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Nicolazzi L, Gilbert L, Horsch A, Quansah DY, Puder JJ. Trajectories and associations of symptoms of mental health and well-being with insulin resistance and metabolic health in women with gestational diabetes. Psychoneuroendocrinology 2024; 160:106919. [PMID: 38091918 DOI: 10.1016/j.psyneuen.2023.106919] [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: 07/26/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is characterized by increased insulin resistance and carries perinatal and long-term risks for the mother and her offspring. There is a link between perinatal depression or anxiety and GDM. Mental health problems are associated with higher insulin resistance and could explain the underlying association between GDM and depression or anxiety symptoms. We investigated the trajectories and associations between symptoms of mental health and well-being with insulin resistance and metabolic health in women with GDM. METHODS This study included the control group (n = 106) of a randomized controlled trial in women with GDM that were followed-up during pregnancy and up to 1-year postpartum. We measured symptoms of mental health (Edinburgh Postnatal Depression Scale (EPDS), Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), well-being (The World Health Organization Well-Being Index (WHO-5)) and metabolic health, including insulin resistance variables (HOMA-insulin resistance (IR) and Matsuda Index of insulin sensitivity) as well as weight during pregnancy and in the postpartum. RESULTS Participants' pre pregnancy weight and BMI were 69.7 kg ± 16.1 and 25.9 kg/m2 ± 5.5 respectively. HOMA-IR was higher during pregnancy compared to 6-8 weeks postpartum and increased between 6-8 weeks and 1-year postpartum (all p < 0.05). Matsuda index decreased between 6-8 weeks and 1-year postpartum (p < 0.001). EPDS scores decreased between pregnancy and both 6-8 weeks and 1-year postpartum (all p < 0.05). HADS-A scores did not change between pregnancy and the postpartum. WHO-5 scores improved significantly from pregnancy and both 6-8 weeks and 1-year postpartum (p < 0.001). Correlation coefficients within outcome at the three different time points were high for metabolic measures and ranged between 0.94 and 0.96 for weight, from 0.77 to 0.89 for HOMA-IR and 0.64 for the Matsuda index (all p < 0.001). Mental health and well-being variables were moderately correlated in all three time points including r = 0.36-0.55 for the EPDS (p < 0.001), r = 0.58 for HADS (p < 0.001), and r = 0.43-0.52 for the WHO-5 (p < 0.01). After adjustment for age and pre-pregnancy BMI, Matsuda index was negatively associated with EPDS scores and positively associated to WHO-5 scores at 6-8 weeks postpartum. No other association between insulin resistance and mental health or well-being outcomes were found. CONCLUSION While insulin resistance fluctuated with values being lowest in the early postpartum and increasing thereafter, both depression and well-being scores decreased between pregnancy and the postpartum and did not change in the postpartum period. Intraindividual variability was larger for mental health and well-being than for metabolic health outcomes at different time points, indicating a higher plasticity for mental health and well-being outcomes that could be acted upon. We found only few associations between mental health and well-being and metabolic health outcomes.
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Affiliation(s)
- Ludmila Nicolazzi
- Department of Medicine, Internal Medicine service, Lausanne University Hospital, Lausanne, Switzerland.
| | - Leah Gilbert
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Switzerland; Neonatalogy Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Dan Yedu Quansah
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Jardena J Puder
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
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Benham JL, Gingras V, McLennan NM, Most J, Yamamoto JM, Aiken CE, Ozanne SE, Reynolds RM. Precision gestational diabetes treatment: a systematic review and meta-analyses. COMMUNICATIONS MEDICINE 2023; 3:135. [PMID: 37794196 PMCID: PMC10550921 DOI: 10.1038/s43856-023-00371-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) affects approximately 1 in 7 pregnancies globally. It is associated with short- and long-term risks for both mother and baby. Therefore, optimizing treatment to effectively treat the condition has wide-ranging beneficial effects. However, despite the known heterogeneity in GDM, treatment guidelines and approaches are generally standardized. We hypothesized that a precision medicine approach could be a tool for risk-stratification of women to streamline successful GDM management. With the relatively short timeframe available to treat GDM, commencing effective therapy earlier, with more rapid normalization of hyperglycaemia, could have benefits for both mother and fetus. METHODS We conducted two systematic reviews, to identify precision markers that may predict effective lifestyle and pharmacological interventions. RESULTS There was a paucity of studies examining precision lifestyle-based interventions for GDM highlighting the pressing need for further research in this area. We found a number of precision markers identified from routine clinical measures that may enable earlier identification of those requiring escalation of pharmacological therapy (to metformin, sulphonylureas or insulin). This included previous history of GDM, Body Mass Index and blood glucose concentrations at diagnosis. CONCLUSIONS Clinical measurements at diagnosis could potentially be used as precision markers in the treatment of GDM. Whether there are other sensitive markers that could be identified using more complex individual-level data, such as omics, and if these can feasibly be implemented in clinical practice remains unknown. These will be important to consider in future studies.
