1
|
de Mucio B, Sosa C, Colomar M, Mainero L, Cruz CM, Chévez LM, Lopez R, Carrillo G, Rizo U, Saint Hillaire EE, Arriaga WE, Guadalupe Flores RM, Ochoa C, Gonzalez F, Castro R, Stefan A, Moreno A, Metelus S, Souza RT, Costa ML, Luz AG, Sousa MH, Cecatti JG, Serruya SJ. The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system. PLoS One 2023; 18:e0296002. [PMID: 38134193 PMCID: PMC10745214 DOI: 10.1371/journal.pone.0296002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). METHODS We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. RESULTS In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25-4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26-3.19]), maternal age (PRadj 1.04; 95%CI [1.02-1.05]), any medical condition (PRadj 1.48; 95%CI [1.24-1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27-11.66]). CONCLUSIONS Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.
Collapse
Affiliation(s)
- Bremen de Mucio
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Claudio Sosa
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Luis Mainero
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | | | | | - Rita Lopez
- Hospital Berta Calderon Roque, Managua, Nicaragua
| | | | | | | | | | | | | | | | | | - Allan Stefan
- Hospital Leonardo Martinez Valenzuela, San Pedro Sula, Honduras
| | | | - Sherly Metelus
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Renato T. Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Adriana G. Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | | | - José G. Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | | |
Collapse
|
2
|
Tol AJC, Hribar K, Kruit J, Bongiovanni L, Vieira-Lara MA, Koster MH, Kloosterhuis NJ, Havinga R, Koehorst M, de Bruin A, Bakker BM, Oosterveer MH, van der Beek EM. Hyperglycaemia, pregnancy outcomes and maternal metabolic disease risk during pregnancy and lactation in a lean gestational diabetes mouse model. J Physiol 2023; 601:1761-1780. [PMID: 37010236 DOI: 10.1113/jp284061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/10/2023] [Indexed: 04/04/2023] Open
Abstract
Hyperglycaemia in pregnancy (HIP) is a pregnancy complication characterized by mild to moderate hyperglycaemia that negatively impacts short- and long-term health of mother and child. However, relationships between severity and timing of pregnancy hyperglycaemia and postpartum outcomes have not been systemically investigated. We investigated the impact of hyperglycaemia developing during pregnancy (gestational diabetes mellitus, GDM) or already present pre-mating (pre-gestational diabetes mellitus, PDM) on maternal health and pregnancy outcomes. GDM and PDM were induced in C57BL/6NTac mice by combined 60% high fat diet (HF) and low dose streptozotocin (STZ). Animals were screened for PDM prior to mating, and all underwent an oral glucose tolerance test on gestational day (GD)15. Tissues were collected at GD18 or at postnatal day (PN)15. Among HFSTZ-treated dams, 34% developed PDM and 66% developed GDM, characterized by impaired glucose-induced insulin release and inadequate suppression of endogenous glucose production. No increased adiposity or overt insulin resistance was observed. Furthermore, markers of non-alcoholic fatty liver disease (NAFLD) were significantly increased in PDM at GD18 and were positively correlated with basal glucose levels at GD18 in GDM dams. By PN15, NAFLD markers were also increased in GDM dams. Only PDM affected pregnancy outcomes such as litter size. Our findings indicate that GDM and PDM, resulting in disturbances of maternal glucose homeostasis, increase the risk of postpartum NAFLD development, related to the onset and severity of pregnancy hyperglycaemia. These findings signal a need for earlier monitoring of maternal glycaemia and more rigorous follow-up of maternal health after GDM and PDM pregnancy in humans. KEY POINTS: We studied the impact of high-fat diet/streptozotocin induced hyperglycaemia in pregnancy in mice and found that this impaired glucose tolerance and insulin release. Litter size and embryo survival were compromised by pre-gestational, but not by gestational, diabetes. Despite postpartum recovery from hyperglycaemia in a majority of dams, liver disease markers were further elevated by postnatal day 15. Maternal liver disease markers were associated with the severity of hyperglycaemia at gestational day 18. The association between hyperglycaemic exposure and non-alcoholic fatty liver disease signals a need for more rigorous monitoring and follow-up of maternal glycaemia and health in diabetic pregnancy in humans.
Collapse
Affiliation(s)
- Angela J C Tol
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kaja Hribar
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Janine Kruit
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Laura Bongiovanni
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | - Marcel A Vieira-Lara
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mirjam H Koster
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Niels J Kloosterhuis
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rick Havinga
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martijn Koehorst
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Alain de Bruin
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Barbara M Bakker
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maaike H Oosterveer
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Eline M van der Beek
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
3
|
Desoye G, Carter AM. Fetoplacental oxygen homeostasis in pregnancies with maternal diabetes mellitus and obesity. Nat Rev Endocrinol 2022; 18:593-607. [PMID: 35902735 DOI: 10.1038/s41574-022-00717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/09/2022]
Abstract
Despite improvements in clinical management, pregnancies complicated by pre-existing diabetes mellitus, gestational diabetes mellitus or obesity carry substantial risks for parent and offspring. Some of the endocrine and metabolic changes in parent and fetus in diabetes mellitus and obesity lead to fetal oxygen deficit, mostly due to insulin-induced accelerated fetal metabolism. The human fetus deals with reduced oxygenation through a wide range of adaptive responses that act at various levels in the placenta as well as the fetus. These responses ensure adequate oxygen delivery to the fetus, increase the oxygen transport capacity of fetal blood and redistribute oxygen-rich blood to vital organs such as the brain and heart. The liver has a central role in adapting to reduced oxygenation by increasing its oxygen extraction and stimulating erythropoietin synthesis to increase haematocrit. The type of adaptive response depends on the onset and duration of hypoxia and the severity of the metabolic disturbance. In pregnancies characterized by diabetes mellitus or obesity, these adaptive systems come under additional strain owing to the increased maternal supply of glucose and resultant fetal hyperinsulinaemia, both of which stimulate oxidative metabolism. In the rare situation that the adaptive responses are overwhelmed, stillbirth can ensue.
