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Stadler JT, van Poppel MNM, Wadsack C, Holzer M, Pammer A, Simmons D, Hill D, Desoye G, Marsche G. Obesity Affects Maternal and Neonatal HDL Metabolism and Function. Antioxidants (Basel) 2023; 12:antiox12010199. [PMID: 36671061 PMCID: PMC9854613 DOI: 10.3390/antiox12010199] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Pregravid obesity is one of the major risk factors for pregnancy complications such as gestational diabetes mellitus (GDM) and an increased risk of cardiovascular events in children of affected mothers. However, the biological mechanisms that underpin these adverse outcomes are not well understood. High-density lipoproteins (HDLs) are antiatherogenic by promoting the efflux of cholesterol from macrophages and by suppression of inflammation. Functional impairment of HDLs in obese and GDM-complicated pregnancies may have long-term effects on maternal and offspring health. In the present study, we assessed metrics of HDL function in sera of pregnant women with overweight/obesity of the DALI lifestyle trial (prepregnancy BMI ≥ 29 kg/m2) and women with normal weight (prepregnancy BMI < 25 kg/m2), as well as HDL functionalities in cord blood at delivery. We observed that pregravid obesity was associated with impaired serum antioxidative capacity and lecithin−cholesterol acyltransferase activity in both mothers and offspring, whereas maternal HDL cholesterol efflux capacity was increased. Interestingly, functionalities of maternal and fetal HDL correlated robustly. GDM did not significantly further alter the parameters of HDL function and metabolism in women with obesity, so obesity itself appears to have a major impact on HDL functionality in mothers and their offspring.
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Affiliation(s)
- Julia T. Stadler
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Mireille N. M. van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
- Correspondence: (M.N.M.v.P.); (G.M.); Tel.: +43-(0)-316-380-2335 (M.N.M.v.P.); +43-316-385-74128 (G.M.)
| | - Christian Wadsack
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
| | - Michael Holzer
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Anja Pammer
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW 2560, Australia
| | - David Hill
- Lawson Health Research Institute, London, ON N6C 2R5, Canada
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
- Correspondence: (M.N.M.v.P.); (G.M.); Tel.: +43-(0)-316-380-2335 (M.N.M.v.P.); +43-316-385-74128 (G.M.)
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Pathirana MM, Andraweera PH, Aldridge E, Leemaqz SY, Harrison M, Harrison J, Verburg PE, Arstall MA, Dekker GA, Roberts CT. Gestational diabetes mellitus and cardio-metabolic risk factors in women and children at 3 years postpartum. Acta Diabetol 2022; 59:1237-1246. [PMID: 35817936 PMCID: PMC9329416 DOI: 10.1007/s00592-022-01914-y] [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: 03/20/2022] [Accepted: 05/30/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is thought to be associated with cardio-metabolic risk factor development in women and their children during the early postpartum period and early childhood. We hypothesized that these women and their children would exhibit increased abnormal cardio-metabolic risk factors three years after pregnancy. METHODS Women from the Screening Tests to Predict Poor Outcomes of Pregnancy study were invited to attend a follow-up with the child from their index pregnancy at 3 years postpartum. Women and children were assessed for anthropometric measures and haemodynamic function. Fasting blood samples were obtained from women to assess lipid and glucose status. RESULTS A total of 281 woman-child dyads participated in the 3-year follow-up, with 40 women developing GDM during their index pregnancy. Fasting serum insulin was higher in women with GDM in index pregnancy compared to those with an uncomplicated pregnancy. However, this association was mediated by early pregnancy BMI and socioeconomic index (SEI). The rate of metabolic syndrome was higher in the GDM group than the uncomplicated pregnancy group. Maternal GDM was associated with elevated maternal fasting serum triglycerides at 3 years after adjustment for early pregnancy BMI and SEI. Children exposed to GDM in utero had higher waist circumference compared to children born after an uncomplicated pregnancy, but this is mediated the above covariates. CONCLUSION Exposure to GDM is associated with elevated serum triglycerides in women at 3 years postpartum but other cardiometabolic outcomes in women and children appear to be mediated by early pregnancy BMI and SEI.
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Affiliation(s)
- Maleesa M Pathirana
- Level 6, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA, 5005, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia.
| | - Prabha H Andraweera
- Level 6, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA, 5005, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Department of Cardiology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia
| | - Emily Aldridge
- Level 6, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA, 5005, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Department of Cardiology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia
| | - Shalem Y Leemaqz
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Madeline Harrison
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Jade Harrison
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Petra E Verburg
- Level 6, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA, 5005, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Margaret A Arstall
- Level 6, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA, 5005, Australia
- Department of Cardiology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia
| | - Gustaaf A Dekker
- Level 6, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA, 5005, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia
| | - Claire T Roberts
- Level 6, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA, 5005, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
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Pathirana MM, Lassi Z, Ali A, Arstall M, Roberts CT, Andraweera PH. Cardiovascular risk factors in women with previous gestational diabetes mellitus: A systematic review and meta-analysis. Rev Endocr Metab Disord 2021; 22:729-761. [PMID: 33106997 DOI: 10.1007/s11154-020-09587-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
This systematic review and meta-analysis aimed to synthesize evidence on conventional cardiovascular disease (CVD) risk factors among women with previous Gestational Diabetes Mellitus (GDM). The review protocol is registered with PROSPERO (CRD42019118149). PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Studies reporting on CVD risk factors in women with previous GDM compared to women without previous GDM were selected. A total of 139 studies were eligible, of which 93 were included in the meta-analysis. Women with previous GDM have significantly higher systolic blood pressure (2.47 mmHg 95% CI 1.74 to 3.40, n = 48, 50,118 participants) diastolic blood pressure (1.89 mmHg 95% CI 1.32 to 2.46, n = 48, 49,495 participants), BMI (1.54 kg/m2 95% CI 1.32 to 2.46, n = 78, 255,308 participants), total cholesterol (0.26 SMD 95% CI 0.15 to 0.37, n = 48, 38,561 participants), LDL cholesterol (0.19 SMD 95% CI 0.08 to 0.30, n = 44, 16,980 participants), triglycerides (0.56 SMD 95% CI 0.42 to 0.70, n = 46, 13,175 participants), glucose (0.69 SMD 95% CI 0.56 to 0.81, n = 55, 127,900 participants), insulin (0.41 SMD 95% CI 0.23 to 0.59, n = 32, 8881 participants) and significantly lower HDL cholesterol (-0.28 SMD 95% CI -0.39 to -0.16, n = 56, 35,882 participants), compared to women without previous GDM. The increased blood pressure, total cholesterol, triglycerides and glucose are seen as early as <1 year post-partum.Women with previous GDM have a higher risk of CVD based on significant increases in conventional risk factors. Some risk factors are seen as early as <1 year post-partum. Women with GDM may benefit from early screening to identify modifiable CVD risk factors.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Zohra Lassi
