Gestational diabetes mellitus increased the risk of adverse neonatal outcomes: A prospective cohort study in Northwest Ethiopia

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.

Association of maternal dietary cholesterol intake during the second and third trimesters of pregnancy and blood glucose and pregnancy outcome in women with gestational diabetes mellitus: a prospective cohort study

Background

Cholesterol is essential for pregnant women to maintain maternal health and fetal support development. This study aimed to assess the cholesterol intake of women with gestational diabetes mellitus (GDM) during the second and third trimesters of pregnancy and to explore its effects on blood glucose and pregnancy outcomes.

Methods

This prospective cohort study collected dietary data using a food frequency questionnaire (FFQ) administered during the 24-30 gestational weeks (first survey) and the 34-42 gestational weeks (second survey). Blood glucose parameters and pregnancy outcomes were obtained from electronic medical records. Participants were divided into two groups according to the median cholesterol intake: low and high cholesterol intake groups.

Results

GDM women generally consumed high levels of cholesterol during pregnancy, with intake increasing in the third trimester compared to the second trimester. Compared to women with high cholesterol intake, GDM women with low cholesterol intake had a higher risk of abnormal hemoglobin A1C (HbA1C) during the second trimester [OR 26.014 (95% CI 2.616-258.727)] and the third trimester [OR 2.773 (95% CI 1.028-7.482)], as well as abnormal fasting blood glucose during the third trimester [OR 2.907 (95% CI 1.011-8.360)]. Furthermore, in the second trimester, GDM women with high cholesterol intake had higher risks of macrosomia [OR 23.195 (95% CI 2.650-203.024)] and large for gestational age (LGA) [OR 3.253 (95% CI 1.062-9.965)] but lower risks of small for gestational age (SGA) [OR 0.271 (95% CI 0.074-0.986)] compared to those with low cholesterol intake. However, in the third trimester, GDM women with high cholesterol intake had lower risks of macrosomia [OR 0.023 (95% CI 0.001-0.436)] and LGA [OR 0.199 (95% CI 0.042-0.949)].

Conclusion

Cholesterol intake among GDM women during pregnancy was associated with blood glucose control and significantly influenced the risks of macrosomia, LGA, and SGA. However, LGA and SGA were also influenced by pre-pregnancy BMI, indicating cholesterol intake was one of multiple contributing factors. Limiting cholesterol intake may help GDM women better manage blood glucose levels and mitigate adverse pregnancy outcomes.

Association between sleep quality and duration during pregnancy and risk of gestational diabetes: A systematic review and meta-analysis

OBJECTIVE

Gestational diabetes mellitus (GDM) is associated with several adverse maternal and neonatal outcomes. Previous studies reported a link between altered sleep and risk of GDM. This systematic review aims to collate evidence on the association between impaired sleep quality and duration, and the risk of GDM.

METHODS

PubMed, Embase, Web of Science, and Scopus databases were searched up to January 20, 2024. Studies reporting the association between impaired sleep quality and duration and risk of GDM were included. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Random-effects meta-analysis was performed, and the results were reported as hazard ratio (HR) with 95% confidence interval (CI).

RESULTS

19 studies were included. Meta-analysis revealed a significant increase in the risk of GDM in pregnant women with poor sleep quality (i.e. <5 PSQI) (HR: 1.50, 95% CI: 1.26 - 1.78, p < .001). Sleep duration of <7 h (HR: 1.56, 95% CI.: 1.20 - 2.01, p < .001), and >8 h (HR: 2.32, 95% CI.: 1.19 - 4.50, p = .01) were also associated with a significantly higher incidence of GDM.

CONCLUSION

Sleep quality and duration emerge as critical risk factors of GDM. Healthcare practitioners should consider targeted interventions to improve sleep hygiene as a potential measure for GDM prevention.

Association of overweight and obesity with gestational diabetes mellitus among pregnant women attending antenatal care clinics in Addis Ababa, Ethiopia: a case-control study

OBJECTIVE

Maternal obesity and gestational diabetes mellitus (GDM) are becoming major public health concerns in developing countries. Understanding their relationship can help in developing contextually appropriate and targeted prevention strategies and interventions to improve maternal and infant health outcomes. This study aimed to determine the association of maternal overweight and obesity with GDM among pregnant women in Ethiopia.

