1
|
Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2022; 377:e067946. [PMID: 35613728 PMCID: PMC9131781 DOI: 10.1136/bmj-2021-067946] [Citation(s) in RCA: 150] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the association between gestational diabetes mellitus and adverse outcomes of pregnancy after adjustment for at least minimal confounding factors. DESIGN Systematic review and meta-analysis. DATA SOURCES Web of Science, PubMed, Medline, and Cochrane Database of Systematic Reviews, from 1 January 1990 to 1 November 2021. REVIEW METHODS Cohort studies and control arms of trials reporting complications of pregnancy in women with gestational diabetes mellitus were eligible for inclusion. Based on the use of insulin, studies were divided into three subgroups: no insulin use (patients never used insulin during the course of the disease), insulin use (different proportions of patients were treated with insulin), and insulin use not reported. Subgroup analyses were performed based on the status of the country (developed or developing), quality of the study, diagnostic criteria, and screening method. Meta-regression models were applied based on the proportion of patients who had received insulin. RESULTS 156 studies with 7 506 061 pregnancies were included, and 50 (32.1%) showed a low or medium risk of bias. In studies with no insulin use, when adjusted for confounders, women with gestational diabetes mellitus had increased odds of caesarean section (odds ratio 1.16, 95% confidence interval 1.03 to 1.32), preterm delivery (1.51, 1.26 to 1.80), low one minute Apgar score (1.43, 1.01 to 2.03), macrosomia (1.70, 1.23 to 2.36), and infant born large for gestational age (1.57, 1.25 to 1.97). In studies with insulin use, when adjusted for confounders, the odds of having an infant large for gestational age (odds ratio 1.61, 1.09 to 2.37), or with respiratory distress syndrome (1.57, 1.19 to 2.08) or neonatal jaundice (1.28, 1.02 to 1.62), or requiring admission to the neonatal intensive care unit (2.29, 1.59 to 3.31), were higher in women with gestational diabetes mellitus than in those without diabetes. No clear evidence was found for differences in the odds of instrumental delivery, shoulder dystocia, postpartum haemorrhage, stillbirth, neonatal death, low five minute Apgar score, low birth weight, and small for gestational age between women with and without gestational diabetes mellitus after adjusting for confounders. Country status, adjustment for body mass index, and screening methods significantly contributed to heterogeneity between studies for several adverse outcomes of pregnancy. CONCLUSIONS When adjusted for confounders, gestational diabetes mellitus was significantly associated with pregnancy complications. The findings contribute to a more comprehensive understanding of the adverse outcomes of pregnancy related to gestational diabetes mellitus. Future primary studies should routinely consider adjusting for a more complete set of prognostic factors. REVIEW REGISTRATION PROSPERO CRD42021265837.
Collapse
Affiliation(s)
- Wenrui Ye
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Cong Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Huang
- National Clinical Research Centre for Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chenglong Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Fangkun Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
2
|
Wojtyla C, Stanirowski P, Gutaj P, Ciebiera M, Wojtyla A. Perinatal Outcomes in a Population of Diabetic and Obese Pregnant Women-The Results of the Polish National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020560. [PMID: 33440848 PMCID: PMC7827210 DOI: 10.3390/ijerph18020560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 01/22/2023]
Abstract
Obesity and diabetes increase the risk of complications during gestation and at delivery. The aim of this study was to compare the perinatal outcomes in the populations of diabetic and obese Polish women, based on the results of a national survey performed in years 2012 and 2017, as well as to determine the risk factors of the gestational diabetes mellitus (GDM). Questionnaires from 6276 women were collected. Obese women constituted 5.5% and 7.5% of study population in years 2012 and 2017, respectively. Among women whose pregnancies were complicated by diabetes mellitus, GDM constituted the most common type of glucose intolerance during both time periods (2012: 89% vs. 2017: 85.6%). In the group of obese women an insignificant increase in the rate of induced deliveries was noted (2012: 9.9% vs. 2017: 11.7%), whereas the fetal birth-weight decreased significantly (2012: 3565 g vs. 2017: 3405 g, p < 0.05). In the group of diabetic pregnant women the percentage of cesarean sections, labour inductions and fetal birth defects was characterized by an insignificant upward trend. Risk of GDM was significantly increased in women aged over 35 years—(2012: OR 1.9 (95% CI: 1.1–2.9) and 2017: OR = 2.1 (95% CI: 1.5–2.9), p < 0.05—, as well as in overweight women—2012: OR 1.8 (95% CI: 1.2–2.7) and 2017: OR 2.6 (95% CI: 1.9–3.4), p < 0.05—during both analysed time periods. Based on the study results, it is necessary to develop population-based programmes to prevent obesity and to introduce and enforce the rules of appropriate screening for glucose tolerance disorders during pregnancy.