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Adelaide G-TRAC Centre & CRE Frailty & Healthy Ageing Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Margaret Arstall
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Prabha H Andraweera
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
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Hinkle SN, Bao W, Wu J, Sun Y, Ley SH, Tobias DK, Qian F, Rawal S, Zhu Y, Chavarro JE, Hu FB, Zhang C. Association of Habitual Alcohol Consumption With Long-term Risk of Type 2 Diabetes Among Women With a History of Gestational Diabetes. JAMA Netw Open 2021; 4:e2124669. [PMID: 34499132 PMCID: PMC8430455 DOI: 10.1001/jamanetworkopen.2021.24669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Women with gestational diabetes are at high risk for type 2 diabetes. Identifying modifiable dietary and lifestyle factors, such as alcohol intake, that can be useful in delaying or preventing progression to overt type 2 diabetes is of particular interest. OBJECTIVE To evaluate the association between alcohol consumption and risk for type 2 diabetes among women with a history of gestational diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study included women from the Nurses' Health Study II cohort who reported a history of gestational diabetes and were followed up from January 1, 1991, to December 31, 2017, as part of the Diabetes & Women's Health Study. Data analysis was performed from 2020 to 2021. EXPOSURES Dietary intakes, including alcohol, were assessed every 4 years using validated food-frequency questionnaires. MAIN OUTCOMES AND MEASURES Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for the association of alcohol intake with risk for incident type 2 diabetes after a pregnancy during which gestational diabetes was diagnosed. RESULTS A total of 4740 women were included in the study; the mean (SD) age at baseline was 38.2 (5.0) years, and the median follow-up time was 24 years (interquartile range, 18-28 years), resulting in 78 328 person-years of follow-up. During this period, 897 incident cases of type 2 diabetes were reported. After adjustment for major dietary and lifestyle factors, compared with women who did not consume any alcohol, only alcohol consumption of 5.0 to 14.9 g/d was associated with decreased risk for incident type 2 diabetes (HR, 0.45; 95% CI, 0.33-0.61); there was no association of alcohol consumption of 0.1 to 4.9 g/d or 15.0 g/d or more (maximum, 74.2 g/d) with risk of type 2 diabetes (0.1 to 4.9 g/d: HR, 0.87 [95% CI, 0.73-1.03]; ≥15.0 g/d: HR, 0.62 [95% CI, 0.37-1.04]). After additional adjustment for body mass index, women who reported alcohol consumption of 5.0 to 14.9 g/d had a 41% lower risk for developing incident type 2 diabetes (HR, 0.59; 95% CI, 0.42-0.81); consumption of 0.1 to 4.9 g/d and consumption of 15.0 g/d or more were still not associated with risk of type 2 diabetes, but the results were attenuated (0.1-4.9 g/d: HR, 1.02 [95% CI, 0.85-1.23]; ≥15.0 g/d: HR, 0.75 [95% CI, 0.42-1.33]). CONCLUSIONS AND RELEVANCE In this cohort study, among women with a history of gestational diabetes, usual alcohol intake of 5.0 to 14.9 g/d (approximately 0.5-1 drinks per day) was associated with a lower risk for type 2 diabetes. These findings should be interpreted in the context of other known risks and benefits of alcohol consumption when considering clinical recommendations for individual women with a history of gestational diabetes.
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Affiliation(s)
- Stefanie N. Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Jing Wu
- Glotech Inc, Rockville, Maryland
| | - Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis
| | - Sylvia H. Ley
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Deirdre K. Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Frank Qian
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Shristi Rawal
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank B. Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Stadler JT, Wadsack C, Marsche G. Fetal High-Density Lipoproteins: Current Knowledge on Particle Metabolism, Composition and Function in Health and Disease. Biomedicines 2021; 9:biomedicines9040349. [PMID: 33808220 PMCID: PMC8067099 DOI: 10.3390/biomedicines9040349] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022] Open
Abstract
Cholesterol and other lipids carried by lipoproteins play an indispensable role in fetal development. Recent evidence suggests that maternally derived high-density lipoprotein (HDL) differs from fetal HDL with respect to its proteome, size, and function. Compared to the HDL of adults, fetal HDL is the major carrier of cholesterol and has a unique composition that implies other physiological functions. Fetal HDL is enriched in apolipoprotein E, which binds with high affinity to the low-density lipoprotein receptor. Thus, it appears that a primary function of fetal HDL is the transport of cholesterol to tissues as is accomplished by low-density lipoproteins in adults. The fetal HDL-associated bioactive sphingolipid sphingosine-1-phosphate shows strong vasoprotective effects at the fetoplacental vasculature. Moreover, lipoprotein-associated phospholipase A2 carried by fetal-HDL exerts anti-oxidative and athero-protective functions on the fetoplacental endothelium. Notably, the mass and activity of HDL-associated paraoxonase 1 are about 5-fold lower in the fetus, accompanied by an attenuation of anti-oxidative activity of fetal HDL. Cholesteryl ester transfer protein activity is reduced in fetal circulation despite similar amounts of the enzyme in maternal and fetal serum. This review summarizes the current knowledge on fetal HDL as a potential vasoprotective lipoprotein during fetal development. We also provide an overview of whether and how the protective functionalities of HDL are impaired in pregnancy-related syndromes such as pre-eclampsia or gestational diabetes mellitus.
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Affiliation(s)
- Julia T. Stadler
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
- Correspondence: (J.T.S.); (G.M.); Tel.: +43-316-385-74115 (J.T.S.); +43-316-385-74128 (G.M.)
| | - Christian Wadsack
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria;
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
- Correspondence: (J.T.S.); (G.M.); Tel.: +43-316-385-74115 (J.T.S.); +43-316-385-74128 (G.M.)
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Donnelly SR, Hinkle SN, Rawal S, Grunnet LG, Chavarro JE, Vaag A, Wu J, Damm P, Mills JL, Li M, Bjerregaard AA, Thuesen ACB, Gore-Langton RE, Francis EC, Ley SH, Hu FB, Tsai MY, Olsen SF, Zhang C. Prospective study of gestational diabetes and fatty liver scores 9 to 16 years after pregnancy. J Diabetes 2019; 11:895-905. [PMID: 31001915 PMCID: PMC6791726 DOI: 10.1111/1753-0407.12934] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) may be at an increased risk of liver complications because chronic hyperglycemia is a risk factor for liver fat accumulation and potential liver dysfunction. Large prospective studies examining liver fat accumulation following a GDM pregnancy are lacking. METHODS The Diabetes & Women's Health Study (2012-2014) examined the association between GDM and subsequent fatty liver scores among 607 women with and 619 women without GDM in the Danish National Birth Cohort. Nine to 16 years postpartum, a clinical examination was performed, with measurement of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transferase, from which fatty liver scoring indices were calculated to assess liver fat score, fatty liver index, hepatic steatosis index, and liver fat percentage. Relative risks (RR) with 95% confidence intervals (CI) for elevated liver scoring indices by GDM status were assessed adjusting for major risk factors, including prepregnancy body mass index. RESULTS Women with prior GDM had higher adjusted ALT and AST levels than women without GDM (by 6.7% [95% CI 1.7-12.0] and 4.8% [95% CI 0.6-9.1], respectively). Women with GDM also had adjusted increased risks for elevated liver fat score (RR 2.34; 95% CI 1.68-3.27), fatty liver index (RR 1.59; 95% CI 1.27-1.99), and hepatic steatosis index (RR 1.44; 95% CI 1.21-1.71). CONCLUSIONS Women with GDM during pregnancy were at an increased risk for fatty liver 9 to 16 years postpartum. Gestational diabetes mellitus may serve as another risk indicator for the early identification and prevention of liver fat accumulation.
