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Wan CS, Teede H, Nankervis A, Aroni R. Ethnic differences in physical activity participation when managing gestational diabetes mellitus: a mixed-methods study comparing ethnic Chinese migrants and Australian women. ETHNICITY & HEALTH 2024; 29:665-684. [PMID: 38805266 DOI: 10.1080/13557858.2024.2359379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/20/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Physical activity is a key component in gestational diabetes mellitus management to optimise glycaemic control and reduce adverse pregnancy outcomes. However, inadequate physical activity during pregnancy is common. Underpinned by a woman-centred pregnancy care model, appropriate strategies targeting patients' cultural needs may facilitate physical activity participation. Ethnic Chinese migrants have a four-fold higher risk of gestational diabetes mellitus than the Australian Caucasian host population. To identify potentially effective disease management strategies to improve physical activity participation, understanding and comparing ethnic Chinese migrants' and Caucasian women's views will provide insights into developing an end-user-informed intervention. AIMS This study aimed to compare perceptions and practices around physical activity participation during pregnancy between 44 ethnic Chinese migrants and 39 Australian-born Caucasian women with gestational diabetes mellitus. METHODS This mixed-methods study used in-depth, semi-structured audio-recorded interviews, validated pregnancy physical activity questionnaires and pedometers. Qualitative data were thematically analysed and compared between ethnicities. SPSS (SPSS Inc) was used in quantitative data analysis. Data triangulation was made to identify patterns in participant characteristics, physical activity beliefs and participation. RESULTS Despite both ethnic groups doing less physical activity than recommended, Chinese participants were less physically active than Caucasian participants. Chinese participants expressed greater safety concerns about physical activity and opted for a more sedentary lifestyle. Data triangulation indicated that non-Australian-born Chinese participants whose husbands were Asian were overcautious about miscarriage risk related to physical activity, which promoted a sedentary lifestyle. Chinese participants suggested individualised, specific physical activity advice on safe physical activity during pregnancy would mitigate their concerns. Caucasian participants reported that digital step measurement technologies motivated their participation in physical activity. CONCLUSION Different strategies are suggested by Chinese and Caucasian participants to improve physical activity participation to manage gestational diabetes mellitus among ethnic Chinese and Caucasian populations, which will be evaluated in future interventions.
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Affiliation(s)
- Ching Shan Wan
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Australia
| | - Alison Nankervis
- Departments of Diabetes and Endocrinology, The Royal Melbourne and Royal Women's Hospitals, Parkville, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Rosalie Aroni
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
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Adamczak L, Mantaj U, Sibiak R, Gutaj P, Wender-Ozegowska E. Physical activity, gestational weight gain in obese patients with early gestational diabetes and the perinatal outcome - a randomised-controlled trial. BMC Pregnancy Childbirth 2024; 24:104. [PMID: 38308265 PMCID: PMC10836025 DOI: 10.1186/s12884-024-06296-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/28/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Excessive gestational weight gain, especially among women with gestational diabetes, is associated with several adverse perinatal outcomes. Our study aimed to analyse the impact of the use of pedometers to supervise physical activity on maternal health and the obstetric outcomes of pregnant women with obesity and early gestational diabetes. METHODS 124 pregnant patients were enrolled in the presented research. INCLUSION CRITERIA singleton pregnancy, age > 18 years, gestational diabetes diagnosed in the first half of pregnancy (< 20th week of pregnancy), obesity according to the American Endocrine Society criteria. Each patient was advised to take at least 5000 steps daily. Patients were randomly assigned to pedometers (N = 62), and were recommended to monitor daily the number of steps. The group without pedometers (N = 62) was not observed. Visit (V1) was scheduled between the 28th and 32nd gestational week (GW), and visit (V2) occurred between the 37th and 39th GW. Anthropometric measurements and blood samples were collected from all patients at each appointment. Foetal and maternal outcomes were analysed at the end of the study. RESULTS In the group supervised by pedometers, there were significantly fewer newborns with macrosomia (p = 0,03). Only 45% of patients satisfied the recommended physical activity guidelines. Patients who walked more than 5000 steps per day had significantly higher body weight at baseline (p = 0,005), but weight gain was significantly lower than in the group that did not exceed 5000 steps per day (p < 0,001). The perinatal outcome in the group of patients performing more than 5000 steps did not demonstrate significant differences with when compared to less active group. ROC curve for weight gain above the guidelines indicated a statistically substantial cut-off point for this group at the level of 4210 steps/day (p = 0.00001). CONCLUSIONS Monitoring the activity of pregnant patients with gestational diabetes and obesity by pedometers did not have a significantly impact on their metabolic control and weight gain. However, it contributed to less macrosomia. Furthermore, physical activity over 5,000 steps per day positively affects weight loss, as well as contributes to improved obstetric and neonatal outcomes.
