Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants

Genetic and epigenetic alterations associated with gestational diabetes mellitus and adverse neonatal outcomes

Gestational diabetes mellitus (GDM) is a metabolic disorder, recognised during 24-28 weeks of pregnancy. GDM is linked with adverse newborn outcomes such as macrosomia, premature delivery, metabolic disorder, cardiovascular, and neurological disorders. Recent investigations have focused on the correlation of genetic factors such as β-cell function and insulin secretary genes (transcription factor 7 like 2, potassium voltage-gated channel subfamily q member 1, adiponectin etc.) on maternal metabolism during gestation leading to GDM. Epigenetic alterations like DNA methylation, histone modification, and miRNA expression can influence gene expression and play a dominant role in feto-maternal metabolic pathways. Interactions between genes and environment, resulting in differential gene expression patterns may lead to GDM. Researchers suggested that GDM women are more susceptible to insulin resistance, which alters intrauterine surroundings, resulting hyperglycemia and hyperinsulinemia. Epigenetic modifications in genes affecting neuroendocrine activities, and metabolism, increase the risk of obesity and type 2 diabetes in offspring. There is currently no treatment or effective preventive method for GDM, since the molecular processes of insulin resistance are not well understood. The present review was undertaken to understand the pathophysiology of GDM and its effects on adverse neonatal outcomes. In addition, the study of genetic and epigenetic alterations will provide lead to researchers in the search for predictive molecular biomarkers.

The first-trimester triglyceride glucose-body mass index is a valuable predictor for adverse pregnancy outcomes

BACKGROUND

Although insulin resistance has been associated with unfavorable pregnancy outcomes, the ability of non-insulin-based insulin resistance indicators to predict adverse pregnancy outcomes has yet to be thoroughly understood. The study aims to investigate the association and predictability of triglyceride glucose-body mass index (TyG-BMI), a biomarker of non-insulin-based insulin resistance, with the risks of adverse pregnancy outcomes.

METHOD

The retrospective study included 1,136 subjects. Group-based trajectory modeling (GBTM) was employed to identify the TyG-BMI index trajectory. Logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis were used to assess the association between the TyG-BMI index trajectory and the first-trimester TyG-BMI index with the risks of adverse pregnancy outcomes. Receiver-operating characteristic (ROC) curve analysis and the DeLong test were utilized to evaluate the prediction ability of the first-trimester TyG-BMI index for adverse pregnancy outcomes.

RESULTS

GBTM revealed three distinct trajectories of the TyG-BMI index. Using the "low-stable" trajectory as a reference, the "high-stable" trajectory was independently associated with an increased risk of gestational diabetes mellitus (GDM) (aOR = 2.01, 95% CI 1.20-3.37), hypertensive disorders of pregnancy (HDP) (aOR = 6.05, 95% CI 3.00-12.18), and large for gestational age (LGA) (aOR = 2.83, 95% CI 1.28-6.25). The highest quartile of the first-trimester TyG-BMI index was independently linked to elevated GDM (aOR = 3.27, 95% CI 1.92-5.59), HDP (aOR = 9.26, 95% CI 3.19-26.88), and LGA (aOR = 2.26, 95% CI 1.00-5.09)risks. Additionally, the third quartile of the first-trimester TyG-BMI index had 2.21-fold increased odds of GDM (aOR = 2.21, 95% CI 1.27-3.82). The first-trimester TyG-BMI index demonstrated a significant linear association with GDM, HDP, SGA, and LGA risks. Compared to the TyG-BMI index trajectory, the highest quartile of the first-trimester TyG-BMI index exhibited a stronger association with the risks of GDM and HDP (aOR = 3.09 and 7.39, respectively). Furthermore, according to the ROC curve, the first-trimester TyG-BMI index outperformed the TyG index and triglyceride/high-density lipoprotein cholesterol (TG/HDL-c) ratio at predicting HDP (0.726 [0.650-0.801] vs. 0.603 [0.527-0.679] vs. 0.615 [0.537-0.693]), LGA (0.619 [0.540-0.699] vs. 0.534 [0.454-0.613] vs. 0.540 [0.458-0.622]), and GDM (0.664 [0.622-0.705] vs. 0.632 [0.588-0.676] vs. 0.604 [0.560-0.649]). According to the DeLong test, the first-trimester TyG-BMI index was a more valuable predictor for LGA and HDP compared to TyG index and TG/HDL-c ratio.

CONCLUSION

Higher levels of first-trimester TyG-BMI and a "high-stable" trajectory were linked to a greater risk of adverse pregnancy outcomes. Furthermore, as compared to TyG and TG/HDL-c, the first-trimester TyG-BMI index is a valuable predictor for HDP, GDM, and LGA.

Impact of interpregnancy weight change on the risk of gestational diabetes mellitus during a second pregnancy in Chinese population: a retrospective cohort study

OBJECTIVES

This study aimed to investigate the impact of interpregnancy weight changes (IPWC) on the gestational diabetes mellitus (GDM) in the second pregnancy.

DESIGN

A single-centre retrospective cohort study was conducted in China.

SETTING

Data were collected in Peking University Shenzhen Hospital from 2013 January to 2021 February.

PARTICIPANTS

Participants include women who had two consecutive singleton deliveries after 28 gestational weeks (n=2372).

OUTCOMES

The GDM in the second pregnancy (s-GDM) was set as the outcome.

METHODS

IPWC was defined as the change in body mass index between the first trimester of the second pregnancy and that of the first pregnancy, categorised into four groups with -1 kg/m² to <1 kg/m² as the reference. Adjusted ORs (aORs) with 95% CIs attained from multivariable logistic regression were used to assess the association between IPWC and s-GDM, in both total subjects and stratified subgroups.

RESULTS

In the overall analysis, s-GDM was found to be significantly associated with IPWC value (aOR 1.111; 95% CI 1.038 to 1.190) and an IPWC category of ≥3 kg/m² (aOR 1.821; 95% CI 1.197 to 2.772). In the stratified analysis, the significant association between IPWC ≥3 kg/m² and s-GDM was evident only in the subgroups of an interpregnancy interval (IPI) of less than 36 months (aOR 2.210, 95% CI 1.251 to 3.904), under the age of 35 (aOR 1.854, 95% CI 1.204 to 2.857), non-diabetic status in the first pregnancy (f-ND) (aOR 1.872, 95% CI 1.143 to 3.065) and those with normal weight in the first pregnancy (aOR 1.936, 95% CI 1.174 to 3.193). The significant association between IPWC value and s-GDM was also shown only in these subgroups (p<0.05). In f-DN subgroup, even an IPWC category of 1 kg/m² to <3 kg/m² was significantly associated with s-GDM (aOR 1.486, 95% CI 1.044 to 2.117). IPWC < -1 kg/m² was not significantly associated with s-GDM either in the overall analysis or in the stratified analysis (p>0.05).

CONCLUSION

An IPWC of 3 kg/m² or higher may increase the risk of s-GDM, particularly among women with an IPI of less than 36 months, those under 35 years old, individuals without diabetes, or those with normal weight during their first pregnancy. The potential influence of prior GDM on the relationship between IPWC and s-GDM warrants further investigation.

First-trimester metabolic profiling of gestational diabetes mellitus: insights into early-onset and late-onset cases compared with healthy controls

Introduction

Gestational diabetes mellitus (GDM) is a global health concern with significant short and long-term complications for both mother and baby. Early prediction of GDM, particularly late-onset, is crucial for implementing timely interventions to mitigate adverse outcomes. In this study, we conducted a comprehensive metabolomic analysis to explore potential biomarkers for early GDM prediction.

Methods

Plasma samples were collected during the first trimester from 60 women: 20 with early-onset GDM, 20 with late-onset GDM, and 20 with normal glucose tolerance. Using advanced analytical techniques, including liquid chromatography-tandem mass spectrometry (LC-MS/MS) and gas chromatography-mass spectrometry (GC-MS), we profiled over 150 lipid species and central carbon metabolism intermediates.

Results

Significant metabolic alterations were observed in both early- and late-onset GDM groups compared to healthy controls, with a specific focus on glycerolipids, fatty acids, and glucose metabolism. Key findings revealed a 4.0-fold increase in TG(44:0), TG(46:0), TG(46:1) with p-values <0.001 and TG(46:2) with 4.7-fold increase and p-value <0.0001 as well as changes in several phospholipids as PC(38:3), PC(40:4) with 1.4-fold increase, p < 0.001 and PE(34:1), PE(34:2) and PE(36:2) with 1.5-fold change, p < 0.001 in late-onset GDM.

Discussion

Observed lipid changes highlight disruptions in energy metabolism and inflammatory pathways. It is suggested that lipid profiles with distinct fatty acid chain lengths and degrees of unsaturation can serve as early biomarkers of GDM risk. These findings underline the importance of integrating metabolomic insights with clinical data to develop predictive models for GDM. Such models could enable early risk stratification, allowing for timely dietary, lifestyle, or medical interventions aimed at optimizing glucose regulation and preventing complications such as preeclampsia, macrosomia, and neonatal metabolic disorders. By focusing on metabolic disruptions evident in the first trimester, this approach addresses a critical window for improving maternal and fetal outcomes. Our study demonstrates the value of metabolomics in understanding the metabolic perturbations associated with GDM. Future research is needed to validate these biomarkers in larger cohorts and assess their integration into clinical workflows for personalized pregnancy care.

Advanced maternal age is a risk factor for both early and late gestational diabetes mellitus: The Japan Environment and Children's Study

AIMS

This study investigated the association between maternal age and early and late gestational diabetes mellitus (GDM).

METHODS

In total, 72,270 pregnant women were included in this prospective birth cohort study. Associations between maternal age and early GDM (diagnosed at <24 gestational weeks) and late GDM (diagnosed at ≥24 gestational weeks) were evaluated using a multinomial logistic regression model with possible confounding factors. The reference category was maternal age of 30-34.9 years.

RESULTS

Higher maternal age was associated with higher odds of early and late GDM (P-value for trend <0.0001 and <0.0001, respectively). The adjusted odds ratios (aORs) for early GDM with maternal age of 35-39.9 years and ≥40 were 1.399 (95% confidence interval [CI]: 1.134-1.725) and 2.494 (95% CI: 1.828-3.402), respectively. The aORs for late GDM with maternal age of 35-39 years and ≥40 were 1.603 (95% CI: 1.384-1.857) and 2.276 (95% CI: 1.798-2.881), respectively.

