1
|
Lin L, Huang Y, Chen L, Zheng L, Feng Y, Lin J, Yan J. Gestational weight trajectory and risk of adverse pregnancy outcomes among women with gestational diabetes mellitus: A retrospective cohort study. MATERNAL & CHILD NUTRITION 2024; 20:e13645. [PMID: 38517119 PMCID: PMC11168372 DOI: 10.1111/mcn.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
The aim of this study was to explore gestational weight gain (GWG) trajectories and their associations with adverse pregnancy outcomes. A retrospective cohort study including 11,064 women with gestational diabetes mellitus (GDM) was conducted between 2015 and 2019 in China. The latent class trajectory model was used to identify GWG trajectories, and logistic regression was performed to examine odds ratio (OR) of pregnancy outcomes. Three trajectories of GWG were identified in these 11,604 women with GDM. Trajectory 1: 64.02% of women had sustained moderate GWG throughout pregnancy; Trajectory 2: 17.75% of women showed a high initial GWG but followed by a low GWG from the third trimester until delivery; Trajectory 3: 18.23% had low initial GWG but followed by drastic GWG from the second trimester until delivery. Compared with pregnant women with Trajectory 1, women with Trajectory 2 had a higher risk of large for gestational age (adjusted odds ratio [AOR]: 1.29, 95% confidence interval [CI]: 1.12-1.48) but at a lower risk of having hypertensive disorders of pregnancy (AOR: 0.76, 95% CI: 0.57-0.96). Women in Trajectory 3 were more likely to develop small for gestational age (AOR: 2.12, 95% CI: 1.62-2.78), low birthweight (AOR: 1.49, 95% CI: 1.07-2.08), preterm birth (AOR: 1.28, 95% CI: 1.05-1.63), caesarean section (AOR: 1.26, 95% CI: 1.112-1.42) and hypertensive disorders of pregnancy (AOR: 2.24, 95% CI: 1.82-2.76). The association of GWG trajectory with adverse pregnancy outcomes differs across prepregnancy body mass index and GWG categories. Women with a slow initial GWG but followed by drastic GWG had higher risks of adverse pregnancy outcomes. Early clinical recognition of poor GWG trajectory will contribute to early intervention in high-risk groups to minimise adverse outcomes.
Collapse
Affiliation(s)
- Lihua Lin
- Department of Healthcare, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Yanhong Huang
- Department of Healthcare, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Lijuan Chen
- Department of Child Healthcare Center, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Lianghui Zheng
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Yebin Feng
- Department of Research Office, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Juan Lin
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| | - Jianying Yan
- Department of Obstetric, Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhouPeople's Republic of China
| |
Collapse
|
2
|
Marques Puga F, Borges Duarte D, Benido Silva V, Pereira MT, Garrido S, Vilaverde J, Sales Moreira M, Pichel F, Pinto C, Dores J. Maternal Hypertriglyceridemia in Gestational Diabetes: A New Risk Factor? Nutrients 2024; 16:1577. [PMID: 38892511 PMCID: PMC11174571 DOI: 10.3390/nu16111577] [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: 04/22/2024] [Revised: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Elevated maternal triglycerides (TGs) have been associated with excessive fetal growth. However, the role of maternal lipid profile is less studied in gestational diabetes mellitus (GDM). We aimed to study the association between maternal lipid profile in the third trimester and the risk for large-for-gestational-age (LGA) newborns in women with GDM. We performed an observational and retrospective study of pregnant women with GDM who underwent a lipid profile measurement during the third trimester. We applied a logistic regression model to assess predictors of LGA. A total of 100 singleton pregnant women with GDM and third-trimester lipid profile evaluation were included. In the multivariate analysis, pre-pregnancy BMI (OR 1.19 (95% CI 1.03-1.38), p = 0.022) and hypertriglyceridemia (OR 7.60 (1.70-34.10), p = 0.008) were independently associated with LGA. Third-trimester hypertriglyceridemia was found to be a predictor of LGA among women with GDM, independently of glycemic control, BMI, and pregnancy weight gain. Further investigation is needed to confirm the role of TGs in excessive fetal growth in GDM pregnancies.
Collapse
Affiliation(s)
- Francisca Marques Puga
- Serviço de Endocrinologia, Diabetes e Metabolismo, Unidade Local de Saúde de Santo António, 4050-366 Porto, Portugal
| | - Diana Borges Duarte
- Serviço de Endocrinologia, Unidade Local de Saúde de Braga, 4710-243 Braga, Portugal
| | - Vânia Benido Silva
- Serviço de Endocrinologia, Unidade Local de Saúde do Tâmega e Sousa, 4560-136 Penafiel, Portugal
| | - Maria Teresa Pereira
- Serviço de Endocrinologia, Diabetes e Metabolismo, Unidade Local de Saúde de Santo António, 4050-366 Porto, Portugal
| | - Susana Garrido
- Serviço de Endocrinologia, Diabetes e Metabolismo, Unidade Local de Saúde de Santo António, 4050-366 Porto, Portugal
| | - Joana Vilaverde
- Serviço de Endocrinologia, Diabetes e Metabolismo, Unidade Local de Saúde de Santo António, 4050-366 Porto, Portugal
| | - Marta Sales Moreira
- Serviço de Obstetrícia e Medicina Materno-Fetal, Unidade Local de Saúde de Santo António, 4050-366 Porto, Portugal
| | - Fernando Pichel
- Serviço de Nutrição, Unidade Local de Saúde de Santo António, 4050-366 Porto, Portugal
| | - Clara Pinto
- Serviço de Obstetrícia e Medicina Materno-Fetal, Unidade Local de Saúde de Santo António, 4050-366 Porto, Portugal
| | - Jorge Dores
- Serviço de Endocrinologia, Diabetes e Metabolismo, Unidade Local de Saúde de Santo António, 4050-366 Porto, Portugal
| |
Collapse
|
3
|
Visolyi GÁ, Kun A, Szalai O, Svébis MM, Domján BA, Zsirai L, Tabák ÁG. Pregnancy outcomes of women with untreated 'mild' gestational diabetes (gestational diabetes by the WHO 2013 but not by the WHO-1999 diagnostic criteria) - A population-based cohort study. Diabetes Res Clin Pract 2023; 203:110874. [PMID: 37579993 DOI: 10.1016/j.diabres.2023.110874] [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: 07/04/2023] [Revised: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
AIMS We compared pregnancy outcomes of untreated 'mild' GDM (GDM by WHO 2013 but not by WHO-1999) to normal glucose tolerant women (NGT). METHODS In a universal screening program 4333 pregnant women had a 3-point 75 g OGTT in Hungary in 2009-2013. By WHO-2013 untreated NGT was diagnosed in n = 3303, 'mild' GDM in n = 336 cases. RESULTS 'Mild' GDM women were older (mean difference, SE: 1.4, 0.3 yrs), had higher fasting (1.0, 0.02), 60-minute (1.0, 0.09), and 120-minute (0.4, 0.06 mmol/l) blood glucose, and blood pressure (2.6, 0.5/2.0, 0.5 mmHg). Weight gain was similar in both groups (-0.3, 0.3 kg). GDM newborns were heavier (142, 50 g) and were more frequently macrosomic (>4000 g, OR 1.85, 95 %CI 1.35-2.54). Hypertension during pregnancy was more prevalent in the GDM group (OR 1.55, 95 %CI 1.05-2.28), as well as induced (OR 1.38, 95 %CI 1.10-1.74) and instrumental delivery (OR 1.34, 95 %CI 1.07-1.68), and acute caesarean section (OR 1.32, 95 %CI 1.04-1.64). Most of these differences substantially attenuated or became non-significant after adjustment for pre-pregnancy BMI. CONCLUSIONS Pregnancy outcomes of 'mild' GDM were worse compared to normal glucose tolerant women however these differences were explained by the pre-pregnancy BMI difference between groups.
Collapse
Affiliation(s)
- Gergely Á Visolyi
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary; Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary.
| | - Attila Kun
- Tolna County Balassa János Hospital, Department of Obstetrics and Gynaecology, Szekszárd, Hungary
| | | | - Márk M Svébis
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary; Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Beatrix A Domján
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - László Zsirai
- Department of Gynecology and Family Planning, Istenhegyi GeneDiagnostic Center, Hungary
| | - Ádám G Tabák
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary; UCL Brain Sciences, University College London, London, United Kingdom; Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary.
| |
Collapse
|
4
|
Rai AS, Sletner L, Jenum AK, Øverby NC, Stafne SN, Qvigstad E, Pripp AH, Sagedal LR. Adverse pregnancy outcomes among women in Norway with gestational diabetes using three diagnostic criteria. PLoS One 2023; 18:e0280750. [PMID: 37410781 PMCID: PMC10325062 DOI: 10.1371/journal.pone.0280750] [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: 02/11/2022] [Accepted: 01/08/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION The aim of this study was to examine the risk of adverse perinatal outcomes in women diagnosed with GDM by the World Health Organization (WHO) 1999 criteria, and in those retrospectively identified by the Norwegian-2017 and WHO-2013 criteria but not by WHO-1999 criteria. We also examine the effect of maternal overweight/obesity and ethnicity. MATERIAL AND METHODS We used pooled data from four Norwegian cohorts (2002-2013), encompassing 2970 mother-child pairs. Results from universally offered 75-g oral glucose tolerance tests measuring fasting plasma glucose (FPG) and 2-hour glucose (2HG) were used to assign women into three diagnostic groups: Diagnosed and treated by WHO-1999 (FPG≥7.0 or (2HG ≥7.8 mmol/L), identified by WHO-2013 (FPG ≥5.1 or 2HG ≥8.5 mmol/L), and identified by Norwegian-2017 criteria (FPG ≥5.3 or 2HG ≥9.0 mmol/L). Perinatal outcomes included large-for-gestational-age (LGA) infants, cesarean section, operative vaginal delivery, preterm birth and preeclampsia. RESULTS Compared to the non-GDM group, women diagnosed with GDM by either of the three criteria had an increased risk of large-for-gestational-age infants (adjusted odds ratios (OR) 1.7-2.2). Those identified by the WHO-2013 and Norwegian-2017 criteria but not diagnosed and treated by WHO-1999 criteria had an additional increased risk of cesarean section (OR 1.36, 95% CI 1.02,1.83 and 1.44, 95% CI 1.03,2.02, respectively) and operative vaginal delivery (OR 1.35, 95% CI 1.1,1.7 and 1.5, 95% CI 1.1,2.0, respectively). The proportions of LGA neonates and cesarean section were higher for women with GDM in both normal-weight and overweight/obese women. Asians had a lower risk of delivering large-for-gestational-age infants than Europeans applying national birthweight references, but maternal glucose values were similarly positively associated with birthweight in all ethnic groups. CONCLUSIONS Women who met the WHO-2013 and Norwegian-2017 criteria, but were not diagnosed by the WHO-1999 criteria and therefore not treated, had an increased risk of LGA, cesarean section and operative vaginal delivery compared to women without GDM.
Collapse
Affiliation(s)
- Anam Shakil Rai
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
| | - Line Sletner
- Department of Pediatric and Adolescents Medicine, Akershus University Hospital, Nordbyhagen, Akershus, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- Department of General Medicine, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Services, St.Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Linda Reme Sagedal
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Department of Obstetrics and Gynaecology, Sorlandet Hospital, Kristiansand, Norway
| |
Collapse
|
5
|
Perea V, Simó-Servat A, Quirós C, Alonso-Carril N, Valverde M, Urquizu X, Amor AJ, López E, Barahona MJ. Role of Excessive Weight Gain During Gestation in the Risk of ADHD in Offspring of Women With Gestational Diabetes. J Clin Endocrinol Metab 2022; 107:e4203-e4211. [PMID: 36073965 DOI: 10.1210/clinem/dgac483] [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: 04/06/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Although attention-deficit/hyperactivity disorder (ADHD) has been associated with gestational diabetes mellitus (GDM) and maternal obesity, excessive weight gain (EWG) during pregnancy has scarcely been evaluated. OBJECTIVE This study aimed to assess the joint effect of maternal weight and EWG on the risk of ADHD in offspring of GDM pregnancies. METHODS In this cohort study of singleton births >22 weeks of gestation of women with GDM between 1991 and 2008, gestational weight gain above the National Academy of Medicine (NAM) recommendations was classified into EWG. Cox-regression models estimated the effect of maternal pregestational weight and EWG on the risk of ADHD (identified from medical records), adjusted for pregnancy outcomes and GDM-related variables. RESULTS Of 1036 children who were included, with a median follow-up of 17.7 years, 135 (13%) were diagnosed with ADHD. ADHD rates according to pregestational maternal weight were 1/14 (7.1%) for underweight, 62/546 (11.4%) for normal weight, 40/281 (14.2%) for overweight, and 32/195 (16.4%) for obesity. Only maternal obesity was independently associated with ADHD (HRadjusted 1.66 [95% CI, 1.07-2.60]), but not maternal overweight or EWG. On evaluating the joint contribution of maternal weight and EWG, maternal obesity with EWG was associated with the highest risk of ADHD (vs normal weight without EWG; HRadjusted 2.13 [95% CI, 1.14-4.01]). Pregestational obesity without EWG was no longer associated (HRadjusted 1.36 [95% CI, 0.78-2.36]). CONCLUSION Among GDM pregnancies, pregestational obesity was associated with a higher risk of ADHD in offspring. Nonetheless, when gestational weight gain was taken into account, only the joint association of obesity and EWG remained significant.