DESIGN

Case-control study.

SETTING

The study was conducted in selected public hospitals in Addis Ababa, Ethiopia, from 10 March to 30 July 2020.

PARTICIPANTS

159 pregnant women with GDM (cases) and 477 pregnant women without GDM (controls).

OUTCOME MEASURES AND DATA ANALYSIS

Screening and diagnosis of GDM in pregnant women was done by a physician using the 2013 WHO criteria of 1-hour plasma glucose level of 10.0 mmol/L (180 mg/dL) or 2-hour plasma glucose level of 8.5-11.0 mmol/L (153-199 mg/dL) following a 75 g oral glucose load. Overweight and obesity were measured using mid-upper arm circumference (MUAC). Binary logistic regression with bivariate and multivariable models was done to measure the association of overweight and obesity with GDM. Adjusted ORs (AORs) with a 95% CI were computed, and statistical significance was determined at a value of p=0.05.

RESULTS

GDM was associated with obesity (MUAC≥31) (AOR 2.80; 95% CI 1.58 to 4.90), previous history of caesarean section (AOR 1.91; 95% CI 1.14 to 3.21) and inadequate Minimum Dietary Diversification Score <5 (AOR 3.55; 95% CI 2.15 to 5.86). The AOR for overweight (MUAC≥28 and MUAC<31) was 1.51 (95% CI 0.71 to 3.21). The odds of developing GDM were 72% lower in pregnant women who were engaging in high-level physical activity (AOR 0.28; 95% CI 0.12 to 0.67).

CONCLUSION

Obesity, but not overweight, was significantly associated with the development of GDM. Screening for GDM is recommended for pregnant women with obesity (MUAC≥31) for targeted intervention. Antenatal care providers should provide information for women of childbearing age on maintaining a healthy body weight before and in-between pregnancies and the need for healthy, diversified food and high-level physical activity.

Association between gestational diabetes mellitus diagnostic criteria and adverse pregnancy outcomes-a systematic review and meta-analysis of adjusted effect sizes from studies using current diagnostic criteria

OBJECTIVES

To quantify the association between Gestational Diabetes Mellitus (GDM) and adverse pregnancy outcomes and primarily compare the associations between diagnostic criteria following the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations and non-IADPSG criteria, which use higher blood glucose cut-offs.

DESIGN

Systematic review and meta-analysis of observational studies using contemporary GDM diagnostic criteria.

DATA SOURCES

PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for articles published between 2010 and 2023. The search was carried out on 15 May 2023.

ELIGIBILITY CRITERIA

Studies were included if they were observational studies that reported adjusted effect sizes for GDM-related adverse outcomes and compared outcomes between women with and without GDM, used contemporary diagnostic criteria and were conducted after 2010.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and assessed study quality using the MethodologicAl STandards for Epidemiological Research (MASTER) scale. Bias-adjusted inverse variance heterogeneity meta-analysis models were used to synthesise adjusted effect sizes. The same meta-analytic models were used to synthesise the overall OR and their 95% CIs for comparisons of the criteria which followed the IADPSG recommendations to other criteria, mostly with higher blood glucose cut-offs (non-IADPSG).

RESULTS

We included 30 studies involving 642 355 participants. GDM was associated with higher odds of maternal outcomes, namely; caesarean section (adjusted OR (aOR) 1.24, 95% CI 1.01 to 1.51) and pregnancy-induced hypertension (aOR 1.55, 95% CI 1.03 to 2.34). GDM was associated with higher odds of neonatal outcomes, specifically; macrosomia (aOR 1.38, 95% CI 1.13 to 1.69), large for gestational age (aOR 1.42, 95% CI 1.23 to 1.63), preterm birth (aOR 1.41, 95% CI 1.21 to 1.64), neonatal intensive care unit admission (aOR 1.42, 95% CI 1.12 to 1.78), neonatal hypoglycaemia (aOR 3.08, 95% CI 1.80 to 5.26) and jaundice (aOR 1.47, 95% CI 1.12 to 1.91). Further analyses showed no major differences in adverse pregnancy outcomes between IADPSG and non-IADPSG criteria.

