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Hivert MF, Backman H, Benhalima K, Catalano P, Desoye G, Immanuel J, McKinlay CJD, Meek CL, Nolan CJ, Ram U, Sweeting A, Simmons D, Jawerbaum A. Pathophysiology from preconception, during pregnancy, and beyond. Lancet 2024; 404:158-174. [PMID: 38909619 DOI: 10.1016/s0140-6736(24)00827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes is the most common medical complication in pregnancy. Historically, gestational diabetes was considered a pregnancy complication involving treatment of rising glycaemia late in the second trimester. However, recent evidence challenges this view. Pre-pregnancy and pregnancy-specific factors influence gestational glycaemia, with open questions regarding roles of non-glycaemic factors in the aetiology and consequences of gestational diabetes. Varying patterns of insulin secretion and resistance in early and late pregnancy underlie a heterogeneity of gestational diabetes in the timing and pathophysiological subtypes with clinical implications: early gestational diabetes and insulin resistant gestational diabetes subtypes are associated with a higher risk of pregnancy complications. Metabolic perturbations of early gestational diabetes can affect early placental development, affecting maternal metabolism and fetal development. Fetal hyperinsulinaemia can affect the development of multiple fetal tissues, with short-term and long-term consequences. Pregnancy complications are prevented by managing glycaemia in early and late pregnancy in some, but not all women with gestational diabetes. A better understanding of the pathophysiology and heterogeneity of gestational diabetes will help to develop novel management approaches with focus on improved prevention of maternal and offspring short-term and long-term complications, from pre-conception, throughout pregnancy, and beyond.
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Affiliation(s)
- Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Helena Backman
- Faculty of Medicine and Health, Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Tufts Medical Center, Boston, MA, USA; School of Medicine, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Sydney, NSW, Australia; Institute for Women's Health, College of Nursing, Texas Woman's University, Denton, TX, USA
| | - Christopher J D McKinlay
- Department of Paediatrics Child and Youth Health, University of Auckland, Auckland, New Zealand; Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Claire L Meek
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Department of Endocrinology, Canberra Health Services, Woden, ACT, Australia
| | - Uma Ram
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamilnadu, India
| | - Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Alicia Jawerbaum
- Facultad de Medicina, Universidad de Buenos Aires (UBA)-CONICET, Buenos Aires, Argentina; Laboratory of Reproduction and Metabolism, CEFYBO-CONICET, Buenos Aires, Argentina
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Celik K, Ozkan Zarif N, Ozen Kucukcetin I, Arayici S, Kihtir Z, Unver Tuhan H, Ongun H. Association of Umbilical Cord Perilipin 2 Levels with Neonatal Anthropometric Measurements in Infants of Diabetic Mothers. CHILDREN (BASEL, SWITZERLAND) 2024; 11:771. [PMID: 39062220 PMCID: PMC11274490 DOI: 10.3390/children11070771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Perilipin 2 (PLIN2) is a protein that contributes to the formation and stability of lipid droplets. It has been associated with the development of several diseases, particularly related to glucose and lipid metabolism. In infants of diabetic mother (IDM), fetal hyperinsulinaemia leads to increased adipose tissue and macrosomia. The aim of this study was to investigate the relationship between PLIN2 levels and anthropometric measurements in the IDM and to investigate the relationship between PLIN2 levels and IGF-1, IGF-2 and leptin levels. METHODS The study group consisted of IDMs, while the control group consisted of infants born to non-diabetic mother, matched for gestational week and gender. Cord blood samples were collected from all patients to determine PLIN2, IGF-1, IGF-2 and leptin levels. Anthropometric measurements were taken for all patients at birth. RESULTS There were no differences between the groups in birth weight, birth length, head circumference and body mass index (BMI), but middle arm circumference, triceps, biceps, subscapular and suprailiac skinfold thickness were significantly higher in the IDM. While PLIN2, IGF-1, IGF-2 and leptin levels were similar between groups, there was a strong correlation between PLIN2 levels and IGF-2 and leptin levels. CONCLUSIONS Even if IDMs were not macrosomic, the presence of high subcutaneous adipose tissue was not associated with PLIN2.
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Affiliation(s)
- Kiymet Celik
- Department Neonatology, Akdeniz University, 07070 Antalya, Turkey; (N.O.Z.); (S.A.); (Z.K.); (H.O.)
| | - Nurten Ozkan Zarif
- Department Neonatology, Akdeniz University, 07070 Antalya, Turkey; (N.O.Z.); (S.A.); (Z.K.); (H.O.)
| | | | - Sema Arayici
- Department Neonatology, Akdeniz University, 07070 Antalya, Turkey; (N.O.Z.); (S.A.); (Z.K.); (H.O.)
| | - Zeynep Kihtir
- Department Neonatology, Akdeniz University, 07070 Antalya, Turkey; (N.O.Z.); (S.A.); (Z.K.); (H.O.)
| | - Hale Unver Tuhan
- Department of Pediatric Endocrinology, Akdeniz University, 07070 Antalya, Turkey;
| | - Hakan Ongun
- Department Neonatology, Akdeniz University, 07070 Antalya, Turkey; (N.O.Z.); (S.A.); (Z.K.); (H.O.)
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Martine-Edith G, Johnson W, Petherick ES. Relationships Between Exposure to Gestational Diabetes Treatment and Neonatal Anthropometry: Evidence from the Born in Bradford (BiB) Cohort. Matern Child Health J 2024; 28:557-566. [PMID: 38019368 PMCID: PMC10914642 DOI: 10.1007/s10995-023-03851-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To examine the relationships between gestational diabetes mellitus (GDM) treatment and neonatal anthropometry. METHODS Covariate-adjusted multivariable linear regression analyses were used in 9907 offspring of the Born in Bradford cohort. GDM treatment type (lifestyle changes advice only, lifestyle changes and insulin or lifestyle changes and metformin) was the exposure, offspring born to mothers without GDM the control, and birth weight, head, mid-arm and abdominal circumference, and subscapular and triceps skinfold thickness the outcomes. RESULTS Lower birth weight in offspring exposed to insulin (- 117.2 g (95% CI - 173.8, - 60.7)) and metformin (- 200.3 g (- 328.5, - 72.1)) compared to offspring not exposed to GDM was partly attributed to lower gestational age at birth and greater proportion of Pakistani mothers in the treatment groups. Higher subscapular skinfolds in offspring exposed to treatment compared to those not exposed to GDM was partly attributed to higher maternal glucose concentrations at diagnosis. In fully adjusted analyses, offspring exposed to GDM treatment had lower weight, smaller abdominal circumference and skinfolds at birth than those not exposed to GDM. Metformin exposure was associated with smaller offspring mid-arm circumference (- 0.3 cm (- 0.6, - 0.07)) than insulin exposure in fully adjusted models with no other differences found. CONCLUSIONS FOR PRACTICE Offspring exposed to GDM treatment were lighter and smaller at birth than those not exposed to GDM. Metformin-exposed offspring had largely comparable birth anthropometric characteristics to those exposed to insulin.
