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Ontiveros J, Gunnarsdóttir J, Einarsdóttir K. Trends in gestational diabetes in Iceland before and after guideline changes in 2012: a nationwide study from 1997 to 2020. Eur J Public Health 2024; 34:794-799. [PMID: 38905590 PMCID: PMC11293813 DOI: 10.1093/eurpub/ckae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Abstract
Internationally accepted diagnostic criteria recommendations for gestational diabetes (GDM) in 2010 resulted in a rise in global prevalence of GDM. Our aim was to describe the trends in GDM before and after Icelandic guideline changes in 2012 and the trends in pregestational diabetes (PGDM). The study included all singleton births (N = 101 093) in Iceland during 1997-2020. Modified Poisson regression models were used to estimate prevalence ratios (PRs) with 95% confidence intervals (CIs) for risk of GDM overall and by maternal age group, as well as overall risk of PGDM, according to time period of birth. The overall prevalence of GDM by time period of birth ranged from 0.6% (N = 101) in 1997-2000 to 16.2% (N = 2720) in 2017-2020, and the prevalence of PGDM ranged from 0.4% (N = 57) in 1997-2000 to 0.7% (N = 120) in 2017-2020. The overall relative GDM prevalence rate difference before and after 2012 was 380%, and the largest difference was found among women aged <25 years at 473%. Risk of GDM increased in 2017-2020 (PR 14.21, CI 11.45, 17.64) compared to 1997-2000 and was highest among women aged >34 years with PR 19.46 (CI 12.36, 30.63) in 2017-2020. Prevalence rates of GDM and PGDM increased during the study period. An accelerated rate of increase in GDM was found after 2012, overall, and among all maternal age groups. Women aged >34 years had the greatest risk of GDM throughout all time periods, while women aged <25 years appear to have a higher relative rate difference after 2012.
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Affiliation(s)
- Jamie Ontiveros
- Centre of Public Health Sciences, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jóhanna Gunnarsdóttir
- Centre of Public Health Sciences, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Obstetrics and Gynecology, Landspítali – The National University Hospital of Iceland, Reykjavík, Iceland
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
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Fathnezhad-Kazemi A, Seifinadergoli Z, Ahmadi M. Factors affecting the quality of life in pregnant women with diabetes: the mediating effect of illnesses acceptance. BMC Pregnancy Childbirth 2024; 24:513. [PMID: 39075420 PMCID: PMC11285530 DOI: 10.1186/s12884-024-06690-x] [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: 03/22/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Gestational diabetes, as a disorder of carbohydrate metabolism, is considered one of the most common metabolic complications in pregnancy. The diagnosis of diabetes in pregnancy leads to changes in lifestyle, and the treatments employed can affect various aspects of pregnant women's lives, including their quality of life. The present study aimed to investigate the relationship between self-efficacy and the mediating effect of illness acceptance on the quality of life in pregnant women diagnosed with diabetes during pregnancy. MATERIALS AND METHODS This cross-sectional study was conducted on 240 pregnant women diagnosed with diabetes who were selected by convenience sampling method. Quality of life tools (SF12), the Acceptance of Illness Scale (AIS), and the Sherer self-efficacy scale were used to collect data. RESULTS The mean (SD) of quality of life, self-efficacy, and disease acceptance were 57.36 (6.63), 51.75 (7.44), and 29.07 (7.69), respectively. In the single-variable regression analysis, self-efficacy and disease acceptance variables could predict 20.6% (β = 0.457, P < 0.001) and 14.4% (β = 0.385, P < 0.001) of the variations in quality of life, respectively. In the multiple regression model, by entering the two main variables (self-efficacy and Acceptance of Illness), demographic characteristics, three disease knowledge variables, health status from an individual perspective, and type of treatment, the variables could explain 25% of the changes of the quality of life (R2adj 0.25, P < 0.001=). Income status and self-efficacy had the highest impact among the variables. According to the results of path analysis, the total effect of self-efficacy on the quality of life of pregnant women with diabetes was 0.711. CONCLUSION The overall quality of life in women with diabetes was moderate, and self-efficacy, illness acceptance, and income status were predictors of overall quality of life. Self-efficacy can influence the quality of life by affecting disease acceptance. The findings highlight the importance of designing educational programs and providing midwifery services to increase self-efficacy and illness acceptance to improve the quality of life of pregnant women with diabetes.
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Affiliation(s)
- Azita Fathnezhad-Kazemi
- Department of Midwifery, Women's Reproductive and Mental Health Research Center, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran.
- Department of Midwifery, Faculty of Medical Sciences, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran.
| | - Zahra Seifinadergoli
- Department of Midwifery, Women's Reproductive and Mental Health Research Center, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran
- Department of Midwifery, Faculty of Medical Sciences, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran
| | - Mohaddeseh Ahmadi
- Students' Research Committee, Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran
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Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, Hivert MF, Immanuel J, Meek C, Oppermann ML, Nolan CJ, Ram U, Schmidt MI, Simmons D, Chivese T, Benhalima K. Epidemiology and management of gestational diabetes. Lancet 2024; 404:175-192. [PMID: 38909620 DOI: 10.1016/s0140-6736(24)00825-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.
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Affiliation(s)
- Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Wesley Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Friedman School of Nutrition Science and Policy, Tufts University School of Medicine, Tufts University, Boston, MA, USA
| | - Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Willliam H Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marie-France Hivert
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Pilgrim Health Care Institute, Harvard Medical School, Harvard University, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Sydney, NSW, Australia; Texas Woman's University, Denton, TX, USA
| | - Claire Meek
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Maria Lucia Oppermann
- Department of Obstetrics and Gynecology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Department of Endocrinology, Canberra Health Services, Woden, ACT, Australia
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, India
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Dunne P, Culliney L, O'Mahony L, Byrne M, Murphy AW, O'Reilly S. Exploring health professionals' knowledge, practices and attitudes regarding gestational diabetes: A cross-sectional Irish national survey. Diabet Med 2024:e15373. [PMID: 38820178 DOI: 10.1111/dme.15373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
AIM Gestational diabetes confers short- and long-term risk of mother and offspring health complications. Healthcare professionals such as endocrinologists, diabetes nurses, dietitians, midwives and general practitioners provide gestational diabetes care. We sought to explore healthcare professionals' perspectives on gestational diabetes care during pregnancy and postpartum. METHODS Healthcare professionals in the Republic of Ireland, whose role included gestational diabetes care were invited to complete an online 20-item survey between June and September 2022. Social media, professional organisations and personal networks were used for recruitment. Questions included guideline use, postpartum diabetes screening and advice practices. Analyses were performed using SPSS statistical software and free text was coded using NVivo. RESULTS Seventeen healthcare professions across primary and secondary care settings participated (n = 127). No differences were noted between groups (medical, nursing/midwifery, allied health/other); therefore, findings were reported as a single group. Healthcare professionals reported using multiple different guidelines to support gestational diabetes management (n = 14). The most cited were 'Health Service Executive guidelines' (24.5%), 'local guidelines' (13.2%) and National Institute for Clinical Excellence guidelines (11.3%); 12.3% cited uncertainty, and 27.5% reported not to follow any named guidelines. For postpartum follow-up, 39% felt clear guidelines were available to support practice, 37% felt appropriate systems were in place and 29% reported effective communication between primary and secondary care services. Qualitative findings emphasised a desire for improved communication between systems, participants and providers, clear interdisciplinary guidelines, and adequate resourcing for gestational diabetes management and postpartum diabetes prevention, including comprehensive support and follow-up. CONCLUSION System-level challenges and ineffective communication across settings are barriers to optimum postpartum care. Nationally agreed guidelines for best practice gestational diabetes management including postpartum diabetes prevention are needed.
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Affiliation(s)
- Pauline Dunne
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | | | | | - Molly Byrne
- Health Behaviour Change Research Group, University of Galway, Galway, Ireland
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
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Reischer T, Prossinger S, Catic A, Healy E, Göbl C, Yerlikaya-Schatten G. Factors Affecting Mode of Birth in Women With Preexisting Diabetes and Gestational Diabetes: A Retrospective Cohort at a Tertiary Referral Center. J Diabetes Res 2024; 2024:5561761. [PMID: 38883259 PMCID: PMC11178421 DOI: 10.1155/2024/5561761] [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: 11/03/2023] [Revised: 03/25/2024] [Accepted: 05/11/2024] [Indexed: 06/18/2024] Open
Abstract
Women with preexisting diabetes and gestational diabetes mellitus (GDM) are at higher risk for adverse maternal and neonatal outcomes. However, there is no consensus on a uniform approach regarding mode of birth (MOB) for all forms of diabetes. The aim of the study is to compare MOB in women with preexisting diabetes and GDM and possible factors influencing it. A retrospective cohort study of women with GDM and preexisting diabetes between 2015 and 2021 at a tertiary referral center was conducted. One thousand three hundred eighty-five singleton pregnancies were included. One thousand twenty-two (74.4%) women had a vaginal birth (VB) and 351 (25.6%) a caesarean section. Preexisting diabetes was significantly associated with caesarean section compared to GDM (OR 2.43). Five hundred fifty-one (40.1%) women underwent induction of labor, and 122 (22.1%) women had a secondary caesarean after IOL. Women induced due to spontaneous rupture of membrane (SROM) achieved the highest rate of VB at 93%. The lowest rates of VB occurred if indication for induction was for preeclampsia or hypertension. IOL was significantly less successful in preexisting diabetes with a VB achieved in 56.4% for type 1 diabetes and 52.6% of type 2 diabetes compared to GDM (78.2% in GDM; 81.2% in IGDM; OR 3.25, 95% CI 1.70-6.19, p < 0.001). The rate of VB was higher who were induced preterm compared to women with term IOL (n = 240 (81.9%) vs. n = 199 (73.2%); p < 0.05). Parity, previous VB and SROM favored VB after IOL, whereas preexisting diabetes, hypertension, and IOL after 40 + 0 weeks are independent risk factors for caesarean delivery.
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Affiliation(s)
- Theresa Reischer
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Sina Prossinger
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Anja Catic
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Eibhlin Healy
- Fetal Medicine Unit Liverpool Women's Hospital, Liverpool, UK
| | - Christian Göbl
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Gülen Yerlikaya-Schatten
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
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Abera D, Larbie C, Abugri J, Ofosu M, Mutocheluh M, Dongsogo J. Prevalence and Predictors of Gestational Diabetes Mellitus in Sub-Saharan Africa: A 10-Year Systematic Review. Endocrinol Diabetes Metab 2024; 7:e00478. [PMID: 38597653 PMCID: PMC11005715 DOI: 10.1002/edm2.478] [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: 11/04/2023] [Revised: 01/18/2024] [Accepted: 02/23/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) remains a global public health problem, which affects the well-being of mothers and their children in sub-Saharan Africa (SSA). Studies conducted in different geographical areas provide varied results on its prevalence and predictors. Understanding the extent and predictors of GDM in SSA is important for developing effective interventions and policies. Thus, this review aimed to investigate the prevalence of GDM and its predictive factors in sub-Saharan Africa. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards in this review. An extensive search of the PubMed, Web of Sciences and EMBASE databases was carried out covering papers from 2012 to 2022 to assess the prevalence and predictors of GDM. Microsoft Excel 2019 was utilised for study management. GraphPad Prism Version 8.0 and the MedCalc statistical software were employed for data analysis. The findings were analysed using textual descriptions, tables, forest plots and heat maps. RESULTS Using 30 studies with 23,760 participants that satisfied the inclusion criteria, the review found the overall prevalence of GDM in SSA to be 3.05% (1.85%-4.54%). History of preterm delivery, alcohol consumption, family history of diabetes, history of stillbirths, history of macrosomia, overweight or obesity and advanced mother age were all significant predictors of gestational diabetes. Additionally, various biomarkers such as haemoglobin, adiponectin, leptin, resistin, visfatin, vitamin D, triglycerides and dietary intake type were identified as significant predictors of GDM. CONCLUSION In sub-Saharan Africa, there is a high pooled prevalence of gestational diabetes mellitus. In the light of the predictors of GDM identified in this review, it is strongly recommended to implement early screening for women at risk of developing gestational diabetes during their pregnancy. This proactive approach is essential for enhancing the overall well-being of both mothers and children.