CONCLUSIONS

GDM is consistently associated with adverse pregnancy, maternal and foetal outcomes, regardless of the diagnostic criteria used. These findings suggest no significant difference in risk between lower and higher blood glucose cut-offs used in GDM diagnosis.

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.

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.

Perinatal factors and early neonatal outcomes of abnormal birthweight infants in Hangzhou, China, 2015-2021: a retrospective cohort study

BACKGROUND

This study aimed to investigate the perinatal factors and early neonatal outcomes of abnormal birth weight (ABW) in Hangzhou, China from 2015 to 2021.

METHODS

A retrospective cohort study was designed to analyse the data of 76 847 newborns, in which the case groups included 3042 cases of low birth weight (LBW) and 2941 cases of fetal macrosomia (MAC), and 70 864 cases of normal weight were as the reference group.

RESULTS

The incidence of LBW and MAC was 3.96% and 3.83% in Hangzhou, China from 2015 to 2021. Prematurity (<37 weeks), multiple births, hospitalisation >7 days, fetal anomalies, caesarean section, pregnancy complications, maternal coinfection with pathogens and summer births would be correlated with the incidence of LBW (ORs=43.50, 7.60, 2.09, 1.89, 1.57, 1.28, 1.19 and 1.18, all p<0.05). Factors such as post-term pregnancy (>41 weeks), scarred uterus, anterior vaginal incision and gravidity ≥2 were correlated with decreased incidence of LBW, with ORs of 0.05, 0.54, 0.65 and 0.80. Moreover, caesarean delivery, post-term pregnancy (> 41 weeks), parity ≥1, lateral vaginal incision, gravidity ≥2, hospitalisation >7 days, winter births and pregnancy complications also have association with the incidence of MAC (ORs=3.92, 2.73, 2.19, 1.87, 1.22, 1.20, 1.17 and 1.13, all p<0.05) while prematurity (<37 weeks), scarred uterus and anterior vaginal incision have close association with decreased incidence of MAC, with ORs of 0.07, 0.21 and 0.74 (all p<0.05).

CONCLUSION

There was a trend of yearly increase in ABW in Hangzhou, China from 2015 to 2021. Several neonatal and maternal-related variables such as caesarean section, pregnancy complications and hospitalisation >7 days are associated with the odds of LBW and MAC, however, factors such as pregnancy with scarred uterus relate to the decrease of ABW. Close monitoring and intervention during pregnancy are essential to reduce the occurrence of ABW.

Epidemiology of hyperglycemia during pregnancy in Ethiopia: prevalence, associated factors, and feto-maternal outcomes: systematic review and meta-analysis

BACKGROUND

Hyperglycemia in pregnancy (HIP) is a significant medical complication affecting pregnant women globally and is considered a public health burden due to the negative outcomes it can cause for both mother and infant. The aim of this systematic review and meta-analysis was to examine the prevalence, risk factors, and feto-maternal outcomes of HIP in Ethiopia.

METHODS

To gather relevant information for this study, both published and unpublished studies were searched for in several major databases, including PubMed, Embase, HINARI, Web of Science direct, and Google Scholar, as well as other sources. The Joanna Briggs Institute (JBI) tool was used to evaluate the methodological quality of the findings from these studies. Data was then extracted and summarized using a template in Microsoft Excel software, and the extracted data was analyzed using Stata software version 16.0. If significant heterogeneity was found between studies, subgroup analyses were conducted to further examine the data.

RESULT

Eighteen studies were included in this systematic review and meta-analysis, involving a total sample size of 50,816 pregnant women in Ethiopia. The prevalence of HIP among pregnant women varied considerably across the primary studies, ranging from 0.4 to 26.2%. The pooled prevalence of HIP among pregnant women in Ethiopia was found to be 6.9% (95% C 2.2-11.6). Pregnant women with a family history of diabetes had 2.5 times higher odds of developing HIP compared to those without a family history of diabetes (OR = 2.49; 95% CI = 2.02, 2.96). However, there was no significant association found between HIP and maternal obesity (OR 2.31, 95% CI = 0.85, 3.78) or previous history of abortion (OR 3.89; 95% CI 0.85, 6.94). The common fetal outcomes associated with HIP were admission to the intensive care unit (46.2; 95% CI 27.4, 65.1), macrosomia (27.3%; 95% CI 9.4%, 45.1%), and preterm birth (16.9; 95% CI 12.5, 21.3). Additionally, hypertensive disorders of pregnancy (28.0%; 95% CI 15.2, 40.8) and operative delivery (51.4%; 95% CI 35.9, 66.8) were more common among women with HIP in Ethiopia.

