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Wang L, Cao Y, Li P, He P, Chen P. Relationship between pelvic floor muscle function and insulin resistance among non-diabetic females: a 3d ultrasound evaluation. J OBSTET GYNAECOL 2024; 44:2381569. [PMID: 39056468 DOI: 10.1080/01443615.2024.2381569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND To use the three-dimensional (3D) ultrasound for assessment of pelvic floor muscle function in non-diabetic females with insulin resistance (IR), and to evaluate its functional relationship with insulin levels. METHODS From October 2022 to November 2023, 216 non-diabetic females with insulin-resistant (IR group) and 118 normal females (control group) were sequentially recruited from our hospital for our study. The 3D ultrasound was used to assess the levator hiatus in resting state for all females regarding diameter lines, perimeters and areas; as well as the Valsalva manoeuvre (VM). The t-test and linear regression model were used to analyse the collected data. RESULTS The analysis indicates that there were significant differences in the resting state of the levator hiatus between the IR and the control groups (14.8 ± 5.8 cm2 and 11.6 ± 2.7 cm2, p < 0.05); and in the VM (18.2 ± 6.3 cm2 and 13.4 ± 3. 4 cm2, p < 0.05). In addition, the anterior-posterior (AP) diameters of the hiatus on VM were significantly increased in the IR group (40.0 ± 4.7 mm and 33.0 ± 4.4 mm, p < 0.05). With insulin levels as the dependent variable, multivariate regression analysis shows that insulin levels were significantly correlated with the levator hiatus area on VM (p < 0.05) and waist circumference (p < 0.05). The pelvic organ descent on VM in the IR group was significant (p < 0.05). CONCLUSIONS The areas of resting state levator hiatus and on VM were significantly larger in the IR than that in the control groups. In addition, the position of the pelvic organ on VM in the IR group was significantly descended. The insulin levels were correlated with the pelvic floor muscle function.
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Affiliation(s)
- Lei Wang
- Departments of Ultrasound Diagnostics, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunyun Cao
- Departments of Ultrasound Diagnostics, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Li
- Departments of Ultrasound Diagnostics, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping He
- Departments of Ultrasound Diagnostics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Chen
- Departments of Ultrasound Diagnostics, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hu Y, Liu Y, Shen J, Yin L, Hu X, Huang X, Chen Y, Zhang Y. Longitudinal observation of tRNA-derived fragments profiles in gestational diabetes mellitus and its diagnostic value. J Obstet Gynaecol Res 2024; 50:1317-1333. [PMID: 38923718 DOI: 10.1111/jog.16008] [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: 03/18/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) poses significant risks to maternal and fetal health. Current diagnostic methods based on glucose tolerance tests have limitations for early detection. tRNA-derived small RNAs (tsRNAs) have emerged as potential molecular regulators in various diseases, including metabolic disorders. However, the diagnostic value of tsRNAs in plasma for early GDM or postpartum remains unclear. METHODS This longitudinal study profiled the expression of tsRNAs across different gestational stages and postpartum in women with GDM (n = 40) and healthy control gestational women (HCs, n = 40). High-throughput small RNA sequencing identified candidate tsRNAs, which were then validated and correlated with clinical biochemical markers such as fasting blood glucose (FBG), HOMA-IR, and GHbA1c. RESULTS tRF-1:32-Val-AAC-1-M6, tRF-1:31-Glu-CTC-1-M2, and tRF-1:30-Gly-CCC-1-M4 were consistently upregulated in the GDM group compared to HCs during the second trimester (p < 0.05). Only tRF-1:31-Glu-CTC-1-M2 was highly expressed during the first trimester, and tRF-1:30-Gly-CCC-1-M4 increased during postpartum. tRF-1:31-Glu-CTC-1-M2 showed a significant correlation with FBG levels in the first trimester (R = 0.317, p = 0.047). The expression of tRF-1:30-Gly-CCC-1-M4 was significantly correlated with HOMA-IR (r = 0.65, p < 0.001) and GHBA1c (r = 0.33, p = 0.037) during postpartum. A joint diagnostic model incorporating tsRNAs expression and clinical markers demonstrated enhanced predictive power for GDM (ROC AUC = 0.768). CONCLUSION Our results revealed distinct expression patterns of specific tsRNAs in GDM, showcasing their correlation with key metabolic parameters. This underscores their promising role as biomarkers for early prediction and diagnosis of GDM. The integration of tRFs into a composite biomarker panel holds the potential to improve clinical outcomes by enabling personalized risk assessment and targeted interventions.
