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Funatake CJ, Armendáriz M, Rauch S, Eskenazi B, Nomura Y, Hivert MF, Rifas-Shiman S, Oken E, Shiboski SC, Wojcicki JM. Validation of Variables for Use in Pediatric Obesity Risk Score Development in Demographically and Racially Diverse United States Cohorts. J Pediatr 2024; 275:114219. [PMID: 39095010 DOI: 10.1016/j.jpeds.2024.114219] [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: 02/26/2024] [Revised: 07/21/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To evaluate the performance of childhood obesity prediction models in four independent cohorts in the United States, using previously validated variables obtained easily from medical records as measured in different clinical settings. STUDY DESIGN Data from four prospective cohorts, Latinx, Eating, and Diabetes; Stress in Pregnancy Study; Project Viva; and Center for the Health Assessment of Mothers and Children of Salinas were used to test childhood obesity risk models and predict childhood obesity by ages 4 through 6, using five clinical variables (maternal age, maternal prepregnancy body mass index, birth weight Z-score, weight-for-age Z-score change, and breastfeeding), derived from a previously validated risk model and as measured in each cohort's clinical setting. Multivariable logistic regression was performed within each cohort, and performance of each model was assessed based on discrimination and predictive accuracy. RESULTS The risk models performed well across all four cohorts, achieving excellent discrimination. The area under the receiver operator curve was 0.79 for Center for the Health Assessment of Mothers and Children of Salinas and Project Viva, 0.83 for Stress in Pregnancy Study, and 0.86 for Latinx, Eating, and Diabetes. At a 50th percentile threshold, the sensitivity of the models ranged from 12% to 53%, and specificity was ≥ 90%. The negative predictive values were ≥ 80% for all cohorts, and the positive predictive values ranged from 62% to 86%. CONCLUSION All four risk models performed well in each independent and demographically diverse cohort, demonstrating the utility of these five variables for identifying children at high risk for developing early childhood obesity in the United States.
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Affiliation(s)
- Castle J Funatake
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Marcos Armendáriz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Stephen Rauch
- Center for Environmental Research and Children's Health, University of California, Berkeley, Berkeley, CA
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health, University of California, Berkeley, Berkeley, CA
| | - Yoko Nomura
- Department of Psychology, Queens College and Graduate Center, the City University of New York (CUNY), New York, NY; Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Sheryl Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Stephen C Shiboski
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Janet M Wojcicki
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
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Aziz F, Khan MF, Moiz A. Gestational diabetes mellitus, hypertension, and dyslipidemia as the risk factors of preeclampsia. Sci Rep 2024; 14:6182. [PMID: 38486097 PMCID: PMC10940289 DOI: 10.1038/s41598-024-56790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a known risk factor for gestational hypertension which further progress toward conditions like proteinuria, dyslipidemia, thrombocytopenia, pulmonary edema leading to Preeclampsia (PE). Pregnancy can be a challenging time for many women, especially those diagnosed with GDM and PE. Thus, the current prospective study investigates the association of OGTT glucose levels with systolic and diastolic blood pressure and lipid profile parameters in pregnant women diagnosed with GDM and PE. A total of 140 pregnant women were stratified into GDM (n = 50), PE (n = 40) and controls (n = 50). Two hour 75 g oral glucose tolerance test (OGTT) was performed for screening GDM. Biochemical parameters analysis of OGTT, total cholesterol (TC), triglyceride (Tg), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), urinary albumin and creatinine were tested to find urinary albumin creatinine ratio (uACR). Statistical analysis was performed using ANOVA followed by post hoc test and regression analysis. Among the studied groups, GDM and PE groups showed no significant difference in age and increased BMI. Increased 2 h OGTT & TC in GDM group; elevated uACR, systolic/diastolic blood pressure, Tg, HDL-C, LDL-C in PE group was observed and differ significantly (p < 0.0001) with other groups. A significant positive effect of 2 h OGTT was observed on blood pressure (R2: GDM = 0.85, PE = 0.71) and lipid profile determinants (R2: GDM = 0.85, PE = 0.33) at p < 0.0001. The current study concludes that glucose intolerance during the later weeks of pregnancy is associated with gestational hypertension and hyperlipidemia as a risk factor for PE. Further research is needed for a detailed assessment of maternal glucose metabolism at various pregnancy stages, including the use of more sensitive markers such as C-peptide and their relation to pregnancy-related hypertensive disorders.
