patient characteristics, maternal–fetal outcomes, and cesarean section rate based on fetal gestational age were collected and analyzed. Differences between deliveries with and without iatrogenic intervention were also analyzed.

Results

The cesarean section rate at ≥ 41 weeks’ gestation was significantly higher than that at 39–39 + 6 weeks (56% vs. 39%, p = 0.031). There were no significant differences in multiple adverse maternal or neonatal outcomes at delivery before and after 39 weeks. Vaginal delivery rates were increased significantly at 39–39 + 6 weeks due to iatrogenic intervention (p = 0.005) and 40–40 + 6 weeks (p = 0.003) in patients without and with spontaneous uterine contractions, respectively.

Conclusions

It’s recommended that optimal delivery time for patients with diet-controlled gestational diabetes mellitus should be between 39- and 40 + 6 weeks’ gestation. Patients who have Bishop scores higher than 4 can undergo iatrogenic intervention at 39–39 + 6 weeks. However iatrogenic interventions are not recommended for patients with low Bishop scores.

Comparative efficacy and safety of glyburide, metformin, and insulin in treatment of gestational diabetes mellitus: A protocol for systematic review and meta-analysis

BACKGROUND

The increased prevalence of gestational diabetes mellitus (GDM) has caused a huge societal economic and healthy burden at both the population and individual levels. We aimed to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in GDM from a protocol for systematic review and meta-analysis.

METHODS

Two individual researchers conducted the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to February 2022. Literature retrieving was carried out through a combined searching of subject terms ("MeSH" on PubMed and "Emtree" on "Embase") and free terms on the platforms of PubMed and Embase, and through keywords searching on platform of Cochrane Library. Systematic review and meta-analysis of the data will be performed in STATA13.0 software according to the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two authors independently performed the literature searching, data extraction, and quality evaluation. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials.

RESULTS

The results will be submitted to a peer-reviewed journal.

CONCLUSION

This meta-analysis will provide a comprehensive analysis and synthesis that can be used as an evidence map to inform practitioners and policy makers about the effectiveness of glyburide, metformin, and insulin for patients with GDM.

Alpha-lipoic acid supplementation effects on serum values of some oxidative stress biomarkers in women with gestational diabetes

AIMS

Alpha-lipoic acid (ALA) is a unique antioxidant that can eradicate different kinds of free radicals. The current trial was designed to investigate the effects of ALA supplementation on some oxidative stress biomarkers in women with GDM.

MATERIALS AND METHODS

Sixty women with GDM at 24-28 weeks of pregnancy were selected and then they were divided into the drug (n = 30) received ALA 300 mg/day for 8 weeks and the placebo (n = 30) groups. Serum values of fasting blood sugar (FBS), thiol groups, glutathione, catalase, total antioxidant capacity (TAC), total oxidant status (TOS) and malondialdehyde (MDA) were measured. Values of the oxidative stress index (OSI), the MDA/TAC ratio and total antioxidant gap (TAG) were calculated.

RESULTS

After the intervention values of FBS (p = .001), TAC (p < .001), OSI (p = .003), TAG (p = .001) and catalase (p < .001) were improved significantly in the drug group. Values of TOS (p = .070) and glutathione (p = .088) were improved marginally in the drug group.

CONCLUSIONS

The current study showed that ALA supplementation at a dosage of 300 mg/day in women with GDM had improving effects on maternal circulating values of FBS, TAC, OSI, TAG, TOS, glutathione and catalase.

Melatonin and Myo-Inositol: Supporting Reproduction from the Oocyte to Birth

Human pregnancy is a sequence of events finely tuned by several molecular interactions that come with a new birth. The precise interlocking of these events affecting the reproductive system guarantees safe embryo formation and fetal development. In this scenario, melatonin and myo-inositol seem to be pivotal not only in the physiology of the reproduction process, but also in the promotion of positive gestational outcomes. Evidence demonstrates that melatonin, beyond the role of circadian rhythm management, is a key controller of human reproductive functions. Similarly, as the most representative member of the inositol’s family, myo-inositol is essential in ensuring correct advancing of reproductive cellular events. The molecular crosstalk mediated by these two species is directly regulated by their availability in the human body. To date, biological implications of unbalanced amounts of melatonin and myo-inositol in each pregnancy step are growing the idea that these molecules actively contribute to reduce negative outcomes and improve the fertilization rate. Clinical data suggest that melatonin and myo-inositol may constitute an optimal dietary supplementation to sustain safe human gestation and a new potential way to prevent pregnancy-associated pathologies.