1
|
Kasuga Y, Miyakoshi K, Yokoyama M, Nakanishi S, Iwama N, Ichikawa R, Abiko A, Harashima S, Sugiyama T. Use of the Japanese gestational diabetes mellitus diagnostic strategy during the COVID-19 pandemic in Japan: A questionnaire survey. J Obstet Gynaecol Res 2024; 50:955-960. [PMID: 38522428 DOI: 10.1111/jog.15929] [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: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
AIM Some concerns exist that diagnosis of gestational diabetes mellitus (GDM) may be missed when the simplified diagnostic criteria of the Japanese Society of Diabetes and Pregnancy (JSDP) for GDM (published during the COVID-19 pandemic) are used. Moreover, limited data is available regarding how widespread these diagnostic criteria are used when managing GDM during the COVID-19 pandemic. Therefore, this study aimed to determine how GDM diagnosis has changed during the COVID-19 pandemic in Japan. METHODS The changes in GDM diagnosis during the COVID-19 pandemic were investigated using an online questionnaire to 2159 obstetric facilities in Japan. The questionnaire collected data on facility type, awareness of Japanese GDM diagnostic strategies, modifications to diagnostic methods for early and late GDM, and opinions on GDM management, with the pandemic divided into seven periods. RESULTS We received responses from 593 facilities (27%). Approximately 90% of the facilities did not change their diagnostic process for early GDM or late GDM (occurring after 24 weeks gestation). However, during the COVID-19 pandemic, 19 facilities discontinued the use of 75-g oral glucose tolerance tests before 24 weeks of gestation, and 17 facilities discontinued it after 24 weeks of gestation, instead using the aforementioned Japanese GDM diagnostic strategy. CONCLUSIONS Although a limited number of facilities modified their diagnostic method in response to the COVID-19 pandemic, this study demonstrated that those that adjusted their diagnostic method primarily used the Japanese COVID-19 GDM strategy by the JSDP.
Collapse
Affiliation(s)
- Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kei Miyakoshi
- Department of Obstetrics and Gynecology, International Catholic Hospital, Tokyo, Japan
| | - Maki Yokoyama
- Department of Obstetrics and Gynecology, Uwajima City Hospital, Uwajima, Ehime, Japan
| | - Sayuri Nakanishi
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Raishi Ichikawa
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Atsuko Abiko
- Department of Diabetology and Endocrinology, Japanese Asahikawa Red Cross Hospital, Asahikawa, Hokkaido, Japan
| | - Shinichi Harashima
- Department of Internal Medicine, Kyoto Goshominami Harashima Clinic, Kyoto, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| |
Collapse
|
2
|
Kasuga Y, Takahashi M, Kajikawa K, Akita K, Otani T, Ikenoue S, Tanaka M. Perinatal Outcomes of Diet Therapy in Gestational Diabetes Mellitus Diagnosed before 24 Gestational Weeks. Nutrients 2024; 16:1553. [PMID: 38892487 PMCID: PMC11174494 DOI: 10.3390/nu16111553] [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: 04/25/2024] [Revised: 05/15/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
To evaluate perinatal outcomes and risk factors for large for gestational age (LGA; birth weight over 90 percentile) in gestational diabetes diagnosed before 24 gestational weeks and treated with diet therapy alone until delivery (Diet Early gestational diabetes mellitus (Diet Early GDM)), we assessed the maternal characteristics and perinatal outcomes of patients with early GDM (n = 309) and normal glucose tolerance (NGT; n = 309) at Keio University Hospital. The gestational weight gain (GWG) expected at 40 weeks was significantly lower in the Diet Early GDM group than in the NGT group. The Diet Early GDM group exhibited a significantly lower incidence of low birth weight (<2500 g) and higher Apgar score at 5 min than the NGT group. Multiple logistic regression analysis revealed that the pre-pregnancy body mass index and GWG expected at 40 weeks were significantly associated with LGA for Diet Early GDM. No differences were observed in random plasma glucose levels in the first trimester, 75 g oral glucose tolerance test values, and initial increase or subsequent decrease between the two groups. Dietary early GDM did not exhibit a worse prognosis than NGT. To prevent LGA, it might be important to control maternal body weight not only during pregnancy but also before conception.
Collapse
Affiliation(s)
- Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 5 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (S.I.); (M.T.)
| | | | | | | | | | | | | |
Collapse
|
3
|
Crimmins SD, Martin LM, Myers M, Elsamadicy E, Quebedeaux TM, Desai AN, Kopelman JN. Hemoglobin A1c as a Substitute for Oral Glucose Testing in Early Pregnancy Screening. Am J Perinatol 2024; 41:e1895-e1900. [PMID: 37308088 DOI: 10.1055/s-0043-1769796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Current recommendations for individuals with risk factors for gestational diabetes mellitus (GDM) call for screening in early pregnancy. However, there is currently no clear consensus on a specific screening modality. This study evaluates whether a hemoglobin A1c (HbA1c) screening in individuals with risk factors for gestational diabetes (GDM) could be used instead of an early 1-hour glucose challenge test (GCT). We hypothesized that the HbA1c could replace 1-hour GCT in early pregnancy evaluation STUDY DESIGN: This is a prospective observational trial at a single tertiary referral center of women with at least one risk factor for GDM who were screened at <16 weeks of gestation with both 1-hour GCT or HbA1c. Exclusion criteria include: previous diagnosis of diabetes mellitus, multiple gestation, miscarriage, or missing delivery information. The diagnosis of GDM was made by a 3-hour 100-g glucose tolerance test, using the Carpenter-Coustan criteria (at least two results >94, 179, 154, and 139 mg/dL for fasting, 1-, 2-, and 3-hour values, respectively), 1-hour GCT > 200 mg/dL, or HbA1c > 6.5%. RESULTS A total of 758 patients met inclusion criteria. A total of 566 completed a 1-hour GCT and 729 had an HbA1c collected. The median gestational age at testing was 91/7 weeks (range: 40/7-156/7 weeks]. Twenty-one participants were diagnosed with GDM at <16 weeks' GA. The receiver operating characteristic (ROC) curves identified the optimal valves for a positive screen for an HbA1c > 5.6%. The HbA1c had a sensitivity of 84.2%, a specificity of 83.3%, and a false positive rate of 16.7% (p < 0.001). The area under the ROC curve for the HbA1c was 0.898. Gestational age of delivery was slightly earlier with individuals with an elevated HbA1c but no other changes in delivery or neonatal outcomes. Contingent screening improved specificity (97.7%) and decreased false positive rate to 4.4%. CONCLUSION HbA1c may be a good assessment in early pregnancy for gestational diabetes. KEY POINTS · HbA1c is a rational assessment in early pregnancy.. · An HbA1c > 5.6% is associated with gestational diabetes.. · Contingent screening limits the need for additional testing..
Collapse
Affiliation(s)
- Sarah D Crimmins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York
| | - Lucille M Martin
- Department of Emergency Medicine, Universiy of Maryland Medical Center, Baltimore, Maryland
| | - Madalyn Myers
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York
| | - Emad Elsamadicy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Vanderbilt University, Nashville, Tennessee
| | - Tabitha M Quebedeaux
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Louisiana State University, New Orleans, Louisiana
| | - Andrea N Desai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jerome N Kopelman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
4
|
Wilkie G, Delpapa E, Leftwich H. Early Diagnosis of Prediabetes among Pregnant Women that Develop Gestational Diabetes Mellitus and Its Influence on Perinatal Outcomes. Am J Perinatol 2024; 41:343-348. [PMID: 34710943 DOI: 10.1055/a-1682-2643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Purpose of this study was to determine whether early identification of impaired glucose tolerance consistent with prediabetes among pregnant women with gestational diabetes mellitus (GDM) in the first trimester impacts maternal and neonatal outcomes. STUDY DESIGN This was a retrospective cohort study of patients who were screened for pregestational diabetes in early pregnancy at a large academic tertiary care center from October 1, 2017, to January 31, 2021, and who subsequently developed GDM. Demographic and perinatal outcomes were compared among women with GDM with a positive early diabetes screen consistent with prediabetes to women who screened negative in the first trimester. Multivariable logistic regression was performed to adjust for baseline demographic differences. RESULTS During the study period, 260 women screened had negative first trimester diabetes screening and subsequently developed GDM, while 696 screened positive for prediabetes and developed GDM. Women with prediabetes were more likely to require insulin treatment for their GDM compared with those that screened negative (79.5 vs. 45.4%, p < 0.001), while those who screened negative were more likely to take an oral medication of metformin or glyburide for GDM management than those with prediabetes (41.5 vs. 16.4%, p < 0.001). Infants born to mothers who screened positive for prediabetes were more likely to require neonatal intensive care unit (NICU) admission compared with those who screened negative even when adjusted for type of GDM treatment used (adjusted odds ratio [aOR] = 8.5, 95% confidence interval [CI]: 1.5-49.9). CONCLUSION Women identified as having early impaired glucose tolerance consistent with prediabetes that subsequently develop GDM are more likely to be prescribed insulin treatment and may be at increased risk of adverse neonatal outcomes leading to NICU admission than women with negative first trimester diabetes screening. Future studies should focus on whether different methods of early treatment and/or intervention improve perinatal outcomes. KEY POINTS · Prediabetes in early pregnancy is associated with higher rates of insulin treatment for GDM.. · Prediabetes in pregnancy increases the risk of developing GDM.. · Prediabetes in early pregnancy is associated with higher rates of NICU admission..