Collapse
Affiliation(s)
- Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Andreu Simó-Servat
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Nuria Alonso-Carril
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Maria-José Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| |
Collapse
|
6
|
Barak O, Yoles I, Wainstock T, Gadassi N, Schiller T, Vaisbuch E. The association between an oral glucose tolerance test performed at term pregnancy and obstetric outcomes. Obstet Med 2022; 15:185-189. [PMID: 36262815 PMCID: PMC9574452 DOI: 10.1177/1753495x211055634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 10/07/2021] [Indexed: 09/03/2023] Open
Abstract
Aims Assessing the value of oral glucose tolerance test performed at term pregnancy in identifying obstetric complications. Methods Retrospective cohort study of women with a normal 50 g glucose challenge test who also had an oral glucose tolerance test at term (defined as at or after 37 weeks of gestation). Comparison between the pathological and normal oral glucose tolerance test groups was performed. Results The mean glucose in the glucose challenge test of women in the normal oral glucose tolerance test (n = 256) group was lower than that in the pathological oral glucose tolerance test (N = 16) group (105 ± 17 mg/dl (5.8 ± 0.9 mmol/l) vs 117 ± 13 mg/dl (6.5 ± 0.7 mmol/l), p = 0.007). Relevant obstetrical complications did not differ significantly between the groups. Of note, in the pathological oral glucose tolerance test group only one woman delivered a macrosomic infant. Conclusions A pathological oral glucose tolerance test performed at term was unable to identify women at risk for impaired glucose metabolism-related obstetric complications and is therefore of limited clinical value and seems to be unjustified.
Collapse
Affiliation(s)
- Oren Barak
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Israel
- Faculty of Medicine, Hebrew University of Jeruslem, Israel
| | - Israel Yoles
- Clalit Health Services, the Central District, Israel
| | | | - Noa Gadassi
- Faculty of Medicine, Hebrew University of Jeruslem, Israel
- Department of Neonatology, Kaplan Medical Center, Israel
| | - Tal Schiller
- Faculty of Medicine, Hebrew University of Jeruslem, Israel
- Diabetes, Endocrinology and Metabolism, Kaplan Medical Center, Israel
| | - Edi Vaisbuch
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Israel
- Faculty of Medicine, Hebrew University of Jeruslem, Israel
| |
Collapse
|
7
|
Lin LH, Lin J, Yan JY. Interactive Affection of Pre-Pregnancy Overweight or Obesity, Excessive Gestational Weight Gain and Glucose Tolerance Test Characteristics on Adverse Pregnancy Outcomes Among Women With Gestational Diabetes Mellitus. Front Endocrinol (Lausanne) 2022; 13:942271. [PMID: 35872998 PMCID: PMC9301308 DOI: 10.3389/fendo.2022.942271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 12/16/2022] Open
Abstract
Purpose To examine the combined effect of pre-pregnancy overweight or obesity, excessive gestational weight gain, and glucose tolerance status on the incidence of adverse pregnancy outcomes among women with gestational diabetes mellitus. Methods A observational study including 5529 gestational diabetes mellitus patients was performed. Logistic regression were used to assess the independent and multiplicative interactions of overweight or obese, excessive gestational weight gain, abnormal items of oral glucose tolerance test and adverse pregnancy outcomes. Additive interactions were calculated using an Excel sheet developed by Anderson to calculate relative excess risk. Results Overall 1076(19.46%) study subject were overweight or obese and 1858(33.60%) women gained weight above recommended. Based on IADPSG criteria, more than one-third women with two, or three abnormal glucose values. Preconception overweight or obesity, above recommended gestational weight gain, and two or more abnormal items of oral glucose tolerance test parameters significantly increased the risk of adverse pregnancy outcomes, separately. After accounting for confounders, each two of overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters, the pairwise interactions on adverse pregnancy outcomes appear to be multiplicative. Coexistence of preconception overweight or obesity, above recommended gestational weight gain and two or more abnormal items of oral glucose tolerance test parameters increased the highest risk for adverse pregnancy outcomes. No additive interaction was found. Conclusions Pre-pregnancy overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters contribute to adverse pregnancy outcomes independently among women with gestational diabetes mellitus. Additionally, the combined effect between these three factors and adverse pregnancy outcomes appear to be multiplicative. Interventions focus on maternal overweight or obesity and gestational weight gain should be offered to improve pregnancy outcomes.
Collapse
Affiliation(s)
- Li-hua Lin
- Department of Healthcare, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Juan Lin
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jian-ying Yan
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Fuzhou, China
| |
Collapse
|
8
|
de Vries B. The "cascade of interventions": Does it really exist? Birth 2022; 49:171-172. [PMID: 34961955 DOI: 10.1111/birt.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Bradley de Vries
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
9
|
Blood Pressure Monitoring and Perinatal Outcomes in Normotensive Women with Gestational Diabetes Mellitus. J Clin Med 2022; 11:jcm11051435. [PMID: 35268526 PMCID: PMC8911501 DOI: 10.3390/jcm11051435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Alterations in ambulatory blood pressure detected by monitoring (ABPM) have been associated with perinatal complications in hypertensive pregnant women. Aim: To establish the relationships between the blood pressure (BP) profiles detected by ABPM and adverse perinatal outcomes in normotensive women with gestational diabetes mellitus (GDM). Methods: A prospective study of normotensive women in whom 24 h ABPM was performed at 28–32 weeks of pregnancy. The obstetric and perinatal outcomes were evaluated. Results: Two hundred patients were included. Thirty-seven women with GDM and obesity had significantly higher mean systolic BP (SBP) and nocturnal SBP and diastolic BP (DBP) compared to women with only GDM (n = 86). Nocturnal SBP (OR = 1.077; p = 0.015) and obesity (OR = 1.131; p = 0.035) were risk factors for the development of hypertensive disorders of pregnancy (HDPs). Mothers of newborns with neonatal complications (n = 27) had higher nocturnal SBP (103.8 vs. 100 mmHg; p = 0.047) and DBP (62.7 vs. 59.4; p = 0.016). Women who delivered preterm (n = 10) had higher BP and a non-dipper pattern (p = 0.005). Conclusions: Nocturnal SBP was a predictor of HDPs in normotensive women with obesity or GDM. Alterations in ABPM in these patients were associated with poor obstetric and perinatal outcomes.
Collapse
|
10
|
Song X, Shu J, Zhang S, Chen L, Diao J, Li J, Li Y, Wei J, Liu Y, Sun M, Wang T, Qin J. Pre-Pregnancy Body Mass Index and Risk of Macrosomia and Large for Gestational Age Births with Gestational Diabetes Mellitus as a Mediator: A Prospective Cohort Study in Central China. Nutrients 2022; 14:nu14051072. [PMID: 35268050 PMCID: PMC8912482 DOI: 10.3390/nu14051072] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
This study aimed to examine the risk of macrosomia and large for gestational age (LGA) births in relation to maternal pre-pregnancy body mass index (BMI) status mediated through gestational diabetes mellitus (GDM). This prospective study included 34,104 singleton pregnancies at 8–14 weeks of gestation. The interesting outcomes were macrosomia (≥4000 g) and LGA (≥90th percentile). Mediation analyses were conducted using log-binomial regression adjusted for age, education, parity, fetal sex, and gestational weight gain. The proportion mediated was estimated based on the risk difference scale, and the E-value was utilized to assess potential confounders. Overall, 15.9% of women had GDM, and there were 4.0% macrosomia and 9.9% LGA births. The proportion mediated by GDM on macrosomia was up to 40% among obese women, and the estimate of the total effect was 6.18 (95% CI: 5.26–7.26), of the natural direct effect was 4.10 (95% CI: 3.35–4.99), and of the natural indirect effect was 1.51 (95% CI: 1.31–1.76). Likewise, among overweight women, the proportion mediated by GDM on macrosomia was up to 40%. Furthermore, consistent findings were evident for the outcome of LGA births. Pre-pregnancy overweight/obesity increased the risk of macrosomia and LGA births independently and partly mediated by GDM.
Collapse
Affiliation(s)
- Xinli Song
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Jing Shu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Jingyi Diao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Jinqi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Yihuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Jianhui Wei
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Yiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Mengting Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
| | - Tingting Wang
- National Health Committee Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, 52 Xiangchun Road, Changsha 410028, China
- Correspondence: (T.W.); (J.Q.); Tel.: +86-15273188582 (T.W.); +86-15974269544 (J.Q.)
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (X.S.); (J.S.); (S.Z.); (L.C.); (J.D.); (J.L.); (Y.L.); (J.W.); (Y.L.); (M.S.)
- National Health Committee Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, 52 Xiangchun Road, Changsha 410028, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Second Road, Guangzhou 510080, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, 110 Xiangya Road, Changsha 410078, China
- Correspondence: (T.W.); (J.Q.); Tel.: +86-15273188582 (T.W.); +86-15974269544 (J.Q.)
| |
Collapse
|
11
|
de Vries BS, Morton R, Burton AE, Kumar P, Hyett JA, Phipps H, Mcgeechan K. Attributable factors for the rising cesarean delivery rate over three decades: an observational cohort study. Am J Obstet Gynecol MFM 2021; 4:100555. [PMID: 34971814 DOI: 10.1016/j.ajogmf.2021.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cesarean delivery rates continue to rise globally the reasons for which are incompletely understood. OBJECTIVES We aimed to characterize attributable factors for increasing cesarean delivery rates over a 30-year period within our health network. STUDY DESIGN This was a planned observational cohort study across two hospitals (a large tertiary referral hospital and a metropolitan hospital) in Sydney, Australia using data from a previously published study. Two time periods were compared: 1989-1999 and 2009-2016, between which the cesarean delivery rate increased from 19% to 30%. Participants were all women who had a cesarean delivery after 24 weeks gestational age. Data were analyzed using multiple imputation and robust Poisson regression to calculate differences in the adjusted and unadjusted relative risk of cesarean delivery and estimate the changes in the cesarean delivery rate attributable to maternal and clinical factors. The primary outcome was cesarean delivery. RESULTS After 576 exclusions, 102 589 births were included in the analysis. Fifty-six percent of the increase in the rate of cesarean delivery was attributed to changes in the distribution of maternal age, body mass index, parity and history of previous cesarean delivery. An additional 10% of the increase was attributed to changes in the obstetric management of the following high-risk pregnancies: multiple gestation, malpresentation (mainly breech) and preterm singleton birth. When pre-labor cesarean deliveries for maternal choice, suspected fetal compromise, previous pregnancy issues and suspected large fetus were excluded, 78% of the increase was attributed to either maternal factors or changes in the obstetric management of these high-risk pregnancies. CONCLUSIONS Most of the steep rise in the cesarean delivery rate from 19% to 30% was attributed to changes in maternal demographic and clinical factors. This observation is relevant to developing preventative strategies which account for nulliparity, age, body mass index, and the management of high-risk pregnancies. TWEETABLE ABSTRACT More than half of the increase in the rate of cesarean delivery is attributable to changes in maternal age, BMI, parity and history of cesarean delivery.