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Affiliation(s)
- Farah Aziz
- Department of Basic Medical Science, College of Applied Medical Science, King Khalid University, Abha, Saudi Arabia.
| | - Mohammad Fareed Khan
- Department of Infection Prevention and Control, The Specialist Hospital, Abha, Saudi Arabia
| | - Amna Moiz
- Medical City, King Khalid University, Abha, Saudi Arabia
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Semnani-Azad Z, Gaillard R, Hughes AE, Boyle KE, Tobias DK, Perng W. Predictors and risk factors of short-term and long-term outcomes among women with gestational diabetes mellitus (GDM) and their offspring: Moving toward precision prognosis? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.14.23288199. [PMID: 37131686 PMCID: PMC10153333 DOI: 10.1101/2023.04.14.23288199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
As part of the American Diabetes Association Precision Medicine in Diabetes Initiative (PMDI) - a partnership with the European Association for the Study of Diabetes (EASD) - this systematic review is part of a comprehensive evidence evaluation in support of the 2 nd International Consensus Report on Precision Diabetes Medicine. Here, we sought to synthesize evidence from empirical research papers published through September 1 st , 2021 to evaluate and identify prognostic conditions, risk factors, and biomarkers among women and children affected by gestational diabetes mellitus (GDM), focusing on clinical endpoints of cardiovascular disease (CVD) and type 2 diabetes (T2D) among women with a history of GDM; and adiposity and cardiometabolic profile among offspring exposed to GDM in utero. We identified a total of 107 observational studies and 12 randomized controlled trials testing the effect of pharmaceutical and/or lifestyle interventions. Broadly, current literature indicates that greater GDM severity, higher maternal body mass index, belonging to racial/ethnic minority group; and unhealthy lifestyle behaviors would predict a woman's risk of incident T2D and CVD, and an unfavorable cardiometabolic profile among offspring. However, the level of evidence is low (Level 4 according to the Diabetes Canada 2018 Clinical Practice Guidelines for diabetes prognosis) largely because most studies leveraged retrospective data from large registries that are vulnerable to residual confounding and reverse causation bias; and prospective cohort studies that may suffer selection and attrition bias. Moreover, for the offspring outcomes, we identified a relatively small body of literature on prognostic factors indicative of future adiposity and cardiometabolic risk. Future high-quality prospective cohort studies in diverse populations with granular data collection on prognostic factors, clinical and subclinical outcomes, high fidelity of follow-up, and appropriate analytical approaches to deal with structural biases are warranted.
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Clinical implications of the 100-g oral glucose tolerance test in the third trimester. Arch Gynecol Obstet 2023; 307:421-429. [PMID: 35344083 DOI: 10.1007/s00404-022-06520-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/09/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The clinical implications of gestational diabetes mellitus (GDM) diagnosed in the third trimester are not well established and controversy continues regarding the performance of diagnostic tests beyond 28-week gestation. This study aimed to evaluate the incidence of abnormal third trimester oral glucose tolerance test (OGTT) results in women at high risk and to compare the obstetric and neonatal outcomes with those of women with normal OGTT results. METHODS The study included 372 women who completed late (>29 weeks) 100-g OGTT due to suspected fetal macrosomia, polyhydramnios or a personal risk factor for GDM, diagnosed according to the Carpenter & Coustan criteria. Women with only one abnormal OGTT value were diagnosed with GDM by abnormal glucose follow-up and analyzed separately. Obstetric and neonatal outcomes were compared between the GDM and the non-GDM groups. RESULTS GDM was diagnosed in 85/372 (22%) women, including 35 (59.3%) women with one abnormal OGTT value who were later diagnosed with GDM. Of 200 women who had a normal 1-h 50-g glucose challenge test at 24-28 weeks, late GDM was diagnosed in 33 (16.5%). Seventy-six (89.5%) of those with GDM were treated by dietary therapy and 9 (10.5%) by pharmacological therapy. Among women with GDM, large-for-gestational-age fetuses, labor induction and elective cesarean section were more prevalent than for those without GDM. Significant differences were not found between the groups in macrosomia and neonatal outcomes. CONCLUSIONS The performance of OGTT in women with risk factors during the third trimester should be considered following further prospective trials.