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Affiliation(s)
- Daniel Ataanya Abera
- Department of Laboratory Technology, Faculty of Health SciencesKumasi Technical UniversityKumasiGhana
- Department of Biochemistry and Biotechnology, Faculty of Bioscience, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Christopher Larbie
- Department of Biochemistry and Biotechnology, Faculty of Bioscience, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - James Abugri
- Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical SciencesC. K. Tedam University of Technology and Applied SciencesNavrongoGhana
| | - Mina Ofosu
- Department of Laboratory Technology, Faculty of Health SciencesKumasi Technical UniversityKumasiGhana
| | - Mohamed Mutocheluh
- Department of Clinical Microbiology, School of Medical ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Julius Dongsogo
- Department of Biochemistry, Faculty of BiosciencesUniversity for Development StudiesTamaleGhana
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Tola A, Assefa N, Dessie Y, Oljira L, Regassa LD, Gure T, Gobena T. Epidemiology of hyperglycemia during pregnancy in Ethiopia: prevalence, associated factors, and feto-maternal outcomes: systematic review and meta-analysis. Syst Rev 2024; 13:116. [PMID: 38685068 PMCID: PMC11057183 DOI: 10.1186/s13643-024-02526-z] [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: 01/13/2023] [Accepted: 04/13/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Hyperglycemia in pregnancy (HIP) is a significant medical complication affecting pregnant women globally and is considered a public health burden due to the negative outcomes it can cause for both mother and infant. The aim of this systematic review and meta-analysis was to examine the prevalence, risk factors, and feto-maternal outcomes of HIP in Ethiopia. METHODS To gather relevant information for this study, both published and unpublished studies were searched for in several major databases, including PubMed, Embase, HINARI, Web of Science direct, and Google Scholar, as well as other sources. The Joanna Briggs Institute (JBI) tool was used to evaluate the methodological quality of the findings from these studies. Data was then extracted and summarized using a template in Microsoft Excel software, and the extracted data was analyzed using Stata software version 16.0. If significant heterogeneity was found between studies, subgroup analyses were conducted to further examine the data. RESULT Eighteen studies were included in this systematic review and meta-analysis, involving a total sample size of 50,816 pregnant women in Ethiopia. The prevalence of HIP among pregnant women varied considerably across the primary studies, ranging from 0.4 to 26.2%. The pooled prevalence of HIP among pregnant women in Ethiopia was found to be 6.9% (95% C 2.2-11.6). Pregnant women with a family history of diabetes had 2.5 times higher odds of developing HIP compared to those without a family history of diabetes (OR = 2.49; 95% CI = 2.02, 2.96). However, there was no significant association found between HIP and maternal obesity (OR 2.31, 95% CI = 0.85, 3.78) or previous history of abortion (OR 3.89; 95% CI 0.85, 6.94). The common fetal outcomes associated with HIP were admission to the intensive care unit (46.2; 95% CI 27.4, 65.1), macrosomia (27.3%; 95% CI 9.4%, 45.1%), and preterm birth (16.9; 95% CI 12.5, 21.3). Additionally, hypertensive disorders of pregnancy (28.0%; 95% CI 15.2, 40.8) and operative delivery (51.4%; 95% CI 35.9, 66.8) were more common among women with HIP in Ethiopia. CONCLUSION Although there was some variation between studies, the meta-analysis revealed that approximately seven out of 100 pregnant women in Ethiopia had HIP. A family history of diabetes was found to be a significant predictor of HIP in Ethiopia. Additionally, HIP was associated with various serious adverse outcomes for both mothers and infants in Ethiopia. These findings highlight the need for national guidelines to ensure that pregnant women are uniformly screened for HIP.
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Affiliation(s)
- Assefa Tola
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Gure
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Eades CE, Burrows KA, Andreeva R, Stansfield DR, Evans JM. Prevalence of gestational diabetes in the United States and Canada: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:204. [PMID: 38491497 PMCID: PMC10941381 DOI: 10.1186/s12884-024-06378-2] [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: 12/16/2022] [Accepted: 02/28/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND An understanding of the prevalence of gestational diabetes mellitus among pregnant women is essential at local, national and international level so that appropriate health care interventions can be planned, financed and delivered. METHODS A systematic review and meta-analysis of primary research reporting the prevalence of gestational diabetes mellitus in Canada or the United States were carried out according to Meta-analysis of Observational Studies in Epidemiology guidelines. Four electronic databases were systematically searched in June 2023 to identify articles that reported gestational diabetes mellitus prevalence using universal screening in pregnant women from eligible general population samples. Estimates were combined using a random effects model, and the effects of moderator variables analysed. RESULTS There were 36 separate samples of women or deliveries (total sample size 1,550,917). Overall mean prevalence of gestational diabetes mellitus was 6.9% (95% CI: 5.7-8.3); 13.7% (95% CI: 10.7-17.3) in studies using a one-step screening strategy, and 5.2% (95% CI: 4.4-6.1) in those using a two-step strategy. Heterogeneity in technical methods between studies produced differences in estimates, as did different diagnostic thresholds used. CONCLUSIONS The meta-analysis suggests a slightly higher prevalence of gestational diabetes mellitus in Canada and the United States, compared to Europe, but highlights the need for standardised protocols for estimating gestational diabetes mellitus prevalence.
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Affiliation(s)
- Claire E Eades
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | - Katherine A Burrows
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Roza Andreeva
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | | | - Josie Mm Evans
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
- Public Health Scotland, Edinburgh, Scotland
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Assaf EA, Al Sabbah H, Momani A, Al-Amer R, A. Al-Sa’ad G, Ababneh A. Factors influencing gestational diabetes self-care among pregnant women in a Syrian Refugee Camp in Jordan. PLoS One 2024; 19:e0297051. [PMID: 38358984 PMCID: PMC10868830 DOI: 10.1371/journal.pone.0297051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/27/2023] [Indexed: 02/17/2024] Open
Abstract
AIM The main objective of this study is to identify the level of self-care practices and the determinants of Gestational Diabetes Mellitus (GDM) among pregnant women residing in one of the refugee camps in Jordan. METHOD A cross-sectional study was conducted on a convenient sample of forty women diagnosed with GDM from the high-risk maternity clinic in one of the Syrian refugee camps in Jordan. The study used the Gestational Diabetes Management Self-Efficacy Scale (GDMSES), Diabetes Knowledge (DMK) assessment, and Diabetes Self-Care Activities Questionnaire (SDSCA) to measure the variables of interest. Descriptive analysis and Multiple logistic regression were used to assess for significant factors. RESULTS Significant associations were found between the subcategories of diet, exercise, and blood sugar control in both the self-efficacy and self-activity scales (p < 0.01, p < 0.01, p < 0.05), respectively. Two factors were associated with higher GDM self-care: diabetes knowledge and higher self-efficacy toward GDM self-care (p < 0.05). CONCLUSION The findings of this study highlight that pregnant women with GDM who have higher levels of self-efficacy and diabetes knowledge are more likely to achieve higher levels of GDM self-care. Beside developing health promotion programs to enhance women's self-efficacy in adhering to GDM care, adequate support and relevant resources to facilitate GDM management among refugee women are recommended. Future research for identifying other potential factors affecting GDM self-care among refugees is highly recommended.
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Affiliation(s)
- Enas A. Assaf
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Haleama Al Sabbah
- College of Health Sciences, Abu Dhabi University, Khalifa City, United Arab Emirates
| | - Aaliyah Momani
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | | | - Ghada A. Al-Sa’ad
- United Nation High Commissioner for Refugees (UNHCR) Jordan Office, Amman, Jordan
| | - Anas Ababneh
- Faculty of Nursing, Yarmouk University, Irbid, Jordan
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Vlachodimitropoulou E, Mogharbel H, Kuo KHM, Hwang M, Ward R, Shehata N, Malinowski AK. Pregnancy outcomes and iron status in β-thalassemia major and intermedia: a systematic review and meta-analysis. Blood Adv 2024; 8:746-757. [PMID: 38181780 PMCID: PMC10847873 DOI: 10.1182/bloodadvances.2023011636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
ABSTRACT Advancements in orally bioavailable iron chelators and MRI methods have improved life expectancy and reproductive potential in thalassemia major (TM) and thalassemia intermedia (TI). Pregnancy is associated with adverse maternal and neonatal outcomes, frequency of which has not been well delineated. This systematic review aims to provide risk estimates of maternal and fetal outcomes in TM and TI and explore pregnancy's impact on iron homeostasis. Fifteen studies (429 participants, 684 pregnancies) were included. Meta-analysis revealed a higher thrombosis risk in TI (3.7%) compared to TM (0.92%), unchanged from prepregnancy. Heart failure risks in the earlier years appeared similar (TM 1.6% vs TI 1.1%), and maternal mortality in TM was 3.7%, but with current management, these risks are rare. Gestational diabetes and pre-eclampsia occurred in 3.9% and 11.3% of TM pregnancies, respectively. Caesarean section rates were 83.9% in TM and 67% in TI. No significant difference in stillbirth, small for gestational age neonates, or preterm birth incidence between TM and TI was observed. In TM pregnancies, red cell requirements significantly increased (from 102 to 139 ml/kg/year, P = 0.001), and 70% of TI pregnancies required blood transfusions. As expected, increased transfusion alongside chelation cessation led to a significant increase in serum ferritin during pregnancy (TM by 1005 ng/mL; TI by 332 ng/mL, P < 0.0001). Deterioration in iron status was further reflected by an increase in liver iron concentration (from 4.6 to 11.9 mg/g dry weight, P < 0.0001), and myocardial T2-star (T2∗) magnetic resonance imaging decreased (from 36.2 ± 2.5 ms to 31.1 ms) during pregnancy. These findings emphasize the elevated maternal risk of iron-related cardiomyopathy during pregnancy and labor, stressing the importance of cardiac monitoring and postpartum chelation therapy resumption.
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Affiliation(s)
| | - Hussain Mogharbel
- Division of Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Kevin H. M. Kuo
- Division of Haematology, University of Toronto, Toronto, ON, Canada
| | - Michelle Hwang
- Sidney Liswood Health Sciences Library, Mount Sinai Hospital, Toronto, ON, Canada
| | - Richard Ward
- Division of Haematology, University of Toronto, Toronto, ON, Canada
| | - Nadine Shehata
- Departments of Medicine and Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ann Kinga Malinowski
- Division of Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
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11
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Hajhashemy Z, Bagherniya M, Sadeghi O, Askari G. The relation of dietary protein intake before and during the pregnancy with gestational diabetes mellitus (GDM): A GRADE-assessed systematic review and dose-response meta-analysis of epidemiologic studies. Clin Nutr 2024; 43:505-518. [PMID: 38215681 DOI: 10.1016/j.clnu.2024.01.007] [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: 06/21/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Although previous studies investigated the relation of protein intake and gestational diabetes mellitus (GDM), their findings were controversial. Therefore, we aimed to summarize this association, through a comprehensive systematic review and dose-response meta-analysis. METHODS Electronic databases including MEDLINE (PubMed), ISI Web of Science, Scopus and motor engineering of Google Scholar were systematically searched up to April 2023. Observational studies which investigated odds of GDM in relation to protein intake were included. RESULTS A total of 31,005 participants with 3451 cases of GDM from 13 eligible investigations were included in the systematic review and meta-analysis. Comparing the highest and lowest intakes of total, animal, and plant proteins revealed the summary RRs of 1.82 (95% CI: 1.42, 2.33), 1.79 (95% CI: 1.50, 2.14), and 0.98 (95% CI: 0.81, 1.20), respectively, indicating a significant positive association between total and animal protein intake and GDM. In the dose-response analyses, each 5% increment in energy intake from total protein during pregnancy was related to 20% increased odds of GDM (RR = 1.20; 95% CI: 1.09, 1.33). In the non-linear dose-response analyses, we found a non-linear association for animal protein intake during pregnancy (P for non-linearity <0.001); so that, a risk increase was seen from zero to 10% of energy intake from animal proteins, however, a risk reduction was seen after 10% of energy intake. However, there was not any significant non-linear trend between plant protein intake during pregnancy and risk of GDM. Based on the GRADE assessment, the quality of evidence for total, animal and plant protein was rated as "moderate", "moderate" and "very low", respectively. CONCLUSION We found a significant positive association between total protein intake and GDM; however, the associations of animal and plant protein intake with GDM were dose-dependent.
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Affiliation(s)
- Zahra Hajhashemy
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran; Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Sadeghi
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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12
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Huang X, Li Y, Tong X, Wu Y, Zhang R, Sheng L, Xu J, Yu Z, Chen Z, Sun T, Wang F, Yang Q, Li Z, Gao C, Ma L, Ding H, Zang S, Yang N, Zhang TN, Liu J. Increased Circulating IL-32 Is Associated With Placenta Macrophage-derived IL-32 and Gestational Diabetes Mellitus. J Clin Endocrinol Metab 2024; 109:333-343. [PMID: 37708356 DOI: 10.1210/clinem/dgad531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Placenta-derived inflammation plays a vital role in the pathophysiology of gestational diabetes mellitus (GDM). IL-32 is a novel pro-inflammatory cytokine and metabolic regulator involved in the development of metabolic disease. We investigated the effect of IL-32 in GDM. MATERIALS AND METHODS First-trimester C-reactive protein (CRP) level was monitored in a case-control study of 186 women with GDM and 186 women without. Placental tissue was lysed and analyzed by high-resolution liquid chromatography-tandem mass spectrometry. Circulating level of inflammatory cytokines IL-32, IL-6, and TNF-α were measured by ELISA kits. The expression of placenta-derived macrophages, inflammatory cytokines, and related pathway proteins were assessed by reverse transcriptase-quantitative PCR, western blot, immunohistochemistry, or immunofluorescence. RESULTS First-trimester CRP level in peripheral blood was closely associated with glucose and insulin resistance index and was an independent correlation with the development of GDM. High-resolution liquid chromatography-tandem mass spectrometry revealed that placenta-derived CRP expression was dramatically elevated in women with GDM. Interestingly, the expression of placenta-derived IL-32 was also increased and located in the macrophages of placental tissue. Meanwhile, the expression of IL-6, TNF-α, and p-p38 were up-regulated in the placental tissues with GDM. Either IL-6 or TNF-α was colocated with IL-32 in the placental tissue. Importantly, circulating IL-32 throughout pregnancy was increased in GDM and was related to placental-derived IL-32 expression, circulating IL-6, and TNF-α, glucose and insulin resistance index. CONCLUSION Increased circulating IL-32 throughout pregnancy was closely associated with placenta macrophage-derived IL-32 expression and GDM. First trimester IL-32 level in peripheral blood may serve to predict the development of GDM.