Collapse
Affiliation(s)
- Cezary Wojtyla
- International Prevention Research Institute—Collaborating Centre, Calisia University, 62-800 Kalisz, Poland
- Club 35, Polish Society of Gynecologists and Obstetricians, 02-677 Warsaw, Poland; (P.S.); (P.G.); (M.C.)
- Department of Oncological Gynecology and Obstetrics, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland
- Correspondence:
| | - Pawel Stanirowski
- Club 35, Polish Society of Gynecologists and Obstetricians, 02-677 Warsaw, Poland; (P.S.); (P.G.); (M.C.)
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland
| | - Pawel Gutaj
- Club 35, Polish Society of Gynecologists and Obstetricians, 02-677 Warsaw, Poland; (P.S.); (P.G.); (M.C.)
- Department of Reproduction, Poznan University of Medical Sciences, St, 60-535 Poznan, Poland
| | - Michal Ciebiera
- Club 35, Polish Society of Gynecologists and Obstetricians, 02-677 Warsaw, Poland; (P.S.); (P.G.); (M.C.)
- Second Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Andrzej Wojtyla
- World Institute for Family Health, Calisia University, 62-800 Kalisz, Poland;
| |
Collapse
|
3
|
Barquiel B, Herranz L, Martínez-Sánchez N, Montes C, Hillman N, Bartha JL. Increased risk of neonatal complications or death among neonates born small for gestational age to mothers with gestational diabetes. Diabetes Res Clin Pract 2020; 159:107971. [PMID: 31805352 DOI: 10.1016/j.diabres.2019.107971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/09/2019] [Accepted: 11/29/2019] [Indexed: 01/18/2023]
Abstract
AIMS To evaluate if neonatal complications or death were poorer for neonates born small for gestational age (SGA) than for those born with adequate weight or large for gestation age (LGA) to women with gestational diabetes mellitus (GDM). METHODS Retrospective analysis of the clinical outcomes of neonates born to 3413 women with GDM. The prevalence of neonatal hypoglycaemia, hypocalcaemia, hyperbilirubinemia, polycythaemia, and death was compared among three birthweight groups: SGA, adequate, and LGA. A two-sided chi-squared or Fisher's exact test was used for between-group comparisons. A forward multiple logistic regression was performed to determine the odds ratio (OR) associated with SGA. RESULTS Neonatal complications were more frequent in the SGA group (20.1%) than in the adequate (9.9%) or LGA (15.2%) groups. There were four deaths (1.6%) in the SGA group compared to one in the LGA (0.4%) and six in the adequate (0.2%) groups (P = 0.002). SGA was a risk factor for neonatal complications or death (OR. 2.122; 95% confidence interval, 1.552-2.899), independent of maternal age, weight gain, fasting glucose, glycaemic control, gestational hypertension, pre-eclampsia, smoking, or neonatal prematurity. CONCLUSION SGA birthweight is an important risk factor for neonatal complications or death among neonates born to mothers with GDM.
Collapse
Affiliation(s)
- Beatriz Barquiel
- Division of Diabetes, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain.
