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Francis EC, Powe CE, Lowe WL, White SL, Scholtens DM, Yang J, Zhu Y, Zhang C, Hivert MF, Kwak SH, Sweeting A. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2023; 3:185. [PMID: 38110524 PMCID: PMC10728189 DOI: 10.1038/s43856-023-00393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. METHODS Systematic literature searches were performed in PubMed and EMBASE from inception to March 2022 for studies comparing perinatal outcomes among women with GDM. We searched for precision markers in the following categories: maternal anthropometrics, clinical/sociocultural factors, non-glycemic biochemical markers, genetics/genomics or other -omics, and fetal biometry. We conducted post-hoc meta-analyses of a subset of studies with data on the association of maternal body mass index (BMI, kg/m2) with offspring macrosomia or large-for-gestational age (LGA). RESULTS A total of 5905 titles/abstracts were screened, 775 full-texts reviewed, and 137 studies synthesized. Maternal anthropometrics were the most frequent risk marker. Meta-analysis demonstrated that women with GDM and overweight/obesity vs. GDM with normal range BMI are at higher risk of offspring macrosomia (13 studies [n = 28,763]; odds ratio [OR] 2.65; 95% Confidence Interval [CI] 1.91, 3.68), and LGA (10 studies [n = 20,070]; OR 2.23; 95% CI 2.00, 2.49). Lipids and insulin resistance/secretion indices were the most studied non-glycemic biochemical markers, with increased triglycerides and insulin resistance generally associated with greater risk of offspring macrosomia or LGA. Studies evaluating other markers had inconsistent findings as to whether they could be used as precision markers. CONCLUSIONS Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. Future studies examining non-glycemic biochemical, genetic, other -omic, or sociocultural precision markers among women with GDM are warranted.
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Affiliation(s)
- Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiaxi Yang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Arslanca SB, Caglar AT. Comprehensive analysis of macrosomia: exploring the association between first-trimester alanine aminotransferase and uric acid measurements in pregnant women. J Perinat Med 2023; 51:1040-1045. [PMID: 37490106 DOI: 10.1515/jpm-2023-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Investigating the relationship between liver enzymes, uric acid (UA), and macrosomia will benefit physicians in the early detection of complications that may emerge during/after pregnancy. The study analyzed liver enzyme activity and UA levels in first-trimester pregnant for the risk of macrosomia. METHODS This retrospective cross-sectional research analyzed the data of pregnant women who gave birth between Jan 2021-2023. All data were extracted from medical records, and UA and AST-ALT were examined in all the participants. RESULTS Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in the macrosomia (p<0.05). Similarly, UA levels were higher in the macrosomia (p<0.001). There was a moderate positive correlation between ALT and birth weight (r=0.168, p<0.01), while we found a strong positive correlation between UA and birth weight (r=0.355, p<0.01). In the ROC (receiver operating characteristic), Area Under the Curve (AUC) for ALT and UA was significant (p<0.0001) but not for AST (p=0.157). UA showed a predictive value for macrosomia with 68.1 % sensitivity and 63.8 % specificity at a 3.15 cut-off (AUC:0.689; p:0.0001; CI:0.644-0.725). CONCLUSIONS These results indicate that ALT and UA may be potentially important in determining the risk of macrosomia. The UA had a more potent marker for macrosomia than ALT. The occurrence of macrosomia might be more closely related to the mother's metabolic syndrome rather than NAFLD.