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Affiliation(s)
- Lukasz Adamczak
- Department of Reproduction, Chair of Fetomaternal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, Poznan, Poland.
| | - Urszula Mantaj
- Department of Reproduction, Chair of Fetomaternal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafał Sibiak
- Department of Reproduction, Chair of Fetomaternal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Poznan, Poland
- Department of Histology and Embryology, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Gutaj
- Department of Reproduction, Chair of Fetomaternal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Wender-Ozegowska
- Department of Reproduction, Chair of Fetomaternal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Tocci V, Mirabelli M, Salatino A, Sicilia L, Giuliano S, Brunetti FS, Chiefari E, De Sarro G, Foti DP, Brunetti A. Metformin in Gestational Diabetes Mellitus: To Use or Not to Use, That Is the Question. Pharmaceuticals (Basel) 2023; 16:1318. [PMID: 37765126 PMCID: PMC10537239 DOI: 10.3390/ph16091318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
In recent years, there has been a dramatic increase in the number of pregnancies complicated by gestational diabetes mellitus (GDM). GDM occurs when maternal insulin resistance develops and/or progresses during gestation, and it is not compensated by a rise in maternal insulin secretion. If not properly managed, this condition can cause serious short-term and long-term problems for both mother and child. Lifestyle changes are the first line of treatment for GDM, but if ineffective, insulin injections are the recommended pharmacological treatment choice. Some guidance authorities and scientific societies have proposed the use of metformin as an alternative pharmacological option for treating GDM, but there is not yet a unanimous consensus on this. Although the use of metformin appears to be safe for the mother, concerns remain about its long-term metabolic effects on the child that is exposed in utero to the drug, given that metformin, contrary to insulin, crosses the placenta. This review article describes the existing lines of evidence about the use of metformin in pregnancies complicated by GDM, in order to clarify its potential benefits and limits, and to help clinicians make decisions about who could benefit most from this drug treatment.
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Affiliation(s)
- Vera Tocci
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (V.T.); (M.M.)
- Operative Unit of Endocrinology, Diabetes in Pregnancy Ambulatory Care Center, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Maria Mirabelli
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (V.T.); (M.M.)
- Operative Unit of Endocrinology, Diabetes in Pregnancy Ambulatory Care Center, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Alessandro Salatino
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (V.T.); (M.M.)
| | - Luciana Sicilia
- Operative Unit of Endocrinology, Diabetes in Pregnancy Ambulatory Care Center, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Stefania Giuliano
- Operative Unit of Endocrinology, Diabetes in Pregnancy Ambulatory Care Center, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Francesco S. Brunetti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (V.T.); (M.M.)
| | - Eusebio Chiefari
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (V.T.); (M.M.)
| | - Giovambattista De Sarro
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (V.T.); (M.M.)
| | - Daniela P. Foti
- Department of Experimental and Clinical Medicine, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Antonio Brunetti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (V.T.); (M.M.)
- Operative Unit of Endocrinology, Diabetes in Pregnancy Ambulatory Care Center, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy
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Do NC, Vestgaard M, Nørgaard SK, Damm P, Mathiesen ER, Ringholm L. Prediction and prevention of preeclampsia in women with preexisting diabetes: the role of home blood pressure, physical activity, and aspirin. Front Endocrinol (Lausanne) 2023; 14:1166884. [PMID: 37614711 PMCID: PMC10443220 DOI: 10.3389/fendo.2023.1166884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/13/2023] [Indexed: 08/25/2023] Open
Abstract
Women with type 1 or type 2 (preexisting) diabetes are four times more likely to develop preeclampsia compared with women without diabetes. Preeclampsia affects 9%-20% of pregnant women with type 1 diabetes and 7%-14% of pregnant women with type 2 diabetes. The aim of this narrative review is to investigate the role of blood pressure (BP) monitoring, physical activity, and prophylactic aspirin to reduce the prevalence of preeclampsia and to improve pregnancy outcome in women with preexisting diabetes. Home BP and office BP in early pregnancy are positively associated with development of preeclampsia, and home BP and office BP are comparable for the prediction of preeclampsia in women with preexisting diabetes. However, home BP is lower than office BP, and the difference is greater with increasing office BP. Daily physical activity is recommended during pregnancy, and limiting sedentary behavior may be beneficial to prevent preeclampsia. White coat hypertension in early pregnancy is not a clinically benign condition but is associated with an elevated risk of developing preeclampsia. This renders the current strategy of leaving white coat hypertension untreated debatable. A beneficial preventive effect of initiating low-dose aspirin (150 mg/day) for all in early pregnancy has not been demonstrated in women with preexisting diabetes.
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Affiliation(s)
- Nicoline Callesen Do
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Vestgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
| | - Sidse Kjærhus Nørgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth R. Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
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Bień A, Pieczykolan A, Korżyńska-Piętas M, Grzesik-Gąsior J. Body Esteem and Self-Efficacy of Pregnant Women with Gestational Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2171. [PMID: 36767537 PMCID: PMC9915844 DOI: 10.3390/ijerph20032171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
The diagnosis of gestational diabetes mellitus provokes a change in a pregnant woman's lifestyle, which may affect her well-being and precipitate a sense of loss of self-control over her own body. The perception of "body image" is not only physical appearance and physical attractiveness but also the emotional attitude to the body and beliefs about it. The aim of the study was to analyze the factors affecting body esteem and analyze the relationship between body esteem and self-efficacy in pregnant women with gestational diabetes mellitus. The study was conducted in the period from April 2019 to January 2021 among 287 women with gestational diabetes mellitus with the use of the following research tools: Body Esteem Scale (BES) and Generalized Self-Efficacy Scale (GSES). The explanatory variables for the sexual attractiveness variable were age (β = 0.252; p = 0.006) and education (β = 0.334; p = 0.007), for the weight concern variable were age (β = 0.161; p = 0.005), BMI (β = 0.334; p = 0.005), and education (β = 0.252; p = 0.033), for the physical condition variable, were age (β = 0.096; p = 0.004) and education (β = 0.213; p = 0.006). Positive correlations were found between self-efficacy and body esteem in the aspects of sexual attractiveness (p = 0.350), weight concern (p = 0.296), and physical condition (p = 0.286). Positive correlations were found between self-efficacy and body esteem in the aspects of sexual attractiveness (p = 0.350), weight concern (p = 0.296), and physical condition (p = 0.286). Older women who had better education and a lower BMI rated their bodies better. In women with gestational diabetes mellitus, high self-efficacy determines a better perception of their bodies in all areas: sexual attractiveness, weight concern, and physical condition.