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Huang YD, Luo YR, Lee MC, Yeh CJ. Effect of maternal hypertensive disorders during pregnancy on offspring's early childhood body weight: A population-based cohort study. Taiwan J Obstet Gynecol 2022; 61:761-767. [PMID: 36088042 DOI: 10.1016/j.tjog.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE The prevalence of hypertensive disorder during pregnancy (HDP) and childhood obesity is increasing worldwide. HDP or obesity in mothers can increase the risk of overweight/obesity (OWOB) in their children. Few longitudinal studies have examined the associations of maternal body weight with the growth and risk factors for overweight in infants born to mothers with HDP. This study examined the risk factors for childhood OWOB through the age of 66 months in children born to mothers with HDP. MATERIALS AND METHODS In total, 24,200 pairs of mothers and their children were selected from the Taiwan Birth Cohort Study. The children's body weights were classified and analyzed to determine infant growth at birth and at the ages of 12, 24, 36, and 66 months. Multiple logistic regression analyses with different model settings were performed to identify the factors affecting growth and childhood OWOB in the children of mothers with HDP. RESULTS The average birth weight of children was lower in the HDP group than in the non-HDP group. The catch-up phenomenon began at the age of 18 months. The incidence of OWOB was higher in the children in the HDP group than in those in the non-HDP group from the age of 24 months and increased with the children's age. At every age point, maternal overweight before pregnancy was the main risk factor for childhood OWOB, and this effect increased with the children's age (odds ratio [OR]: 1.83 at 66 months). The effect of excessive maternal gestational weight gain on childhood OWOB was significant (OR: 1.26-1.44 for various age points). CONCLUSION Maternal overweight is the main risk factor for OWOB in children born to mothers with HDP. After adjusting for related confounders, we determined that HDP did not exert a significant effect on the risk of childhood OWOB.
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Affiliation(s)
- Yuan-Der Huang
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chia-Yi Hospital, Ministry of Health and Welfare, Chia-Yi, Taiwan
| | - Yun-Ru Luo
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; College of Management, Chaoyang University of Technology, Taichung, Taiwan.
| | - Chih-Jung Yeh
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan.
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Vakil P, Henry A, Craig ME, Gow ML. A review of infant growth and psychomotor developmental outcomes after intrauterine exposure to preeclampsia. BMC Pediatr 2022; 22:513. [PMID: 36042465 PMCID: PMC9426217 DOI: 10.1186/s12887-022-03542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Preeclampsia is a hypertensive disorder of pregnancy with serious health implications for mother and their offspring. The uteroplacental vascular insufficiency caused by preeclampsia is associated with epigenetic and pathological changes in the mother and fetus. However, the impact of preeclampsia in infancy (birth to 2 years), a time of rapid development influenced by pre- and postnatal factors that can predict future health outcomes, remains inconclusive. This narrative review of 23 epidemiological and basic science studies assessed the measurement and impact of preeclampsia exposure on infant growth and psychomotor developmental outcomes from birth to 2 years. Studies assessing infant growth report that preeclampsia-exposed infants have lower weight, length and BMI at 2 years than their normotensive controls, or that they instead experience accelerated weight gain to catch up in growth by 2 years, which may have long-term implications for their cardiometabolic health. In contrast, clear discrepancies remain as to whether preeclampsia exposure impairs infant motor and cognitive development, or instead has no impact. It is additionally unknown whether any impacts of preeclampsia are independent of confounders including shared genetic factors that predispose to both preeclampsia and childhood morbidity, perinatal factors including small for gestational age or preterm birth and their sequelae, and postnatal environmental factors such childhood nutrition. Further research is required to account for these variables in larger cohorts born at term, to help elucidate the independent pathophysiological impact of this clinically heterogenous and dangerous disease.
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Affiliation(s)
- Priya Vakil
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Maria E Craig
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, Australia.,University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia
| | - Megan L Gow
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia. .,Department of Women's and Children's Health, St George Hospital, Sydney, Australia. .,University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia.