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Affiliation(s)
- Gilberte Martine-Edith
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Emily S Petherick
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK.
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Buck CO, Shabanova V, Clark RH, Taylor SN. Diabetes in Pregnancy, Neonatal Morbidities, and Early Growth in Moderate or Late Preterm Infants. Pediatrics 2023; 152:e2023061285. [PMID: 37969002 DOI: 10.1542/peds.2023-061285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES To compare differences in short term morbidities and early growth among moderate and late preterm infants of mothers with and without diabetes (DM) in pregnancy. METHODS In a longitudinal analysis using data from the Pediatrix Clinical Data Warehouse of preterm infants (born 32 0/7 to 36 6/7 weeks) discharged from neonatal intensive care units from 2008 to 2019, health characteristics were compared between DM exposure groups. Change in growth from birth to discharge were compared using linear mixed effects modeling. RESULTS Among 301 499 moderate and late preterm infants in the analysis, 14% (N = 42 519) were exposed to DM in pregnancy. Incidence of congenital anomalies, hypoglycemia, and hyperbilirubinemia were higher in DM-group (P < .001), and DM-group was more likely to need respiratory support in the first postnatal days (P = .02). Percent weight change from birth differed by gestational age, such that 36-week DM-group infants remained on average 2% (95% confidence interval [CI]: 1.57 to 2.41) below birth weight on day 14, whereas 32-week DM-group infants were on average 2.1% (95% CI: 1.69 to 2.51) above birth weight on day 14. In the regression analysis, DM-group had faster weight loss in the first postnatal week when stratified by gestational age. The adjusted difference in weight velocity (g per day) from days 0 to 3 was -4.5 (95% CI: -5.1 to -3.9), -6.5 (95% CI: -7.4 to -5.7), and -7.2 (95% CI: -8.2 to -6.2) for infants born 34-, 35-, and 36-weeks, respectively. CONCLUSIONS In moderate or late preterm infants, diabetes in pregnancy is associated with common neonatal morbidities. Examination of intensive care nutritional practices may identify reasons for observed differences in weight trajectories by gestational age and diabetes exposure.
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Affiliation(s)
- Catherine O Buck
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
| | - Veronika Shabanova
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, Florida
| | - Sarah N Taylor
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
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Martine‐Edith G, Johnson W, Petherick ES. Associations between maternal gestational diabetes metformin or insulin treatment and offspring growth trajectories from birth to 60 months of age: Findings from the Born in Bradford (BiB) study. Diabet Med 2023; 40:e15204. [PMID: 37597238 PMCID: PMC10946820 DOI: 10.1111/dme.15204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/19/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023]
Abstract
AIM To investigate the associations between gestational diabetes mellitus (GDM) metformin or insulin treatment and offspring growth trajectories from 0 to 60 months. METHODS Participants were from the Born in Bradford birth cohort study. Using covariate-adjusted multilevel linear spline models (4 splines: 0-1.6, 1.6-6, 6-17 and 17-60 months), we compared weight, height and body mass index (BMI) z-score trajectories of: (1) 76 offspring exposed to metformin (OGDM-Metformin) and 420 offspring exposed to insulin (OGDM-Insulin); (2) OGDM-Metformin and 9171 offspring not exposed to GDM (No-GDM); (3) OGDM-Insulin and No-GDM. RESULTS (1) OGDM-Metformin had comparable growth trajectories to OGDM-Insulin from 0 to 60 months. (2) OGDM-Metformin had a lower mean birthweight z-score than No-GDM. OGDM-Metformin had faster changes in height z-score (0.13 [95% CI 0.026, 0.24]) from 17 to 60 months and by 60 months, had comparable mean BMI z-score to No-GDM. (3) OGDM-insulin had lower mean birthweight and height z-scores than No-GDM. OGDM-Insulin had faster changes in weight (0.32 [0.021, 0.62]) and height (0.50 [0.087, 0.91]) from 1.6 to 6 months and by 60 months, had comparable mean BMI z-score to No-GDM. CONCLUSIONS GDM metformin treatment was not associated with differences in offspring growth trajectories compared to insulin treatment. Both metformin and insulin-exposed offspring had comparable BMI z-score to No-GDM by 60 months.
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Affiliation(s)
| | - William Johnson
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Emily S. Petherick
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
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Lin Q, Fang ZJ. Establishment and evaluation of a risk prediction model for gestational diabetes mellitus. World J Diabetes 2023; 14:1541-1550. [PMID: 37970129 PMCID: PMC10642414 DOI: 10.4239/wjd.v14.i10.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/21/2023] [Accepted: 09/14/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a condition characterized by high blood sugar levels during pregnancy. The prevalence of GDM is on the rise globally, and this trend is particularly evident in China, which has emerged as a significant issue impacting the well-being of expectant mothers and their fetuses. Identifying and addressing GDM in a timely manner is crucial for maintaining the health of both expectant mothers and their developing fetuses. Therefore, this study aims to establish a risk prediction model for GDM and explore the effects of serum ferritin, blood glucose, and body mass index (BMI) on the occurrence of GDM. AIM To develop a risk prediction model to analyze factors leading to GDM, and evaluate its efficiency for early prevention. METHODS The clinical data of 406 pregnant women who underwent routine prenatal examination in Fujian Maternity and Child Health Hospital from April 2020 to December 2022 were retrospectively analyzed. According to whether GDM occurred, they were divided into two groups to analyze the related factors affecting GDM. Then, according to the weight of the relevant risk factors, the training set and the verification set were divided at a ratio of 7:3. Subsequently, a risk prediction model was established using logistic regression and random forest models, and the model was evaluated and verified. RESULTS Pre-pregnancy BMI, previous history of GDM or macrosomia, hypertension, hemoglobin (Hb) level, triglyceride level, family history of diabetes, serum ferritin, and fasting blood glucose levels during early pregnancy were de-termined. These factors were found to have a significant impact on the development of GDM (P < 0.05). According to the nomogram model's prediction of GDM in pregnancy, the area under the curve (AUC) was determined to be 0.883 [95% confidence interval (CI): 0.846-0.921], and the sensitivity and specificity were 74.1% and 87.6%, respectively. The top five variables in the random forest model for predicting the occurrence of GDM were serum ferritin, fasting blood glucose in early pregnancy, pre-pregnancy BMI, Hb level and triglyceride level. The random forest model achieved an AUC of 0.950 (95%CI: 0.927-0.973), the sensitivity was 84.8%, and the specificity was 91.4%. The Delong test showed that the AUC value of the random forest model was higher than that of the decision tree model (P < 0.05). CONCLUSION The random forest model is superior to the nomogram model in predicting the risk of GDM. This method is helpful for early diagnosis and appropriate intervention of GDM.