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Affiliation(s)
- Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4/6 Staszica St., 20-081 Lublin, Poland
| | - Agnieszka Pieczykolan
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4/6 Staszica St., 20-081 Lublin, Poland
| | - Magdalena Korżyńska-Piętas
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4/6 Staszica St., 20-081 Lublin, Poland
| | - Joanna Grzesik-Gąsior
- State University of Applied Sciences in Krosno, 6 KazimierzaWielkiego St., 38-400 Krosno, Poland
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Ayenigbara IO. Diabetes Prevention and Measures to Ensuring a Healthy Lifestyle during COVID-19 Pandemic and after. Korean J Fam Med 2023; 44:11-20. [PMID: 36709956 PMCID: PMC9887446 DOI: 10.4082/kjfm.21.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/03/2022] [Indexed: 01/20/2023] Open
Abstract
The incidence of diabetes mellitus (DM) is increasing exponentially globally, with 90% of the confirmed cases being type 2 DM. The global incidence of DM is expected to increase by 48% during 2017-2045. The coronavirus disease 2019 (COVID-19) pandemic continues to have a massive impact on human health, causing sudden lifestyle changes through quarantine measures, such as lockdown, social distancing, various curfews, and isolation at home. This in turn might increase the risk of developing numerous chronic diseases, such as DM, obesity, and cardiovascular diseases, which increase the severity of COVID-19. To this end, we performed a comprehensive review to determine viable measures for the prevention of DM and its subsequent upsurge globally. Additionally, we have determined strategies that should be adopted globally to ensure a healthy lifestyle during the COVID-19 pandemic and later.
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Affiliation(s)
- Israel Oluwasegun Ayenigbara
- School and Community Health Promotion Unit, Department of Health Education, University of Ibadan, Ibadan, Nigeria,Corresponding Author: Israel Oluwasegun Ayenigbara https://orcid.org/0000-0002-0085-5493 Tel: +234-8139177538, Fax: +234-8098103043, E-mail:
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Li Q, Zhang G, Lin L, Wu M, Cao X, Xiao D, Wang X, Zhang X, Xu S, Li X, Zhong C, Tan T, Chen X, Huang L, Zhang Y, Chen R, Zhou X, Xiong T, Wu Y, Gao Q, Wu J, Li D, Cui W, Tu M, Zhang H, Yang S, Liu J, Yang H, Yang X, Hao L, Yang N. Plasma Manganese Levels and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:15860-15868. [PMID: 36215214 DOI: 10.1021/acs.est.2c03330] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Manganese (Mn) intake has been found to be linked with risk of type 2 diabetes. However, the role of Mn in the development of gestational diabetes mellitus (GDM) remains to be investigated. This prospective study included pregnant women from the Tongji Maternal and Child Health Cohort. A total of 2327 participants with plasma specimens before 20 weeks were included. Among the pregnant women, 9.7% (225/2327) were diagnosed with GDM. After adjustment, pregnant women with the third and highest quartile of plasma Mn levels had 1.31-fold (RR, 2.31 [1.48, 3.61]) and 2.35-fold (RR, 3.35 [2.17, 5.17]) increased risk of GDM compared with those with the lowest quartile. A 1 standard deviation increment of ln-transformed plasma Mn levels (0.53 μg/L) was related to elevated risks of GDM with RRs of 1.28 [1.17, 1.40]. The positive associations between Mn and GDM remained consistent in all the subgroups. The weighted quantile sum index was significantly related to GDM (RR, 1.60 [1.37, 1.86]). The contribution of Mn (58.69%) to the metal mixture index was the highest related to GDM. Higher plasma Mn levels were found to be linked with elevated fasting and 2 h post-load blood glucose. This study revealed relationships of higher plasma Mn levels in early pregnancy and increased risk of GDM, suggesting that though essential, excess Mn in the body might be a potential important risk factor for GDM.
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Affiliation(s)
- Qian Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Guofu Zhang
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Lixia Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Meng Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xiyu Cao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Daxiang Xiao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xiaoyi Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xu Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Shangzhi Xu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xiating Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Chunrong Zhong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Tianqi Tan
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xi Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Li Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yu Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Renjuan Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xuezhen Zhou
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Ting Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yuanjue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Qin Gao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Jiangyue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - De Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Wenli Cui
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Menghan Tu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Huaqi Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Siyu Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Jin Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Hongying Yang
- Hubei Center for Disease Control and Prevention, Wuhan, Hubei 430079, P.R. China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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8
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Malini H, Zhahara S, Lenggogeni DP, Putri ZM. SELF-CARE AND QUALITY OF LIFE PEOPLE WITH TYPE 2 DIABETES DURING THE COVID-19: CROSS-SECTIONAL STUDY. J Diabetes Metab Disord 2022; 21:785-790. [PMID: 35637659 PMCID: PMC9134729 DOI: 10.1007/s40200-022-01055-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/31/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022]
Abstract
Background . Social distancing and emotional stress during the COVID-19 pandemic have affected the self-care management of type 2 diabetes mellitus patients. There was a shift in self-care management during the COVID-19 that will impact the quality of life of type 2 diabetes mellitus (T2DM) patients. This study aims to determine the relationship between self-care management and quality of life of T2DM patients in the community health center during the lockdown. Methods . This research was a quantitative study with a cross-sectional study approach. The sampling technique used a non-probability sampling with total sampling of 89 respondents. The instruments used in this study were WHO Quality of Life-BREF and Summary of Diabetes Self Care Activities. Findings The results showed a significant relationship between self-care management and the quality of life of people with type 2 diabetes (p = 0.000) with moderate strength and a positive direction. Conclusions People with diabetes coped well with their disease management which was supported by family and health professionals. Sustainable health education and motivation for patients and families are important so that the patients always carry out self-care management to improve the quality of life of type 2 diabetes mellitus patients.