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Affiliation(s)
- Sarah R Donnelly
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Stefanie N Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Shristi Rawal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Louise G Grunnet
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Jorge E Chavarro
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Allan Vaag
- Cardiovascular and Metabolic Disease Translational Medicine Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Jing Wu
- Glotech, Rockville, Maryland
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - James L Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Mengying Li
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Anne A Bjerregaard
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Ellen C Francis
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | - Sylvia H Ley
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Frank B Hu
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Sjurdur F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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7
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Wu P, Mamas MA, Gulati M. Pregnancy As a Predictor of Maternal Cardiovascular Disease: The Era of CardioObstetrics. J Womens Health (Larchmt) 2019; 28:1037-1050. [DOI: 10.1089/jwh.2018.7480] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Pensee Wu
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Unit of Obstetrics and Gynecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona
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Sia WW, Pertman SM, Yan RM, Tsuyuki RT. Are Preeclampsia and Adverse Obstetrical Outcomes Predictors of Cardiovascular Disease? A Case-Control Study of Women With Heart Disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1760-1767. [PMID: 31279766 DOI: 10.1016/j.jogc.2019.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study sought to determine whether preeclampsia; gestational diabetes; and adverse obstetrical outcomes such as placental abruption, intrauterine growth restriction, and preterm delivery are independent risk factors for cardiovascular disease later in life. METHODS This was a retrospective, age-matched, case-control study that surveyed 244 cases (women with confirmed coronary artery disease) and 246 controls (women who did not have coronary artery disease) on their obstetrical history and outcomes, as well as traditional cardiovascular risk factors. Analyses were performed using SAS software version 9.1.3. (Canadian Task Force Classification II-2). RESULTS Women with coronary artery disease had significantly higher rates of maternal complications such as gestational hypertension (odds ratio [OR] 3.34; 95% confidence interval [CI] 1.03-10.9), as well as conventional vascular risk factors such as dyslipidemia (OR 5.38; 95% CI 2.70-10.7), hypertension (OR 2.40; 95% CI 1.23-4.70), diabetes (OR 2.32; 95% CI 1.07-5.01), and smoking (current smoker: OR; 4.82 95% CI 1.66-14.00; former smoker: OR 2.86; 95% CI 1.43-5.71). There were more cases with preeclampsia (9.8%, vs. 5.4% in controls); however, the difference was not statistically significant. CONCLUSION Among the adverse maternal conditions, there was more gestational hypertension in women with coronary artery disease. In this study, hypertensive disorders of pregnancy were the most important maternal risk factors for cardiovascular disease later in life and should be flagged early for close monitoring and/or intervention.
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Affiliation(s)
- Winnie W Sia
- Department of Medicine, University of Alberta, Edmonton, AB.
| | - Shea M Pertman
- Department of Medicine, University of Alberta, Edmonton, AB
| | - Raymond M Yan
- Faculty of Medicine, University of Calgary, Calgary, AB
| | - Ross T Tsuyuki
- Department of Medicine, University of Alberta, Edmonton, AB
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Festa C, Mattei L, Bitterman O, Pintaudi B, Framarino Dei Malatesta M, Bianchi P, Trappolini M, Colatrella A, Napoli A. Hypertensive disorders during pregnancy and 3 years after delivery in women with gestational hyperglycemia. J Endocrinol Invest 2018; 41:1075-1082. [PMID: 29368139 DOI: 10.1007/s40618-018-0833-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/12/2018] [Indexed: 12/30/2022]
Abstract
AIMS Women with gestational hyperglycemia commonly experience hypertensive disorders during pregnancy. More information is needed about how hypertension develops in these patients over time. We investigated the prevalence of hypertension during and 3 years after pregnancy in Caucasian women with gestational hyperglycemia. We also investigated metabolic syndrome presence, glucose tolerance status, insulin sensitivity and insulin secretion levels in the follow-up period. METHODS In a prospective longitudinal study with a 3-year follow-up, we assessed hypertension status and clinical-related characteristics of 103 consecutive women with gestational hyperglycemia sub-grouped according to their hypertensive status during and after pregnancy. RESULTS Overall, 29 (28.1%) women had hypertension during pregnancy (24 gestational hypertension; 4 chronic hypertension; 1 preeclampsia). At follow-up 16 (15.5%) women were diagnosed as having hypertension (11 with hypertension in pregnancy; 5 with a normotensive pregnancy). Women with hypertension after pregnancy had higher BMI, metabolic syndrome rate and worse insulin resistance indexes than normotensive women. Weight increase at follow-up (OR 1.17, 95% CI 1.00-1.35) and hypertension in pregnancy (OR 6.72, 95% CI 1.17-38.64) were associated with hypertension after pregnancy. CONCLUSIONS Women with gestational hyperglycemia should undergo regular monitoring during and after pregnancy to detect metabolic and clinical impairments and to prevent cardiovascular harm.
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Affiliation(s)
- C Festa
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - L Mattei
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - O Bitterman
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - B Pintaudi
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | | | - P Bianchi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - M Trappolini
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - A Colatrella
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - A Napoli
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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10
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Rawal S, Olsen SF, Grunnet LG, Ma RC, Hinkle SN, Granström C, Wu J, Yeung E, Mills JL, Zhu Y, Bao W, Ley SH, Hu FB, Damm P, Vaag A, Tsai MY, Zhang C. Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy. Diabetes Care 2018; 41:1378-1384. [PMID: 29728364 PMCID: PMC6014536 DOI: 10.2337/dc17-2629] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/11/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether gestational diabetes mellitus (GDM), independent of subsequent diabetes, is an early risk factor for renal impairment long term after the index pregnancy. RESEARCH DESIGN AND METHODS In the Diabetes & Women's Health (DWH) study (2012-2016), we examined the independent and joint associations of GDM and subsequent diabetes with long-term renal function among 607 women with and 619 women without GDM in the Danish National Birth Cohort (DNBC) index pregnancy (1996-2002). At median follow-up of 13 years after the index pregnancy, serum creatinine (mg/dL) and urinary albumin (mg/L) and creatinine (mg/dL) were measured, from which estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (UACR) (mg/g) were derived. RESULTS Compared with women without GDM or subsequent diabetes, women with a GDM history had significantly higher eGFR even if they had not subsequently developed diabetes (adjusted β-coefficient [95% CI] = 3.3 [1.7, 5.0]). Women who had a GDM history and later developed diabetes (n = 183) also had significantly higher UACR [exponent β = 1.3 [95% CI 1.1, 1.6]) and an increased risk of elevated UACR (≥20 mg/g) [adjusted relative risk [95% CI] = 2.3 [1.1, 5.9]) compared with women with neither. After adjusting for potential confounders including prepregnancy BMI and hypertension, GDM without subsequent diabetes was not related to UACR. CONCLUSIONS Women who develop GDM in pregnancy were more likely to show increased eGFR levels 9-16 years postpartum, which could indicate early stages of glomerular hyperfiltration and renal damage. However, only those who subsequently developed diabetes showed overt renal damage as evidenced by elevated UACR.