| | - Lucrecia Herranz
- Division of Diabetes, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Nuria Martínez-Sánchez
- Department of Obstetrics, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Cristina Montes
- Division of Diabetes, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - Natalia Hillman
- Division of Diabetes, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics, Diabetes and Pregnancy Unit, La Paz University Hospital, Madrid, Spain
| |
Collapse
|
4
|
Nahavandi S, Seah JM, Shub A, Houlihan C, Ekinci EI. Biomarkers for Macrosomia Prediction in Pregnancies Affected by Diabetes. Front Endocrinol (Lausanne) 2018; 9:407. [PMID: 30108547 PMCID: PMC6079223 DOI: 10.3389/fendo.2018.00407] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/29/2018] [Indexed: 12/16/2022] Open
Abstract
Large birthweight, or macrosomia, is one of the commonest complications for pregnancies affected by diabetes. As macrosomia is associated with an increased risk of a number of adverse outcomes for both the mother and offspring, accurate antenatal prediction of fetal macrosomia could be beneficial in guiding appropriate models of care and interventions that may avoid or reduce these associated risks. However, current prediction strategies which include physical examination and ultrasound assessment, are imprecise. Biomarkers are proving useful in various specialties and may offer a new avenue for improved prediction of macrosomia. Prime biomarker candidates in pregnancies with diabetes include maternal glycaemic markers (glucose, 1,5-anhydroglucitol, glycosylated hemoglobin) and hormones proposed implicated in placental nutrient transfer (adiponectin and insulin-like growth factor-1). There is some support for an association of these biomarkers with birthweight and/or macrosomia, although current evidence in this emerging field is still limited. Thus, although biomarkers hold promise, further investigation is needed to elucidate the potential clinical utility of biomarkers for macrosomia prediction for pregnancies affected by diabetes.
Collapse
Affiliation(s)
- Sofia Nahavandi
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Jas-mine Seah
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Alexis Shub
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Mercy Hospital for Women, Mercy Health, Melbourne, VIC, Australia
| | - Christine Houlihan
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
- Mercy Hospital for Women, Mercy Health, Melbourne, VIC, Australia
| | - Elif I. Ekinci
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Al-Ajlan A, Al-Musharaf S, Fouda MA, Krishnaswamy S, Wani K, Aljohani NJ, Al-Serehi A, Sheshah E, Alshingetti NM, Turkistani IZ, Afrah Alharbi A, Alraqebah BA, Ali AM, Al-Saeed G, Al-Daghri NM. Lower vitamin D levels in Saudi pregnant women are associated with higher risk of developing GDM. BMC Pregnancy Childbirth 2018; 18:86. [PMID: 29631547 PMCID: PMC5891955 DOI: 10.1186/s12884-018-1723-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 03/29/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has serious consequences such as increased risks of preeclampsia, macrosomia and cesarean delivery. Even though the mechanistic basis of GDM has not been completely understood, several risk factors have been identified and one of these is vitamin D. However, the link between vitamin D deficiency and development of GDM is yet to be proven with certainty. METHODS This study aimed to investigate the link between the incidence of GDM and serum vitamin D level in pregnant women of Saudi Arabia. 515 Saudi women (ages 18-46) in their 24-28th week of pregnancy, visiting various hospitals of Riyadh, participated in this study. Serum vitamin D and various biochemical and anthropometric parameters were determined in the first trimester and the recruits were screened for GDM by OGTT according to IADPSG criteria in their 2nd trimester. The association between vitamin D deficiency and development of GDM was calculated based on odds ratio of the incidence of GDM among vitamin D deficient and normal women. RESULTS In this study cohort of 515 pregnant women, in the first trimester vitamin D deficiency (< 50 nmol/l) was detected in 425 (82.5%). On their 2nd visit (2nd trimester), 116 (27.7%) were diagnosed with GDM out of 419 with OGTT, according to IADPSG criteria. GDM risk was significantly higher among vitamin D deficient than non-deficient women (Odds Ratio: 2.87; Confidence Interval: 1.32-6.25; P = 0.008) even after adjusting for season, sun exposure and vitamin D intake (OR: 2.9; CI: 1.07-7.89). Of the various anthropometric and biochemical parameters, the GDM women differed significantly from non-GDM women with respect to serum levels of triglycerides (in mmol/l) (1.3 ± 0.6; 1.5 ± 0.6, p = 0.018) and fasting glucose (in mmol/l) [4.7 (4.3-5.2); 5.1 (4.6-5.6), p < 0.01]. Also, fasting glucose level in the 2nd trimester correlated inversely to serum vitamin D level determined during the 1st trimester (r = - 0.121; p = 0.014). CONCLUSIONS Results of our study reveal a significantly higher risk of development of GDM among pregnant women having deficient vitamin D status.