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Affiliation(s)
- Hema Malini
- Faculty of Nursing, Universitas Andalas, 25163 West Sumatra, Indonesia
| | - Sonia Zhahara
- Nurse, Bhayangkara Hospital, West Sumatra, Indonesia
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9
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Catinelli BB, Rossignoli PS, Floriano JF, Carr AM, de Oliveira RG, Dos Santos NJ, Úbeda LCC, Spadella MA, Hallur RLS, Sobrevia L, Felisbino SL, Calderon IMP, Barbosa AMP, Rudge MVC. Reversal of diabetic-induced myopathy by swimming exercise in pregnant rats: a translational intervention study. Sci Rep 2022; 12:7375. [PMID: 35513450 PMCID: PMC9072313 DOI: 10.1038/s41598-022-10801-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
Gestational diabetes mellitus (GDM) plus rectus abdominis muscle (RAM) myopathy predicts long-term urinary incontinence (UI). Atrophic and stiff RAM are characteristics of diabetes-induced myopathy (DiM) in pregnant rats. This study aimed to determine whether swimming exercise (SE) has a therapeutic effect in mild hyperglycemic pregnant rats model. We hypothesized that SE training might help to reverse RAM DiM. Mild hyperglycemic pregnant rats model was obtained by a unique subcutaneous injection of 100 mg/kg streptozotocin (diabetic group) or citrate buffer (non-diabetic group) on the first day of life in Wistar female newborns. At 90 days of life, the rats are mated and randomly allocated to remain sedentary or subjected to a SE protocol. The SE protocol started at gestational day 0 and consisted of 60 min/day for 6 days/week in a period of 20 days in a swim tunnel. On day 21, rats were sacrificed, and RAM was collected and studied by picrosirius red, immunohistochemistry, and transmission electron microscopy. The SE protocol increased the fiber area and diameter, and the slow-twitch and fast-twitch fiber area and diameter in the diabetic exercised group, a finding was also seen in control sedentary animals. There was a decreased type I collagen but not type III collagen area and showed a similar type I/type III ratio compared with the control sedentary group. In conclusion, SE during pregnancy reversed the RAM DiM in pregnant rats. These findings may be a potential protocol to consider in patients with RAM damage caused by GDM.
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Affiliation(s)
- Bruna B Catinelli
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Patrícia S Rossignoli
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
| | - Juliana F Floriano
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Aline M Carr
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Rafael G de Oliveira
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Nilton J Dos Santos
- Laboratory of Extracellular Matrix Biology, Department of Structural and Functional Biology, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Department of Structural and Functional Biology, Institute of Biology (IB), UNICAMP, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Lara C C Úbeda
- University of Marília (UNIMAR), Marília, São Paulo, Brazil
| | | | - Raghavendra L S Hallur
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Pravara Institute of Medical Sciences (Deemed to be University), Loni, Rahata Taluk, Ahmednagar District, Maharashtra, 413736, India
| | - Luis Sobrevia
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330024, Santiago, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, 41012, Seville, Spain
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, 4029, Australia
- Division of Pathology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, The Netherlands
| | - Sérgio L Felisbino
- Laboratory of Extracellular Matrix Biology, Department of Structural and Functional Biology, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Iracema M P Calderon
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Angélica M P Barbosa
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
| | - Marilza V C Rudge
- Postgraduate Program on Tocogynecology, Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
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Li S, Yang Y, Liu F, Song Q. Molecular Mechanism of miR-29b on Gestational Diabetes and Its Influence on Trophoblast Cell Function. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To explore the mechanism of miR-29b in gestational diabetes mellitus (GDM) and its effect on the function of trophoblast cell (TBC), the placenta tissues of 55 normal term pregnancies and 55 GDM patients were selected and rolled into control group and observation group. In the early
stage, microRNA (miRNA) chips were utilized to screen the differentially expressed miRNAs in the placenta of observation group and control group. According to the microarray results of miRNAs, three differentially expressed miRNAs, namely let-7b, miR-1202, and miR-29b were selected. Then,
the differences in the miR-29b level in the four groups were analyzed, namely the microRNA-29b (miR-29b minic), mini-control (minic control), microRNA-29b inhibitor (miR-29b inhibitor), and inhibitor control (inhibitor control). The results showed that miR-29b level in the placenta of observation
group was substantially inferior to that of controls, with remarkable differences (P < 0.05). miR-29b level in miR-29b minic and minic control had significant changes (P < 0.01). The TBC activity of minic control was greatly superior to that of minic control, and there
was considerable difference between the two (P < 0.05). The difference between miR-29b inhibitor and inhibitor control in TBC was not obvious, without considerable differences (P > 0.05). The invasion ability of miR-29b inhibitor TBC was notably superior to inhibitor control,
and there were substantial differences (P < 0.05). To sum up, miR-29b had a significant inhibitory effect on the proliferation and cell activity of TBC, and can promote the apoptosis and death of TBC. Moreover, its inhibitory effect on cell migration and invasion was also suggested.