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Affiliation(s)
- Xinmei Huang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Yue Li
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Xiaoxu Tong
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yueyue Wu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Rui Zhang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Li Sheng
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Jiong Xu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Zhiyan Yu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Zaoping Chen
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Tiange Sun
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Fang Wang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Qian Yang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Zhangyan Li
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Cuijun Gao
- Department of Obstetrics, Wujing Hospital, Shanghai 200241, China
| | - Ling Ma
- Department of Obstetrics, Wujing Hospital, Shanghai 200241, China
| | - Heyuan Ding
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Shufei Zang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Ni Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Tie-Ning Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jun Liu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
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13
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Ghanei A, Mohammadzade G, Gholami Banadkoki M, Meybodi AE. The predictive role of serum uric acid levels before pregnancy in the development of gestational diabetes mellitus. Diabetol Int 2024; 15:123-129. [PMID: 38264224 PMCID: PMC10800320 DOI: 10.1007/s13340-023-00662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/29/2023] [Indexed: 01/25/2024]
Abstract
Objective With the prevalence of obesity, growing age of first pregnancy, highly processed high-calorie diet, consumption of saturated fats as well as sedentary and stressful life, the prevalence of gestational diabetes mellitus (GDM) is increasing. We aimed to determine the predictive role of pre-pregnancy serum uric acid levels and the occurrence of GDM during pregnancy. Methods This study was a descriptive-analytical study that was performed retrospectively through case-control. The Subjects of this study were women over 18 years of age who were 24-28 weeks pregnant. All subjects of this study were evaluated for GDM based on the ADA guideline and were divided into case and control groups. All data relating to the period of 6 months before pregnancy of the study participants including blood uric acid level, blood pressure, etc. were collected and analyzed. Results In this study, 454 normal individuals without GDM and 478 others with GDM were examined. The mean serum uric acid showed to be 4.47 ± 1.33 mg/dl in patients with GDM but 3.7 ± 1.25 mg/dl in patients without GDM (p value = 0.001). The results of the regression test showed that the incidence of GDM in people with blood uric acid levels of 4.1-5, 5.1-6, and more than 6 mg/dl is 2.46, 3.42, and 4.9 times higher in people with uric acid levels less than 3 mg/dl, respectively. Conclusion The present study identified that serum uric acid levels in the period of 6 months before pregnancy can be used as an independent predictor marker for future GDM.
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Affiliation(s)
- Azam Ghanei
- Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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14
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Kjerpeseth LJ, Hjellvik V, Gulseth HL, Karlstad Ø, Lopez-Doriga Ruiz P, Wensaas KA, Furu K. Prevalence and treatment of gestational diabetes in Norway 2010-2020. Diabetes Res Clin Pract 2024; 207:111025. [PMID: 38000666 DOI: 10.1016/j.diabres.2023.111025] [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: 01/28/2023] [Revised: 10/12/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
AIMS Estimate prevalence of gestational diabetes mellitus (GDM) and its treatment in Norway 2010-2020 and explore impact of new national GDM guidelines in 2017. METHODS We identified women giving birth in a nationwide cohort study using registers on births, prescriptions, education, primary and specialist care. For each year, we estimated prevalence of GDM overall, by BMI, age, education, and mother's birthplace; proportions of GDM pregnancies receiving pharmacological treatment; and distribution of the gestational week when GDM was diagnosed. RESULTS In 633,169 pregnancies, prevalence of GDM increased from 2.6 % in 2010 to 6.0 % in 2016, then stabilized. Similar patterns were seen across strata of BMI, age, education, and maternal birthplace, although prevalence was higher with higher BMI, higher age, lower education, and mothers born in Asia, Africa, or Middle East. The proportion of the GDM population pharmacologically treated increased from 11.6 % in 2010 to 13.6 % in 2016 and 31.6 % in 2020. GDM was diagnosed in recommended gestational week 24-28 in 19 % versus 45 % of GDM pregnancies in 2010 and 2020, respectively. CONCLUSIONS Both the proportion diagnosed with GDM within recommended time of screening, and who received pharmacological treatment, increased substantially following new guidelines in 2017. Prevalence of GDM increased from 2010 to 2016, then plateaued.
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Affiliation(s)
- Lars J Kjerpeseth
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
| | - Vidar Hjellvik
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
| | - Hanne L Gulseth
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
| | | | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway.
| | - Kari Furu
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
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15
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Scheuer CM, Jensen DM, McIntyre HD, Ringholm L, Mathiesen ER, Nielsen CPK, Nolsöe RLM, Milbak J, Hillig T, Damm P, Overgaard M, Clausen TD. Applying WHO2013 diagnostic criteria for gestational diabetes mellitus reveals currently untreated women at increased risk. Acta Diabetol 2023; 60:1663-1673. [PMID: 37462764 PMCID: PMC10587026 DOI: 10.1007/s00592-023-02148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 10/21/2023]
Abstract
AIMS To estimate the prevalence of gestational diabetes mellitus (GDM) in a Danish cohort comparing the current Danish versus the WHO2013 diagnostic criteria, and to evaluate adverse pregnancy outcomes among currently untreated women in the gap between the diagnostic thresholds. METHODS Diagnostic testing was performed by a 75 g oral glucose tolerance test (OGTT) at 24-28 weeks' gestation in a cohort of pregnant women. GDM diagnosis was based on the current Danish criterion (2-h glucose ≥ 9.0 mmol/L, GDMDK) and on the WHO2013 criteria (fasting ≥ 5.1, 1 h ≥ 10.0 or 2 h glucose ≥ 8.5 mmol/L, GDMWHO2013). Currently untreated women fulfilling the WHO2013 but not the Danish diagnostic criteria were defined as New-GDM-women (GDMWHO2013-positive and GDMDK-negative). Adverse outcomes risks were calculated using logistic regression. RESULTS OGTT was completed by 465 women at a median of 25.7 weeks' gestation. GDMDK prevalence was 2.2% (N = 10) and GDMWHO2013 21.5% (N = 100). New-GDM was present in 19.4% (N = 90), of whom 90.0% had elevated fasting glucose. Pregnancies complicated by New-GDM had higher frequencies of pregnancy-induced hypertension (13.3% vs 4.1%, p = 0.002), large-for-gestational-age infants (22.2% vs 9.9%, p = 0.004), neonatal hypoglycaemia (8.9% vs 1.9%, p = 0.004) and neonatal intensive care unit admission (16.7% vs 5.8%, p = 0.002) compared to pregnancies without GDM. CONCLUSIONS GDM prevalence increased tenfold when applying WHO2013 criteria in a Danish population, mainly driven by higher fasting glucose levels. Untreated GDM in the gap between the current Danish and the WHO2013 diagnostic criteria resulted in higher risks of adverse pregnancy outcomes.
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Affiliation(s)
- Cathrine Munk Scheuer
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H David McIntyre
- Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Julie Milbak
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Martin Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Tine Dalsgaard Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
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16
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Linares-Pineda TM, Peña-Montero N, Gutiérrez-Repiso C, Lima-Rubio F, Sánchez-Pozo A, Tinahones FJ, Molina-Vega M, Picón-César MJ, Morcillo S. Epigenome wide association study in peripheral blood of pregnant women identifies potential metabolic pathways related to gestational diabetes. Epigenetics 2023; 18:2211369. [PMID: 37192269 DOI: 10.1080/15592294.2023.2211369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023] Open
Abstract
Gestational diabetes mellitus (GDM) increases the risk of developing metabolic disorders in both pregnant women and their offspring. Factors such as nutrition or the intrauterine environment may play an important role, through epigenetic mechanisms, in the development of GDM. The aim of this work is to identify epigenetic marks involved in the mechanisms or pathways related to gestational diabetes. A total of 32 pregnant women were selected, 16 of them with GDM and 16 non-GDM. DNA methylation pattern was obtained from Illumina Methylation Epic BeadChip, from peripheral blood samples at the diagnostic visit (26-28 weeks). Differential methylated positions (DMPs) were extracted using ChAMP and limma package in R 2.9.10, with a threshold of FDR <0.05, deltabeta >|5|% and B >0. A total of 1.141 DMPs were found, and 714 were annotated in genes. A functional analysis was performed, and we found 23 genes significantly related to carbohydrate metabolism. Finally, a total of 27 DMPs were correlated with biochemical variables such as glucose levels at different points of oral glucose tolerance test, fasting glucose, cholesterol, HOMAIR and HbA1c, at different visits during pregnancy and postpartum. Our results show that there is a differentiated methylation pattern between GDM and non-GDM. Furthermore, the genes annotated to the DMPs could be implicated in the development of GDM as well as in alterations in related metabolic variables.
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Affiliation(s)
- Teresa María Linares-Pineda
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Departamento de Bioquímica y Biología Molecular 2, Universidad de Granada, Granada, Spain
| | - Nerea Peña-Montero
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - Carolina Gutiérrez-Repiso
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Fuensanta Lima-Rubio
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - Antonio Sánchez-Pozo
- Departamento de Bioquímica y Biología Molecular 2, Universidad de Granada, Granada, Spain
| | - Francisco J Tinahones
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - María Molina-Vega
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - María José Picón-César
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - Sonsoles Morcillo
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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17
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Shahriari M, Shahriari A, Khooshideh M, Dehghaninezhad A, Maleki-Hajiagha A, Karimi R. Maternal and fetal outcomes of pregnancies associated with single versus double abnormal values in 100 gr glucose tolerance test. J Diabetes Metab Disord 2023; 22:1347-1353. [PMID: 37975110 PMCID: PMC10638114 DOI: 10.1007/s40200-023-01253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/13/2023] [Indexed: 11/19/2023]
Abstract
Purpose of the study Comparing maternal and fetal outcomes in pregnancies associated with single versus double abnormal values in 100 gr oral glucose tolerance test (OGTT). Methods This cohort study was performed in Arash women's Hospital, Tehran, Iran from 2019 to 2020. Patients with normal fasting blood sugar (FBS) tests were divided into two groups according to their OGTT results. The first group had a single abnormal value in their OGTT and the second group showed two abnormal values. Both groups were followed regularly until the end of pregnancy. Results Our results showed higher rates of macrosomia (birth of newborns weighed over 4 kg) and the need for pharmacological treatment for the management of GDM in the second group (P = 0.05). There were no differences between the two groups in terms of other maternal (polyhydramnios, shoulder dystocia, operative vaginal delivery, atony, postpartum bleeding, cesarean delivery, preeclampsia, and IUFD) and fetal outcomes (Apgar score, seizure, NICU admission, and hypoglycemia in the first 24 h). Conclusion We found no significant differences between pregnant women with single and double abnormal values in 100 gr OGTT regarding maternal and neonatal outcomes, except for macrosomia and need for pharmaceutical treatment.
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Affiliation(s)
| | - Ali Shahriari
- Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khooshideh
- Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Dehghaninezhad
- Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Maleki-Hajiagha
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Rashid Ave, Resalat Highway, Tehranpars, Tehran, P.O Box: 1653915981, Iran
| | - Rana Karimi
- Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Rashid Ave, Resalat Highway, Tehranpars, Tehran, P.O Box: 1653915981, Iran
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18
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Jaihow S, Phasuk N, Narkkul U, Pensuksan WC, Scholand SJ, Punsawad C. Maternal and Neonatal Outcomes of Pregnant Women with Abnormal 50 g Glucose Challenge Tests in Nakhon Si Thammarat, Thailand: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7038. [PMID: 37998269 PMCID: PMC10671579 DOI: 10.3390/ijerph20227038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/28/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
(1) Background: An abnormal 50 g glucose challenge test (50 g GCT) during pregnancy, even without a diagnosis of gestational diabetes mellitus (GDM), may result in undesirable obstetric and neonatal outcomes. This study sought to evaluate the outcomes in pregnant women with abnormal 50 g GCT in secondary care hospitals in Thailand. (2) Methods: A total of 1129 cases of pregnant women with abnormal 50 g GCT results who delivered between January 2018 and December 2020 at Thasala, Sichon, and Thungsong hospitals were retrospectively reviewed and divided into three groups: abnormal 50 g GCT and normal 100 g oral OGTT (Group 1; n = 397 cases), abnormal 50 g GCT and one abnormal 100 g OGTT value (Group 2; n = 452 cases), and GDM (Group 3; n = 307 cases). (3) Results: Cesarean section rates in group 3 (61.9%) were statistically higher than those in groups 1 (43.6%) and 2 (49.4%) (p < 0.001). In addition, the highest rate of birth asphyxia was found in group 2 (5.9%), which was significantly higher than that in Groups 1 (1.8%) and 3 (3.3%) (p = 0.007). (4) Conclusions: Pregnant women with abnormal 50 g GCTs without a diagnosis of GDM had undesirable maternal and neonatal outcomes, as well as those who had GDM, suggesting that healthcare providers should closely monitor them throughout pregnancy and the postpartum period.
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Affiliation(s)
- Suda Jaihow
- School of Nursing, Walailak University, Nakhon Si Thammarat 80160, Thailand;
| | - Nonthapan Phasuk
- Department of Medical Clinical Sciences, School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand;
- Research Center in Tropical Pathobiology, Walailak University, Nakhon Si Thammarat 80160, Thailand;
| | - Udomsak Narkkul
- Research Center in Tropical Pathobiology, Walailak University, Nakhon Si Thammarat 80160, Thailand;
- Department of Medical Sciences, School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | | | | | - Chuchard Punsawad
- Research Center in Tropical Pathobiology, Walailak University, Nakhon Si Thammarat 80160, Thailand;
- Department of Medical Sciences, School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand
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19
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Iser BPM, Stein C, Alves LF, Carvalho MLDS, Espinoza SAR, Schmidt MI. A portrait of gestational diabetes mellitus in Brazil: A systematic review and meta-analysis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e220521. [PMID: 37856706 DOI: 10.20945/2359-4292-2022-0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
The diagnostic criteria for gestational diabetes mellitus (GDM), a transient hyperglycemic state during pregnancy, has varied remarkably over time, resulting in a diversity of prevalence rates. The aim of this systematic literature review was to provide estimates of prevalence rates of GDM in Brazil according to different diagnostic criteria. We identified, reviewed, and extracted data from the scientific literature on studies estimating the prevalence of diabetes in pregnant women living in Brazil. The databases searched were PubMed, LILACS, SciELO, Embase, Web of Science, and Cochrane Library. We grouped studies by the source of information assessing GDM, patients' age, and criteria used to diagnose GDM. When three or more studies were available in a group, we calculated the pooled prevalence. The Joanna Briggs Institute (JBI) appraisal tool was used to assess the risk of bias. The data were reported according to the 2020 PRISMA recommendations. The study protocol was registered in PROSPERO. We identified 1,328 records and selected 21 studies involving 122,635 pregnant women. Studies in adults only, with primary data and laboratory measurements, and using the IADPSG criteria (n = 3) had a GDM prevalence of 18.0% (95% confidence interval [CI]: 16.0-20.1%) and included 6,243 participants. Estimates of self-reported GDM (n = 3; 10,136 participants of all ages) had a pooled GDM prevalence of 2.1% (95% CI: 1.5-5.2%), with high heterogeneity (I2 = 85.0%, p < 0.01). Studies including adolescents had consistently low prevalences. The prevalence of GDM in Brazil varied, was greater when the IADPSG criteria were applied, and depended on the methods used to obtain the GDM information and the age structure of the sample.