Collapse
Affiliation(s)
- Gianna Wilkie
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ellen Delpapa
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, Massachusetts
| | - Heidi Leftwich
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, Massachusetts
| |
Collapse
|
5
|
Sartorão Filho CI, Pinheiro FA, Takano L, Prudêncio CB, Nunes SK, Rls H, Calderon IMP, Barbosa AMP, Rudge MVC. Risk factors for postpartum urinary incontinence: The impact of early-onset and late-onset Gestational Diabetes Mellitus in a nested case-control study. Eur J Obstet Gynecol Reprod Biol 2023; 290:5-10. [PMID: 37708658 DOI: 10.1016/j.ejogrb.2023.09.007] [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: 11/27/2022] [Revised: 07/29/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) and many other clinical variables have been associated with postpartum urinary incontinence (UI). However, the data are still restricted, and no study explored early- or late-onset GDM as a risk factor for this condition. We aimed to identify independent risk factors for postpartum UI, focusing on GDM and its early or late onset. METHODS A nested case control derived from the Diamater cohort study included 517 pregnant women who submitted to a planned C-section and followed by 6-18 months after delivery according to the timing of GDM diagnosis: early-onset GDM (before 20 weeks) and late-onset GDM(24-28 weeks) and the occurrence of UI. RESULTS Univariate analysis showed that the risk for 6-18 months postpartum UI was 49% higher in non-Caucasian ethnicity (1.49,1.02-2.18), 3,3 times higher in previous bariatric surgery [3.37,1.36-8.21], 39% higher in GDM women (1.39,1.01-1.93), and 5% higher for each BMI score in prepregnancy (1.05, 1.03-1.08) and at the end of pregnancy (1.05,1.02-1.08). Multivariate logistic regression analysis indicates that prepregnancy BMI was the only independent factor associated with the 6-18 months postpartum UI (adj 1.05, 95 %CI 1.02-1.08, P <.001). After stratifying, a second univariate and multivariate analysis were done according to the prepregnancy BMI cutoff score of 25. Thus, a significant association between GDM and postpartum UI in prepregnancy overweight women (RR: 1.91; 95 %CI 1.25-2.90, P =.003) and no association between GDM and 6-18 months postpartum UI in normal prepregnancy BMI (RR: 0.78, 95 %CI 0.39-1.54, P =.482) were found. After multivariate regression, the early-onset-GDM remained the unique independent adjusted risk factor for 6-18 months postpartum UI analysis (adjRR 2.15, 95 %CI 1.33-3.46, P =.002). CONCLUSION After a planned C-section, we observed a 6-18 months postpartum UI higher occurrence after GDM, either in early-onset GDM or late-onset GDM. In addition, being overweight (BMI > 25) among women with early-onset GDM was associated with postpartum UI.
Collapse
Affiliation(s)
- Carlos I Sartorão Filho
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil; Educational Foundation of the Municipality of Assis (FEMA), Department of Medical School, Assis, Brazil
| | - Fabiane A Pinheiro
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Luiz Takano
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil; Educational Foundation of the Municipality of Assis (FEMA), Department of Medical School, Assis, Brazil
| | - Caroline B Prudêncio
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Sthefanie K Nunes
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Hallur Rls
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Iracema M P Calderon
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil
| | - Angélica M P Barbosa
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil; São Paulo State University (UNESP), Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, Marília, Brazil
| | - Marilza V C Rudge
- São Paulo State University (UNESP), Department of Gynecology and Obstetrics, Botucatu Medical School, Botucatu, Brazil.
| |
Collapse
|
6
|
Jacobson LT, Bakhache N, Dowling J, Okut H, Zackula R, Robbins DC, Stern JE, Grainger DA, Befort C. Electronic Monitoring of Mom's Schedule (eMOMS TM): A Qualitative Study of Experiences in a Lifestyle Change Program with Lactation Support. Am J Health Promot 2023; 37:953-963. [PMID: 37461383 DOI: 10.1177/08901171231189540] [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] [Indexed: 08/19/2023]
Abstract
PURPOSE To elicit feedback from participants who completed the eMOMSTM study, a feasibility randomized controlled trial (NCT04021602), on their perceptions of program strengths and weaknesses. STUDY DESIGN Qualitative - Semi-structured, telephone interview guide using open-ended questions. SETTING Rural Great Plains state, United States. PARTICIPANTS Of 26 individuals who completed the eMOMSTM study, 24 consented to an interview. METHOD Interviews were completed between October 2020 and May 2021. Audio-recordings were transcribed verbatim and organized in Microsoft 365. Data were analyzed using an exploratory, inductive thematic analysis. RESULTS Participants' mean age was 27.5 (± 5.4) years and mean pre-pregnancy BMI was 29.5 kg/m2 (± 2.7). The majority (71%) were non-Hispanic White and 54% had a high school education/some college. Based on specific areas of inquiry, the following themes emerged: convenience of online program access using Facebook, importance of health coach's support and online interaction, positivity toward improving one's health, increased consciousness of health behaviors, diverse lactation educational needs, importance of educational materials on depression, and grief over the loss of birth expectations during COVID-19. CONCLUSION Findings suggest participants' perceived value of a lifestyle change program coupled with lactation education and support delivered using social media. Findings inform future studies to further adapt lifestyle change programs.
Collapse
Affiliation(s)
- Lisette T Jacobson
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Nathalie Bakhache
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Jolynn Dowling
- School of Nursing, Wichita State University, Wichita, KS, USA
| | - Hayrettin Okut
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Rosey Zackula
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - David C Robbins
- Diabetes Institute, University of Kansas Medical Center-Kansas City, Kansas City, KS, USA
| | - Judy E Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Health and the Geisel School of Medicine, Lebanon, NH, USA
| | - David A Grainger
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Christie Befort
- Department of Population Health, University of Kansas School of Medicine-Kansas City, Kansas City, KS, USA
| |
Collapse
|
7
|
Ramezani Tehrani F, Farzadfar F, Hosseinpanah F, Rahmati M, Firouzi F, Abedini M, Hadaegh F, Valizadeh M, Torkestani F, Khalili D, Solaymani-Dodaran M, Bidhendi-Yarandi R, Bakhshandeh M, Ostovar A, Dovom MR, Amiri M, Azizi F, Behboudi-Gandevani S. Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter? Front Endocrinol (Lausanne) 2023; 14:1155007. [PMID: 37334302 PMCID: PMC10273274 DOI: 10.3389/fendo.2023.1155007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives The aim of the study was to investigate the effect of treatment on pregnancy outcomes among women who had fasting plasma glucose (FPG) 5.1-5.6 mmol/l in the first trimester of pregnancy. Methods We performed a secondary-analysis of a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. All pregnant women with FPG values range 5.1-5.6 mmol/l in the first trimester of gestation were included in the present study (n=3297) and classified to either the (i) intervention group who received treatment for GDM along with usual prenatal care (n=1,198), (ii) control group who received usual-prenatal-care (n=2,099). Macrosomia/large for gestational age (LGA) and primary cesarean-section (C-S) were considered as primary-outcomes. A modified-Poisson-regression for binary outcome data with a log link function and robust error variance was used to RR (95%CI) for the associations between GDM status and incidence of pregnancy outcomes. Results The mean maternal age and BMI of pregnant women in both study groups were similar. There were no statistically significant differences in the adjusted risks of adverse pregnancy outcomes, including macrosomia, primary C-S, preterm birth, hyperbilirubinemia, preeclampsia, NICU-admission, birth trauma, and LBW both groups. Conclusions It is found that treating women with first-trimester FPG values of 5.1-5.6 mmol/l could not improve adverse pregnancy outcomes including macrosomia, Primary C-S, Preterm birth, hypoglycemia, hypocalcemia, preeclampsia, NICU admission, Birth trauma and LBW. Therefore, extrapolating the FPG cut-off point of the second trimester to the first -which has been proposed by the IADPSG, might therefore not be appropriate. Clinical Trial Registration https://www.irct.ir/trial/518, identifier IRCT138707081281N1.