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Affiliation(s)
- Qing Lin
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Zhuan-Ji Fang
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian Province, China
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Olga L, Vervoort J, van Diepen JA, Gross G, Petry CJ, Prentice PM, Chichlowski M, van Tol EAF, Hughes IA, Dunger DB, Ong KK. Associations between breast milk intake volume, macronutrient intake and infant growth in a longitudinal birth cohort: the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF). Br J Nutr 2023; 130:56-64. [PMID: 36259139 PMCID: PMC10244014 DOI: 10.1017/s0007114522003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 02/16/2023]
Abstract
Growth patterns of breastfed infants show substantial inter-individual differences, partly influenced by breast milk (BM) nutritional composition. However, BM nutritional composition does not accurately indicate BM nutrient intakes. This study aimed to examine the associations between both BM intake volumes and macronutrient intakes with infant growth. Mother-infant dyads (n 94) were recruited into the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF) from a single maternity hospital at birth; all infants received exclusive breast-feeding (EBF) for at least 6 weeks. Infant weight, length and skinfolds thicknesses (adiposity) were repeatedly measured from birth to 12 months. Post-feed BM samples were collected at 6 weeks to measure TAG (fat), lactose (carbohydrate) (both by 1H-NMR) and protein concentrations (Dumas method). BM intake volume was estimated from seventy infants between 4 and 6 weeks using dose-to-the-mother deuterium oxide (2H2O) turnover. In the full cohort and among sixty infants who received EBF for 3+ months, higher BM intake at 6 weeks was associated with initial faster growth between 0 and 6 weeks (β + se 3·58 + 0·47 for weight and 4·53 + 0·6 for adiposity gains, both P < 0·0001) but subsequent slower growth between 3 and 12 months (β + se - 2·27 + 0·7 for weight and -2·65 + 0·69 for adiposity gains, both P < 0·005). BM carbohydrate and protein intakes at 4-6 weeks were positively associated with early (0-6 weeks) but tended to be negatively related with later (3-12 months) adiposity gains, while BM fat intake showed no association, suggesting that carbohydrate and protein intakes may have more functional relevance to later infant growth and adiposity.
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Affiliation(s)
- Laurentya Olga
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Jacques Vervoort
- Department of Agrotechnology and Food Sciences, Wageningen University, Wageningen, the Netherlands
| | - Janna A. van Diepen
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Nijmegen, the Netherlands; Evansville, IN, USA
| | - Gabriele Gross
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Nijmegen, the Netherlands; Evansville, IN, USA
| | - Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Maciej Chichlowski
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Nijmegen, the Netherlands; Evansville, IN, USA
| | - Eric A. F. van Tol
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Nijmegen, the Netherlands; Evansville, IN, USA
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, CB2 0QQ, UK
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Abstract
Gestational diabetes mellitus (GDM) traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy. GDM has long been associated with obstetric and neonatal complications primarily relating to higher infant birthweight and is increasingly recognized as a risk factor for future maternal and offspring cardiometabolic disease. The prevalence of GDM continues to rise internationally due to epidemiological factors including the increase in background rates of obesity in women of reproductive age and rising maternal age and the implementation of the revised International Association of the Diabetes and Pregnancy Study Groups' criteria and diagnostic procedures for GDM. The current lack of international consensus for the diagnosis of GDM reflects its complex historical evolution and pragmatic antenatal resource considerations given GDM is now 1 of the most common complications of pregnancy. Regardless, the contemporary clinical approach to GDM should be informed not only by its short-term complications but also by its longer term prognosis. Recent data demonstrate the effect of early in utero exposure to maternal hyperglycemia, with evidence for fetal overgrowth present prior to the traditional diagnosis of GDM from 24 weeks' gestation, as well as the durable adverse impact of maternal hyperglycemia on child and adolescent metabolism. The major contribution of GDM to the global epidemic of intergenerational cardiometabolic disease highlights the importance of identifying GDM as an early risk factor for type 2 diabetes and cardiovascular disease, broadening the prevailing clinical approach to address longer term maternal and offspring complications following a diagnosis of GDM.
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Affiliation(s)
- Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Helen R Murphy
- Diabetes in Pregnancy Team, Cambridge University Hospitals, Cambridge, UK
- Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, UK
- Division of Women’s Health, Kings College London, London, UK
| | - Glynis P Ross
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Diet-Treated Gestational Diabetes Mellitus Is an Underestimated Risk Factor for Adverse Pregnancy Outcomes: A Swedish Population-Based Cohort Study. Nutrients 2022; 14:nu14163364. [PMID: 36014870 PMCID: PMC9414969 DOI: 10.3390/nu14163364] [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: 07/09/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
In Sweden, diet-treated gestational diabetes mellitus (GDM) pregnancies have been managed as low risk. The aim was to evaluate the risk of adverse perinatal outcomes among women with diet-treated GDM compared with the background population and with insulin-treated GDM. This is a population-based cohort study using national register data between 1998 and 2012, before new GDM management guidelines and diagnostic criteria in Sweden were introduced. Singleton pregnancies (n = 1,455,580) without pregestational diabetes were included. Among 14,242 (1.0%) women diagnosed with GDM, 8851 (62.1%) were treated with diet and 5391 (37.9%) with insulin. In logistic regression analysis, the risk was significantly increased in both diet- and insulin-treated groups (vs. background) for large-for-gestational-age newborns, preeclampsia, cesarean section, birth trauma and preterm delivery. The risk was higher in the insulin-treated group (vs. diet) for most outcomes, but perinatal mortality rates neither differed between treatment groups nor compared to the background population. Diet as a treatment for GDM did not normalize pregnancy outcomes. Pregnancies with diet-treated GDM should therefore not be considered as low risk. Whether changes in surveillance and treatment improve outcomes needs to be evaluated.