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Affiliation(s)
- Jamie L Benham
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Véronique Gingras
- Department of Nutrition, Université de Montréal, Montreal, QC, Canada
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Niamh-Maire McLennan
- MRC Centre for Reproductive Health, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jasper Most
- Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, the Rosie Hospital, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Susan E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
- Centre for Cardiovascular Science, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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Runkle JD, Risley K, Roy M, Sugg MM. Association Between Perinatal Mental Health and Pregnancy and Neonatal Complications: A Retrospective Birth Cohort Study. Womens Health Issues 2023; 33:289-299. [PMID: 36621340 PMCID: PMC10213085 DOI: 10.1016/j.whi.2022.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Maternal mental health as an important precursor to reproductive and neonatal complications remains understudied in the United States, particularly in the Southeastern region, despite high medical costs, maternal morbidity, and infant burden. This study sought to estimate the incidence of perinatal mental health disorders and the associated increased risk of leading pregnancy and infant complications. METHODS A population-based retrospective birth cohort of childbirth hospitalizations and readmissions was constructed for women in South Carolina, 1999 to 2017. Prevalence rates were calculated for perinatal mood and anxiety disorders (PMAD), severe mental illness, and mental disorders of pregnancy (MDP). Poisson regression models using generalized estimating equations were used to estimate adjusted relative risks for the association between mental health conditions and severe maternal morbidity, hypertensive disorders of pregnancy, gestational diabetes, cesarean section, preterm birth, and low birthweight. RESULTS The most prevalent maternal mental condition was MDP (3.9%), followed by PMAD (2.7%) and severe mental illness (0.13%). PMAD was associated with a higher risk of severe maternal morbidity, hypertensive disorders of pregnancy, and cesarean section, as well as a higher risk of preterm birth and low birthweight infants. Severe mental illness was associated with low birthweight, hypertensive disorders of pregnancy, and cesarean section. Pregnant populations with MDP were more at risk for severe maternal morbidity, preterm birth, hypertensive disorders of pregnancy, low birthweight, and cesarean section. Each maternal mental health outcome was associated with an increased risk for hospital readmissions up to 45 days after childbirth. CONCLUSIONS Results demonstrate the escalating burden of PMAD and MDP for pregnant populations over time, with important consequences related to maternal and infant morbidity.
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Affiliation(s)
- Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina.
| | - Kendra Risley
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina
| | - Manan Roy
- Department of Nutrition and Health Care Management, Appalachian State University, Boone, North Carolina
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
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Quansah DY, De Giorgi S, Le Dizes O, Camponovo C, Benhalima K, Cosson E, Puder JJ. Reactive hypoglycaemia during the OGTT after gestational diabetes mellitus: Metabolic implications and evolution. Diabet Med 2022; 39:e14920. [PMID: 35870144 PMCID: PMC9804199 DOI: 10.1111/dme.14920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/17/2022] [Accepted: 07/21/2022] [Indexed: 01/05/2023]
Abstract
AIMS Gestational diabetes (GDM) presents an increased cardio-metabolic risk and is diagnosed with an oral glucose tolerance test (OGTT). Reactive hypoglycaemia (RH) during the OGTT in pregnancy is associated with adverse outcomes. Although postpartum OGTT after GDM is recommended, the occurrence and implications of RH are unknown. We investigated the prevalence, metabolic implications and longitudinal evolution of RH at 6-8 weeks postpartum in women with a history of GDM. METHODS Between 2011 and 2021, we consecutively followed 1237 women with previous GDM undergoing an OGTT at 6-8 weeks postpartum. RH was defined as 2-h glucose <3.9 mmoL/L after the OGTT. Metabolic outcomes were compared in women with and without RH (RH+/RH-). We also included a subcohort of 191 women with data on insulin sensitivity/secretion indices (MATSUDA, HOMA-IR, insulin-adjusted-secretion ISSI-2). RESULTS The postpartum prevalence of RH was 12%. RH+ women had a more favourable metabolic profile including a 2-5-times lower prevalence of glucose intolerance and metabolic syndrome at 6-8 weeks postpartum compared to RH- (all p ≤ 0.034). In the subcohort, women with RH+ had higher insulin sensitivity, higher ISSI-2 and an earlier glucose peak after OGTT (p ≤ 0.049) compared to RH- women at the same time point. Insulin resistance increased and ISSI-2 decreased over the first year postpartum in both groups. These changes were associated with a 50% reduction in overall RH prevalence at 1-year postpartum. Some of the favourable profiles of RH+ persisted at 1-year postpartum, without group differences in the longitudinal metabolic changes. CONCLUSIONS At 6-8 weeks postpartum, RH was frequent in women after GDM and associated with a better metabolic profile including increased insulin sensitivity and higher insulin-adjusted-secretory capacity. RH might be a marker of favourable metabolic prognosis in women with a history of GDM.