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Affiliation(s)
- Sheng Li
- School of Medicine, Jianghan University, Wuhan, 430056, Hubei, China
| | - Youhua Yang
- Department of Basic Medical Sciences, Jianghan University, Wuhan, 430056, Hubei, China
| | - Fang Liu
- Department of Obstetrics, Hubei Maternal and Child Health Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430070, Hubei, China
| | - Qian Song
- Department of Obstetrics, Wuhan No. 6 Hospital Affiliated to Jianghan University, Wuhan, 430014, Hubei, China
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Napoli A, Sciacca L, Pintaudi B, Tumminia A, Dalfrà MG, Festa C, Formoso G, Fresa R, Graziano G, Lencioni C, Nicolucci A, Rossi MC, Succurro E, Sculli MA, Scavini M, Vitacolonna E, Bonomo M, Torlone E. Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements-the STRONG observational study. Acta Diabetol 2021; 58:1187-1197. [PMID: 33842997 PMCID: PMC8316164 DOI: 10.1007/s00592-021-01707-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/12/2021] [Indexed: 12/18/2022]
Abstract
AIMS To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). METHODS Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. RESULTS From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60-8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81-87 mg/dl (4.5-4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. CONCLUSIONS Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.
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Affiliation(s)
- Angela Napoli
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy.
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy.
| | - Laura Sciacca
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy
| | - Basilio Pintaudi
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy
| | - Andrea Tumminia
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy
| | | | - Camilla Festa
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
| | - Gloria Formoso
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Medicine and Aging Sciences; Center for Advanced Studies and Technology (CAST, Ex CeSI-Met), G. D'Annunzio University, Chieti, Italy
| | - Raffaella Fresa
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Endocrinology and Diabetes Unit, ASL Salerno, Salerno, Italy
| | - Giusi Graziano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Cristina Lencioni
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Diabetes and Endocrinology Unit, Usl Nord Ovest Tuscany, Lucca, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Elena Succurro
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maria Angela Sculli
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Endocrinology and Diabetes, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
| | - Marina Scavini
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ester Vitacolonna
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti-Pescara, Chieti, Italy
| | - Matteo Bonomo
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy
| | - Elisabetta Torlone
- AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy
- Internal Medicine, Endocrinology and Metabolism, S. Maria Della Misericordia Hospital, Perugia, Italy
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12
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Festa C, Fresa R, Visalli N, Bitterman O, Giuliani C, Suraci C, Bongiovanni M, Napoli A. Insulin Requirements and Carbohydrate to Insulin Ratio in Normal Weight, Overweight, and Obese Women With Type 1 Diabetes Under Pump Treatment During Pregnancy: A Lesson From Old Technologies. Front Endocrinol (Lausanne) 2021; 12:610877. [PMID: 33732212 PMCID: PMC7959706 DOI: 10.3389/fendo.2021.610877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/14/2021] [Indexed: 11/29/2022] Open
Abstract
Aim The primary aim of this study was to assess insulin requirements and carbohydrate to insulin ratio (CHO/IR) in normal weight, overweight, and obese pregnant women with type 1 diabetes across early, middle, and late pregnancy. Methods In this multicenter, retrospective, observational study we evaluated 86 of 101 pregnant Caucasian women with type 1 diabetes under pump treatment. The women were trained to calculate CHO/IR daily by dividing CHO grams of every single meal by insulin units injected. Since the purpose of the study was to identify the CHO/IR able to reach the glycemic target, we only selected the CHO/IR obtained when glycemic values were at target. Statistics: SPSS 20. Results We studied 45 normal weight, 31 overweight, and 10 obese women. Insulin requirements increased throughout pregnancy (p < 0.0001 and <0.001 respectively) in the normal and overweight women, while it remained unchanged in the obese women. Insulin requirements were different between groups when expressed as an absolute value, but not when adjusted for body weight. Breakfast CHO/IR decreased progressively throughout pregnancy in the normal weight women, from 13.3 (9.8-6.7) at the first stage of pregnancy to 6.2 (3.8-8.6) (p = 0.01) at the end stage, and in the overweight women from 8.5 (7.1-12.6) to 5.2 (4.0-8.1) (p = 0.001), while in the obese women it remained stable, moving from 6.0 (5.0-7.9) to 5.1 (4.1-7.4) (p = 0.7). Likewise, lunch and dinner CHO/IR decreased in the normal weight and overweight women (p < 0.03) and not in the obese women. The obese women gained less weight than the others, especially in early pregnancy when they even lost a median of 1.25 (-1 -1.1) kg (p = 0.005). In early pregnancy, we found a correlation between pregestational BMI and insulin requirements (IU/day) or CHO/IR at each meal (p < 0.001 and p = 0.001, respectively). In late pregnancy, a relationship between pre-gestational BMI and CHO/IR change was found (P = 0.004), as well as between weight gain and CHO/IR change (p=0.02). The significance was lost when both variables were included in the multiple regression analysis. There was no difference in pregnancy outcomes except for a higher pre-term delivery rate in the obese women. Conclusion Pre-gestational BMI and weight gain may play a role in determining CHO/IR during pregnancy in women with type 1 diabetes under pump treatment.