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Chen Z, Zhang Z, Wang Z, Zhang Z, Wang Q, Pan Y. Heterozygosity and homozygosity regions affect reproductive success and the loss of reproduction: a case study with litter traits in pigs. Comput Struct Biotechnol J 2022; 20:4060-4071. [PMID: 35983229 PMCID: PMC9364102 DOI: 10.1016/j.csbj.2022.07.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/23/2022] Open
Abstract
Runs of heterozygosity (ROHet) and homozygosity (ROH) harbor useful information related to traits of interest. There is a lack of investigating the effect of ROHet and ROH on reproductive success and the loss of reproduction in mammals. Here, we detected and characterized the ROHet and ROH patterns in the genomes of Chinese indigenous pigs (i.e., Jinhua, Chun’an, Longyou Black, and Shengxian Spotted pigs), revealing the similar genetic characteristics of indigenous pigs. Later, we highlighted the underlying litter traits-related ROHet and ROH using association analysis with linear model in these four indigenous pig breeds. To pinpoint the promising candidate genes associated with litter traits, we further in-depth explore the selection patterns of other five pig breeds (i.e., Erhualian, Meishan, Minzhu, Rongchang, and Diqing pigs) with different levels of reproduction performance at the underlying litter traits-related ROHet and ROH using FST and genetic diversity ratio. Then, we identified a set of known and novel candidate genes associated with reproductive performance in pigs. For the novel candidate genes (i.e., CCDC91, SASH1, SAMD5, MACF1, MFSD2A, EPC2, and MBD5), we obtained public available datasets and performed multi-omics analyses integrating transcriptome-wide association studies and comparative single-cell RNA-seq analyses to uncover the roles of them in mammalian reproductive performance. The genes have not been widely reported to be fertility-related genes and can be complementally considered as prior biological information to modify genomic selections models that benefits pig genetic improvement of litter traits. Besides, our findings provide new insights into the function of ROHet and ROH in mammals.
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Li C, Cai Y, Li Y, Peng B, Liu Y, Wang Z, Yang T, Hu Y, Fu Y, Shi T, Peng H, Zhang Y, Chen J, Li T, Chen L. Well-controlled gestational diabetes mellitus without pharmacologic therapy decelerates weight gain in infancy. Front Endocrinol (Lausanne) 2022; 13:1063989. [PMID: 36601002 PMCID: PMC9807162 DOI: 10.3389/fendo.2022.1063989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
AIM There are no prospective longitudinal studies on the association between well-controlled gestational diabetes mellitus (GDM) without pharmacologic therapy and the physical growth of offspring in infancy. We aimed to identify the trajectories in physical growth (from 0-12 months of age) in the offspring of mothers with well-controlled GDM without pharmacologic therapy in a prospective cohort in China. METHODS This study included 236 offspring of mothers with GDM and 369 offspring of mothers without GDM. Mothers with GDM were not on pharmacologic therapy. The length and weight of infants were measured at 0, 1, 3, 6, and 12 months. Linear mixed-effect models and linear mixed-effect models were applied. RESULTS The fully adjusted model showed that the weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and BMI-for-age z-score (BMIZ) were similar at birth for the GDM and control groups. However, subsequent increases in WAZ and BMIZ for the GDM group lagged the increases for the control group at the subsequent periods of observation, 0-1, 0-6, and 0-12 months. CONCLUSIONS Well-controlled GDM without pharmacologic therapy may normalize physical growth of offspring at birth and decelerate their weight gain in infancy. Whether glycemic control can mitigate the long-term effects of GDM on the growth trajectory in offspring remains unclear.
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Affiliation(s)
- Chao Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yixi Cai
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yinying Li
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Bin Peng
- School of Public Health and Management, Department of Health Statistics, Chongqing Medical University, Chongqing, China
| | - Yongfang Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Zhenming Wang
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Ting Yang
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yirong Hu
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yajun Fu
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Tingmei Shi
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Hong Peng
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yue Zhang
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Jie Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Tingyu Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Li Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- *Correspondence: Li Chen, ;;
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12
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Chae SA, Son JS, Du M. Prenatal exercise in fetal development: a placental perspective. FEBS J 2021; 289:3058-3071. [PMID: 34449982 DOI: 10.1111/febs.16173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/09/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
Maternal obesity (MO) and gestational diabetes mellitus (GDM) are common in Western societies, which impair fetal development and predispose offspring to metabolic dysfunction. Placenta is the organ linking the mother to her fetus, and MO suppresses the development of vascular system and expression of nutrient transporters in placenta, thereby affecting fetal development. For maintaining its proper physiological function, placenta is energy demanding, which is met through extensive oxidative phosphorylation. However, the oxidative capacity of placenta is suppressed due to MO and GDM. Recently, several studies showed that physical activity during pregnancy enhances oxidative metabolism and improves placental function, which might be partially mediated by exerkines, referring to cytokines elicited by exercise. In addition, as an endocrine organ, placenta secretes cytokines, termed placentokines, including apelin, superoxide dismutase 3, irisin, and adiponectin, which mediate fetal development and maternal metabolism. Possible molecular mechanisms linking maternal exercise and placentokines to placental and fetal development are further discussed. As an emerging field, up to now, available studies are limited, mostly conducted in rodents. Given the epidemics of obesity and metabolic disorders, as well as the prevalence of maternal sedentary lifestyle, the effects of exercise of pregnant women on placental function and placentokine secretion, as well as their impacts on fetal development, need to be further examined.
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Affiliation(s)
- Song Ah Chae
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Jun Seok Son
- Laboratory of Perinatal Kinesioepigenetics, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Du
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
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13
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Extensive Study of Breast Milk and Infant Growth: Protocol of the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF). Nutrients 2021; 13:nu13082879. [PMID: 34445039 PMCID: PMC8400677 DOI: 10.3390/nu13082879] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022] Open
Abstract
Growth and nutrition during early life have been strongly linked to future health and metabolic risks. The Cambridge Baby Growth Study (CBGS), a longitudinal birth cohort of 2229 mother-infant pairs, was set up in 2001 to investigate early life determinant factors of infant growth and body composition in the UK setting. To carry out extensive profiling of breastmilk intakes and composition in relation to infancy growth, the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF) was established upon the original CBGS. The strict inclusion criteria were applied, focusing on a normal birth weight vaginally delivered infant cohort born of healthy and non-obese mothers. Crucially, only infants who were exclusively breastfed for the first 6 weeks of life were retained in the analysed study sample. At each visit from birth, 2 weeks, 6 weeks, and then at 3, 6, 12, 24, and 36 months, longitudinal anthropometric measurements and blood spot collections were conducted. Infant body composition was assessed using air displacement plethysmography (ADP) at 6 weeks and 3 months of age. Breast milk was collected for macronutrients and human milk oligosaccharides (HMO) measurements. Breast milk intake volume was also estimated, as well as sterile breastmilk and infant stool collection for microbiome study.