CONCLUSION

Although there was some variation between studies, the meta-analysis revealed that approximately seven out of 100 pregnant women in Ethiopia had HIP. A family history of diabetes was found to be a significant predictor of HIP in Ethiopia. Additionally, HIP was associated with various serious adverse outcomes for both mothers and infants in Ethiopia. These findings highlight the need for national guidelines to ensure that pregnant women are uniformly screened for HIP.

The Influence of Airborne Particulate Matter on the Risk of Gestational Diabetes Mellitus: A Large Retrospective Study in Chongqing, China

Emerging research findings suggest that airborne particulate matter might be a risk factor for gestational diabetes mellitus (GDM). However, the concentration-response relationships and the susceptible time windows for different types of particulate matter may vary. In this retrospective analysis, we employ a novel robust approach to assess the crucial time windows regarding the prevalence of GDM and to distinguish the susceptibility of three GDM subtypes to air pollution exposure. This study included 16,303 pregnant women who received routine antenatal care in 2018-2021 at the Maternal and Child Health Hospital in Chongqing, China. In total, 2482 women (15.2%) were diagnosed with GDM. We assessed the individual daily average exposure to air pollution, including PM2.5, PM10, O3, NO2, SO2, and CO based on the volunteers' addresses. We used high-accuracy gridded air pollution data generated by machine learning models to assess particulate matter per maternal exposure levels. We further analyzed the association of pre-pregnancy, early, and mid-pregnancy exposure to environmental pollutants using a generalized additive model (GAM) and distributed lag nonlinear models (DLNMs) to analyze the association between exposure at specific gestational weeks and the risk of GDM. We observed that, during the first trimester, per IQR increases for PM10 and PM2.5 exposure were associated with increased GDM risk (PM10: OR = 1.19, 95%CI: 1.07~1.33; PM2.5: OR = 1.32, 95%CI: 1.15~1.50) and isolated post-load hyperglycemia (GDM-IPH) risk (PM10: OR = 1.23, 95%CI: 1.09~1.39; PM2.5: OR = 1.38, 95%CI: 1.18~1.61). Second-trimester O3 exposure was positively correlated with the associated risk of GDM, while pre-pregnancy and first-trimester exposure was negatively associated with the risk of GDM-IPH. Exposure to SO2 in the second trimester was negatively associated with the risk of GDM-IPH. However, there were no observed associations between NO2 and CO exposure and the risk of GDM and its subgroups. Our results suggest that maternal exposure to particulate matter during early pregnancy and exposure to O3 in the second trimester might increase the risk of GDM, and GDM-IPH is the susceptible GDM subtype to airborne particulate matter exposure.

Update on gestational diabetes and adverse pregnancy outcomes

PURPOSE OF REVIEW

To explore the recent literature concerning the effect of gestational diabetes (GDM) on adverse pregnancy outcomes (APO).

RECENT FINDINGS

Literature search on PubMed, Medline and British Journal of Obstetrics and Gynaecology was conducted using keywords. Search fields were filtered down to include articles from 2019 onwards. GDM is common during pregnancy and is on the rise because of increasing in obesity rates. GDM tended to show an increased risk of APO compared with non-GDM. Treatment of these pregnancies tended to improve these outcomes, particularly for LGA and macrosomia. Additional factors such as prepregnancy BMI and gestational weight gain (GWG) were shown to influence risk. More studies are needed to determine the true effect on postpartum haemorrhage (PPH) and induction of labour (IOL).

SUMMARY

The review agrees with the findings from previous studies and adds to the current literature. Early intervention to manage glycaemic control and GWG may help improve these outcomes. Public health strategies that tackle obesity rates will help to reduce prepregnancy BMI and, therefore, rates of GDM.