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You Y, Hu H, Cao C, Han Y, Tang J, Zhao W. Association between the triglyceride to high-density lipoprotein cholesterol ratio and the risk of gestational diabetes mellitus: a second analysis based on data from a prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1153072. [PMID: 37576966 PMCID: PMC10415043 DOI: 10.3389/fendo.2023.1153072] [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: 01/28/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023] Open
Abstract
Background Although there is strong evidence linking triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio to insulin resistance and diabetes mellitus, its clinical importance in pregnant women has not been well determined. This study sought to determine the connection between the TG/HDL-C ratio in the first trimester and the eventual onset of gestational diabetes mellitus (GDM). Methods We performed a secondary analysis of open-access data from a prospective cohort study. This present study included 590 singleton pregnant women at 10-14 weeks who visited the outpatient clinics for prenatal checks and were recorded at Incheon Seoul Women's Hospital and Seoul Metropolitan Government Seoul National University Boramae Medical Center in Korea. A binary logistic regression model, a series of sensitivity analyses, and subgroup analysis were used to examine the relationship between TG/HDL-C ratio and incident GDM. A receiver operating characteristic (ROC) analysis was also conducted to assess the ability of the TG/HDL-C ratio to predict GDM. Results The mean age of the included individuals was 32.06 ± 3.80 years old. The mean TG/HDL-C ratio was 1.96 ± 1.09. The incidence rate of GDM was 6.27%. After adjustment for potentially confounding variables, TG/HDL-C ratio was positively associated with incident GDM (OR=1.77, 95%CI: 1.32-2.38, P=0.0001). Sensitivity analyses and subgroup analysis demonstrated the validity of the relationship between the TG/HDL-C ratio and GDM. The TG/HDL-C ratio was a good predictor of GDM, with an area under the ROC curve of 0.7863 (95% CI: 0.7090-0.8637). The optimal TG/HDL-C ratio cut-off value for detecting GDM was 2.2684, with a sensitivity of 72.97% and specificity of 75.05%. Conclusion Our results demonstrate that the elevated TG/HDL-C ratio is related to incident GDM. The TG/HDL-C ratio at 10-14 weeks could help identify pregnant women at risk for GDM and may make it possible for them to receive early and effective treatment to improve their prognosis.
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Affiliation(s)
- Yun You
- Department of Obstetrics, Shantou University Medical College, Shantou, Guangdong, China
- Department of Obstetrics, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Jie Tang
- Department of Obstetrics, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Weihua Zhao
- Department of Obstetrics, Shantou University Medical College, Shantou, Guangdong, China
- Department of Obstetrics, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
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Wan Y, Chen Y, Wu X, Yin A, Tian F, Zhang H, Huang X, Wu L, Niu J. Mediation effect of maternal triglyceride and fasting glucose level on the relationship between maternal overweight/ obesity and fetal growth: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:449. [PMID: 37328759 PMCID: PMC10276493 DOI: 10.1186/s12884-023-05716-0] [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: 02/01/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Previous studies have suggested that maternal overweight/obesity is asscociated with macrosomia. The present study aimed to investigate the mediation effects of fasting plasma glucose (FPG) and maternal triglyceride (mTG) in the relationship between maternal overweight/obesity and large for gestational age (LGA) among non-diabetes pregnant women. METHODS This prospective cohort study was conducted in Shenzhen from 2017 to 2021. A total of 19,104 singleton term non-diabetic pregnancies were enrolled form a birth cohort study. FPG and mTG were measured at 24-28 weeks. We analyzed the association of maternal prepregancy overweight/obesity with LGA and mediation effects of FPG and mTG. Multivariable logistic regression analysis and serial multiple mediation analysis were performed. The odds ratio (OR) and 95% confidence intervals (CIs) were calculated. RESULTS Mothers who were overweight or obese had higher odds of giving birth to LGA after adjusting potential confounders (OR:1.88, 95%CI: 1.60-2.21; OR:2.72, 95%CI: 1.93-3.84, respectively). The serial multiple mediation analysis found prepregnancy overweight can not only have a direct positive effect on LGA (effect = 0.043, 95% CI: 0.028-0.058), but also have an indirect effect on the LGA through two paths: the independent mediating role of FPG (effect = 0.004, 95% CI: 0.002-0.005); the independent mediating role of mTG (effect = 0.003,95% CI: 0.002-0.005). The chain mediating role of FPG and mTG has no indirect effect. The estimated proportions mediated by FPG and mTG were 7.8% and 5.9%. Besides, the prepregnancy obesity also has a direct effect on LGA (effect = 0.076; 95%CI: 0.037-0.118) and an indirect effect on LGA through three paths: the independent mediating role of FPG (effect = 0.006; 95%CI: 0.004-0.009); the independent mediating role of mTG (effect = 0.006; 95%CI: 0.003-0.008), and the chain mediating role of FPG and mTG (effect = 0.001; 95%CI: 0.000-0.001). The estimated proportions were 6.7%, 6.7%, and 1.1%, respectively. CONCLUSION This study found that in nondiabetic women, maternal overweight/obesity was associated with the occurence of LGA, and this positive association was partly mediated by FPG and mTG, suggesting that FPG and mTG in overweight/obese nondiabetic mothers deserve the attention of clinicians.