Collapse
Affiliation(s)
- Bradley S de Vries
- School of Public Health, University of Sydney, Sydney, Australia; Sydney Institute for Women, Children and their Families
| | - Rhett Morton
- Royal Prince Alfred Hospital, Women and Babies, Sydney, Australia; Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Alice E Burton
- Royal Prince Alfred Hospital, Women and Babies, Sydney, Australia
| | - Praneel Kumar
- Royal Prince Alfred Hospital, Women and Babies, Sydney, Australia
| | - Jon A Hyett
- Sydney Institute for Women, Children and their Families; Department of Obstetrics and Gynaecology, School of Medicine, Western Sydney University
| | - Hala Phipps
- Sydney Institute for Women, Children and their Families; University of Technology, Sydney
| | - Kevin Mcgeechan
- School of Public Health, University of Sydney, Sydney, Australia
| |
Collapse
|
12
|
Longitudinal Association of Maternal Pre-Pregnancy BMI and Third-Trimester Glycemia with Early Life Growth of Offspring: A Prospective Study among GDM-Negative Pregnant Women. Nutrients 2021; 13:nu13113971. [PMID: 34836226 PMCID: PMC8619788 DOI: 10.3390/nu13113971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/22/2023] Open
Abstract
Intrauterine modifiable maternal metabolic factors are essential to the early growth of offspring. The study sought to evaluate the associations of pre-pregnancy BMI and third-trimester fasting plasma glucose (FPG) with offspring growth outcomes within 24 months among GDM-negative pregnant women. Four hundred eighty-three mother –offspring dyads were included from the Shanghai Maternal-Child Pairs Cohort. The pregnant women were categorized into four mutually exclusive groups according to pre-pregnancy BMI as normal or overweight/obesity and third-trimester FPG as controlled or not controlled. Offspring growth in early life was indicated by the BAZ (BMI Z-score), catch-up growth, and overweight/obesity. Among those with controlled third-trimester FPG, pre-pregnancy overweight/obesity significantly increased offspring birth weight, BAZ, and risks of overweight/obesity (RR 1.83, 95% CI 1.23 to 2.73) within 24 months. Those who had uncontrolled third-trimester FPG had a reduced risk of offspring overweight/obesity within 24 months by 47%. The combination of pre-pregnancy overweight/obesity and maternal uncontrolled third-trimester FPG increased 5.24-fold risk of offspring catch-up growth within 24 months (p < 0.05). Maternal pre-pregnancy overweight/obesity and uncontrolled third-trimester glycemia among GDM-negative women both have adverse effects on offspring growth within 24 months. With the combination of increasing pre-pregnancy BMI and maternal third-trimester FPG, the possibility of offspring catch-up growth increases.
Collapse
|
13
|
Fonseca L, Saraiva M, Amado A, Paredes S, Pichel F, Pinto C, Vilaverde J, Dores J. Third trimester HbA1c and the association with large-for-gestational-age neonates in women with gestational diabetes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:328-335. [PMID: 33939909 PMCID: PMC10065336 DOI: 10.20945/2359-3997000000366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To evaluate the association between HbA1c levels measured in the third trimester and the risk for large for gestational age (LGA) in neonates of mothers affected by gestational diabetes mellitus (GDM). Secondarily, we aimed to identify an ideal cut-off for increased risk of LGA amongst pregnant women with GDM. Methods Observational retrospective review of singleton pregnant women with GDM evaluated in a diabetes and pregnancy clinic of a tertiary and academic hospital. From January/2011 to December/2017, 1,085 pregnant women underwent evaluation due to GDM, of which 665 had an HbA1c test in the third trimester. A logistic regression model was performed to evaluate predictors of LGA. A receiver-operating-characteristic (ROC) curve was used to evaluate the predictive ability of third trimester HbA1c for LGA identification. Results A total of 1,085 singleton pregnant women were evaluated during the study period, with a mean age of 32.9 ± 5.3 years. In the multivariate analysis, OGTT at 0 minutes (OR: 1.040; CI 95% 1.006-1.076, p = 0.022) and third trimester HbA1c (OR: 4.680; CI 95% 1.210-18.107, p = 0.025) were associated with LGA newborns. Using a ROC curve to evaluate the predictive ability of third trimester HbA1c for LGA identification, the optimal HbA1c cut-off point was 5.4% where the sensitivity was 77.4% and the specificity was 71.7% (AUC 0.782; p < 0.001). Conclusion Few studies in the Mediterranean population have evaluated the role of HbA1c in predicting neonatal complications in women with GDM. A third trimester HbA1c > 5.4% was found to have good sensitivity and specificity for identifying the risk of LGA.
Collapse
Affiliation(s)
- Liliana Fonseca
- Departamento de Endocrinologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal,
| | - Miguel Saraiva
- Departamento de Endocrinologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Ana Amado
- Departamento de Endocrinologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Sílvia Paredes
- Departamento de Endocrinologia, Hospital de Braga, Braga, Portugal
| | - Fernando Pichel
- Departamento de Nutrição, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Clara Pinto
- Departamento de Ginecologia e Obstetrícia, Centro Materno-Infantil do Norte, Porto, Portugal
| | - Joana Vilaverde
- Departamento de Endocrinologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Jorge Dores
- Departamento de Endocrinologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| |
Collapse
|
14
|
No impact of gestational diabetes mellitus on pregnancy complications in women with PCOS, regardless of GDM criteria used. PLoS One 2021; 16:e0254895. [PMID: 34297751 PMCID: PMC8301673 DOI: 10.1371/journal.pone.0254895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/04/2021] [Indexed: 12/04/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is characterized by the presence of insulin resistance, and women with PCOS have high prevalence of gestational diabetes (GDM). Both conditions have been associated with increased risk for pregnancy complications such as preterm birth, preeclampsia and increased offspring birth weight. We aimed to estimate the prevalence of GDM in women with PCOS using both previous and new diagnostic criteria, and to analyse whether the risk of pregnancy complications increased with the presence of GDM. In addition, we aimed to assess the response to metformin treatment in PCOS women with GDM. We performed post-hoc analysis of three prospective, double blinded studies of altogether 791 pregnant women with PCOS randomized to either metformin or placebo treatment from first trimester to delivery. Glucose data allowing GDM classification after previous (WHO 1999) and new (WHO 2013 and Norwegian 2017) diagnostic criteria were available for 722 of the women. Complications such as preeclampsia, late miscarriage and preterm birth, birth weight and gestational age were correlated to the presence of GDM and metformin treatment. The prevalence of GDM was 28.3% (WHO 1999), 41.2% (WHO 2013) and 27.2% (Norwegian 2017). Having GDM already in first trimester associated with increased risk for late miscarriage (p<0.01). Having GDM according to newer criteria correlated to increased maternal age and BMI (p<0.001). Otherwise, having GDM (any criteria) correlated neither to the development of preeclampsia, nor to birth weight z-score or the proportion of offspring being large for gestational weight. Maternal age and BMI, parity and gestational weight gain, but not GDM or metformin treatment, were determinants for birth weight z-score. Conclusion: in pregnant women with PCOS, having GDM did not increase the risk for other pregnancy complications except for an increased risk for late miscarriage among those with GDM already in the first trimester.
Collapse
|
15
|
Macrosomía fetal: factores de riesgo y resultados perinatales. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
16
|
Schneider AK, Leemaqz SY, Dalton J, Verburg PE, Mol BW, Dekker GA, Roberts CT, Grieger JA. The interaction between metabolic syndrome and physical activity, and risk for gestational diabetes mellitus. Acta Diabetol 2021; 58:939-947. [PMID: 33743081 DOI: 10.1007/s00592-021-01696-9] [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: 12/19/2020] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
AIMS Metabolic syndrome (MetS) is a cluster of risk factors which increases risk of cardiometabolic diseases in the adult population and increases risk for pregnancy complications such as gestational diabetes mellitus (GDM). Epidemiological data indicate that moderate-to-high levels of physical activity reduces the risk for GDM. The study aims to determine whether the association between MetS and GDM is affected by physical activity. METHODS We performed a prospective cohort study among 1373 pregnant nulliparous women in Adelaide, South Australia. At 9-16 weeks' gestation, demographic, lifestyle and self-reported frequencies of physical activity were obtained, and a non-fasting blood sample was taken for assessment of MetS, defined using the International Diabetes Federation criteria. GDM was diagnosed at 24-28 weeks' gestation using the World Health Organization classification. RESULTS 1158 pregnant women were included: 107 (9%) women had MetS in early pregnancy, and 184 (16%) developed GDM. Having MetS increased the risk of developing GDM (37.4% vs. 13.7%, adjusted RR 2.5; 95% CI 1.7, 3.6). The interaction effect (RR; (95% CI) between MetS and physical activity was not significant (vigorous physical activity: 2.60; 0.46, 14.71) for ≥ 4 times per week; less vigorous activity; 0.77; 0.15, 4.02 for ≥ 4 times per week; stair climbing ≥ once day (1.16; 0.54, 2.51), all compared to no physical activity). CONCLUSIONS Physical activity was not an effect modifier in the association between GDM and MetS. Information collected about the nature and extent of physical activity needs to be more detailed and granular to determine whether physical activity really has an effect.
Collapse
Affiliation(s)
- Ashleigh K Schneider
- Robinson Research Institute, University of Adelaide, North Adelaide, 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, 5005, Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, University of Adelaide, North Adelaide, 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, 5005, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, Australia
| | - Julia Dalton
- Robinson Research Institute, University of Adelaide, North Adelaide, 5005, Australia
- Women and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, 5112, Australia
| | - Petra E Verburg
- Robinson Research Institute, University of Adelaide, North Adelaide, 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, 5005, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, 3168, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - Gus A Dekker
- Robinson Research Institute, University of Adelaide, North Adelaide, 5005, Australia
- Women and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, 5112, Australia
| | - Claire T Roberts
- Robinson Research Institute, University of Adelaide, North Adelaide, 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, 5005, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, Australia
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, North Adelaide, 5005, Australia.
- Adelaide Medical School, University of Adelaide, Adelaide, 5005, Australia.
| |
Collapse
|
17
|
Xu Q, Zhou Q, Yang Y, Liu F, Wang L, Wang Q, Shen H, Xu Z, Zhang Y, Yan D, Peng Z, He Y, Wang Y, Zhang Y, Zhang H, Ma X, Li X. Maternal Pre-conception Body Mass Index and Fasting Plasma Glucose With the Risk of Pre-term Birth: A Cohort Study Including 4.9 Million Chinese Women. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:622346. [PMID: 36304061 PMCID: PMC9580732 DOI: 10.3389/frph.2021.622346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background: To evaluate the associations of pre-conception body mass index (BMI), fasting plasma glucose (FPG) alone and their combination with pre-term birth (PTB) risk. Methods: We conducted a population-based retrospective cohort study with 4,987,129 reproductive-aged women, who participated in National Free Pre-Pregnancy Checkups Project in 2013–2016 and had a singleton delivery before December 2017 in China. All data analyses were conducted in 2018–2021. Results: A total of 339,662 (6.81%) women had pre-term deliveries. Compared with women with normal weight and normal glucose, underweight and normal weight were associated with PTB among hypoglycemia women, the adjusted odd ratios (aORs) were 1.24 (95% CI: 1.05–1.48) and 1.16 (95% CI: 1.07–1.25), respectively; underweight, overweight and obesity were associated with PTB among women with normal glucose, the aORs were 1.09 (95% CI: 1.08–1.10), 1.06 (95% CI: 1.05–1.07) and 1.08 (95% CI: 1.05–1.12), respectively; all the BMI groups were significantly associated with PTB among women with pre-diabetes or diabetes (P < 0.05). The dose-response relationships of BMI with PTB varied in different FPG level, with U-shaped curve in normal glucose and pre-diabetes women, J-shaped in diabetes women, L-shaped in hypoglycemia women. For FPG with PTB, the dose-response relationships were U-shaped in normal weight, overweight, and obesity women, and L-shaped in underweight women. Conclusion: We found that the associations of PTB with BMI varied with levels of FPG, and associations of PTB with FPG varied with levels of BMI. There was a synergistic effect on PTB risk due to abnormal weight and glycemia besides a conventional main effect derived from either of them. Achieving desirable weight and glucose control before conception should be advised.