Collapse
Affiliation(s)
- Abdulrahman Al-Ajlan
- Department of Clinical Lab Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Sara Al-Musharaf
- Division of Metabolic and Vascular Health, University of Warwick, CV47AL, Coventry, UK
| | - Mona A Fouda
- Department of Medicine, Endocrinology Division, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Soundararajan Krishnaswamy
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia
| | - Kaiser Wani
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia
| | - Naji J Aljohani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia
| | - Amal Al-Serehi
- Maternal-Fetal Medicine Department, King Fahad Medical City, Riyadh, 59406, Saudi Arabia
| | - Eman Sheshah
- Obstetrics and Gynaecology Department, King Salman Bin Abdulaziz Hospital, Riyadh, 11564, Saudi Arabia
| | - Naemah M Alshingetti
- Department of Medicine, Endocrinology Division, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Iqbah Z Turkistani
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - A Afrah Alharbi
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia.,Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia
| | - Buthaynah A Alraqebah
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia.,Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia
| | - Aisha Mansoor Ali
- Diabetes Care Center, King Salman Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Gawaher Al-Saeed
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Nasser M Al-Daghri
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Department of Biochemistry, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Saudi Arabia. .,Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia.
| |
Collapse
|
6
|
Barquiel B, Herranz L, Hillman N, Burgos MÁ, Grande C, Tukia KM, Bartha JL, Pallardo LF. HbA1c and Gestational Weight Gain Are Factors that Influence Neonatal Outcome in Mothers with Gestational Diabetes. J Womens Health (Larchmt) 2016; 25:579-85. [DOI: 10.1089/jwh.2015.5432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Beatriz Barquiel
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - Lucrecia Herranz
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - Natalia Hillman
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| | - M Ángeles Burgos
- Diabetes and Pregnancy Unit, Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Cristina Grande
- Diabetes and Pregnancy Unit, Department of Biochemistry, Hospital Universitario La Paz, Madrid, Spain
| | - Keleni M. Tukia
- Division of Hematology/Oncology, Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - José Luis Bartha
- Diabetes and Pregnancy Unit, Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Luis Felipe Pallardo
- Diabetes and Pregnancy Unit, Division of Diabetes, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
7
|
Elhadd TA, Al-Amoudi AA, Alzahrani AS. Epidemiology, clinical and complications profile of diabetes in Saudi Arabia: a review. Ann Saudi Med 2007; 27:241-50. [PMID: 17684435 PMCID: PMC6074292 DOI: 10.5144/0256-4947.2007.241] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2007] [Indexed: 11/22/2022] Open
Abstract
Diabetes mellitus is emerging as a major public health problem in Saudi Arabia in parallel with the worldwide diabetes pandemic, which is having a particular impact upon the Middle East and the third world. This pandemic has accompanied the adoption of a modern lifestyle and the abandonment of a traditional lifestyle, with a resultant increase in rates of obesity and other chronic non-communicable diseases. The indigenous Saudi population seems to have a special genetic predisposition to develop type 2 diabetes, which is further amplified by a rise in obesity rates, a high rate of consanguinity and the presence of other variables of the insulin resistance syndrome. We highlight the epidemiology, clinical and complications profiles of diabetes in Saudi people. Diabetes is well studied in Saudi Arabia; however, there seems to be little research in the area of education and health care delivery. This is of paramount importance to offset the perceived impact on health care delivery services, to lessen chronic diabetes complications, and to reduce the expected morbidity and mortality from diabetes.
Collapse
Affiliation(s)
- Tarik A Elhadd
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah.
| | | | | |
Collapse
|
8
|
Affiliation(s)
- U Kamath
- Department of Biochemistry, Katsturba Medical College, Manipal, Karnataka, India
| | | | | | | | | |
Collapse
|
9
|
. JE, . SA, . NB. Microbial Population Dynamics as a Function of Sediment Salinity Gradients in the Qua Iboe Estuary Mangrove Swamp (Nigeria). ACTA ACUST UNITED AC 2006. [DOI: 10.3923/jm.2006.255.265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
Das UG, Sysyn GD. Abnormal fetal growth: intrauterine growth retardation, small for gestational age, large for gestational age. Pediatr Clin North Am 2004; 51:639-54, viii. [PMID: 15157589 DOI: 10.1016/j.pcl.2004.01.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The two extremes of abnormal fetal growth are restricted growth and excessive growth, both of which originate from alterations in the uterine metabolic milieu. The fetus must adapt to these conditions to survive. In both instances, however, the inciting insult and the subsequent adaptation of the fetus carry long-term health consequences. In some instances, these changes may have generational implications. Counseling and care by pediatricians should be directed at the continuum of age ranges, including the expectant mother, the newborn, the child and adolescent, and future generations.