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Affiliation(s)
- Yanmei Wan
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Yixuan Chen
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Xiaoxia Wu
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Aiqi Yin
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Fuying Tian
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Huafan Zhang
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Xuna Huang
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Linlin Wu
- Department of Obstetrics and Gynecology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.
| | - Jianmin Niu
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China.
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Gleason B, Kuang A, Bain JR, Muehlbauer MJ, Ilkayeva OR, Scholtens DM, Lowe WL. Association of Maternal Metabolites and Metabolite Networks with Newborn Outcomes in a Multi-Ancestry Cohort. Metabolites 2023; 13:metabo13040505. [PMID: 37110162 PMCID: PMC10145069 DOI: 10.3390/metabo13040505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
The in utero environment is important for newborn size at birth, which is associated with childhood adiposity. We examined associations between maternal metabolite levels and newborn birthweight, sum of skinfolds (SSF), and cord C-peptide in a multinational and multi-ancestry cohort of 2337 mother–newborn dyads. Targeted and untargeted metabolomic assays were performed on fasting and 1 h maternal serum samples collected during an oral glucose tolerance test performed at 24–32 week gestation in women participating in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Anthropometric measurements were obtained on newborns at birth. Following adjustment for maternal BMI and glucose, per-metabolite analyses demonstrated significant associations between maternal metabolite levels and birthweight, SSF, and cord C-peptide. In the fasting state, triglycerides were positively associated and several long-chain acylcarnitines were inversely associated with birthweight and SSF. At 1 h, additional metabolites including branched-chain amino acids, proline, and alanine were positively associated with newborn outcomes. Network analyses demonstrated distinct clusters of inter-connected metabolites significantly associated with newborn phenotypes. In conclusion, numerous maternal metabolites during pregnancy are significantly associated with newborn birthweight, SSF, and cord C-peptide independent of maternal BMI and glucose, suggesting that metabolites in addition to glucose contribute to newborn size at birth and adiposity.
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Asltoghiri M, Moghaddam-Banaem L, Behboudi-Gandevani S, Rahimi Froushani A, Ramezani Tehrani F. Prediction of adverse pregnancy outcomes by first-trimester components of metabolic syndrome: a prospective longitudinal study. Arch Gynecol Obstet 2023; 307:1613-1623. [PMID: 36869203 DOI: 10.1007/s00404-023-06967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 02/05/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE This study aimed to identify the optimal cutoff values of each component of metabolic syndrome (MetS) in the first trimester of pregnancy for predicting adverse pregnancy outcomes. METHODS A total of 1076 pregnant women in the first trimester of gestation were recruited in this prospective longitudinal cohort study. Specifically, 993 pregnant women at 11-13 weeks of gestation who were followed up until the end of pregnancy were included in the final analysis. The cutoff values of each component of MetS in the occurrence of adverse pregnancy outcomes including gestational diabetes (GDM), gestational hypertensive disorders, and preterm birth were obtained via receiver operating characteristic (ROC) curve analysis using the Youden's index. RESULTS Among the 993 pregnant women studied, the significant associations between the first trimester MetS components and adverse pregnancy outcomes were as follows: triglyceride (TG) and body mass index (BMI) with preterm birth; mean arterial pressure (MAP), TG, and high-density lipoprotein cholesterol (HDL-C) with gestational hypertensive disorders; BMI, fasting plasma glucose (FPG), and TG with GDM (all p values < 0.05). The cutoff point values for the above-mentioned MetS components were: TG > 138 mg/dl and BMI < 21 kg/m2 for the occurrence of preterm birth; TG > 148 mg/dL, MAP > 84, and HDL-C < 84 mg/dl for gestational hypertensive disorders; BMI > 25 kg/m2, FPG > 84 mg/dl, and TG > 161 mg/dl for GDM. CONCLUSION The study findings imply the importance of early management of metabolic syndrome in pregnancy to improve maternal-fetal outcomes.