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Affiliation(s)
| | - Caroline Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brasil
| | - Luisia Feichas Alves
- Universidade Federal do Rio Grande do Sul (UFRGS), Biblioteca Central, Porto Alegre, RS, Brasil
| | | | | | - Maria Inês Schmidt
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brasil
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20
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Ugwudike B, Kwok M. Update on gestational diabetes and adverse pregnancy outcomes. Curr Opin Obstet Gynecol 2023; 35:453-459. [PMID: 37560815 DOI: 10.1097/gco.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW To explore the recent literature concerning the effect of gestational diabetes (GDM) on adverse pregnancy outcomes (APO). RECENT FINDINGS Literature search on PubMed, Medline and British Journal of Obstetrics and Gynaecology was conducted using keywords. Search fields were filtered down to include articles from 2019 onwards. GDM is common during pregnancy and is on the rise because of increasing in obesity rates. GDM tended to show an increased risk of APO compared with non-GDM. Treatment of these pregnancies tended to improve these outcomes, particularly for LGA and macrosomia. Additional factors such as prepregnancy BMI and gestational weight gain (GWG) were shown to influence risk. More studies are needed to determine the true effect on postpartum haemorrhage (PPH) and induction of labour (IOL). SUMMARY The review agrees with the findings from previous studies and adds to the current literature. Early intervention to manage glycaemic control and GWG may help improve these outcomes. Public health strategies that tackle obesity rates will help to reduce prepregnancy BMI and, therefore, rates of GDM.
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Affiliation(s)
- Bryan Ugwudike
- Queen Mary University of London, School of Medicine and Dentistry
| | - ManHo Kwok
- Royal London Hospital, Barts Health NHS Trust, London, UK
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21
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Okami H, Kawaharada R, Yoshizaki H, Toriumi A, Tsutsumi S, Nakamura A. Maternal n-7 Unsaturated Fatty Acids Protect the Fetal Brain from Neuronal Degeneration in an Intrauterine Hyperglycemic Animal Model. Nutrients 2023; 15:3434. [PMID: 37571372 PMCID: PMC10421171 DOI: 10.3390/nu15153434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
We previously reported that glycation induces insulin resistance in the hearts of newborn pups from a gestational diabetes mellitus (GDM) rat model. Administration of n-3 unsaturated fatty acids suppressed glycation and improved signaling in GDM rat pups. In this study, we investigated their effects on cranial neurons using the GDM rat model and PC12 cells derived from rat adrenal pheochromocytomas. Additionally, we examined whether n-3 and n-7 unsaturated fatty acids (cis-palmitoleic acid [CPA] and trans-palmitoleic acid [TPA]) ameliorate the detrimental effects of high glucose exposure on rats. In the neonatal cerebrum of GDM rats, increased levels of advanced glycation end products (AGEs) inhibited Akt phosphorylation; however, CPA and TPA intake during pregnancy ameliorated these abnormalities. Furthermore, exposure to high-glucose-induced apoptosis in PC12 cells compared to the cells cultured in control glucose. PC12 cells exposed to high-glucose with fatty acids exhibited reduced AGE production and apoptosis induction compared to the high-glucose group. These findings suggest that a hyperglycemic environment during pregnancy promotes AGE formation in brain neuronal proteins and induces apoptosis. Both TPA and CPA mitigated these abnormalities; however, CPA is cytotoxic, highlighting its safety in pregnant women.
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Affiliation(s)
- Haruka Okami
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi 371-8511, Japan;
| | - Ritsuko Kawaharada
- Department of Health and Nutrition, Takasaki University of Health and Welfare, Takasaki 370-0033, Japan;
| | - Hitomi Yoshizaki
- Department of Bioregulatory Science (Physiology), Nippon Medical School, Tokyo 113-8602, Japan;
| | - Akiyo Toriumi
- Department of Public Health, Graduate School of Medicine, Gunma University, Maebashi 371-8511, Japan;
| | - Saki Tsutsumi
- Department of Neurophysiology & Neural Repair, Graduate School of Medicine, Gunma University, Maebashi 371-8511, Japan;
| | - Akio Nakamura
- Department of Molecular Nutrition, Faculty of Human Life Sciences, Jissen Women’s University, Hino 191-8510, Japan
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22
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Linares-Pineda T, Peña-Montero N, Fragoso-Bargas N, Gutiérrez-Repiso C, Lima-Rubio F, Suarez-Arana M, Sánchez-Pozo A, Tinahones FJ, Molina-Vega M, Picón-César MJ, Sommer C, Morcillo S. Epigenetic marks associated with gestational diabetes mellitus across two time points during pregnancy. Clin Epigenetics 2023; 15:110. [PMID: 37415231 PMCID: PMC10324212 DOI: 10.1186/s13148-023-01523-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
An adverse intrauterine or periconceptional environment, such as hyperglycemia during pregnancy, can affect the DNA methylation pattern both in mothers and their offspring. In this study, we explored the epigenetic profile in maternal peripheral blood samples through pregnancy to find potential epigenetic biomarkers for gestational diabetes mellitus (GDM), as well as candidate genes involved in GDM development. We performed an epigenome-wide association study in maternal peripheral blood samples in 32 pregnant women (16 with GDM and 16 non-GDM) at pregnancy week 24-28 and 36-38. Biochemical, anthropometric, and obstetrical variables were collected from all the participants. The main results were validated in an independent cohort with different ethnic origin (European = 307; South Asians = 165). Two hundred and seventy-two CpGs sites remained significantly different between GDM and non-GDM pregnant women across two time points during pregnancy. The significant CpG sites were related to pathways associated with type I diabetes mellitus, insulin resistance and secretion. Cg01459453 (SELP gene) was the most differentiated in the GDM group versus non-GDM (73.6 vs. 60.9, p = 1.06E-11; FDR = 7.87E-06). Three CpG sites (cg01459453, cg15329406, and cg04095097) were able to discriminate between GDM cases and controls (AUC = 1; p = 1.26E-09). Three differentially methylated positions (DMPs) were replicated in an independent cohort. To conclude, epigenetic marks during pregnancy differed between GDM cases and controls suggesting a role for these genes in GDM development. Three CpGs were able to discriminate GDM and non-GDM groups with high specificity and sensitivity, which may be biomarker candidates for diagnosis or prediction of GDM.
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Affiliation(s)
- Teresa Linares-Pineda
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Universitario Virgen de la Victoria, 29010, Málaga, Spain
- Departamento de Bioquímica y Biología Molecular 2, Universidad de Granada, Granada, Spain
| | - Nerea Peña-Montero
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Universitario Virgen de la Victoria, 29010, Málaga, Spain
| | - Nicolás Fragoso-Bargas
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carolina Gutiérrez-Repiso
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Universitario Virgen de la Victoria, 29010, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 29029, Madrid, Spain
| | - Fuensanta Lima-Rubio
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Universitario Virgen de la Victoria, 29010, Málaga, Spain
| | - María Suarez-Arana
- Departamento de Obstetricia y Ginecología, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Regional Universitario de Málaga, 29009, Málaga, Spain
| | - Antonio Sánchez-Pozo
- Departamento de Bioquímica y Biología Molecular 2, Universidad de Granada, Granada, Spain
| | - Francisco J Tinahones
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Universitario Virgen de la Victoria, 29010, Málaga, Spain
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010, Málaga, Spain
| | - María Molina-Vega
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Universitario Virgen de la Victoria, 29010, Málaga, Spain
| | - María José Picón-César
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Universitario Virgen de la Victoria, 29010, Málaga, Spain.
| | - Christine Sommer
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sonsoles Morcillo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA_Plataforma Bionand, Hospital Universitario Virgen de la Victoria, 29010, Málaga, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 29029, Madrid, Spain.
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23
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Yang N, Zhang W, Ji C, Ge J, Zhang X, Li M, Wang M, Zhang T, He J, Zhu H. Metabolic alteration of circulating steroid hormones in women with gestational diabetes mellitus and the related risk factors. Front Endocrinol (Lausanne) 2023; 14:1196935. [PMID: 37396163 PMCID: PMC10310992 DOI: 10.3389/fendo.2023.1196935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Abnormally changed steroid hormones during pregnancy are closely related to the pathological process of gestational diabetes mellitus (GDM). Our aim was to systematically profile the metabolic alteration of circulating steroid hormones in GDM women and screen for risk factors. Methods This study was a case-control study with data measured from 40 GDM women and 70 healthy pregnant women during their 24-28 gestational weeks. 36 kinds of steroid hormones, including 3 kinds of corticosteroids, 2 kinds of progestins, 5 kinds of androgens and 26 kinds of downstream estrogens in serum were systematically measured using a combined sensitive UPLC-MS/MS method. The flux of different metabolic pathways of steroid hormones was analyzed. Logistic regression and ROC curve model analyses were performed to identify potential steroid markers closely associated with GDM development. Results Serum corticosteroids, progestins and almost all the estrogen metabolites via 16-pathway from parent estrogens were higher in GDM women compared with healthy controls. Most of the estrogen metabolites via 4-pathway and more than half of the metabolites via 2-pathway were not significantly different. 16α-hydroxyestrone (16OHE1), estrone-glucuronide/sulfate (E1-G/S) and the ratio of total 2-pathway estrogens to total estrogens were screened as three indicators closely related to the risk of GDM development. The adjusted odds ratios of GDM for the highest quartile compared with the lowest were 72.22 (95% CI 11.27-462.71, P trend <0.001) for 16OHE1 and 6.28 (95% CI 1.74-22.71, P trend <0.05) for E1-G/S. The ratio of 2-pathway estrogens to total estrogens was negatively associated with the risk of GDM. Conclusion The whole metabolic flux from cholesterol to downstream steroid hormones increased in GDM condition. The most significant changes were observed in the 16-pathway metabolism of estrogens, rather than the 2- or 4-pathway or other types of steroid hormones. 16OHE1 may be a strong marker associated with the risk for GDM.
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Affiliation(s)
- Na Yang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Wei Zhang
- Nanjing Qlife Medical Technology Co., Ltd, Nanjing, Jiangsu, China
| | - Cheng Ji
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jiajia Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaoli Zhang
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Meijuan Li
- Nanjing Qlife Medical Technology Co., Ltd, Nanjing, Jiangsu, China
| | - Min Wang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Tianqi Zhang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jun He
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huaijun Zhu
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
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24
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Danielli M, Thomas RC, Gillies CL, Lambert DG, Khunti K, Tan BK. Soluble Vascular Adhesion Protein 1 (sVAP-1) as a biomarker for pregnancy complications: A pilot study. PLoS One 2023; 18:e0284412. [PMID: 37253043 PMCID: PMC10228776 DOI: 10.1371/journal.pone.0284412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/30/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Vascular adhesion protein 1 (VAP-1) has been implicated in a wide range of clinical conditions. Moreover, serum levels are associated with disease prediction and progression in several clinical studies. There is a paucity of data on VAP-1 and pregnancy. Given the emerging role of VAP-1 in pregnancy, the aim of this study was to examine sVAP-1 as an early biomarker of pregnancy complications, especially hypertension during pregnancy. The objectives of the study are to associate sVAP-1 levels with other pregnancy complications, patient demographics and blood tests performed throughout pregnancy. METHODS We conducted a pilot study in a cohort of pregnant women (gestational week lower than 20 at the time of recruitment) attending their first antenatal ultrasound scan at the Leicester Royal Infirmary (LRI, UK). Data were both prospectively generated (from blood sample analysis) and retrospectively collected (from hospital records). RESULTS From July and October 2021, a total of 91 participants were enrolled. Using ELISA (enzyme-linked immunosorbent assay), we found reduced serum levels of sVAP-1 in pregnant women with either pregnancy induced hypertension (PIH) (310 ng/mL) or GDM (366.73 ng/mL) as compared to controls (427.44 ng/mL and 428.34 ng/mL, respectively). No significant difference was found between women with FGR compared to controls (424.32 ng/mL vs 424.52 ng/mL), and patients with any pregnancy complications compared to healthy pregnancies (421.28 ng/mL vs 428.34 ng/mL). CONCLUSION Further studies are needed to establish whether or not sVAP-1 might be considered as an early, non-invasive, and affordable biomarker to screen women who will develop PIH or GDM. Our data will aid sample size calculations for such larger studies.