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14
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Associations between Maternal Iron Supplementation in Pregnancy and Changes in Offspring Size at Birth Reflect Those of Multiple Micronutrient Supplementation. Nutrients 2021; 13:nu13072480. [PMID: 34371987 PMCID: PMC8308651 DOI: 10.3390/nu13072480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 02/03/2023] Open
Abstract
It was previously observed that in a population of a high-income country, dietary multiple micronutrient supplementation in pregnancy was associated with an increased risk of gestational diabetes (GDM) and increased offspring size at birth. In this follow-up study, we investigated whether similar changes are observed with dietary iron supplementation. For this we used the prospective Cambridge Baby Growth Study with records of maternal GDM status, nutrient supplementation, and extensive offspring birth size measurements. Maternal iron supplementation in pregnancy was associated with GDM development (risk ratio 1.67 (1.01-2.77), p = 0.048, n = 677) as well as offspring size and adiposity (n = 844-868) at birth in terms of weight (β' = 0.078 (0.024-0.133); p = 0.005), head circumference (β' = 0.060 (0.012-0.107); p = 0.02), body mass index (β' = 0.067 (0.014-0.119); p = 0.01), and various skinfold thicknesses (β' = 0.067-0.094; p = 0.03-0.003). In a subset of participants for whom GDM statuses were available, all these associations were attenuated by adjusting for GDM. Iron supplementation also attenuated the associations between multiple micronutrient supplementation and these same measures. These results suggest that iron supplementation may mediate the effects associated with multiple micronutrient supplementation in pregnancy in a high-income country, possibly through the increased risk of developing GDM.
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15
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Petry CJ, Burling KA, Barker P, Hughes IA, Ong KK, Dunger DB. Pregnancy Serum DLK1 Concentrations Are Associated With Indices of Insulin Resistance and Secretion. J Clin Endocrinol Metab 2021; 106:e2413-e2422. [PMID: 33640968 PMCID: PMC8424055 DOI: 10.1210/clinem/dgab123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Delta like noncanonical notch ligand 1 (DLK1) is a paternally expressed imprinted gene that encodes an epidermal growth factor repeat-containing transmembrane protein. A bioactive, truncated DLK1 protein is present in the circulation and has roles in development and metabolism. OBJECTIVE We sought to investigate links between maternal pregnancy circulating DLK1 concentrations and: (1) maternal and fetal DLK1 genotypes, (2) maternal insulin resistance and secretion, and (3) offspring size at birth. PATIENTS, DESIGN, AND SETTING We measured third-trimester maternal serum DLK1 concentrations and examined their associations with parentally transmitted fetal and maternal DLK1 genotypes, indices of maternal insulin resistance and secretion derived from 75-g oral glucose tolerance tests performed around week 28 of pregnancy, and offspring size at birth in 613 pregnancies from the Cambridge Baby Growth Study. RESULTS Maternal DLK1 concentrations were associated with the paternally transmitted fetal DLK1 rs12147008 allele (P = 7.8 × 10-3) but not with maternal rs12147008 genotype (P = 0.4). Maternal DLK1 concentrations were positively associated with maternal prepregnancy body mass index (P = 3.5 × 10-6), and (after adjustment for maternal body mass index) with both maternal fasting insulin resistance (Homeostatic Model Assessment of Insulin Resistance: P = 0.01) and measures of maternal insulin secretion in response to oral glucose (insulinogenic index: P = 1.2 × 10-3; insulin disposition index: P = 0.049). Further positive associations were found with offspring weight (P = 0.02) and head circumference at birth (P = 0.04). CONCLUSION These results are consistent with a partial paternal or placental origin for the maternal circulating DLK1 which may lead to increased maternal circulating DLK1 concentrations, stimulation of maternal insulin resistance and compensatory hyperinsulinemia during pregnancy, and the promotion of fetal growth.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- Correspondence: Clive Petry, Department of Paediatrics, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - Keith A Burling
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Peter Barker
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
| | - Ken K Ong
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- MRC Epidemiology Unit, Cambridge Biomedical Campus, Cambridge, UK
- Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - David B Dunger
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
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16
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Petry CJ, Ong KK, Hughes IA, Dunger DB. Folic acid supplementation during pregnancy and associations with offspring size at birth and adiposity: a cohort study. BMC Res Notes 2021; 14:160. [PMID: 33931129 PMCID: PMC8086326 DOI: 10.1186/s13104-021-05575-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
Objective Previously we observed that maternal multiple micronutrient supplementation in pregnancy was associated with increased offspring size at birth and adiposity, as well as with maternal gestational diabetes risk, in the Cambridge Baby Growth Study. In this study we therefore investigated whether folic acid supplementation specifically is associated with similar changes, to test the hypothesis that folic acid supplementation mediates such changes. Results The majority of mothers who reported supplementing with folic acid in pregnancy (n = 776 in total, 526 of which took multiple micronutrient preparations) did so either from pre- (n = 139) or post-conception (n = 637) largely for all or just the first half of pregnancy. A minority of mothers (n = 198) reported not supplementing with folic acid. Folic acid supplementation in pregnancy was not associated with birth weight [β’ = − 0.003, p = 0.9], height [β’ = − 0.013, p = 0.6], head circumference [β’ = 0.003, p = 0.09] or adiposity (ponderal index [β’ = 0.020, p = 0.5], skinfolds thicknesses [β’ = − 0.029 to + 0.008, p = 0.4–0.9]). Neither was it associated with the development of maternal gestational diabetes (risk ratio 1.2 [0.6‒2.2], p = 0.6). These results suggest that folic acid supplementation in pregnancy did not mediate the previously observed increases in offspring size at birth and adiposity, or the raised gestational diabetes risk, in response to supplementation with multiple micronutrients.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.,MRC Department of Epidemiology, University of Cambridge, Cambridge, UK.,Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.,Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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17
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Huvinen E, Tuomaala AK, Bergman PH, Meinilä J, Tammelin T, Kulmala J, Engberg E, Koivusalo SB. Ascending Growth is Associated with Offspring Adiposity in Pregnancies Complicated with Obesity or Gestational Diabetes. J Clin Endocrinol Metab 2021; 106:e1993-e2004. [PMID: 33524144 DOI: 10.1210/clinem/dgaa979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Early growth is associated with childhood adiposity, but the influence of lifestyle remains unknown. OBJECTIVE This work aimed to investigate the association of growth profiles from high-risk pregnancies with adiposity at age 5 years, taking into account lifestyle and several antenatal/postnatal exposures. METHODS This prospective cohort study. INCLUDED 609 children born during the Finnish Gestational Diabetes Prevention Study (RADIEL), recruiting women with body mass index (BMI) greater than or equal to 30 and/or prior gestational diabetes mellitus (GDM) (2008-2013). Altogether 332 children attended the 5-year follow-up (2014-2017). Main outcome measures included growth profiles based on ponderal index (PI = weight/height3), investigated using latent class mixed models. Adiposity was assessed with anthropometrics and body composition (InBody720). RESULTS We identified 3 growth profiles: ascending (n = 82), intermediate (n = 351), and descending (n = 149). Children with ascending growth had a higher body fat percentage, ISO-BMI, and waist circumference (P < .05) at age 5 years. Ascending (β 4.09; CI, 1.60-6.58) and intermediate (β 2.27; CI, 0.50-4.03) profiles were associated with higher fat percentage, even after adjustment for age, sex, gestational age, diet, physical activity, education, and prepregnancy BMI. Similar associations existed with ISO-BMI. After adjusting for age and education, ascending growth was associated with prepregnancy BMI (odds ratio [OR] 1.06; CI, 1.01-1.12), primiparity (OR 3.07; CI, 1.68-5.62), cesarean delivery (OR 2.23; CI, 1.18-4.21), and lifestyle intervention (OR 2.56; CI, 1.44-4.57). However, meeting the intervention goals and exclusive breastfeeding for 3 months or more were associated with lower odds of ascending growth. CONCLUSION Accelerated early growth was associated with higher adiposity in 5-year-old children from high-risk pregnancies, even when adjusted for lifestyle. Reducing cesarean deliveries and promoting breastfeeding may be beneficial for postnatal growth.