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Affiliation(s)
- Camilla Festa
- Department of Clinical and Molecular Medicine Sapienza University of Rome, Rome, Italy
| | | | | | - Olimpia Bitterman
- Department of Clinical and Molecular Medicine Sapienza University of Rome, Rome, Italy
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
| | - Chiara Giuliani
- Department of Clinical and Molecular Medicine Sapienza University of Rome, Rome, Italy
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
| | - Concetta Suraci
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
- Policlinico Casilino, Rome, Italy
| | | | - Angela Napoli
- Department of Clinical and Molecular Medicine Sapienza University of Rome, Rome, Italy
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Bianchi C, de Gennaro G, Romano M, Baronti W, Aragona M, Battini L, Bottone P, Del Prato S, Bertolotto A. Exercise during pregnancy: how much active are pregnant women at risk of gestational diabetes despite few contraindications? Gynecol Endocrinol 2021; 37:101-104. [PMID: 32490696 DOI: 10.1080/09513590.2020.1775196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Diet and physical activity are cornerstones in prevention and treatment of Gestational Diabetes (GDM) though some caution may be required under specific circumstances. The aims of this study were to evaluate activity habits during pregnancy and contraindications to physical activity in women at risk for GDM. METHODS 536 pregnant women (age 35 ± 5 years; gestation week 25 ± 4; pre-pregnancy BMI 24.6 ± 12.9 kg/m2), selective screened for GDM, filled out a standardized questionnaire recording physical activity during pregnancy. RESULTS Of 536 women, 73.4% reported regular exercise before pregnancy and 95.5% of them continued during pregnancy. 8.2% had absolute contraindications to exercise, such as placenta praevia /vaginal bleeding and incompetent cervix/cerclage. Physical activity during the last month was reported by 66.2% of women; frequency was 1-2 times/week (44%); intensity was light (83%) and duration on average (44%) 20-40 min/day. 48% of women spent most of their time in sedentary behaviors (sitting). Among women with GDM, physical activity was associated with better metabolic profile and lower needed of insulin therapy. CONCLUSION Women at risk for GDM spent most of their time in sedentary behaviors, despite a low prevalence of contraindications to exercise. Therefore, our data call for the need of motivational counseling aimed to implement physical activity during pregnancy.
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Affiliation(s)
- Cristina Bianchi
- Department of Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giovanni de Gennaro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matilde Romano
- Maternal-Infant Department, University Hospital of Pisa, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Aragona
- Department of Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lorella Battini
- Maternal-Infant Department, University Hospital of Pisa, Pisa, Italy
| | - Pietro Bottone
- Maternal-Infant Department, University Hospital of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Abstract
The prevalence of diabetes in reproductive age women has been reported to be as high as 6.8%, with pregestational diabetes affecting 2% of all pregnancies. As cases of diabetes in children and adolescents rise, more patients will be entering reproductive age and pregnancy with diagnoses of obesity, prediabetes, type 2 diabetes. Early interventions of diet modification and exercise to maintain healthy weights can delay or even prevent these complications. It is critical for health care providers to emphasize the importance of preconception counseling in this high-risk patient population to reduce the morbidities associated with obesity and diabetes in pregnancy.
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Tura A, Göbl C, Morettini M, Burattini L, Kautzky-Willer A, Pacini G. Insulin clearance is altered in women with a history of gestational diabetes progressing to type 2 diabetes. Nutr Metab Cardiovasc Dis 2020; 30:1272-1280. [PMID: 32513580 DOI: 10.1016/j.numecd.2020.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Insulin clearance is a relevant process in glucose homeostasis. In this observational study, we aimed to assess insulin clearance (ClINS) in women with former gestational diabetes (fGDM) both early after delivery and after a follow-up. METHODS AND RESULTS We analysed 59 fGDM women, and 16 women not developing GDM (CNT). All women underwent an oral glucose tolerance test (OGTT) yearly, and an insulin-modified intravenous glucose tolerance test (IVGTT) at baseline and at follow-up end (until 7 years). Both IVGTT and OGTT ClINS was assessed as insulin secretion to plasma insulin ratio. We also defined IVGTT first (0-10 min) and second phase (10-180 min) ClINS. We found that 14 fGDM women progressed to type 2 diabetes (PROG), whereas 45 women remained diabetes-free (NONPROG). At baseline, IVGTT ClINS showed alterations in PROG, especially in second phase (0.88 ± 0.10 l·min-1 in PROG, 0.60 ± 0.06 in NONPROG, 0.54 ± 0.07 in CNT, p ≤ 0.03). Differences in ClINS were not found from OGTT. Cox regression analysis showed second phase ClINS as significant type 2 diabetes predictor (hazard ratio = 1.90, 95% confidence interval 1.09-3.30, p = 0.02). CONCLUSION This study showed that insulin clearance derived from an insulin-modified IVGTT is notably altered in women with history of GDM progressing towards type 2 diabetes.
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Affiliation(s)
- Andrea Tura
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy.
| | - Christian Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Micaela Morettini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Laura Burattini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Giovanni Pacini
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy
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16
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Mohammadi Zeidi B, Kariman N, Kashi Z, Mohammadi Zeidi I, Alavi Majd H. Predictors of physical activity following gestational diabetes: Application of health action process approach. Nurs Open 2020; 7:1060-1066. [PMID: 32587725 PMCID: PMC7308703 DOI: 10.1002/nop2.486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 02/02/2023] Open
Abstract
Aim Regular physical activity can reduce the chance of developing type 2 diabetes in women with a history of gestational diabetes. The present study investigated the relationship between the constructs of the health action process approach and regular physical activity in women with a history of gestational diabetes. Design This was a cross-sectional study. Methods A total of 150 women who had given birth 6-24 months prior to the study and had experienced gestational diabetes in their recent pregnancy were selected using multistage cluster sampling. Data were collected from December 2018 to May 2019 using a researcher-made questionnaire including constructs of health action process approach. Results The common fit indices revealed that health action process approach had an acceptable fit to the observations (root mean square error of approximation = 0.054, Tucker-Lewis index = 0.95, comparative fit index = 0.955). The model's constructs predicted 48% of intention variance and 35% of physical activity variance. Action self-efficacy and coping planning were the most important predictors of intention and behaviour, respectively.