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Affiliation(s)
- Marianna Danielli
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Roisin C. Thomas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Clare L. Gillies
- Diabetes Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - David G. Lambert
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, Leicester, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration–East Midlands (ARC-EM), Leicester General Hospital, Leicester, United Kingdom
| | - Bee Kang Tan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester General Hospital, Leicester, United Kingdom
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25
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Pinto Y, Frishman S, Turjeman S, Eshel A, Nuriel-Ohayon M, Shrossel O, Ziv O, Walters W, Parsonnet J, Ley C, Johnson EL, Kumar K, Schweitzer R, Khatib S, Magzal F, Muller E, Tamir S, Tenenbaum-Gavish K, Rautava S, Salminen S, Isolauri E, Yariv O, Peled Y, Poran E, Pardo J, Chen R, Hod M, Borenstein E, Ley RE, Schwartz B, Louzoun Y, Hadar E, Koren O. Gestational diabetes is driven by microbiota-induced inflammation months before diagnosis. Gut 2023; 72:918-928. [PMID: 36627187 PMCID: PMC10086485 DOI: 10.1136/gutjnl-2022-328406] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a condition in which women without diabetes are diagnosed with glucose intolerance during pregnancy, typically in the second or third trimester. Early diagnosis, along with a better understanding of its pathophysiology during the first trimester of pregnancy, may be effective in reducing incidence and associated short-term and long-term morbidities. DESIGN We comprehensively profiled the gut microbiome, metabolome, inflammatory cytokines, nutrition and clinical records of 394 women during the first trimester of pregnancy, before GDM diagnosis. We then built a model that can predict GDM onset weeks before it is typically diagnosed. Further, we demonstrated the role of the microbiome in disease using faecal microbiota transplant (FMT) of first trimester samples from pregnant women across three unique cohorts. RESULTS We found elevated levels of proinflammatory cytokines in women who later developed GDM, decreased faecal short-chain fatty acids and altered microbiome. We next confirmed that differences in GDM-associated microbial composition during the first trimester drove inflammation and insulin resistance more than 10 weeks prior to GDM diagnosis using FMT experiments. Following these observations, we used a machine learning approach to predict GDM based on first trimester clinical, microbial and inflammatory markers with high accuracy. CONCLUSION GDM onset can be identified in the first trimester of pregnancy, earlier than currently accepted. Furthermore, the gut microbiome appears to play a role in inflammation-induced GDM pathogenesis, with interleukin-6 as a potential contributor to pathogenesis. Potential GDM markers, including microbiota, can serve as targets for early diagnostics and therapeutic intervention leading to prevention.
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Affiliation(s)
- Yishay Pinto
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Sigal Frishman
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Biochemistry, School of Nutritional Sciences Food Science and Nutrition, The School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sondra Turjeman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Adi Eshel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Oshrit Shrossel
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
| | - Oren Ziv
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - William Walters
- Department of Microbiome Science, Max Planck Institute for Developmental Biology, Tubingen, Germany
| | - Julie Parsonnet
- Department of Medicine, Stanford University, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Catherine Ley
- Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Krithika Kumar
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Ron Schweitzer
- Department of Natural Compounds and Analytical Chemistry, Migal-Galilee Research Institute, Kiryat Shmona, Israel
- Analytical Chemistry Laboratory, Tel-Hai College, Upper Galilee, Israel
| | - Soliman Khatib
- Department of Natural Compounds and Analytical Chemistry, Migal-Galilee Research Institute, Kiryat Shmona, Israel
- Analytical Chemistry Laboratory, Tel-Hai College, Upper Galilee, Israel
| | - Faiga Magzal
- Laboratory of Human Health and Nutrition Sciences, Migal-Galilee Technology Center, Kiryat Shmona, Israel
- Nutritional Science Department, Tel Hai College, Upper Galilee, Israel
| | - Efrat Muller
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Snait Tamir
- Laboratory of Human Health and Nutrition Sciences, Migal-Galilee Technology Center, Kiryat Shmona, Israel
- Nutritional Science Department, Tel Hai College, Upper Galilee, Israel
| | - Kinneret Tenenbaum-Gavish
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuli Rautava
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
- University of Helsinki & Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki, Finland
| | - Seppo Salminen
- Functional Foods Forum, University of Turku, Turku, Finland
| | - Erika Isolauri
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Or Yariv
- Clalit Health Services, Tel Aviv, Israel
| | - Yoav Peled
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Eran Poran
- Clalit Health Services, Tel Aviv, Israel
| | - Joseph Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elhanan Borenstein
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Ruth E Ley
- Department of Microbiome Science, Max Planck Institute for Developmental Biology, Tubingen, Germany
| | - Betty Schwartz
- Institute of Biochemistry, School of Nutritional Sciences Food Science and Nutrition, The School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Yoram Louzoun
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omry Koren
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Galdikaitė G, Simanauskaitė A, Ramonienė G, Savukynė E, Malakauskienė L, Tarasevičienė V. The Effect of Timing and Methods for the Diagnosis of Gestational Diabetes Mellitus on Obstetric Complications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050854. [PMID: 37241086 DOI: 10.3390/medicina59050854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Aim. To compare the impact of the time and method of diagnosis on gestational diabetes mellitus (GDM) in women who gave birth at the Hospital of the Lithuanian University of Health Sciences (LUHS) Kauno klinikos. Methods. A retrospective study was performed using data from the Department of Obstetrics and Gynecology of the LUHS Birth Registry to analyze the data of women who gave birth and had GDM in 2020-2021. The subjects were divided based on the type of diagnosis: GDM was diagnosed either at the first antenatal visit when fasting plasma glycemia (FPG) was ≥5.1 mmol/L (early diagnosis group) or after OGTT at 24 + 0 - 28 + 6 weeks of gestation when at least one pathological glycemic index was observed: fasting glycemia 5.1-6.9 mmol/L or 1-h glycemia ≥10.0 mmol/L or 2 h glycemia 8.5-11.0 mmol/L (late diagnosis group). The results were processed using IBM SPSS. Results. The early diagnosis group had 1254 (65.7%) women, the late diagnosis group had 654 (34.3%). More primigravida women were in the late diagnosis group (p = 0.017) while more multigravida were in the early diagnosis group (p = 0.033). The early diagnosis group had more obese women (p = 0.001), including those with a BMI > 40 (p = 0.001). In the early diagnosis group, GDM was more frequently diagnosed in women who gained <11 kg (p = 0.005), while in the late diagnosis group->16 kg (p = 0.001). FPG was higher in the early diagnosis group (p = 0.001). Glycemia was more commonly corrected with lifestyle changes in the late diagnosis group (p = 0.001), and with additional insulin therapy in the early diagnosis group (p = 0.001). Polyhydramnios and preeclampsia were more common in the late diagnosis group (p = 0.027 and p = 0.009). There were more large-for-gestational-age neonates in the late diagnosis group (p = 0.005). Macrosomia was more common in the late diagnosis group (p = 0.008). Conclusions. GDM is more commonly diagnosed with OGTT in primigravida women. Higher pregestational weight and BMI has an impact on the early diagnosis of GDM and need for insulin therapy with lifestyle changes. Late diagnosis of GDM is connected with obstetric complications.
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Affiliation(s)
- Gintarė Galdikaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Atėnė Simanauskaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Gitana Ramonienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Eglė Savukynė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Laura Malakauskienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Viktorija Tarasevičienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
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Beyene FY, Kassa BG, Mihretie GN, Ayele AD. Gestational diabetes mellitus and its associated factors in Ethiopia: a systematic review and meta-analysis. Eur J Med Res 2023; 28:125. [PMID: 36922857 PMCID: PMC10015783 DOI: 10.1186/s40001-023-01088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND In Ethiopia, gestational diabetes mellitus (GDM) is a significant public health issue and a risk to maternal and child health. Understanding the prevalence and factors of GDM in Ethiopia may also help determine the best interventions. Therefore, we tried to review gestational diabetes and its factors in Ethiopia.AQ: Please check and confirm the edit made to the article title.yes i have checked and confirm METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) instrument was used to conduct the review. In order to report on the prevalence and contributing factors of gestational diabetes mellitus, the following databases were used: Google Scholar, PubMed, EMBASE, Scopus, Web of Sciences, and Grey literature. Pilo-tests were conducted using a standardized data gathering form in research using a random sample. All statistical analyses were performed using STATA version 16 software for Windows and the random-effects meta-analysis method. The results are presented using texts, tables, and forest plots, along with measure of effect and a 95% confidence interval.Affiliations: Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author Given name: [Fentahun Yenealem], Last name [Beyene], Given name: [Bekalu Getnet], Last name [Kassa], Given name: [Gedefaye Nibret], Last name [Mihretie], Given name: [Alemu Degu], Last name [Ayele].yes checked and corrected AQ: Is this word Pilo-tests spelled correctly throughout the article?Thank you the correction Affiliations: Please check and confirm whether the city name is correctly identified for the affiliation 2.yes checked and corrected RESULTS: Out of 1755 records, 10 studies with 6525 participants that fully satisfy the inclusion criteria were included for the meta-analysis. The pooled prevalence of gestational diabetes mellitus in Ethiopia was 12.04% [95% CI (8.17%, 15.90%)]. Inadequate dietary diversity, high body mass index, having a family history of DM, history of having macrosomic neonate, low physical activity, and previous history of GDM were statistically significant.AQ: Please note that the sentence Inadequate dietary diversity, high body mass index… is repeated under the below heading Conclusion.yes checked and corrected CONCLUSION: The pooled prevalence of gestational diabetes mellitus is high in Ethiopia. Inadequate dietary diversity, high body mass index, having a family history of DM, history of having macrosomic neonate, low physical activity and previous history of GDM were statically significant variables. Emphasize on early screening, prenatal care and all women having risk factors and trying to get pregnant should get screens for diabetes to improve the maternal and child health at large.AQ: Please check the clarity of the sentence Emphasize on early screening, prenatal…it is clear and easly understand the readers.
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Affiliation(s)
- Fentahun Yenealem Beyene
- Department of Midwifery, College of Medicine and Health Science, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia.
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Bahir Dar, Amhara, Ethiopia
| | - Gedefaye Nibret Mihretie
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Bahir Dar, Amhara, Ethiopia
| | - Alemu Degu Ayele
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Bahir Dar, Amhara, Ethiopia
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28
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Stalheim AM, Iversen MM, Jenum AK, Sletner L, Stafne SN, Qvigstad E, Sagedal L, Nilsen RM, Aasheim V, Strandberg RB. Seasonal variation in gestational diabetes mellitus among women in Norway: a national population-based study. BMJ Open 2023; 13:e063725. [PMID: 36918247 PMCID: PMC10016255 DOI: 10.1136/bmjopen-2022-063725] [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] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES Previous research on seasonal variation in the incidence of gestational diabetes mellitus (GDM) has shown inconclusive results. Furthermore, little is known about whether a seasonal variation in GDM might be associated with the maternal country of birth. We examined whether there was seasonal variation in GDM incidence by the maternal country background. DESIGN National population-based registry study. SETTING AND PARTICIPANTS We used national population-based data from the Medical Birth Registry of Norway (MBRN), n=1 443 857 (1990-2016) and data from four merged community-based studies (4GDM) with universal screening for GDM, n=2 978 (2002-2013). OUTCOME MEASURES The association between season of pregnancy onset with incidence of GDM was examined separately in both datasets using logistic regression analyses, stratified by the mother's country background using two broad geographical categories (MBRN: Norwegian and immigrant; 4GDM: European and African/Asian ethnicity). Winter season was used as reference category. RESULTS The incidence of GDM in MBRN was highest when the pregnancy started during the winter (Norwegian-born: 1.21%; immigrants: 3.32%) and lowest when pregnancy started during the summer for both Norwegian and immigrant women (Norwegian-born: 1.03% (OR 0.85, 95% CI 0.81 to 0.98); immigrants: 2.99% (OR 0.90, 95% CI 0.84 to 0.96)). The 4GDM data showed that women with European ancestry had the highest incidence of GDM when pregnancy started during autumn (10.7%, OR 1.01, 95% CI 0.69 to 1.46) and winter (10.6%), while ethnic African and Asian women had the highest incidence when pregnancy onset was during the summer (15.3%, OR 1.17, 95% CI 0.54 to 2.53). CONCLUSIONS Based on national population-based data, this study suggests that GDM incidence varies by season in both Norwegian-born and immigrant women. The 4GDM dataset did not show a clear seasonal variation in GDM incidence, possibly due to the relatively small sample. Causes for the seasonal variation in GDM should be explored further.
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Affiliation(s)
- Astrid Melteig Stalheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | | | - Anne Karen Jenum
- Department of General Practice, General Practice Unit (AFE), Insitute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Line Sletner
- Department for Paediatric and Adolescent Medicine, Akershus University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Signe N Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Sagedal
- Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway
| | - Roy Miodini Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Vigdis Aasheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Piffer S, Pedron M, Rizzello R, Orrasch M, Zambotti F, Zardini S. Prevalence of gestational diabetes and recourse to postpartum oral glucose tolerance test in the Autonomous Province of Trento (Italy). Eur J Obstet Gynecol Reprod Biol 2023; 282:50-54. [PMID: 36634406 DOI: 10.1016/j.ejogrb.2022.12.028] [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: 05/16/2022] [Revised: 12/01/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The occurrence of gestational diabetes (GDM) is increasing worldwide, and such a diagnosis is important for women's health beyond pregnancy. Therefore, many guidelines suggest the re-evaluation of glucose tolerance with a postpartum oral glucose tolerance test (OGTT) in women with GDM. This study reports the prevalence of GDM and the use of a postpartum OGTT in women assisted at maternity units in the Autonomous Province of Trento in the years 2017-2018, investigating the socio-demographic and health-care variables that can facilitate access to the test. STUDY DESIGN For the diagnosis of GDM, the International Association of Diabetes and Pregnancy Study Group criteria were used. The Birth Assistance Certificate and the Hospital Information System were used to retrieve clinical and socio-demographic data. Univariate and multivariate analyses were performed to evaluate the stratification of the use of a postpartum OGTT. RESULTS In total, 8,308 pregnant women were assisted at the maternity units in Trento. There were 532 recorded cases of GDM (266 cases per year) and the overall average prevalence was 6.4 % (95 % CI, 5.90-6.90), 4.9 % of whom were Italian (95 % CI, 4.38-5.42) and 10.4 %, foreigners (95 % CI, 9.13-11.67). 135 women diagnosed with GDM and residing in Trento out of 513 were evaluated using a postpartum OGTT (26.3%, CI 95% 22.50-30.10), with pathological results in 61 cases (45.2%). In the multivariate analyses, insulin therapy during pregnancy, delivery at a third-level birth point, and a discharge letter informing of the presence of GDM and of the need for a postpartum OGTT were independent factors associated with the probability of carrying out a postpartum OGTT. CONCLUSIONS The prevalence of GDM in our study is lower than in previous Italian studies; however, it is consistent with European data. The proportion of women who were assessed using the postpartum OGTT is lower than that reported by previous studies. The health-care factors seem predominant among the socio-demographic characteristics of the cases in influencing access to the test. The awareness of women, the sharing of guidelines among the different sectors of the health system, and an optimal management of the discharge from the birth point are critical in ensuring an optimal follow-up in women with GDM.