CONCLUSIONS

Higher maternal age was associated with an increased risk of GDM regardless of when GDM was diagnosed. The association between maternal age and early GDM was similar to that between maternal age and late GDM.

WeChat mini-program, a preliminary applied study of the gestational blood glucose management model for pregnant women with gestational diabetes mellitus

BACKGROUND

The mHealth has been increasing in pregnancy. However, the WeChat mini-program based gestational glucose management model for gestational diabetes mellitus (GDM) during pregnancy has not been established.

METHODS

56 GDM pregnant women were selected. The control group received routine pregnancy health care, and the experimental group received WeChat mini-program GDM women's blood glucose management model, Intervention from diagnosis of GDM to delivery. Two-hour postprandial glucose, self-management ability, maternal and infant outcomes, satisfaction and so on were collected, with an additional mHealth app usability questionnaire collected by the experimental group.

RESULTS

The WeChat mini-program GDM women's blood glucose management model reduced two-hour postprandial glucose, the birth weight of newborns and the incidence of other complications(P < 0.05). The model also improved self-management ability and blood glucose management satisfaction(P < 0.01). The mHealth app usability questionnaire score tends to be close to 1, which indicates that the WeChat mini-program has usability.

CONCLUSION

The WeChat mini-program blood glucose management model reduces two-hour postprandial glucose and improves the self-management ability, which verifies the feasibility and effectiveness of the blood glucose management model relying on the WeChat mini-program.

Assessment of adverse pregnancy outcomes associated with Helicobacter pylori infection

The background of Helicobacter pylori (H. pylori) infection is complex, and its influence on adverse pregnancy outcomes is inconsistently reported. We performed a multi-institutional, retrospective analysis using de-identified electronic health records from the TriNetX Research Network to compare various pregnancy outcomes in women with and those without H. pylori infection. A 1:1 propensity score matching (PSM) was performed with covariates including age, race, pre-pregnancy body mass index, history of diabetes, presence of gastroesophageal reflux disease nausea, and vomiting. Between January 2010 and October 2024, we identified 5,148 pregnant women with H. pylori infection and 4,740,133 women from the general population with no positive test results or diagnosis for H. pylori. Following PSM, both cohorts contained 5,116 patients each. Our results showed that H. pylori infection was associated with an increased risk of hyperemesis gravidarum. A significant association with hyperemesis gravidarum were also found when comparing patients with positive H. pylori test results to those with negative test results. Secondary outcomes also showed positive correlations between H. pylori infection and low gestational weight gain, fetal growth restriction, and intrauterine fetal demise. Contrarily, the risk of gestational diabetes, preeclampsia and preterm delivery did not increase significantly. Our study confirmed the association between H. pylori infection and multiple adverse pregnancy outcomes. Given its high prevalence, further research is warranted to investigate effective screening and treatment protocols for H. pylori infection during pregnancy.

Maternal Macronutrient Intake and Associated Risk for Gestational Diabetes Mellitus: Results from the BORN2020 Study

Background/Objectives: Limited evidence links maternal macronutrient intake to gestational diabetes mellitus (GDM) risk. Therefore, we evaluated these intakes both before and during pregnancy, comparing macronutrient data against the European Food and Safety Authorities' (EFSA) Dietary Reference Values (DRVs). Methods: Data were prospectively collected from the Greek BORN2020 epidemiologic pregnant cohort, which included 797 pregnant women, of whom 14.7% were diagnosed with GDM. A multinomial logistic regression model assessed the association between macronutrient intake and GDM, adjusting for maternal, lifestyle, and pregnancy-related factors. Results: Women with GDM had higher maternal age (34.15 ± 4.48 vs. 32.1 ± 4.89 years), higher pre-pregnancy BMI (median 23.7 vs. 22.7 kg/m2), and were more likely to smoke during mid-gestation (17.95% vs. 8.82%). Pre-pregnancy energy intake exceeding EFSA recommendations was associated with increased GDM risk (aOR = 1.99, 95%CI: 1.37-2.86). During mid-gestation, higher dietary fiber intake (aOR = 1.05, 95%CI: 1.00-1.10), higher protein intake (aOR = 1.02, 95% CI: 1.00-1.04), and higher protein percentage of energy intake (aOR = 1.08, 95%CI: 1.01-1.17) were all significantly associated with increased GDM risk. Changes from pre-pregnancy to pregnancy showed significant increases in dietary fiber intake (aOR = 1.07, 95%CI: 1.04-1.10), protein (aOR = 1.00, 95%CI: 1.00-1.01), fat (aOR = 1.00, 95%CI: 1.00-1.01), vegetable protein (aOR = 1.01, 95%CI: 1.00-1.03), animal protein (aOR = 1.00, 95%CI: 1.00-1.01), and monounsaturated fatty acid (MUFA) intake (aOR = 1.01, 95%CI: 1.00-1.02), all of which were associated with increased GDM risk. Conclusions: Energy intake above upper levels set by EFSA, as well as increased protein, MUFA, and fiber intake, although beneficial in balanced intakes, may negatively affect gestation by increasing GDM likelihood when consumed beyond requirements.

Conceiving during the first postoperative year after bariatric surgery: a retrospective study of pregnancy outcomes

BACKGROUND

An increasing number of childbearing-aged women have undergone bariatric surgery (BS). Although pregnancy outcomes generally improve after BS, concern remains over the impact of rapid weight loss and the catabolic state that occurs soon after BS. At least a 12-month surgery-to-conception time (SCT) is recommended, though the reasoning behind this has been questioned. This retrospective study was conducted to compare post-BS pregnancies with SCTs of less (Group 1) or more (Group 2) than 12 months.

METHODS

The Hospital Register and Finnish Medical Birth Register were queried for data on BS and subsequent pregnancies. The characteristics of women at surgery and maternal and newborn outcomes in post-BS pregnancies were collected.

RESULTS

Between 2010 and 2022, 113 women gave birth after BS. This included 17 and 96 patients in Groups 1 and 2. The mean SCTs were 8.0 ± 2.7 and 39.0 ± 24.3 months (p < 0.001), respectively. At BS, the characteristics of age (p = 0.316), weight (p = 0.718), body mass index (BMI) (p = 0.114) and surgical technique used (p = 0.648) were similar. During pregnancy, the mean age of Group 1 women was significantly lower (p = 0.005). With no difference in weight (p = 0.961) or BMI (p = 0.567), the incidence of gestational diabetes mellitus (GDM, p = 0.039) was higher in Group 2. The mean gestational age at delivery (p = 0.206) and incidence rates of preterm (p = 0.645), post-term (p = 1.00) and caesarean deliveries (p = 1.00) in the groups were similar. A significantly higher incidence of delivery induction (p < 0.001 was detected in Group 2. The mean newborn weight in Group 1 was lower (p = 0.038), but the mean birth weight standard deviation (p = 0.883) and incidences of low birth weight (< 2500 g, p = 0.345) and small-for-gestational-age newborns (p = 0.469) were similar. The 1- (p = 0.191) and 5-min (p = 0.174) Apgar points in the groups were similar, and no associations between pregnancy outcomes and surgery technique were detected.

CONCLUSIONS

The outcome in pregnancies with an SCT 12 months, postponing pregnancy may not always improve pregnancy outcomes. Therefore, all risks should be weighed when counselling women regarding the optimal time of pregnancy after BS.

Characterizing sociodemographic disparities and predictors of Gestational Diabetes Mellitus among Asian and Native Hawaiian or other Pacific Islander pregnant people: an analysis of PRAMS data, 2016-2022

BACKGROUND

Gestational Diabetes Mellitus (GDM) affects between 2 and 10% of pregnancies in the United States, with trends of increasing prevalence and a significant amount of variability across race and ethnicity, maternal age, and insurance status. Asian and Native Hawaiian or Other Pacific Islanders (NHOPI) have been documented to have a higher prevalence and risk of developing GDM compared to non-Hispanic white populations and have been under-studied in health disparities research.

METHODS

Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2022 surveys, we conducted analyses for the overall PRAMS sample as well as within-group analyses among participants who identify as Asian and NHOPI to identify risk factors for GDM. Descriptive statistics were also collected in the Asian and NHOPI subsample, stratified by Asian and NHOPI ethnicity. Bivariate analyses were performed to explore the relationship between potential GDM risk factors among the overall analytic sample and within the Asian and NHOPI subsample, and multivariable logistic regression was used to investigate potential predictors of GDM.

RESULTS

Asian and NHOPI ethnicities differed by prevalence of GDM at 17.2%, 19.56%, 10.8%, 10.71%, and 18.49% for Chinese, Filipino, Japanese, Native Hawaiian/Other Pacific Islander, and Other Asian, respectively. Compared to White individuals (reference group), the odds of GDM were higher for Asian and Native Hawaiian/Other Pacific Islander individuals in the adjusted model (adjusted odds ratio (aOR) = 2.19, 95% CI: 2.62-2.9). Native mothers also demonstrated significantly elevated odds (aOR = 1.48, 95% CI: 1.4-1.6), while Mixed-race individuals exhibited slightly increased odds (OR = 1.22, 95% CI: 1.14-1.29). The findings revealed notable variability in GDM risk factors across ANHOPI subgroups. Obesity emerged as a consistent and strong predictor of GDM across all groups, while other factors such as interpersonal violence exposure and prenatal depression demonstrated limited or subgroup specific effects.

CONCLUSION

This analysis of 2016 to 2022 PRAMS data illustrated significant variations of GDM predictors between the general population and the Asian and NHOPI population, as well as differences between Asian and NHOPI ethnicities.

Osteopontin Levels in Maternal Serum, Cord Blood, and Breast Milk According to Gestational Diabetes Mellitus: A Case-Control Study

BACKGROUND/OBJECTIVES

The prevalence of gestational diabetes mellitus (GDM) is increasing, and GDM poses health risks for both mothers and newborns. This study investigated the association between GDM and two biomarkers, osteopontin (OPN) and betatrophin (ANGPTL8).

METHODS

This study involved face-to-face interviews with 165 participants-81 in the GDM group and 84 in the control group-to gather maternal-newborn data. Maternal serum OPN levels, along with cord serum OPN and ANGPTL8 levels, were measured at birth. OPN levels in breast milk were also measured between postnatal days 10-15. Statistical analysis included Student's t-test for comparing biomarker levels, chi-square tests for GDM incidence across OPN quartile levels, multiple logistic regression for assessing GDM frequency by OPN quartile levels, and the Pearson correlation coefficient to explore relationships between biomarker levels and maternal-newborn characteristics.