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Affiliation(s)
- Maryam Asltoghiri
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Lida Moghaddam-Banaem
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | | | - Abbas Rahimi Froushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pielesz A, Biniaś D, Waksmańska W, Bobiński R. Lipid bands of approx. 1740 cm -1 as spectral biomarkers and image of tissue oxidative stress. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2023; 286:121926. [PMID: 36257216 DOI: 10.1016/j.saa.2022.121926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Studies with the use of FTIR and FTR methods to find spectroscopic biomarkers within the 1740 cm-1 band of pathological tissues found that oxidative stress, including damage to epidermis and structural changes in pathological amnion and placenta tissue, are associated with the occurrence of products of lipid peroxidation and have impact on fluidity and transport function of membranes. In particular, the findings show that the absence of a marker lipid band of approx. 1743 cm-1 and the occurrence of a minimum of 1764 cm-1 (FTIR) and 1734 cm-1 (FTR) testify to the integrity and absence of damage in the allogeneic dermis, while the presence the 1743 or 1747 cm-1 bands indicates denaturation of the thermally or electrically burned epidermis. The absence of a marker lipid band of approx. 1736-1740 cm-1 for a healthy placental and amniotic tissue and the presence of a band of 1740 cm-1 indicate placental gestosis, while the presence of a band of 1742 cm-1 indicates hypotrophy. The 1738 cm-1 bands indicate amniotic macrosomia. Structural changes caused by tissue modification with antioxidants, which were observed on individual samples: the L-ascorbic acid (presence of a lipid band marker at a frequency of 1755 cm-1), sodium ascorbate (disappearance of the marker band), orthosilicic acid (disappearance or decrease in the intensity of the marker band with a decrease in the concentration of the modifier), as well as graphene oxide (separation of the marker lipid band of 1755 cm-1), inform us about the effect of modifiers on the tissue repair process. The studies also tracked spectral changes identified in serum. Withing the range of the lipid band and the amide I and II bands (α → β conversion), there are clear differences between normal and pathological serum lyophilisates and a sample analyzed from the solution.
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Affiliation(s)
- Anna Pielesz
- University of Bielsko-Biała, Faculty of Materials, Civil and Environmental Engineering, ul. Willowa 2, 43-300 Bielsko-Biała, Poland.
| | - Dorota Biniaś
- University of Bielsko-Biała, Faculty of Materials, Civil and Environmental Engineering, ul. Willowa 2, 43-300 Bielsko-Biała, Poland
| | - Wioletta Waksmańska
- University of Bielsko-Biała, Faculty of Health Sciences, ul. Willowa 2, 43-300 Bielsko-Biała, Poland
| | - Rafał Bobiński
- University of Bielsko-Biała, Faculty of Health Sciences, ul. Willowa 2, 43-300 Bielsko-Biała, Poland
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Bulut AN, Ceyhan V, Dolanbay M. Can alanine aminotransferase measured in early pregnancy predict macrosomia? J OBSTET GYNAECOL 2022; 42:1799-1802. [PMID: 35275022 DOI: 10.1080/01443615.2022.2039905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a part of the metabolic syndrome and is associated with adverse pregnancy outcomes. The aim of this study was to determine whether unexplained elevated ALT in early pregnancy has any effect in the prediction of large for gestational age (LGA) infants. In this study, the relationship between birth weights of LGA babies and babies with normal weight for gestational age (AGA) and ALT values measured in early pregnancy was evaluated. While a positive, moderately strong, statistically significant correlation was found between infant birth weight and ALT levels in LGA babies this correlation was continued when GDM was not detected and ALT levels were below 36 U/L. Foetal macrosomia, which can develop in advanced gestational weeks, can be predicted with this cheap, easy and simple method that can be checked in the first trimester and pregnancy follow-up can be shaped accordingly.IMPACT STATEMENTWhat is already known on this subject? It is suggested that asymptomatic high ALT values measured in the first trimester can predict a macrosomic foetus.What do the results of this study add? Asymptomatic elevated ALT values measured in the first trimester can predict a macrosomic foetus.What are the implications of these findings for clinical practice and/or further research? Macrosomic foetus development can be predicted with abnormal results obtained with this simple, cheap and easy measurement method measured in the first trimester and pregnancy follow-up can be managed accordingly.