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Affiliation(s)
- Silvano Piffer
- Clinical and Evaluative Epidemiology Service, Provincial Health Agency, Trento, Italy.
| | - Mariangela Pedron
- Clinical and Evaluative Epidemiology Service, Provincial Health Agency, Trento, Italy.
| | - Roberto Rizzello
- Clinical and Evaluative Epidemiology Service, Provincial Health Agency, Trento, Italy.
| | - Massimo Orrasch
- Diabetes Care Center, Provincial Health Agency, Trento, Italy.
| | | | - Sara Zardini
- Obstetrics and Gynecology Unit, Trento S. Chiara Hospital, Provincial Health Agency, Trento, Italy.
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30
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Martínez-Vizcaíno V, Sanabria-Martínez G, Fernández-Rodríguez R, Cavero-Redondo I, Pascual-Morena C, Álvarez-Bueno C, Martínez-Hortelano JA. Exercise during pregnancy for preventing gestational diabetes mellitus and hypertensive disorders: An umbrella review of randomised controlled trials and an updated meta-analysis. BJOG 2023; 130:264-275. [PMID: 36156844 PMCID: PMC10092296 DOI: 10.1111/1471-0528.17304] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to provide, through an umbrella review, an overview of the effect of single exercise interventions during pregnancy on gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). Also, to update the current evidence through an updated meta-analysis. DESIGN Umbrella review. SETTING PubMed, EMBASE, Web of Science, Cochrane database of systematic reviews, Epistemonikos, SPORTDiscus, Clinicaltrials.gov, and PROSPERO register were searched from the database inception until August 2021. POPULATION Peer-reviewed systematic reviews and meta-analyses of randomised controlled trials (RCTs) and RCTs samples. METHODS Random-effects model was used to calculate relative risk with 95% confidence interval in the updated meta-analysis. The reference category was the groups that received usual prenatal care. AMSTAR 2 and the Cochrane Collaboration tool were used to assess the quality and GRADE approach was used to assess the overall certainly of evidence. MAIN OUTCOME MEASURES GDM and HDP relative risk. RESULTS Twenty-three systematic reviews and meta-analyses; and 63 RCTs were included. Single exercise interventions reduced the incidence of GDM and HDP in most systematic reviews and meta-analyses. Moreover, exercise interventions during pregnancy decrease the incidence of developing GDM and GH, particularly when they are supervised, have a low to moderate intensity level, and are initiated during the first trimester of pregnancy. CONCLUSION Based on the findings, obstetric and physical exercise professionals could recommend exercise interventions during pregnancy as an effective strategy to improve maternal outcomes.
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Affiliation(s)
- Vicente Martínez-Vizcaíno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Ciencias de la Salud Talca, Universidad Autónoma de Chile, Providencia, Chile
| | | | | | - Iván Cavero-Redondo
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Ciencias de la Salud Talca, Universidad Autónoma de Chile, Providencia, Chile
| | | | - Celia Álvarez-Bueno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Yby Yaú, Paraguay
| | - José Alberto Martínez-Hortelano
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Enfermería, Universidad de Alcalá de Henares, Alcalá de Henares, Spain
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31
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Whigham CA, Vollenhoven B, Vincent AJ. Reproductive health in Turner syndrome: A narrative review. Prenat Diagn 2023; 43:261-271. [PMID: 36336873 DOI: 10.1002/pd.6261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
Turner syndrome (TS), a common chromosomal abnormality affecting females, is associated with partial or complete loss of the second sex chromosome. Although the classic karyotype is 45, X, the detection of mosaic TS is increasing. TS is a multi-system disorder with significant endocrine, cardiovascular and reproductive impacts. Accelerated ovarian follicular loss leads to primary amenorrhoea or premature ovarian insufficiency and infertility. Early diagnosis and counselling regarding hormone replacement therapy and future reproductive capacity, including fertility preservation, are essential to improve reproductive outcomes. Pubertal induction or estrogen replacement is usually required to optimise long-term health outcomes; however, initiation may be delayed due to delayed diagnosis. Spontaneous pregnancy occurs in a small number of women; however, many require donor oocytes and assisted reproductive technology to achieve a pregnancy. Pregnancy is a high risk especially when associated with congenital heart disease. Prepregnancy counselling by the multidisciplinary team (MDT) to identify contraindications and optimise pre-existing health issues is essential. Pregnancy management should be led by a maternal-fetal medicine unit with input from the MDT. This review examines reproductive health outcomes in women with TS and how best to manage them to reduce health risks and improve maternal and neonatal outcomes.
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Affiliation(s)
- Carole-Anne Whigham
- Women's and Newborn Program, Monash Health, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Beverley Vollenhoven
- Women's and Newborn Program, Monash Health, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,Monash IVF, Clayton, Victoria, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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32
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Hao H, Liu Q, Chen J, Zhou H. Overexpression of circRNAs LRP6 in gestational diabetes mellitus predicts foetal malformation and intrauterine death. ENDOCRINOL DIAB NUTR 2023; 70:124-129. [PMID: 36925229 DOI: 10.1016/j.endien.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 03/15/2023]
Abstract
INTRODUCTION circRNA LRP6 participates in high-glucose-regulated cellular behaviours, while its role in gestational diabetes mellitus (GDM) is unclear. Our preliminary sequencing analysis revealed the altered expression of LRP6, suggesting its potential involvement in GDM and possible clinical value. This study explored the involvement of LRP6 in GDM. METHODS In this study, a total of 300 pregnant women were enrolled and followed up until delivery. The occurrence of GDM and adverse outcomes was recorded. These 300 participants were grouped into high and low LRP6 level groups (n=150; cutoff=median). Occurrence of GDM and adverse outcomes were compared between the two groups. ROC curve analysis was conducted to explore the role of LRP6 expression on the day of admission in predicting GDM. Associations between LRP6 expression and adverse outcomes were analysed with the Chi-squared test. RESULTS We observed that participants in the high LRP6 level group experienced a higher incidence of GDM during follow-up (33/150) compared to those in the low LRP6 level group (10/150). Compared to participants who developed GDM during follow-up, participants who did not develop GDM showed lower expression levels of LRP6 in plasma. ROC curve analysis showed that high expression levels of LRP6 on the day of admission effectively distinguished potential GDM patients from other participants. Interestingly, LRP6 was only closely associated with foetal malformation and intrauterine death, but not premature delivery, hypertension, macrosomia, intrauterine distress, miscarriage and intrauterine infection in all participants. CONCLUSION Therefore, increased expression levels of LRP6 in GDM predicts foetal malformation and intrauterine death.
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Affiliation(s)
- Hairong Hao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, Jiangsu 223002, PR China
| | - Qun Liu
- Lianshui County People's Hospital, Huai'an, Jiangsu 223400, PR China
| | - Jianhui Chen
- Jiangsu Food and Pharmaceutical Science College, Huai'an, Jiangsu 223003, PR China
| | - Huan Zhou
- Department of Obstetrics and Gynaecology, Huai'an Maternity and Child Health Hospital, Huai'an, Jiangsu 223002, PR China.
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33
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Guillet S, Loustau V, Boutin E, Zarour A, Comont T, Souchaud-Debouverie O, Costedoat Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Viallard JF, Morin AS, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Lambotte O, Girault S, Lioger B, Audia S, Sacre K, Lega JC, Langlois V, Benachi A, Orvain C, Devidas A, Humbert S, Gambier N, Ruivard M, Zarrouk V, Ebbo M, Willems L, Segaux L, Mahevas M, Haddad B, Michel M, Canoui-Poitrine F, Godeau B. Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study. Blood 2023; 141:11-21. [PMID: 36054922 PMCID: PMC10644036 DOI: 10.1182/blood.2022017277] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 01/10/2023] Open
Abstract
The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 × 109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 × 109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 × 109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.
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MESH Headings
- Infant, Newborn
- Female
- Humans
- Pregnancy
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Purpura, Thrombocytopenic, Idiopathic/complications
- Cohort Studies
- Prospective Studies
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/therapy
- Thrombocytopenia, Neonatal Alloimmune/therapy
- Retrospective Studies
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Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Valentine Loustau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Service de Médecine Interne, Centre Hospitalier Alpes Léman, Contamine sur Arve, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Anissa Zarour
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Thibault Comont
- Service de Médecine Interne et d’Immunopathologie–IUCT-Oncopole, CHU de Toulouse, Toulouse, France
| | | | - Nathalie Costedoat Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
- Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, AP-HP, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | | | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Stéphane Cheze
- Institut d’Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Gaetan Sauvetre
- Service de Médecine Interne, Hôpital Charles Nicolle, Université de Rouen, Rouen, France
| | - Manuel Cliquennois
- Service d'Onco-hématologie Adulte, Hôpital Saint-Vincent de Paul, GH de l'institut Catholique de Lille, Lille, France
| | - Bruno Royer
- Service d’Immuno-hématologie, Hôpital Saint Louis, Paris, France
- Service d’Hématologie clinique, CHU d’Amiens, Amiens, France
| | - Agathe Masseau
- Service de Médecine Interne, CHU de Nantes, Nantes, France
| | - Louis Terriou
- Service de Médecine Interne et d’Immunologie Clinique, CHU Lille, Université de Lille, Lille, France
| | - Claire Fieschi
- Service d’Immunologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - Olivier Lambotte
- Service de Médecine Interne et d’Immunologie Clinique, Hôpital Bicêtre, Université Paris Sacly, Le Kremlin-Bicêtre, France
| | - Stéphane Girault
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Dupuytren, Limoges, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d’Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, CHU Dijon-Bourgogne, Dijon, France
| | - Karim Sacre
- Service de Médecine Interne, Hôpital Bichat, AP-HP, Paris, France et Université de Paris, Centre de Recherche sur l’Inflammation, INSERM UMR1149, CNRS ERL8252, Laboratoire d’Excellence Inflamex, Paris, France
| | - Jean Christophe Lega
- Service de Médecine Interne et Médecine Vasculaire, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Université de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS-UMR 5588, Université Lyon 1, Lyon, France
| | - Vincent Langlois
- Service de Médecine Interne, Hôpital Jacques Monod, Le Havre, France
| | - Alexandra Benachi
- Service d’Obstétrique et Gynécologie, Hôpital Antoine-Béclère, AP-HP, Université Paris-Saclay, Clamart, France
| | - Corentin Orvain
- Service d’Hématologie, Hôpital d’Anger, INSERM, CRCINA, Université d’Angers, Angers, France
| | - Alain Devidas
- Service d’Hématologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Nicolas Gambier
- Service de Médecine Interne, CH Général Delafontaine, St Denis, France
| | - Marc Ruivard
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Clichy, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital de la Conception, AP-HP, Université Aix-Marseille, Marseille, France
| | - Lise Willems
- Service d’Hématologie Clinique, Hôpital Cochin, Paris, France
| | - Lauriane Segaux
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bassam Haddad
- Centre Hospitalier Inter-Communal de Créteil, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Equipe Immunorégulation et Biothérapie (I-BIOT), Université Paris Est Créteil, Univ Paris Est Créteil, INSERM U955, Institut Mondor De Recherche Biomédicale (IMRB), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
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Prozorova TM, Zhulkevych IV, Andreychyn SM, Korylchuk NI, Hanberher II, Riabokon SS, Kamyshnyi AM. EXPERIMENTAL GESTATIONAL DIABETES DISRUPTS THE FORMATION OF IMMUNE TOLERANCE IN OFFSPRING. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:115-121. [PMID: 36883499 DOI: 10.36740/wlek202301116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The aim: To analyze the mRNA gene expression level of Aire, Deaf1, Foxp3, Ctla4, Il10, Nlrp3 and distribution of NLRP3+-cells in mesenteric lymph nodes (MLNs) of the offspring of rats with GD, both untreated and treated with glibenclamide and in conditions of insulin oral tolerance formation. PATIENTS AND METHODS Materials and methods: The study involves 160 male rats, one- or six-month-old. The mRNA genes expression was studied by real time quantitative poly¬merase chain reaction. Structure of Nlrp3+ -cells population was studied by histological sections of MLNs. RESULTS Results: We observed AIRE gene repression, reduced mRNA levels of Deaf1 and the transcription factor Foxp3 in offspring of rats with GD. This was accompanied by inhibition of IL-10 gene expression and negative costimulatory molecules Ctla4. The development of the experimental GD was accompanied by transcrip¬tional induction of the Nlrp3 gene in MLNs of descendants. The administration of glibenclamide to pregnant female rats with GD inhibited the transcription of the Nlrp3 gene only in one-month-old offspring (5.3-fold) and did not change it in six-month-old animals. In offspring of rats with GD, the density of the NLRP3+-lymphocyte population in the MLNs increased, more pronounced in one-month-old animals. The administration of glibenclamide to pregnant rats with GD reduced the number of NLRP3+ -lymphocytes only in one-month-old offspring (by 33.0 %), whereas this index in six month-old offspring even increased. CONCLUSION Conclusions: Experimental prenatal hyperglycemia leads to increased proinflammatory signaling and violation of peripheral immunological tolerance formation more pronounced at one month of life.