RESULTS

No significant differences in cord OPN or ANGPTL8 levels were detected between the groups. However, the OPN levels in maternal serum and breast milk were greater in the GDM group than in the control group. We found an association between increasing maternal serum and breast milk OPN levels in quartile groups and the risk of GDM. Additionally, there was a moderate correlation between cord OPN and both maternal serum OPN (r = 0.45) and breast milk OPN (r = 0.43).

CONCLUSIONS

The differences in OPN levels between the GDM and control groups suggest that OPN may reflect metabolic changes associated with GDM, possibly as a consequence of the condition itself or its treatment. Further research is necessary to validate these findings and uncover the underlying mechanisms involved.

National, state and territory trends in gestational diabetes mellitus in Australia, 2016-2021: Differences by state/territory and country of birth

OBJECTIVE

To examine trends of gestational diabetes mellitus (GDM) in Australia by state/territory and country of birth.

METHODS

A cross-sectional study was undertaken from 2016 to 2021 using data from the National Diabetes Services Scheme (NDSS) and Australian Bureau of Statistics. The trends were assessed using Average Annual Percentage Changes (AAPCs) and the Cochrane-Armitage test.

RESULTS

Nationally, the age-standardised incidence of GDM was 9.3% (95%CI; 9.1-9.4) in 2016 and 15.7% (95%CI; 15.4-15.9) in 2021, representing AAPC of +10.9%. The highest increase was in the Northern Territory, from 6.7% (95%CI; 5.1-8.3) in 2016 to 19.2% (95%CI; 16.9-21.6) in 2021, AAPC=+24.6%. In Southeast Asian-born women, the incidence of GDM rose from 12.2% (95%CI; 11.7-12.7) in 2016 to 22.5% (95%CI; 21.9-23.2) in 2021 (p-trend<0.001).

CONCLUSIONS

The incidence of GDM has risen in Australia, particularly in the Northern Territory and Victoria, as well as among those born in Southeast Asia and South and Central Asia.

IMPLICATIONS FOR PUBLIC HEALTH

This increase in GDM incidence in Australia underscores the pressing need for location and culturally responsive GDM prevention interventions. The lack of information on some risk factors of GDM (e.g. high body mass index) in the NDSS registry requires further investigation.

Nutritional education on health beliefs, metabolic profiles, and quality of life among high-risk pregnant women for gestational diabetes mellitus: a randomized controlled trial

In recent years, nutrition has become increasingly important in treating and managing gestational diabetes mellitus. The Health Belief Model (HBM) is a conceptual framework in health behavior research used in some medical research. The present study aimed to evaluate the effect of glycemic index training based on the HBM on metabolic indicators and pregnant women's health-related quality of life. In this open-label, parallel-controlled randomized trial, 90 pregnant women from primary health centers in Iran were recruited and randomly assigned to either the intervention group or the control group, using a block randomization method with a block size of six. The intervention group underwent 12 weeks of nutritional education on the glycemic index and load of foodstuff. The control group only received routine health care. Valid and reliable questionnaires included demographic and prenatal information, physical activity, three days of food records, quality of life (SF-12), and HBM constructs. Fasting blood samples were taken at baseline and end of the study, to assess fasting blood glucose (FBS), fasting insulin, hs-CRP, and lipids. Eighty-four pregnant women with an age mean of 30.12 ± 4.35 completed 12 weeks of intervention. At baseline, there were no significant differences between groups in the HBM subscales (P > 0.05). However, within the intervention group, there was an increase in perceived susceptibilities (mean change 1.45 ± 4.21; P = 0.03) and cue to action (mean change: 1.22 ± 3.38; P = 0.02). In the adjusted model, the General Health subscale of Quality of Life showed a significant increase in the comparison between groups (mean change 13.69 ± 29.83 vs. 0.00 ± 29.58; P = 0.04). Additionally, the adjusted model revealed a notable difference between the groups in serum hs-CRP level, (mean change -0.877 ± 3.47 vs. -0.067 ± 3.40; P = 0.01) and triglyceride level (mean change - 55.24 ± 111.21 vs. 40.92 ± 142.01; P = 0.001). However, in the adjusted model, the total cholesterol levels increased between groups (mean change 22.75 ± 66.17 vs. 30.12 ± 61.33; P = 0.01) at the end of the study. There was no significant difference in glycemic indices (P > 0.05). Participation in a nutrition education program might positively impact nutritional beliefs, behaviors, and some biochemical indicators among pregnant women. Future studies with larger sample sizes and longer follow-ups are warranted.Trial registration number: IRCTID: IRCT20190227042858N1. Registration date: 2019-07-18.

A sequential explanatory mixed method study of maternal and fetal outcome in gestational diabetes mellitus using Diabetes in Pregnancy Study Group India (DIPSI) test in Puducherry

Background

Gestational diabetes mellitus in pregnancy is associated with polyhydramnios, macrosomia, and shoulder dystocia, and it also increases maternal and perinatal mortality.

Methods

This sequential explanatory mixed-method study was conducted for six months. All the pregnant women attending the outpatient department of the Obstetrics and Gynaecology Department at 24-28 weeks of gestation were subjected to universal screening with 75 gms of glucose and 2 hours of plasma glucose >140 mgs% is taken for diagnosis (according to DIPSI guidelines). After diagnosis, they were subjected to an HbA1c test. Women with HbA1c is >6.5% were excluded from the study. If pregnant women are screened negative by the DIPSI test, the test was repeated in the third trimester (32-34 weeks of gestation). Chi-square tests were used to find out the test of association for quantitative data and manual content analysis was performed for qualitative data.

Results

DIPSI test was found to decrease the adverse maternal and neonatal outcome by early screening and management. The stakeholders' perspectives identified by key informant interview were improper knowledge and awareness about the testing and others were anxiety and fear associated with the testing procedure.

Conclusions

As DIPSI test is an effective single step in screening and diagnostic test, hence all pregnant mothers should undergo this glucose challenge test in their antenatal visits.

Adherence to plant-based diet during pregnancy and risk of gestational diabetes: a prospective birth cohort study

BACKGROUND

Studies have shown that plant-based foods have a protective effect against gestational diabetes (GDM). We examined the association between plant-based dietary patterns and the risk of GDM in a sample of Iranian adults.

METHODS

We enrolled 635 pregnant women for the present study. Dietary intakes were evaluated by using a 90-item food frequency questionnaire during the first trimester of pregnancy. Three plant-based including plant-based (PDI), unhealthy (uPDI) and healthy (hPDI) were calculated. Cox proportional hazard model were fitted to estimate hazard ratio (HR) and 95% confidence interval (CI) of GDM across categories of the plan-based dietary indices, while controlling for age, educational level, physical activity, family income, prepregnancy body mass index, gestational weight gain, and total energy intake.

RESULTS

A total of 635 mothers were included, of whom 79 participants were diagnosed with GDM. Those in the third tertile of the PDI (HR: 0.55, 95% CI: 0.30, 0.98) and hPDI (HR: 0.43, 95% CI: 0.24, 0.78) had a lower risk of developing GDM during their current pregnancy as compared to the first tertile. There was no association between uPDI and risk of GDM.

CONCLUSIONS

We found that higher adherence to a plant-based diet during early pregnancy may be associated with a lower GDM risk among Iranian women. Confirmation of this finding is necessary in larger cohort studies, taking into account other pregnancy outcomes such as birth weight.

Prevalence and factors associated with gestational diabetes mellitus in Malaysia: a population-based study comparing 2016 and 2022

BACKGROUND

Gestational diabetes mellitus (GDM) poses substantial health risks to both mothers and infants. Malaysia exhibits a heightened prevalence of GDM.

OBJECTIVE

This study aims to examine the changes in the prevalence of GDM between 2016 and 2022 and its determining factors.

METHODS

The data analysed in this study were derived from the National Health and Morbidity Survey (NHMS) 2016 and 2022, a nationwide study employing a two-stage stratified random sampling design in Malaysia. Changes in the prevalence were compared between data from NHMS 2016 and 2022, while factors were evaluated based on data from NHMS 2022. Descriptive statistics and multiple logistic regression analyses were performed using IBM SPSS version 27.

RESULTS

The prevalence of GDM increased from 12.5% in 2016 to 27.1% in 2022. In both years, the prevalence was highest among those aged 44-49 years, those of Indian ethnicity, those in higher income groups and those with higher education levels. Advanced maternal age, high body mass index (BMI) and hypertension were associated with a greater risk of GDM.

CONCLUSION

The prevalence of GDM among the Malaysian population doubled from 2016 to 2022. The findings underscore the importance of implementing targeted programs for expectant mothers in high-risk groups to mitigate the incidence of GDM and its associated morbidities.

Changes in the Epidemiological Landscape of Diabetes in South Korea: Trends in Prevalence, Incidence, and Healthcare Expenditures

Diabetes is a serious public health concern that significantly contributes to the global burden of disease. In Korea, the prevalence of diabetes is 12.5% among individuals aged 19 and older, and 14.8% among individuals aged 30 and older as of 2022. The total number of people with diabetes among those aged 19 and older is estimated to be 5.4 million. The incidence of diabetes decreased from 8.1 per 1,000 persons in 2006 to 6.3 per 1,000 persons in 2014, before rising again to 7.5 per 1,000 persons in 2019. Meanwhile, the incidence of type 1 diabetes increased significantly, from 1.1 per 100,000 persons in 1995 to 4.8 per 100,000 persons in 2016, with the prevalence reaching 41.0 per 100,000 persons in 2017. Additionally, the prevalence of gestational diabetes saw a substantial rise from 4.1% in 2007 to 22.3% in 2023. These changes have resulted in increases in the total medical costs for diabetes, covering both outpatient and inpatient services. Therefore, effective diabetes prevention strategies are urgently needed.

Analysis of Risk Factors Associated with Gestational Diabetes Mellitus: A Retrospective Case-Control Study

Objective

Gestational diabetes mellitus (GDM) is a complication of abnormal glucose tolerance during pregnancy, with incidence is on the rise. There are inconsistent results on the risks of GDM and it has not been reported in our region. The purpose of this study is to explore the risk factors of GDM.