Collapse
Affiliation(s)
- Utpala G Das
- Division of Neonatology, Medical College of Wisconsin, MS 213, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | | |
Collapse
|
11
|
Peuchant E, Brun JL, Rigalleau V, Dubourg L, Thomas MJ, Daniel JY, Leng JJ, Gin H. Oxidative and antioxidative status in pregnant women with either gestational or type 1 diabetes. Clin Biochem 2004; 37:293-8. [PMID: 15003731 DOI: 10.1016/j.clinbiochem.2003.12.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Revised: 12/04/2003] [Accepted: 12/05/2003] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate oxidative and antioxidative status in pregnant diabetic women between 26 and 32 weeks of gestation. DESIGN AND METHODS Free and total malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPX), and vitamins A and E were determined in plasma and erythrocytes of 54 pregnant women. Among these, 27 were diabetics with either gestational diabetes mellitus (GDM), sub-group I, or previous insulin-dependent diabetes mellitus (type 1 diabetes), sub-group II. The other 27 patients were controls. Fasting plasma glucose and HbA(1c) levels were determined in all women. RESULTS HbA(1c) levels, plasma-, and erythrocyte-free MDA levels were significantly higher in all diabetic women and in both sub-groups than in controls. Plasma vitamin E and erythrocyte vitamin A levels were significantly lower in all diabetic women than in controls. Moreover, GPX and SOD activities were significantly reduced in all diabetic women, GPX in both sub-groups and SOD only in type 1 diabetes. CONCLUSIONS The increased oxidative stress we demonstrated in pregnant women with previous type 1 diabetes or with GDM should be monitored by strictly controlling blood glucose during pregnancy with stringent recommendations and perhaps antioxidant supplementation.
Collapse
Affiliation(s)
- Evelyne Peuchant
- Biologie de la Différenciation et du Développement, Université Victor Segalen, 33076 Bordeaux cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Yang X, Zhang H, Dong L, Yu S, Guo Z, Hsu-Hage BHH. The effect of glucose levels on fetal birth weight: a study of Chinese gravidas in Tianjin, China. J Diabetes Complications 2004; 18:37-41. [PMID: 15019598 DOI: 10.1016/s1056-8727(03)00030-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2002] [Revised: 02/17/2003] [Accepted: 02/24/2003] [Indexed: 12/16/2022]
Abstract
The relationship between maternal glucose intolerance and fetal birth weight remains, to a large extent, unknown in Chinese gravidas. From December 1998 to December 1999, 9471[corrected] women in six urban districts of Tianjin, China, underwent an initial screening using a 50-g, 1-h glucose load at 26-30 gestational weeks. Women with a serum glucose reading >or=7.8 mmol/l, were followed up for a 75-g, 2-h glucose tolerance test, which was interpreted using the 1998 World Health Organization's (WHO) criteria for diabetes. A total of 174 women had gestational diabetes mellitus. Complete data was collected in 170 women. Among them, 56 accepted diabetes management including self-home glucose monitoring, diet, and physical activity advice, and others received no treatment. The comparison group was 302 women with normal glucose tolerance (NGT). Glucose levels at the initial screening (partial R(2)=.0343, P<.0001), maternal weight gain during pregnancy (partial R(2)=.0915, P<.0001), and gestational week at delivery (partial R(2)=.0432, P<.0001) were determinants of fetal birth weight, controlling for maternal age, pregravid BMI, maternal stature, and other confounders. Both gestational diabetes mellitus (GDM) status and a positive screening but normal oral glucose tolerance test (OGTT) result were predictors of macrosomia (birth weight >or=4000 g). It concludes that maternal glucose levels correlate with fetal birth weight and a glucose level of 7.8 mmol/l or more at the initial screening is predictive of macrosomia in Chinese gravidas regardless of GDM status.