Collapse
Affiliation(s)
- Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
- Center for Pregnant Women with Diabetes, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Anthony M Carter
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Zhang X, Xu L, Chen H, Zhang X, Lei Y, Liu W, Xu H, Ma B, Zhu C. Novel Hydroxychalcone-Based Dual Inhibitors of Aldose Reductase and α-Glucosidase as Potential Therapeutic Agents against Diabetes Mellitus and Its Complications. J Med Chem 2022; 65:9174-9192. [PMID: 35749671 DOI: 10.1021/acs.jmedchem.2c00380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We designed a novel series of bifunctional inhibitors of α-glucosidase and aldose reductase (ALR2) based on the structure of hydroxychalcone. The two enzymes relate to blood glucose level and anomalously elevated polyol pathway of glucose metabolism under hyperglycemia, respectively. Most compounds in the series exhibited a potent inhibitory activity for both enzymes, and a significant antioxidant property was shown. Further in vivo studies of 11j and 14d using streptozotocin (STZ)-induced diabetic rats as a model found that 11j achieved not only good antihyperglycemic and glucose tolerance effect in a dose-dependent manner (p < 0.01) but also showed effective inhibition of polyol pathway. 14d significantly suppressed the maltose-induced postprandial glucose elevation. Additionally, they effectively improved lipid metabolisms and restored an antioxidant ability. Therefore, the two compounds may be promising agents for the prevention and treatment of diabetic complications.
Collapse
Affiliation(s)
- Xiaonan Zhang
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Long Xu
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Huan Chen
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Xin Zhang
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Yanqi Lei
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Wenchao Liu
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Hulin Xu
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Bing Ma
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Changjin Zhu
- Key Laboratory of Cluster Science, Ministry of Education of China, Beijing Key Laboratory of Photoelectronic; Electrophotonic Conversion Materials, School of Chemistry and Chemical Engineering, Beijing Institute of Technology, Beijing 100081, China
| |
Collapse
|
5
|
A Pragmatic Approach to the Treatment of Women With Type 2 Diabetes in Pregnancy. Clin Obstet Gynecol 2020; 64:159-173. [PMID: 33481417 DOI: 10.1097/grf.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Type 2 diabetes mellitus (DM) is a growing problem among reproductive-aged women. Contemporary trends in obesity and delayed child-bearing are expected to result in an increasing number of pregnancies affected by type 2 DM. Women with known type 2 DM can greatly benefit from preconception care as improved periconception glycemic control and weight loss can decrease the neonatal and maternal risks associated with type 2 DM and pregnancy. Antenatal mainstays of management include frequent blood glucose monitoring, insulin therapy, optimization of coexisting medical conditions, and fetal surveillance. Careful attention to postpartum glucose control, infant feeding choices, and contraceptive counseling are important aspects of immediate postpartum care.
Collapse
|
6
|
Eckert LO, Jones CE, Kachikis A, Bardají A, Silva FTD, Absalon J, Rouse CE, Khalil A, Cutland CL, Kochhar S, Munoz FM. Obstetrics risk Assessment: Evaluation of selection criteria for vaccine research studies in pregnant women. Vaccine 2020; 38:4542-4547. [PMID: 32448618 PMCID: PMC7211583 DOI: 10.1016/j.vaccine.2020.05.022] [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: 01/02/2020] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 10/31/2022]
Abstract
Vaccines designed for use in pregnancy and vaccine trials specifically involving pregnant women are rapidly expanding. One of the key challenges in designing maternal immunization trials is that developing exclusion criteria requires understanding and quantifying the background risk for adverse pregnancy outcomes in the pregnancy being studied, which can occur independent of any intervention and be unrelated to vaccine administration. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project has developed and published case definitions and guidelines for data collection, analysis, and evaluation of maternal immunization safety in trials involving pregnant women. Complementing this work, we sought to understand how to best assess obstetric risk of adverse outcomes and differentiate it from the assessment of vaccine safety. Quantification of obstetric risk is based on prior and current obstetric, and maternal medical history. We developed a step-wise approach to evaluate and quantify obstetric and maternal risk factors in pregnancy based on review of published literature and guidelines, and critically assessed these factors in the context of designing inclusion and exclusion criteria for maternal vaccine studies. We anticipate this risk assessment evaluation may assist clinical trialists with study design decisions, including selection of exclusion criteria for vaccine trials involving pregnant women, consideration of sub-group classification, such as high or low risk subjects, or schedule considerations, such as preferred trimester of gestation for an intervention during pregnancy. Additionally, this tool may be utilized in data stratification at time of study analyses.