Methods

A total of 383 pregnant women were analyzed, including 67 (17.5%) pregnant women with GDM and 316 (82.5%) with normal glucose tolerance (NGT). The relationship of personal history, family history and reproductive history of pregnant women, the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), inflammatory markers in blood cell analysis at the first prenatal examination, and fetal ultrasound indices and the risk of GDM were analyzed.

Results

The fetal biparietal diameter, head circumference, and femur length were negatively correlated with HCG level, but not inflammatory markers. The proportion of pregnant women aged ≥30 years old, body mass index (BMI) in early pregnancy≥24.0 kg/m2, history of polycystic ovary syndrome (PCOS), cesarean section, adverse pregnancy, and oral contraceptive use, and pregnant women who conceived through assisted reproduction in GDM group were higher than those in NGT group. Logistic regression analysis showed that age of pregnant woman ≥30 years old (≥30 vs <30 years old, odds ratio (OR): 2.142, 95% confidence interval (CI): 1.183-3.878, p=0.012), BMI≥24.0 kg/m2 (≥24.0 kg/m2 vs 18.5-23.9 kg/m2, OR: 1.887, 95% CI: 1.041-3.420, p=0.036), history of adverse pregnancy (yes vs no, OR: 1.969, 95% CI: 1.022-3.794, p=0.043), and history of oral contraceptive use (yes vs no, OR: 2.868, 95% CI: 1.046-7.863, p=0.041) were associated with GDM.

Conclusion

Age of pregnant woman ≥30 years old, BMI≥24.0 kg/m2, history of adverse pregnancy and oral contraceptive use were independent risk factors for GDM.

Outcome of Pregnancy Oral Glucose Tolerance Test and Preterm Birth

BACKGROUND

Gestational diabetes is associated with adverse outcomes such as preterm birth (<37 weeks). However, there is no international consensus on screening criteria or diagnostic levels for gestational diabetes, and it is unknown whether body mass index (BMI) or obesity modifies the relation between glucose level and preterm birth.

METHODS

We studied a pregnancy cohort restricted to two Danish regions from the linked Danish Medical Birth Register to study associations between glucose measurements from the 2-hour postload 75-g oral glucose tolerance test (one-step approach) and preterm birth from 2004 to 2018. In Denmark, gestational diabetes screening is a targeted strategy for mothers with identified risk factors. We used Poisson regression to estimate rate ratios (RR) of preterm birth with z-standardized glucose measurements. We assessed effect measure modification by stratifying analyses and testing for heterogeneity.

RESULTS

Among 11,337 pregnancies (6.2% delivered preterm), we observed an adjusted preterm birth RR of 1.2 (95% confidence interval [CI] = 1.1, 1.3) for a one-standard deviation glucose increase of 1.4 mmol/l from the mean of 6.7 mmol/l. There was evidence for effect measure modification by obesity, for example, adjusted RR for nonobese (BMI, <30): 1.2 (95% CI = 1.1, 1.3) versus obese (BMI, ≥30): 1.3 (95% CI = 1.2-1.5), P = 0.05 for heterogeneity.

CONCLUSION

Among mothers screened for gestational diabetes, increased glucose levels, even those below the diagnostic level for gestational diabetes in Denmark, were associated with increased preterm birth risk. Obesity (BMI, ≥30) may be an effect measure modifier, not just a confounder, of the relation between blood glucose and preterm birth risk.

Examining Cesarean Among Individuals of Advanced Maternal Age in Nurse-Midwifery Care

INTRODUCTION

Cesarean rates are rising, especially for individuals of advanced maternal age (AMA), defined as aged 35 or older. The Robson 10-Group Classification System (TGCS) facilitates assessment and comparison of cesarean rates among individuals in different settings. In midwifery-led care, in which pregnant people are typically healthier and seek a vaginal birth, it is unknown whether individuals of AMA have different antecedents leading to cesarean compared with younger counterparts. This study aimed to examine antecedents contributing to cesarean using Robson TGCS for individuals across age groups in midwifery care.

METHODS

This study was a secondary analysis of 2 cohort data sets from Oregon Health & Science University (OHSU) and University of Michigan Health Systems (UMHS) hospitals. The samples were individuals in midwifery-led care birthing at either OHSU from 2012 to 2019 or UMHS from 2007 to 2019.

RESULTS

A total of 11,951 individuals were studied. Overall cesarean rates were low; however, the rate for individuals of AMA was higher than the rate of their younger counterparts (18.30% vs 15.10%). The Robson groups were similar; however, the primary contributor among AMA individuals was group 5 (multiparous with previous cesarean), followed by group 2 [nulliparous with labor induced or prelabor cesarean], and group 1 [nulliparous with spontaneous labor]. In contrast, the primary contributors for younger individuals were groups 1, 2, and 5, respectively. In addition, prelabor cesarean and induced labor partly mediated the relationship between AMA and cesarean among nulliparous individuals, whereas prelabor cesarean was the key contributor to cesarean among multiparous people.

DISCUSSION

The cesarean rate in midwifery-led care was low. Using Robson TGCS provided additional insight into the antecedents to cesarean, rather than viewing cesarean as a single outcome. Future studies should continue to use Robson TGCS and investigate antecedents to cesarean, including factors influencing successful vaginal birth after cesarean in individuals of AMA.

Trends in the Incidence of Gestational Diabetes Mellitus Among the Medicaid Population Before and During the COVID-19 Pandemic

Importance: Although there are many regional and national studies on the trends in the incidence of gestational diabetes mellitus (GDM), the trends in the incidence of GDM among the Medicaid population are lacking, especially before and during coronavirus disease of 2019 (COVID-19). Objective: To investigate the trends in the incidence of GDM before and during COVID-19 pandemic (2016-2021) among the Louisiana Medicaid population. Design, Setting, and Participants: This study included 111,936, Louisiana Medicaid pregnant women of age 18-50 between January 1, 2016, to December 31, 2021. Main Outcomes and Measures: Pregnancies, GDM, and pre-pregnancy diabetes cases were identified by using the Tenth Revisions of the International Classification of Disease code. The annual incidence of GDM and annual prevalence of pre-pregnancy diabetes were calculated for each age and race subgroup. Results: The age-standardized incidence of GDM increased from 10.2% in 2016 to 14.8 in 2020 and decreased to 14.0% in 2021. The age-standardized prevalence of pre-pregnancy diabetes increased from 2.8% in 2016 to 3.4% in 2018 and decreased to 2.3% in 2021. The age-standardized rate of GDM was the highest among Asian women (23.0%), then White women (15.5%), and African American women (13.9%) (p for difference <0.001). The COVID-19 pandemic saw an increase in the incidence of GDM, with a rise in prominent GDM risk factors, such as obesity and sedentary behaviors, suggesting an association. Conclusion and Relevance: The incidence of GDM significantly increased during the COVID-19 pandemic. Potential reasons might include increased sedentary behavior and increased prevalence of obesity. GDM is a major public health issue, and the prevention of GDM is particularly essential for the Louisiana Medicaid population owing to the high prevalence of GDM-related risk factors in this population.

Uric acid and risk of gestational diabetes mellitus: an observational study and mendelian randomization analysis

OBJECTIVE

Our aim was to explore the relationship between serum uric acid (UA) levels in early pregnancy and the development of gestational diabetes mellitus (GDM), and to further explore whether there is a causal relationship.

METHODS

684 pregnant women with GDM and 1162 pregnant women without GDM participated in this study. 311 pregnant women with GDM and 311 matched controls were enrolled in a 1:1 case-control study. We used conditional logistic regression to explore the relationship between UA levels and the risk of developing GDM. The causal relationship between the two was examined by two-sample Mendelian randomization (MR) analysis.

RESULTS

In the 1:1 matched population, the odds ratio (OR) of developing GDM compared with the extreme tertiles of UA levels was 1.967 (95% confidence interval [CI]: 1.475-2.625; P < 0.001). Restricted cubic spline analyses showed a linear relationship between UA and GDM when UA exceeded 222 µmol/L. GDM and UA levels maintained a statistically significant positive correlation in different stratified regression analyses (P < 0.001). However, no evidence of a causal relationship between uric acid and GDM was found by MR analyses with an OR of 1.06 (95% CI: 0.91-1.25) per unit increase in UA.

CONCLUSION

There is a positive correlation between UA levels in early pregnancy and the subsequent risk of developing GDM. However, no genetic evidence was found to support a cause-effect relationship between UA and GDM.

Examining rurality and social determinants of health among women with GDM: a 15-year comprehensive population analysis

BACKGROUND

Gestational diabetes mellitus (GDM) is a common pregnancy complication with long-term health consequences for mothers and their children. The escalating trends of GDM coupled with the growing prevalence of maternal obesity, a significant GDM risk factor projected to approach nearly 60% by 2030 in Kansas, has emerged as a pressing public health issue.

METHODS

The aim of this study was to compare GDM and maternal obesity trends in rural and urban areas and investigate maternal demographic characteristics influencing the risk of GDM development over a 15-year period. Trend analyses and a binary logistic regression were employed utilizing 2005 to 2019 de-identified birth record vital statistics from the Kansas Department of Health and Environment (N = 589,605).

RESULTS

Over the cumulative 15-year period, a higher prevalence of GDM was observed across age, race/ethnicity, education, and insurance source. Throughout this period, there was an increasing trend in both GDM and obese pre-pregnancy BMI age-adjusted prevalence, with noticeable rural-urban disparities. From 2005 to 2019, women, including Asians (OR: 2.73, 95% CI 2.58%-2.88%), American Indian or Alaskan Natives (OR: 1.58, 95%, CI 1.44-1.73%), Hispanics (OR: 1.42, 95% CI 1.37%-1.48%), women residing in rural areas (OR: 1.09, 95%, CI 1.06-1.12%), with advanced maternal age (35-39 years, OR: 4.83 95% CI 4.47%-5.22%; ≥40 years, OR: 6.36 95%, CI 5.80-6.98%), with lower educational status (less than high school, OR: 1.15, 95% CI 1.10%-1.20%; high school graduate, OR: 1.10, 95% CI 1.06%-1.13%), Medicaid users (OR: 1.10, 95% CI 1.06%-1.13%), or with an overweight (OR: 1.78, 95% CI 1.72%-1.84%) or obese (OR: 3.61, 95% CI 3.50%-3.72%) pre-pregnancy BMI were found to be at an increased risk of developing GDM.