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Affiliation(s)
- Shristi Rawal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ
| | - Sjurdur F Olsen
- Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark
| | - Louise G Grunnet
- Department of Endocrinology, Rigshospitalet University Hospital, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Stefanie N Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | | - Jing Wu
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Edwina Yeung
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - James L Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Sylvia H Ley
- Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Allan Vaag
- Department of Endocrinology, Rigshospitalet University Hospital, Copenhagen, Denmark
- Cardiovascular and Metabolic Disease Translational Medicine Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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11
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Tobias DK, Stuart JJ, Li S, Chavarro J, Rimm EB, Rich-Edwards J, Hu FB, Manson JE, Zhang C. Association of History of Gestational Diabetes With Long-term Cardiovascular Disease Risk in a Large Prospective Cohort of US Women. JAMA Intern Med 2017; 177:1735-1742. [PMID: 29049820 PMCID: PMC5820722 DOI: 10.1001/jamainternmed.2017.2790] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Previous studies identify gestational diabetes (GD) as a risk factor for intermediate markers of cardiovascular disease (CVD) risk; however, few are prospective, evaluate hard CVD end points, or account for shared risk factors including body weight and lifestyle. OBJECTIVE To prospectively evaluate history of GD in relation to incident CVD risk. DESIGN, SETTING, AND PARTICIPANTS The Nurses' Health Study II (NHS II) is an observational cohort study of US female nurses established in 1989, with ongoing follow-up. Biennial questionnaires updated behavioral characteristics, health outcomes, and lifestyle factors. Multivariable Cox models estimated the hazard ratio (HR) and 95% CI for CVD risk. We included 89 479 women who reported at least 1 pregnancy and were free of CVD and cancer at baseline. Follow-up through May 31, 2015, was complete for more than 90% of eligible participants. EXPOSURES History of GD was self-reported at baseline (1989) via questionnaire and updated every 2 years. MAIN OUTCOMES AND MEASURES We observed 1161 incident self-reported nonfatal or fatal myocardial infarction or stroke, confirmed via medical records. RESULTS Participants had a mean (SD) age of 34.9 (4.7) years. Adjusting for age, prepregnancy body mass index, and other covariates, GD vs no GD was associated with subsequent CVD (HR, 1.43; 95% CI, 1.12-1.81). Additional adjustment for weight gain since pregnancy and updated lifestyle factors attenuated the association (HR, 1.29; 95% CI, 1.01-1.65). Classifying GD by progression to T2D in relation to CVD risk indicated a positive association for GD with progression to T2D vs no GD or T2D (HR, 4.02; 95% CI, 1.94-8.31), and an attenuated relationship for GD only (HR, 1.30; 95% CI, 0.99-1.71). CONCLUSIONS AND RELEVANCE Gestational diabetes was positively associated with CVD later in life, although the absolute rate of CVD in this younger cohort of predominantly white women was low. This relationship is possibly mediated in part by subsequent weight gain and lack of healthy lifestyle.
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Affiliation(s)
- Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jennifer J Stuart
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shanshan Li
- Boston University School of Medicine, Boston, Massachusetts
| | - Jorge Chavarro
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Janet Rich-Edwards
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Frank B Hu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cuilin Zhang
- Boston University School of Medicine, Boston, Massachusetts.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland
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12
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Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF. Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis. BJOG 2015; 122:643-51. [PMID: 25612005 DOI: 10.1111/1471-0528.13261] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lipid levels during pregnancy in women with gestational diabetes mellitus (GDM) have been extensively studied; however, it remains unclear whether dyslipidaemia is a potential marker of preexisting insulin resistance. OBJECTIVE To evaluate the relationship between lipid measures throughout pregnancy and GDM. SEARCH STRATEGY We searched PubMed-MedLine and SCOPUS (inception until January 2014) and reference lists of relevant studies. SELECTION CRITERIA Publications describing original data with at least one raw lipid (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], or triglyceride) measurement during pregnancy in women with GDM and healthy pregnant controls were retained. DATA COLLECTION AND ANALYSIS Data extracted from 60 studies were pooled and weighted mean difference (WMD) in lipid levels was calculated using random effects models. Meta-regression was also performed to identify sources of heterogeneity. MAIN RESULTS Triglyceride levels were significantly elevated in women with GDM compared with those without GDM (WMD 30.9, 95% confidence interval [95% CI] 25.4-36.4). This finding was consistent in the first, second and third trimesters of pregnancy. HDL-C levels were significantly lower in women with GDM compared with those without GDM in the second (WMD -4.6, 95% CI -6.2 to -3.1) and third (WMD -4.1, 95% CI -6.5 to -1.7) trimesters of pregnancy. There were no differences in aggregate total cholesterol or LDL-C levels between women with GDM and those without insulin resistance. AUTHOR'S CONCLUSIONS Our meta-analysis shows that triglycerides are significantly elevated among women with GDM compared with women without insulin resistance and this finding persists across all three trimesters of pregnancy.
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Affiliation(s)
- K K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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13
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Molęda P, Fronczyk A, Safranow K, Majkowska L. Homocysteine levels in women with a history of gestational diabetes mellitus. Diabetol Metab Syndr 2015; 7:93. [PMID: 26512299 PMCID: PMC4623911 DOI: 10.1186/s13098-015-0088-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/14/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous gestational diabetes (pGDM) is a risk factor of type 2 diabetes, hypertension and cardiovascular diseases. Homocysteine is one of markers of cardiovascular risk. The aim of this study was to assess the homocysteine levels in women with pGDM and to evaluate its relationship with current carbohydrate metabolism and nourishment status. METHODS The study group comprised 199 women at 7.8 ± 1.0 years after pGDM and 50 control women in whom pGDM was excluded. The analyzed parameters: BMI, WHR, body composition (Tanita SC-330S analyzer), glucose and insulin levels in oral glucose tolerance test (OGTT), insulin resistance index (HOMA-IR), HbA1c, lipid profile, homocysteine, creatinine and creatinine clearance. The Mann-Whitney test and Chi-squared test were used for comparison of continuous and nominal variables, respectively. Correlations between continuous variables in each group were analyzed using Spearman's rank correlation coefficient (Rs). A logarithmic transformation was applied for variables with non-normal distribution. RESULTS There were no differences between the pGDM women and controls in terms of age, number of childbirths, time from indexed pregnancy, pre-pregnancy BMI, or current anthropometric parameters. In pGDM women HbA1c and all glucose levels in OGTT were significantly higher, but still within the normal range. No significant differences were found in homocysteine levels, HOMA-IR, blood lipids, creatinine and creatinine clearance. Homocysteine levels did not differ significantly in subgroups categorized according to the current OGTT results or BMI. Carbohydrate metabolism disorders, overweight and obesity were associated with higher creatinine clearance. Positive correlation between homocysteine and creatinine (r = 0.21, p < 0.004), and a negative correlation with creatinine clearance (r = -0.16, p < 0.03) were found. CONCLUSIONS In women with pGDM, homocysteine is not a marker of glucose tolerance disturbances and cardiovascular risk. Increased glomerular filtration rate, observed in more severe disorders of carbohydrate metabolism and greater BMI, may temporarily protect against an increase of proatherogenic homocysteine.