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Affiliation(s)
| | - Igor V Zhulkevych
- I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE
| | | | | | - Irina I Hanberher
- I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE
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Cooke H, Craig S, Kahal H, Talbot F, Lonnen K. Impact of using fasting plasma glucose and
HbA
1c
instead of
OGTT
as a screening tool for gestational diabetes: a retrospective study. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hannah Cooke
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
| | - Stephen Craig
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
| | - Hassan Kahal
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
| | - Fleur Talbot
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
| | - Kathryn Lonnen
- Department of Diabetes and Endocrinology, Southmead Hospital, North Bristol NHS Trust Bristol UK
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Xu X, Huang F, Guo Y, Zheng L, Yan J. Interactive effect of prepregnancy overweight/obesity and GDM history on prevalence of GDM in biparous women. Front Endocrinol (Lausanne) 2023; 14:1084288. [PMID: 36875471 PMCID: PMC9978813 DOI: 10.3389/fendo.2023.1084288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Prepregnancy overweight/obesity (OWO) and gestational diabetes mellitus (GDM) history may increase the prevalence of GDM in parous women, but little is known about their potential combined effect on the prevalence of GDM in biparous women. OBJECTIVE This study aims to explore the interactive effect of prepregnancy overweight/obesity (OWO) and GDM history on the prevalence of GDM in biparous women. METHODS A retrospective study was conducted on 16,282 second-birth women who delivered a single neonate at ≧28 weeks of gestation twice. Logistic regression was used to assess the independent and multiplicative interactions of prepregnancy overweight/obesity (OWO) and GDM history on the risk of GDM in biparous women. Additive interactions were calculated using an Excel sheet that was made by Anderson to calculate relative excess risk. RESULTS A total of 14,998 participants were included in this study. Both prepregnancy OWO and GDM history were independently associated with an increased risk of GDM in biparous women (odds ratio (OR) = 19.225, 95% confidence interval (CI) = 17.106, 21.607 and OR = 6.826, 95% CI = 6.085, 7.656, respectively). The coexistence of prepregnancy OWO and GDM history was associated with GDM, with an adjusted OR of 1.754 (95% CI, 1.625, 1.909) compared to pregnant women without either condition. The additive interaction between prepregnancy OWO and GDM history was found to be not significant with regard to GDM in biparous women. CONCLUSIONS Prepregnancy OWO and GDM history both increase the risk of GDM in biparous women and have multiplicative interactions but not additive interactions.
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Karavasileiadou S, Almegwely W, Alanazi A, Alyami H, Chatzimichailidou S. Self-management and self-efficacy of women with gestational diabetes mellitus: a systematic review. Glob Health Action 2022; 15:2087298. [PMID: 35867537 PMCID: PMC9310944 DOI: 10.1080/16549716.2022.2087298] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a temporary form of diabetes induced by pregnancy and is potentially harmful to both the mother and fetus The impact of GDM diagnosis on pregnant women needs to be taken into account. This is related to the capacity for self-management of GDM, for which quality evidence is still lacking. OBJECTIVE to identify several aspects of self-management and self- efficacy for women with GDM. METHOD Electronic databases were searched for studies related to the self-management, self-efficacy, and glycemic control of women with GDM, from January 2012 to January 2021. The extraction of study features was based on study location, reported research aims, study design, methodology, and the analytical approach, using Endnote Version X7.7.1. The Critical Appraisal Skills Program Qualitative Checklist (CASP) was used to assess quality, as recommended by the Cochrane Qualitative Research Methods Group. RESULTS Ten out of 70 studies were identified as meeting the established criteria and including a diverse population. The synthesis revealed seven major themes: preliminary psychological impact, communicating the diagnosis, knowledge of GDM, self-efficacy and self-management of GDM, risk perception, the burden of GDM, and gaining control. The benefits of a diagnosis were behavioral and were mostly crystalized if a particular level of self-management and self-efficacy was reached and women were able to have specific control over their diet and body weight. On the other hand, women reported that the diagnosis increased their responsibility, as they had to take extra precautions regarding their dietary regimen. CONCLUSION Self-management and self-efficacy for GDM management are possible, despite the psychological hurdles that most women confront. There is still potential for improvement in terms of developing a healthy lifestyle that not only manages GDM for the best pregnancy result, but also prevents diabetes after pregnancy.
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Affiliation(s)
- Savvato Karavasileiadou
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Wafa Almegwely
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Anwar Alanazi
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hanan Alyami
- Medical - Surgical Nursing Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sofia Chatzimichailidou
- Department of Pathology, Hippokration General Teaching Hospital, Municipality of Thessaloniki, Greece
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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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Ramos-Leví AM, Fernández-Pombo A, García-Fontao C, Gómez-Vázquez E, Cantón-Blanco A, Martínez-Olmos MÁ, Andújar-Plata P, Mariño PB, Rodríguez-Carnero MG, Villar-Taibo R. Gestational weight gain influences neonatal outcomes in women with obesity and gestational diabetes. ENDOCRINOL DIAB NUTR 2022; 69:852-858. [PMID: 36526355 DOI: 10.1016/j.endien.2022.11.018] [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: 11/02/2021] [Accepted: 01/11/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Obesity and gestational diabetes mellitus (GDM) are associated with an increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and foetal outcomes is controversial. PATIENTS AND METHODS Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI)>30kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding their prior BMI and GWG. We evaluated the impact of GWG on perinatal and obstetric outcomes. RESULTS Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as class I in 55.3% of the cases, class II in 32.0% and class III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (<5kg) in 41.8% and excessive (>9kg) in 34.2%. Birth weight was within normal range in 81.9%, 3.6% were small for gestational age (microsomia) and 14.4% were large for gestational age (macrosomia). Insufficient GWG was associated with a higher rate of microsomal offspring, excessive GWG was associated to macrosomia and adequate GWG with normal birth weight. CONCLUSION GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated with microsomia and excessive GWG is associated with macrosomia. Women with adequate GWG according to the IOM guidelines obtained better perinatal outcomes.
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Affiliation(s)
- Ana M Ramos-Leví
- Department of Endocrinology and Nutrition, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Universidad Autónoma, Madrid, Spain
| | - Antía Fernández-Pombo
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Cristina García-Fontao
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Eva Gómez-Vázquez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Ana Cantón-Blanco
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Miguel Ángel Martínez-Olmos
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Paula Andújar-Plata
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Pilar Bolaño Mariño
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Maria Gemma Rodríguez-Carnero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain.
| | - Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
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Effects of a smartphone-based nursing counseling and feedback system for women with gestational diabetes on compliance, glycemic control, and satisfaction: a randomized controlled study. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Saei Ghare Naz M, Sheidaei A, Azizi F, Ramezani Tehrani F. Gestational diabetes mellitus and hypertensive disorder of pregnancy play as spouse-pair risk factors of diabetes and hypertension: Insights from Tehran Lipid and Glucose Study. J Diabetes Complications 2022; 36:108311. [PMID: 36201894 DOI: 10.1016/j.jdiacomp.2022.108311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/27/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Complicated pregnancies by gestational diabetes mellitus (GDM) and hypertensive disorder of pregnancy (HDP) are relatively common worldwide. The evidence is still inconclusive regarding the role of GDM and HDP as spousal risk factor of diabetes (DM) and hypertension (HTN). This study aimed to determine the spousal risk of development of DM and/or HTN in the context of GDM and/or HDP. METHODS This population-based cohort study involved couples who participated in Tehran Lipid and Glucose Study. A total of 3650 pairs of spouses were identified, and among them, 2820 met the inclusion criteria. Included participants, followed up 3-year intervals visits from 1999 to 2018. All pairs underwent standard data collection. GDM and HDP were the main exposure of interest in females, and DM and HTN were the main outcomes in both females and their spouses. Cox proportional hazard regression models were used for both females and their spouses, adjusting for age, consanguinity, waist-to-height ratio, physical activity, smoking, and parity. RESULTS Of 2820 females, 558 (19.79 %) had histories of GDM or HDP, and 72 (2.55 %) experienced both. Among females who experienced GDM and HDP, 24 (33 %) and 31 (33 %) developed DM and HTN during the follow-up. The corresponding numbers were 89 (16 %) and 191 (34 %) for those who experienced GDM or HPD, and 274 (13 %) and 623 (28 %) for the non-risk factors group. The incidences of DM were 9 (12 %), 100 (18 %), and 373 (17 %) for males whose spouses experienced both GDM and HDP, either one or none of them, respectively. Among males in these groups, 20 (28 %), 150 (27 %), and 630 (29 %) developed HTN, respectively. Females who never had history of GDM and HDP have 34 % (95 % CI: 21, 45) less hazard of being diabetic than their spouses if they have the same age and waist to hip ratio. In cases with histories of both GDM and HDP, the risk of females increases to 3.05 (95 % CI: 1.43, 6.52) times of their spouses. Also, females who had experienced GDM (HR: 3.51, 95 % CI: 2.23, 5.53), or HDP (HR: 2.80, 95 % CI: 1.72, 4.56) were at higher risk of developing DM compared with females who never had GDM or HDP. We found that females with neither GDM nor HDP were more likely than males to be hypertensive in the future by the hazard ratio of 1.21 (95 % CI: 1.06, 1.39). CONCLUSIONS Complicated pregnancies by GDM and/or HDP were associated with increased risk of development DM and HTN in later life of females and their spouses. Further studies are required to confirm these results. Preventive care programs should be considered pregnancy complications as couple-based risk factors for subsequent DM and HTN.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Hao H, Liu Q, Chen J, Zhou H. Overexpression of circRNAs LRP6 in gestational diabetes mellitus predicts foetal malformation and intrauterine death. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Šimják P, Krejčí H, Hornová M, Mráz M, Pařízek A, Kršek M, Haluzík M, Anderlová K. Establishing the Optimal Time for Induction of Labor in Women with Diet-Controlled Gestational Diabetes Mellitus: A Single-Center Observational Study. J Clin Med 2022; 11:jcm11216410. [PMID: 36362638 PMCID: PMC9657511 DOI: 10.3390/jcm11216410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/25/2022] Open
Abstract
To determine the optimal week for labor induction in women with diet-controlled gestational diabetes mellitus by comparing differences in perinatal and neonatal outcomes of labor induction to expectant management at different gestational weeks. Methods: This was a retrospective analysis of a prospectively recruited cohort of 797 singleton pregnancies complicated by diet-controlled gestational diabetes mellitus that were diagnosed, treated, and delivered after 37 weeks in a tertiary, university-affiliated perinatal center between January 2016 and December 2021. Results: The incidence of neonatal complications was highest when delivery occurred at 37 weeks, whereas fetal macrosomia occurred mostly at 41 weeks (20.7%); the frequency of large for gestational age infants did not differ between the groups. Conversely, the best neonatal outcomes were observed at 40 weeks due to the lowest number of neonates requiring phototherapy for neonatal jaundice (1.7%) and the smallest proportion of neonates experiencing composite adverse neonatal outcomes defined as neonatal hypoglycemia, phototherapy, clavicle fracture, or umbilical artery pH < 7.15 (10.4%). Compared with expectant management, the risk for neonatal hypoglycemia was increased for induction at 39 weeks (adjusted odds ratio 12.29, 95% confidence interval 1.35−111.75, p = 0.026) and that for fetal macrosomia was decreased for induction at 40 weeks (adjusted odds ratio 0.11, 95% confidence interval 0.01−0.92, p = 0.041), after adjusting for maternal pre-pregnancy body mass index, nulliparity, and mean pregnancy A1c. Conclusions: The lowest rate of neonatal complications was observed at 40 weeks. Labor induction at 40 weeks prevented fetal macrosomia.
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Affiliation(s)
- Patrik Šimják
- Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Hana Krejčí
- Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, 128 08 Prague, Czech Republic
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Markéta Hornová
- Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Miloš Mráz
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Antonín Pařízek
- Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Michal Kršek
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Kateřina Anderlová
- Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, 128 08 Prague, Czech Republic
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, 128 08 Prague, Czech Republic
- Correspondence: ; Tel.: +420-224-967-413
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Yang Z, Wang S, Zheng R, Ren W, Zhang X, Wang C, Zhang H. Value of PAPP-A combined with BMI in predicting the prognosis of gestational diabetes mellitus: an observational study. J OBSTET GYNAECOL 2022; 42:2833-2839. [PMID: 35980753 DOI: 10.1080/01443615.2022.2109951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this study was to investigate the potential of pregnancy-associated plasma protein A (PAPP-A) and clinical data in predicting gestational diabetes mellitus (GDM). Clinical data of 318 pregnant women with GDM and 200 healthy pregnant women were retrospectively analysed. The age, BMI and caesarean section in GDM were significantly higher than in normal group. Serum and placental levels of PAPP-A were significantly lower in GDM than in normal group. Pearson's correlation analysis showed that serum levels of PAPP-A were negatively correlated with BMI and blood glucose level. Binary logistic regression analysis displayed that PAPP-A were the potential factors influencing GDM. The area under the ROC curve (AUC) for PAPP-A combined with BMI in predicting GDM was 0.941, significantly higher than that of the single one. The potential of PAPP-A in the first trimester is limited in predicting GDM. PAPP-A combined with BMI is highly conductive for predicting GDM.Impact statementWhat is already known on this subject? GDM not only increases the risk of perinatal morbidity, but also results in an increased risk of long-term sequelae for both mother and child including diabetes, cardiovascular disease obesity. Previous data indicate that besides glycemic control in the second trimester, interventions initiated early in pregnancy can reduce the rate of GDM in pregnant women. The expression of PAPP-A in serum of GDM pregnant women was decreased in the first trimester. Whereas, whether PAPP-A can be as an early predictor of GDM is not clear.What do the results of this study add? The present study shows that PAPP-A MoM was less than 0.6757 in the first trimester of pregnancy is more prone to GDM. The potential of PAPP-A in the first trimester is limited in predicting GDM. PAPP-A combined with BMI is highly conductive for predicting GDM.What are the implications of these findings for clinical practice and/or further research? Early GDM prediction is crucial for prevention and management of GDM, to cope with the rising prevalence of GDM and reduce later life chronic disease of both mother and child. Based on the level of PAPP-A MoM and BMI, interventions such as lifestyle changes initiated early in pregnancy shouldbeenabledin pregnant women.