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Affiliation(s)
- Banafsheh Mohammadi Zeidi
- Student Research CommitteeDepartment of Midwifery and Reproductive HealthSchool of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Nourossadat Kariman
- Midwifery and Reproductive Health Research CenterMidwifery and Reproductive Health DepartmentSchool of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Zahra Kashi
- Diabetes Research CenterImam Khomeini HospitalMazandaranIran
| | - Isa Mohammadi Zeidi
- Department of Public HealthSchool of HealthQazvin University of Medical SciencesQazvinIran
| | - Hamid Alavi Majd
- Department of BiostatisticsParamedical SchoolShahid Beheshti University of Medical SciencesTehranIran
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Egan AM, Bogdanet D, Griffin TP, Kgosidialwa O, Cervar-Zivkovic M, Dempsey E, Allotey J, Alvarado F, Clarson C, Cooray SD, de Valk HW, Galjaard S, Loeken MR, Maresh MJA, Napoli A, O'Shea PM, Wender-Ozegowska E, van Poppel MNM, Thangaratinam S, Crowther C, Biesty LM, Devane D, Dunne FP. A core outcome set for studies of gestational diabetes mellitus prevention and treatment. Diabetologia 2020; 63:1120-1127. [PMID: 32193573 PMCID: PMC7228989 DOI: 10.1007/s00125-020-05123-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/18/2020] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS The aim of this systematic review was to develop core outcome sets (COSs) for trials evaluating interventions for the prevention or treatment of gestational diabetes mellitus (GDM). METHODS We identified previously reported outcomes through a systematic review of the literature. These outcomes were presented to key stakeholders (including patient representatives, researchers and clinicians) for prioritisation using a three-round, e-Delphi study. A priori consensus criteria informed which outcomes were brought forward for discussion at a face-to-face consensus meeting where the COS was finalised. RESULTS Our review identified 74 GDM prevention and 116 GDM treatment outcomes, which were presented to stakeholders in round 1 of the e-Delphi study. Round 1 was completed by 173 stakeholders, 70% (121/173) of whom went on to complete round 2; 84% (102/121) of round 2 responders completed round 3. Twenty-two GDM prevention outcomes and 30 GDM treatment outcomes were discussed at the consensus meeting. Owing to significant overlap between included prevention and treatment outcomes, consensus meeting stakeholders agreed to develop a single prevention/treatment COS. Fourteen outcomes were included in the final COS. These consisted of six maternal outcomes (GDM diagnosis, adherence to the intervention, hypertensive disorders of pregnancy, requirement and type of pharmacological therapy for hyperglycaemia, gestational weight gain and mode of birth) and eight neonatal outcomes (birthweight, large for gestational age, small for gestational age, gestational age at birth, preterm birth, neonatal hypoglycaemia, neonatal death and stillbirth). CONCLUSIONS/INTERPRETATION This COS will enable future GDM prevention and treatment trials to measure similar outcomes that matter to stakeholders and facilitate comparison and combination of these studies. TRIAL REGISTRATION This study was registered prospectively with the Core Outcome Measures in Effectiveness Trials (COMET) database: http://www.comet-initiative.org/studies/details/686/.
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Affiliation(s)
- Aoife M Egan
- Division of Endocrinology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Delia Bogdanet
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Tomás P Griffin
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Eugene Dempsey
- INFANT Centre and Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
| | - John Allotey
- Barts Research Centre for Women's Health (BARC), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Fernanda Alvarado
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
| | - Cheril Clarson
- Department of Pediatrics, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Shamil D Cooray
- Barts Research Centre for Women's Health (BARC), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC, Australia
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia
| | - Harold W de Valk
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Sander Galjaard
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands.
| | - Mary R Loeken
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael J A Maresh
- Department of Obstetrics, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Paula M O'Shea
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Ewa Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Shakila Thangaratinam
- Barts Research Centre for Women's Health (BARC), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Caroline Crowther
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- HRB-Trials Methodology Research Network, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Declan Devane
- INFANT Centre and Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- HRB-Trials Methodology Research Network, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Fidelma P Dunne
- School of Medicine, National University of Ireland Galway, Galway, Ireland
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Tan L, Zou J, Zhang Y, Yang Q, Shi H. A Longitudinal Study of Physical Activity to Improve Sleep Quality During Pregnancy. Nat Sci Sleep 2020; 12:431-442. [PMID: 32765140 PMCID: PMC7367923 DOI: 10.2147/nss.s253213] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To explore the association between maternal physical activity (PA) and sleep quality during pregnancy, and the necessary PA level at different gestational stages to attain improved sleep quality. METHODS A total of 2443 participants were recruited from the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) study, who had completed questionnaires including the Pittsburgh Sleep Quality Index (PSQI) and the International Physical Activity Questionnaire (IPAQ) at gestational weeks (GW) of 12-16 and 32-36. PSQI scores and their seven components at the two GW were compared, as were PSQI scores at 12-16 and 32-36 GW and the increment in PSQI relative to PA. Regression analysis was conducted to assess the effect of PA and its change on the total PSQI score at different GW. RESULTS The mean PSQI scores increased significantly during pregnancy, from 6.30 ± 3.01 at 12-16 GW to 7.23 ± 3.47 at 32-36 GW. Compared with women in low PA level, moderate levels of PA at both 12-16 GW and 32-36 GW were significantly reduced PSQI scores of 0.42 (95% CI:-0.68,-0.16) and 0.32 (95% CI:-0.63,-0.01), respectively. At 32-36 GW, high PA level also significantly decreased PSQI score, with a greater decline than moderate PA level. (AOR=-0.87,95% CI:-1.57,-0.18). PA increment from 12-16 to 32-36 weeks of pregnancy created a significant decline of 0.54 in PSQI scores. CONCLUSION The study revealed sleep quality was worse at the third trimester and moderate PA level had the potential for improvement of sleep quality both in the first and the third trimester. High PA level was also beneficial to improve sleep quality of pregnant women in the third trimester.