Collapse
Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faegheh Firouzi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marzieh Bakhshandeh
- Family Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
8
|
Ding L, Chen Z, Chen Y, Zhu Y. Combining HbA1c and insulin resistance to assess the risk of gestational diabetes mellitus: a prospective cohort study. Diabetes Res Clin Pract 2023; 199:110673. [PMID: 37075929 DOI: 10.1016/j.diabres.2023.110673] [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: 12/31/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To investigate the association of glycated hemoglobin (HbA1c) and homeostasis model assessment insulin resistance (HOMA-IR) with gestational diabetes mellitus (GDM) risk. METHODS Data for this study were from a prospective cohort in Hangzhou, China. We included pregnant women with HbA1c, fasting insulin, and fasting glucose (FG) measured at 15-20 weeks of gestation and underwent oral glucose tolerance test (OGTT) at 24-28 weeks. Based on HbA1c and HOMA-IR, participants were divided into four groups. We estimated the odds ratios (OR) with 95% confidence intervals (CI) to assess the associations of HbA1c and HOMA-IR with GDM occurrence. Finally, we the potential additive interaction between HbA1c and HOMA-IR by calculating relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). RESULT 462 pregnant women were included, of whom 136 (29.44%) developed GDM. Based on HbA1c and HOMA-IR, the study population was divided into four groups, with the percentages of each group being 51.30%, 15.58%, 20.56%, and 12.55%, respectively. The incidence of GDM increased with the increase of HOMA-IR and HbA1c, respectively, and the risk of GDM was significantly increased when both HOMA-IR and HbA1c were elevated. However, no such risk was observed in pregnant women < 35 years. Finally, we found significantly higher FG at 24-28 weeks in the high HOMA-IR and HbA1c group among GDM-positive pregnant women. CONCLUSIONS The incidence of GDM increased with increasing HbA1c and HOMA-IR, and the risk of GDM was significantly increased when both HbA1c and HOMA-IR were elevated. This finding may help to identify high-risk women for GDM early in pregnancy and provide timely interventions.
Collapse
Affiliation(s)
- Lijing Ding
- Department of Laboratory Medicine, The Women's Hospital of Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, 310006, China
| | - Zhuopeng Chen
- Department of Laboratory Medicine, The Women's Hospital of Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, 310006, China
| | - Yan Chen
- Department of Laboratory Medicine, The Women's Hospital of Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, 310006, China
| | - Yuning Zhu
- Department of Laboratory Medicine, The Women's Hospital of Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, 310006, China.
| |
Collapse
|
9
|
Jiang W, Sun X, Liu F, Cheng G, Li S, Xu M, Wu Y, Wang L. Circulating lncRNAs NONHSAT054669.2 and ENST00000525337 can be used as early biomarkers of gestational diabetes mellitus. Exp Biol Med (Maywood) 2023; 248:508-518. [PMID: 37070250 PMCID: PMC10281535 DOI: 10.1177/15353702231160327] [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: 09/18/2022] [Accepted: 02/01/2023] [Indexed: 04/19/2023] Open
Abstract
Early diagnosis can help prevent and reduce the adverse effects of gestational diabetes mellitus (GDM). This study intended to investigate key circulating long non-coding RNAs (lncRNAs) as novel biomarkers for diagnosis of GDM at the early stages. First, lncRNA microarray analysis was conducted for plasma samples of GDM women before delivery and 48 h after delivery. The expression of differentially expressed lncRNAs in clinical samples at different trimesters was randomly validated by quantitative polymerase chain reaction (PCR). Moreover, the correlation between lncRNA expression and oral glucose tolerance test (OGTT) level in GDM women during the second trimester was analyzed, followed by evaluating the diagnostic value of key lncRNAs during different trimesters using receiver operating characteristic (ROC) curve. Higher NONHSAT054669.2 expression and lower ENST00000525337 expression were revealed in GDM women before delivery relative to 48 h after delivery (P < 0.05). The expression of NONHSAT054669.2 and ENST00000525337 in GDM women during the first and second trimesters was dramatically higher than pregnant women (P < 0.05) with normal glucose tolerance (NGT). During the second trimester, NONHSAT054669.2 expression was positively related to OGTT level at 1 h (r = 0.41455, P < 0.001). Furthermore, ROC curve analysis revealed that ENST00000525337 alone, NONHSAT054669.2 alone, and their combination had high diagnostic value for GDM during the first (area under the ROC curve (AUC) = 0.979, 0.956, and 0.984, respectively) and second (AUC = 0.829, 0.809, and 0.838, respectively) trimesters (all P < 0.001). The plasma level of NONHSAT054669.2 and ENST00000525337 may be applied as novel diagnostic biomarkers for early diagnosis of GDM.
Collapse
Affiliation(s)
- Wen Jiang
- Central Research Laboratory, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, P.R. China
| | - Xiubin Sun
- Department of Biostatistics, School of Public Health, Cheeloo Collage of Medicine, Shandong University, Jinan 250012, P.R. China
| | - Fangfei Liu
- Central Research Laboratory, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, P.R. China
| | - Guanghui Cheng
- Central Research Laboratory, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, P.R. China
| | - Siyuan Li
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated with Shandong University, Jinan 250001, P.R. China
| | - Mengru Xu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Yu Wu
- Department of Gynecology and Obstetrics, Liaocheng People’s Hospital, Liaocheng 252000, P.R. China
| | - Lina Wang
- Central Research Laboratory, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, P.R. China
| |
Collapse
|
10
|
Cui J, Li P, Chen X, Li L, Ouyang L, Meng Z, Fan J. Study on the Relationship and Predictive Value of First-Trimester Pregnancy-Associated Plasma Protein-A, Maternal Factors, and Biochemical Parameters in Gestational Diabetes Mellitus: A Large Case-Control Study in Southern China Mothers. Diabetes Metab Syndr Obes 2023; 16:947-957. [PMID: 37033400 PMCID: PMC10075321 DOI: 10.2147/dmso.s398530] [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: 11/21/2022] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE To investigate the relationship and predictive value of first-trimester pregnancy-associated plasma protein A (PAPP-A), maternal factors, and biochemical parameters with gestational diabetes mellitus (GDM) in southern China mothers. METHODS This study recruited 4872 pregnant women. PAPP-A, the free beta subunit of human chorionic gonadotropin (free β-HCG), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high- and low-density lipoproteins (HDL, LDL) were measured at 11-13+ weeks of gestation. GDM was diagnosed based on a 75 g oral glucose tolerance test at 24-28 weeks of gestation. We performed stepwise logistic regression analysis to determine the odds ratio (OR) and the 95% confidence interval (CI) of GDM. We used Receiver Operating Characteristic (ROC) curves with the area under the curve (AUC) to evaluate the predictive value of PAPP-A, maternal factors, and biochemical markers. The significance of the differences between the AUC values was assessed using the DeLong test. RESULTS GDM was diagnosed in 750 (15.39%) women. Independent factors for GDM were age, pre-gestational BMI, GWG before a diagnosis of GDM, previous history of GDM, family history of diabetes, FPG, TG, LDL, PAPP-A, and TC. The AUC of PAPP-A was 0.56 (95% CI 0.53-0.58). The AUC of a model based on combined maternal factors, biochemical markers, and PAPP-A was 0.70 (95% CI 0.68-0.72). Differences in AUC values between PAPP-A alone and the model based on combined maternal factors, biochemical markers, and PAPP-A were statistically significant (Z= 9.983, P<0.001). CONCLUSION A Low serum PAPP-A level in the first trimester is an independent risk factor for developing GDM later in pregnancy. However, it is not a good independent predictor although the predictive value of a low serum PAPP-A level increases when combined with maternal factors and biochemical markers.
Collapse
Affiliation(s)
- Jinhui Cui
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Ping Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Xinjuan Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Ling Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Liping Ouyang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Zhaoran Meng
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Jianhui Fan
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
- Correspondence: Jianhui Fan, No. 600, Tianhe Road, Tianhe, Guangzhou, People’s Republic of China, Tel +86 18922102608, Email
| |
Collapse
|
11
|
Hillier TA, Pedula KL, Ogasawara KK, Vesco KK, Oshiro C, Van Marter JL. Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes. J Perinat Med 2022; 50:1036-1044. [PMID: 35534914 PMCID: PMC9519183 DOI: 10.1515/jpm-2021-0581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/07/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Gestational diabetes (GDM) screening at 24-28 weeks' gestation reduces risk of adverse maternal and perinatal outcomes. While experts recommend first-trimester screening for high-risk patients, including those with obesity, data supporting this recommendation is limited. METHODS We implemented a systematic population intervention to encourage first-trimester GDM screening by oral glucose tolerance testing in a cohort of pregnant people with obesity in two integrated health systems from 2009 to 2013, and compared outcomes to the same population pre-intervention (2006-2009). Up to five years of postpartum glucose testing results (through 2018) were assessed among GDM cases in the post-intervention group. Primary outcomes were large-for-gestational-age birthweight (LGA); macrosomia; a perinatal composite outcome; gestational hypertension/preeclampsia; cesarean delivery; and medication treatment of GDM. RESULTS A total of 40,206 patients (9,156 with obesity) were screened for GDM; 2,672 (6.6%) were diagnosed with GDM. Overall, multivariate adjusted risk for LGA and cesarean delivery were lower following the intervention (LGA: aOR 0.89 [0.82, 0.96]; cesarean delivery: 0.89 [0.85, 0.93]). This difference was more pronounced in patients diagnosed with GDM (LGA: aOR 0.52 [0.39, 0.70]; cesarean delivery 0.78 [0.65, 0.94]); insulin/oral hypoglycemic treatment rates for GDM were also higher post-intervention than pre-intervention (22 vs. 29%; p<0.0001). There were no differences for the other primary outcomes. Only 20% of patients diagnosed with GDM early in pregnancy who had postpartum testing had results in the overt diabetes range, suggesting a spectrum of diabetes detected early in pregnancy. CONCLUSIONS First trimester GDM screening for pregnant people with obesity may improve GDM-associated outcomes.