Association Between ABO Blood Group and Gestational Diabetes Mellitus in Pregnant Women at King Abdulaziz University Hospital: A Retrospective Study

Objective Gestational diabetes mellitus (GDM) can occur during pregnancy. One of the leading causes of it is a hormone produced by the placenta that interferes with glucose absorption and causes glucose buildup in the bloodstream. Genetic variations between ethnicities are believed to be associated with GDM, and there has been some research on the association of ABO blood group with GDM in different populations. However, the results so far are inconsistent, and there is no conclusive evidence on how ABO blood group affects the occurrence of GDM. This study aims to examine the link between ABO blood group and GDM in pregnant women at King Abdulaziz University Hospital. Methodology A retrospective cohort study was conducted on a group of GDM patients between 2019 and 2022 using data collected from the patients' medical records at King Abdulaziz University Hospital. Results The overall prevalence of GDM was high at 74.7%, and the percentage of patients with A, O, B, and AB blood group who had GDM was 42.9%, 41.41%, 12.1%, and 3.59%, respectively. However, there was no significant difference in Rh status or any other clinical characteristic between the participants who had GDM and those who did not have GDM. Conclusion The present findings indicate that blood group is not associated with the development of GDM in this cohort from Saudi Arabia. However, more studies are required in the future to corroborate these findings.

Association between gestational diabetes mellitus and adverse obstetric outcomes among women with advanced maternal age: A retrospective cohort study

To explore the association of gestational diabetes mellitus (GDM) with maternal and neonatal adverse outcomes among women with advanced maternal age. This retrospective cohort study included 1551,140 eligible pregnant women from the National Vital Statistics System database in 2017 to 2019, and all participants were divided into two groups: GDM group (n = 154,646) and non-GDM group (n = 1396,494). Univariate and multivariate logistic regression analyses were used to assess the association of GDM and maternal and neonatal outcomes; additionally, we also adopted subgroup analysis to analyze the association in detail based on gestational weight gain (GWG) levels. The risk of each adverse outcome was presented by using odds ratio (OR) and 95% confidence interval (CI). After adjusted some covariables, GDM increased the risk of neonatal assisted ventilation (OR = 1.380, 95% CI: 1.345-1.417), neonatal intensive care unit (NICU, OR = 1.436, 95% CI: 1.410-1.463) admission, neonatal low Apgar score at the fifth minutes (OR = 1.034, 95% CI: 1.018-1.051), neonatal high birth weight (OR = 1.132, 95% CI: 1.111-1.153), neonatal premature birth (OR = 1.244, 95% CI: 1.223-1.266), mothers entered intensive care unit (ICU, OR = 1.247, 95% CI: 1.107-1.406), and mothers took cesarean section (OR = 1.193, 95% CI: 1.180-1.207) among women with advanced maternal age. The study findings indicated that GDM was the risk factor for obstetric outcomes among women with advanced maternal age, which will have important implications for the management of GDM in women with advanced maternal age.

Incidence and risk factors of gestational diabetes mellitus in Goba town, Southeast Ethiopia: a prospective cohort study

OBJECTIVE

Gestational diabetes mellitus (GDM) is becoming a public health concern in low/middle-income countries, and is known to cause severe morbidity and mortality for mothers and newborns. However, evidence reported for the incidence and risk factors of GDM is scant in Ethiopia. We aimed to assess the incidence of, and risk factors for, GDM in Goba town, Southeast Ethiopia.

DESIGN

Prospective cohort study.

SETTING

Goba town, Southeast Ethiopia.

PARTICIPANTS

Four hundred eighty pregnant women on antenatal care follow-up from 30 April to 30 September 2021.

PRIMARY AND SECONDARY OUTCOMES

Incidence and risk factors of GDM using fasting capillary blood glucose. Log-binomial model was used to identify the risk factors of GDM. Adjusted relative risk (aRR), along with 95% CIs, were calculated to estimate the strength of associations.

RESULTS

The cumulative incidence rate of GDM in this study was 15.7% (95% CI: 12.3% to 19.2%). Being unemployed (aRR=2.73; 95% CI: 1.36 to 5.47), having a family history of diabetes mellitus (DM) (3.01; 2.09 to 4.35), low physical activity (2.43; 1.11 to 5.32), inadequate dietary diversity (1.48; 1.29 to 1.92), anaemia (2.51; 1.32 to 3.54) and antenatal depression (4.95; 3.35 to 7.31) were significantly associated with GDM.

