Diagnosis, prevention and management of gestational diabetes mellitus

Temporal Patterns of Diabetes in Pregnancy: Analyzing Pregestational and Gestational Diabetes Mellitus Among Women Aged 15-44 Years Using the United States Diabetes Surveillance System (USDDS) Database

BACKGROUND

Diabetes in pregnancy, including pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), is a significant global health concern. Understanding its temporal patterns is crucial for effective healthcare planning and intervention strategies.

METHODS

This retrospective observational study utilized data from the United States Diabetes Surveillance System (USDDS) spanning 2000 to 2019. We conducted a comprehensive analysis of temporal trends in PGDM and GDM prevalence among people aged 15-44 years. Additionally, age and race-based subgroup analyses were performed to identify variations in diabetes patterns.

RESULTS

Over the two-decade study period, PGDM and GDM exhibited distinct temporal patterns. PGDM prevalence remained stable initially (1.1% per 100 deliveries) but gradually increased to 1.6% by 2019. In contrast, GDM prevalence showed a consistent rise, reaching 9.6% per 100 deliveries by 2019. Age-specific analysis revealed higher prevalence rates in older age groups, peaking at 40-44 years. Race-based analyses unveiled significant disparities, with Asians having the highest GDM rates and Black individuals having the highest PGDM rates.

CONCLUSION

The prevalence of diabetes in pregnancy in the United States has increased significantly from 2000 to 2019, emphasizing the need for continued surveillance and tailored interventions. Age and race-specific disparities highlight the importance of the growing impact of diabetes in pregnancy on maternal and fetal health.

Diseases and conditions that impact maternal and fetal health and the potential for nanomedicine therapies

Maternal mortality rates in the United States have steadily increased since 1987 to the current rate of over 16 deaths per 100,000 live births. Whereas most of these deaths are related to an underlying condition, such as cardiovascular disease, many pregnant women die from diseases that emerge as a consequence of pregnancy. Both pre-existing and emergent diseases and conditions are difficult to treat in pregnant women because of the potential harmful effects of the treatment on the developing fetus. Often the health of the woman and the health of the baby are at odds and must be weighed against each other when medical treatment is needed, frequently leading to iatrogenic preterm birth. However, the use of engineered nanomedicines has the potential to fill the treatment gap for pregnant women. This review describes several conditions that may afflict pregnant women and fetuses and introduces how engineered nanomedicines may be used to treat these illnesses. Although the field of maternal-fetal nanomedicine is in its infancy, with additional research and development, engineered nanotherapeutics may greatly improve outcomes for pregnant women and their offspring in the future.

The isoflavonoid calycosin inhibits inflammation and enhances beta cell function in gestational diabetes mellitus by suppressing RNF38 expression

BACKGROUND

Gestational diabetes mellitus (GDM) is a medical complication and metabolic disorder associated with pregnancy. Calycosin is a traditional Chinese herbal medicine that is used for the treatment of multiple diseases. This study focused on exploring the effects and underlying mechanisms of Calycosin on GDM.

METHODS

The db/+ diabetic mice model of GDM was used to evaluate the effects of calycosin administration on the symptoms of GDM mice. Blood glucose, cytokine production (interleukin 6, IL-6; tumor necrosis factor-α, TNF-α), and insulin levels were measured by ELISA assay. The expression level of signal transducer and activator of transcription 3 (STAT3), ring finger protein 38 (RNF38), and SH2-containing protein tyrosine phosphatase 1 (SHP-1) were determined by Western Blot assay. Beta cell proliferation was assessed by CCK-8 assay.

RESULTS

Our data indicated that administration of calycosin significantly improved the GDM symptoms in pregnant db/+ mice as demonstrated by reduced blood glucose, TNF-a, and IL-6 levels as well as increased insulin level, and body weight. Furthermore, we revealed that RNF38/SHP-1/STAT3 signaling should play a critical role in calycosin-promoted beta cell function, and forced expression of RNF38 attenuated the positive effects of calycosin on beta cells.

CONCLUSION

Our study implied that calycosin exerts favorable effects on GDM mice via rebalancing insulin sensitivity and inflammatory response.

Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis

AIM

To provide a comprehensive update on the most prevalent, significant risk factors for neonatal brachial plexus palsy (NBPP).

METHOD

Cochrane CENTRAL, MEDLINE, Web of Science, Embase, and ClinicalTrials.gov were searched for relevant publications up to March 2019. Studies assessing risk factors of NBPP in relation to typically developing comparison individuals were included. Meta-analysis was performed for the five most significant risk factors, on the basis of the PRISMA statement and MOOSE guidelines. Pooled odds ratios (ORs), 95% confidence intervals (CIs), and across-study heterogeneity (I² ) were reported. Reporting bias and quality of evidence was rated. In addition, we assessed the incidence of NBPP.

