The Association Between Trimester-Specific Weight Gain and Severe Preeclampsia/Adverse Perinatal Outcome in Gestational Diabetes Mellitus Complicated by Preeclampsia: A Retrospective Case Study

The Influence of HbA1c and Gestational Weight Gain on Pregnancy Outcomes in Pregnant Women With Gestational Diabetes Mellitus

Background

To investigate the influence of HbA1c level and GWG on pregnancy outcomes in pregnant women with GDM.

Methods

A total of 2,171 pregnant women with GDM were retrospectively included and categorized as follows: (1) normal (HbA1c <6%) and elevated (HbA1c ≥6%) HbA1c groups according to the HbA1c level in the second trimester, and (2) inadequate, appropriate, and excessive GWG groups according to the IOM guidelines.

Results

In pregnant women with GDM, advanced age and high pre-pregnancy BMI were high-risk factors for elevated HbA1c. Pregnant women with elevated HbA1c had higher OGTT levels than those with normal HbA1c, and the risks of adverse pregnancy outcomes were higher (P < 0.05). The risks of primary cesarean section, hypertensive disorders during pregnancy, and macrosomia in pregnant women with excessive GWG were significantly higher than those with inadequate and appropriate GWG (P < 0.05). When GWG was appropriate, the risk of hypertensive disorders during pregnancy in the elevated HbA1c group was higher than that in the normal HbA1c group. When GWG was excessive, the risks of postpartum hemorrhage, macrosomia, and neonatal asphyxia in the elevated HbA1c group were significantly higher than in the normal HbA1c group (P < 0.05).

Conclusion

Monitoring and controlling blood glucose levels have shown effectiveness in reducing the adverse pregnancy outcomes in women with GDM, particularly for those who had excessive GWG.

Effects of pre-pregnancy BMI and gestational weight gain on adverse pregnancy outcomes and complications of GDM

To investigate the effects of pre-pregnancy BMI and gestational weight gain on adverse pregnancy outcomes and complications of gestational diabetes mellitus. 3966 pregnant women were enrolled in this study. Multivariate logistic regression analysis was conducted to estimate the relative risk between pre-pregnancy BMI, gestational weight gain, and adverse pregnancy outcome. Pre-pregnancy BMI was found to be a risk factor for preeclampsia (OR = 1.159), gestational diabetes mellitus (OR = 1.191), gestational hypertension (OR = 1.221), and macrosomia (OR = 1.165). Gestational weight gain was a risk factor for preeclampsia (OR = 1.783), placental abruption (OR = 2.209), and macrosomia (OR = 1.506). Total weight gain during pregnancy cannot be used as a predictor of GDM. Pre-pregnancy BMI is a risk factor for gestational diabetes mellitus complicated with preeclampsia, preterm delivery, gestational hypertension, and macrosomia. Impact statementWhat is already known on this subject? Obesity during pregnancy includes pre-pregnancy obesity and excessive weight gain during pregnancy. Obese pregnant women have a higher risk of pregnancy complications.What do the results of this study add? We focus on the effects of pre-pregnancy BMI on pregnancy outcomes, classified by Asian criteria. Our findings suggest for the first time that excessive weight gain during pregnancy is a risk factor for placental abruption and we specifically point out that total weight gain during pregnancy cannot be used as a predictor of GDM.What are the implications of these findings for clinical practice and/or further research? This study is helpful to monitor the risk of adverse pregnancy outcomes in the Asian population and suggest the risk of pregnancy complications, such as gestational diabetes mellitus and placental abruption.

Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

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.

LncRNA OIP5-AS1 Signatures as a Biomarker of Gestational Diabetes Mellitus and a Regulator on Trophoblast Cells

OBJECTIVES

Gestational diabetes mellitus (GDM) is a common disorder in pregnant women. Long noncoding RNA (lncRNA) is a fundamental mediator in the pathogenesis of GDM. The study aimed to detect the clinical importance of lncRNA OIP5-AS1 and its underlying regulation on trophoblast cells.

DESIGN

The expression of OIP5-AS1 and miR-137-3p was assessed by the quantitative real-time PCR technique. The prognostic effect of OIP5-AS1 was analyzed by the receiver operating characteristic curve. The influences of OIP5-AS1 on cells were indicated by cell counting kit-8, transwell experiments, and flow cytometry. Luciferase activity assay was used to identify the target relationships among OIP5-AS1, miR-137-3p, and EZH2.

PARTICIPANTS

A total of 75 pregnant women with GDM who were treated in the Dongying People's Hospital were selected as the GDM group. Besides, 72 pregnant women with non-GDM who underwent physical examination in the same hospital were selected as the control group.