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Affiliation(s)
- Piotr Molęda
- />Department of Diabetology and Internal Medicine, Pomeranian Medical University in Szczecin, Siedlecka 2 Str, 72-010 Police, Poland
| | - Aneta Fronczyk
- />Department of Diabetology and Internal Medicine, Pomeranian Medical University in Szczecin, Siedlecka 2 Str, 72-010 Police, Poland
| | - Krzysztof Safranow
- />Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich Av. 72, 71-899 Szczecin, Poland
| | - Lilianna Majkowska
- />Department of Diabetology and Internal Medicine, Pomeranian Medical University in Szczecin, Siedlecka 2 Str, 72-010 Police, Poland
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14
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ŽÁKOVIČOVÁ E, KITTNAR O, SLAVÍČEK J, MEDOVÁ E, ŠVÁB P, CHARVÁT J. ECG Body Surface Mapping in Patients With Gestational Diabetes Mellitus and Optimal Metabolic Compensation. Physiol Res 2014; 63:S479-87. [DOI: 10.33549/physiolres.932921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Women with gestational diabetes mellitus (GDM) are at increased risk for cardiovascular diseases (CVD) events compared with women without GDM. The aim of the present study was to evaluate 200 parameters of the heart electric field in 35 women with GDM under optimal glycemic compensation compared to 32 healthy pregnant women. All examinations were performed in the 36th week of gestation. The parameters in ECG body surface mapping (BSM) were registered by the diagnostic system Cardiag 112.2. The absolute values of maximum and minimum in depolarization and repolarization isopotential, isointegral and isoarea maps were not significantly different between the groups. These findings correspond to the result of heart rate variability examination. However BSM revealed the significant prolongation of QRS complex (p=0.05), shortening of ventricular myocardial activation time (ICHVAT) (p=0.01), prolongation of mean QT duration (p=0.01) and increase of QT interval dispersion (p=0.01) in women with GDM. Duration of QRS and ICHVAT significantly correlated with interventricular septum and posterior wall thickness in GDM group, QTd interval correlated significantly with HbA1C level. We conclude that despite of optimal metabolic control several significant abnormalities detected by ECG BSM are still present in patients with GDM.
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Affiliation(s)
| | - O. KITTNAR
- Institute of Physiology of the First Faculty of Medicine, Charles University, Prague, Czech Republic
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15
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Shek NWM, Ngai CSW, Lee CP, Chan JYC, Lao TTH. Lifestyle modifications in the development of diabetes mellitus and metabolic syndrome in Chinese women who had gestational diabetes mellitus: a randomized interventional trial. Arch Gynecol Obstet 2013; 289:319-27. [PMID: 23897066 DOI: 10.1007/s00404-013-2971-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/15/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To study whether lifestyle intervention can reduce the development of type II diabetes mellitus (DM) and metabolic syndrome (MS) among Chinese women who had gestational diabetes mellitus (GDM). METHODS A prospective randomized controlled interventional trial of 450 women who had GDM and impaired glucose tolerance (IGT) postpartum. Advice on diet and exercise was given to the intervention group and reinforced in each follow-up visit. Women in both arms were followed for 36 months. Blood pressure and anthropometry were measured at each visit and blood tests were repeated. RESULTS Fewer women in the intervention group developed DM (15 versus 19 %) but this was not statistically significant, and there was a lower incidence of DM among women over 40 years old. No difference was found in fasting glucose, insulin and homeostasis model assessment (HOMA) index. Both systolic and diastolic blood pressures, and triglyceride level, were lower but the significance was inconsistent among visits. BMI and percentage body fat were also significantly lower in the later visits. There was no difference in waist-hip ratio and basal metabolic rate. CONCLUSIONS Our results demonstrate a trend towards lower incidence of type II DM within 3 years postpartum in GDM women given lifestyle advice, which also potentially offers protection against development of MS, in terms of lower blood pressure and triglyceride level. Women over 40 years old are more likely to benefit. Future studies should address ways to maximize compliance to lifestyle intervention as its potential benefits can be undermined by challenges of motherhood.
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Affiliation(s)
- Noel Wan Man Shek
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR, China,
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16
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Bo S, Menato G, Botto C, Cotrino I, Bardelli C, Gambino R, Cassader M, Durazzo M, Signorile A, Massobrio M, Pagano G. Mild gestational hyperglycemia and the metabolic syndrome in later life. Metab Syndr Relat Disord 2012; 4:113-21. [PMID: 18370757 DOI: 10.1089/met.2006.4.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Diabetes and obesity, components of the metabolic syndrome, are common longterm complications in women with previous gestational diabetes (pGDM). Long-term follow-up of women with mild gestational hyperglycemia is lacking. METHODS Fifty women with previous positive oral glucose challenge test and negative oral glucose tolerance test (pOGCT+OGTT-), 161 with previous normal glucose tolerance (pNGT), and 182 pGDM were studied after 6.5 years from the index pregnancy. RESULTS Patients with pGDM showed a worse metabolic pattern than pNGT. Women with pOGCT+OGTT- had significantly higher levels of fasting glucose, homeostasis model assessment (HOMA), percentage of impaired fasting glucose, and low age and high-density lipoprotein (HDL)-cholesterol than pNGT subjects. Prevalence of the metabolic syndrome (MS) was, respectively, sixfold and twofold higher in pGDM and pOGCT+OGTT- than in pNGT. In a Cox proportional hazard model, after multiple adjustments, pGDM was significantly associated with subsequent hyperglycemia (hazard ratio [HR] = 4.2; 95% CI 1.6-11.1), low HDL-cholesterol (HR = 1.7, 1.1-2.8), hypertriglyceridemia (HR = 4.2, 1.2-14.9), hypertension (HR = 2.2, 1.3-3.6), MS (HR = 3.7, 1.3-10.8), while pOGCT+OGTT- was associated with subsequent hyperglycemia (HR = 4.3, 1.3-14.7), and low HDL-cholesterol (HR = 2.0, 1.0-3.8). The metabolic syndrome was present in 52.6% of obese pGDM, 50% of obese pOGCT+OGTT-, and 28.6% of obese pNGT women; the corresponding HRs were, respectively, HR = 2.20, 0.74-6.57 (pGDM), and HR = 3.56, 1.10-11.5 (pOGCT+OGTT-). CONCLUSIONS Women who failed the OGCT, but not the OGTT, showed a subsequent worse metabolic pattern than pNGT subjects, independently of confounding factors. In the presence of obesity, the prevalence of the metabolic syndrome was similar to that of obese pGDM women, and almost twofold higher than in obese pNGT controls.