Collapse
Affiliation(s)
- Qin Xu
- National Research Institute for Health and Family Planning, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Qiongjie Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Ying Yang
- National Research Institute for Health and Family Planning, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
- China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China
- *Correspondence: Ying Yang
| | - Fangchao Liu
- Department of Epidemiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Long Wang
- National Research Institute for Health and Family Planning, Beijing, China
- School of Public Health, Institute of Epidemiology and Statistics, Lanzhou University, Lanzhou, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Zongyu Xu
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Health and Family Planning, Beijing, China
- China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China
| | - Yuan He
- National Research Institute for Health and Family Planning, Beijing, China
- China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Health and Family Planning, Beijing, China
- China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China
| | - Ya Zhang
- National Research Institute for Health and Family Planning, Beijing, China
- China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Health and Family Planning, Beijing, China
- China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China
| | - Xu Ma
- National Research Institute for Health and Family Planning, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
- China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China
- Xu Ma
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
- Institute of Biomedical Sciences, Fudan University, Shanghai, China
- Xiaotian Li
| |
Collapse
|
18
|
Alfadhli EM. Maternal obesity influences Birth Weight more than gestational Diabetes author. BMC Pregnancy Childbirth 2021; 21:111. [PMID: 33549038 PMCID: PMC7866872 DOI: 10.1186/s12884-021-03571-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Maternal obesity and gestational diabetes (GDM) are commonly encountered during pregnancy. Both conditions are independently associated with unfavorable pregnancy consequences. The objective of this study was to compare the effects of obesity and GDM on birth weight, macrosomia, and other adverse pregnancy outcomes. METHODS This cohort study involved 531 women with a singleton pregnancy attending the Maternity and Children's Hospital, Medina, Saudi Arabia, between June 2014 and June 2015. Participants underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. The International Association of Diabetes and Pregnancy Study Groups criteria were used for GDM diagnosis. BMI was assessed at the first antenatal visit, and obesity was defined as a BMI ≥30.0 kg/m2. All women were followed up until delivery. Women were divided into 4 groups: non-GDM nonobese (reference group), GDM nonobese, obese non-GDM, and obese GDM. Clinical characteristics and adverse pregnancy outcomes were compared. RESULTS The mean age and BMI of the participants were 30.5 years and 29.3 kg/m2, respectively. GDM was diagnosed in 50.2% of the participants, and obesity was diagnosed in 47.8% of the participants. Obese women with GDM were the oldest and heaviest among all women. The mean birth weight increased in order among the four groups; it was highest in the infants in the obese GDM group, followed by those in the obese non-GDM, GDM nonobese and reference groups. Obesity and GDM alone or in combination were associated with higher rates of macrosomia and cesarean deliveries than the reference group. Neonatal intensive care unit (NICU) admission was higher in infants in the GDM nonobese and obese GDM groups. The frequency of low Apgar score was significantly higher in infants in the obese GDM group than in infants in the reference group. CONCLUSIONS Maternal obesity seems to influence birth weight more than GDM, while GDM is associated with a greater risk of admission to the NICU. The combination of both conditions is associated with the greatest risk of adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Eman M Alfadhli
- Medicine department, Taibah University Medical College, PO Box 344, Girls section. Universities Road, T 0966555305170, Medina, Saudi Arabia.
| |
Collapse
|
19
|
Li MF, Ke JF, Ma L, Wang JW, Zhang ZH, Li JB, Li LX. Maternal Pre-Pregnancy Obesity Combined With Abnormal Glucose Metabolism Further Increases Adverse Pregnancy Outcomes in Chinese Pregnant Women. Front Endocrinol (Lausanne) 2021; 12:754406. [PMID: 35095754 PMCID: PMC8793842 DOI: 10.3389/fendo.2021.754406] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Our aim was to evaluate the separate and combined effects of maternal pre-pregnancy obesity and gestational abnormal glucose metabolism (GAGM) on adverse perinatal outcomes. METHODS A total of 2,796 Chinese pregnant women with singleton delivery were studied, including 257 women with pre-pregnancy obesity alone, 604 with GAGM alone, 190 with both two conditions, and 1,745 with neither pre-pregnancy obesity nor GAGM as control group. The prevalence and risks of adverse pregnancy outcomes were compared among the four groups. RESULTS Compared with the normal group, pregnant women with maternal pre-pregnancy obesity alone, GAGM alone, and both two conditions faced significantly increased risks of pregnancy-induced hypertension (PIH) (odds ratio (OR) 4.045, [95% confidence interval (CI) 2.286-7.156]; 1.993 [1.171-3.393]; 8.495 [4.982-14.485]), preeclampsia (2.649 [1.224-5.735]; 2.129 [1.128-4.017]; 4.643 [2.217-9.727]), cesarean delivery (1.589 [1.212-2.083]; 1.328 [1.095-1.611]; 2.627 [1.908-3.617]), preterm delivery (1.899 [1.205-2.993]; 1.358 [0.937-1.968]; 2.301 [1.423-3.720]), macrosomia (2.449 [1.517-3.954]; 1.966 [1.356-2.851]; 4.576 [2.895-7.233]), and total adverse maternal outcomes (1.762 [1.331-2.332]; 1.365 [1.122-1.659]; 3.228 [2.272-4.587]) and neonatal outcomes (1.951 [1.361-2.798]; 1.547 [1.170-2.046]; 3.557 [2.471-5.122]). Most importantly, there were no obvious risk differences in adverse pregnancy outcomes between maternal pre-pregnancy obesity and GAGM group except PIH, but pregnant women with both obesity and GAGM exhibited dramatically higher risks of adverse pregnancy outcomes than those with each condition alone. CONCLUSIONS Maternal pre-pregnancy obesity and GAGM were independently associated with increased risks of adverse pregnancy outcomes. The combination of pre-pregnancy obesity and GAGM further worsens adverse pregnancy outcomes compared with each condition alone.
Collapse
Affiliation(s)
- Mei-Fang Li
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiang-Feng Ke
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Li Ma
- Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun-Wei Wang
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Zhi-Hui Zhang
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Jing-Bo Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lian-Xi Li
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| |
Collapse
|
20
|
Grieger JA, Hutchesson MJ, Cooray SD, Bahri Khomami M, Zaman S, Segan L, Teede H, Moran LJ. A review of maternal overweight and obesity and its impact on cardiometabolic outcomes during pregnancy and postpartum. Ther Adv Reprod Health 2021; 15:2633494120986544. [PMID: 33615227 PMCID: PMC7871058 DOI: 10.1177/2633494120986544] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
The rates of maternal overweight and obesity, but also excess gestational weight gain, are increasing. Pregnancy complications, including gestational diabetes mellitus, gestational hypertension, pre-eclampsia and delivery of a preterm or growth restricted baby, are higher for both women with overweight and obesity and women who gain excess weight during their pregnancy. Other conditions such as polycystic ovary syndrome are also strongly linked to overweight and obesity and worsened pregnancy complications. All of these conditions place women at increased risk for future cardiometabolic diseases. If overweight and obesity, but also excess gestational weight gain, can be reduced in women of reproductive age, then multiple comorbidities associated with pregnancy complications may also be reduced in the years after childbirth. This narrative review highlights the association between maternal overweight and obesity and gestational weight gain, with gestational diabetes, pre-eclampsia, polycystic ovary syndrome and delivery of a preterm or growth restricted baby. This review also addresses how these adverse conditions are linked to cardiometabolic diseases after birth. We report that while the independent associations between obesity and gestational weight gain are evident across many of the adverse conditions assessed, whether body mass index or gestational weight gain is a stronger driving factor for many of these is currently unclear. Mechanisms linking gestational diabetes mellitus, gestational hypertension, pre-eclampsia, preterm delivery and polycystic ovary syndrome to heightened risk for cardiometabolic diseases are multifactorial but relate to cardiovascular and inflammatory pathways that are also found in overweight and obesity. The need for post-partum cardiovascular risk assessment and follow-up care remains overlooked. Such early detection and intervention for women with pregnancy-related complications will significantly attenuate risk for cardiovascular disease.
Collapse
Affiliation(s)
- Jessica A. Grieger
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Melinda J. Hutchesson
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Shamil D. Cooray
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Diabetes Unit, Monash Health, Melbourne, VIC, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, AustraliaSchool of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Louise Segan
- Department of Cardiology, Alfred Health, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Diabetes Unit, Monash Health, Melbourne, VIC, Australia
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia. Robinson Research Institute, The University of Adelaide, Adelaide 5000, SA, Australia
| |
Collapse
|
21
|
Wang CC, Tung YT, Chang HC, Lin CH, Chen YC. Effect of Probiotic Supplementation on Newborn Birth Weight for Mother with Gestational Diabetes Mellitus or Overweight/Obesity: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12113477. [PMID: 33198366 PMCID: PMC7696869 DOI: 10.3390/nu12113477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
High birth weight indicates the future risk of obesity and increased fat mass in childhood. Maternal gestational diabetes mellitus (GDM) or overweight are powerful predictors of high birth weight. Studies on probiotic supplementation during pregnancy have reported its benefits in modulating gut microbiota composition and improving glucose and lipid metabolism in pregnant women. Therefore, probiotic intervention during pregnancy was proposed to interrupt the transmission of obesity from mothers to newborns. Thus, we performed a meta-analysis to investigate the effect of probiotic intervention in pregnant women with GDM or overweight on newborn birth weight. We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases up to 18 December 2019. Randomized controlled trials (RCTs) comparing pregnant women with GDM or overweight who received probiotic intervention during pregnancy with those receiving placebo were eligible for the analysis. Newborn birth weights were pooled to calculate the mean difference with a 95% confidence interval (CI). Two reviewers assessed the trial quality and extracted data independently. Seven RCTs involving 1093 participants were included in the analysis. Compared with the placebo, probiotics had little effect on newborn birth weight of pregnant women with GDM or overweight (mean difference = -10.27, 95% CI = -90.17 to 69.63, p = 0.801). The subgroup analysis revealed that probiotic intake by women with GDM decreased newborn birth weight, whereas probiotic intake by obese pregnant women increased newborn birth weight. Thus, no evidence indicates that probiotic intake by pregnant women with GDM or overweight can control newborn birth weight.
Collapse
Affiliation(s)
- Chun-Chi Wang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei City 110, Taiwan; (C.-C.W.); (C.-H.L.)
| | - Yu-Tang Tung
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei City 110, Taiwan;
- Nutrition Research Center, Taipei Medical University Hospital, Taipei City 110, Taiwan
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei City, 110, Taiwan
| | - Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei City 110, Taiwan;
| | - Chang-Hsien Lin
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei City 110, Taiwan; (C.-C.W.); (C.-H.L.)
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei City 110, Taiwan; (C.-C.W.); (C.-H.L.)
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei City 110, Taiwan;
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei City 110, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Correspondence: ; Tel.: +886-2-2737-2181 (ext. 3032); Fax: +886-2-2738-9804
| |
Collapse
|
22
|
Xie X, Liu J, Pujol I, López A, Martínez MJ, García-Patterson A, Adelantado JM, Ginovart G, Corcoy R. Inadequate Weight Gain According to the Institute of Medicine 2009 Guidelines in Women with Gestational Diabetes: Frequency, Clinical Predictors, and the Association with Pregnancy Outcomes. J Clin Med 2020; 9:jcm9103343. [PMID: 33080994 PMCID: PMC7603144 DOI: 10.3390/jcm9103343] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Background: In the care of women with gestational diabetes mellitus (GDM), more attention is put on glycemic control than in factors such as gestational weight gain (GWG). We aimed to evaluate the rate of inadequate GWG in women with GDM, its clinical predictors and the association with pregnancy outcomes. Methods: Cohort retrospective analysis. Outcome variables: GWG according to Institute of Medicine 2009 and 18 pregnancy outcomes. Clinical characteristics were considered both as GWG predictors and as covariates in outcome prediction. Statistics: descriptive, multinomial and logistic regression. Results: We assessed 2842 women diagnosed with GDM in the 1985–2011 period. GWG was insufficient (iGWG) in 50.3%, adequate in 31.6% and excessive (eGWG) in 18.1%; length of follow-up for GDM was positively associated with iGWG. Overall pregnancy outcomes were satisfactory. GWG was associated with pregnancy-induced hypertension, preeclampsia, cesarean delivery and birthweight-related outcomes. Essentially, the direction of the association was towards a higher risk with eGWG and lower risk with iGWG (i.e., with Cesarean delivery and excessive growth). Conclusions: In this cohort of women with GDM, inadequate GWG was very common at the expense of iGWG. The associations with pregnancy outcomes were mainly towards a higher risk with eGWG and lower risk with iGWG.
Collapse
Affiliation(s)
- Xinglei Xie
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain; (X.X.); (J.L.)
| | - Jiaming Liu
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain; (X.X.); (J.L.)
| | - Isabel Pujol
- Servei d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (I.P.); (A.L.); (M.J.M.)
| | - Alicia López
- Servei d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (I.P.); (A.L.); (M.J.M.)
| | - María José Martínez
- Servei d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (I.P.); (A.L.); (M.J.M.)
| | | | - Juan M. Adelantado
- Servei de Ginecologia i Obstetricia, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Gemma Ginovart
- Servei de Pediatria, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Rosa Corcoy
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain; (X.X.); (J.L.)
- Servei d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (I.P.); (A.L.); (M.J.M.)