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Affiliation(s)
- Ayca Nazli Bulut
- Department of Obstetrics and Gynecology, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Venhar Ceyhan
- Department of Obstetrics and Gynecology, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Mehmet Dolanbay
- Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Ye X, Li Z, Li Y, Cai Q, Sun L, Zhu W, Ding X, Guo D, Qin Y, Lu X. Reduced mechanical function of the left atrial predicts adverse outcome in pregnant women with clustering of metabolic risk factors. BMC Cardiovasc Disord 2021; 21:265. [PMID: 34051751 PMCID: PMC8164318 DOI: 10.1186/s12872-021-02082-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The left atrial (LA) strain and strain rate are sensitive indicators of LA function. However, they are not widely used for the evaluation of pregnant women with metabolic diseases. The aim of this study was to assess the LA strain and strain rate of pregnant women with clustering of metabolic risk factors and to explore its prognostic effect on adverse pregnancy outcomes. MATERIALS AND METHODS Sixty-three pregnant women with a clustering of metabolic risk factors (CMR group), fifty-seven women with pregnancy-induced hypertension (PIH group), fifty-seven women with gestational diabetes mellitus (GDM group), and fifty matched healthy pregnant women (control group) were retrospectively evaluated. LA function was evaluated with two-dimensional speckle-tracking imaging. Iatrogenic preterm delivery caused by severe preeclampsia, placental abruption, and fetal distress was regarded as the primary adverse outcome. RESULTS The CMR group showed the lowest LA strain during reservoir phase (LASr), strain during contraction phase (LASct) and peak strain rate during conduit phase (pLASRcd) among the three groups (P < 0.05). LA strain during conduit phase (LAScd) and peak strain rate during reservoir phase (pLASRr) in the CMR group were lower than those in the control and GDM groups (P < 0.05). Multivariable Cox regression analysis demonstrated systolic blood pressure (HR = 1.03, 95% CI 1.01-1.05, p = 0.001) and LASr (HR = 0.86, 95% CI 0.80-0.92, p < 0.0001) to be independent predictors of iatrogenic preterm delivery. An LASr cutoff value ≤ 38.35% predicted the occurrence of iatrogenic preterm delivery. CONCLUSIONS LA mechanical function in pregnant women with metabolic aggregation is deteriorated. An LASr value of 38.35% or less may indicate the occurrence of adverse pregnancy outcomes.
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Affiliation(s)
- Xiaoguang Ye
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Zhitian Li
- Department of Thoracic Surgery, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China
| | - Yidan Li
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Qizhe Cai
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Lanlan Sun
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xueyan Ding
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Dichen Guo
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yunyun Qin
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing ChaoYang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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Liu PJ, Liu Y, Ma L, Yao AM, Chen XY, Hou YX, Wu LP, Xia LY. The Predictive Ability of Two Triglyceride-Associated Indices for Gestational Diabetes Mellitus and Large for Gestational Age Infant Among Chinese Pregnancies: A Preliminary Cohort Study. Diabetes Metab Syndr Obes 2020; 13:2025-2035. [PMID: 32606861 PMCID: PMC7305827 DOI: 10.2147/dmso.s251846] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/27/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS To investigate the potential of maternal first-trimester triglyceride (TG) to high-density lipoprotein cholesterol (TG/HDL-c) ratio, triglyceride glucose index (TyG) and total cholesterol (TC)/HDL-c to predict the risk of later gestational diabetes mellitus (GDM) and large for gestational age (LGA) newborn in Chinese women. METHODS We included 352 women with a singleton pregnancy, who were followed up prospectively from the first prenatal visit until delivery. Fasting glucose and plasma lipid profiles including TG, TC, HDL-c, and low-density lipoprotein cholesterol (LDL-c) were measured in the first trimester. A binary logistic regression analysis was performed to determine the odds ratios (ORs) and 95% confidence intervals (CIs) of GDM and LGA according to tertiles of those indices, respectively. Receiver-operating characteristic curve (ROC) and areas under the curve (AUC) were employed to evaluate the ability of those indices to predict the risk of GDM and LGA infants, and differences in the AUC values between them were compared. RESULTS Women with the top tertile of TG/HDL-c or TyG other than TC/HDL-c had a significantly higher risk of GDM (ORTG/HDL-c=2.388, 95% CI 1.026-5.467; ORTyG=3.535, 95% CI 1.483-8.426, respectively) and LGA infant delivery (ORTG/HDL-c=3.742, 95% CI 1.114-12.569; ORTyG=3.011, 95% CI 1.012-8.962, respectively) than women with the lowest tertile of TG/HDL-c or TyG after adjusting for confounders. The AUC of TG/HDL-c and TyG to detect GDM was 0.664 (95% CI 0.595-0.733) and 0.686 (95% CI 0.615-0.756), respectively, and that to detect LGA was 0.646 (95% CI 0.559-0.734) and 0.643 (95% CI 0.552-0.735), respectively (all P < 0.01). There were no statistical differences between TG/HDL-c and TyG in the ability of predicting the risk of GDM or LGA infants. CONCLUSION Maternal first-trimester TG/HDL-c and TyG are both good indicators in predicting the risk of later GDM and LGA newborn, and it may be useful to evaluate them in early pregnancy.