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Affiliation(s)
- Dan Yedu Quansah
- Obstetric Service, Department Woman‐Mother‐ChildLausanne University HospitalLausanneSwitzerland
| | - Sara De Giorgi
- Service of Endocrinology, Diabetes and Metabolism, Department of MedicineLausanne University HospitalLausanneSwitzerland
| | - Olivier Le Dizes
- Service of Endocrinology, Diabetes and Metabolism, Department of MedicineLausanne University HospitalLausanneSwitzerland
| | - Chiara Camponovo
- Clinic for Endocrinology and Diabetology, Lugano Regional HospitalEnte Ospedaliero Cantonale (EOC)LuganoSwitzerland
| | | | - Emmanuel Cosson
- Department of Endocrinology‐Diabetology‐Nutrition, AP‐HPAvicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH‐IdF, CINFOBobignyFrance
- Sorbonne Paris CitéUMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13BobignyFrance
| | - Jardena J. Puder
- Obstetric Service, Department Woman‐Mother‐ChildLausanne University HospitalLausanneSwitzerland
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Gilbert L, Sandoz V, Quansah DY, Puder JJ, Horsch A. Prospective Associations Between Maternal Depression and Infant Sleep in Women With Gestational Diabetes Mellitus. Front Psychol 2022; 13:926315. [PMID: 35769757 PMCID: PMC9234523 DOI: 10.3389/fpsyg.2022.926315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 12/27/2022] Open
Abstract
BackgroundWomen with gestational diabetes mellitus have higher rates of perinatal depressive symptoms, compared to healthy pregnant women. In the general population, maternal depressive symptoms have been associated with infant sleep difficulties during the first year postpartum. However, there is lack of data on infants of mothers with gestational diabetes mellitus.MethodsThis study assessed the prospective associations between maternal perinatal depressive symptoms and infant sleep outcomes. The study population consisted of 95 Swiss women with gestational diabetes mellitus and their infants, enrolled in the control group of the MySweetheart trial (NCT02890693). Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale at the first gestational diabetes mellitus visit during pregnancy, at 6–8 weeks postpartum, and 1 year postpartum. The Brief Infant Sleep Questionnaire was used to assess infant sleep (i.e., nocturnal sleep duration, number of night waking, and maternal perception of infant sleep) at 1 year postpartum. Relevant maternal and infant measurements (e.g., infant sex or maternal age or social support) were collected or extracted from medical records as covariates.ResultsAntenatal maternal depressive symptoms at the first gestational diabetes mellitus visit were inversely associated with infant nocturnal sleep duration at 1 year postpartum (β = –5.9, p = 0.046). This association became marginally significant when covariates were added (β = –5.3, p = 0.057). Maternal depressive symptoms at 6–8 weeks postpartum were negatively and prospectively associated with infant nocturnal sleep duration (β = –9.35, p = 0.016), even when controlling for covariates (β = –7.32, p = 0.042). The association between maternal depressive symptoms and maternal perception of infant sleep as not a problem at all was significant at 1 year postpartum (β = –0.05, p = 0.006), although it became non-significant when controlling for appropriate covariates. No other significant associations were found.LimitationsThis study solely included measures derived from self-report validated questionnaires.ConclusionOur findings suggest it is of utmost importance to support women with gestational diabetes mellitus as a means to reduce the detrimental impact of maternal perinatal depressive symptoms on infant sleep, given its predictive role on infant metabolic health.