Collapse
Affiliation(s)
- Teresa A. Hillier
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kathryn L. Pedula
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Hawaii Permanente Medical Group, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Keith K. Ogasawara
- Hawaii Permanente Medical Group, Kaiser Permanente Hawaii, Honolulu, HI, USA
- Department of Obstetrics & Gynecology, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Kimberly K. Vesco
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Department of Obstetrics & Gynecology, Kaiser Permanente Northwest, Portland, OR, USA
| | - Caryn Oshiro
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Jan L. Van Marter
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| |
Collapse
|
12
|
Weiss RE, Badreldin N, Drexler K, Niznik C, Yee LM. Pregnancy Outcomes Associated with Introduction of Early Diabetes Screening Guidelines. Am J Perinatol 2022; 39:1176-1182. [PMID: 33352587 PMCID: PMC10151121 DOI: 10.1055/s-0040-1721712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The study aimed to evaluate perinatal outcomes associated with introduction of and adherence to early diabetes screening guidelines. STUDY DESIGN Retrospective cohort study of all women who received prenatal care at a single, high-volume tertiary care center before ("preguidelines") and after ("postguidelines") American College of Obstetrics and Gynecology guidelines for early pregnancy diabetes screening for women at high risk for diabetes. Women with known pregestational diabetes, late entry to prenatal care, a fetus with a known anomaly, or multiple gestation were excluded. Multivariable linear and logistic regression models were constructed to compare maternal and neonatal outcomes between women in the preguidelines cohort to those in the postguidelines cohort. Similarly, adherence to screening guidelines was assessed, and among all women who were eligible for early diabetes screening, multivariable linear, and logistic models were created to compare outcomes between those women who were screened early to those who were not. RESULTS Of the 2,069 women eligible for analysis, 64.6% (n = 1,337) were in the postguideline cohort. Women in the postguideline cohort were older, less likely to have a history of smoking, and more likely to be non-Hispanic white. On multivariable analysis, women in the postguideline cohort had significantly less gestational weight gain (aβ = -2.3; 95% confidence interval [CI]: -3.4 to -1.1), but a higher odds of 5-minute Apgar's score of <7 (adjusted odds ratio: 2.51; 95% CI: 1.11-5.66). Of 461 women who met ACOG early diabetes screening criteria, 58.7% (n = 270) were screened appropriately. Adherence to screening was associated with parity, race, insurance, and BMI. On multivariable analysis, there were no significant differences in neonatal outcomes between women meeting early screening criteria who were screened early and those who were not. CONCLUSION Introduction of early diabetes screening guidelines was associated with a significant decrease in gestational weight gain, but did not improve neonatal outcomes. KEY POINTS · Introduction of early diabetes screening guideline did not improve rate of early screening.. · Detection and treatment of gestational diabetes may not improve perinatal outcomes.. · Early screening guidelines was associated with decreased gestational weight..
Collapse
Affiliation(s)
- Rebecca E Weiss
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nevert Badreldin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathleen Drexler
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charlotte Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
13
|
Hannah W, Bhavadharini B, Beks H, Deepa M, Anjana RM, Uma R, Martin E, McNamara K, Versace V, Saravanan P, Mohan V. Global burden of early pregnancy gestational diabetes mellitus (eGDM): A systematic review. Acta Diabetol 2022; 59:403-427. [PMID: 34743219 DOI: 10.1007/s00592-021-01800-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/07/2021] [Indexed: 01/02/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) diagnosed during the first trimester of pregnancy is called 'early pregnancy Gestational Diabetes Mellitus' (eGDM). The burden of eGDM has only been studied sporadically. This review aims to understand the global burden of eGDM in terms of prevalence, risk factors, pregnancy outcomes, treatment and postpartum dysglycemia. METHODS: A review of epidemiologic studies reporting on early GDM screening as per Joanna Briggs Institute (JBI) methodology for prevalence reviews was conducted. A customized search strategy was used to search electronic databases namely, PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, MEDLINE, Ovid, ScienceDirect, and Google Scholar. Three independent reviewers reviewed studies using Covidence software. Observational studies irrespective of study design and regardless of diagnostic criteria were included. Quality of evidence was appraised, and findings were synthesized. RESULTS Of 58 included studies, 41 reported a prevalence of eGDM, ranging from 0.7 to 36.8%. Body mass index (BMI), previous history of GDM, family history of diabetes and multiparity were reported as eGDM risk factors. Adverse pregnancy outcomes associated with eGDM were macrosomia, caesarean delivery, induction of labour, hypertension, preterm delivery, and shoulder dystocia. The incidence of postpartum dysglycemia and the need for insulin was higher in women with eGDM. The risk of bias was moderate. Heterogeneity of studies is a limitation. Meta-analysis was not performed. CONCLUSIONS There is heterogeneity in the prevalence of eGDM and intrapartum and postpartum ill effects for the mother and the offspring. There is a need to develop a universal screening protocol for eGDM.
Collapse
Affiliation(s)
- Wesley Hannah
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
- Deakin University, Geelong, Australia
| | | | | | - Mohan Deepa
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ram Uma
- Seethapathy Clinic & Hospital, Chennai, India
| | | | | | | | - Ponnusamy Saravanan
- Populations, Evidence and Technologies, Warwick Medical School, Gibbet Hill, Division of Health Sciences, University of Warwick, Coventry, UK
- Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital NHS Trust, Nunetaon, UK
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
| |
Collapse
|
14
|
Kasuga Y, Kawai T, Miyakoshi K, Hori A, Tamagawa M, Hasegawa K, Ikenoue S, Ochiai D, Saisho Y, Hida M, Tanaka M, Hata K. DNA methylation analysis of cord blood samples in neonates born to gestational diabetes mothers diagnosed before 24 gestational weeks. BMJ Open Diabetes Res Care 2022; 10:10/1/e002539. [PMID: 35046013 PMCID: PMC8772407 DOI: 10.1136/bmjdrc-2021-002539] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Genome-wide methylation analyses of gestational diabetes mellitus (GDM) diagnosed after 24 gestational weeks (late GDM (L-GDM)) using cord blood have been reported. However, epigenetic changes in neonates born to mothers with GDM diagnosed before 24 gestational weeks (early GDM (E-GDM)) have not been reported. We investigated DNA methylation in neonates born to mothers with E-GDM using cord blood samples. RESEARCH DESIGN AND METHODS Genome-wide DNA methylation analysis was performed using an Illumina EPIC array to compare methylation rates of 754 255 autosomal sites in cord blood samples from term neonates born to 162 mothers with GDM (E-GDM: n=84, L-GDM: n=78) and 60 normal glucose tolerance (normal OGTT) pregnancies. GDM was diagnosed based on Japan Society of Obstetrics and Gynecology criteria modified with International Association of Diabetes in Pregnancy Study Group criteria. In this study, all GDM mothers underwent dietary management, while self-monitoring of blood glucose and insulin administration was initiated when dietary modification did not achieve glycemic control. RESULTS There were no significant differences in genome-wide DNA methylation of cord blood samples between the GDM (E-GDM and L-GDM) groups and normal OGTT group or between the E-GDM and normal OGTT groups, L-GDM and normal OGTT groups, and E-GDM and L-GDM groups. CONCLUSIONS This is the first report to determine the DNA methylation patterns in neonates born to mothers with E-GDM. Neonates born to mothers with GDM, who were diagnosed based on Japan Society of Obstetrics and Gynecology criteria, may not differ in DNA methylation compared with those born to normal OGTT mothers.