- Institut de Recerca, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- CIBER-BBN, 28029 Madrid, Spain
- Correspondence: ; Tel.: +349-3556-5661
| |
Collapse
|
23
|
Cremona A, Saunders J, Cotter A, Hamilton J, Donnelly AE, O'Gorman CS. Maternal obesity and degree of glucose intolerance on neonatal hypoglycaemia and birth weight: a retrospective observational cohort study in women with gestational diabetes mellitus. Eur J Pediatr 2020; 179:653-660. [PMID: 31873801 DOI: 10.1007/s00431-019-03554-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is an increasing problem worldwide. Postnatal hypoglycaemia and excess foetal growth are known important metabolic complications of neonates born to women with diabetes. This retrospective cohort study aims to determine the influence of obesity and glucose intolerance on neonatal hypoglycaemia and birth weight over the 90th percentile (LGA). Data were abstracted from 303 patient medical records from singleton pregnancies diagnosed with GDM. Data were recorded during routine hospital visits. Demographic data were acquired by facilitated questionnaires and anthropometrics measured at the first antenatal appointment. Blood biochemical indices were recorded. Plasma glucose area under the curve (PG-AUC) was calculated from OGTT results as an index of glucose intolerance. OGTT results of 303 pregnant women aged between 33.6 years (29.8-37.7) diagnosed with GDM were described. Neonates of mothers with a BMI of over 30 kg/m2 were more likely to experience neonatal hypoglycaemia (24 (9.2%) vs. 23 (8.8%), p = 0.016) with odds ratio for neonatal hypoglycaemia significantly higher at 2.105, 95% CI (1.108, 4.00), p = 0.023. ROC analysis showed poor strength of association (0.587 (95% CI, .487 to .687). Neonatal LGA was neither associated with or predicted by PG-AUC nor obesity; however, multiparous women were 2.8 (95% CI (1.14, 6.78), p = 0.024) times more likely to have a baby born LGA.Conclusion: Maternal obesity but not degree of glucose intolerance increased occurrence of neonatal hypoglycaemia. Multiparous women had greater risk of neonates born LGA.What is Known:•Excess foetal growth in utero has long-term metabolic implications which track into adulthood.•Neonatal hypoglycaemia is detrimental to newborns in the acute phase with potential long-term implications on the central nervous system.What is New:•Maternal obesity but not degree of glucose intolerance in a GDM cohort increased occurrence of neonatal hypoglycaemia.•Multiparous women diagnosed had greater risk of neonates born LGA.
Collapse
Affiliation(s)
- Alexandra Cremona
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland. .,School of Allied Health, University of Limerick, Limerick, Ireland. .,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland. .,Institute of Nutrition & Dietetics (INDI), Dublin, Ireland. .,Physical Education and Sports Science (PESS), University of Limerick, Limerick, Ireland.
| | - Jean Saunders
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Statistics Consulting Unit (SCU/CSTAR @ UL), University of Limerick, Limerick, Ireland
| | - Amanda Cotter
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Jill Hamilton
- The Division of Endocrinology, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Alan E Donnelly
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,Physical Education and Sports Science (PESS), University of Limerick, Limerick, Ireland
| | - Clodagh S O'Gorman
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,Department of Paediatrics, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
24
|
Hidayat K, Zou SY, Shi BM. The influence of maternal body mass index, maternal diabetes mellitus, and maternal smoking during pregnancy on the risk of childhood-onset type 1 diabetes mellitus in the offspring: Systematic review and meta-analysis of observational studies. Obes Rev 2019; 20:1106-1120. [PMID: 31090253 DOI: 10.1111/obr.12858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/07/2019] [Accepted: 03/07/2019] [Indexed: 12/12/2022]
Abstract
There is emerging evidence that events occurring before and shortly after birth may be important in determining the risk of childhood-onset type 1 diabetes mellitus (T1DM). We aimed to summarize and synthesize the associations between maternal body mass index (BMI), maternal diabetes mellitus (DM), and maternal smoking during pregnancy and the risk of childhood-onset T1DM in the offspring by performing a systematic review and meta-analysis of observational studies. A random effects model was used to generate the summary risk estimates. The PubMed and Web of Science databases were searched to identify relevant observational studies. Twenty one observational studies were included in the present meta-analysis. Compared with offspring of mothers with normal weight, offspring of women with overweight or obesity were at an increased risk of developing childhood-onset T1DM (overweight: relative risk [RR] 1.09, 95% confidence interval [CI], 1.03-1.15; obesity: RR 1.25, 95% CI, 1.16-1.34; per 5 kg m-2 increase in BMI: RR 1.10, 95% CI, 1.06-1.13). No association was found for maternal underweight (RR 0.92, 95% CI, 0.75-1.13). Maternal DM was associated with an increased risk of childhood-onset T1DM (RR 3.26, 95% CI, 2.84-3.74). Regarding the type of maternal DM, the greatest risk of T1DM in the offspring appeared to be conferred by maternal T1DM (RR 4.46, 95% CI, 2.89-6.89), followed by maternal gestational diabetes mellitus (RR 1.66, 95% CI, 1.16-2.36), and lastly by maternal type 2 diabetes mellitus (RR 1.11, 95% CI, 0.69-1.80). Additional analysis of studies comparing maternal versus paternal T1DM within the same population revealed that offspring of fathers with T1DM had a 1.5 times higher risk of developing childhood-onset T1DM than offspring of mothers with T1DM (RR 9.58, 95% CI, 6.33-14.48 vs. RR 6.24, 95% CI, 5.52-7.07). Furthermore, a reduced risk of childhood-onset T1DM was observed in infants born to mothers who smoked during pregnancy compared with infants born to mothers who did not smoke during pregnancy (RR 0.79, 95% CI, 0.71-0.87). In summary, our findings add further evidence that early-life events or environmental factors may play a role in modulating infants' risk of developing T1DM later in life.
Collapse
Affiliation(s)
- Khemayanto Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng-Yi Zou
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bi-Min Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
25
|
Aubry EM, Oelhafen S, Fankhauser N, Raio L, Cignacco EL. Adverse perinatal outcomes for obese women are influenced by the presence of comorbid diabetes and hypertensive disorders. Sci Rep 2019; 9:9793. [PMID: 31278325 PMCID: PMC6611811 DOI: 10.1038/s41598-019-46179-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 06/20/2019] [Indexed: 01/20/2023] Open
Abstract
Maternal obesity often occurs together with comorbid diabetes and hypertensive disorders. All three conditions are independently associated with negative perinatal outcomes. Our objective was to determine the risk and burden of adverse perinatal outcome that could be attributed to maternal obesity in combination with a comorbid status. We analyzed data from 324'664 singleton deliveries in Switzerland between 2005 and 2016. For the association of maternal obesity in the presence or absence of comorbidities with various perinatal outcomes, we estimated adjusted relative risk (RR) using multivariable regression modeling and determined the multivariable-adjusted attributable fraction of the population (AFp). Obesity was a main predictor for macrosomia, fracture of the clavicle, failure to progress in labor and prolonged labor. By stratifying women based on comorbidities, we identified significantly increased risk for preterm birth and early neonatal death only for women diagnosed with a comorbidity. However, various other outcomes were independently associated with either obesity or comorbidities. The AFp showed greatest reduction in comorbidities (15.4/15.0/13.2%), in macrosomia (6.3%) and in shoulder dystocia (4.8%) if all women were to become non-obese. We suggest that comorbidities such as diabetes and hypertensive disorders should be considered when relating maternal obesity to adverse perinatal outcomes.
Collapse
Affiliation(s)
- Evelyne M Aubry
- Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Stephan Oelhafen
- Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Niklaus Fankhauser
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, CH-3012, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology. Inselspital, University of Bern, Bern, Switzerland
| | - Eva L Cignacco
- Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| |
Collapse
|
26
|
Lv Y, Tian W, Chen D, Liu Y, Wang L, Duan F. The prevalence and associated factors of symptomatic cervical Spondylosis in Chinese adults: a community-based cross-sectional study. BMC Musculoskelet Disord 2018; 19:325. [PMID: 30205836 PMCID: PMC6134586 DOI: 10.1186/s12891-018-2234-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cervical spondylosis adversely affects life quality for its heavy disease burden. The report on the community-based prevalence and associated factors of cervical spondylosis is rare, especially in Chinese population. Whether prevention is needed and how to prevent it is not clear. This study aims to explore its prevalence and related lifestyle factors and provide evidence on prevention of cervical spondylosis. METHODS A community-based multistage cross-sectional survey of six communities from the Chinese population was conducted. A face-to-face interview was conducted to obtain individual information, and prevalence was calculated. Single-factor analysis and multivariable logistic regressions were used to explore the associated factors in total and subgroup populations. RESULTS A total of 3859 adults were analyzed. The prevalence of cervical spondylosis was 13.76%, although it differed significantly among the urban, suburban, and rural populations (13.07%, 15.97%, and 12.25%, respectively). Moreover, it was higher in females than in males (16.51% vs 10.49%). The prevalence among different age groups had an inverted U shape. The highest prevalence was in the age group from 45 to 60 years old. The associated factors differed by subgroups. There were positive associations between engaging in mental work, high housework intensity, and sleep duration of less than 7 h/day with cervical spondylosis. Going to work on foot was a negative factor of cervical spondylosis in the total population. For people aged less than 30 years, keeping the same work posture for 1-2.9 h/day was a special related factor. Exposure to vibration was an associated factor for females aged 45-60 years. Menopause was a special related factor for women. CONCLUSIONS Prevalence of cervical spondylosis was high in Chinese population. People younger than 60 years were the focus of prevention for cervical spondylosis. Moreover, the characters between male and female and among different age groups were different and required targeted interventions.
Collapse
Affiliation(s)
- Yanwei Lv
- Department of Epidemiology and Biostatistics, Public Health College, Peking University, 38# Xueyuan Road, Haidian district, Beijing, 100191, China.,Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, 31# Xinjiekou Dongjie, West district, Beijing, 100035, China.,Department of Spine, Beijing Jishuitan Hospital, 31# Xinjiekou Dongjie, West district, Beijing, 100035, China
| | - Wei Tian
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, 31# Xinjiekou Dongjie, West district, Beijing, 100035, China. .,Department of Spine, Beijing Jishuitan Hospital, 31# Xinjiekou Dongjie, West district, Beijing, 100035, China.
| | - Dafang Chen
- Department of Epidemiology and Biostatistics, Public Health College, Peking University, 38# Xueyuan Road, Haidian district, Beijing, 100191, China.
| | - Yajun Liu
- Department of Spine, Beijing Jishuitan Hospital, 31# Xinjiekou Dongjie, West district, Beijing, 100035, China
| | - Lifang Wang
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, 31# Xinjiekou Dongjie, West district, Beijing, 100035, China
| | - Fangfang Duan
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, 31# Xinjiekou Dongjie, West district, Beijing, 100035, China
| |
Collapse
|
27
|
Joint impact of gestational diabetes and obesity on perinatal outcomes. J Gynecol Obstet Hum Reprod 2018; 47:469-476. [PMID: 30153508 DOI: 10.1016/j.jogoh.2018.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/20/2018] [Accepted: 08/20/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Gestational diabetes and obesity are independent risk factors for obstetric and neonatal complications. The purpose of our study was to evaluate the impact of their association on pregnancy outcomes. MATERIAL AND METHODS Monocentric retrospective cohort study including patients with obesity and gestational diabetes (GDM), those with GD without obesity, and those with obesity without GDM, who gave birth between 01 January 2012 and 31 December 2014, and whose GDM was exclusively monitored at our centre. The diagnostic criteria and management modalities of GDM were based on the 2010 CNGOF (Collège National des Gynécologues et Obstétriciens Français [French national college of obstetricians and gynaecologists]) Clinical Practice Recommendations. Obesity was defined as having a body mass index ≥30 Kg/m2. RESULTS A total of 1,484 patients were included, 259 with GDM and obesity, 549 with GDM without obesity, 676 with obesity without GDM. In the GDM + obesity group, GDM was treated earlier and was more uncontrolled and more often treated with insulin in relation to non-obese women with GDM. These patients also presented a higher risk of caesarean section (OR 2.92, CI 95% 2.04-4.16, P<0.001), preeclampsia (OR 4.62, CI 95% 1.31-16.32, P=0.017), maternal morbidity (OR 2.05, CI 95% 1.37-3.04, P<0.001) and large foetus for gestational age (OR 1.91, CI 95% 1.26-2.88, P=0.002). Obesity alone was a risk factor in its own right for preeclampsia (OR 7.32, CI 95% 2.50-21.45, P<0.001) and macrosomia (OR 3.55, IC 95% 2.24-5.62, P<0.001), compared to non-obese patients with GDM. Uncontrolled GDM was associated independently of obesity with the risk of induced labour and large foetus for gestational age. CONCLUSION Obesity on its own is a risk factor for obstetric complications and its association with GDM strongly impacts on pregnancy outcomes.