CONCLUSION

The cumulative incidence of GDM was relatively high among the study participants. Having antenatal depression symptoms, low physical activity, inadequate dietary diversity, being unemployed, anaemia and a family history of DM were significant risk factors for GDM.

Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis

OBJECTIVE

To investigate the association between gestational diabetes mellitus and adverse outcomes of pregnancy after adjustment for at least minimal confounding factors.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Web of Science, PubMed, Medline, and Cochrane Database of Systematic Reviews, from 1 January 1990 to 1 November 2021.

REVIEW METHODS

Cohort studies and control arms of trials reporting complications of pregnancy in women with gestational diabetes mellitus were eligible for inclusion. Based on the use of insulin, studies were divided into three subgroups: no insulin use (patients never used insulin during the course of the disease), insulin use (different proportions of patients were treated with insulin), and insulin use not reported. Subgroup analyses were performed based on the status of the country (developed or developing), quality of the study, diagnostic criteria, and screening method. Meta-regression models were applied based on the proportion of patients who had received insulin.

RESULTS

156 studies with 7 506 061 pregnancies were included, and 50 (32.1%) showed a low or medium risk of bias. In studies with no insulin use, when adjusted for confounders, women with gestational diabetes mellitus had increased odds of caesarean section (odds ratio 1.16, 95% confidence interval 1.03 to 1.32), preterm delivery (1.51, 1.26 to 1.80), low one minute Apgar score (1.43, 1.01 to 2.03), macrosomia (1.70, 1.23 to 2.36), and infant born large for gestational age (1.57, 1.25 to 1.97). In studies with insulin use, when adjusted for confounders, the odds of having an infant large for gestational age (odds ratio 1.61, 1.09 to 2.37), or with respiratory distress syndrome (1.57, 1.19 to 2.08) or neonatal jaundice (1.28, 1.02 to 1.62), or requiring admission to the neonatal intensive care unit (2.29, 1.59 to 3.31), were higher in women with gestational diabetes mellitus than in those without diabetes. No clear evidence was found for differences in the odds of instrumental delivery, shoulder dystocia, postpartum haemorrhage, stillbirth, neonatal death, low five minute Apgar score, low birth weight, and small for gestational age between women with and without gestational diabetes mellitus after adjusting for confounders. Country status, adjustment for body mass index, and screening methods significantly contributed to heterogeneity between studies for several adverse outcomes of pregnancy.

CONCLUSIONS

When adjusted for confounders, gestational diabetes mellitus was significantly associated with pregnancy complications. The findings contribute to a more comprehensive understanding of the adverse outcomes of pregnancy related to gestational diabetes mellitus. Future primary studies should routinely consider adjusting for a more complete set of prognostic factors.

REVIEW REGISTRATION

PROSPERO CRD42021265837.

Antenatal depression among women with gestational diabetes mellitus: a pilot study

Background

Gestational diabetes mellitus (GDM) is quite prevalent in low- and middle-income countries, and has been proposed to increase the risk of depression. There is only a prior study assessing antenatal depression among the subjects with GDM in the Bangladesh, which leads this study to be investigated.

Objective

To determine the prevalence of depressive symptoms and potential associations among pregnant women diagnosed with GDM.

Methods

A cross-sectional study was carried out among 105 pregnant women diagnosed with GDM over the period of January to December 2017 in 4- hospitals located in two different cities (Dhaka and Barisal). A semi-structured questionnaire was developed consisting of items related to socio-demographics, reproductive health history, diabetes, anthropometrics, and depression.

Results

Mild to severe antenatal depression was present in 36.2% of the subjects (i.e., 14.3%, 19% and 2.9% for mild, moderate and severe depression, respectively). None of the socio-demographic factors were associated with depression, but the history of reproductive health-related issues (i.e., abortion, neonatal death) and uncontrolled glycemic status were associated with the increased risk of depressive disorders.

Conclusions

GDM is associated with a high prevalence of depressive symptoms, which is enhanced by poor diabetes control. Thus, in women presenting with GDM, screening for depression should be pursued and treated as needed.

Effect of later cord clamping on umbilical cord blood gas in term neonates of diabetic mothers: a randomized clinical trial

Objective

To evaluate the effect of later cord clamping (LCC) on umbilical arterial blood gas in neonates of diabetic mothers.