Collapse
Affiliation(s)
- Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Tomoko Kawai
- Division of Fetal Development, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Kei Miyakoshi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Asuka Hori
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan
- Department of Medical Genetics and Genomics, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Masumi Tamagawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Keita Hasegawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Daigo Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan
| |
Collapse
|
15
|
Tamagawa M, Kasuga Y, Saisho Y, Tanaka Y, Hasegawa K, Oishi M, Endo T, Sato Y, Ikenoue S, Tanaka M, Ochiai D. Predictors of later insulin therapy for gestational diabetes diagnosed in early pregnancy. Endocr J 2021; 68:1321-1328. [PMID: 34108310 DOI: 10.1507/endocrj.ej21-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Interventions for gestational diabetes mellitus (GDM), diagnosed in early pregnancy, have been a topic of controversy. This study aimed to elucidate factors that predict patients with GDM diagnosed before 24 gestational weeks (early GDM: E-GDM) who require insulin therapy later during pregnancy. Furthermore, we identified patients whose impaired glucose tolerance should be strictly controlled from early gestation onward. Women diagnosed with GDM were categorized based on the gestational age at diagnosis into E-GDM (n = 388) or late GDM (L-GDM, diagnosed after 24 weeks, n = 340) groups. Clinical features were compared between the groups, and the predictors for insulin therapy was evaluated in the E-GDM group. There were no significant between-group differences in terms of perinatal outcomes (e.g., gestational weeks at delivery, fetal growth, hypertensive disorder of pregnancy), with the exception of the Apgar score at 5 min. Moreover, there was no significant difference in the frequency of insulin therapy during pregnancy between the two groups. Using multiple logistic regression analysis, pre-pregnancy body mass index (BMI) ≥25 kg/m2, a family history of diabetes, and higher fasting plasma glucose (FPG), 1 h-plasma glucose (PG), and 2 h-PG values increased insulin therapy risk during pregnancy in the E-GDM group. Furthermore, since E-GDM patients with abnormal levels of FPG, as well as 1 h-PG or 2 h-PG, and those with pre-pregnancy BMI ≥25 kg/m2 and a family history of diabetes had a higher risk of later insulin therapy during pregnancy, they may require more careful follow-up in the perinatal period.
Collapse
Affiliation(s)
- Masumi Tamagawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yuya Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Keita Hasegawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Maki Oishi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toyohide Endo
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yu Sato
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Daigo Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| |
Collapse
|
16
|
Population-based study on birth outcomes among women with hypertensive disorders of pregnancy and gestational diabetes mellitus. Sci Rep 2021; 11:17391. [PMID: 34462468 PMCID: PMC8405617 DOI: 10.1038/s41598-021-96345-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
To evaluate birth outcomes in women with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), we used insurance data of Taiwan to evaluate 11 adverse neonatal outcomes of infants born to women with HDP (N = 7775) and with both HDP and GDM (HDP/GDM) (N = 1946), comparing to women with neither disorder (N = 19,442), matched by age. The impacts of preeclampsia/eclampsia were also evaluated. Results showed that Caesarean section delivery was near 1.7-fold greater in the HDP/GDM and HDP groups than in comparisons. The preterm delivery rates were more than threefold greater in HDP/GDM group and HDP group than in comparisons with adjusted odds ratios (aORs) of 4.84 (95% confidence interval (CI) 4.34–5.40) and 3.92 (95% CI 3.65–4.21), respectively, followed by jaundice (aORs 2.95 (95% CI 2.63–3.33) and 1.90 (95% CI 1.76–2.06)), and small gestation age (SGA) (aORs 6.57 (95% CI 5.56–7.75) and 5.81 (95% CI 5.15–6.55)). Incidence rates of birth trauma, patent ductus arteriosus, atrial septal defect, respiratory distress syndrome, and neonatal hypoglycemia were also higher in the HDP/GDM and HDP groups than in the comparison group. Most adverse outcomes increased further in women with preeclampsia or eclampsia. In conclusion, women with HDP are at elevated risks of adverse neonatal outcomes. Risks of most adverse outcomes increase further for women with both HDP and GDM. Preeclampsia or eclampsia may also contribute to these outcomes to higher risk levels. Every pregnant woman with these conditions deserves specialized prenatal care.
Collapse
|
17
|
Kim W, Park SK, Kim YL. Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus. Diabetes Metab J 2021; 45:547-557. [PMID: 33663202 PMCID: PMC8369219 DOI: 10.4093/dmj.2020.0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fetal abdominal obesity (FAO) has been reported to be affected at gestational diabetes mellitus (GDM) diagnosis at 24 to 28 weeks of gestation in older and/or obese women. This study investigated whether the management of GDM improves FAO in GDM subjects near term. METHODS Medical records of 7,099 singleton pregnant women delivering at CHA Gangnam Medical Center were reviewed retrospectively. GDM was diagnosed by 100-g oral glucose tolerance test after 50-g glucose challenge test based on Carpenter-Coustan criteria. GDM subjects were divided into four study groups according to maternal age and obesity. FAO was defined as ≥90th percentile of fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter, or femur length, respectively. RESULTS As compared with normal glucose tolerance (NGT) subjects near term, FAORs and odds ratio for FAO were significantly higher in old and/or obese women with GDM but not in young and nonobese women with GDM. For fetuses of GDM subjects with FAO at the time of GDM diagnosis, the odds ratio for exhibiting FAO near term and being large for GA at birth were 7.87 (95% confidence interval [CI], 4.38 to 14.15) and 10.96 (95% CI, 5.58 to 20.53) compared with fetuses of NGT subjects without FAO at GDM diagnosis. CONCLUSION Despite treatment, FAO detected at the time of GDM diagnosis persisted until delivery. Early diagnosis and treatment might be necessary to prevent near term FAO in high-risk older and/or obese women.
Collapse
Affiliation(s)
- Wonjin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
- Yonsei University College of Medicine, Seoul, Korea
| | - Soo Kyung Park
- Department of Biostatics and Data Science, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yoo Lee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
- Corresponding author: Yoo Lee Kim https://orcid.org/0000-0002-9025-9774 Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-ro, Gangnam-gu, Seoul 06135, Korea E-mail:
| |
Collapse
|
18
|
Thomakos P, Kepaptsoglou O, Korantzis A, Trouva A, Sklavounos I, Trouvas D, Taraoune N, Barreto C, Zoupas CS. The diagnosis of Gestational Diabetes Mellitus and its impact on In Vitro Fertilization pregnancies. A pilot study. J Diabetes Complications 2021; 35:107914. [PMID: 33773900 DOI: 10.1016/j.jdiacomp.2021.107914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND In Vitro Fertilization (IVF) is increasingly becoming a necessary mode of reproduction. This high risk group is prone to Gestational Diabetes Mellitus (GDM) which further exposes these pregnancies to an increased risk of adverse outcomes. In light of the limited data in the current literature, further investigation is needed regarding the time of GDM diagnosis in IVF pregnancies as well as the outcome of IVF pregnancies complicated by GDM. METHODS In this three center pilot cross sectional study, the data of 101 singleton IVF pregnancies complicated by GDM were analyzed. Prompt GDM diagnosis in IVF pregnancies was accomplished by self-blood glucose monitoring (SMBG) from the first antenatal visit and confirmed by an OGTT. To evaluate pregnancy outcome, maternal and fetal complications in the 101 GDM IVF group was compared to 101 IVF as well as 101 spontaneous conceptions (SC). The three groups were matched by age. The effect of demographic and glycemic parameters on the outcome of GDM IVF pregnancies was investigated. RESULTS GDM diagnosis was made before the 24th week in 37.6% of the GDM IVF group. The week of delivery was earlier for the GDM IVF group (37 ± 1.7) relative to the IVF (37.9 ± 0.9, p < 0.001) and the SC group (38.1 ± 0.8, p < 0.001). GDM IVF pregnancies exhibited greater preeclampsia rates and 84.8% underwent caesarian section. No significant difference regarding LGA and SGA birth weights was found. Complications of GDM IVF pregnancies were associated with the 1-h postprandial BG (r = 0.267, p = 0.007). CONCLUSION GDM screening in IVF pregnancies may be considered earlier than the 24th week. IVF pregnancies affected by GDM are prone to increased maternal and fetal complications which are associated with 1-h postprandial BG.