Collapse
|
28
|
Patel A, Prakash AA, Das PK, Gupta S, Pusdekar YV, Hibberd PL. Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India. BMJ Open 2018; 8:e021623. [PMID: 30093518 PMCID: PMC6089300 DOI: 10.1136/bmjopen-2018-021623] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To study the trend in the prevalence of anaemia and low BMI among pregnant women from Eastern Maharashtra and evaluate if low BMI and anaemia affect pregnancy outcomes. DESIGN Prospective observational cohort study. SETTING Catchment areas of 20 rural primary health centres in four eastern districts of Maharashtra State, India. PARTICIPANTS 72 750 women from the Nagpur site of Maternal and Newborn Health Registry of NIH's Global Network, enrolled from 2009 to 2016. MAIN OUTCOME MEASURES Mode of delivery, pregnancy related complications at delivery, stillbirths, neonatal deaths and low birth weight (LBW) in babies. RESULTS Over 90% of the women included in the study were anaemic and over a third were underweight (BMI <18 kg/m2) and with both conditions. Mild anaemia at any time during delivery significantly increased the risk (Risk ratio; 95% confidence interval (RR;(95% CI)) of stillbirth (1.3 (1.1-1.6)), neonatal deaths (1.3 (1-1.6)) and LBW babies (1.1 (1-1.2)). The risks became even more significant and increased further with moderate/severe anaemia any time during pregnancy for stillbirth (1.4 (1.2-1.8)), neonatal deaths (1.7 (1.3-2.1)) and LBW babies (1.3 (1.2-1.4)).,. Underweight at anytime during pregnancy increased the risk of neonatal deaths (1.1 (1-1.3)) and LBW babies (1.2;(1.2-1.3)).The risk of having stillbirths (1.5;(1.2-1.8)), neonatal deaths (1.7;(1.3-2.3)) and LBW babies (1.5;(1.4-1.6)) was highest when - the anaemia and underweight co-existed in the included women. Obesity/overweight during pregnancy increased the risk of maternal complications at delivery (1.6;(1.5-1.7)) and of caesarean section (1.5;(1.4-1.6)) and reduced the risk of LBW babies 0.8 (0.8-0.9)). CONCLUSION Maternal anaemia is associated with enhanced risk of stillbirth, neonatal deaths and LBW. The risks increased if anaemia and underweight were present simultaneously. TRIAL REGISTRATION NUMBER NCT01073475.
Collapse
Affiliation(s)
- Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | | | - Swarnim Gupta
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | - Patricia L Hibberd
- Boston University School of Public Health and Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
29
|
Cortés-Vásquez J, Noreña I, Mockus I. Hypertriglyceridemia and adverse outcomes during pregnancy. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n2.60791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introducción. Durante el embarazo, los niveles séricos de triglicéridos maternos aumentan como un mecanismo de adaptación fisiológica para suplir las necesidades del feto en desarrollo. Pese a que el incremento excesivo se ha asociado a preeclampsia, macrosomía y parto pretérmino, no se han establecido de manera contundente los niveles a partir de los cuales se deben tomar medidas en cada trimestre para prevenir complicaciones.Objetivo. Hacer una revisión sobre fisiopatología, efectos en madre e hijo, valores esperados en cada trimestre e intervenciones terapéuticas en hipertrigliceridemia gestacional.Materiales y métodos. Se realizó una revisión con la búsqueda de artículos en las bases de datos ScienceDirect, PubMed, Scopus, LILACS, Cochrane y SciELO con los términos: Pregnancy; Hypertriglyceridemia; Maternal-Fetal Exchange; Fetal Development; Pregnancy Complications y sus equivalentes en español.Resultados. Se encontraron 59 artículos que cumplieron los criterios de búsqueda y daban respuesta a los objetivos.Conclusiones. El número limitado y la gran variabilidad de los datos indican la necesidad de realizar más investigaciones que establezcan los rangos de normalidad de los triglicéridos durante los tres trimestres del embarazo y así determinar riesgos e intervenciones eficaces antes de la gestación y reducir la morbimortalidad materno-infantil.
Collapse
|
30
|
Egan AM, Vellinga A, Harreiter J, Simmons D, Desoye G, Corcoy R, Adelantado JM, Devlieger R, Van Assche A, Galjaard S, Damm P, Mathiesen ER, Jensen DM, Andersen L, Lapolla A, Dalfrà MG, Bertolotto A, Mantaj U, Wender-Ozegowska E, Zawiejska A, Hill D, Jelsma JGM, Snoek FJ, Worda C, Bancher-Todesca D, van Poppel MNM, Kautzky-Willer A, Dunne FP. Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe. Diabetologia 2017; 60:1913-1921. [PMID: 28702810 PMCID: PMC6448875 DOI: 10.1007/s00125-017-4353-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/26/2017] [Indexed: 12/03/2022]
Abstract
AIMS/HYPOTHESIS Accurate prevalence estimates for gestational diabetes mellitus (GDM) among pregnant women in Europe are lacking owing to the use of a multitude of diagnostic criteria and screening strategies in both high-risk women and the general pregnant population. Our aims were to report important risk factors for GDM development and calculate the prevalence of GDM in a cohort of women with BMI ≥29 kg/m2 across 11 centres in Europe using the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)/WHO 2013 diagnostic criteria. METHODS Pregnant women (n = 1023, 86.3% European ethnicity) with a BMI ≥29.0 kg/m2 enrolled into the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) pilot, lifestyle and vitamin D studies of this pan-European multicentre trial, attended for an OGTT during pregnancy. Demographic, anthropometric and metabolic data were collected at enrolment and throughout pregnancy. GDM was diagnosed using IADPSG/WHO 2013 criteria. GDM treatment followed local policies. RESULTS The number of women recruited per country ranged from 80 to 217, and the dropout rate was 7.1%. Overall, 39% of women developed GDM during pregnancy, with no significant differences in prevalence across countries. The prevalence of GDM was high (24%; 242/1023) in early pregnancy. Despite interventions used in the DALI study, a further 14% (94/672) had developed GDM when tested at mid gestation (24-28 weeks) and 13% (59/476) of the remaining cohort at late gestation (35-37 weeks). Demographics and lifestyle factors were similar at baseline between women with GDM and those who maintained normal glucose tolerance. Previous GDM (16.5% vs 7.9%, p = 0.002), congenital malformations (6.4% vs 3.3%, p = 0.045) and a baby with macrosomia (31.4% vs 17.9%, p = 0.001) were reported more frequently in those who developed GDM. Significant anthropometric and metabolic differences were already present in early pregnancy between women who developed GDM and those who did not. CONCLUSIONS/INTERPRETATION The prevalence of GDM diagnosed by the IADPSG/WHO 2013 GDM criteria in European pregnant women with a BMI ≥29.0 kg/m2 is substantial, and poses a significant health burden to these pregnancies and to the future health of the mother and her offspring. Uniform criteria for GDM diagnosis, supported by robust evidence for the benefits of treatment, are urgently needed to guide modern GDM screening and treatment strategies.
Collapse
Affiliation(s)
- Aoife M Egan
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland
| | - Akke Vellinga
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - David Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain
| | - Juan M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Andre Van Assche
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Liselotte Andersen
- Department of Endocrinology, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Urszula Mantaj
- Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - David Hill
- Recherche en Santé Lawson SA, St Gallen, Switzerland
| | - Judith G M Jelsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, EMGO+ Institute for Health and Care Research, VU University Medical Centre and Medical Psychology AMC, Amsterdam, the Netherlands
| | - Christof Worda
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Dagmar Bancher-Todesca
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
- Institute of Sports Science, University of Graz, Graz, Austria.
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Fidelma P Dunne
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland.
| | | |
Collapse
|
31
|
Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies. J Perinatol 2017; 37:360-368. [PMID: 28079866 DOI: 10.1038/jp.2016.254] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/23/2016] [Accepted: 12/07/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) in singleton pregnancy is associated with large for gestational age neonates and adverse perinatal outcomes; however, the impact of GDM in twin pregnancy is unclear. Thus, the aim of this study is to assess the perinatal outcomes of twin pregnancies complicated by GDM by performing a meta-analysis of observational studies. STUDY DESIGN Studies investigating GDM in twin pregnancy were identified through an online search of three databases: Medline, Embase and Web of Science. Selection criteria comprised full paper observational studies (retrospective or prospective) published in English that examined GDM in twin pregnancy compared with non-GDM twin pregnancy and reported on birth weight and/or adverse perinatal outcomes. Random-effects models with inverse-variance weighting were used to calculate standardized mean differences and unadjusted odds ratios. Sensitivity analyses were carried out to determine the impact of possible maternal confounders (body mass index and age) and GDM diagnostic criteria on perinatal outcomes. RESULTS Thirteen observational studies were included. GDM twins were born at the same gestation as non-GDM twins, with marginally lower birth weight. There was no difference in the incidence of large or small for gestational age neonates. Although there was no correlation between GDM in twin pregnancy and respiratory distress, neonatal hypoglycemic or low Apgar score, GDM twins had a higher rate of neonatal intensive care unit admission (OR 1.49; 95% confidence interval: 1.10, 2.02; P<0.01). CONCLUSION Identification and subsequent treatment of GDM in twin pregnancy demonstrates a similar risk of adverse perinatal outcomes compared with non-GDM twin pregnancies.
Collapse
|
32
|
Li YY, Ye SQ, Zhong ZH, Xu Q, Mai WB, Yin CX, Zhu ZQ, He XQ, Xiao Q. Associations between maternal BMI as well as glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome. Gynecol Endocrinol 2017; 33:328-331. [PMID: 27911105 DOI: 10.1080/09513590.2016.1261104] [Citation(s) in RCA: 4] [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] [Indexed: 10/20/2022] Open
Abstract
This retrospective, cohort study examined the association between maternal pre-pregnancy body mass index (BMI), independent of glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome (PCOS), for which there are few previous studies. Medical records from 2012 to 2015 at Guangzhou Women and Children's Medical Center, China were reviewed for women previously diagnosed with PCOS with normal 2-h 75-g oral glucose tolerance test (OGTT) results (n = 1249). The separate and joint effects of maternal BMI and glucose levels on pregnancy outcomes were assessed. Maternal pre-pregnancy BMI was associated with hypertensive disorders of pregnancy (HDP) (OR: 1.22, 95% CI: 1.02-1.45), preterm birth (OR: 1.49, 95% CI: 1.08-2.17), and large for gestational age (LGA) (OR: 1.69, 95% CI: 1.16-2.20). Elevated fasting glucose and maternal pre-pregnancy BMI were jointly associated with increased risks of HDP, preterm birth, and LGA. Therefore, among women with PCOS and normal glucose tolerance, maternal pre-pregnancy BMI is an independent risk factor of adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Ying-Ying Li
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Su-Qi Ye
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Zhuo-Hui Zhong
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Qiong Xu
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Wei-Bi Mai
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Cai-Xin Yin
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Zhi-Qin Zhu
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Xiao-Qian He
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Qing Xiao
- a Department of Obstetrics and Gynecology , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| |
Collapse
|
33
|
Affiliation(s)
- T Cundy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - R I G Holt
- Diabetes and Endocrinology, Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
34
|
Effect of maternal body mass index and weight gain in women with gestational diabetes on the incidence of large-for-gestational-age infants. DIABETES & METABOLISM 2016; 42:471-474. [DOI: 10.1016/j.diabet.2016.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 06/22/2016] [Accepted: 06/26/2016] [Indexed: 11/20/2022]
|
35
|
Hildén K, Hanson U, Persson M, Fadl H. Overweight and obesity: a remaining problem in women treated for severe gestational diabetes. Diabet Med 2016; 33:1045-51. [PMID: 27172974 PMCID: PMC5089567 DOI: 10.1111/dme.13156] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 01/21/2023]
Abstract
AIM To analyse the impact of overweight and obesity on the risk of adverse maternal outcomes and fetal macrosomia in pregnancies of women treated for severe gestational diabetes. METHODS This was a population-based cohort study including all singleton pregnancies in Sweden without pre-existing diabetes in the period 1998-2012. Only mothers with an early- pregnancy BMI of ≥ 18.5 kg/m² were included. Logistic regression analysis was used to determine odds ratios with 95% CIs for maternal outcomes and fetal growth. Analyses were stratified by maternal gestational diabetes/non-gestational diabetes to investigate the impact of overweight/obesity in each group. RESULTS Of 1 249 908 singleton births, 13 057 were diagnosed with gestational diabetes (1.0%). Overweight/obesity had the same impact on the risks of caesarean section and fetal macrosomia in pregnancies with and without gestational diabetes, but the impact of maternal BMI on the risk of preeclampsia was less pronounced in women with gestational diabetes. Normal-weight women with gestational diabetes had an increased risk of caesarean section [odds ratio 1.26 (95% CI 1.16-1.37)], preeclampsia [odds ratio 2.03 (95% CI 1.71-2.41)] and large-for-gestational-age infants [odds ratio 2.25 (95% CI 2.06-2.46)]. Risks were similar in the overweight group without gestational diabetes, caesarean section [odds ratio 1.34 (1.33-1.36)], preeclampsia odds ratio [1.76 (95% CI 1.72-1.81)], large-for-gestational-age [odds ratio 1.76 (95% CI 1.74-1.79)]. CONCLUSIONS Maternal overweight and obesity is associated with similar increments in risks of adverse maternal outcomes and delivery of large-for-gestational-age infants in women with and without gestational diabetes. Obese women with gestational diabetes are defined as a high-risk group. Normal-weight women with gestational diabetes have similar risks of adverse outcomes to overweight women without gestational diabetes.