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Affiliation(s)
- Yifang Hu
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Yan Liu
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Jun Shen
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Lihua Yin
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Xiaoxia Hu
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Xiaolei Huang
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Yingyuan Chen
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Yisheng Zhang
- Department of Obstetrics, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
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Chhabria K, Selvaraj S, Refuerzo J, Truong C, Cazaban CG. Investigating the association between metabolic syndrome conditions and perinatal mental illness: a national administrative claims study. BMC Pregnancy Childbirth 2024; 24:409. [PMID: 38849738 PMCID: PMC11157911 DOI: 10.1186/s12884-024-06542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/25/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Although the association between mental disorder and metabolic syndrome as a bidirectional relationship has been demonstrated, there is little knowledge of the cumulative and individual effect of these conditions on peripartum mental health. This study aims to investigate the association between metabolic syndrome conditions (MetS-C) and maternal mental illness in the perinatal period, while exploring time to incident mental disorder diagnosis in postpartum women. METHODS This observational study identified perinatal women continuously enrolled 1 year prior to and 1 year post-delivery using Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2014 to 2019 with MetS-C i.e. obesity, diabetes, high blood pressure, high triglycerides, or low HDL (1-year prior to delivery); perinatal comorbidities (9-months prior to and 4-month postpartum); and mental disorder (1-year prior to and 1-year post-delivery). Additionally, demographics and the number of days until mental disorder diagnosis were evaluated in this cohort. The analysis included descriptive statistics and multivariable logistic regression. MetS-C, perinatal comorbidities, and mental disorder were assessed using the International Classification of Diseases, Ninth, and Tenth Revision diagnosis codes. RESULTS 372,895 deliveries met inclusion/exclusion criteria. The prevalence of MetS-C was 13.43%. Multivariable logistic regression revealed prenatal prevalence (1.64, CI = 1.59-1.70) and postpartum incident (1.30, CI = 1.25-1.34) diagnosis of mental health disorder were significantly higher in those with at least one MetS-C. Further, the adjusted odds of having postpartum incident mental illness were 1.51 times higher (CI = 1.39-1.66) in those with 2 MetS-C and 2.12 times higher (CI = 1.21-4.01) in those with 3 or more MetS-C. Young women (under the age of 18 years) were more likely to have an incident mental health diagnosis as opposed to other age groups. Lastly, time from hospital discharge to incident mental disorder diagnosis revealed an average of 157 days (SD = 103 days). CONCLUSION The risk of mental disorder (both prenatal and incident) has a significant association with MetS-C. An incremental relationship between incident mental illness diagnosis and the number of MetS-C, a significant association with younger mothers along with a relatively long period of diagnosis mental illness highlights the need for more screening and treatment during pregnancy and postpartum.
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Affiliation(s)
- Karishma Chhabria
- Division of Management Policy and Community Health, Center for Healthcare Data Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.
- Department of Public Health, Usha Kundu MD College of Health, University of West Florida 11000 University Pkwy, Pensacola, FL, 32514, USA.