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Affiliation(s)
- Simona Bo
- Department of Internal Medicine, University of Turin, Turin, Italy
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17
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Baliutavičienė D, Buinauskienė JB, Petrenko V, Danytė E, Žalinkevičius R. Gestational Diabetes, Obesity, and Metabolic Syndrome Diagnosed During Pregnancy. Metab Syndr Relat Disord 2012; 10:214-7. [DOI: 10.1089/met.2011.0067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Dalia Baliutavičienė
- Department of Obstetrics and Gynecology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jūratė B. Buinauskienė
- Department of Neonatology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vladimiras Petrenko
- Department of Endocrinology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Evalda Danytė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Žalinkevičius
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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18
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Ku YH, Choi SH, Lim S, Cho YM, Park YJ, Park KS, Kim SY, Jang HC. Carotid intimal-medial thickness is not increased in women with previous gestational diabetes mellitus. Diabetes Metab J 2011; 35:497-503. [PMID: 22111041 PMCID: PMC3221025 DOI: 10.4093/dmj.2011.35.5.497] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/30/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is known to increase the risk of cardiovascular diseases. Measuring the carotid artery intimal-medial thickness (CIMT) is a non-invasive technique used to evaluate early atherosclerosis and to predict future cardiovascular diseases. We examined the association between CIMT and cardiovascular risk factors in young Korean women with previous GDM. METHODS One hundred one women with previous GDM and 19 women who had normal pregnancies (NP) were recruited between 1999 and 2002. At one year postpartum, CIMT was measured using high-resolution B-mode ultrasonography, and oral glucose tolerance tests were performed. Fasting glucose, glycated hemoglobin A1c (HbA1c), insulin levels and lipid profiles were also measured. CIMTs in the GDM and NP groups were compared, and the associations between CIMT and cardiovascular risk factors were analyzed in the GDM group. RESULTS CIMT results of the GDM group were not significantly different from those of the NP group (GDM, 0.435±0.054 mm; NP, 0.460±0.046 mm; P=0.069). In the GDM group, a higher HbA1c was associated with an increase in CIMT after age adjustment (P=0.011). CIMT results in the group with HbA1c >6.0% were higher than those of the normal HbA1c (HbA1c ≤6.0%) (P=0.010). Nine of the patients who are type 2 diabetes mellitus converters within one year postpartum but showed no significant difference in CIMT results compared to NP group. CONCLUSION Higher HbA1c is associated with an increase in CIMT in women with previous GDM. However, CIMT at one year postpartum was not increased in these women compared to that in NP women.
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Affiliation(s)
- Yun Hyi Ku
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Yeon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Koo BK. The Association between Carotid Atherosclerosis and Glucose. Diabetes Metab J 2011; 35:466-8. [PMID: 22111037 PMCID: PMC3221021 DOI: 10.4093/dmj.2011.35.5.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
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Stasenko M, Liddell J, Cheng YW, Sparks TN, Killion M, Caughey AB. Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus. Am J Obstet Gynecol 2011; 204:522.e1-6. [PMID: 21514559 DOI: 10.1016/j.ajog.2011.01.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 12/02/2010] [Accepted: 01/26/2011] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of the study was to evaluate the efficacy of an educational intervention at increasing the rates of postpartum (PP) follow-up for women with gestational diabetes mellitus (GDM). STUDY DESIGN A retrospective cohort study of all patients with GDM delivering during 2002-2009 was conducted. The primary outcome was obtaining PP diabetes testing. The 2002-2006 cohort was advised to obtain PP testing by their providers. The 2007-2009 cohort received educational counseling at the 37-38 week visit by a nurse educator. Univariate and multivariable statistical tests were utilized. RESULTS The PP testing frequency was 53% for the 2007-2009 cohort, compared with 33% for the 2002-2006 cohort (P < .001). When stratified by race/ethnicity, increased rates of testing were seen in whites (28% to 53%, P < .001), Latinas (15% to 50%, P < .001), and Asians (43% to 59%, P = .005). There was a nonsignificant decrease in the African American follow-up, 28% to 17% (P = .414). CONCLUSION GDM precedes the development of type 2 diabetes. Antepartum education counseling increases postpartum diabetes testing. More efforts are needed to obtain universal screening.
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Akinci B, Celtik A, Genc S, Yener S, Demir T, Secil M, Kebapcilar L, Yesil S. Evaluation of postpartum carbohydrate intolerance and cardiovascular risk factors in women with gestational diabetes. Gynecol Endocrinol 2011; 27:361-7. [PMID: 20540676 DOI: 10.3109/09513590.2010.492885] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We aimed to evaluate the predictors of subsequent development of postpartum carbohydrate intolerance, metabolic syndrome and cardiovascular risk factors in women with previous GDM. Two hundred fifty-two consecutive women with GDM were enrolled. After exclusion of women who did not attend to the hospital for follow-up visits for minimum 1 year, data of 195 patients were evaluated. Seventy-one lean women with negative screening for GDM were included as a control group. The prevalence of diabetes, impaired glucose tolerance and impaired fasting glucose and metabolic syndrome was significantly higher in women with previous GDM than healthy controls. Women with previous GDM were more insulin resistant, had an atherogenic lipid profile and increased carotid IMT. The most important predictors of postpartum diabetes were the need for insulin treatment during index pregnancy and glucose values on antepartum OGTT. Among women with previous GDM, the development of postpartum diabetes and metabolic syndrome was associated with increased carotid IMT. Our data show that women with previous GDM are at high risk for developing carbohydrate intolerance, metabolic syndrome and atherosclerosis. Antepartum prediction of high risk subjects for the subsequent development of postpartum carbohydrate intolerance and metabolic syndrome seems to be vital to prevent cardiovascular outcomes.
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Affiliation(s)
- Baris Akinci
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey.
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Sugulle M, Kvehaugen AS, Brække K, Harsem NK, Staff AC. Plasma calprotectin as inflammation marker in pregnancies complicated by diabetes mellitus and superimposed preeclampsia. Pregnancy Hypertens 2011; 1:137-42. [PMID: 26104494 DOI: 10.1016/j.preghy.2011.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/02/2011] [Accepted: 02/03/2011] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We hypothesized that pregnancies complicated by diabetes mellitus with or without preeclampsia show an elevated systemic inflammatory response evaluated by the inflammation markers calprotectin and high-sensitivity C-reactive protein (hsCRP). STUDY DESIGN Third trimester EDTA plasma and serum from 138 women with diabetes mellitus (type 1, n=53; type 2, n=11; gestational diabetes mellitus (GDM), n=63; diabetes mellitus with preeclampsia, n=11) were analyzed for calprotectin and hsCRP and compared to previously published results from 37 healthy and 27 preeclamptic pregnancies. RESULTS Median plasma calprotectin concentration was intermediate in women with GDM as compared to healthy and preeclamptic pregnancies (729 vs 552 and 1081μg/L, P=.006 and P=.001, respectively). In diabetic pregnancies with preeclampsia, median plasma calprotectin concentration was elevated as compared to controls, but not different from women with preeclampsia alone (969 vs 552 and 1081μg/L, P=.01 and P=.1, respectively). hsCRP was only elevated in type 2 diabetic pregnancies as compared to healthy pregnancies (6.6 vs 3.8mg/L, P=.02). CONCLUSION Elevated plasma calprotectin concentrations in GDM may reflect an accentuated inflammatory process, possibly contributing to the augmented preeclampsia risk. Increased plasma calprotectin in diabetic pregnancies with preeclampsia may originate from the excess systemic inflammatory response associated with preeclampsia.