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Affiliation(s)
- Liwei Tan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Jiaojiao Zou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Yunhui Zhang
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Qing Yang
- Department of Child Care, The Maternal and Child Healthcare Institute of Songjiang District, Shanghai, People's Republic of China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, People's Republic of China
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Abstract
BACKGROUND A good metabolic control before conception and throughout pregnancy with diabetes decreases the risk of short- and long-term adverse outcomes of the mothers and their offsprings. Insulin treatment remains the gold standard treatment recommended for any type of diabetes. New technologies including new insulins and insulin analogues, continuous subcutaneous insulin infusion without and with sensors, the low-glucose predictive suspension function, and closed-loop systems that persistently and automatically self-adjust according to patients' continuous glucose monitoring readings have expanded the offer to clinicians for achieving tight glucose control. AREAS OF UNCERTAINTY Unsafe effects of insulin and insulin analogues in pregnancy with diabetes could be linked with changes in insulin immunogenicity, teratogenicity, and mitogenicity. Second-generation insulin analogues need to be tested and proven. Effectiveness and safety of new insulin delivery systems in real life of diabetic women in pregnancy need further confirmations. SOURCES MEDLINE, EMBASE, Web of Science, Cochrane Library, randomized controlled trials, systematic review and meta-analysis, observational prospective and retrospective studies, case series reports for the most recent insulin analogues, published in English impacted journals, and consensus statements from scientific societies I excluded 60 from 221 papers as not suitable for the purpose of the subject. RESULTS Subcutaneous insulin infusion can be safely used during pregnancy and delivery of well-trained women. Sensors are increasingly accurate tools that improve the efficacy and safety of integrated systems' functioning. Continuous glucose monitoring provides metrics ("time in range" time in "hypoglycemia" and in "hyperglycemia," glucose variability, average glucose levels in different time intervals) used as a guide to diabetes management; these new metrics are object of discussion in special populations. Randomized controlled trials have shown that sensor-augmented pump therapy improves pregnancy outcomes in women with type 1 diabetes. Closed-loop insulin delivery provides better glycemic control than sensor-augmented pump therapy during pregnancy, before, and after delivery. CONCLUSION Second-generation insulin analogues and newer insulin infusion systems that automatically self-adjust according to patients continuous glucose monitor readings are important tools improving the treatment and quality of life of these women. Multi-institutional and disciplinary teams are working to develop and evaluate a pregnancy-specific artificial pancreas.
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Huang X, Huang J, Wu J, Li M, Yang Z, Liu L, Lin T, Lan Y, Chen K. Different exercises for pregnant women with gestational diabetes: a meta-analysis of randomized controlled trials. J Sports Med Phys Fitness 2019; 60:464-471. [PMID: 31684704 DOI: 10.23736/s0022-4707.19.10131-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There is evidence that maternal and child outcomes in patients with gestational diabetes mellitus (GDM) are associated with different exercise patterns. However, the evidence on which forms of exercise are beneficial for pregnant women with GDM is unclear. EVIDENCE ACQUISITION PubMed, EMBASE, the Cochrane Library and the Web of Science were systematically searched for eligible studies until Feb.24, 2019. A randomized controlled trial (RCT) was used as the study method. The literature quality was evaluated and the data extracted by two researchers, and statistical analysis was carried out using Review Manage 5.2 software. EVIDENCE SYNTHESIS A total of nine RCTs were included. The research results show that compared with the conventional treatment group, aerobic exercise reduced the fasting blood glucose (WMD=-0.35, 95% CI: -0.62 to -0.08, I2=87%), postprandial blood glucose (WMD=-0.62, 95% CI:-0.95 to -0.29, I2=84%) and glycosylated hemoglobin levels (WMD=-0.35, 95% CI:-0.49 to -0.20, I2=71%) in patients with GDM. Compared with the conventional treatment group, the dosage of insulin (WMD=0.97, 95% CI: 0.42-2.26, I2=0%) in patients with GDM in the resistance exercise group was reduced, and the effect of combined treatment was statistically significant. Compared with the conventional treatment group, the combination of aerobic exercise plus resistance exercise training reduced postprandial blood glucose in patients with GDM (WMD=-0.64, 95% CI:-0.94 to -0.34), and the combined treatment effect was statistically significant. CONCLUSIONS Different types of exercise have different intervention effects on the outcome of patients with gestational diabetes. However, we do not have enough data to determine whether infants benefit from this exercise, and it is still necessary to conduct large-scale, high-quality and long-term intervention studies for verification.
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Affiliation(s)
- Xiaoyi Huang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jingxing Huang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jiezhu Wu
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Min Li
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ziqing Yang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Liuhong Liu
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Tian Lin
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yutao Lan
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ken Chen
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China -
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