CONCLUSIONS

There are persistent rural-urban and racial/ethnic disparities present from 2005 to 2019 among pregnant women in Kansas with or at-risk of GDM. There are several socioeconomic factors that contribute to these health disparities affecting GDM development. These findings, alongside with prominent rising maternal obesity trends, highlight the need to expand GDM services in a predominantly rural state, and implement culturally-responsive interventions for at-risk women.

Improved Diabetes Screening for Women After Gestational Diabetes Mellitus

OBJECTIVE

This study aimed to assess the need for practice-wide quality improvement to support evidence-based type 2 diabetes screening for women with a history of gestational diabetes mellitus (GDM) receiving primary care. We sought to add the diagnosis of GDM to the problem list of women who did not have it at baseline.

RESEARCH DESIGN AND METHODS

We identified all women in our practice with a history of GDM diagnosed between 2002 and 2023, quantified the proportion with GDM documented in their problem list, and examined patient- and clinician-level factors associated with having GDM appropriately documented at baseline.

RESULTS

We identified 203 women with GDM receiving primary care within internal medicine. Of the 203 women, 73 (35.0%) did not have GDM documented in their problem list. Of those without GDM included on the problem list, 52% were overdue for type 2 diabetes screening compared with 41% of those with GDM documented before our intervention. We found race, parity, and previous abnormal glycemic laboratory test results to be highly predictive of whether the history of GDM was on patients' problem list. Upon completion of our intervention, we successfully achieved a 100% documentation rate for GDM diagnosis for women who previously lacked documentation in their problem list.

CONCLUSION

This work paves the way for targeted interventions aimed at improving care for women with a history of GDM, including delivery of interventions and education to prevent the onset of an appropriate clinical screening for type 2 diabetes.

Gestational Diabetes Prevalence Estimates from Three Data Sources, 2018

INTRODUCTION

We investigated 2018 gestational diabetes mellitus (GDM) prevalence estimates in three surveillance systems (National Vital Statistics System, State Inpatient Database, and Pregnancy Risk Assessment Monitoring Survey).

METHODS

We calculated GDM prevalence for jurisdictions represented in each system; a subset of data was analyzed for people 18-39 years old in 22 jurisdictions present in all three systems to observe dataset-specific demographics and GDM prevalence using comparable categories.

RESULTS

GDM prevalence estimates varied widely by data system and within the data subset despite comparable demographics.

DISCUSSION

Understanding the differences between GDM surveillance data systems can help researchers better identify people and places at higher risk of GDM.

Trends in gestational diabetes in Iceland before and after guideline changes in 2012: a nationwide study from 1997 to 2020

Internationally accepted diagnostic criteria recommendations for gestational diabetes (GDM) in 2010 resulted in a rise in global prevalence of GDM. Our aim was to describe the trends in GDM before and after Icelandic guideline changes in 2012 and the trends in pregestational diabetes (PGDM). The study included all singleton births (N = 101 093) in Iceland during 1997-2020. Modified Poisson regression models were used to estimate prevalence ratios (PRs) with 95% confidence intervals (CIs) for risk of GDM overall and by maternal age group, as well as overall risk of PGDM, according to time period of birth. The overall prevalence of GDM by time period of birth ranged from 0.6% (N = 101) in 1997-2000 to 16.2% (N = 2720) in 2017-2020, and the prevalence of PGDM ranged from 0.4% (N = 57) in 1997-2000 to 0.7% (N = 120) in 2017-2020. The overall relative GDM prevalence rate difference before and after 2012 was 380%, and the largest difference was found among women aged <25 years at 473%. Risk of GDM increased in 2017-2020 (PR 14.21, CI 11.45, 17.64) compared to 1997-2000 and was highest among women aged >34 years with PR 19.46 (CI 12.36, 30.63) in 2017-2020. Prevalence rates of GDM and PGDM increased during the study period. An accelerated rate of increase in GDM was found after 2012, overall, and among all maternal age groups. Women aged >34 years had the greatest risk of GDM throughout all time periods, while women aged <25 years appear to have a higher relative rate difference after 2012.

Parents' age and total fertility rate in selected high-income countries from Europe and North America, 1990-2020

OBJECTIVE

To provide a comprehensive picture of trends in parents' age and total fertility rate in selected most populous high-income countries from Europe and North America.

STUDY DESIGN

Data were retrieved from official statistics published by the United Nations, the World Bank, the European Union (EU), and by national health statistics offices.

RESULTS

Mean maternal age at birth showed increasing trends in all considered countries; in 2020, the highest mean age was observed in Italy (32.2) and Spain (32.3), and the lowest one in the USA (28.8). Mean maternal age at first birth also showed upward trends. In the 1990s, mean age at first birth ranged from 25.5 to 26.9 years, except for the USA where it was below 25 years. The countries with the highest average maternal age at first birth were Italy and Spain, reaching 31 years over the most recent years. Data on mean paternal age at birth were scant. In Germany (2019) it was 34.6 and in the USA (2014) 27.9 years. In Italy, mean paternal age increased from 34.2 in 2000 to 35.5 in 2018, in the UK from 30.7 in 1990 to 33.4 in 2017, and in Canada, a decrease was observed from 29.1 in 2006 to 28.3 in 2011. Finally, Sweden and the USA had the highest fertility rates, around two children in some years, while Italy and Spain had the lowest ones, with less than 1.5 children over the whole period.

CONCLUSIONS

Monitoring of trends in reproductive factors is crucial to gain insight into society from a cultural and sociological point of view and to analyze the impact of these changes on reproductive health and related conditions.

Epidemiology and management of gestational diabetes

Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.

Insulin Blood Levels in Gestational Diabetes Mellitus in Relation to Ethnicity and Age in the Kingdom of Bahrain: A Cross-Sectional Study

BACKGROUND

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It may be attributed to certain placental hormones during pregnancy which render insulin less effective. Our study aimed to focus on the levels of insulin in gestational diabetic women in the Kingdom of Bahrain as compared with non-diabetic pregnant women. Furthermore, we studied the correlation between insulin levels by ethnicity and age of the pregnant women.  Methods: A cross-sectional study was conducted on 75 pregnant participants: 41 with GDM (test group) and 34 without GDM (control group). Insulin levels were determined in patients with GDM and compared to non-diabetic pregnant women. A comparison between Bahraini and non-Bahraini women was carried out in two different age groups: below and above 30 years of age. P values < 0.05 were considered significant.

RESULTS

The results showed higher mean values of fasting blood glucose (FBG), random blood glucose (RBG), and insulin levels in the test group when compared to the control group. There was no significant difference in FBG, RBG, and insulin levels among Bahraini women with GDM and non-Bahraini women (Indian, Pakistani. Bengali, and Filipino) with GDM. Age, less than 30 vs more than 30 years, had no significant effect on women with GDM.

CONCLUSION

Insulin levels were higher in pregnant women with GDM irrespective of their ethnicity or age. The lack of blood glucose control in GDM even in the presence of high insulin secretion may suggest loss of insulin effectiveness due to other factors such as stress and lactogenic placental hormones.

Establishment of gestational diabetes risk prediction model and clinical verification

OBJECTIVE

The present study aimed to evaluate the risk factors for gestational diabetes mellitus (GDM) and build and validate an early risk prediction model of GDM by comparing the differences in the indicators of the first trimester of pregnancy between pregnant women with GDM and non-gestational diabetes mellitus (NGDM). Thus, this study provided a theoretical basis for early intervention of GDM.

METHODS

A total of 6000 pregnant women who underwent a routine prenatal examination in Qinhuangdao Maternal and Child Health Hospital (Qinhuangdao City, Hebei Province, China) from January 2016-2022 were retrospectively selected and randomly divided into a modeling cohort (4200 cases) and validation cohort (1800 cases) at a ratio of 3:7. According to the results of oral glucose tolerance test (OGTT), they were divided into NGDM and GDM groups. The modeling cohort consisted of 2975 NGDM and 1225 GDM cases, while the validation cohort consisted of 1281 NGDM and 519 GDM cases. The differences in general conditions and laboratory indicators between different groups were compared, and logistic regression analysis was further used to establish a risk prediction model for GDM in the first trimester. The receiver operating characteristic curve (ROC) and Hosmer-Lemeshow (HL) tests were used to evaluate the prediction of the model efficacy.

RESULTS

Age, pre-pregnancy body mass index (BMI), glycosylated hemoglobin (HbA1c), blood uric acid (UA), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) in the first trimester were independent risk factors for GDM (P < 0.05). The model equation was Y = 1/{1 + exp[- (- 18.373 + age × 0.065 + BMI × 0.030 + first-trimester HbA1c × 2.519 + UA × 0.014 + TG × 0.224-HDL-C × 0.635)]}. The area under the ROC curve (AUC) of the model cohort was 0.803 (0.788-0.817), the sensitivity was 72.0%, and the specificity was 73.5%. The AUC of the validation cohort was 0.782 (0.759-0.806), the sensitivity was 68.6%, and the specificity was 73.8%. The P values of the HL test in both the training and validation sets were > 0.05, indicating a satisfactory model fit.

CONCLUSION

Age, pre-pregnancy BMI, HbA1C in early pregnancy, blood UA, TG, and HDL-C are independent risk factors for GDM. The risk prediction model established by combining age, pre-pregnancy BMI, and laboratory indicators in the first trimester can provide a theoretical basis for early screening, monitoring, and intervention of GDM high-risk pregnant women.

Maternal diabetes and risk of attention-deficit/hyperactivity disorder in offspring in a multinational cohort of 3.6 million mother-child pairs

Previous studies report an association between maternal diabetes mellitus (MDM) and attention-deficit/hyperactivity disorder (ADHD), often overlooking unmeasured confounders such as shared genetics and environmental factors. We therefore conducted a multinational cohort study with linked mother-child pairs data in Hong Kong, New Zealand, Taiwan, Finland, Iceland, Norway and Sweden to evaluate associations between different MDM (any MDM, gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM)) and ADHD using Cox proportional hazards regression. We included over 3.6 million mother-child pairs between 2001 and 2014 with follow-up until 2020. Children who were born to mothers with any type of diabetes during pregnancy had a higher risk of ADHD than unexposed children (pooled hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 1.08-1.24). Higher risks of ADHD were also observed for both GDM (pooled HR = 1.10, 95% CI = 1.04-1.17) and PGDM (pooled HR = 1.39, 95% CI = 1.25-1.55). However, siblings with discordant exposure to GDM in pregnancy had similar risks of ADHD (pooled HR = 1.05, 95% CI = 0.94-1.17), suggesting potential confounding by unmeasured, shared familial factors. Our findings indicate that there is a small-to-moderate association between MDM and ADHD, whereas the association between GDM and ADHD is unlikely to be causal. This finding contrast with previous studies, which reported substantially higher risk estimates, and underscores the need to reevaluate the precise roles of hyperglycemia and genetic factors in the relationship between MDM and ADHD.