Collapse
Affiliation(s)
- Linda O Eckert
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA; Department of Global Health, University of Washington School of Medicine, Seattle, WA.
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA
| | - Azucena Bardají
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Caroline E Rouse
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN
| | - Asma Khalil
- Department of Obstetrics & Gynecology, St. George's Hospital, University of London, London, UK
| | - Clare L Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, African Leadership Iin Vaccinology Expertise, Faculty of Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonali Kochhar
- Department of Global Health, University of Washington School of Medicine, Seattle, WA; Global Healthcare Consulting, India; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Flor M Munoz
- Department of Pediatrics and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States.
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW This review will focus on the long-term outcomes in offspring exposed to in utero hyperglycemia and gestational diabetes (GDM), including obesity, adiposity, glucose metabolism, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, and puberty. RECENT FINDINGS There is evidence, mostly from observational studies, that offspring of GDM mothers have increased risk of obesity, increased adiposity, disorders of glucose metabolism (insulin resistance and type 2 diabetes), and hypertension. In contrast, evidence from the two intervention studies of treatment of mild GDM and childhood measures of BMI, adiposity, and glucose tolerance do not demonstrate that GDM treatment significantly reduces adverse childhood metabolic outcomes. Thus, more evidence is needed to understand the impact of maternal GDM on offspring's adiposity, glucose metabolism, lipid metabolism, risk of fatty liver disease, and pubertal onset. Offspring of GDM mothers may have increased risk for metabolic and cardiovascular complications. Targeting this group for intervention studies to prevent obesity and disorders of glucose metabolism is one potential strategy to prevent adverse metabolic health outcomes.
Collapse
Affiliation(s)
- Monica E Bianco
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 54, Chicago, IL, 60611, USA
| | - Jami L Josefson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 54, Chicago, IL, 60611, USA.
| |
Collapse
|
8
|
Abstract
Although it has been accepted for decades that women with gestational diabetes mellitus (GDM) are at high risk for future development of type 2 diabetes, vigorous debate regarding the value of detecting and treating GDM has persisted into the twenty-first century. Although results from 2 randomized trials provide strong evidence that treating GDM reduces adverse perinatal outcomes, it remains to be determined whether treatment impacts long-term offspring outcomes. Insulin is the first-line pharmacologic treatment and is added when glycemic goals are not met with nutritional modifications. Oral agent use is controversial, as data on long-term offspring outcomes are lacking.
Collapse
Affiliation(s)
- Emily D Szmuilowicz
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, 530-24, Chicago, IL 60611, USA
| | - Jami L Josefson
- Division of Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 54, Chicago, IL 60611, USA
| | - Boyd E Metzger
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Tarry Building, Room 12-703, 300 East Superior, Chicago, IL 60611, USA.
| |
Collapse
|
9
|
Chen L, Wang WJ, Auger N, Xiao L, Torrie J, McHugh NGL, Luo ZC. Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort study. BMJ Open 2019; 9:e025084. [PMID: 30992290 PMCID: PMC6500205 DOI: 10.1136/bmjopen-2018-025084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Both pregestational and gestational diabetes mellitus (PGDM, GDM) occur more frequently in First Nations (North American Indians) pregnant women than their non-Indigenous counterparts in Canada. We assessed whether the impacts of PGDM and GDM on perinatal and postneonatal mortality may differ in First Nations versus non-Indigenous populations. DESIGN A population-based linked birth cohort study. SETTING AND PARTICIPANTS 17 090 First Nations and 217 760 non-Indigenous singleton births in 1996-2010, Quebec, Canada. MAIN OUTCOME MEASURES Relative risks (RR) of perinatal and postneonatal death. Perinatal deaths included stillbirths and neonatal (0-27 days of postnatal life) deaths; postneonatal deaths included infant deaths during 28-364 days of life. RESULTS PGDM and GDM occurred much more frequently in First Nations (3.9% and 10.7%, respectively) versus non-Indigenous (1.1% and 4.8%, respectively) pregnant women. PGDM was associated with an increased risk of perinatal death to a much greater extent in First Nations (RR=5.08[95% CI 2.99 to 8.62], p<0.001; absolute risk (AR)=21.6 [8.6-34.6] per 1000) than in non-Indigenous populations (RR=1.76[1.17, 2.66], p=0.003; AR=4.2[0.2, 8.1] per 1000). PGDM was associated with an increased risk of postneonatal death in non-Indigenous (RR=3.46[1.71, 6.99], p<0.001; AR=2.4[0.1, 4.8] per 1000) but not First Nations (RR=1.16[0.28, 4.77], p=0.35) infants. Adjusting for maternal and pregnancy characteristics, the associations were similar. GDM was not associated with perinatal or postneonatal death in both groups. CONCLUSIONS The study is the first to reveal that PGDM may increase the risk of perinatal death to a much greater extent in First Nations versus non-Indigenous populations, but may substantially increase the risk of postneonatal death in non-Indigenous infants only. The underlying causes are unclear and deserve further studies. We speculate that population differences in the quality of glycaemic control in diabetic pregnancies and/or genetic vulnerability to hyperglycaemia's fetal toxicity may be contributing factors.