Collapse
Affiliation(s)
- Petros Thomakos
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece.
| | - Olga Kepaptsoglou
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece.
| | - Asteris Korantzis
- IASO Maternity Hospital, 37-39 Kifisias Avenue, 151 23 Marousi, Athens, Greece.
| | - Anastasia Trouva
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - Ioannis Sklavounos
- Mitera Maternity Hospital, 6 Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - Dimitris Trouvas
- Mitera Maternity Hospital, 6 Erythrou Stavrou, 151 23 Marousi, Athens, Greece.
| | - Nadia Taraoune
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - Carol Barreto
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - Christos Sp Zoupas
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece.
| |
Collapse
|
19
|
Redman LM, Drews KL, Klein S, Horn LV, Wing RR, Pi-Sunyer X, Evans M, Joshipura K, Arteaga SS, Cahill AG, Clifton RG, Couch KA, Franks PW, Gallagher D, Haire-Joshu D, Martin CK, Peaceman AM, Phelan S, Thom EA, Yanovski SZ, Knowler WC. Attenuated early pregnancy weight gain by prenatal lifestyle interventions does not prevent gestational diabetes in the LIFE-Moms consortium. Diabetes Res Clin Pract 2021; 171:108549. [PMID: 33238176 PMCID: PMC9041868 DOI: 10.1016/j.diabres.2020.108549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/29/2020] [Accepted: 11/06/2020] [Indexed: 12/30/2022]
Abstract
AIMS To examine the effect of lifestyle (diet and physical activity) interventions on the prevalence of GDM, considering the method of GDM ascertainment and its association with early pregnancy characteristics and maternal and neonatal outcomes in the LIFE-Moms consortium. METHODS LIFE-Moms evaluated the effects of lifestyle interventions to optimize gestational weight gain in 1148 pregnant women with BMI ≥ 25 kg/m2 and without known diabetes at enrollment, compared with standard care. GDM was assessed between 24 and 31-weeks gestation by a 2-hour, 75-gram OGTT or by local clinical practice standards. RESULTS Lifestyle interventions initiated prior to 16 weeks reduced early excess GWG compared with standard care (0.35 ± 0.24 vs 0.43 ± 0.26 kg per week, p=<0.0001) but did not affect GDM diagnosis (11.1% vs 11.6%, p = 0.91). Using the 75-gram, 2-hour OGTT, 13. 0% of standard care and 11.0% of the intervention group had GDM by the IADPSG criteria (p = 0.45). The 'type of diagnostic test' did not change the result (p = 0.86). Women who developed GDM were significantly heavier, more likely to have obesity, and more likely to have dysglycemia at baseline. CONCLUSION Moderate-to-high intensity lifestyle interventions grounded in behavior change theory initiated between 9 and 16-weeks gestation did not affect the prevalence of GDM despite reducing early GWG. CLINICALTRIALS.GOV: NCT01545934, NCT01616147, NCT01771133, NCT01631747, NCT01768793, NCT01610752, NCT01812694.
Collapse
Affiliation(s)
- Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Kimberly L Drews
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Xavier Pi-Sunyer
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD, USA
| | - Kaumudi Joshipura
- Center for Clinical Research and Health Promotion, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico; Department of Epidemiology, Harvard T.H. Chan Public Health School, Harvard University, Boston, MA, USA
| | - S Sonia Arteaga
- Division of Cardiovascular Diseases, The National Heart, Lung, and Blood Institute, Bethesda, MD, USA; The Environmental Influences on Child Health Outcomes (ECHO) Program Office, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Alison G Cahill
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, TX, USA
| | - Rebecca G Clifton
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Kimberly A Couch
- Phoenix Indian Medical Center, Indian Health Service, Phoenix, AZ, USA
| | - Paul W Franks
- Department of Nutrition, Harvard T.H. Chan Public Health School, Harvard University, Boston, MA, USA; Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
| | - Dympna Gallagher
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Alan M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Elizabeth A Thom
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| |
Collapse
|
20
|
Ran G, Zhu X, Qin Y. LncRNA SOX2OT is Upregulated in Gestational Diabetes Mellitus (GDM) and Correlated with Multiple Adverse Events. Diabetes Metab Syndr Obes 2021; 14:3989-3995. [PMID: 34531671 PMCID: PMC8439441 DOI: 10.2147/dmso.s319739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/29/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE LncRNA SOX2OT plays protective roles in high glucose-induced injuries, suggesting its potential involvement in diabetes. Therefore, we analyzed the role of SOX2OT in gestational diabetes mellitus (GDM). METHODS A total of 216 pregnant women with a gestational age of about 2 months were enrolled in this study. The 216 pregnant women were monitored until delivery to record the occurrence of GDM. Adverse events, including miscarriage, premature delivery, intrauterine distress, intrauterine death, intrauterine infection, fetal malformation, macrosomia, and hypertension, were recorded. RESULTS Two hundred sixteen pregnant women were divided into high and low SOX2OT level groups (n=108), with the median plasma SOX2OT level on the day of admission as the cutoff value. It was observed that the incidence of GDM was higher in the high SOX2OT level group (40/108) than in the low SOX2OT level group (12/108). Moreover, the SOX2OT expression level was higher in GDM patients than in non-GDM participants, and ROC curve analysis showed that plasma SOX2OT levels on the day of admission could separate potential GDM patients from the rest participants. Importantly, higher incidences of miscarriage, premature delivery, intrauterine distress, intrauterine death, intrauterine infection, fetal malformation, macrosomia, and hypertension were observed in the high SOX2OT group compared to the low SOX2OT group. CONCLUSION SOX2OT is highly expressed in GDM and is closely correlated with multiple adverse events.
Collapse
Affiliation(s)
- Guangqin Ran
- Department of Obstetrics and Gynecology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 401147, People’s Republic of China
| | - Xiaofan Zhu
- Department of Obstetrics and Gynecology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 401147, People’s Republic of China
| | - Yan Qin
- Department of Obstetrics and Gynecology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 401147, People’s Republic of China
- Correspondence: Yan Qin Department of Obstetrics and Gynecology, Chongqing General Hospital, University of Chinese Academy of Sciences, No. 118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147, People’s Republic of ChinaTel +86 23-63390545 Email
| |
Collapse
|
21
|
Prognosis associated with initial care of increased fasting glucose in early pregnancy: A retrospective study. DIABETES & METABOLISM 2020; 47:101197. [PMID: 33039671 DOI: 10.1016/j.diabet.2020.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 01/25/2023]
Abstract
AIM To evaluate whether the initial care of women with fasting plasma glucose (FPG) levels at 5.1-6.9mmol/L before 22 weeks of gestation (WG), termed 'early fasting hyperglycaemia', is associated with fewer adverse outcomes than no initial care. METHODS A total of 523 women with early fasting hyperglycaemia were retrospectively selected in our department (2012-2016) and separated into two groups: (i) those who received immediate care (n=255); and (ii) those who did not (n=268), but had an oral glucose tolerance test (OGTT) at or after 22 WG, with subsequent standard care if hyperglycaemia (by WHO criteria) was present. The number of cases of large-for-gestational age (LGA) infants, shoulder dystocia and preeclampsia with initial care of early fasting hyperglycaemia were compared after propensity score modelling and accounting for covariates. RESULTS Of the 268 women with no initial care, 134 had hyperglycaemia after 22 WG and then received care. Women who received initial care vs those who did not were more likely to be insulin-treated during pregnancy (58.0% vs 20.9%, respectively; P<0.00001), gained less gestational weight (8.6±5.4kg vs 10.8±6.1kg, respectively; P<0.00001), had a lower rate of preeclampsia [1.2% vs 2.6%, respectively; adjusted odds ratio (aOR): 0.247 (0.082-0.759), P=0.01], and similar rates of LGA infants (12.2% vs 11.9%, respectively) and shoulder dystocia (1.6% vs 1.5%, respectively). When initial FPG levels were ≥5.5mmol/L (prespecified group, n=137), there was a lower rate of LGA infants [6.7% vs 16.1%, respectively; aOR: 0.332 (0.122-0.898); P=0.03]. CONCLUSION Treating women with early fasting hyperglycaemia, especially when FPG is ≥5.5mmol/L, may improve pregnancy outcomes, although this now needs to be confirmed by randomized clinical trials.
Collapse
|
22
|
Immanuel J, Eagleton C, Baker J, Simmons D. Pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy in an urban New Zealand population and their association with postnatal HbA1c uptake. Aust N Z J Obstet Gynaecol 2020; 61:69-77. [PMID: 32880893 DOI: 10.1111/ajo.13231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adverse pregnancy outcomes are more common in women with hyperglycaemia. Many women have suboptimal uptake of HbA1c testing postdelivery. AIMS To compare pregnancy outcomes among multi-ethnic women with different degrees of hyperglycaemia during pregnancy, and their association with postnatal HbA1c uptake after the introduction of email reminders. MATERIALS AND METHODS A retrospective and prospective single-centre study was conducted in South Auckland in 2639 women with early gestational diabetes mellitus (GDM) (diagnosed < 20 weeks), late GDM (diagnosed ≥ 20 weeks), overt diabetes in pregnancy, or known type 2 diabetes (T2DM) during pregnancy. Automated email reminders were sent to general practitioners to increase postnatal HbA1c screening. RESULTS HbA1c during pregnancy increased across the late GDM (n = 1425), early GDM (n = 148), overt diabetes (n = 573) and T2DM (n = 493) groups (P < 0.001). Stillbirth was least common in the late GDM group (0, 0.7, 0.5, and 1.9%, respectively, P < 0.001), as were caesarean delivery (32.7, 45.1, 39.4, and 53.5%, respectively, P < 0.001), large for gestational age (LGA) (14.7, 18.2, 22.3, and 30.5%, respectively, P < 0.001), small for gestational age (8.8, 16.7, 11.0, and 11.1%, respectively, P = 0.02), and preeclampsia/eclampsia (7.7, 9.2, 13.0, and 14.8%, respectively, P < 0.001). LGA and preeclampsia/eclampsia were more common among Pacific and Māori women than European women (LGA, 30.1, 22.7, 10.3%, respectively, P < 0.001; preeclampsia/eclampsia, 13.5, 14.0, and 8.1%, respectively, P < 0.001). Postpartum HbA1c screening increased among women with GDM/overt diabetes after the introduction of the reminder emails (39.6% vs 34.0%, P = 0.03). CONCLUSIONS Women with late GDM are least likely to experience adverse outcomes. Email reminders to improve postpartum HbA1c screening warrant further investigation.