Methods

This prospective study included a group of 160 diabetic mothers (DM) whose neonates were randomized to immediate cord clamping (ICC) (≤ 15 s after birth) or LCC (≥ 30 s after birth), and a group of 208 non-diabetic mothers (NDM) whose neonates were randomized to ICC or LCC as a reference. Cord arterial pH, base excess (BE), bicarbonate (HCO₃⁻), partial pressure of carbon dioxide (pCO₂), partial pressure of oxygen (pO₂), lactate, hemoglobin, hematocrit and glucose were compared among groups.

Results

In neonates of DM, there was no significant difference in cord arterial pH between the ICC and LCC group. LCC of ≥ 30 s decreased umbilical arterial HCO₃⁻ and BE and increased lactate (ICC versus LCC, HCO₃⁻: 24.3 (22.7, 25.8) versus 23.7 (22.3, 24.7) mmol/L, P = 0.01; BE: -2.70 (-4.80, -1.50) versus − 3.72 (-5.66, -2.36) mmol/L, P = 0.006; lactate: 2.1 (1.6, 3.7) versus 2.7 (2.1, 4.3) mmol/L, P = 0.005), without the alterations of pCO₂, pO₂, hemoglobin, hematocrit and glucose. Similar results were found in neonates of NDM (ICC versus LCC, HCO₃⁻: 24.3 (23.1, 25.7) versus 23.5 (22.3, 24.8) mmol/L, P = 0.01; BE: -2.39 (-3.73, -1.51) versus − 3.40 (-4.73, -1.91) mmol/L, P = 0.001; lactate: 2.2 (1.9, 3.3) versus 2.5 (2.0, 4.3) mmol/L, P = 0.01), except for the higher level of hemoglobin in the LCC group. The majority of diabetic mothers (ICC: 92.0%; LCC: 91.8%) had good blood glucose control. No differences were observed in acid-base status and glucose between neonates of DM and neonates of NDM in both ICC and LCC, but hemoglobin and hematocrit were elevated after ICC in neonates of DM compared to neonates of NDM.

Conclusions

Later cord clamping of ≥ 30 s resulted in a tendency towards metabolic acidosis of umbilical arterial blood in neonates of DM and NDM. Umbilical arterial blood gas parameters at birth were similar in neonates of DM and NDM.

Trial registration

ClinicalTrials.gov: NCT04369313; date of registration: 30/04/2020 (retrospectively registered).

Perinatal asphyxia and associated factors among neonates admitted to a specialized public hospital in South Central Ethiopia: A retrospective cross-sectional study

Introduction

Perinatal asphyxia continues to be a significant clinical concern around the world as the consequences can be devastating. World Health Organization data indicates perinatal asphyxia is encountered amongst 6–10 newborns per 1000 live full-term birth, and the figures are higher for low and middle-income countries. Nevertheless, studies on the prevalence of asphyxia and the extent of the problem in poorly resourced southern Ethiopian regions are limited. This study aimed to determine the magnitude of perinatal asphyxia and its associated factors.

Methods

A retrospective cross-sectional study design was used from March to April 2020. Data was collected from charts of neonates who were admitted to NICU from January 2016 to December 31, 2019.

Result

The review of 311 neonates’ medical records revealed that 41.2% of the neonates experienced perinatal asphyxia. Preeclampsia during pregnancy (AOR = 6.2, 95%CI:3.1–12.3), antepartum hemorrhage (AOR = 4.5, 95%CI:2.3–8.6), gestational diabetes mellitus (AOR = 4.2, 95%CI:1.9–9.2), premature rupture of membrane (AOR = 2.5, 95%CI:1.33–4.7) fetal distress (AOR = 3,95%CI:1.3–7.0) and meconium-stained amniotic fluid (AOR = 7.7, 95%CI: 3.1–19.3) were the associated factors.

Conclusion

Substantial percentages of neonates encounter perinatal asphyxia, causing significant morbidity and mortality. Focus on early identification and timely treatment of perinatal asphyxia in hospitals should, therefore, be given priority.