Collapse
Affiliation(s)
- Lu Chen
- Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Québec, Canada
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai Jiaotong University School of Medicine, Xinhua Hospital, Shanghai, China
| | - Wen-Juan Wang
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai Jiaotong University School of Medicine, Xinhua Hospital, Shanghai, China
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Nathalie Auger
- Epidemiology, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Lin Xiao
- Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Jill Torrie
- Public Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, Canada
| | - Nancy Gros-Louis McHugh
- Research Sector, First Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, Canada
| | - Zhong-Cheng Luo
- Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Québec, Canada
| |
Collapse
|
10
|
|
11
|
Abstract
Women with type 1 diabetes (T1DM) have unique needs during the preconception, pregnancy, and postpartum periods. Preconception counseling is essential for women with T1DM to minimize pregnancy risks. The goals of preconception care should be tight glycemic control with a hemoglobin A1c (A1C) < 7 % and as close to 6 % as possible, without significant hypoglycemia. This will lower risks of congenital malformations, preeclampsia, and perinatal mortality. The safety of medications should be assessed prior to conception. Optimal control of retinopathy, hypertension, and nephropathy should be achieved. During pregnancy, the goal A1C is near-normal at <6 %, without excessive hypoglycemia. There is no clear evidence that continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) is superior in achieving the desired tight glycemic control of T1DM during pregnancy. Data regarding continuous glucose monitoring (CGM) in pregnant women with T1DM is conflicting regarding improved glycemic control. However, a recent CGM study does provide some distinct patterns of glucose levels associated with large for gestational age infants. Frequent eye exams during pregnancy are essential due to risk of progression of retinopathy during pregnancy. Chronic hypertension treatment goals are systolic blood pressure 110-129 mmHg and diastolic blood pressure 65-79 mmHg. Labor and delivery target plasma glucose levels are 80-110 mg/dl, and an insulin drip is recommended to achieve these targets during active labor. Postpartum, insulin doses must be reduced and glucoses closely monitored in women with T1DM because of the enhanced insulin sensitivity after delivery. Breastfeeding is recommended and should be highly encouraged due to maternal benefits including increased insulin sensitivity and weight loss and infant and childhood benefits including reduced prevalence of overweight. In this article, we discuss the care of pregnant patients with T1DM.
Collapse
Affiliation(s)
- Anna Z Feldman
- Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02115, USA
| | | |
Collapse
|
12
|
Toledano Y, Hadar E, Hod M. Safety of insulin analogues as compared with human insulin in pregnancy. Expert Opin Drug Saf 2016; 15:963-73. [DOI: 10.1080/14740338.2016.1182153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
13
|
Garamvölgyi Z, Prohászka Z, Rigó J, Kecskeméti A, Molvarec A. Increased circulating heat shock protein 70 (HSPA1A) levels in gestational diabetes mellitus: a pilot study. Cell Stress Chaperones 2015; 20:575-81. [PMID: 25720752 PMCID: PMC4463915 DOI: 10.1007/s12192-015-0579-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/15/2015] [Accepted: 02/16/2015] [Indexed: 12/15/2022] Open
Abstract
Recent data indicate that serum Hsp70 (HSPA1A) levels are increased in type 1 and 2 diabetes mellitus. However, there is no report in the literature on circulating Hsp70 levels in gestational diabetes mellitus. In this pilot study, we measured serum Hsp70 levels in 11 pregnant women with pregestational diabetes, 38 women with gestational diabetes, and 40 healthy pregnant women with ELISA. Plasma glucose levels, serum insulin concentrations, HbA1c values, and the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) index were also determined. According to our results, serum Hsp70 concentrations were significantly higher in women with pregestational and gestational diabetes mellitus than in healthy pregnant women. In addition, pregestational diabetic women had significantly higher Hsp70 levels than those with gestational diabetes. Furthermore, in the group of women with gestational diabetes mellitus, serum Hsp70 levels showed a significant positive correlation with HbA1c values. However, there was no other relationship between clinical features and metabolic parameters of the study subjects and their serum Hsp70 levels in either study group. In conclusion, we demonstrated for the first time in the literature that serum Hsp70 levels are increased and correlate with HbA1c values in women with gestational diabetes mellitus. Nevertheless, further studies are needed to determine whether circulating Hsp70 plays a causative role in the pathogenesis of gestational diabetes or elevated serum Hsp70 levels are only consequences of the disease.
Collapse
Affiliation(s)
- Zoltán Garamvölgyi
- />First Department of Obstetrics and Gynecology, Semmelweis University, Baross utca 27, Budapest, 1088 Hungary
| | - Zoltán Prohászka
- />Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary
- />Research Group of Inflammation Biology and Immunogenomics, Hungarian Academy of Sciences, Budapest, Hungary
| | - János Rigó
- />First Department of Obstetrics and Gynecology, Semmelweis University, Baross utca 27, Budapest, 1088 Hungary
| | - András Kecskeméti
- />First Department of Obstetrics and Gynecology, Semmelweis University, Baross utca 27, Budapest, 1088 Hungary
| | - Attila Molvarec
- />First Department of Obstetrics and Gynecology, Semmelweis University, Baross utca 27, Budapest, 1088 Hungary
| |
Collapse
|
14
|
Korkmazer E, Solak N, Tokgöz VY. Gestational Diabetes: Screening, Management, Timing of Delivery. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0113-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Abstract
Pregestational diabetes currently complicates 4% of pregnancies, while gestational diabetes complicates approximately 8% of pregnancies. Increased risk of stillbirth in diabetic pregnancies has been a well-known and recognized complication for decades. While stillbirth rates for diabetic pregnancies have decreased due to screening, treatment, and antenatal surveillance of these patients, about 4% of all stillbirths remain attributable to diabetes, and diabetic pregnancies continue to be at increased risk for perinatal mortality. The purpose of this article is to review the literature on the epidemiology, pathophysiology, and prevention, as well as future research, of diabetes-associated perinatal mortality.