Collapse
Affiliation(s)
- Jincy Immanuel
- Western Sydney University, Sydney, New South Wales, Australia
| | - Carl Eagleton
- Counties Manukau District Health Board, Auckland, New Zealand
| | - John Baker
- Counties Manukau District Health Board, Auckland, New Zealand
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
23
|
Harper LM, Jauk V, Longo S, Biggio JR, Szychowski JM, Tita AT. Early gestational diabetes screening in obese women: a randomized controlled trial. Am J Obstet Gynecol 2020; 222:495.e1-495.e8. [PMID: 31926951 PMCID: PMC7196002 DOI: 10.1016/j.ajog.2019.12.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although in 2013 the American College of Obstetricians and Gynecologists recommended early screening for gestational diabetes in obese women, no studies demonstrate an improvement in perinatal outcomes with this strategy. OBJECTIVE We sought to determine whether early screening for gestational diabetes improves perinatal outcomes in obese women. MATERIALS AND METHODS Randomized controlled trial comparing early gestational diabetes screening (14-20 weeks) to routine screening (24-28 weeks) in obese women (body mass index ≥30 kg/m2) at 2 tertiary care centers in the United States. Screening was performed using a 50-g, 1-hour glucose challenge test followed by a 100-g, 3-hour glucose tolerance test if the initial screen was ≥135 mg/dL. Gestational diabetes was diagnosed using Carpenter-Coustan criteria. Women not diagnosed at 14 to 20 weeks were rescreened at 24 to 28 weeks. Exclusion criteria were pre-existing diabetes, major medical illness, bariatric surgery, and prior cesarean delivery. The primary outcome was a composite of macrosomia (>4000 g), primary cesarean delivery, hypertensive disease of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of birth). RESULTS A total of 962 women were randomized, and outcomes were available for 922. Of these 922 women, 459 (49.8%) were assigned to early screen and 463 (50.2%) to routine screen. Baseline characteristics were balanced between groups. In the early screening group, 69 (15.0%; 95% confidence interval, 11.9-18.6%) were diagnosed with gestational diabetes: 29 (6.3%; 95% confidence interval, 4.3-8.9%) at <20 weeks and 40 (8.7%; 95% confidence interval, 6.3-11.7%) at >24 weeks. Of those randomized to routine screening, 56 (12.1%; 95% confidence interval, 9.3-15.4%) had gestational diabetes. Early screening did not reduce the incidence of the primary outcome (56.9% in the early screen versus 50.8% in the routine screen, P = .07; relative risk, 1.12; 95% confidence interval, 0.99-1.26). CONCLUSION Early screening for gestational diabetes in obese women did not reduce the composite perinatal outcome.
Collapse
Affiliation(s)
- Lorie M Harper
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL.
| | - Victoria Jauk
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Sherri Longo
- Women's Services Center of Excellence, Ochsner Health System, New Orleans, LA
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL; Women's Services Center of Excellence, Ochsner Health System, New Orleans, LA
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Alan T Tita
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
24
|
Early Pregnancy Screening for Women at High-Risk of GDM Results in Reduced Neonatal Morbidity and Similar Maternal Outcomes to Routine Screening. J Pregnancy 2020; 2020:9083264. [PMID: 32411467 PMCID: PMC7204101 DOI: 10.1155/2020/9083264] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 01/30/2023] Open
Abstract
The Australasian Diabetes in Pregnancy Society recommends screening high-risk women for gestational diabetes mellitus (GDM) before 24 weeks gestation, under the assumption that an earlier diagnosis and opportunity to achieve normoglycemia will minimize adverse outcomes. However, little evidence exists for this recommendation. The study objective was to compare the pregnancy outcomes of high-risk women diagnosed with GDM before 24 weeks gestation and routinely diagnosed women after 24 weeks gestation. A retrospective audit was conducted of all pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Groups criteria over 12 months at a tertiary Australian hospital. Adverse perinatal outcomes were compared between “Early GDM” diagnosed before 24 weeks (n = 133) and “Late GDM” diagnosed from 24 weeks (n = 636). Early GDM had a significantly lower newborn composite outcome frequency (hypoglycemia, birth trauma, NICU/SCN admission, stillbirth, neonatal death, respiratory distress, and phototherapy) compared to Late GDM (20.3% vs. 30.0%, p = 0.02). Primary cesarean, hypertensive disorders, postpartum hemorrhage, birthweight >90th percentile, macrosomia, and preterm birth frequencies were not significantly different between groups. Therefore, high-risk women diagnosed with GDM in early pregnancy were not more likely to have an adverse outcome compared to routinely diagnosed women. As they are a high-risk group, this may indicate a possible benefit to the early diagnosis of GDM.
Collapse
|
25
|
Deshmukh SV, Prabhakar B, Kulkarni YA. Water Soluble Vitamins and their Role in Diabetes and its Complications. Curr Diabetes Rev 2020; 16:649-656. [PMID: 31526351 DOI: 10.2174/1573399815666190916114040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/18/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetes is a metabolic disorder associated with abnormally high levels of glucose in the blood due to inadequate production of insulin or inadequate sensitivity of cells to the action of insulin. Diabetes has become an increasing challenge in the world. The predicted diabetic population according to the World Health Organization is 8.7% between the age group 20-70 years. There are many complications linked to prolonged high blood glucose levels, such as microvascular complications and macrovascular complications. Vitamins play an important role in glucose metabolism and the potential utility of supplementation is relevant for the prevention and/or management of diabetes mellitus and its complications. METHODS Literature search was performed using various dataset like PUBMED, EBSCO, ProQuest, Scopus and selected websites like the National Institute of Health and the World Health Organization. RESULT Water-soluble vitamins have been thoroughly studied for their activity in diabetes and diabetic complications. CONCLUSION Water-soluble vitamins like B1, B3, B6, B7, B9 and B12 have notable effects in diabetes mellitus and its related complications like nephropathy, neuropathy, retinopathy and cardiomyopathy.
Collapse
Affiliation(s)
- Shreeya V Deshmukh
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta road, Vile Parle (W), Mumbai-400056, India
| | - Bala Prabhakar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta road, Vile Parle (W), Mumbai-400056, India
| | - Yogesh A Kulkarni
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta road, Vile Parle (W), Mumbai-400056, India
| |
Collapse
|
26
|
Kim W, Park SK, Kim YL. Gestational diabetes mellitus diagnosed at 24 to 28 weeks of gestation in older and obese Women: Is it too late? PLoS One 2019; 14:e0225955. [PMID: 31841546 PMCID: PMC6913988 DOI: 10.1371/journal.pone.0225955] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/16/2019] [Indexed: 12/15/2022] Open
Abstract
Aim/Background The prevalence of elderly pregnancy and maternal obesity is increasing worldwide. In old and obese women, metabolic derangement affecting fetal growth might be present earlier than the diagnosis of gestational diabetes mellitus (GDM) or even before pregnancy. We thus investigated whether GDM diagnosed at 24–28 weeks of gestation had already affected fetal abdominal growth and, if so, whether elderly pregnancy and/or maternal obesity aggravate fetal abdominal obesity. Methods We retrospectively reviewed the medical records of 7820 singleton pregnant women who had been universally screened using a 50-g glucose challenge test (GCT) at 24–28 weeks of gestation, and underwent a 3-h 100-g oral glucose tolerance test (OGTT) if GCT were ≥140mg/dl. GDM and normal glucose tolerance (NGT) were diagnosed using the Carpenter-Coustan criteria. Fetal abdominal obesity was investigated by assessing the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter or femur length, respectively. Fetal abdominal overgrowth was defined as FAOR ≥ 90th percentile. The subjects were divided into four study groups: group 1 (age < 35 years and pre-pregnancy body mass index [BMI] < 25 kg/m2), group 2 (age < 35 years and ≥ 25), group 3 (age ≥ 35 years and BMI < 25), and group 4 (age ≥ 35 years and ≥ 25). Results The overall prevalence of GDM was 5.1%, with old and obese group 4 exhibiting the highest prevalence (22.4%). FAORs were significantly higher in the fetus of those with GDM than in the NGT subjects. But, in the subgroup analysis, only old and nonobese group 3 and old and obese group 4 with GDM exhibited significantly higher FAORs than the NGT subjects. Also, risk of fetal abdominal overgrowth was increased in group 3 and 4 subjects with GDM but not in young and nonobese group 1 GDM. The risk of fetal abdominal overgrowth significantly increased with maternal age >35 years, pre-pregnancy BMI >20kg/m2, and HbA1c >37.7 mmol/mol (5.6%). In multivariate analyses, maternal age and HbA1c were significantly associated with FAORs. Conclusion GDM diagnosed at 24–28 weeks of gestation already affected fetal abdominal obesity in older and/or obese women, but not in younger and nonobese women. Our data suggest that selective screening and appropriate intervention of GDM earlier than 24–28 weeks of gestation might be necessary for high-risk old and/or obese women.