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Ghorbani A, Hashemipour S, Mohammadi Z, Zohal M, Lalooha F. Appropriate neck/waist circumference cut-off points for gestational diabetes prediction in Iranian pregnant women: The baseline analysis of the Qazvin maternal and neonatal metabolic study (QMNMS), Iran. Diabetes Metab Syndr 2022; 16:102579. [PMID: 35921767 DOI: 10.1016/j.dsx.2022.102579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gestational diabetes is the most common complication during pregnancy and it is essential to identify the high-risk groups for gestational diabetes mellitus (GDM) in the first trimester. A large neck circumference (NC) in the first trimester is a measure of obesity. OBJECTIVE The present study investigated whether pregnant women's first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis. MATERIALS AND METHODS This longitudinal cohort study was conducted on 676 pregnant women aged ≥20 years. Pregnant women at 12-14th (baseline) gestational weeks underwent measurement of neck and other anthropometric indices. GDM was diagnosed with 75-g oral glucose tolerance test at 24-28th gestational week. RESULTS GDM was developed in 110 (16.3%) pregnant women. The logistic regression analysis showed that baseline NC > 33.5 cm (OR: 2.037, 95% CI: 1.313-3.161; P = 0.002) and WC > 90.5 (OR: 2.299, 95% CI: 1.510-3.501; p < 0.001) were independent predictors of GDM. The area under the receiver operating characteristic (ROC) curve analysis of baseline NC and WC for GDM prediction respectively yielded 0.614 (95% CI: 0.558-0.670, p < 0.001) and 0.641 (CI: 0.583-0.698, p < 0.001). The optimal cut-off level of maternal baseline NC was >33.5 cm, with 68.5% sensitivity and 48.3% specificity, and for baseline WC it was >90.5.50 cm, with 57% sensitivity and 63.4% specificity. CONCLUSION Pregnant women with an NC > 33.5 cm and a WC > 90.5 cm at baseline (12-14th gestational weeks) had a higher chance of developing GDM. first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis.
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Affiliation(s)
- Azam Ghorbani
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sima Hashemipour
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zahrasadat Mohammadi
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammadali Zohal
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Lalooha
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran.
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Zhu BB, Gao H, Geng ML, Wu X, Tong J, Deng F, Zhang SY, Wu LH, Huang K, Wu XY, Gan H, Zhu P, Tao FB. Sex Discrepancy Observed for Gestational Metabolic Syndrome Parameters and Polygenic Risk Associated With Preschoolers' BMI Growth Trajectory: The Ma'anshan Birth Cohort Study. Front Endocrinol (Lausanne) 2022; 13:857711. [PMID: 35846310 PMCID: PMC9283700 DOI: 10.3389/fendo.2022.857711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Few studies have investigated the associations of childhood growth trajectories with the prenatal metabolic risks of mothers and their interaction with children's genetic susceptibility. Objective To investigate the effects of gestational metabolic syndrome (GMS) risks and children's polygenic risk scores (PRSs), and their interaction effect on the BMI trajectory and obesity risk of offspring from birth to 6 years of age. Methods A total of 2,603 mother-child pairs were recruited from the Ma'anshan birth cohort (Anhui Province of China) study. Data on maternal prepregnancy obesity, gestational weight gain (GWG), gestational diabetes mellitus (GDM), and hypertensive disorders of pregnancy (HDP) were used to evaluate maternal GMS risk. In addition, 1,482 cord blood samples were used to genotype 11 candidate single-nucleotide polymorphisms (SNPs) to calculate children's PRSs. The latent class growth model using the longitudinal BMI-for-age z scores (BMIz) was applied to validly capture the BMIz growth trajectory. Results Maternal GMS status was associated with higher BMIz scores and with an increased risk of overweight/obesity. Positive relationships were revealed between PRS and the risk of overweight/obesity among girls. Additionally, maternal GMS significantly interacted with the child's PRS on BMIz scores and the risk of overweight/obesity among girls. Hierarchical BMI trajectory graphs by different exposure groups showed consistent findings, and both boys' and girls' BMIz trajectories were divided into three groups. Among girls, the higher the GMS risk or PRS they had, the higher the probability of being in the high BMIz trajectory group. Conclusions Maternal GMS status increased BMIz scores and the risk of obesity in both boys and girls and elevated the child's BMI trajectory from birth to 6 years of age among girls. PRSs were significantly associated with children's BMI trajectory and the risk of obesity and modified the associations between maternal GMS status and obesity biomarkers only among girls. Thus, regarding childhood obesity, steps should be taken to decrease maternal metabolic risks before and during pregnancy, and sex discrepancies should be noted to identify high-risk populations after birth to hierarchically manage them.