Correlation of body composition in early pregnancy on gestational diabetes mellitus under different body weights before pregnancy

OBJECTIVE

The prediction of gestational diabetes mellitus (GDM) by body composition-related indicators in the first trimester was analyzed under different body mass index (BMI) values before pregnancy.

METHODS

This was a retrospective analysis of pregnant women who were treated, had documented data, and received regular perinatal care at the Third Affiliated Hospital of Zhengzhou University from January 1, 2021, to December 31, 2021. Women with singleton pregnancies who did not have diabetes before pregnancy were included. In the first trimester (before the 14th week of pregnancy), bioelectric impedance assessment (BIA) was used to analyze body composition-related indicators such as protein levels, mineral levels, fat volume, and the waist-hip fat ratio. The Pearman's correlation coefficient was used to evaluate the linear relationship between the continuous variables and pre-pregnancy body mass index (BMI). In the univariate body composition analysis, the association with the risk of developing GDM was included in a multivariate analysis using the relative risk and 95% confidence interval obtained from logarithmic binomial regression, and generalized linear regression was used for multivariate regression analysis. Furthermore, the area under the curve (AUC) was calculated by receiver operating characteristic (ROC) curves. The optimal cutoff value of each risk factor was calculated according to the Youden Index.

RESULTS

In a retrospective study consisting of 6698 pregnant women, we collected 1109 cases of gestational diabetes. Total body water (TBW), protein levels, mineral levels, bone mineral content (BMC), body fat mass (BFM), soft lean mass (SLM), fat-free mass (FMM), skeletal muscle mass (SMM), percent body fat (PBF), the waist-hip ratio (WHR), the visceral fat level (VFL), and the basal metabolic rate (BMR) were significantly higher in the GDM group than in the normal group (P<0.05). Under the pre-pregnancy BMI groupings, out of 4157 pregnant women with a BMI <24 kg/m², 456 (10.97%) were diagnosed with GDM, and out of 2541 pregnant women with a BMI ≥24 kg/m², 653 (25.70%) were diagnosed with GDM. In the generalized linear regression model, it was found that in all groups of pregnant women, pre-pregnancy BMI, age, gestational weight gain (GWG) in the first trimester, and weight at the time of the BIA had a certain risk for the onset of GDM. In Model 1, without adjusting for confounders, the body composition indicators were all positively correlated with the risk of GDM. In Model 3, total body water, protein levels, mineral levels, bone mineral content, soft lean mass, fat-free mass, skeletal muscle mass, and the basal metabolic rate were protective factors for GDM. After Model 4 was adjusted for confounders, only the waist-hip ratio was positively associated with GDM onset. Among pregnant women with a pre-pregnancy BMI <24 kg/m², the body composition-related indicators in Model 2 were all related to the onset of GDM. In Model 3, total body water, soft lean mass, fat-free mass, and the basal metabolic rate were negatively correlated with GDM onset. In the body composition analysis of among women with a pre-pregnancy BMI ≥ 24 kg/m², only Model 1 and Model 2 were found to show positive associations with GDM onset. In the prediction model, in the basic data of pregnant women, the area under the receiver operating characteristic curve predicted by gestational weight gain for GDM was the largest (0.795), and its cutoff value was 1.415 kg. In the body composition results, the area under the receiver operating characteristic curve of body fat mass for predicting GDM risk was larger (0.663) in all pregnant women.

CONCLUSIONS

Through this retrospective study, it was found that the body composition-related indicators were independently associated with the onset of GDM in both the pre-pregnancy BMI <24 kg/m² and pre-pregnancy BMI ≥24 kg/m² groups. Body fat mass, the visceral fat level, and the waist-hip ratio had a higher correlation with pre-pregnancy BMI. Total body water, protein levels, mineral levels, bone mineral content, soft lean mass, fat-free mass, skeletal muscle mass, and the basal metabolic rate were protective factors for GDM after adjusting for some confounders. In all pregnant women, the waist-hip ratio was found to be up to 4.562 times the risk of GDM development, and gestational weight gain had the best predictive power for GDM. Gestational weight gain in early pregnancy, body fat mass, and the waist-hip ratio can assess the risk of GDM in pregnant women, which can allow clinicians to predict the occurrence of GDM in pregnant women as early as possible and implement interventions to reduce adverse perinatal outcomes.