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Jiang L, Tang K, Magee LA, von Dadelszen P, Ekeroma A, Li X, Zhang E, Bhutta ZA. A global view of hypertensive disorders and diabetes mellitus during pregnancy. Nat Rev Endocrinol 2022; 18:760-775. [PMID: 36109676 PMCID: PMC9483536 DOI: 10.1038/s41574-022-00734-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.
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Affiliation(s)
- Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Alec Ekeroma
- Department of Obstetrics and Gynecology, Wellington School of Medicine, University of Otago, Wellington, New Zealand
- National University of Samoa, Apia, Samoa
| | - Xuan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Enyao Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan.
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Rezaei M, Błaszczyk M, Tinkov AA, Binkowski LJ, Mansouri B, Skalny A, Azadi N, Doşa MD, Bjørklund G. Relationship between gestational diabetes and serum trace element levels in pregnant women from Eastern Iran: a multivariate approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:45230-45239. [PMID: 33860892 DOI: 10.1007/s11356-021-13927-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
The prevalence of gestational diabetes mellitus (GDM) has increased over the recent decades. Exposure to environmental contaminants may be a risk factor for the development of GDM, but this is heavily dependent on particular circumstances. Studies on various areas linking various factors are therefore needed. We examined the associations between serum trace element levels and incidents of GDM among 102 pregnant women (diabetic n = 60 and healthy n = 42) living in Birjand (Iran). Blood serum samples were analyzed for concentrations of elements linked to particulate matter air pollution such as As, Cd, Cu, Hg, Mn, Ni, V, and Zn. Concentrations of As (8.58 vs. 3.15 μg/L), Cd (6.74 vs. 0.52 μg/L), and Hg (2.60 vs. 0.90 μg/L) were significantly higher in women with GDM. Risk difference (RD) estimation showed that As, 0.516 (0.355, 0.677); Cd, 0.719 (0.534, 0.904); and Hg, 0.505 (0.276, 0.735) increase GDM probability, while V lower that risk, -0.139 (-0.237, -0.042). With the principal component analysis, we were able to separate subjects according to their GDM status based on element levels. Such classification revealed very high efficiency with a true positive rate of 93%, according to linear discriminant analysis. GDM subjects presented higher levels of As, Cd, and Hg, indicating that these elements may disturb insulin metabolism and promote the development of GDM. Therefore, we conclude that systematic monitoring of trace elements followed by multivariate modeling in women planning pregnancy should be carried out to prevent the development of GDM.
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Affiliation(s)
- Maryam Rezaei
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Martyna Błaszczyk
- Institute of Biology, Pedagogical University of Krakow, Podchorazych 2, 30-084, Krakow, Poland
| | - Alexey A Tinkov
- IM Sechenov First Moscow State Medical University, Moscow, Russia
- K.G. Razumovsky Moscow State University of Technologies and Management, Moscow, Russia
| | - Lukasz J Binkowski
- Institute of Biology, Pedagogical University of Krakow, Podchorazych 2, 30-084, Krakow, Poland
| | - Borhan Mansouri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Anatoly Skalny
- IM Sechenov First Moscow State Medical University, Moscow, Russia
- K.G. Razumovsky Moscow State University of Technologies and Management, Moscow, Russia
| | - Namamali Azadi
- Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Monica Daniela Doşa
- Department of Pharmacology, Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
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Liu X, Zhang L, Li J, Meng G, Chi M, Li T, Zhao Y, Wu Y. A nested case-control study of the association between exposure to polybrominated diphenyl ethers and the risk of gestational diabetes mellitus. ENVIRONMENT INTERNATIONAL 2018; 119:232-238. [PMID: 29980046 DOI: 10.1016/j.envint.2018.06.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is rapidly increasing worldwide. Exposure to endocrine-disrupting chemicals such as polybrominated diphenyl ethers (PBDEs) is thought to be a contributor to GDM, independent of diet and physical activity. OBJECTIVE The prospective association between PBDEs body burden in early pregnancy and GDM risk was investigated. METHODS A nested case-control study of 439 pregnant women was conducted between 2013 and 2015 in Beijing, China. Seven predominant PBDE congeners were measured in first trimester maternal serum by gas chromatography-high resolution mass spectrometry. Pregnant women were screened for GDM at 24-28 weeks of gestation using the oral glucose tolerance test. GDM was defined based on the diagnostic criteria set by China Ministry of Health. Conditional logistic and linear regression were used to estimate the association between PBDEs exposure and GDM risk, and PBDEs exposure and glucose level, respectively. RESULTS A total of 77 (17.5%) women developed GDM in this study. Median concentrations of PBDEs were higher in women with GDM. Analyses parameterizing PBDE concentrations as continuous variables suggested significant associations between BDE-153, -154, -183 and GDM risk with an estimated odds ratio of 4.04 (95%CI: 1.92, 8.52), 1.88 (95%CI: 1.15, 3.09) and 1.91 (95%CI: 1.31, 2.08), respectively. In the quartile analyses, a significant increase in the odds ratio of GDM was associated with the highest levels of BDE-153 (OR = 3.42 95%CI: 1.49, 7.89) and BDE-183 (OR = 3.70, 95%CI: 1.58, 8.65), whereas, BDE-154 demonstrated an inverted U-shaped association with GDM. In addition, BDE-153 and -154 were significantly positively associated with fasting glucose, and both 1 h and 2 h glucose level (p < 0.05). CONCLUSIONS These results suggest that exposure to PBDEs disturbs maternal glucose homeostasis and increases the risk of GDM. These findings should be replicated in future studies with a larger population and wider range of exposure.