Collapse
Affiliation(s)
- Roman Starikov
- , 106 Irving Street Suite 108, Washington, DC, 20010, USA,
| | | | | |
Collapse
|
16
|
The offspring of the diabetic mother – Short- and long-term implications. Best Pract Res Clin Obstet Gynaecol 2015; 29:256-69. [DOI: 10.1016/j.bpobgyn.2014.08.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022]
|
17
|
Fong A, Serra AE, Gabby L, Wing DA, Berkowitz KM. Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus. Am J Obstet Gynecol 2014; 211:641.e1-7. [PMID: 24912095 DOI: 10.1016/j.ajog.2014.06.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/09/2014] [Accepted: 06/05/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this study was to assess an early hemoglobin A1c (HgbA1c) value from 5.7-6.4% as an early predictor of progression to gestational diabetes (GDM). STUDY DESIGN A retrospective cohort study was performed on all women who delivered at a single institution over 2 years who had an early screening HgbA1c test performed at ≤20 weeks of gestation. Women with known preexisting diabetes mellitus or HgbA1c values ≥6.5% were excluded. The primary outcome was GDM development. Secondary outcomes included delivery route, maternal weight gain, birthweight, and neonatal morbidities. Women with an HgbA1c value of 5.7-6.4% were compared with those with an HgbA1c level of <5.7%. RESULTS Nearly one-third of those patients in the HgbA1c 5.7-6.4% group (27.3%) experience the development of GDM compared with only 8.7% in the HgbA1c <5.7% group (odds ratio, 3.9; 95% confidence level, 2.0-7.7). This 3-fold increase remained significant (adjusted odds ratio, 2.4) after adjustment for age, prepregnancy body mass index, gestational age at HgbA1c collection, gestational age at screening, ethnicity, and method of screening. There were no significant differences in the need for medical treatment, weight gain, delivery route, birthweight, macrosomia, or neonatal morbidities. CONCLUSION More than 10% of patients in our cohort had an early screening HgbA1c value of 5.7-6.4%. Women in this group have a significantly higher risk of progression to GDM compared with women with normal HgbA1c values and should be considered for closer GDM surveillance and possible intervention.
Collapse
|
18
|
Abstract
Diabetes in pregnancy represents a risk condition for adverse maternal and feto-neonatal outcomes and many of these complications might occur during labor and delivery. In this context, the obstetrician managing women with pre-existing and gestational diabetes should consider (1) how these conditions might affect labor and delivery outcomes; (2) what are the current recommendations on management; and (3) which other factors should be considered to decide about the timing and mode of delivery. The analysis of the studies considered in this review leads to the conclusion that the decision to deliver should be primarily intended to reduce the risk of stillbirth, macrosomia, and shoulder dystocia. In this context, this review provides useful information for managing specific subgroups of diabetic women that may present overlapping risk factors, such as women with insulin-requiring diabetes and/or obesity and/or prenatal suspicion of macrosomic fetus. To date, the lack of definitive evidences and the complexity of the problem suggest that the "appropriate" clinical management should be customized according with the clinical condition, the type and mode of intervention, its consequences on outcomes, and considering the woman's consent and informed decisions.
Collapse
Affiliation(s)
- Gianpaolo Maso
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, 34137, Italy,
| | | | | | | | | |
Collapse
|
19
|
Keller-Wood M, Feng X, Wood CE, Richards E, Anthony RV, Dahl GE, Tao S. Elevated maternal cortisol leads to relative maternal hyperglycemia and increased stillbirth in ovine pregnancy. Am J Physiol Regul Integr Comp Physiol 2014; 307:R405-13. [PMID: 24920731 DOI: 10.1152/ajpregu.00530.2013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In normal pregnancy, cortisol increases; however, further pathological increases in cortisol are associated with maternal and fetal morbidities. These experiments were designed to test the hypothesis that increased maternal cortisol would increase maternal glucose concentrations, suppress fetal growth, and impair neonatal glucose homeostasis. Ewes were infused with cortisol (1 mg·kg(-1)·day(-1)) from day 115 of gestation to term; maternal glucose, insulin, ovine placental lactogen, estrone, progesterone, nonesterified free fatty acids (NEFA), β-hydroxybutyrate (BHB), and electrolytes were measured. Infusion of cortisol increased maternal glucose concentration and slowed the glucose disappearance after injection of glucose; maternal infusion of cortisol also increased the incidence of fetal death at or near parturition. The design of the study was altered to terminate the study prior to delivery, and post hoc analysis of the data was performed to test the hypothesis that maternal metabolic factors predict the fetal outcome. In cortisol-infused ewes that had stillborn lambs, plasma insulin was increased relative to control ewes or cortisol-infused ewes with live lambs. Maternal cortisol infusion did not alter maternal food intake or plasma NEFA, BHB, estrone, progesterone or placental lactogen concentrations, and it did not alter fetal body weight, ponderal index, or fetal organ weights. Our study suggests that the adverse effect of elevated maternal cortisol on pregnancy outcome may be related to the effects of cortisol on maternal glucose homeostasis, and that chronic maternal stress or adrenal hypersecretion of cortisol may create fetal pathophysiology paralleling some aspects of maternal gestational diabetes.