| | - Sudhakar Selvaraj
- Louis Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Clinical Development, Intra-Cellular Therapies, Inc., 430 East 29th Street, New York, NY, United States
| | - Jerrie Refuerzo
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Chau Truong
- Division of Management Policy and Community Health, Center for Healthcare Data Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Cecilia Ganduglia Cazaban
- Division of Management Policy and Community Health, Center for Healthcare Data Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Nguyen B, Tselovalnikova T, Drees BM. Gestational Diabetes Mellitus and Metabolic Syndrome: A Review of the Associations and Recommendations. Endocr Pract 2024; 30:78-82. [PMID: 37918624 DOI: 10.1016/j.eprac.2023.10.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) and metabolic syndrome (MetS) share common characteristics and risk factors. Both conditions increase the risk of chronic diseases and, thus, may share a common pathogenesis. This review begins with a clinical vignette, followed by evidence supporting the risk of MetS after GDM among women and their offspring and the risk of having GDM among pregnant women who have MetS before pregnancy. METHODS Research studies published between 2010 and 2023 were identified via several databases, including PubMed, the Web of Science, MEDLINE, Science Direct, ERIC, and EBSCOhost. Search terms included gestational diabetes and metabolic syndrome. Reviews, books/e-books, patents, news, trade publications, reports, dissertations/theses, conference materials, and articles in non-English languages were all excluded. RESULTS MetS increases not only the incidence of GDM during pregnancy but also the risk of diabetes in women with a history of GDM. On the other hand, women with a history of GDM had an almost 4 times increased risk of developing MetS at minimum of 1 year after delivery, and the risk increases with longer time lapse since the index pregnancy. Prepregnancy body mass index appears to be the strongest factor predicting MetS. Children exposed to GDM in utero have at least a 2 times increased risk of MetS in later life. CONCLUSION Timely assessment and continuing surveillance of MetS before and after pregnancy followed by GDM are recommended. Weight management and nutrition counseling are of importance to reduce the risk of GDM and MetS among pregnant women.
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Affiliation(s)
- Bong Nguyen
- Department of Internal Medicine and Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Tatiana Tselovalnikova
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Betty M Drees
- Department of Internal Medicine and Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Graduate School of the Stowers Institute for Medical Research, Kansas City, Missouri
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Habibi N, Leemaqz S, Louie JCY, Wycherley TP, Grieger JA. Dietary Strategies to Reduce Triglycerides in Women of Reproductive Age: A Simulation Modelling Study. Nutrients 2023; 15:5137. [PMID: 38140396 PMCID: PMC10745529 DOI: 10.3390/nu15245137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Many women of reproductive age have poor diet quality and are at higher risk of chronic diseases such as diabetes. Triglycerides are a critical risk factor for chronic diseases, and although they can be influenced by diet, there are minimal dietary intervention studies identifying key foods/food groups that reduce triglycerides. We performed data simulation modelling to estimate the potential reductions in fasting triglycerides that could be achieved by different dietary strategies in reproductive age women. The model was created using data from the 2011-2013 Australian Health Survey and incorporated various factors such as demographics, nutrient intake, and plasma biomarkers. Multiple linear regression analysis was conducted to estimate triglyceride levels, considering nutrient intake and pre-determined covariates. Dietary scenarios were developed, reducing the consumption of processed/ultra-processed foods, while increasing the intake of minimally processed foods like fruits, vegetables, fish, and nuts. A total of 606 women were included. Reducing processed foods by 50% plus increasing intakes of fruits (75-225 g/day), vegetables (75-225 g/day), or nuts (10-40 g/day) decreased triglycerides by up to 4.3%. Additionally, incorporating 80 g/day of omega 3 fish (>800 mg long-chain omega 3/100 g) decreased triglycerides by 8.2%. The clinical relevance of lowering triglycerides for cardiometabolic disease management should be tested in dietary intervention studies in women.
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Affiliation(s)
- Nahal Habibi
- Robinson Research Institute, The University of Adelaide, Adelaide 5005, Australia; (N.H.)
- Adelaide Medical School, The University of Adelaide, Adelaide 5005, Australia
| | - Shalem Leemaqz
- Robinson Research Institute, The University of Adelaide, Adelaide 5005, Australia; (N.H.)
- Adelaide Medical School, The University of Adelaide, Adelaide 5005, Australia
| | - Jimmy Chun Yu Louie
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne 3122, Australia;
| | - Thomas P. Wycherley
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia;
| | - Jessica A. Grieger
- Robinson Research Institute, The University of Adelaide, Adelaide 5005, Australia; (N.H.)