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Affiliation(s)
- Emilia Huvinen
- Teratology Information Service, Emergency Medicine, Department of Prehospital Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paula H Bergman
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jelena Meinilä
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Tuija Tammelin
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Janne Kulmala
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Elina Engberg
- Folkhälsan Research Center, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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18
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Herath MP, Beckett JM, Hills AP, Byrne NM, Ahuja KDK. Gestational Diabetes Mellitus and Infant Adiposity at Birth: A Systematic Review and Meta-Analysis of Therapeutic Interventions. J Clin Med 2021; 10:jcm10040835. [PMID: 33670645 PMCID: PMC7922793 DOI: 10.3390/jcm10040835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 12/16/2022] Open
Abstract
Exposure to untreated gestational diabetes mellitus (GDM) in utero increases the risk of obesity and type 2 diabetes in adulthood, and increased adiposity in GDM-exposed infants is suggested as a plausible mediator of this increased risk of later-life metabolic disorders. Evidence is equivocal regarding the impact of good glycaemic control in GDM mothers on infant adiposity at birth. We systematically reviewed studies reporting fat mass (FM), percent fat mass (%FM) and skinfold thicknesses (SFT) at birth in infants of mothers with GDM controlled with therapeutic interventions (IGDMtr). While treating GDM lowered FM in newborns compared to no treatment, there was no difference in FM and SFT according to the type of treatment (insulin, metformin, glyburide). IGDMtr had higher overall adiposity (mean difference, 95% confidence interval) measured with FM (68.46 g, 29.91 to 107.01) and %FM (1.98%, 0.54 to 3.42) but similar subcutaneous adiposity measured with SFT, compared to infants exposed to normal glucose tolerance (INGT). This suggests that IGDMtr may be characterised by excess fat accrual in internal adipose tissue. Given that intra-abdominal adiposity is a major risk factor for metabolic disorders, future studies should distinguish adipose tissue distribution of IGDMtr and INGT.
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19
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Olga L, van Diepen J, Bobeldijk-Pastorova I, Gross G, Prentice P, Snowden S, Furse S, Kooistra T, Hughes I, Schoemaker M, van Tol E, van Duyvenvoorde W, Wielinga P, Ong K, Dunger D, Kleemann R, Koulman A. Lipid ratios representing SCD1, FADS1, and FADS2 activities as candidate biomarkers of early growth and adiposity. EBioMedicine 2021; 63:103198. [PMID: 33421943 PMCID: PMC7806876 DOI: 10.1016/j.ebiom.2020.103198] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Altered lipid metabolism in early life has been associated with subsequent weight gain and predicting this could aid in obesity prevention and risk management. Here, a lipidomic approach was used to identify circulating markers for future obesity risk in translational murine models and validate in a human infant cohort. METHODS Lipidomics was performed on the plasma of APOE*3 Leiden, Ldlr-/-.Leiden, and the wild-type C57BL/6J mice to capture candidate biomarkers predicting subsequent obesity parameters after exposure to high-fat diet. The identified candidate biomarkers were mapped onto corresponding lipid metabolism pathways and were investigated in the Cambridge Baby Growth Study. Infants' growth and adiposity were measured at 0-24 months. Capillary dried blood spots were sampled at 3 months for lipid profiling analysis. FINDINGS From the mouse models, cholesteryl esters were correlated with subsequent weight gain and other obesity parameters after HFD period (Spearman's r≥0.5, FDR p values <0.05) among APOE*3 Leiden and Ldlr-/-.Leiden mice, but not among the wild-type C57BL/6J. Pathway analysis showed that those identified cholesteryl esters were educts or products of desaturases activities: stearoyl-CoA desaturase-1 (SCD1) and fatty acid desaturase (FADS) 1 and 2. In the human cohort, lipid ratios affected by SCD1 at 3 months was inversely associated with 3-12 months weight gain (B±SE=-0.31±0.14, p=0.027), but positively with 12-24 months weight and adiposity gains (0.17±0.07, p=0.02 and 0.17±0.07, 0.53±0.26, p=0.04, respectively). Lipid ratios affected by SCD1 and FADS2 were inversely associated with adiposity gain but positively with height gain between 3-12 months. INTERPRETATION From murine models to human setting, the ratios of circulating lipid species indicating key desaturase activities in lipid metabolism were associated with subsequent body size increase, providing a potential tool to predict early life weight gain.