Collapse
Affiliation(s)
- Wonjin Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
- Yonsei University College of Medicine, Seoul, Korea
| | - Soo Kyung Park
- Departmentof Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Yoo Lee Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
- * E-mail: ,
| |
Collapse
|
27
|
Jiao Y, Zhang S, Zhang J, Du J. Tetramethylpyrazine attenuates placental oxidative stress, inflammatory responses and endoplasmic reticulum stress in a mouse model of gestational diabetes mellitus. Arch Pharm Res 2019; 42:1092-1100. [DOI: 10.1007/s12272-019-01197-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022]
|
28
|
Cosson E, Vicaut E, Sandre-Banon D, Gary F, Pharisien I, Portal JJ, Banu I, Bianchi L, Cussac-Pillegand C, Dina R, Chiheb S, Valensi P, Carbillon L. Early screening for gestational diabetes mellitus is not associated with improved pregnancy outcomes: an observational study including 9795 women. DIABETES & METABOLISM 2019; 45:465-472. [DOI: 10.1016/j.diabet.2018.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
|
29
|
de Oliveira Santini C, Imakawa TDS, Duarte G, Quintana SM, Moisés ECD. Do the body mass index and the diagnosis of gestational diabetes mellitus influence the level of physical activity during pregnancy and postpartum? PLoS One 2019; 14:e0220947. [PMID: 31398219 PMCID: PMC6688803 DOI: 10.1371/journal.pone.0220947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
Abstract
Obesity and lack of physical exercise are associated with the increase of diabetes mellitus in women of reproductive age and during the gestational period. The objective of the present study was to evaluate physical activity levels during the pregnancy and postpartum periods and the influence of body mass index (BMI) in women with gestational diabetes mellitus (GDM) or low risk pregnancy. The Pregnancy Physical Activity Questionnaire (PPAQ), translated and validated for Portuguese, was used for the evaluation of physical activity (PA) level. The sample was stratified according to preconception BMI and the presence or absence of diagnosis of GDM, resulting in four groups with 66 participants each: low risk pregnancy (LRP) with normal weight (BMI ≥ 18.5 and ≤ 24 kg/m2), LRP and overweight/obese (BMI ≥ 25 kg/m2), GDM with normal weight and GDM with overweight/obese. The level of PA of each participant was measured as Metabolic Equivalent of Task (MET) during the preconceptional period (T0), in the third trimester of gestation (T1), and three months after delivery (T2). The comparison of the MET values showed that the values found in the evaluation three months after delivery (T2) were higher than 1.00 (1.10 MET for the LRP-normal weight, 1.06 MET for LRP-overweight/obese, 1.02 MET for the GDM- normal weight, 1.07 MET for the GDM-overweight/obese). On the pre-gestational (T0) and third trimester (T1) analyzes, the values were less than 1.00 MET. The analysis between groups in relation to BMI and diagnosis of GDM showed no difference.
Collapse
Affiliation(s)
- Cibele de Oliveira Santini
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Elaine Christine Dantas Moisés
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
30
|
Bianchi C, de Gennaro G, Romano M, Battini L, Aragona M, Corfini M, Del Prato S, Bertolotto A. Early vs. standard screening and treatment of gestational diabetes in high-risk women - An attempt to determine relative advantages and disadvantages. Nutr Metab Cardiovasc Dis 2019; 29:598-603. [PMID: 30954416 DOI: 10.1016/j.numecd.2019.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Screening for Gestational Diabetes (GDM) is usually recommended between 24 and 28 weeks of pregnancy; however available evidence suggests that GDM may be already present before recommended time for screening, in particular among high-risk women as those with prior GDM or obesity. The purpose of this retrospective study was to evaluate whether early screening (16-18 weeks) and treatment of GDM may improve maternal and fetal outcomes. METHODS AND RESULTS In 290 women at high-risk for GDM, we analyzed maternal and fetal outcomes, according to early or standard screening and GDM diagnosis time. Early screening was performed by 50% of high-risk women. The prevalence of GDM was 62%. Among those who underwent early screened, GDM was diagnosed at the first evaluation in 42.7%. Women with early diagnosis were more frequently treated with insulin and had a slightly lower HbA1c than women with who were diagnosed late. No differences were observed in the prevalence of Cesarean section, operative delivery, gestational age at the delivery, macrosomia, neonatal weight, Ponderal Index and Large-for-Gestational-Age among women with early or late GDM diagnosis or NGT. However, compared to NGT women, GDM women, irrespective of the time of diagnosis, had a lower gestational weight gain, lower prevalence of macrosomia (3.9% vs. 11.4%), small (1.7% vs. 8.3%) as well as large for gestational age (3.3% vs. 16.7%), but higher prevalence of pre-term delivery (8.9% vs. 2.7%). CONCLUSION Early vs. standard screening and treatment of GDM in high-risk women is associated with similar short-term maternal-fetal outcomes, although women with an early diagnosis were treated to a greater extent with insulin therapy.
Collapse
Affiliation(s)
- C Bianchi
- Diabetes Section, University Hospital of Pisa, Italy.
| | - G de Gennaro
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Romano
- Maternal-Infant Department, University Hospital of Pisa, Italy
| | - L Battini
- Maternal-Infant Department, University Hospital of Pisa, Italy
| | - M Aragona
- Diabetes Section, University Hospital of Pisa, Italy
| | - M Corfini
- Diabetes Section, University Hospital of Pisa, Italy
| | - S Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - A Bertolotto
- Diabetes Section, University Hospital of Pisa, Italy
| |
Collapse
|
31
|
Thompson AM, Thompson JA. An evaluation of whether a gestational weight gain of 5 to 9 kg for obese women optimizes maternal and neonatal health risks. BMC Pregnancy Childbirth 2019; 19:126. [PMID: 30975086 PMCID: PMC6460820 DOI: 10.1186/s12884-019-2273-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/31/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Maternal obesity has a wide range of health effects on both the pregnant woman and developing fetus. The clinical significance of these disorders, combined with a dramatically increasing prevalence of obesity among pregnant women has precipitated a major health crisis in the United States. The most commonly used recommendations for gestational weight gain were established by the Institute of Medicine (IOM) in 2009 and have become well known and often adopted. The authors of the IOM report acknowledged that the recommended gestational weight gain of 5 to 9 kg for obese women whose body mass index was greater than 30 kg/m2 was based on very little empirical evidence. The objective of this study was to evaluate whether a 5 to 9 kg weight gain, for obese women, optimized a set of maternal and neonatal health outcomes. METHODS Data containing approximately 12,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2016. A Bayesian modeling approach was used to estimate the controlled direct effects of pre-pregnancy body mass index and gestational weight gain. RESULTS Obese women gaining less than 5 kg during pregnancy had reduced maternal risks for gestational hypertension, eclampsia, induction of labor and Caesarian section. In contrast, maternal gestational weight gain of less than 5 kg was associated with increased risks for multiple adverse neonatal outcomes with macrosomia the exception. Obese women who gained more than 9 kg during pregnancy had increased risk for multiple maternal and neonatal adverse outcomes. CONCLUSIONS Obese women who were observed to gain less than 5 kg during gestation had reduced odds of several peripartum disorders. However, this lower gestational weight gain was associated with an increase in multiple risks for the neonate.
Collapse
Affiliation(s)
- Abaigeal M Thompson
- School of Medicine, University of Texas, Rio Grande Valley, 1201 West University Drive, Edinburg, TX, 78539, USA
| | - James A Thompson
- College of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, TX, 77843-4475, USA.
| |
Collapse
|