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Affiliation(s)
- Bei-bei Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Hui Gao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, (Anhui Medical University), National Health Commission of the People’s Republic China, Hefei, China
| | - Meng-long Geng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Xiulong Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Juan Tong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Fen Deng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Si-ying Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Li-hong Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Xiao-yan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Hong Gan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Fang-biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
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Yang Y, Wu N. Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors. Front Cardiovasc Med 2022; 9:831297. [PMID: 35252402 PMCID: PMC8889031 DOI: 10.3389/fcvm.2022.831297] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) and preeclampsia (PE) are common pregnancy complications with similar risk factors and pathophysiological changes. Evidence from previous studies suggests that the incidence of PE is significantly increased in women with GDM, but whether GDM is independently related to the occurrence of PE has remained controversial. GDM complicated by PE further increases perinatal adverse events with greater impact on the future maternal and offspring health. Identify factors associated with PE in women with GDM women, specifically those that are controllable, is important for improving pregnancy outcomes. This paper provides the findings of a review on the correlation between GDM and PE, factors associated with PE in women with GDM, possible mechanisms, and predictive markers. Most studies concluded that GDM is independently associated with PE in singleton pregnancy, and optimizing the treatment and management of GDM can reduce the incidence of PE, which is very helpful to improve pregnancy outcomes.
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Affiliation(s)
- Ying Yang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Na Wu
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Yan S, Lyu J, Liu Z, Zhou S, Ji Y, Wang H. Association of gestational hypertension and preeclampsia with offspring adiposity: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:906781. [PMID: 36082079 PMCID: PMC9445980 DOI: 10.3389/fendo.2022.906781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association of gestational hypertension (GH) and preeclampsia (PE) with offspring adiposity outcomes had controversial results in different studies. OBJECTIVE We conducted a systematic review and meta-analysis to evaluate the relationship between maternal GH/PE and offspring adiposity outcomes. SEARCH STRATEGY Studies were identified in PubMed, Embase, and Cochrane databases, with keywords including "gestational hypertension", "preeclampsia", "offspring", "weight", "cohort study", etc., without year restriction. This study was registered with PROSPERO, CRD42022292084. SELECTION CRITERIA We set the selection criteria for six aspects: population, outcome, time frame, study design, and availability. For the studies included in the meta-analysis, we required the potential confounders in these studies have been adjusted. DATA COLLECTION AND ANALYSIS Two reviewers independently evaluated the data from the included studies. The meta-analyses included mean differences, regression coefficients, and corresponding 95% confidence intervals. Results were performed using RevMan software (version 5.4; Cochrane Collaboration). Heterogeneity among the included studies was assessed using the I2 statistic. MAIN RESULTS A total of 16 studies were included in our review, 15 of which were evaluated as high quality. In all offspring, during the early life (28 days-36 months), GH/PE exposure was found to be not or inversely associated with offspring obesity, then become positively associated at larger ages (3-19 years old). In offspring with adverse birth outcomes, the maternal GH/PE-exposed group had a lower weight in the short term (28 days to 18 months), but there was a trend of rapid weight gain as they grew older, compared with the non-exposed group. The meta-analysis showed that the BMI of the female offspring in the maternal PE-exposed group was significantly higher than that of the non-exposed offspring (MD=1.04, 95% CI: 0.67~1.42, P < 0.05). CONCLUSIONS The systematic review suggested that maternal exposure to de novo hypertension disorders of pregnancy (HDP) was associated with obesity in offspring, extending from early childhood to adolescence. The meta-analysis showed that PE was associated with higher BMI in female offspring. More studies are needed to conduct stratified analyses by PE/GH, the severity of HDP, or gender. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier CRD42022292084.