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Affiliation(s)
- L. Olga
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - J.A. van Diepen
- Mead Johnson Pediatric Nutrition Institute, Nijmegen, the Netherlands
| | - I. Bobeldijk-Pastorova
- Department of Metabolic Health Research, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - G. Gross
- Mead Johnson Pediatric Nutrition Institute, Nijmegen, the Netherlands
| | - P.M. Prentice
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - S.G. Snowden
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - S. Furse
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - T. Kooistra
- Department of Metabolic Health Research, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - I.A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - M.H. Schoemaker
- Mead Johnson Pediatric Nutrition Institute, Nijmegen, the Netherlands
| | - E.A.F. van Tol
- Mead Johnson Pediatric Nutrition Institute, Nijmegen, the Netherlands,Department of Metabolic Health Research, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - W. van Duyvenvoorde
- Department of Metabolic Health Research, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - P.Y. Wielinga
- Department of Metabolic Health Research, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - K.K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge, UK,MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK,Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories’ or (IMS-MRL), University of Cambridge, Cambridge, UK
| | - D.B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK,Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories’ or (IMS-MRL), University of Cambridge, Cambridge, UK
| | - R. Kleemann
- Department of Metabolic Health Research, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands,Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A. Koulman
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK,MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK,Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories’ or (IMS-MRL), University of Cambridge, Cambridge, UK,Corresponding author: Dr Albert Koulman, Scientific Director of the NIHR BRC Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science-Metabolic Research Laboratories University of Cambridge School of Clinical Medicine Cambridge Biomedical Campus Cambridge CB2 0QQ United Kingdom. Telephone: +44 (0)1223 336792+44 (0)1223 336792+44 (0)1223 336792
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20
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Schütte T, Kedziora SM, Haase N, Herse F, Busjahn A, Birukov A, Alenina N, Müller DN, Bader M, Schupp M, Dechend R, Kräker K, Golic M. Intrauterine Exposure to Diabetic Milieu Does Not Induce Diabetes and Obesity in Male Adulthood in a Novel Rat Model. Hypertension 2020; 77:202-215. [PMID: 33249866 DOI: 10.1161/hypertensionaha.120.16360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several studies show an association of maternal diabetes during pregnancy with adverse offspring metabolic health. Other studies, however, suggest that this effect might be biased by obesity, which is independently associated with offspring metabolic disease and often coexistent to maternal diabetes. We performed a prospective study in a rat model to test the hypothesis that the burden of a diabetic pregnancy without obesity deteriorates metabolic health in male offspring. We generated maternal type 2 diabetes before conception that persisted during pregnancy by knockdown of the insulin receptor in small hairpin RNA-expressing transgenic rats. Male WT (wild type) offspring were followed up until adulthood and metabolically challenged by high-fat diet. Blood glucose was measured continuously via a telemetry device. Glucose and insulin tolerance tests were performed, and body composition was analyzed. Weight gain and glucose levels during adolescence and adulthood were similar in male offspring of diabetic and control pregnancies. Body weight and fat mass after high-fat diet, as well as glucose and insulin tolerance tests, were unaltered between male adult offspring of both groups. Glycemic control consisting of up to 49 000 individual glucose measures was comparable between both groups. Intrauterine exposure to maternal hyperglycemia and hyperinsulinemia without obesity had no impact on male offspring metabolic health in our model. We conclude that the intrauterine exposure itself does not represent a mechanism for fetal programming of diabetes and obesity in our model. Other maternal metabolic parameters during pregnancy, such as obesity, might impact long-term offspring metabolic health.
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Affiliation(s)
- Till Schütte
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Institute of Pharmacology, Berlin, Germany (T.S., M.S.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.)
| | - Sarah M Kedziora
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.).,Experimental and Clinical Research Center-a joint cooperation between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin Berlin, Germany (S.M.K., N.H., F.H., A. Birukov, D.N.M., R.D., K.K., M.G.)
| | - Nadine Haase
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.).,Experimental and Clinical Research Center-a joint cooperation between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin Berlin, Germany (S.M.K., N.H., F.H., A. Birukov, D.N.M., R.D., K.K., M.G.)
| | - Florian Herse
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.).,Experimental and Clinical Research Center-a joint cooperation between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin Berlin, Germany (S.M.K., N.H., F.H., A. Birukov, D.N.M., R.D., K.K., M.G.)
| | | | - Anna Birukov
- German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Experimental and Clinical Research Center-a joint cooperation between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin Berlin, Germany (S.M.K., N.H., F.H., A. Birukov, D.N.M., R.D., K.K., M.G.).,Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany (A. Birukov).,German Center for Diabetes Research, München-Neuherberg, Germany (A. Birukov)
| | - Natalia Alenina
- Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.)
| | - Dominik N Müller
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.).,Experimental and Clinical Research Center-a joint cooperation between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin Berlin, Germany (S.M.K., N.H., F.H., A. Birukov, D.N.M., R.D., K.K., M.G.)
| | - Michael Bader
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.).,Institute for Biology, University of Lübeck, Germany (M.B.)
| | - Michael Schupp
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Institute of Pharmacology, Berlin, Germany (T.S., M.S.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.)
| | - Ralf Dechend
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.).,Experimental and Clinical Research Center-a joint cooperation between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin Berlin, Germany (S.M.K., N.H., F.H., A. Birukov, D.N.M., R.D., K.K., M.G.).,HELIOS Klinikum, Department of Cardiology and Nephrology, Berlin, Germany (R.D.)
| | - Kristin Kräker
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.).,Experimental and Clinical Research Center-a joint cooperation between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin Berlin, Germany (S.M.K., N.H., F.H., A. Birukov, D.N.M., R.D., K.K., M.G.)
| | - Michaela Golic
- From the Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., D.N.M., M.B., M.S., R.D., K.K., M.G.).,Berlin Institute of Health, Germany (T.S., S.M.K., N.H., F.H., N.A., D.N.M., M.B., M.S., R.D., K.K., M.G.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (T.S., S.M.K., N.H., A. Birukov, N.A., D.N.M., M.B., R.D., K.K., M.G.).,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (S.M.K., N.H., F.H., N.A., D.N.M., M.B., R.D., K.K., M.G.).,Experimental and Clinical Research Center-a joint cooperation between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin Berlin, Germany (S.M.K., N.H., F.H., A. Birukov, D.N.M., R.D., K.K., M.G.)
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21
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Huang SJ, Wang HW, Wu HF, Wei QY, Luo S, Xu L, Guan HQ. Osteoprotegerin, interleukin and hepatocyte growth factor for prediction of diabetes and hypertension in the third trimester of pregnancy. World J Clin Cases 2020; 8:5529-5534. [PMID: 33344543 PMCID: PMC7716305 DOI: 10.12998/wjcc.v8.i22.5529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women. Screening and management of GDM and gestational hypertension (GH) in pregnancy helps to control and reduce these risks and prevent adverse effects on mothers and their fetuses. Currently, the majority criteria used for screening of diabetes mellitus is oral glucose tolerance tests, and blood pressure test is usually used for the screening and diagnosis of hypertension. However, these criteria might not anticipate or detect all GDM or GH cases. Therefore, new specific predictive and diagnostic tools should be evaluated for this population. This study selected three biomarkers of osteoprotegerin (OPG), interleukin (IL) and hepatocyte growth factor (HGF) for GDM and GH predication and diagnosis.
AIM To explore the feasibility of changes in placental and serum OPG, IL and HGF as tools for prediction and diagnosis of diabetes and hypertension in pregnant women.
METHODS From January 2018 to January 2019, 44 pregnant women with GDM and GH were selected as an observation group, and 44 healthy pregnant women were selected as a control group in the same period. Serum OPG, IL and HGF were compared between the two groups.
RESULTS The levels of OPG and HGF in the observation group were lower than in the control group, and the level of IL-1β was higher in the observation group than in the control group (all P < 0.05). Furthermore, OPG and HGF were negatively associated with gestational diabetes and gestational hypertension, while IL-1β was positively associated with GDM complicated with GH (all P < 0.05).
CONCLUSION The evaluation of serum OPG, HGF and IL-1β levels in patients with coexistent gestational diabetes complicated with hypertension can predict the degree of disease and play an important role in the follow-up treatment and prognosis prediction.