RESULTS

Twenty-two observational studies with a total sample size of 29 419 037 live births were selected. Significant risk factors included shoulder dystocia (OR 115.27; 95% CI 81.35-163.35; I² =92%), macrosomia (OR 9.75; 95% CI 8.29-11.46; I² =70%), (gestational) diabetes (OR 5.33; 95% CI 3.77-7.55; I² =59%), instrumental delivery (OR 3.8; 95% CI 2.77-5.23; I² =77%), and breech delivery (OR 2.49; 95% CI 1.67-3.7; I² =70%). Caesarean section appeared as a protective factor (OR 0.13; 95% CI 0.11-0.16; I² =41%). The pooled overall incidence of NBPP was 1.74 per 1000 live births. It has decreased in recent years.

INTERPRETATION

The incidence of NBPP is decreasing. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are risk factors for NBPP. Caesarean section appears as a protective factor.

WHAT THIS PAPER ADDS

The overall incidence of neonatal brachial plexus palsy is 1.74 per 1000 live births. The incidence has declined significantly. Shoulder dystocia, macrosomia, maternal diabetes, instrumental delivery, and breech delivery are the main risk factors. Prevention is difficult owing to unpredictability and often labour-related risk.

Cost effectiveness of different screening strategies for gestational diabetes mellitus screening: study protocol of a randomized community non-inferiority trial

BACKGROUND

There is lack of ideal and comprehensive economic evaluations of various GDM strategies. The aim of this study is to the compare efficacy and cost-effectiveness of five different methods of screening for gestational diabetes mellitus (GDM).

METHODS

This study is a randomized community non-inferiority trial among 30,000 pregnant women in five different geographic regions of Iran, who were randomly assigned to one of the five GDM screening methods. All first trimester pregnant women, seeking prenatal care in governmental health care systems, who met our eligibility criteria were enrolled. The criteria suggested by the International-Association-of-Diabetes-in-Pregnancy-Study-Group, the most intensive approach, were used as reference. We used the non-inferiority approach to compare less intensive strategies to the reference one. Along with routine prenatal standard care, all participants were scheduled to have two phases of GDM screening in first and second-trimester of pregnancy, based on five different pre-specified protocols. The screening protocol included fasting plasma glucose in the first trimester and either a one step or a two-step screening method in the second trimester of pregnancy. Pregnant women were classified in three groups based on the results: diagnosed with preexisting pre-gestational overt diabetes; gestational diabetes and non-GDM women. Each group received packages for standard-care and all participants were followed till delivery; pregnancy outcomes, quality of life and cost of health care were recorded in detail using specific standardized questionnaires. Primary outcomes were defined as % birth-weight > 90th percentile and primary cesarean section. In addition, we assessed the direct health care direct and indirect costs.

RESULTS

This study will enable us to compare the cost effectiveness of different GDM screening protocols and intervention intensity (low versus high).

CONCLUSION

Results which if needed, will also enable policy makers to optimize the national GMD strategy as a resource for enhancing GDM guidelines.Trial registration Name of the registry: Iranian Registry of Clinical Trials. Trial registration number: IRCT138707081281N1. Date of registration: 2017-02-15. URL of trial registry record: https://www.irct.ir/trial/518.

Lentinus edodes Exposure before and after Fetus Implantation: Materno-Fetal Development in Rats with Gestational Diabetes Mellitus

Background: The presence of β-glucans and phenolic compounds in Lentinus edodes suggests this mushroom can be used as a nutritional supplement. Two gestational conditions (before and after fetus implantation) were evaluated, and Lentinus edodes exposure was performed in diabetes mellitus rat model induced by streptozotocin in pre-clinical tests. Methods: On the 20th day of pregnancy, cesarean sections were performed. Blood was collected for biochemical, hematologic parameters and oxidative stress biomarkers. Placenta and amniotic fluid were collected, and fetuses were analyzed through morphological evaluation. Results: The mushroom did not reduce the severe hyperglycemia of the mother-concept but promoted an increase in maternal insulin levels; reduced the levels of alanine aminotransferase, and aspartate aminotransferase, triglyceride and total cholesterol; protected the animals from post-implantation losses. Liver damage induced by streptozotocin was reversed in experimental groups. Conclusions: Lentinus edodes mushroom has antioxidant properties that can minimize the damage caused by gestational diabetes mellitus.

Ethnic variations on gestational diabetes mellitus and evidence-based first-line interventions

PURPOSE/OBJECTIVES

To analyze the cultural and ethnic impact of gestational diabetes mellitus (GDM), report the associated complications, and investigate how lifestyle interventions are effective in preventing these associated complications.

METHODS

A literature review was conducted using online databases like CINAHL and Cochrane review. Findings were limited to journal articles published between 2012 and 2017. Irrelevant and relevant articles were determined by research topic, specific population, and type of interventions.

RESULTS

Due to the growing rate of Hispanics, this ethnic group will have the most impact of GDM. There is a link between the prevalence of GDM and being classified as obese or overweight among women of childbearing age. Differences in perinatal outcomes were noted in different ethnicities especially between Hispanic and Caucasian women. Higher prevalence of GDM did not equal higher impact. In fact, the ethnicity with the highest rate tends to have the lowest impact. Lifestyle interventions reduced the rate and impact of complications of GDM.

CONCLUSIONS

There is ethnic variation on the impact of GDM, with the Hispanic women having the most prevalence. Lifestyle interventions such as diet and exercise should be the first-line therapy for all women with GDM.