The effect of per and polyfluoroalkyl substance (PFAS) exposure on gestational diabetes mellitus and its subclinical risk factors: A systematic review and meta-analysis protocol

BACKGROUND

Multiple lines of evidence suggest that exposure to per- and polyfluoroalkyl substances (PFAS) may alter glucose homeostasis, particularly during pregnancy, and may affect risk for developing gestational diabetes mellitus (GDM). While previous systematic reviews have been conducted on this topic, they did not assess internal validity of the included studies and their search strategies were narrowly focused.

OBJECTIVE

The objective of this study is to assess the effect of higher PFAS exposure (defined by individual compounds or mixtures measured before or during pregnancy) on GDM and subclinical measures of impaired glucose homeostasis (measured during pregnancy) compared to lower PFAS exposure in pregnant.

METHODS

We developed our systematic review protocol in accordance with the Navigation Guide. Peer-reviewed journal and grey literature searches were piloted in to identify relevant studies and refine our search terms and strategy. We also piloted the study screening criteria and data extraction form in DistillerSR, and refined our protocol accordingly. The risk of bias assessment protocol was adapted from Navigation Guide guidance and will be piloted and performed in DistillerSR. Pending the identification of comparable studies, quantitative meta-analyses will be performed where possible. Study results that cannot be quantitatively synthesized will be included in a narrative synthesis. The quality and strength of the body of evidence will be evaluated using Navigation Guide methodology, which is informed by guidance from the Cochrane Collaboration and Grading of Recommendations Assessment, Development and Evaluation (GRADE). We also made refinements to the quality of evidence considerations based on guidance from the National Institute of Environmental Health Sciences (NIEHS) Office of Health Assessment and Translation (OHAT).

FUNDING

This work was supported by the Systematizing Data on Per- and Polyfluoroalkyl Substances and Health Northeastern University TIER 1 Award.

Prevalence and Risk Factors of Confirmed Gestational Diabetes Mellitus Among Pregnant Women With Prior Positive Screening: A Case-Control Study

BACKGROUND

 Saudi Arabia has a higher rate of gestational diabetes mellitus (GDM) than most other countries. There is a paucity of data on the risk factors for GDM, particularly positive screening for diabetes in the initial period of pregnancy.

OBJECTIVES

 The aim of this study was to determine the prevalence of confirmed GDM in pregnant women who initially screened positive for GDM, as well as to identify its association with age, nationality, and clinical risk factors.

PATIENTS AND METHODS

 This case-control study was conducted retrospectively at a tertiary referral center in Jeddah, Saudi Arabia. It included pregnant women who were referred between January 2019 and December 2022 after having tested positive on a 50 g oral glucose tolerance test (OGTT). They subsequently underwent a 75 g or 100 g confirmatory OGTT at our center. The sociodemographic and clinical characteristics of those with confirmed GDM (cases) and those with negative confirmatory OGTT (controls) were compared.

RESULTS

 The majority of participants (75.4%) had confirmed GDM. However, there were no significant differences between cases and controls with regard to age, nationality, or clinical or pregnancy-related factors. Of note, the cohort was characterized by high gravidity and high parity, which may indicate susceptibility to GDM.

CONCLUSION

 The study findings support the usefulness of the 50 g OGTT for the screening of pregnant women at high risk for GDM. In addition, high gravidity and parity may also be risk factors for GDM, warranting closer monitoring for GDM and further research in a high-natality population such as that of Saudi Arabia.

The environmental risk factors associated with fetal macrosomia: An umbrella review

The present umbrella review evaluated the environmental risk factors prior to conception associated with fetal macrosomia based on meta-analyses and systematic reviews. We systematically searched international databases, including PubMed, Scopus, and Web of Science, until April 2023 by using some relevant keywords. The quality of the included studies was assessed using the AMSTAR 2checklist. The risk factor of advanced maternal age 35-39 years compared with <30 years (OR 1·42, 95 % CI: 1·25, 1·60), prepregnancy obesity (OR 1.93, 95 % CI: 1.65, 2.27) and excessive weight gain before and during pregnancy (OR 2.35, 95 % CI: 1.95, 2.85) were graded as suggestive evidence (class III). Two risk factors of advanced maternal age >40 years compared with <30 years (OR 1.40, 95 % CI: 1.02, 1.78) and gestational diabetes mellitus (GDM) without insulin use (OR 1.70, 95 % CI: 1.23, 2.36) were graded as risk factors with weak evidence (class IV). Advanced maternal age, prepregnancy obesity, excessive weight gain before and during pregnancy, and GDM without insulin use were environmental risk factors for macrosomia.

The application of plasma circRAD18 in the prediction of gestational diabetes mellitus (GDM) and its adverse effects

BACKGROUND

In cancer biology, circRAD18 promotes glucose metabolism, potentially indicating its involvement in glucose metabolism-related disorders, such as gestational diabetes mellitus (GDM). The present study investigated the predictive role of circRAD18 in GDM and its potential adverse effects.

METHODS

A total of 482 women who intended to get pregnant in short-term were enrolled. For those who successfully conceived, plasma samples were collected and followed up until delivery to monitor the occurrence of GDM and its associated adverse events. The accumulation of circRAD18 in plasma was analyzed using RT-qPCR. GDM-free curves and ROC curves were plotted to assess the predictive value of plasma circRAD18 for GDM.

RESULTS

After admitting 482 female patients, 388 of them achieved pregnancy within half a year. During the follow-up period, 52 cases were diagnosed with GDM. Compared to non-GDM group (n = 336), the GDM group (n = 52) had a lower accumulation level of circRAD18 on the day of pregnancy confirmation. In addition, low levels of circRAD18 accumulation on that day distinguished potential GDM patients from non-GDM cases. The 388 cases were divided into high and low circRAD18 level groups (n = 194). GDM-free curve analysis showed that patients in the low circRAD18 level group had a higher incidence of GDM compared to the high level group (43/194 vs. 9/194). A close association was found between low levels of plasma circRAD18 and hypertension, but not premature delivery, intrauterine death, malformation, intrauterine infection, miscarriage, macrosomia or intrauterine distress.

CONCLUSION

The reduction in the accumulation of plasma circRAD18 is predictive of GDM and hypertension in pregnant women.

Associations between diet quality and dietary patterns and gestational diabetes mellitus in a low-risk cohort of pregnant women in Australia: a cross-sectional study

INTRODUCTION

Evidence of associations between the Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) score and gestational diabetes mellitus (GDM) in pregnant women is limited. This study examined changes in MDS and DASH and dietary patterns in Australian pregnant women between early and late pregnancy and their associations with GDM.

METHODS

The data from n = 284 participants were analysed. Diet quality indices and empirical dietary patterns were determined in early (15 ± 3 weeks gestation) and late pregnancy (35 ± 2 weeks gestation). Paired t-tests were used to examine changes in scores for diet quality indices and dietary patterns from early to late pregnancy. Logistic regression analysis was used to examine associations between GDM, diet quality indices and dietary patterns.

RESULTS

Three major dietary patterns were identified at early pregnancy. The first and second dietary patterns included unhealthier and healthier food groups, respectively, and the third comprised mixed food groups. Although diet quality scores did not change over time, consumption of the first dietary pattern increased (p = 0.01), and consumption of the second dietary pattern decreased by late pregnancy in women without GDM (p < 0.001).

CONCLUSION

No associations between DASH score, MDS and GDM were found; however an inverse association was observed between the first dietary pattern and GDM in late pregnancy (p = 0.023). Longitudinal studies are needed to examine diet quality and dietary patterns at early and late pregnancy to inform the development of tailored dietary advice for GDM.

Trends in the prevalence of gestational diabetes in Catalonia from 2010 to 2019

INTRODUCTION

Gestational diabetes mellitus (GDM) is globally increasing due to changes in risk factors such as gestational age, obesity, and socioeconomic status (SES). This study examined trends of GDM prevalence over ten years using a real-world Primary Health Care database from Catalonia (Spain).

METHODS

A retrospective analysis of pregnant women screened for GDM was conducted, using clinical and SES data from the SIDIAP database.

RESULTS

Among 221,806 women studied from 2010 to 2019,17,587 had GDM, equating to a 7.9% prevalence (95% CI 7.8-8.04). GDM subjects were older (33.5 ± 5.1 vs. 31.2 ± 5.6 years; p < 0.001) and had higher BMI (29.2 ± 5.1 vs .27.8 ± 4.8 kg/m²; p < 0.001) than non-GDM individuals. Overall GDM prevalence remained unchanged throughout the study, although an increase was observed in younger women (below 20 years: 1.28% [95% CI 0.59-2.42] in 2010 to 2.22% [95% CI 0.96-4.33] in 2019, p = 0.02; ages 20-25.9 years: 3.62% [95% CI 3.12-4.17] in 2010 to 4.63% [95% CI 3.88-5.48)] in 2019, p = 0.02). Age, BMI ≥ 25 kg/m2, deprived SES, and previous hypertension and dyslipidaemia were positively associated with GDM.

CONCLUSIONS

This study offers insights into GDM prevalence in Catalonia (Spain),showing overall stability except for a rising trend among younger women.

The effect of gestational diabetes mellitus on pregnancy outcomes in advanced primiparous women: A retrospective study

Gestational diabetes mellitus (GDM) could have a variable degree of adverse effects on pregnancy outcomes for both pregnant women and newborns. The purpose of the study was to explore the effect of GDM on pregnancy outcomes in advanced primiparous women. A total of 1076 advanced primiparous women were included between January 2020 and December 2022. All these women were divided into the GDM group (n = 434) and the non-GDM group (n = 642). Variables included baseline characteristics, maternal, and newborn outcomes were collected. The risk of each adverse outcome was analyzed by multivariate logistic regression models. The effect of blood glucose control on pregnancy outcomes was further analyzed among GDM women with good glycaemic control (n = 381) and poor glycaemic control (n = 53). Analysis of baseline characteristics demonstrated a significant difference in prepregnancy body mass index (median, IQR: 22.27 [20.58-24.44] vs 21.17 [19.53-22.86], P < .01) between the GDM group and the non-GDM group. A significantly higher incidence rate of adverse pregnancy outcomes was found in advanced primiparous women with GDM, such as polyhydramniosis, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission (all P < .05). Compared with the non-GDM group, the risk of polyhydramniosis was nearly twice as high in the GDM group (adjusted odds ratio: 1.94, 95% confidence interval: 1.01-3.72, P = .04) after adjusted baseline characteristics. Among the GDM group, the women with poor glycaemic control showed a significantly higher incidence rate of polyhydramnios, hypertensive disorders of pregnancy, cesarean delivery, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission was significant than the women with good glycaemic control (all P < .05). GDM was an independent risk factor for polyhydramnios in advanced primiparous women. At the same time, good glycaemic control in diabetics advanced primiparous women could reduce adverse pregnancy outcomes.