RESULTS

Decreased expression of OIP5-AS1 was confirmed in GDM patients, and the level of OIP5-AS1 could be used as a basis for evaluating GDM patients. Upregulation of OIP5-AS1 ameliorated the viability, migration, invasion, and apoptosis of HG-stimulated HTR-8/SVneo cells by sponging miR-137-3p. EZH2 was a direct target of miR-137-3p.

CONCLUSIONS

OIP5-AS1 level decreased in women with GDM. OIP5-AS1 appeared to help separating GDM patients from healthy pregnant women. The OIP5-AS1/miR-137-3p/EZH2 pathway could exert its function on HG-induced HTR-8/SVneo models.

Maintaining Safe Breastfeeding Practices During the COVID-19 Pandemic: An Overview of the Evidence to Inform Clinical Guidelines

The impact of the COVID-19 pandemic upon the health care landscape has prompted many organizations to revise policies in response to ever-changing guidelines and recommendations regarding safe breastfeeding practices. The application of these professional guidelines into clinical practice is fraught with barriers, inconsistencies, and often-minimal evidential support. Key concerns for health care providers and patients include antenatal versus postnatal transmission, milk transmission, and separation care versus rooming-in, including the subsequent impacts upon breastfeeding and bonding. While SARS-CoV-2 is a novel virus, the volume of literature to support best practice for couplet care continues to be developed at a rapid pace. The benefits of breastfeeding are steeped in evidence and outweigh the potential risk of transmission of COVID-19 from mother to newborn. Health care organizations must continue to seek guidance for policy revision within the ever-growing body of evidence for best practice and evaluate current practices for feasibility during and after hospitalization.

Association Between Maternal Glucose/Lipid Metabolism Parameters and Abnormal Newborn Birth Weight in Gestational Diabetes Complicated by Preeclampsia: A Retrospective Analysis of 248 Cases

INTRODUCTION

Women with gestational diabetes mellitus (GDM) with co-existent preeclampsia (GCP) are at increased risk of giving birth to a baby with an abnormal birth weight. We have analyzed the risk factors for abnormal newborn birth weight (NBW) in women with co-presence of GDM and GCP, focusing on maternal glucose/lipid metabolism, with the aim to optimize the clinical intervention strategy.

METHODS

The clinical data of 248 pregnant women with GCP and their infants were retrospectively analyzed through a comprehensive review of the electronic medical records of Women and Children's Hospital, Xiamen University (Xiamen, China). These women had received prenatal care and had their baby delivered in the hospital between January 2016 and November 2018. Major characteristics assessed were large for gestational age (LGA), small for gestational age (SGA), severe preeclampsia (S-PE), and maternal plasma glucose/lipid profile in late pregnancy. Secondary characteristics were maternal age, height, body mass index (BMI), gestational weight gain (GWG), abortion history, education level, primipara or not, preterm or not, and fetal gender. Regression analysis was used to analyze the association between maternal glucose/lipid metabolism parameters and LGA or SGA.

RESULTS

There was no difference in the ratio of advanced maternal age, primipara, abortion history, preterm delivery, and newborn sex between the control group and the LGA or SGA group. Logistic regression analysis, with such factors as maternal stature, BMI, among others, was applied. Multivariate analysis of SGA infants revealed the following associations: S-PE (odds ratio [OR] 3.226, 95% confidence interval [CI] 1.385-7.515; adjusted OR [AOR] 3.675, 95% CI 1.467-9.207; p  < 0.05); high levels of glycated hemoglobin (HbA1c > 6.5%) (OR 0.436, 95% CI 0.187-1.017; AOR 0.459, 95% CI 0.179-1.173; p  > 0.05); low levels of high-density lipoprotein cholesterol (HDL-C < 1.0 mmol/L) (OR 0.625, 95% CI 0.287-1.361; AOR 0.637, 95% CI 0.267-1.520; p  > 0.05). Multivariate analysis of LGA revealed the following associations: S-PE (OR 30.885, 95% CI 0.398-2.013; AOR 0.974, 95% CI 0.400-2.371; p  > 0.05); high levels of HbA1c (OR 4.542, 95% CI 0.187-11.824; AOR 3.997, 95% CI 1.452-10.998; p  < 0.05); low levels of HDL (OR 3.393, 95% CI 1.362-8.453; AOR 2.900, 95% CI 1.100-7.647; p  < 0.05).

CONCLUSIONS

The results of our analysis revealed that severity of preeclampsia was associated with SGA. The high HbA1c and low HDL-C values found in our analysis were independent risk factors for LGA in women with GCP, while other lipoproteins were not associated with abnormal NBW. These findings suggest that there are differences in the effects of various maternal lipid parameters on NBW.