Collapse
Affiliation(s)
- Maureen Keller-Wood
- Department of Pharmacodynamics, University of Florida, Gainesville, Florida;
| | - Xiaodi Feng
- Department of Pharmacodynamics, University of Florida, Gainesville, Florida
| | - Charles E Wood
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Elaine Richards
- Department of Pharmacodynamics, University of Florida, Gainesville, Florida
| | - Russell V Anthony
- Department of Biomedical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | - Geoffrey E Dahl
- Department of Animal Sciences, University of Florida, Gainesville, Florida; and
| | - Sha Tao
- Department of Animal Sciences, University of Florida, Gainesville, Florida; and
| |
Collapse
|
20
|
Mitanchez D, Burguet A, Simeoni U. Infants born to mothers with gestational diabetes mellitus: mild neonatal effects, a long-term threat to global health. J Pediatr 2014; 164:445-50. [PMID: 24331686 DOI: 10.1016/j.jpeds.2013.10.076] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/23/2013] [Accepted: 10/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Delphine Mitanchez
- Division of Neonatology, Department of Perinatology, Armand Trousseau Hospital, Paris, France; Pierre et Marie Curie Paris 6 University, Faculté de Médecine, Paris, France.
| | - Antoine Burguet
- Division of Pediatrics 2, Hôpital du Bocage, Dijon Cedex, Paris, France; INSERM UMR S 953, Paris, France
| | - Umberto Simeoni
- Department of Neonatology, Assistance Publique - Hôpitaux de Marseille, Marseille, France; UMR608 INSERM, Aix-Marseille University, Marseille, France
| |
Collapse
|
21
|
Jorgensen M, McPherson E, Zaleski C, Shivaram P, Cold C. Stillbirth: the heart of the matter. Am J Med Genet A 2014; 164A:691-9. [PMID: 24459042 DOI: 10.1002/ajmg.a.36366] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/28/2013] [Indexed: 11/06/2022]
Abstract
We evaluated 2,083 cases within the Wisconsin Stillbirth Service Program (WiSSP) that had autopsy reports or ultrasound data relevant to the heart. Of these, 167/1,782 (9.4%) stillbirths after 20 weeks and 11/301 (3.7%) miscarriages <20 weeks had congenital heart disease (CHD). Cases were classified by type of heart defect and whether it related to cause of death. Among cardiac anomalies that contributed significantly to fetal death, 125/151 (83%) were associated with underlying conditions or syndromes, nearly half of which were chromosomal. The most common forms of CHD in stillborns were severe cyanotic lesions (3%), then ventricular (2.6%) and atrial (1.9%) septal defects. Compared to livebirths, this represents a shift toward more severe cardiac lesions, although all comparable categories, including non-lethal conditions such as atrial septal defect, are more common in stillbirths. Clinical cardiomyopathy was identified as cause of death in 1.2% of stillborns. Cardiomegaly, occurring in 26.7% of all cases and 76.7% of infants born to diabetic mothers, may represent undiagnosed cardiomyopathy and/or may decrease fetal tolerance of hypoxia. In contrast, 78.5% of Turner syndrome infants, all <32 weeks, had small hearts. More attention to cardiac findings can lead to increased understanding of stillbirth causes. Based on our findings, we recommend chromosome studies on all stillbirths and close attention to the heart during second trimester ultrasounds, with chromosome studies offered if CHD is found. Consideration of heart size can result in prenatal identification of infants at risk for stillbirth, particularly large hearts in fetuses of diabetic mothers in the third trimester, which may identify fetal cardiomyopathy before it becomes life-threatening.
Collapse
Affiliation(s)
- Michael Jorgensen
- Department of Medical Genetics Services, Marshfield Clinic, Marshfield, Wisconsin
| | | | | | | | | |
Collapse
|
22
|
Castori M. Diabetic embryopathy: a developmental perspective from fertilization to adulthood. Mol Syndromol 2013; 4:74-86. [PMID: 23653578 DOI: 10.1159/000345205] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Maternal diabetes mellitus is one of the strongest human teratogens. Despite recent advances in the fields of clinical embryology, experimental teratology and preventive medicine, diabetes-related perturbations of the maternofetal unit maintain a considerable impact on the Healthcare System. Classic consequences of prenatal exposure to hyperglycemia encompass (early) spontaneous abortions, perinatal death and malformations. The spectrum of related malformations comprises some recurrent blastogenic monotopic patterns, i.e. holoprosencephaly, caudal dysgenesis and oculoauriculovertebral spectrum, as well as pleiotropic syndromes, i.e. femoral hypoplasia-unusual face syndrome. Despite this, most malformed fetuses display multiple blastogenic defects of the VACTERL type, whose (apparently) casual combination preclude recognizing recurrent patterns, but accurately testifies to their developmental stage at onset. With the application of developmental biology in modern medicine, the effects of diabetes on the unborn patient are expanded to include the predisposition to develop insulin resistance in adulthood. The mechanisms underlying the transgenerational correlation between maternal diabetes and proneness to adult disorders in the offspring remain unclear, and the epigenetic plasticity may represent the missing link. In this scenario, a development-driven summary of the multifaced consequences of maternal diabetes on fertility and child health may add a practical resource to the repertoire of available information on early stages of embryogenesis.