Missed Diagnosis of Gestational Diabetes Mellitus Due to Selective Screening: Evidence from a Cross-Sectional Study in the West Nile Sub-Region, Uganda

Purpose

To ascertain the prevalence and risk factors of gestational diabetes mellitus (GDM) in pregnant women receiving antenatal care (ANC) services within the West Nile subregion of Uganda.

Patients and Methods

An analytical cross-sectional study was conducted on 233 pregnant women who are within 24-28 weeks of gestation and are receiving ANC services in selected hospitals. GDM was diagnosed according to the World Health Organization (WHO) criteria (2013). A questionnaire and anthropometric measurements were used to obtain relevant data. The chi-square test and logistic regression were used to determine the association between GDM and the study variables, including participants' sociodemographic and medical characteristics.

Results

The prevalence of hyperglycemia first detected in pregnancy among the participants tested was 8%. Overall, 7.45% had GDM and 0.53% had diabetes mellitus in pregnancy. The fasting plasma glucose test alone was positive in 86.7% of the GDM cases. The factors that were significantly associated with GDM included age ≥25 years (p = 0.017, AOR = 3.51) and body mass index (BMI) ≥25 kg/m2 (p = 0.024, AOR = 2.67). Out of the participants diagnosed with GDM, 28.6% did not have a known risk factor. Of the pregnant women with GDM, 57% would have been missed if the selective screening in the national clinical guidelines had been followed. Urinary tract infection (UTI) and Candida were detected in 36.36% and 13.85% of the participants, respectively.

Conclusion

The study provides new data on the prevalence of GDM in rural settings in the West Nile subregion of Uganda. Of the participants, 7.5% were diagnosed with GDM, of which 57% would have been missed based on the selective screening of the national clinical guidelines. The study findings support the universal screening of GDM in pregnant women.

Synergistic effect between pre-pregnancy smoking and assisted reproductive technology on gestational diabetes mellitus in twin pregnancies

AIM

Women with twin pregnancies have an increased risk of gestational diabetes mellitus (GDM). Assisted reproductive technology (ART) and pre-pregnancy smoking were both associated with GDM. However, the relationships between pre-pregnancy smoking and ART and GDM in twin pregnancies were unclear. Herein, this study aims to explore the roles of pre-pregnancy smoking and ART in GDM among women with twin pregnancies.

METHODS

Data of women with twin pregnancies were extracted from the National Vital Statistics System (NVSS) database in 2016-2020 in this retrospective cohort study. Univariate and multivariate logistic regression analyses were used to explore the associations between pre-pregnancy smoking and ART and GDM in women with twin pregnancies. The evaluation index was odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analysis of age and BMI was also performed.

RESULTS

A total of 19,860 (9.15%) women had GDM in our study. After adjusting for covariates, we found that receiving ART was associated with high odds of GDM [OR = 1.41, 95% CI (1.34-1.48)], while pre-pregnancy smoking combined with ART was associated with higher odds of GDM [OR = 1.66, 95% CI (1.14-2.42)]. In addition, these relationships were also found in women who aged ≥ 35 years old [OR = 1.98, 95% CI (1.14-3.44)] and with BMI ≥ 25 kg/m2 [OR = 1.69, 95% CI (1.11-2.55)].

CONCLUSION

Pre-pregnancy smoking may further increase the risk of GDM from ART in women with twin pregnancies. In clinical, women who are ready to receive ART treatment are recommend to quit smoking, which may reduce the risk of GDM and prevent adverse pregnancy outcomes.

The relation of dietary protein intake before and during the pregnancy with gestational diabetes mellitus (GDM): A GRADE-assessed systematic review and dose-response meta-analysis of epidemiologic studies

BACKGROUND

Although previous studies investigated the relation of protein intake and gestational diabetes mellitus (GDM), their findings were controversial. Therefore, we aimed to summarize this association, through a comprehensive systematic review and dose-response meta-analysis.

METHODS

Electronic databases including MEDLINE (PubMed), ISI Web of Science, Scopus and motor engineering of Google Scholar were systematically searched up to April 2023. Observational studies which investigated odds of GDM in relation to protein intake were included.

RESULTS

A total of 31,005 participants with 3451 cases of GDM from 13 eligible investigations were included in the systematic review and meta-analysis. Comparing the highest and lowest intakes of total, animal, and plant proteins revealed the summary RRs of 1.82 (95% CI: 1.42, 2.33), 1.79 (95% CI: 1.50, 2.14), and 0.98 (95% CI: 0.81, 1.20), respectively, indicating a significant positive association between total and animal protein intake and GDM. In the dose-response analyses, each 5% increment in energy intake from total protein during pregnancy was related to 20% increased odds of GDM (RR = 1.20; 95% CI: 1.09, 1.33). In the non-linear dose-response analyses, we found a non-linear association for animal protein intake during pregnancy (P for non-linearity <0.001); so that, a risk increase was seen from zero to 10% of energy intake from animal proteins, however, a risk reduction was seen after 10% of energy intake. However, there was not any significant non-linear trend between plant protein intake during pregnancy and risk of GDM. Based on the GRADE assessment, the quality of evidence for total, animal and plant protein was rated as "moderate", "moderate" and "very low", respectively.

CONCLUSION

We found a significant positive association between total protein intake and GDM; however, the associations of animal and plant protein intake with GDM were dose-dependent.

The COVID-19 pandemic and its impact on the development of gestational diabetes mellitus (GDM) in West Virginia

OBJECTIVE

To examine the rate of gestational diabetes mellitus (GDM) prevalence before and during the COVID-19 pandemic.

RESULTS

Analysis revealed that GDM prevalence was significantly higher during the COVID-19 pandemic compared to pre-pandemic (8.59 % vs 7.77 %). The risk of GDM was 12 % higher during the pandemic vs. pre-pandemic (aRR = 1.12, 95 % CI 1.06, 1.19) and the aRD = 0.95 % (95 % CI 0.56 %, 1.33 %) adjusting for maternal age and substance use in pregnancy.

CONCLUSIONS

GDM rates in WV increased from the period directly before the COVID-19 pandemic to during the COVID-19 pandemic. More research is needed to understand the pathophysiological mechanisms of pandemics and pandemic-related risk factors for this observed association. Supporting pregnant individuals during such events is critical to both maternal and child health.

Risk of adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus by age: a multicentric cohort study in Hebei, China

Gestational diabetes mellitus (GDM) is an unique metabolic disorder that occurs during pregnancy. Both GDM and advanced age increase the risk of adverse pregnancy outcomes. This study used a GDM cohort study to investigate the role of age in the adverse pregnancy outcomes for pregnant women with GDM. From 2015 to 2021, 308,175 pregnant women were selected, and the data received from 22 hospitals by the Hebei Province Maternal Near Miss Surveillance System. There were 24,551 pregnant women with GDM that were divided into five groups by age (20-24, 25-29, 30-34, 35-39, 40-44 years old). Because the prevalence of adverse pregnancy outcomes was lower in pregnant women with GDM aged 25-29, they were used as a reference group (P < 0.05). Compared with GDM women aged 25-29 years, GDM women aged 35-44 years had a significant higher risk of cesarean delivery (aOR: 2.86, 95% CI 2.52-3.25) (P < 0.001), abnormal fetal position (aOR: 1.78, 95% CI 1.31-2.37) (P < 0.001), pre-eclampsia (aOR: 1.28, 95% CI 1.01-1.61) (P < 0.05), macrosomia (aOR: 1.25, 95% CI 1.08-1.45) (P < 0.05), and large for gestational age (LGA) (aOR: 1.16, 95% CI 1.02-1.31) (P < 0.05), GDM women aged 40-44 years had a higher risk of placenta previa (aOR: 2.53, 95% CI 1.01-6.35) (P < 0.05), anemia (aOR: 3.45, 95% CI 1.23-9.68) (P < 0.05) and small for gestational age (aOR: 1.32, 95% CI 1.01-1.60) (P < 0.05). Advanced maternal age was an independent risk factor for abnormal fetal position, pre-eclampsia, anemia, macrosomia, and LGA in pregnant women with GDM.

Using individual approach to examine the association between urban heat island and preterm birth: A nationwide cohort study in China

BACKGROUND

Evidence suggests that maternal exposure to heat might increase the risk of preterm birth (PTB), but no study has investigated the effect from urban heat island (UHI) at individual level.

AIMS

Our study aimed to investigate the association between individual UHI exposure and PTB.

METHODS

We utilized data from the ongoing China Birth Cohort Study (CBCS), encompassing 103,040 birth records up to December 2020. UHI exposure was estimated for each participant using a novel individual assessment method based on temperature data and satellite-derived land cover data. We used generalized linear mixed-effects models to estimate the association between UHI exposure and PTB, adjusting for potential confounders including maternal characteristics and environmental factors.

RESULTS

Consistent and statistically significant associations between UHI exposure and PTB were observed up to 21 days before birth. A 5 °C increment in UHI exposure was associated with 27 % higher risk (OR = 1.27, 95 % confident interval: 1.20, 1.34) of preterm birth in lagged day 1. Stratified analysis indicated that the associations were more pronounced in participants who were older, had higher pre-pregnancy body mass index level, of higher socioeconomic status and living in greener areas.

CONCLUSION

Maternal exposure to UHI was associated with increased risk of PTB. These findings have implications for developing targeted interventions for susceptible subgroups of pregnant women. More research is needed to validate our findings of increased risk of preterm birth due to UHI exposure among pregnant women.