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Affiliation(s)
- Zhifen Yang
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shengpu Wang
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Zheng
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weina Ren
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoli Zhang
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chunyang Wang
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huixin Zhang
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Flachs Madsen LR, Gerdøe-Kristensen S, Lauenborg J, Damm P, Kesmodel US, Lynge E. Long-Term Follow-Up on Morbidity Among Women With a History of Gestational Diabetes Mellitus: A Systematic Review. J Clin Endocrinol Metab 2022; 107:2411-2423. [PMID: 35763540 PMCID: PMC9387689 DOI: 10.1210/clinem/dgac373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) complicates up to 10% of pregnancies and is a well-known risk factor for type 2 diabetes mellitus (T2DM) and cardiovascular disease. Little is known about possible long-term risks of other diseases. BACKGROUND The aim was to review the literature for evidence of associations with morbidity other than T2DM and cardiovascular disease and with long-term mortality. METHODS A systematic review based on searches in Medline, Embase, and Cochrane Library until March 31, 2021, using a broad range of keywords. We extracted study characteristics and results on associations between GDM and disease occurrence at least 10 years postpartum, excluding studies on women with diabetes prior to pregnancy or only diabetes prior to outcome. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Newcastle-Ottawa Scale was used to assess risk of bias. RESULTS We screened 3084 titles, 81 articles were assessed full-text, and 15 included in the review. The strongest evidence for an association was for kidney diseases, particularly in Black women. We found indication of an association with liver disease, possibly restricted to women with T2DM postpartum. The association between GDM and breast cancer had been studied extensively, but in most cases based on self-reported diagnosis and with conflicting results. Only sparse and inconsistent results were found for other cancers. No study on thyroid diseases was found, and no study reported on short-term or long-term mortality in women with a history of GDM. CONCLUSION Given the frequency of GDM, there is a need for better evidence on possible long-term health consequences, in particular, studies based on comprehensive records of diagnosis of GDM and long-term health outcomes.
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Affiliation(s)
- Lana R Flachs Madsen
- Correspondence: Lana Rashid Flachs Madsen, Department of Gynecology, Obstetrics and Pediatrics, Nykøbing Falster Hospital, Fjordvej 15, 4800 Nykøbing Falster, Denmark.
| | - Stine Gerdøe-Kristensen
- Department of Anesthesiology and Intensive Care, Nykøbing Falster Hospital, 4800 Nykøbing Falster, Denmark
| | - Jeannet Lauenborg
- Department of Gynecology, Obstetrics and Pediatrics, Nykøbing Falster Hospital, 4800 Nykøbing Falster, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, 2100 Copenhagen Ø, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Elsebeth Lynge
- Center for Epidemiological Research, Nykøbing Falster Hospital, University of Copenhagen, Ejegodvej 63, 4800 Nykøbing Falster, Denmark
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Pagel KA, Chu H, Ramola R, Guerrero RF, Chung JH, Parry S, Reddy UM, Silver RM, Steller JG, Yee LM, Wapner RJ, Hahn MW, Natarajan S, Haas DM, Radivojac P. Association of Genetic Predisposition and Physical Activity With Risk of Gestational Diabetes in Nulliparous Women. JAMA Netw Open 2022; 5:e2229158. [PMID: 36040739 PMCID: PMC9428742 DOI: 10.1001/jamanetworkopen.2022.29158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Polygenic risk scores (PRS) for type 2 diabetes (T2D) can improve risk prediction for gestational diabetes (GD), yet the strength of the association between genetic and lifestyle risk factors has not been quantified. OBJECTIVE To assess the association of PRS and physical activity in existing GD risk models and identify patient subgroups who may receive the most benefits from a PRS or physical activity intervention. DESIGN, SETTINGS, AND PARTICIPANTS The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort was established to study individuals without previous pregnancy lasting at least 20 weeks (nulliparous) and to elucidate factors associated with adverse pregnancy outcomes. A subcohort of 3533 participants with European ancestry was used for risk assessment and performance evaluation. Participants were enrolled from October 5, 2010, to December 3, 2013, and underwent genotyping between February 19, 2019, and February 28, 2020. Data were analyzed from September 15, 2020, to November 10, 2021. EXPOSURES Self-reported total physical activity in early pregnancy was quantified as metabolic equivalents of task (METs). Polygenic risk scores were calculated for T2D using contributions of 84 single nucleotide variants, weighted by their association in the Diabetes Genetics Replication and Meta-analysis Consortium data. MAIN OUTCOMES AND MEASURES Estimation of the development of GD from clinical, genetic, and environmental variables collected in early pregnancy, assessed using measures of model discrimination. Odds ratios and positive likelihood ratios were used to evaluate the association of PRS and physical activity with GD risk. RESULTS A total of 3533 women were included in this analysis (mean [SD] age, 28.6 [4.9] years). In high-risk population subgroups (body mass index ≥25 or aged ≥35 years), individuals with high PRS (top 25th percentile) or low activity levels (METs <450) had increased odds of a GD diagnosis of 25% to 75%. Compared with the general population, participants with both high PRS and low activity levels had higher odds of a GD diagnosis (odds ratio, 3.4 [95% CI, 2.3-5.3]), whereas participants with low PRS and high METs had significantly reduced risk of a GD diagnosis (odds ratio, 0.5 [95% CI, 0.3-0.9]; P = .01). CONCLUSIONS AND RELEVANCE In this cohort study, the addition of PRS was associated with the stratified risk of GD diagnosis among high-risk patient subgroups, suggesting the benefits of targeted PRS ascertainment to encourage early intervention.
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Affiliation(s)
- Kymberleigh A. Pagel
- Department of Computer Science, Indiana University, Bloomington
- Institute of Computational Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hoyin Chu
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rashika Ramola
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
| | - Rafael F. Guerrero
- Department of Biological Sciences, North Carolina State University, Raleigh
| | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of California, Irvine
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia
| | - Uma M. Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
| | | | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald J. Wapner
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Matthew W. Hahn
- Department of Computer Science, Indiana University, Bloomington
- Department of Biology, Indiana University, Bloomington
| | | | - David M. Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - Predrag Radivojac
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
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Yang W, Braun JM, Vuong AM, Percy Z, Xu Y, Xie C, Deka R, Calafat AM, Ospina M, Yolton K, Cecil KM, Lanphear BP, Chen A. Maternal urinary organophosphate ester metabolite concentrations and glucose tolerance during pregnancy: The HOME Study. Int J Hyg Environ Health 2022; 245:114026. [PMID: 36029741 PMCID: PMC10127082 DOI: 10.1016/j.ijheh.2022.114026] [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: 03/22/2022] [Revised: 07/22/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Endocrine-disrupting chemicals may alter glucose homeostasis, especially during pregnancy. Biomonitoring studies suggest ubiquitous human exposure to organophosphate esters (OPEs), chemicals with endocrine-disrupting capabilities. Few studies have examined the association between maternal exposure to OPEs and blood glucose during pregnancy. METHODS With data from 301 pregnant women in the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort in Cincinnati, Ohio, USA, we examined whether OPE concentrations were associated with changes in blood glucose. We quantified four OPE metabolites in maternal spot urine samples collected at 16- and 26-weeks pregnancy. We extracted results from the glucose challenge test (GCT) and oral glucose tolerance test (OGTT) via medical chart review. Women with GCT ≥ 140 mg/dL or any abnormal values in OGTT (≥ 95 mg/dL fasting glucose, ≥ 180 mg/dL 1-h glucose, ≥ 155 mg/dL 2-h glucose, ≥ 140 mg/dL 3-h glucose) were defined as having elevated glucose levels. We used linear regression and Bayesian Kernel Machine Regression (BKMR) to estimate the associations of individual OPE metabolites and OPE mixtures with blood glucose levels during pregnancy. We used modified Poisson regression to estimate the associations of OPE metabolite concentrations with elevated glucose levels. We further examined effect measure modification by maternal characteristics (age, pre-pregnancy body mass index [BMI], and race/ethnicity). RESULTS Diphenyl phosphate (DPHP) had the highest geometric mean concentration of the urinary OPE metabolites (1.83 μg/L at 16 weeks, 1.24 μg/L at 26 weeks). Thirty women (10.0%) had elevated glucose levels. Individual OPE metabolites or their mixtures were not significantly associated with continuous GCT results. We did not observe effect measure modification by maternal age, pre-pregnancy BMI categories, or race/ethnicity. Compared with women in the 1st tertile of average DPHP of 16- and 26 weeks of pregnancy, women in the 3rd tertile tended to have a reduced risk of elevated glucose levels (RR = 0.41, 95% CI = 0.16-1.06, p for trend = 0.06). CONCLUSION In this cohort, maternal urinary OPE metabolite concentrations were weakly associated with blood glucose levels during pregnancy.
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Affiliation(s)
- Weili Yang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Changchun Xie
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Child and Family Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
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Adverse Pregnancy Outcomes and International Immigration Status: A Systematic Review and Meta-analysis. Ann Glob Health 2022; 88:44. [PMID: 35854922 PMCID: PMC9248985 DOI: 10.5334/aogh.3591] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Disparities in health outcomes between immigrant and native-origin populations, particularly pregnant women, pose significant challenges to healthcare systems. The aim of this systematic-review and meta-analysis was to investigate the risk of adverse pregnancy outcomes among immigrant-women compared to native-origin women in the host country. Methods: PubMed (including MEDLINE), Scopus, and Web of Science were searched to retrieve studies published in English language up to September 2020. All observational studies examining the prevalence of at least one of the short-term single pregnancy outcomes for immigrants who crossed international borders compared to native-origin pregnant population were included. The meta-prop method was used for the pooled-estimation of adverse pregnancy-outcomes’ prevalence. For pool-effect estimates, the association between the immigration-status and outcomes of interest, the random-effects model was applied using the model described by DerSimonian and Laird. I2 statistic was used to assess heterogeneity. The publication bias was assessed using the Harbord-test. Meta-regression was performed to explore the effect of geographical region as the heterogeneity source. Findings: This review involved 11 320 674 pregnant women with an immigration-background and 56 102 698 pregnant women as the native-origin population. The risk of emergency cesarean section (Pooled-OR = 1.1, 95%CI = 1.0–1.2), shoulder dystocia (Pooled-OR = 1.1, 95%CI = 1.0–1.3), gestational diabetes mellites (Pooled-OR = 1.4, 95%CI = 1.2–1.6), small for gestational age (Pooled-OR=1.3, 95%CI = 1.1–0.4), 5-min Apgar less than 7 (Pooled-OR = 1.2, 95%CI = 1.0–1.3) and oligohydramnios (Pooled-OR = 1.8, 95%CI = 1.0–3.3) in the immigrant women were significantly higher than those with the native origin background. The immigrant women had a lower risk of labor induction (Pooled-OR = 0.8, 95%CI = 0.7–0.8), pregnancy induced hypertension (Pooled-OR = 0.6, 95%CI = 0.5–0.7) preeclampsia (Pooled-OR = 0.7, 95%CI = 0.6–0.8), macrosomia (Pooled-OR = 0.8, 95%CI = 0.7–0.9) and large for gestational age (Pooled-OR = 0.8, 95%CI = 0.7–0.8). Also, the risk of total and primary cesarean section, instrumental-delivery, preterm-birth, and birth-trauma were similar in both groups. According to meta-regression analyses, the reported ORs were not influenced by the country of origin. Conclusion: The relationship between the immigration status and adverse perinatal outcomes indicated a heterogenous pattern, but the immigrant women were at an increased risk of some important adverse pregnancy outcomes. Population-based studies with a focus on the various aspects of this phenomena are required to explain the source of these heterogenicities.
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Wegler C, Saleh A, Lindqvist A, Nordeng H, Smeraglia J, Baranczewski P. Simple and rapid quantification of cetirizine, venlafaxine, and O-desmethylvenlafaxine in human breast milk, and metformin in human milk and plasma with UHPLC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1205:123340. [PMID: 35732105 DOI: 10.1016/j.jchromb.2022.123340] [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: 04/28/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
The majority of women have health problems that require medication after giving birth. Complications such as allergies, postpartum depression, and diabetes are often treated with drugs such as cetirizine, venlafaxine, and metformin, respectively. These treatments are considered safe during lactation, but information of the transfer of drugs to breast milk and possible effects on the infant is scarce. Therefore, this needs to be systematically investigated in larger populations. To enable the determination of drug transfer, we here describe the validation of two rapid, sensitive, and high-throughput analysis methods for 1) simultaneous quantification of cetirizine, venlafaxine, and O-desmethylvenlafaxine in human breast milk, and 2) metformin in human breast milk and plasma. In both methods, a simple protein precipitation protocol with acetonitrile and benchtop-centrifugation was used prior to compound analysis with liquid-chromatography tandem mass spectrometry. The methods had linear ranges between 0.39 - 194.5 ng/mL for cetirizine, 0.28 - 138.7 ng/mL for venlafaxine, 0.26 - 131.7 ng/mL for O-desmethylvenlafaxine, in milk, and 0.65 - 193.7 ng/mL for metformin in both milk and plasma. Intra-run and inter-run precision and accuracy were ≤ 9% for cetirizine, venlafaxine, and O-desmethylvenlafaxine in milk, and ≤ 7% for metformin in milk and plasma. Cetirizine was measured to median milk concentrations of 13 ng/mL (range: 0.65 - 65 ng/mL) in 228 donor samples from breast-feeding women.
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Affiliation(s)
- Christine Wegler
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden
| | - Aljona Saleh
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden
| | - Annika Lindqvist
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - John Smeraglia
- Development Sciences, Translational Biomarkers and Bioanalysis, UCB BioPharma SPRL, B-1420 Braine-l'Alleud, Belgium
| | - Pawel Baranczewski
- Department of Pharmacy, Uppsala Drug Optimization and Pharmaceutical Profiling (UDOPP), Uppsala University, SE-75123 Uppsala, Sweden; Department of Pharmacy, SciLifeLab Drug Discovery and Development Platform, Uppsala University, SE-75123 Uppsala, Sweden.
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Begum R, Roy S, Banik S. The prevalence of gestational diabetes mellitus in Bangladesh: a systematic review and meta-analysis. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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