Collapse
Affiliation(s)
- M Castori
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| |
Collapse
|
23
|
|
24
|
Strøm-Roum EM, Haavaldsen C, Tanbo TG, Eskild A. Placental weight relative to birthweight in pregnancies with maternal diabetes mellitus. Acta Obstet Gynecol Scand 2013; 92:783-9. [DOI: 10.1111/aogs.12104] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/19/2013] [Indexed: 01/07/2023]
Affiliation(s)
| | - Camilla Haavaldsen
- Department of Gynecology and Obstetrics; Akershus University Hospital and Institute of Clinical Medicine; University of Oslo; Lørenskog; Norway
| | - Tom G. Tanbo
- Department of Gynecology; Oslo University Hospital; Rikshospitalet and Institute of Clinical Medicine; University of Oslo; Oslo; Norway
| | | |
Collapse
|
25
|
Burmeister B, Zaleski C, Cold C, McPherson E. Wisconsin Stillbirth Service Program: Analysis of large for gestational age cases. Am J Med Genet A 2012; 158A:2493-8. [DOI: 10.1002/ajmg.a.35578] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 06/25/2012] [Indexed: 11/05/2022]
|
26
|
Magon N, Chauhan M. Pregnancy in Type 1 Diabetes Mellitus: How Special are Special Issues? NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:250-6. [PMID: 22754875 PMCID: PMC3385360 DOI: 10.4103/1947-2714.97202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
India leads the world with largest number of diabetics earning the dubious distinction of "the diabetes capital of the world." Diabetes is associated with maternal and perinatal morbidity and mortality. The number of pregnant women with pre-existing diabetes is increasing, mainly from an increase in type 2 diabetes, but also an increase in type 1 diabetes. Overall, type 1 diabetes accounts for approximately 5% to 10% of all diabetes outside of pregnancy, and in pregnancy put together with type 2 account for 10% of diabetic pregnancies. Management of the pregnant diabetic woman is a complex task that ideally begins before conception. Specific attention is required for diabetic pregnancies in different trimesters of pregnancy. Diabetes, especially type 1 diabetes, can be a challenge in pregnancy, but with education, close monitoring, and latest therapeutic modalities, these women can have healthy newborns. Close attention to diet, glycemic control, metabolic stresses, and early diagnosis and monitoring of complications can make pregnancy a successful experience for women with diabetes. A MedLine search was done to review relevant articles in English literature on diabetes and pregnancy, and specific issues related to pregnancy in type 1 diabetes were reviewed.
Collapse
Affiliation(s)
- Navneet Magon
- Department of Obstetrics and Gynaecology, Air Force Hospital, Nathu Singh Road, Kanpur Cantt, Uttar Pradesh, India
| | - Monica Chauhan
- Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, Madhya Pradesh, India
| |
Collapse
|
27
|
MacDorman MF. Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: an overview. Semin Perinatol 2011; 35:200-8. [PMID: 21798400 DOI: 10.1053/j.semperi.2011.02.017] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infant mortality, fetal mortality, and preterm birth all represent important health challenges that have shown little recent improvement. The rate of decrease in both fetal and infant mortality has slowed in recent years, with little decrease since 2000 for infant mortality, and no significant decrease from 2003 to 2005 for fetal mortality. The percentage of preterm births increased by 36% from 1984 to 2006, and then decreased by 4% from 2006 to 2008. There are substantial race and ethnic disparities in fetal and infant mortality and preterm birth, with non-Hispanic black women at greatest risk of unfavorable birth outcomes, followed by American Indian and Puerto Rican women. Infant mortality, fetal mortality, and preterm birth are multifactorial and interrelated problems with similarities in etiology, risk factors and disease pathways. Preterm birth prevention is critical to lowering the infant mortality rate, and to reducing race and ethnic disparities in infant mortality.
Collapse
Affiliation(s)
- Marian F MacDorman
- Reproductive Statistics Branch, Division of Vital Statistics, NCHS, Hyattsville, MD 20782, USA.