Rural-urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross-sectional analysis of over 12 million pregnancies

OBJECTIVE

To compare trends in pregestational (DM) and gestational diabetes (GDM) in pregnancy in rural and urban areas in the USA, because pregnant women living in rural areas face unique challenges that contribute to rural-urban disparities in adverse pregnancy outcomes.

DESIGN

Serial, cross-sectional analysis.

SETTING

US National Center for Health Statistics (NCHS) Natality Files from 2011 to 2019.

POPULATION

A total of 12 401 888 singleton live births to nulliparous women aged 15-44 years.

METHODS

We calculated the frequency (95% confidence interval [CI]) per 1000 live births, the mean annual percentage change (APC), and unadjusted and age-adjusted rate ratios (aRR) of DM and GDM in rural compared with urban maternal residence (reference) per the NCHS Urban-Rural Classification Scheme overall, and by delivery year, reported race and ethnicity, and US region (effect measure modification).

MAIN OUTCOME MEASURES

The outcomes (modelled separately) were diagnoses of DM and GDM.

RESULTS

From 2011 to 2019, there were increases in both the frequency (per 1000 live births; mean APC, 95% CI per year) of DM and GDM in rural areas (DM: 7.6 to 10.4 per 1000 live births; APC 2.8%, 95% CI 2.2%-3.4%; and GDM: 41.4 to 58.7 per 1000 live births; APC 3.1%, 95% CI 2.6%-3.6%) and urban areas (DM: 6.1 to 8.4 per 1000 live births; APC 3.3%, 95% CI 2.2%-4.4%; and GDM: 40.8 to 61.2 per 1000 live births; APC 3.9%, 95% CI 3.3%-4.6%). Individuals living in rural areas were at higher risk of DM (aRR 1.48, 95% CI 1.45%-1.51%) and GDM versus those in urban areas (aRR 1.17, 95% CI 1.16%-1.18%). The increased risk was similar each year for DM (interaction p = 0.8), but widened over time for GDM (interaction p < 0.01). The rural-urban disparity for DM was wider for individuals who identified as Hispanic race/ethnicity and in the South and West (interaction p < 0.01 for all); and for GDM the rural-urban disparity was generally wider for similar factors (i.e. Hispanic race/ethnicity, and in the South; interaction p < 0.05 for all).

CONCLUSIONS

The frequency of DM and GDM increased in both rural and urban areas of the USA from 2011 to 2019 among nulliparous pregnant women. Significant rural-urban disparities existed for DM and GDM, and increased over time for GDM. These rural-urban disparities were generally worse among those of Hispanic race/ethnicity and in women who lived in the South. These findings have implications for delivering equitable diabetes care in pregnancy in rural US communities.

Prediction of Gestational Diabetes Mellitus in the First Trimester of Pregnancy Based on Maternal Variables and Pregnancy Biomarkers

Gestational diabetes mellitus (GDM) is a significant health concern with adverse outcomes for both pregnant women and their offspring. Recognizing the need for early intervention, this study aimed to develop an early prediction model for GDM risk assessment during the first trimester. Utilizing a prospective cohort of 4917 pregnant women from the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, the study sought to combine maternal characteristics, obstetric and medical history, and early pregnancy-specific biomarker concentrations into a predictive tool. The primary objective was to create a series of predictive models that could accurately identify women at high risk for developing GDM, thereby facilitating early and targeted interventions. To this end, maternal age, body mass index (BMI), obstetric and medical history, and biomarker concentrations were analyzed and incorporated into five distinct prediction models. The study's findings revealed that the models varied in effectiveness, with the most comprehensive model combining maternal characteristics, obstetric and medical history, and biomarkers showing the highest potential for early GDM prediction. The current research provides a foundation for future studies to refine and expand upon the predictive models, aiming for even earlier and more accurate detection methods.

Blood manganese level and gestational diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

Previous studies evaluating the relationship between blood manganese (Mn) level and gestational diabetes mellitus (GDM) in pregnant women showed inconsistent results. A systematic review and meta-analysis was therefore performed to investigate the above association.

METHODS

Relevant observational studies were obtained by search of electronic databases including Medline, Embase, Cochrane Library and Web of Science from database inception to 10 March 2023. Two authors independently performed database search, literature identification and data extraction. A randomised-effects model was selected to pool the data by incorporating the influence of potential heterogeneity. Subgroup analysis was performed to evaluate the influence of study characteristics on the results of the meta-analysis.

RESULTS

Six datasets from five observational studies, involving 91,249 pregnant women were included in the meta-analysis. Among the participants, 3597 (3.9%) were diagnosed as GDM. Overall, pooled results showed that a high blood level of Mn was associated with a higher risk of GDM (compared between women with highest versus lowest category blood Mn, odds ratio: 1.31, 95% confidence interval: 1.19-1.44, p < .001) with no significant heterogeneity (p for Cochrane Q-test = 0.93, I2 = 0%). Subgroup analyses according to study design, mean maternal age, matrix or methods for measuring blood Mn, and the incidence of GDM also showed consistent results (p for subgroup difference all >.05).

CONCLUSIONS

Results of the meta-analysis suggest that a high blood Mn level may be a risk factor of GDM in pregnant women. Studies are needed to determine the underlying mechanisms, and to investigate if the relationship between blood Mn level and GDM is dose-dependent.

Advanced maternal age leads to changes within the insulin/IGF system and lipid metabolism in the reproductive tract and preimplantation embryo: insights from the rabbit model

Reproductive potential in women declines with age. The impact of ageing on embryo-maternal interactions is still unclear. Rabbits were used as a reproductive model to investigate maternal age-related alterations in reproductive organs and embryos on Day 6 of pregnancy. Blood, ovaries, endometrium, and blastocysts from young (16-20 weeks) and advanced maternal age phase (>108 weeks, old) rabbits were analysed at the mRNA and protein levels to investigate the insulin-like growth factor (IGF) system, lipid metabolism, and stress defence system. Older rabbits had lower numbers of embryos at Day 6 of pregnancy. Plasma insulin and IGF levels were reduced, which was accompanied by paracrine regulation of IGFs and their receptors in ovaries and endometrium. Embryos adapted to hormonal changes as indicated by reduced embryonic IGF1 and 2 levels. Aged reproductive organs increased energy generation from the degradation of fatty acids, leading to higher oxidative stress. Stress markers, including catalase, superoxide dismutase 2, and receptor for advanced glycation end products were elevated in ovaries and endometrium from aged rabbits. Embryonic fatty acid uptake and β-oxidation were increased in both embryonic compartments (embryoblast and trophoblast) in old rabbits, associated with minor changes in the oxidative and glycative stress defence systems. In summary, the insulin/IGF system, lipid metabolism, and stress defence were dysregulated in reproductive tissues of older rabbits, which is consistent with changes in embryonic metabolism and stress defence. These data highlight the crucial influence of maternal age on uterine adaptability and embryo development.

The yield of early-pregnancy homeostasis of model assessment -insulin resistance (HOMA-IR) for predicting gestational diabetes mellitus in different body mass index and age groups

BACKGROUND

Early prediction of gestational diabetes mellitus(GDM) can be beneficial for lifestyle modifications to prevent GDM. The aim of this study was to investigate the predictive values of Homeostasis of Model Assessment -Insulin Resistance (HOMA-IR) in early pregnancy to predict GDM development in different body mass index (BMI) and age risk categories.

MATERIALS AND METHODS

This study is part of the Qazvin Maternal and Neonatal Metabolic Study (QMNMS) in Iran (2018-2021). In this prospective longitudinal study, pregnant women with a gestational age ≤ 14 weeks were enrolled in the study using convenience sampling method and were followed up until delivery to investigate risk factors for maternal and neonatal complications. Data collection was done using questionnaires. Serum sampling was done at a gestational age ≤ 14 weeks and sera were frozen until the end of study. GDM was diagnosed at 24-28 weeks of pregnancy using 75gr oral glucose tolerance test. Fasting blood glucose and insulin were measured in sera taken during early pregnancy in 583 participants. The Mann-Whitney U test, independent t-test, and Chi-square test were used for comparing variables between groups. The logistic regression analysis was used to examine the independent association of HOMA-IR with GDM development and receiver operating characteristic analysis was used for finding the best cut-off of HOMA-IR for predicting GDM.

RESULTS

GDM was developed in 90 (15.4%) of the participants. The third HOMA-IR tertile was independently associated with 3.2 times higher GDM occurrence (95% CI:1.6-6.2, P = 0.001). Despite the high prevalence of GDM in advanced maternal age (GDM rate = 28.4%), HOMA-IR had no association with GDM occurrence in this high-risk group. In both normal BMI and overweight/obese groups, HOMA-IR was a moderate predictor of GDM development (AUC = 0.638, P = 0.005 and AUC = 0.622, P = 0.008, respectively). However, the best cut-off for predicting GDM was 2.06 (sensitivity 67.5%, specificity 61.1%) in normal BMI and 3.13 (sensitivity 64.6%, specificity61.8%) in overweight/obese BMI.

CONCLUSION

The present study revealed the necessity of considering the BMI and age risk groups when using the HOMA-IR index to predict GDM. Using lower cut-offs is more accurate for women with a normal BMI. In the advanced maternal age, there is no yield of HOMA-IR for predicting GDM.

The CHANGED Score-A New Tool for the Prediction of Insulin Dependency in Gestational Diabetes

Gestational diabetes (GDM) is a frequent complication during pregnancy. We aimed to develop a score to predict future insulin dependency in gestational diabetes (GDM). Data from 1611 patients from Charité Berlins gestational diabetes clinic from 2015 to 2022 were utilized. A stepwise backwards regression, including patient characteristics obtained at the initial presentation, was performed. Predictors examined included age, fasting blood glucose level, blood glucose levels one and two hours after oral glucose tolerance test, pre-pregnancy BMI, number of previous pregnancies and births, and fetal sex. The ideal cutoff value between high and low risk for insulin dependency was assessed and the score was internally validated. There were 1249 (77.5%) women diagnosed with dietary GDM and 362 (22.5%) were diagnosed with insulin-dependent GDM. The CHarité AssessmeNt of GEstational Diabetes (CHANGED) Score achieved an area under the curve of 0.77 (95% confidence interval 0.75-0.80; 0.75 in internal validation). The optimal cutoff value was calculated at a score value of 9 (72% sensitivity, 69% specificity). We developed an easily applicable tool to accurately predict insulin dependency in gestational diabetes. The CHANGED Score is routinely available and can potentially improve maternal and fetal outcomes.