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Affiliation(s)
- Peng Ju Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yanping Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Yanping Liu Tel +86-10-69159081Fax +86-10-69155551 Email
| | - Liangkun Ma
- Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ai Min Yao
- Department of Gynaecology and Obstetrics, Shunyi District Maternal and Child Health Hospital, Beijing, People’s Republic of China
| | - Xiao Yan Chen
- Department of Gynaecology and Obstetrics, Quanzhou Maternal and Child Health Hospital, Fujian, People’s Republic of China
| | - Yi Xuan Hou
- Peking Union Medical College School of Nursing, Beijing, People’s Republic of China
| | - Li Ping Wu
- Peking Union Medical College School of Nursing, Beijing, People’s Republic of China
| | - Liang Yu Xia
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
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Samsuddin S, Arumugam PA, Md Amin MS, Yahya A, Musa N, Lim LL, Paramasivam SS, Ratnasingam J, Ibrahim L, Chooi KC, Tan A, Tan PC, Omar SZ, Samingan N, Ahmad Kamar A, Anuar Zaini A, Jalaluddin MY, Vethakkan SR. Maternal lipids are associated with newborn adiposity, independent of GDM status, obesity and insulin resistance: a prospective observational cohort study. BJOG 2019; 127:490-499. [PMID: 31778255 DOI: 10.1111/1471-0528.16031] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs. DESIGN Prospective observational cohort study. SETTING Single tertiary multidisciplinary antenatal clinic in Malaysia. POPULATION A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI ≥ 27.5 kg/m2 ), and 268 who were not obese with NGT. METHODS Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36 weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records. MAIN OUTCOME MEASURES Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT) > 90th centile. RESULTS Fasting Tg > 95th centile (3.6 mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95% CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95% CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of <23 kg/m2 and 61% had a pre-gravid BMI of ≤ 25 kg/m2 , yet a GWG of >10 kg was associated with a 4.25-fold risk (95% CI 1.71-10.53) of BWR > 90th centile. CONCLUSION Maternal lipaemia and GWG at a low threshold (>10 kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy. TWEETABLE ABSTRACT Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance.