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Affiliation(s)
- Leah Gilbert
- Department Woman-Mother-Child, Interdisciplinary GDM Group Lausanne, Obstetric Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Vania Sandoz
- Faculty of Biology and Medicine, Lausanne Perinatal Research Group, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department Woman-Mother-Child, Child Abuse and Neglect Team, Lausanne University Hospital, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Department Woman-Mother-Child, Interdisciplinary GDM Group Lausanne, Obstetric Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J. Puder
- Department Woman-Mother-Child, Interdisciplinary GDM Group Lausanne, Obstetric Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Antje Horsch
- Faculty of Biology and Medicine, Lausanne Perinatal Research Group, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Neonatalogy Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- *Correspondence: Antje Horsch,
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Antoniou MC, Gilbert L, Gross J, Rossel JB, Fumeaux CJF, Vial Y, Puder JJ. Sex-dependent influence of maternal predictors on fetal anthropometry in pregnancies with gestational diabetes mellitus. BMC Pregnancy Childbirth 2022; 22:460. [PMID: 35650561 PMCID: PMC9158189 DOI: 10.1186/s12884-022-04767-z] [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: 12/23/2021] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Third trimester fetal anthropometric parameters are known to predict neonatal complications. A better understanding of predictors of adverse fetal parameters might help to personalize the use and frequency of fetal ultrasound. The objectives of this study were: (a) to evaluate the utility of maternal sociodemographic, anthropometric and metabolic predictors to predict 3rd trimester fetal anthropometric parameters in women with gestational diabetes mellitus (GDM), (b) to assess whether the impact of these maternal predictors is fetal sex-dependent, and (c) to provide a risk stratification for markers of fetal overgrowth (fetal weight centile (FWC) and fetal abdominal circumference centile (FACC) depending on prepregnancy BMI and gestational weight gain (GWG) until the 1st GDM visit. Methods This prospective study included 189 women with GDM. Maternal predictors were age, ethnicity, prepregnancy BMI, GWG and excessive weight gain until the 1st GDM visit, fasting, 1-hour and 2-hour blood glucose oral glucose tolerance test values, HbA1c at the 1st visit and medical treatment requirement. Fetal outcomes included FWC, FWC >90% and <10%, FACC, FACC >90% and <10%, at 29 0/7 to 35 6/7 weeks of gestational age. We performed univariate and multivariate regression analyses and probability analyses. Results In multivariate analyses, prepregnancy BMI was associated with FWC, FWC > 90% and FACC. GWG until the 1st GDM visit was associated with FWC, FACC and FACC > 90% (all p ≤ 0.045). Other maternal parameters were not significantly associated with fetal anthropometry in multivariate analyses (all p ≥ 0.054). In female fetuses, only GWG was associated with FACC (p= 0.044). However, in male fetuses, prepregnancy BMI was associated with FWC, FWC > 90% and FACC and GWG with FWC in multivariate analyses (all p ≤ 0.030). In women with a prepregnancy BMI of ≥ 25 kg/m2 and a GWG until the 1st GDM visit ≥ 10.3 kg (mean GWG), the risk for FWC > 90% and FACC > 90% was 5.3 and 4 times higher than in their counterparts. Conclusions A personalized fetal ultrasound surveillance guided by fetal sex, prepregnancy BMI and GWG may be beneficial in reducing adverse fetal and neonatal outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04767-z.
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Affiliation(s)
- Maria-Christina Antoniou
- Pediatric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland.