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Affiliation(s)
- Xin Liu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China
| | - Lei Zhang
- The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China
| | - Jingguang Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China.
| | - Guimin Meng
- Beijing Fengtai Hospital Obstetrics and Gynecology, Beijing, China
| | - Min Chi
- School of Food Science and Technology, Nanchang University, Nanchang, China
| | - Tiantian Li
- Department of Environmental Health Risk Assessment, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunfeng Zhao
- The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China
| | - Yongning Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China; The Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing, China; School of Food Science and Technology, Nanchang University, Nanchang, China
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Metabolomics in gestational diabetes. Clin Chim Acta 2017; 475:116-127. [DOI: 10.1016/j.cca.2017.10.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022]
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Vafeiadi M, Roumeliotaki T, Chalkiadaki G, Rantakokko P, Kiviranta H, Fthenou E, Kyrtopoulos SA, Kogevinas M, Chatzi L. Persistent organic pollutants in early pregnancy and risk of gestational diabetes mellitus. ENVIRONMENT INTERNATIONAL 2017; 98:89-95. [PMID: 27743729 DOI: 10.1016/j.envint.2016.10.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 10/06/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND Persistent organic pollutants (POPs) are a group of diverse substances, including polychlorinated biphenyls (PCBs) and organochlorine pesticides that are resistant to biodegradation and ubiquitously present in our environment. Exposure to endocrine disrupting chemicals such as POPs has been linked to type 2 diabetes and metabolic disturbances in epidemiological and animal studies, but little is known about POPs exposure during pregnancy and the development of gestational diabetes mellitus (GDM). The purpose of this study was to determine the extent to which exposure to current low levels of different POPs in the first trimester of pregnancy is associated with GDM risk in 939 women from the "Rhea" pregnancy cohort in Crete, Greece. METHODS Concentrations of several PCBs, dichlorodiphenyldichloroethene (DDE), and hexachlorobenzene (HCB) were determined in first trimester maternal serum by triple quadrupole mass spectrometry. We defined total PCBs as the sum of all congeners, nondioxin-like PCBs as the sum of PCB 153, 138, 170 and 180, and dioxin-like PCBs as the sum of PCB 118 and 156. Pregnant women were screened for gestational diabetes mellitus (GDM) between 24 and 28weeks of gestation, and GDM was defined by the criteria proposed by Carpenter and Coustan. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression models. RESULTS Of the 939 women, 68 (7%) developed GDM. Serum concentrations of POPs were higher in women with GDM. Women in the medium and high tertiles of PCBs had 3.90 (95% CI: 1.37, 11.06) and 3.60 (95% CI: 1.14, 11.39) fold respectively higher odds of developing GDM compared to women in the lowest tertile of PCB exposure after adjusting for pre-pregnancy BMI and several other confounders. Odds of GDM for women in the medium and high tertiles of dioxin-like PCBs was 5.63 (95% CI: 1.81, 17.51) and 4.71 (95% CI: 1.38, 16.01) and for nondioxin-like PCBs 2.36 (95% CI: 0.89, 6.23) and 2.26 (95% CI: 0.77, 6.68) respectively. Prenatal DDE and HCB exposure were not significantly associated GDM risk. CONCLUSIONS These findings suggest that women with high PCBs levels in early pregnancy had higher risk for GDM. Further studies are needed to replicate these results and to evaluate potential biological mechanisms underlying the observed associations.
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Affiliation(s)
- Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Panu Rantakokko
- Department of Environmental Health, National Institute for Health and Welfare, Chemicals and Health Unit, Kuopio, Finland
| | - Hannu Kiviranta
- Department of Environmental Health, National Institute for Health and Welfare, Chemicals and Health Unit, Kuopio, Finland
| | - Eleni Fthenou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Soterios A Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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Eslami B, Naddafi K, Rastkari N, Rashidi BH, Djazayeri A, Malekafzali H. Association between serum concentrations of persistent organic pollutants and gestational diabetes mellitus in primiparous women. ENVIRONMENTAL RESEARCH 2016; 151:706-712. [PMID: 27640070 DOI: 10.1016/j.envres.2016.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/28/2016] [Accepted: 09/05/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND There is growing evidence that persistent organic pollutants (POPs) may play an important role in increasing the risk of gestational diabetes mellitus (GDM). OBJECTIVES The aim of this study was to examine the association between polychlorinated biphenyls (PCBs, 10 congeners) and polybrominated diphenyl ethers (PBDEs, 8 congeners) and GDM in primiparous women with no family history of diabetes in first-degree relatives during the third trimester of pregnancy. METHODS This case-control study was performed among the three university hospitals of Tehran University of Medical Sciences. Serum samples were collected from cases (n=70) that were diagnosed with GDM and from controls (n=70) with a normal pregnancy that attended the same hospital for a routine prenatal visit. Pollutant levels were analyzed by Gas Chromatography Mass Spectrometry (GC/MS). RESULTS Logistic regression analyses manifested the positive association between total POPs (sum of total PCBs and PBDEs) (Odds ratio (OR)=1.61, 95% CI: 1.31-1.97, p-value <0.0001) and total PCBs (OR=1.75, 95% CI: 1.35-2.27, p-value<0.0001) and GDM considering confounding variables (age, gestational age, pre-pregnancy body mass index (BMI), and total maternal serum lipid). In addition, we found a positive association between total PBDEs and GDM (OR =2.21; 95% CI: 1.48-3.30, p-value <0.0001). Finally, we found a positive association between Ln PCB 187, 118 and Ln PBDE 99, 28 with GDM. Meanwhile a negative association between Ln PCB 28 and GDM was established. CONCLUSION Our data suggest that exposure to certain POPs (PCBs and PBDEs) could be a potential modifying risk factor for GDM.
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Affiliation(s)
- Bita Eslami
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Rastkari
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Batool Hossein Rashidi
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Djazayeri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Malekafzali
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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