Collapse
Affiliation(s)
- K Hildén
- Department of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - U Hanson
- Department of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Persson
- Department of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - H Fadl
- Department of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
36
|
Barquiel B, Herranz L, Hillman N, Burgos MÁ, Grande C, Tukia KM, Bartha JL, Pallardo LF. HbA1c and Gestational Weight Gain Are Factors that Influence Neonatal Outcome in Mothers with Gestational Diabetes. J Womens Health (Larchmt) 2016; 25:579-85. [DOI: 10.1089/jwh.2015.5432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Beatriz Barquiel
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - Lucrecia Herranz
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - Natalia Hillman
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - M Ángeles Burgos
- Diabetes and Pregnancy Unit, Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Cristina Grande
- Diabetes and Pregnancy Unit, Department of Biochemistry, Hospital Universitario La Paz, Madrid, Spain
| | - Keleni M. Tukia
- Division of Hematology/Oncology, Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - José Luis Bartha
- Diabetes and Pregnancy Unit, Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Luis Felipe Pallardo
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
37
|
Innes KE, Kandati S, Flack KL, Agarwal P, Selfe TK. The Relationship of Restless Legs Syndrome to History of Pregnancy-Induced Hypertension. J Womens Health (Larchmt) 2016; 25:397-408. [PMID: 26913940 DOI: 10.1089/jwh.2015.5484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Restless legs syndrome (RLS), a burdensome sleep disorder, has been associated with cardiovascular disease (CVD), hypertension, diabetes, and related disorders. However, the relationship of RLS to history of pregnancy-induced hypertension (PIH), a predictor of subsequent CVD, diabetes, and associated conditions, remains little explored. In this study, we investigated the relationship of RLS to history of PIH in a sample of primary care patients. METHODS Participants were women aged ≥40 years drawn from an anonymous survey study of West Virginia primary care patients. Data collected included detailed information on demographics, lifestyle factors, sleep patterns, and reproductive/medical history; the survey also included an RLS diagnostic questionnaire. Women who were pregnant or unsure about their pregnancy status were excluded from the analyses. RESULTS Of the 498 participants in the final analytic sample, 24.5% met diagnostic criteria for RLS (17.9% with symptoms ≥once/week, 11.9% with symptoms ≥3 times/week); 73 (16.5% of parous women) reported a history of PIH, defined as physician-diagnosed preeclampsia or gestational hypertension. After adjustment for demographics, lifestyle characteristics, obesity, reproductive history, health conditions, and other factors, those reporting a history of PIH were approximately twice as likely to meet criteria for RLS (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.1, 3.6). These associations increased in magnitude with increasing symptom frequency (adjusted OR for RLS with symptoms ≥3 times/week = 3.8; CI 1.9, 7.6; p for trend = 0.003). CONCLUSIONS History of PIH was strongly and positively related to current RLS in this study of primary care patients; these findings further support a possible role for metabolic dysregulation in RLS etiology.
Collapse
Affiliation(s)
- Kim E Innes
- 1 Department of Epidemiology, West Virginia University School of Public Health , Morgantown, West Virginia.,2 Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System , Charlottesville, Virginia.,3 Department of Physical Medicine and Rehabilitation, University of Virginia Health System , Charlottesville, Virginia
| | - Sahiti Kandati
- 1 Department of Epidemiology, West Virginia University School of Public Health , Morgantown, West Virginia
| | - Kathryn L Flack
- 1 Department of Epidemiology, West Virginia University School of Public Health , Morgantown, West Virginia.,4 WV Focus: Reproductive Education & Equality , Charleston, West Virginia
| | - Parul Agarwal
- 5 Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy , Morgantown, West Virginia
| | - Terry Kit Selfe
- 1 Department of Epidemiology, West Virginia University School of Public Health , Morgantown, West Virginia.,2 Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System , Charlottesville, Virginia
| |
Collapse
|
38
|
Yang Y, Wei Q, Yu H, Wang P, Xia W, Huang R, Cai R, Sun H, Wang S. Higher pre-pregnancy body mass index is associated with excessive gestational weight gain in normal weight Chinese mothers with gestational diabetes. J Obstet Gynaecol Res 2016; 42:511-8. [PMID: 26786662 DOI: 10.1111/jog.12934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/07/2015] [Accepted: 11/27/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Yue Yang
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Qiong Wei
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Hong Yu
- Department of Obstetrics and Gynecology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Pin Wang
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Wenqing Xia
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Rong Huang
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Rongrong Cai
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Haixia Sun
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Shaohua Wang
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| |
Collapse
|
39
|
Wang LF, Wang HJ, Ao D, Liu Z, Wang Y, Yang HX. Influence of pre-pregnancy obesity on the development of macrosomia and large for gestational age in women with or without gestational diabetes mellitus in Chinese population. J Perinatol 2015; 35:985-90. [PMID: 26401753 DOI: 10.1038/jp.2015.119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/12/2015] [Accepted: 08/18/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effects of gestational diabetes mellitus (GDM) and pre-pregnancy obesity on macrosomia and large for gestational age (LGA). STUDY DESIGN We conducted a prospective cohort study of 587 GDM women and 478 non-GDM women from 2012 to 2013. We collected their data of the pre-pregnancy weight, sociodemographic data, medical histories, clinical treatment, and followed-up the outcomes of delivery including birth weight. Multiple logistic regression models were used to test associations between pre-pregnant obesity and macrosomia/LGA and between GDM and macrosomia/LGA. RESULT Of 1065 women we studied, obese women had 4.17 times and 2.27 times increased risk of developing macrosomia (95% CI: 2.52 to 6.91) and LGA (95% CI: 1.60 to 3.21), respectively, than non-obese women after adjustment for maternal age, gestational weeks and GDM. We did not find GDM is a risk factor for macrosomia or LGA after GDM treatment. CONCLUSION Pre-pregnancy obesity accounts for a high prevalence of macrosomia. Interventions that focus on pre-pregnancy obesity have the potential to reach far more women at risk of macrosomia.
Collapse
Affiliation(s)
- L-F Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - H-J Wang
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China.,Key Laboratory of Reproductive Health, Ministry of Health, Beijing, China
| | - D Ao
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China.,Health Management Center, Xinjiang Medical University, Xinjiang, China
| | - Z Liu
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China.,Key Laboratory of Reproductive Health, Ministry of Health, Beijing, China
| | - Y Wang
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China.,Key Laboratory of Reproductive Health, Ministry of Health, Beijing, China
| | - H-X Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| |
Collapse
|
40
|
Ogonowski J, Miazgowski T. Intergenerational transmission of macrosomia in women with gestational diabetes and normal glucose tolerance. Eur J Obstet Gynecol Reprod Biol 2015; 195:113-116. [PMID: 26512436 DOI: 10.1016/j.ejogrb.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/04/2015] [Accepted: 10/06/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES It has been suggested that neonatal macrosomia may contribute to increased risk of obesity and type 2 diabetes in later life. Much less is known about the association between maternal birth weight (MBW) and offspring birth weight (OBW). This retrospective study evaluated the prevalence of macrosomia in women with treated gestational diabetes mellitus (GDM) and normal glucose tolerance during pregnancy. The study also investigated associations between MBW and OBW. STUDY DESIGN Medical records of 519 pregnant women with treated GDM and 766 women with normal glucose tolerance, referred to the Gestational Diabetes Outpatient Clinic in Szczecin, Poland, were analyzed. The following data were assessed: maternal age, pregravid body weight, height, gestational weight gain, prior GDM, prior macrosomia, MBW and OBW. Birth weight was classified as small for gestational age (SGA), appropriate for gestational age (AGA), large for gestational age (LGA) and macrosomia (≥4000g). OBW was obtained from birth certificates, and MBW was obtained from birth certificates or self-report. RESULTS The overall prevalence of macrosomia was 8.1%, and was comparable in subgroups of women with and without GDM (7.7% and 8.4%, respectively; p=0.905). The frequencies of SGA, AGA and LGA did not differ between study groups. A positive correlation was found between MBW and OBW in women with treated GDM (r=0.211, p<0.001) and in women with normal glucose tolerance (r=0.220, p<0.001). Regardless of glucose tolerance status during pregnancy, the greatest proportion of macrosomic babies were born to mothers who were themselves born macrosomic (26.5% in mothers with GDM and 20.0% in mothers with normal glucose tolerance; p=0.631). On logistic regression, MBW was found to be a robust predictor of macrosomia in offspring [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.15-2.36 in women with treated GDM; OR 1.35, 95% CI 1.07-1.76 in women with normal glucose tolerance). Other independent predictors of fetal macrosomia were gestational weight gain, prior macrosomia and pregravid body mass index (BMI). CONCLUSIONS MBW, prior macrosomia, pregravid BMI and gestational weight gain were predictors of macrosomia in offspring, but GDM was not. High MBW seems to contribute to intergenerational transmission of macrosomia.
Collapse
Affiliation(s)
- J Ogonowski
- Outpatient Clinic for Diabetic Pregnant Women, Provincial Hospital, Szczecin, Poland; Department of Civilization Diseases, Pomeranian Medical University, Szczecin, Poland
| | - T Miazgowski
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland.
| |
Collapse
|
41
|
Benhalima K, Mathieu C, Damm P, Van Assche A, Devlieger R, Desoye G, Corcoy R, Mahmood T, Nizard J, Savona-Ventura C, Dunne F. A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG). Diabetologia 2015; 58:1422-9. [PMID: 25952480 DOI: 10.1007/s00125-015-3615-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/15/2015] [Indexed: 01/17/2023]
Abstract
Screening and diagnostic criteria for gestational diabetes (GDM) are inconsistent across Europe, and the development of a uniform GDM screening strategy is necessary. Such a strategy would create opportunities for more women to receive timely treatment for GDM. Developing a consensus on screening for GDM in Europe is challenging, as populations are diverse and healthcare delivery systems also differ. The European Board & College of Obstetrics and Gynaecology (EBCOG) has responded to this challenge by appointing a steering committee, including members of the EBCOG and the Diabetic Pregnancy Study Group (DPSG) associated with the EASD, to develop a proposal for the use of uniform diagnostic criteria for GDM in Europe. A proposal has been developed and has now been approved by the Council of the EBCOG. The current proposal is to screen for overt diabetes at the first prenatal contact using cut-off values for diabetes outside pregnancy, with particular efforts made to screen high-risk groups. When screening for GDM is performed at 24 weeks' gestation or later, the proposal is now to use the 75 g OGTT with the new WHO diagnostic criteria for GDM. However, more research is necessary to evaluate the best GDM screening strategy for different populations in Europe. Therefore, no clear recommendation has been made on whether a universal one-step, two-step or a risk-factor-based screening approach should be used. The use of the same WHO diagnostic GDM criteria across Europe will be an important step towards uniformity.
Collapse
Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. ANNALS OF NUTRITION AND METABOLISM 2015; 66 Suppl 2:14-20. [PMID: 26045324 DOI: 10.1159/000371628] [Citation(s) in RCA: 466] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fetal macrosomia, defined as a birth weight ≥ 4,000 g, may affect 12% of newborns of normal women and 15-45% of newborns of women with gestational diabetes mellitus (GDM). The increased risk of macrosomia in GDM is mainly due to the increased insulin resistance of the mother. In GDM, a higher amount of blood glucose passes through the placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia, which is also called 'large for gestational age'. This paper reviews studies that explored the impact of GDM and fetal macrosomia as well as macrosomia-related complications on birth outcomes and offers an evaluation of maternal and fetal health. SUMMARY Fetal macrosomia is a common adverse infant outcome of GDM if unrecognized and untreated in time. For the infant, macrosomia increases the risk of shoulder dystocia, clavicle fractures and brachial plexus injury and increases the rate of admissions to the neonatal intensive care unit. For the mother, the risks associated with macrosomia are cesarean delivery, postpartum hemorrhage and vaginal lacerations. Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age (during adolescence) and are more likely to develop type II diabetes later in life. Besides, the findings of several studies that epigenetic alterations of different genes of the fetus of a GDM mother in utero could result in the transgenerational transmission of GDM and type II diabetes are of concern.
Collapse
Affiliation(s)
- Kamana Kc
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | | | | |
Collapse
|
43
|
Graves E, Hill DJ, Evers S, Van Aarsen K, Yama B, Yuan S, Campbell MK. The impact of abnormal glucose tolerance and obesity on fetal growth. J Diabetes Res 2015; 2015:847674. [PMID: 25977929 PMCID: PMC4421033 DOI: 10.1155/2015/847674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/30/2015] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Factors linked with insulin resistance were examined for their association with large-for-gestational-age (LGA) infant birth weight and gestational diabetes. STUDY DESIGN Data came from a longitudinal cohort study of 2,305 subjects without overt diabetes, analyzed using multinomial logistic and linear regression. RESULTS High maternal BMI (OR = 1.53 (1.11, 2.12)), height (1.98 (1.62, 2.42)), antidepressant use (1.71 (1.20, 2.44)), pregnancy weight-gain exceeding 40 pounds (1.79 (1.25, 2.57)), and high blood sugar (2.68, (1.53, 5.27)) were all positively associated with LGA birth. Strikingly, the difference in risk from diagnosed and treated gestational diabetes compared to women with a single abnormal glucose tolerance test (but no diagnosis of gestational diabetes) was significant (OR = 0.65, p = 0.12 versus OR = 2.84, p < 0.01). When weight/length ratio was used instead, different factors were found to be significant. BMI and pregnancy weight-gain were found to influence the development of gestational diabetes, through an additive interaction. CONCLUSIONS High prepregnancy BM, height, antidepressant use, pregnancy weight-gain exceeding 40 pounds, and high blood sugar were associated with LGA birth, but not necessarily infant weight/length ratio. An additive interaction between BMI and pregnancy weight-gain influenced gestational diabetes development.