- Adelaide Medical School, The University of Adelaide, Adelaide 5005, Australia
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Guleroglu FY, Ozmen AB, Bakirci IT, Dogu SY, Yılmaz I, Cetin A. Fetal pancreas size and maternal serum biomarkers glycated albumin and insulin-regulated aminopeptidase provide no potential for early prediction of gestational diabetes mellitus. Arch Gynecol Obstet 2023; 308:1505-1514. [PMID: 36436013 PMCID: PMC9702770 DOI: 10.1007/s00404-022-06860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to determine the predictive values of fetal pancreas size and maternal serum biomarkers glycated albumin (GA) and insulin-regulated aminopeptidase (IRAP) for gestational diabetes mellitus (GDM). MATERIALS AND METHODS In this prospective observational study including 109 pregnant women, the fetal pancreas size and maternal serum biomarkers GA and IRAP were measured at the gestational age of 20-22 weeks and later at the gestational age of 24-28 weeks, in 19 participants of them, GDM was confirmed with the 75-g oral glucose tolerance test (OGTT) and the fetal pancreas size was measured in all the participants again. RESULTS The median fetal pancreas sizes were significantly higher in women with or without GDM when measured at the 24-28 weeks of pregnancy compared to those at the 20-22 weeks of pregnancy (p < 0.05). At both of the 20-22 and 24-28 weeks of pregnancy, the median values of fetal pancreas sizes in the women with or without GDM were found comparable (p > 0.05). There were no significant differences between pregnant women with or without GDM regarding maternal serum biomarkers GA and IRAP (p > 0.05). Multivariate logistic regression analysis revealed no meaningful association of study parameters with the development of GDM. CONCLUSION The fetal pancreas size and maternal serum biomarkers GA and IRAP provide no potential for early prediction of GDM at the 20-22 weeks of gestation. Further studies, including serial measurement of these parameters during the second and third trimesters of GDM pregnancies, may clarify their role in the antenatal care of women with GDM. CLINICAL TRIALS NCT05392231.
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Affiliation(s)
- Filiz Yarsilikal Guleroglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital Affiliated With Health Sciences University, Istanbul, Turkey.
| | - Aliye Balkan Ozmen
- Division of Perinatology, Department of Obstetrics and Gynecology, Bursa City Hospital, Bursa, Turkey
| | - Isil Turan Bakirci
- Division of Perinatology, Department of Obstetrics and Gynecology, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | - Sevilay Yavuz Dogu
- Division of Perinatology, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital Affiliated With Health Sciences University, Istanbul, Turkey
| | - Ibrahim Yılmaz
- Department of Biochemistry, Haseki Training and Research Hospital Affiliated With the Health Sciences University, Istanbul, Turkey
| | - Ali Cetin
- Division of Perinatology, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital Affiliated With Health Sciences University, Istanbul, Turkey
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Sirico A, Rossi ED, Degennaro VA, Arena V, Rizzi A, Tartaglione L, Di Leo M, Pitocco D, Lanzone A. Placental diabesity: placental VEGF and CD31 expression according to pregestational BMI and gestational weight gain in women with gestational diabetes. Arch Gynecol Obstet 2023; 307:1823-1831. [PMID: 35835917 DOI: 10.1007/s00404-022-06673-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/14/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of this study is to investigate the placental expression of VEGF and CD31 in pregnancies complicated by gestational diabetes (GDM) and the influence of pregestational BMI and gestational weight gain (GWG) on this expression. METHODS We prospectively enrolled pregnant women with diagnosis of GDM and healthy controls who delivered in our Center between December 2016 and May 2017. Patients were grouped according to the presence of GDM and we compared pregnancy characteristics, placental VEGF and CD31 expression between the cases and controls. Immunochemistry analysis was performed to assess biomarkers positivity. Positivity of biomarkers was assessed in a dichotomic fashion with positivity set at 5% for VEGF and 1% for CD31. RESULTS 39 patients matched inclusion criteria, 29 (74.3%) women with GDM and 10 (25.7%) healthy controls. Immunochemistry analysis showed that VEGF was more expressed in placentas from women with GDM compared to controls (21/29, 72.4% vs 2/10, 20%; p = 0.007), and CD31 was more expressed in placentas from women with GDM compared to controls (6/29, 20.7% vs 0/10, 0%; risk difference 0.2). VEGF positivity was associated with the presence of GDM (aOR 22.02, 95% CI 1.13-428.08, p = 0.04), pregestational BMI (aOR 1.53, 1.00-2.34, p = 0.05) and GWG (aOR 1.47, 95% CI 1.03-2.11, p = 0.03). CD31 positivity was associated with the pregestational BMI (aOR 1.47, 95% CI 1.00-2.17, p = 0.05) and with the gestational weight gain (aOR 1.32, 95% CI 1.01-1.72, p = 0.04). CONCLUSION Pregnancies complicated by GDM are characterized by increased placental expression of VEGF and CD31, and the expression of these markers is also independently associated to maternal increased pregestational BMI and GWG, defining the concept of "placental diabesity".