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Affiliation(s)
- Meryam Sugulle
- Department of Obstetrics and Gynaecology, Women and Children's Division, Oslo University Hospital, Ullevål, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Anne Stine Kvehaugen
- Department of Obstetrics and Gynaecology, Women and Children's Division, Oslo University Hospital, Ullevål, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Kristin Brække
- Department of Paediatrics, Women and Children's Division, Oslo University Hospital, Ullevål, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Nina K Harsem
- Department of Obstetrics and Gynaecology, Women and Children's Division, Oslo University Hospital, Ullevål, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Anne Cathrine Staff
- Department of Obstetrics and Gynaecology, Women and Children's Division, Oslo University Hospital, Ullevål, P.O. Box 4956, Nydalen, 0424 Oslo, Norway; Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
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Akinci B, Celtik A, Yener S, Yesil S. Prediction of developing metabolic syndrome after gestational diabetes mellitus. Fertil Steril 2010; 93:1248-54. [DOI: 10.1016/j.fertnstert.2008.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/28/2008] [Accepted: 12/03/2008] [Indexed: 10/21/2022]
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Negrato CA, Jovanovic L, Rafacho A, Tambascia MA, Geloneze B, Dias A, Rudge MVC. Association between different levels of dysglycemia and metabolic syndrome in pregnancy. Diabetol Metab Syndr 2009; 1:3. [PMID: 19825195 PMCID: PMC2758580 DOI: 10.1186/1758-5996-1-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Accepted: 08/26/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In this study, we sought to evaluate the prevalence of metabolic syndrome (MS) in a cohort of pregnant women with a wide range of glucose tolerance, prepregnancy risk factors for MS during pregnancy, and the effects of MS in the outcomes in the mother and in the newborn. METHODS One hundred and thirty six women with positive screening for gestational diabetes mellitus (GDM) were classified by two diagnostic methods: glycemic profile and 100 g OGTT as normoglycemic, mild gestational hyperglycemic, GDM, and overt GDM. Markers of MS were measured between 2428th during the screening. RESULTS The prevalence of MS was: 0%; 20.0%; 23.5% and 36.4% in normoglycemic, mild hyperglycemic, GDM, and overt GDM groups, respectively. Previous history of GDM with or without insulin use, BMI >/= 25, hypertension, family history of diabetes in first degree relatives, non-Caucasian ethnicity, history of prematurity and polihydramnios were statistically significant prepregnancy predictors for MS in the index pregnancy, that by its turn increased the adverse outcomes in the mother and in the newborn. CONCLUSION The prevalence of MS increases with the worsening of glucose tolerance; impaired glycemic profile identifies pregnancies with important metabolic abnormalities even in the presence of a normal OGTT, in patients that are not classified as having GDM.
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Affiliation(s)
- Carlos A Negrato
- School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | - Lois Jovanovic
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Alex Rafacho
- School of Sciences, São Paulo State University - UNESP, Bauru, São Paulo, Brazil
| | - Marcos A Tambascia
- School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Bruno Geloneze
- School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Adriano Dias
- School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | - Marilza VC Rudge
- School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
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Wendland EMDR, Duncan BB, Belizán JM, Vigo A, Schmidt MI. Gestational diabetes and pre-eclampsia: common antecedents? ACTA ACUST UNITED AC 2009; 52:975-84. [PMID: 18820808 DOI: 10.1590/s0004-27302008000600008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 07/04/2008] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate commonality of risk factor profiles of women who develop gestational diabetes and pre-eclampsia. METHODS Prospective cohort study in prenatal clinics of the Brazilian Unified Health System in six state capitals. 4.766 pregnant women between 20 to 48 years old were consecutively enrolled between 20th and 28th gestational weeks. Smoking habits and traditional risk factors for pre-eclampsia and gestational diabetes were obtained by the interview at enrollment. Gestational diabetes was diagnosed using a 75-g oral glucose tolerance test and pre-eclampsia through chart review. RESULTS Both gestational diabetes and pre-eclampsia were associated with age (OR 2.07; 95% CI 1.65-2.23 and OR 1.55; 95% CI 1.08-2.23, respectively), pre-pregnancy body mass index (OR 1.62; 95% CI 1.40-3.53 and OR 1.83; 95% CI 1.52-4.80, respectively) and weight gain in early pregnancy (OR 1.28; 95% CI 1.12-1.47 and OR 1.27; 95% CI 1.06-1.52, respectively). Lower odds of gestational diabetes (OR 0.31; 95% CI 0.22-0.44) and pre-eclampsia (OR 0.36; 95% CI 0.20-0.51) were observed in nulliparous women who have smoked during pregnancy. CONCLUSIONS Gestational diabetes and pre-eclampsia share a pattern of risk factors, suggesting the possibility of common aetiology.
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Affiliation(s)
- Eliana M Da Ros Wendland
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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King KB, Gerich JE, Guzick DS, King KU, McDermott MP. Is a history of gestational diabetes related to risk factors for coronary heart disease? Res Nurs Health 2009; 32:298-306. [DOI: 10.1002/nur.20325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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27
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Sugulle M, Dechend R, Herse F, Weedon-Fekjaer MS, Johnsen GM, Brosnihan KB, Anton L, Luft FC, Wollert KC, Kempf T, Staff AC. Circulating and placental growth-differentiation factor 15 in preeclampsia and in pregnancy complicated by diabetes mellitus. Hypertension 2009; 54:106-12. [PMID: 19470878 DOI: 10.1161/hypertensionaha.109.130583] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Growth-differentiation factor 15 (GDF-15), a stress-responsive transforming growth factor-beta-related cytokine, is emerging as a new risk marker in patients with cardiovascular disease. We explored GDF-15 in preeclampsia and in diabetic pregnancies, because these conditions are associated with augmented risk for cardiovascular disease, both in mother and in offspring. Plasma from pregnant women (n=267; controls: n=59, preeclampsia: n=85, diabetes mellitus: n=112, and superimposed preeclampsia in diabetes mellitus: n=11), fetal plasma (n=72), and amniotic fluid (n=99) were analyzed by immunoassay for GDF-15. Placental GDF-15 mRNA and protein expression levels were analyzed by quantitative real-time PCR and immunoblots in 78 and 18 pregnancies, respectively. Conditioned media from preeclamptic (n=6) and control (n=6) villous placenta explants were analyzed by immunoassay for GDF-15. Median maternal GDF-15 concentration was elevated in those with diabetes mellitus, as compared with controls (91 549 versus 79 875 ng/L; P=0.02). Median GDF-15 concentration was higher in patients with preeclampsia than in controls in term maternal blood samples (127 061 versus 80 319 ng/L; P<0.001). In the fetal circulation and amniotic fluid, GDF-15 was elevated in preeclampsia and superimposed preeclampsia in diabetes mellitus, as compared with controls. GDF-15 placental mRNA expression was elevated in preeclampsia, as compared with controls (P=0.002). Placenta immunoblots confirmed a single GDF-15 protein band, and a time-dependent increase in GDF-15 protein was detected in the conditioned media. Our study is the first to show that GDF-15 is dysregulated, both in preeclampsia and in diabetic pregnancies. The mechanisms and diagnostic implications of these findings remain to be explored.