| | - Leah Gilbert
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland
| | - Justine Gross
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland.,Service of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne, 1011, Lausanne, Switzerland
| | - Jean-Benoît Rossel
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Céline Julie Fischer Fumeaux
- Clinic of Neonatology, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland
| | - Yvan Vial
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland
| | - Jardena Jacqueline Puder
- Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland
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Corcillo A, Quansah DY, Kosinski C, Benhalima K, Puder JJ. Impact of Risk Factors on Short and Long-Term Maternal and Neonatal Outcomes in Women With Gestational Diabetes Mellitus: A Prospective Longitudinal Cohort Study. Front Endocrinol (Lausanne) 2022; 13:866446. [PMID: 35795139 PMCID: PMC9251201 DOI: 10.3389/fendo.2022.866446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Universal screening of gestational diabetes mellitus (GDM) in women with no risk factors (RF) for GDM remains controversial. This study identified the impact of the presence of RF on perinatal and postpartum outcomes. METHODS This prospective cohort study included 780 women with GDM. GDM RF included previous GDM, first grade family history of type 2 diabetes, high-risk ethnicity and pre-pregnancy overweight/obesity (OW/OB). Outcomes included obstetrical, neonatal and maternal metabolic parameters during pregnancy and up to 1 year postpartum. RESULTS Out of 780 patients, 24% had no RF for GDM. Despite this, 40% of them needed medical treatment and they had a high prevalence of glucose intolerance of 21 and 27% at 6-8 weeks and 1-year postpartum, respectively. Despite similar treatment, women with RF had more neonatal and obstetrical complications, but they had especially more frequent adverse metabolic outcomes in the short- and long-term. The most important RF for poor perinatal outcome were previous GDM and pre-pregnancy OW/OB, whereas high-risk ethnicity and pre-pregnancy OW/OB were RF for adverse postpartum metabolic outcomes. Increasing number of RF were associated with worsened perinatal and long-term postpartum outcomes except for pregnancy-induced hypertension, C-section delivery and neonatal hypoglycaemia. CONCLUSION Women with no RF had a high prevalence of adverse perinatal and postpartum outcomes, while the presence of RF particularly increased the risk for postpartum adverse metabolic outcomes. This calls for a RF-based long-term follow-up of women with GDM.
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Affiliation(s)
- Antonella Corcillo
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
- *Correspondence: Antonella Corcillo,
| | - Dan Yedu Quansah
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Christophe Kosinski
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Katrien Benhalima
- Department of Endocrinology, Universitair Ziekenhuis (UZ) Gasthuisberg, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Jardena J. Puder
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Kosinski C, Rossel JB, Gross J, Helbling C, Quansah DY, Collet TH, Puder JJ. Adverse metabolic outcomes in the early and late postpartum after gestational diabetes are broader than glucose control. BMJ Open Diabetes Res Care 2021; 9:9/2/e002382. [PMID: 34750153 PMCID: PMC8576469 DOI: 10.1136/bmjdrc-2021-002382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/03/2021] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus is associated with an increased cardiovascular risk. To better target preventive measures, we performed an in-depth characterization of cardiometabolic risk factors in a cohort of women with gestational diabetes in the early (6-8 weeks) and late (1 year) postpartum. RESEARCH DESIGN AND METHODS Prospective cohort of 622 women followed in a university gestational diabetes clinic between 2011 and 2017. 162 patients who attended the late postpartum visit were analyzed in a nested long-term cohort starting in 2015. Metabolic syndrome (MetS) was based on the International Diabetes Federation definition, and then having at least two additional criteria of the MetS (blood pressure, triglycerides, high-density lipoprotein (HDL) cholesterol, plasma glucose above or below the International Diabetes Federation cut-offs). RESULTS Compared with prepregnancy, weight retention was 4.8±6.0 kg in the early postpartum, and the prevalence of obesity, pre-diabetes, MetS-body mass index (BMI) and MetS-waist circumference (WC) were 28.8%, 28.9%, 10.3% and 23.8%, respectively. Compared with the early postpartum, weight did not change and waist circumference decreased by 2.6±0.6 cm in the late postpartum. However, the prevalence of obesity, pre-diabetes, MetS-WC and MetS-BMI increased (relative increase: 11% for obesity, 82% for pre-diabetes, 50% for MetS-WC, 100% for MetS-BMI; all p≤0.001).Predictors for obesity were the use of glucose-lowering treatment during pregnancy and the prepregnancy BMI. Predictors for pre-diabetes were the early postpartum fasting glucose value and family history of diabetes. Finally, systolic blood pressure in pregnancy and in the early postpartum, the 2-hour post oral glucose tolerance test glycemia and the HDL-cholesterol predicted the development of MetS (all p<0.05). CONCLUSIONS The prevalence of metabolic complications increased in the late postpartum, mainly due to an increase in fasting glucose and obesity, although weight did not change. We identified predictors of late postpartum obesity, pre-diabetes and MetS that could lead to high-risk identification and targeted preventions.
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Affiliation(s)
- Christophe Kosinski
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Benoît Rossel
- Department Woman-Mother-Child, Service of Obstetrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Justine Gross
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department Woman-Mother-Child, Service of Obstetrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline Helbling
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Department Woman-Mother-Child, Service of Obstetrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Geneve, Switzerland
| | - Jardena J Puder
- Department Woman-Mother-Child, Service of Obstetrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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