Collapse
Affiliation(s)
- Erin Graves
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
| | - David J. Hill
- Department of Physiology and Pharmacology, Western University, London, ON, Canada N6A 5C1
- Lawson Health Research Institute, London, ON, Canada N6C 2R5
| | - Susan Evers
- Department of Family Relations and Applied Nutrition, Guelph, ON, Canada N1G 2W1
| | - Kristine Van Aarsen
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
| | - Brie Yama
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
| | - Su Yuan
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
| | - M. Karen Campbell
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada N6A 5C1
- Lawson Health Research Institute, London, ON, Canada N6C 2R5
- Department of Obstetrics and Gynaecology, Western University, London, ON, Canada N6H 5W9
- Department of Paediatrics, Western University, London, ON, Canada N6C 2R6
- Children's Health Research Institute, London, ON, Canada N6C 2V5
| |
Collapse
|
44
|
Naveiro Fuentes M, Jiménez-Moleón J, Olmedo Requena R, Amezcua Prieto C, Bueno Cabanillas A, Mozas Moreno J. Resultados perinatales en función de 3 criterios diagnósticos de diabetes gestacional. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2015. [DOI: 10.1016/j.gine.2013.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
45
|
|
46
|
Kaul P, Savu A, Nerenberg KA, Donovan LE, Chik CL, Ryan EA, Johnson JA. Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: a population-level analysis. Diabet Med 2015; 32:164-73. [PMID: 25407209 DOI: 10.1111/dme.12635] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 01/11/2023]
Abstract
AIMS To examine the association between gestational diabetes mellitus (GDM) and high maternal weight and the risk of development of chronic disease. METHODS Women with singleton deliveries between April 1999 and March 2010 in Alberta, Canada, were categorized according to pre-pregnancy weight (overweight ≥ 91 kg) and GDM status. Obstetric and neonatal outcomes, as well as the long-term incidence of maternal diabetes, hypertension and cardiovascular disease were examined. RESULTS Of 240 083 women, 213 765 (89%) had no GDM and were not overweight (reference group), 17 587 (7.3%) were overweight only, 7332 (3%) had GDM only and 1399 (0.6%) had GDM and were overweight. Significant differences in Caesarean section rates, induction rates and birthweight were observed across the four groups. During a median follow-up of 5.3 years, diabetes incidence was 36% in the GDM and overweight, 18.8% in the GDM only, 4.8% in the overweight only and 1.1% in the reference group. With respect to hypertension and cardiovascular disease, the GDM and overweight group had the highest rates (26.8% and 3.1%, respectively) and the reference group had the lowest rates (5.8% and 1.0%, respectively). However, rates were similar in the GDM only (14.9% and 1.9%, respectively) and overweight only groups (14.9% and 1.5%, respectively). CONCLUSIONS Not surprisingly, the presence of both high maternal weight and GDM compounds the risk of developing diabetes. However, the association between overweight alone and GDM alone and hypertension and cardiovascular disease appears similar suggesting a need for effective interventions to manage both these conditions to improve the health of these patients.
Collapse
Affiliation(s)
- P Kaul
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
OBJECTIVE To examine impact on perinatal outcome of untreated gestational diabetes (GDM) and non-diabetics stratified by body mass index (BMI). RESEARCH DESIGN AND METHODS This is a secondary analysis of our investigation of the consequences of not treating GDM. We evaluated 555 untreated GDMs matched to 1100 non-diabetics. BMI was determined using subjects' recalled pre-pregnancy weight. A primary composite variable consisted of stillbirth, neonatal macrosomia/large-for-gestational-age (LGA), neonatal hypoglycemia, erythrocytosis and hyperbilirubinemia. Secondary outcomes included shoulder dystocia, respiratory complications, cesarean delivery and pregnancy-related hypertension. RESULTS Untreated subjects in the normal weight category had an ∼2-fold increase for composite outcome and LGA and a 7-fold increase in metabolic complications. The overweight untreated group showed composite outcome, LGA and metabolic complications 2-3-fold higher and induction of labor 5-fold higher. For obese untreated GDMs, significantly higher rates of composite outcome, LGA and metabolic complications, induction of labor and cesarean delivery were 10-, 3-, 5-, 4- and 9-fold, respectively. Perinatal outcome for normal weight untreated GDM was similar to obese non-diabetics. CONCLUSIONS Maternal obesity and GDM independently affect adverse pregnancy outcome. The combination has a greater impact than each one alone. However, glycemic level contributes a greater portion to the adverse pregnancy equation.
Collapse
|
48
|
Wahabi HA, Fayed AA, Alzeidan RA, Mandil AA. The independent effects of maternal obesity and gestational diabetes on the pregnancy outcomes. BMC Endocr Disord 2014; 14:47. [PMID: 24923207 PMCID: PMC4065087 DOI: 10.1186/1472-6823-14-47] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 06/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity and gestational diabetes (GDM) in pregnancy are recognized risk factors for adverse outcomes, including cesarean section (CS), macrosomia and preeclampsia. The aim of this study was to investigate the independent effect of GDM and obesity on the adverse pregnancy outcomes at term. METHODS A retrospective cohort of postpartum women, in King Khalid University Hospital, were stratified according to body mass index (obese ≥30 kg/m2, non-obese <30 kg/m2) and the results of GDM screening into the following groups, women with no obesity and no GDM (reference group), women with no obesity but with GDM, women with obesity but no GDM and women with both GDM and obesity. Adverse pregnancy outcomes included high birth weight, macrosomia, CS delivery and preeclampsia. Multiple logistic regression used to examine independent associations of GDM and obesity with macrosomia and CS. RESULTS 2701 women were included, 44% of them were obese and 15% had GDM. 63% of the women with GDM were obese. There was significant increase in the percentage of macrosomia, P < 0.001, high birth weight, P < 0.001, CS, P < 0.001 and preeclampsia, P < 0.001 in women with GDM and obesity compared to the reference group. Obesity increased the estimated risk of CS delivery, odds ratio (OR) 2.16, confidence intervals (CI) 1.74-2.67. The combination of GDM and obesity increased the risk of macrosomia OR 3.45, CI 2.05-5.81 and the risk of CS delivery OR 2.26, CI 1.65-3.11. CONCLUSION Maternal obesity and GDM were independently associated with adverse pregnancy outcomes. The combination of both conditions further increase the risk.
Collapse
Affiliation(s)
- Hayfaa A Wahabi
- Sheikh Bahmdan Chair of Evidence-Based Healthcare and Knowledge Translation, College of Medicine, King Saud University, P.O Box 102799, Riyadh 11685, Kingdom of Saudi Arabia
| | - Amel A Fayed
- King Saud Ben AbdulAziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- High Institute of Public Health Alexandria University, Alexandria, Egypt
| | - Rasmieh A Alzeidan
- Sheikh Bahmdan Chair of Evidence-Based Healthcare and Knowledge Translation, College of Medicine, King Saud University, P.O Box 102799, Riyadh 11685, Kingdom of Saudi Arabia
| | - Ahmed A Mandil
- Department of Family and Community Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
49
|
Sugiyama T, Metoki H, Hamada H, Nishigori H, Saito M, Yaegashi N, Kusaka H, Kawano R, Ichihara K, Yasuhi I, Hiramatsu Y, Sagawa N. A retrospective multi-institutional study of treatment for mild gestational diabetes in Japan. Diabetes Res Clin Pract 2014; 103:412-8. [PMID: 24485857 DOI: 10.1016/j.diabres.2013.12.017] [Citation(s) in RCA: 13] [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] [Received: 04/09/2013] [Revised: 10/17/2013] [Accepted: 12/18/2013] [Indexed: 12/16/2022]
Abstract
AIMS To determine whether treating mild gestational diabetes mellitus (GDM) is associated with improvement of pregnancy outcomes in Japan. METHODS In a multi-institutional retrospective study, we examined pregnant women meeting the criteria for mild GDM (i.e., only one abnormal value [OAV] for 75-g OGTT; fasting glucose ≥100 mg/dL, 1-h postprandial glucose ≥180 mg/dL, and 2-h postprandial glucose ≥150 mg/dL), receiving either routine prenatal care (non-treatment group) or dietary intervention alone or dietary intervention with self-monitoring of blood glucose and/or insulin therapy, if necessary (treatment group). Pregnancy outcomes were compared between these groups. RESULTS Data from 893 eligible women were collected from 30 institutions. Participants included 542 untreated and 351 treated women. Although there were no significant differences in baseline clinical characteristics or maternal and perinatal outcomes between these groups, the incidence of large-for-gestational-age (LGA) infants was lower in the treatment group (P=0.07). Multiple logistic regression analysis (MLRA) revealed that pre-pregnancy BMI and gestational weight gain were associated with LGA infants, while 75-g OGTT results were unrelated to LGA. When overweight and obese women were the subjects, the number of LGA infants was significantly lower in the intervention than in the control group, and gestational weight gain was significantly lower in the treatment than in the control group. MLRA showed that intervention was significantly related to a lower incidence of LGA infants. CONCLUSIONS Our study suggests that maternal BMI impacts fetal growth and that treatment for overweight or obese mothers with OAV is associated with a lower frequency of LGA infants.
Collapse
Affiliation(s)
- Takashi Sugiyama
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan.
| | - Hirohito Metoki
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hidekazu Nishigori
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hideto Kusaka
- Department of Obstetrics and Gynecology, National Hospital Organization Mie Chuo Medical Center, Tsu, Mie 514-1101, Japan
| | - Reo Kawano
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Kiyoshi Ichihara
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki 856-8562, Japan
| | - Yuji Hiramatsu
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Norimasa Sagawa
- Department of Obstetrics and Gynecology, Rakuwakai Otowa Hospital, Kyoto 607-8062 Japan
| |
Collapse
|
50
|
Barquiel B, Herranz L, Grande C, Castro-Dufourny I, Llaro M, Parra P, Burgos MA, Pallardo LF. Body weight, weight gain and hyperglycaemia are associated with hypertensive disorders of pregnancy in women with gestational diabetes. DIABETES & METABOLISM 2014; 40:204-10. [PMID: 24503192 DOI: 10.1016/j.diabet.2013.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/14/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to measure the capacity of glucose- and weight-related parameters to predict pregnancy-induced hypertensive disorders in women with gestational diabetes. METHODS An observational study was conducted involving 2037 women with gestational diabetes. The associations of glycaemic and weight-related parameters with pregnancy-induced hypertensive disorders were obtained by univariate and adjusted multivariate analyses. Also, model predictability and attributable predictor risk percentages were calculated, and collinearity and factor interactions examined. RESULTS Multivariate analyses revealed that hypertensive disorders were mainly predicted by average third-trimester glycated haemoglobin (HbA(1c)) levels ≥ 5.9%, by being overweight or obese before pregnancy and by excess gestational weight gain after adjusting for age, tobacco use, chronic hypertension, parity, urinary tract infections and gestational age at delivery. Prepregnancy body weight (overweight and obesity) had the strongest impact on pregnancy-related hypertensive disorders (attributable risk percentages were 51.5% and 88.8%, respectively). The effect of being overweight or obese on hypertensive disorders was enhanced by HbA(1c) levels and gestational weight gain, with elevated HbA(1c) levels multiplying the effect of being overweight before pregnancy. CONCLUSION The average third-trimester HbA1c level is a novel risk factor for pregnancy-induced hypertensive disorders in women with gestational diabetes. HbA(1c) levels ≥ 5.9%, prepregnancy overweight or obesity and excess gestational weight gain are all independent risk factors of pregnancy-related hypertensive disorders in such women. In treated gestational diabetes patients, the strongest influence on hypertensive disorders is prepregnancy obesity.
Collapse
Affiliation(s)
- B Barquiel
- Unidad de Diabetes, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - L Herranz
- Unidad de Diabetes, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - C Grande
- Servicio de Bioquímica, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - I Castro-Dufourny
- Unidad de Diabetes, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - M Llaro
- Unidad de Diabetes, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - P Parra
- Unidad de Diabetes, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - M A Burgos
- Servicio de Ginecología y Obstetricia, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - L F Pallardo
- Unidad de Diabetes, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| |
Collapse
|