Collapse
Affiliation(s)
- Xilin Yang
- Tianjin Institute for Women's Health, Tianjin, China.
| | | | | | | | | | | |
Collapse
|
13
|
Yang X, Hsu-Hage B, Zhang H, Zhang C, Zhang Y, Zhang C. Women with impaired glucose tolerance during pregnancy have significantly poor pregnancy outcomes. Diabetes Care 2002; 25:1619-24. [PMID: 12196437 DOI: 10.2337/diacare.25.9.1619] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This article tests the hypothesis that women with impaired glucose tolerance (IGT) have the same pregnancy outcomes as those of their counterparts with normal glucose tolerance. RESEARCH DESIGN AND METHODS From December 1998 to December 1999, 84 of 90 antenatal care base units (ACBUs) under the Tianjin Antenatal Care Network in China participated in the first screening program for gestational diabetes mellitus (GDM). A total of 9,471 pregnant women under the care of participating ACBUs were screened. Of the women screened, 154 were positive for IGT. Of the 154 women, 102 opted for conventional obstetric care. The comparison group was 302 women of normal glucose tolerance (NGT). The initial screening consisted of a 50-g 1-h glucose test, and was carried out at 26-30 gestational weeks. Women with a serum glucose > or =7.8 mmol/l were followed up with a 75-g 2-h oral glucose tolerance test. The World Health Organization's diagnostic criteria for GDM were used. RESULTS Women with IGT were at increased risk for premature rupture of membranes (P-ROM) (odds ratio [OR] 10.07; 95% CI 2.90-34.93); preterm birth (6.42; 1.46-28.34); breech presentation (3.47; 1.11-10.84); and high birth weight (90th percentile or 4,000 g) (2.42; 1.07-5.46); adjusting for maternal age, pregravid BMI, hospital levels, and other confounding factors. CONCLUSIONS The presence of IGT in pregnancy is predictive of poor pregnancy outcomes.
Collapse
Affiliation(s)
- Xilin Yang
- Department of Rural Health, University of Melbourne, Melbourne, Australia. Tianjin Centre of Disease Control and Prevention, Tianjin, China. Tianjin Institute for Women's Health, Tianjin, China
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
The prevalence of obesity is currently rising in developed countries, making pregravid overweight one of the most common high-risk obstetric situations. Although the designs and populations of published studies vary widely, most authors agree that pregravid overweight increases maternal and fetal morbidity. Even moderate overweight is a risk factor for gestational diabetes and hypertensive disorders of pregnancy, and the risk is higher in subjects with overt obesity. Compared with normal weight, maternal overweight is related to a higher risk of cesarean deliveries and a higher incidence of anesthetic and postoperative complications in these deliveries. Low Apgar scores, macrosomia, and neural tube defects are more frequent in infants of obese mothers than in infants of normal-weight mothers. The regional distribution of fat modulates the effects of weight on carbohydrate tolerance, hemodynamic adaptation, and fetal size. Maternal obesity increases perinatal mortality. Long-term complications include worsening of maternal obesity and development of obesity in the infant. The average cost of hospital prenatal and postnatal care is higher for overweight mothers than for normal-weight mothers, and infants of overweight mothers require admission to neonatal intensive care units more often than do infants of normal-weight mothers. Preconception counseling, careful prenatal management, tight monitoring of weight gain, and long-term follow-up could minimize the social and economic consequences of pregnancies in overweight women.
Collapse
Affiliation(s)
- F Galtier-Dereure
- Service d'Endocrinologie, Hôpital Lapeyronie, CHU Montpellier, France.
| | | | | |
Collapse
|
15
|
Abstract
In summary, fetal macrosomia occurs in almost one third of diabetic pregnancies regardless of class. Abnormal fetal fat stores lead to difficult labor, dystocia, and birth injury as well as postnatal metabolic transition. The abnormal body fat distribution at birth may destine some of these infants to lifelong obesity. Abnormal fetal growth in diabetic pregnancy appears to occur with any elevations in maternal glucose levels, however modest. Detection of macrosomia is therefore a major goal of diabetic pregnancy management.
Collapse
Affiliation(s)
- T R Moore
- Department of Reproductive Medicine, University of California, School of Medicine, San Diego, California, USA
| |
Collapse
|