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Affiliation(s)
- S Samsuddin
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - P A Arumugam
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Md S Md Amin
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - A Yahya
- Department of Social and Preventive Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - N Musa
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - L-L Lim
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - S S Paramasivam
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - J Ratnasingam
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - L Ibrahim
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - K C Chooi
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Atb Tan
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - P C Tan
- Department of Obstetrics and Gynaecology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - S Z Omar
- Department of Obstetrics and Gynaecology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - N Samingan
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - A Ahmad Kamar
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - A Anuar Zaini
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - M Y Jalaluddin
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - S R Vethakkan
- Endocrine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Neonatal outcomes and its association among gestational diabetes mellitus with and without depression, anxiety and stress symptoms in Malaysia: A cross-sectional study. Midwifery 2019; 81:102586. [PMID: 31830674 DOI: 10.1016/j.midw.2019.102586] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Prevalence of depression, anxiety and stress symptoms in gestational diabetes mellitus ranges from 10.2% to 39.9% based on previous studies in Malaysia. Presence of depression, anxiety or stress in pregnancy may increase the risk of neonatal morbidity and mortality. The aim of this study was to determine the prevalence of neonatal outcomes and its association among mothers with gestational diabetes mellitus with and without the presence of depression, anxiety and stress symptoms in Malaysia. DESIGN This was a cross-sectional study. SETTING Tertiary hospitals in Malaysia. PARTICIPANTS Mothers with gestational diabetes mellitus (n = 418) who deliver their neonates at two major tertiary hospitals in Malaysia. MEASUREMENTS Neonatal outcomes, such as low birth weight, preterm birth, macrosomia, metabolic and electrolyte disorders, neonatal respiratory distress and congenital anomalies were determined. FINDINGS Prevalence of low birth weight in neonates born to mothers with gestational diabetes mellitus was 14.6%, followed by metabolic and electrolyte disorders 10.5%, preterm birth 9.1%, macrosomia 4.8%, neonatal respiratory distress 5.8% and congenital anomalies (2.4%). Among the adverse neonatal outcomes, neonatal respiratory distress was significantly associated with the presence of depression symptoms in mothers with gestational diabetes mellitus using univariate analysis (p = 0.010). After controlling for confounding factors, predictors for neonatal respiratory distress at delivery were the presence of depression symptoms in mothers with gestational diabetes mellitus (Adjusted OR = 3.87, 95% CI = 1.32-11.35), living without a husband (Adjusted OR = 9.74, 95% CI = 2.04-46.51), preterm delivery (Adjusted OR = 7.20, 95% CI = 2.23-23.30), caesarean section (Adjusted OR = 3.33, 95% CI = 1.09-10.15), being nulliparous and primiparous (Adjusted OR = 3.62, 95% CI = 1.17-11.17) and having family history of diabetes (Adjusted OR = 3.20, 95% CI = 1.11-9.21). KEY CONCLUSIONS The findings of this study demonstrate the positive association of neonatal respiratory distress with the presence of depression symptoms in mothers with gestational diabetes mellitus. IMPLICATIONS FOR PRACTICE It is therefore important to identify depression symptoms after a diagnosis of gestational diabetes mellitus in pregnant mothers is made to enable early referral and interventions.
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Bao H, Yu P, Song X, Zhou Y, Zhu Y, Xu X. The influence of home-based exercise on gestational diabetes: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2019; 33:2300-2305. [PMID: 30626247 DOI: 10.1080/14767058.2018.1548595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: The impact of home-based exercise for gestational diabetes remains controversial. We conduct a systematic review and meta-analysis to explore the influence of home-based exercise on glycemic control for gestational diabetes.Methods: We search PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through April 2018 for randomized controlled trials (RCTs) assessing the effect of home-based exercise on glycemic control for gestational diabetes.Results: Five RCTs involving 266 patients are included in the meta-analysis. Overall, compared with control group for gestational diabetes, home-based exercise shows no important impact on fasting glucose (std. MD =0.18; 95% CI = -0.11-0.46; p = .22), HbA1c (std. MD = -0.05; 95% CI = -0.32-0.22; p = .70), insulin requirement (risk ratios (RR) = 1.63; 95% CI =0.51-5.17; p = .41), insulin sensitivity index (std. MD = -0.18; 95% CI = -1.02-0.66; p = .67), gestational age at delivery (std. MD =0.01; 95% CI = -0.26-0.28; p = .95), preterm birth (RR =1.01; 95% CI =0.34-2.99; p = .99), birth weight (std. MD =0.06; 95% CI = -0.45-0.58; p = .81) and head circumference (std. MD =0.11; 95% CI = -0.16-0.38; p = .44).Conclusions: Home-based exercise demonstrates no substantial benefits to fasting glucose, HbA1c, insulin requirement, insulin sensitivity index, gestational age at delivery, preterm birth, birth weight and head circumference for gestational diabetes women.
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Affiliation(s)
- Hongdan Bao
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Endocrinology, Fourth hospital of Ningbo City, Ningbo, China
| | - Pingxiang Yu
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxiao Song
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yafen Zhou
- Department of Endocrinology, Fourth hospital of Ningbo City, Ningbo, China
| | - Yuyu Zhu
- Department of Endocrinology, Fourth hospital of Ningbo City, Ningbo, China
| | - Xiaohong Xu
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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