| |
Collapse
|
28
|
Mitanchez D. Foetal and neonatal complications in gestational diabetes: perinatal mortality, congenital malformations, macrosomia, shoulder dystocia, birth injuries, neonatal complications. DIABETES & METABOLISM 2011; 36:617-27. [PMID: 21163425 DOI: 10.1016/j.diabet.2010.11.013] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the risks of perinatal complications in infants born to mothers with treated or untreated gestational diabetes mellitus (GDM). METHODS A search of the PubMed database was performed and recommendations from NICE and the French National Authority for Health were consulted. RESULTS Untreated moderate or severe GDM increases the risk of foetal and neonatal complications (EL1). The risk of malformations slightly increases in newborns of mothers with GDM compared to the general population (EL2). This risk is probably associated with the presence of undiagnosed type 2 diabetes among patients with GDM (EL2). There is a linear relationship between maternal blood glucose levels and an increased birth weight (EL2). Treatment for GDM reduces the incidence of macrosomia (EL1). Although the risk of cardiomyopathy in cases of GDM cannot be accurately estimated based on the available data, severe clinical forms are rare. The risks of neonatal asphyxia and perinatal mortality are no higher in infants born to women with GDM (EL2). Birth injuries and brachial plexus injuries are rare, and no more likely to occur in cases of untreated GDM. It is difficult to assess the risk of respiratory distress, regardless of its cause. It is not possible to establish a link between GDM and neonatal respiratory problems due to insufficient data. Although the risk of neonatal hypoglycaemia is difficult to determine due to the variable definitions reported in the literature, the incidence of hypoglycaemia requiring intravenous therapy is low (EL1). The risks of hypocalcaemia (EL4) and hyperbilirubinemia (EL1) are similar to the general population. CONCLUSION Serious perinatal complications specifically associated with GDM are rare. Macrosomia has been demonstrated to be the predominant adverse outcome in cases of GDM. It is the main factor linked to reported cases of complications in GDM. Maternal obesity is an additional risk factor for complications, regardless of diabetes status.
Collapse
Affiliation(s)
- D Mitanchez
- Université Pierre et Marie Curie, Faculté de médecine, Pôle de périnatalité, Service de néonatologie, AP-HP, Hôpital Armand Trousseau, 75571 Paris Cedex 12, France.
| |
Collapse
|
29
|
Abstract
The prevalence of preexisting diabetes in pregnancy is increasing largely because of an increase in type 2 diabetes. Outcomes of diabetic pregnancies for mother and newborn have improved greatly in recent decades from advances in understanding the disease process, improved education, and new treatment modalities delivered in a team approach. Nausea and vomiting from pregnancy and pregnancy-associated insulin resistance can make glycemic control a challenge. Care of women with preexisting diabetes demands careful monitoring in the preconception, prenatal, and peripartum periods.
Collapse
Affiliation(s)
- Gabriella Pridjian
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, SL11, Tulane University Medical School, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
| |
Collapse
|
30
|
Thiebaugeorges O, Guyard-Boileau B. [Obstetrical care in gestational diabetes and management of preterm labor]. J Gynecol Obstet Hum Reprod 2010; 39:S264-S273. [PMID: 21185476 DOI: 10.1016/s0368-2315(10)70052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Search for data necessary to elaborate recommendations for obstetrical care in gestational diabetes and management of preterm labor. METHODS Systematic review of the literature and levels of evidence. RESULTS In case of gestational diabetes and in the absence of disease or other risk factor associated, there is no evidence to support a systematic rate of clinical follow up different from other pregnancy. The relevance of ultrasound estimates of fetal weight is limited. No formula is superior to others or to the simple measurement of abdominal circumference for the prediction of macrosomia (EL3). The usefulness of the research septal hypertrophy is not demonstrated (EL4). The systematic application of umbilical Doppler has no proven benefits in the absence of growth restriction or hypertension associated (EL4). Monthly ultrasound monitoring of the fetus can be proposed for diabetics on insulin or poorly controlled. In cases of gestational diabetes controlled by diet, cardiotocography of fetal heart rate has not proven useful. In poorly controlled diabetes and/or on insulin, the registration may be discussed taking into account other risk factors associated (EL4). A weekly recording of fetal heart rate is often recommended in case of type 2 diabetes discovered during pregnancy. In case of preterm labor, calcium channel blockers and oxytocin antagonists can be used without specific precautions. The risk of using beta-adrenergic outweighs the benefit. Administration of corticosteroid can be done under glycemic control, with insulin therapy if necessary. Screening test for gestational diabetes should not be performed within few days after last steroid injection.
Collapse
Affiliation(s)
- O Thiebaugeorges
- Service obstétrique, maternité régionale universitaire de Nancy, 10 rue du Dr Heydenreich, 54000 Nancy, France.
| | | |
Collapse
|
31
|
Thiebaugeorges O, Guyard-Boileau B. Obstetrical care in gestational diabetes and management of preterm labour. DIABETES & METABOLISM 2010; 36:672-81. [DOI: 10.1016/j.diabet.2010.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
32
|
Mitanchez D. Complications fœtales et néonatales du diagnostic gestationnel : mortalité périnatale, malformations congénitales, macrosomie, dystocie des épaules, traumatisme obstétrical, complications néonatales. ACTA ACUST UNITED AC 2010; 39:S189-99. [DOI: 10.1016/s0368-2315(10)70046-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
33
|
Diabetes crisis in pregnancy: a case report. J Perinat Neonatal Nurs 2009; 23:131-40. [PMID: 19474583 DOI: 10.1097/jpn.0b013e3181a2c044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optimal maternal, fetal, and neonatal outcomes are the goal of care for pregnant women with preexisting diabetes. Women with a long history of poorly managed diabetes begin pregnancy with a deficit that poses additional challenges for the patient and the healthcare team. The following case study presents a woman who had a history of type 1 diabetes that was poorly controlled and experienced an incidence of severe hypoglycemia with serious sequelae.
Collapse
|