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Affiliation(s)
- Shiyu Yan
- School of Public Health, Zhejiang University Medical School, Hangzhou, China
| | - Jinlang Lyu
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Zheng Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yuelong Ji
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- *Correspondence: Haijun Wang, ; Yuelong Ji,
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- *Correspondence: Haijun Wang, ; Yuelong Ji,
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Yin B, Hu L, Meng X, Wu K, Zhang L, Zhu Y, Zhu B. Association of higher HbA1c within the normal range with adverse pregnancy outcomes: a cross-sectional study. Acta Diabetol 2021; 58:1081-1089. [PMID: 33768379 DOI: 10.1007/s00592-021-01691-0] [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: 01/04/2021] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between a relatively high HbA1c level within the normal range and the risk of adverse pregnancy outcomes. METHODS This retrospective cohort study was conducted between March 2018 and March 2019 at Women's Hospital, School of Medicine, Zhejiang University. Multiple logistic regression models after adjusting for plausible confounders were implemented to assess the relationships between the level of HbA1c and adverse pregnancy outcomes. RESULTS A total of 8585 women were included in our study. The rates of preterm birth, macrosomia and preeclampsia were 4.4% (380/8585), 5.3% (457/8585) and 1.7% (149/8585), respectively. After adjusting for potential confounding variables, an HbA1c range of 5.5-5.9% (37-41 mmol/mol) remained significantly associated with an increased risk of preterm delivery (a-OR 2.27; 95% CI, 1.50-3.43), macrosomia (a-OR 1.97; 95% CI, 1.32-2.94) and preeclampsia (a-OR 3.70; 95% CI, 2.07-6.60). GDM-negative pregnant women with an HbA1c level in the range of 5.5-5.9% (37-41 mmol/mol) had an increased risk of preterm delivery (a-OR 2.84; 95% CI, 1.71-4.71) and preeclampsia (a-OR 3.82; 95% CI, 1.81-8.04). However, GDM-positive pregnant women had an increased risk of macrosomia (a-OR 2.12; 95% CI, 1.13-3.97) and preeclampsia (a-OR 2.62; 95% CI, 1.01-6.81). CONCLUSION A higher HbA1c level within the normal range is an independent risk factor for preterm delivery and preeclampsia, especially among GDM-negative women. Therefore, relevant medical staff should enhance the awareness of risk and prevention to strengthen pregnancy monitoring.
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Affiliation(s)
- Binbin Yin
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China
| | - Lingwei Hu
- Department of Genetics and Metabolism, School of Medicine, The Children's Hospital, Zhejiang University, ZheJiang 310058, Hangzhou, China
| | - Xingjun Meng
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China
| | - Kaiqi Wu
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China
| | - Long Zhang
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China
| | - Yuning Zhu
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China.
| | - Bo Zhu
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China.
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Growth from birth to 6 months of infants with and without intrauterine preeclampsia exposure. J Dev Orig Health Dis 2021; 13:151-155. [PMID: 33977898 DOI: 10.1017/s2040174421000167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating in the Post-partum, Physiology, Psychology and Paediatric follow-up cohort study. Birth and 6-month weight and length z-scores were calculated for term and preterm (<37 weeks) babies, and change in weight z-score, rapid weight gain (≥0.67 increase in weight z-score) and conditional weight gain z-score were calculated. Compared with normotensive exposed infants (n = 298), preeclampsia exposed infants (n = 84) were more likely to be born SGA (7% versus 23%; P < 0.001), but weight gain from birth to 6 months, by any measure, did not differ between groups. Infants born SGA, irrespective of pregnancy exposure, were more likely to have rapid weight gain and had greater increases in weight z-score compared with those not born SGA. Preeclampsia exposed infants born SGA may benefit from interventions designed to prevent future cardiometabolic disease.
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Wulaningsih I, Hapsari ED, Pangastuti HS, Priharjo R. Life Experience of Pregnant Woman with Gestational Diabetes Mellitus in Maternal Role Attainment in Special Region of Yogyakarta. JURNAL NERS 2020. [DOI: 10.20473/jn.v15i2.19306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Gestational Diabetes Mellitus (GDM) is any abnormal carbohydrate intolerance that begins or is first recognized during pregnancy. The presence of GDM has important implications for both the baby and the mother. Objective: This study explored life experience of pregnant woman with GDM in maternal role attainment. Methods: This was a phenomenological approach qualitative research. Participants were 12 mothers who gave birth to a maximum of 1 year with a history of GDM selected by purposive sampling technique with sampling criteria. Data analysis used the Colaizzi method (2011). Results: There were eight categories, e.g. the experience of the mother in GDM diagnosis; the influence GDM of the pregnancy; mother's experience in trying hard to keep her pregnancy; a variation of life experience of mothers during pregnancy, childbirth, and post-delivery; the perception of mother of her role being a mother, the factors that support the development and achievement of the maternal role attainment; the mother's experience in integrating the identity of her role as mother; gap and the desire of the mother with GDM in receiving health services. Life experience of GDM mothers in achieving maternal role attainment has a diversity. Discussion: Pregnant mothers with GDM experience various maternal role attainments. They cannot attain the role optimally.
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