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Affiliation(s)
- Angelo Sirico
- Obstetrics and High-Risk Pregnancy Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, RM, Italy.
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Anna Degennaro
- Obstetrics and High-Risk Pregnancy Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, RM, Italy
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Vincenzo Arena
- Pathology Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Alessandro Rizzi
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Linda Tartaglione
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Mauro Di Leo
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Dario Pitocco
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Antonio Lanzone
- Obstetrics and High-Risk Pregnancy Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, RM, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Jayasinghe IU, Agampodi TC, Dissanayake AK, Agampodi SB. Early pregnancy metabolic syndrome and risk for adverse pregnancy outcomes: findings from Rajarata Pregnancy Cohort (RaPCo) in Sri Lanka. BMC Pregnancy Childbirth 2023; 23:231. [PMID: 37020187 PMCID: PMC10074348 DOI: 10.1186/s12884-023-05548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/25/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Despite the intergenerational effects of metabolic disorders, evidence is greatly lacking on early pregnancy metabolic syndrome (MetS) and its effects on pregnancy outcomes from low- and middle-income countries. Thus, this prospective cohort of South Asian pregnant women aimed to evaluate how early pregnancy MetS would affect pregnancy outcomes. METHODS A prospective cohort study was conducted among first-trimester (T1) pregnant women of Anuradhapura district, Sri Lanka recruited to the Rajarata Pregnancy Cohort in 2019. MetS was diagnosed by the Joint Interim Statement criteria before 13 weeks of gestational age (GA). Participants were followed up until their delivery, and the major outcomes measured were large for gestational age (LGA), small for gestational age (SGA), preterm birth (PTB) and miscarriage (MC). Gestational weight gain, gestational age at delivery and neonatal birth weight were used as measurements to define the outcomes. Additionally, outcome measures were re-assessed with adjusting fasting plasma glucose (FPG) thresholds of MetS to be compatible with hyperglycemia in pregnancy (Revised MetS). RESULTS 2326 T1 pregnant women with a mean age of 28.1 years (SD-5.4), and a median GA of 8.0 weeks (IQR-2) were included. Baseline MetS prevalence was 5.9% (n = 137, 95%CI-5.0-6.9). Only 2027 (87.1%) women from baseline, had a live singleton birth, while 221(9.5%) had MC and 14(0.6%) had other pregnancy losses. Additionally, 64(2.8%) were lost to follow-up. A higher cumulative incidence of LGA, PTB, and MC was noted among the T1-MetS women. T1-MetS carried significant risk (RR-2.59, 95%CI-1.65-3.93) for LGA, but reduced the risk for SGA (RR-0.41, 95%CI-0.29-0.78). Revised MetS moderately increased the risk for PTB (RR-1.54, 95%CI-1.04-2.21). T1-MetS was not associated (p = 0.48) with MC. Lowered FPG thresholds were significantly associated with risk for all major pregnancy outcomes. After adjusting for sociodemographic and anthropometric confounders, revised MetS remained the only significant risk predictor for LGA. CONCLUSION Pregnant women with T1 MetS in this population are at an increased risk for LGA and PTB and a reduced risk for SGA. We observed that a revised MetS definition with lower threshold for FPG compatible with GDM would provide a better estimation of MetS in pregnancy in relation to predicting LGA.
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Affiliation(s)
- Imasha Upulini Jayasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
| | - Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Ajith Kumara Dissanayake
- Department of Gynaecology and Obstetrics, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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