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Affiliation(s)
- Su-Jing Huang
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Hong-Wei Wang
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Hai-Fang Wu
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Qiu-Yuan Wei
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Shu Luo
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Lin Xu
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
| | - Hong-Qiong Guan
- Department of Obstetrics, The Second Affiliated Hospital of Hainan Medical College, Haikou 570311, Hainan Province, China
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22
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Petry CJ, Ong KK, Hughes IA, Dunger DB. Multiple Micronutrient Supplementation during Pregnancy and Increased Birth Weight and Skinfold Thicknesses in the Offspring: The Cambridge Baby Growth Study. Nutrients 2020; 12:nu12113466. [PMID: 33198145 PMCID: PMC7697774 DOI: 10.3390/nu12113466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 01/08/2023] Open
Abstract
Multiple micronutrient supplementation (MMS) in pregnancy has previously been associated with positive effects on fetal growth, but its value in high-income countries remains controversial. In this study, we investigated effects of pregnancy MMS on offspring size at birth and adiposity, along with risks of various maternal outcomes of pregnancy, using the prospective Cambridge Baby Growth Study. Maternal MMS was reported in 528 out of 970 women who completed pregnancy questionnaires. Gestational diabetes (GDM) was assessed using results from 75 g oral glucose tolerance tests at week 28 of pregnancy. Offspring size at birth was assessed using standard anthropometric measurements and adiposity using skinfold calipers. MMS was associated with increased risk of developing GDM (risk ratio = 1.86 (1.13–3.08), p = 0.02), as well as increased offspring size at birth in terms of weight (p = 0.03), head circumference (p = 0.04), and flank, and subscapular and triceps skinfold thicknesses (p = 0.04, 0.03, and 0.003, respectively). There was no association with quadriceps skinfold thickness (p = 0.2), suggesting that the increased adiposity was partially regionalized. In women who underwent oral glucose tolerance testing, nearly all of these associations were attenuated by adjusting for GDM. These results suggest that the increased offspring size at birth, including (regionalized) adiposity associated with pregnancy, and MMS may be partially related to the development of GDM.
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Affiliation(s)
- Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Correspondence: ; Tel.: +44-(0)1223-762945
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- MRC Department of Epidemiology, University of Cambridge, Cambridge CB2 0SL, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
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23
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Codner E. Metabolic Problems in the Offspring of Women with Gestational Diabetes and Obesity: An Opportunity for Prevention. J Clin Endocrinol Metab 2020; 105:5846187. [PMID: 32453829 DOI: 10.1210/clinem/dgaa307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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24
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Quaresima P, Visconti F, Chiefari E, Mirabelli M, Borelli M, Caroleo P, Foti D, Puccio L, Venturella R, Di Carlo C, Brunetti A. Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia. J Diabetes Res 2020; 2020:5393952. [PMID: 33015192 PMCID: PMC7520011 DOI: 10.1155/2020/5393952] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Screening strategies for gestational diabetes mellitus (GDM) earlier than 24-28 weeks of gestation should be considered to prevent adverse pregnancy outcomes. Nonetheless, there is uncertainty about which women would benefit most from early screening and which screening strategies should be offered to women with GDM. The Italian National Healthcare Service (NHS) recommendations on selective screening for GDM at 16-18 weeks of gestation are effective in preventing fetal macrosomia in high-risk (HR) women, but the appropriateness of timing and effectiveness of these recommendations in medium- (MR) and low-risk (LR) women are still controversial. Patients and Methods. We retrospectively enrolled 769 consecutive singleton pregnant women who underwent both anomaly scan at 19-21 weeks of gestation and screening for GDM at 16-18 and/or 24-28 weeks of gestation, in agreement with the NHS recommendations and risk stratification criteria. Comparison of maternal characteristics, fetal biometric parameters at anomaly scan (head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)), and neonatal birth weight (BW) percentile among risk groups was examined. RESULTS 219 (28.5%) women were diagnosed with GDM, while 550 (71.5%) were normal glucose-tolerant women. Out of 164 HR women, only 62 (37.8%) underwent the recommended early screening for GDM at 16-18 weeks of gestation. AC and EFW percentiles, as well as neonates' BW percentiles, were significantly higher in HR women diagnosed with GDM at 24-28 weeks of gestation with respect to normal glucose-tolerant women, as well as MR and LR women who tested positive for GDM. Comparative analysis between MR and LR women with GDM and women with normal glucose tolerance revealed significant differences in both AC and EFW percentiles (P < 0.05), while there was no significant difference in neonatal BW percentiles. CONCLUSION In MR and LR women with GDM, a mild acceleration of fetal growth can be detected at the time of anomaly scan. However, in these at-risk categories, the NHS recommendations for screening and treatment of GDM at 24-28 weeks of gestation are still effective in normalizing BW and preventing fetal macrosomia, thus supporting a risk factor-based selective screening program for GDM.
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Affiliation(s)
- Paola Quaresima
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Federica Visconti
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Mirabelli
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Massimo Borelli
- UMG School of PhD Programmes Life Sciences and Technologies, University “Magna Græcia” of Catanzaro, Italy
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Italy
| | - Patrizia Caroleo
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Viale Pio X, 88100 Catanzaro, Italy
| | - Daniela Foti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Viale Pio X, 88100 Catanzaro, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Costantino Di Carlo
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
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25
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Petry CJ, Ong KK, Hughes IA, Acerini CL, Dunger DB. Temporal Trends in Maternal Food Intake Frequencies and Associations with Gestational Diabetes: The Cambridge Baby Growth Study. Nutrients 2019; 11:E2822. [PMID: 31752255 PMCID: PMC6893826 DOI: 10.3390/nu11112822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
Previous studies have suggested that in the first decade of this century the incidence of gestational diabetes (GDM) in pregnancy rose worldwide. In the Cambridge Baby Growth Study cohort we observed that this temporal trend was associated with an index of multiple deprivation and reductions in indices of insulin secretion. Deprivation level was not directly associated with GDM, suggesting that the temporal trend may relate more to other factors linked to it, such as dietary composition. In this study we investigated temporal trends in perceived food intake frequencies, derived from a qualitative, short questionnaire, in 865 pregnant Cambridge Baby Growth Study (CBGS) recruits. A number of food frequency ranks showed both temporal trends and associations with GDM, but of note is the frequency of egg consumption (negative temporal trend p = 0.03, slope = -6.2 ranks/year; negative association with GDM p = 3.0 × 10-8, slope = -0.002 increased risk/rank) as it was also positively associated with the insulin disposition index (p = 1.17 × 10-3, slope = 0.42 ranks. L/mmoL). These results are consistent with a potential protective effect of factors related to the frequency of egg consumption in pregnancy. Such factors may have contributed to the observed temporal trend in GDM risk but the overall detectable effect appears to have been small.
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Affiliation(s)
- Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- MRC Epidemiology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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