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Affiliation(s)
- Meryam Sugulle
- Department of Obstetrics and Gynaecology, Oslo University Hospital, University of Oslo, Norway
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Vohr BR, Boney CM. Gestational diabetes: the forerunner for the development of maternal and childhood obesity and metabolic syndrome? J Matern Fetal Neonatal Med 2008; 21:149-57. [PMID: 18297569 DOI: 10.1080/14767050801929430] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the risk of obesity and metabolic syndrome in women with a history of gestational diabetes mellitus and in offspring born to mothers with gestational diabetes mellitus. METHODS A review of studies examining the development of obesity, hypertension, metabolic abnormalities, metabolic syndrome, and type II diabetes in mothers with a history of gestational diabetes mellitus and control mothers, and offspring of mothers with a history of gestational diabetes and control mothers. RESULTS Longitudinal studies demonstrate that women with a prior history of gestational diabetes mellitus and obesity are at significantly greater risk of developing metabolic syndrome than mothers with no history of gestational diabetes or obesity. The development of metabolic syndrome in children with increasing age is related to maternal gestational diabetes mellitus, maternal glycemia in the 3rd trimester, maternal obesity, neonatal macrosomia, and childhood obesity. CONCLUSIONS The current prevalence of obesity in both adults and children and associated disorders of blood pressure and lipid metabolism, suggest a perpetuating cycle of increasing obesity, insulin resistance, and abnormal lipid metabolism, which has ominous consequences for future generations.
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Affiliation(s)
- Betty R Vohr
- Department of Pediatrics, The Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA.
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Lee H, Jang HC, Park HK, Cho NH. Early manifestation of cardiovascular disease risk factors in offspring of mothers with previous history of gestational diabetes mellitus. Diabetes Res Clin Pract 2007; 78:238-45. [PMID: 17499877 DOI: 10.1016/j.diabres.2007.03.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 03/12/2007] [Accepted: 03/29/2007] [Indexed: 11/20/2022]
Abstract
This study investigated the long-term adverse effects of maternal gestational diabetes mellitus (GDM) on cardiovascular disease (CVD) risk factors in offspring. A total of 298 offspring (202 offspring of GDM mothers and 96 offspring of mothers with impaired glucose tolerance [IGT]) participated in the study. CVD risk factors included elevated body mass index (BMI), skinfold thickness, body fat, blood pressure, lipid profiles, and glucose values measured with a 2h oral glucose tolerance test. The BMI of offspring >or=5 years of age of GDM mothers was significantly higher than that of offspring of mothers with IGT when analysed according to age. In offspring of GDM mothers, CVD risk factors were positively correlated with age, except for lipid profiles. A significant negative relationship between age and BMI was observed in offspring of IGT mothers. The slope of the linear regression lines for BMI and fasting plasma insulin levels with age were significantly steeper for the offspring of GDM mothers than for those of IGT mothers. We conclude that childhood obesity, as well as altered glucose metabolism influenced by the maternal uterine environment, is more likely with advancing years in the offspring of GDM mothers than in the offspring of IGT mothers.
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Affiliation(s)
- Hoon Lee
- Department of Preventive Medicine, Ajou University School of Medicine, #5 Wonchon-Dong, Youngtong-Gu, Suwon 442-749, Republic of Korea
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Di Cianni G, Lencioni C, Volpe L, Ghio A, Cuccuru I, Pellegrini G, Benzi L, Miccoli R, Del Prato S. C-reactive protein and metabolic syndrome in women with previous gestational diabetes. Diabetes Metab Res Rev 2007; 23:135-40. [PMID: 16770838 DOI: 10.1002/dmrr.661] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study evaluates the presence of metabolic syndrome (MS) and its association with C-reactive protein (CRP) and other cardiovascular (CV) risk factors, in a sample of women with and without previous Gestational Diabetes (pGDM). METHODS One hundred and sixty-six women with pGDM and 98 women (controls) with uncomplicated pregnancy were studied 16 months after delivery. In all women, plasma glucose, insulin, lipid profile, serum uric acid, C-reactive protein, fibrinogen and homocysteine were measured. MS was defined according to NCEP ATPIII criteria. RESULTS MS was identified in 15 pGDM women (9%) versus 1 control (1%) (p < 0.001). The more frequent metabolic traits were abdominal obesity (36% vs 17%) and low HDL-cholesterol (34% vs 17% in pGDM women and controls, respectively; all p < 0.01). HOMA-R, LDL-cholesterol, fibrinogen, serum uric acid and CRP resulted significantly higher in pGDM women with MS as compared to those without MS after adjustment for BMI. In women with no criteria for MS, only CRP levels were found to be higher in pGDM women compared to controls (p < 0.05). Seventeen percent of pGDM women with no criteria for MS had CRP levels >or=1 mg/L (all controls showed CRP levels <1 mg/L). After a stepwise regression analysis, CRP levels were independently correlated to HOMA-R (r2 = 0.27, p < 0.001) and fibrinogen (r2 = 0.30, p < 0.001). CONCLUSIONS In our population, MS occurs in a sizable proportion of pGDM women and is associated with increased levels of CRP, fibrinogen, uric acid and LDL-cholesterol. Moreover, higher levels of CRP, a marker of chronic low-grade inflammation, are present in a subset of women with pGDM, independently of MS.
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Affiliation(s)
- G Di Cianni
- Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa and Azienda Ospedaliera Pisana, Pisa, Italy.
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Carr DB, Utzschneider KM, Hull RL, Tong J, Wallace TM, Kodama K, Shofer JB, Heckbert SR, Boyko EJ, Fujimoto WY, Kahn SE. Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes. Diabetes Care 2006; 29:2078-83. [PMID: 16936156 DOI: 10.2337/dc05-2482] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to determine whether a history of gestational diabetes mellitus (GDM) further increases the risk of cardiovascular disease (CVD) in parous women with first-degree relatives with type 2 diabetes. RESEARCH DESIGN AND METHODS Women with (n = 332) and without (n = 663) a history of GDM were compared regarding 1) the revised National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome criteria, 2) the prevalence of type 2 diabetes, and 3) self-reported CVD. RESULTS Women with prior GDM were younger (48.6 +/- 0.7 vs. 52.4 +/- 0.6 years [means +/- SE];P < 0.001) and less likely to be postmenopausal (48.3 vs. 57.9%; P < 0.005). Although both groups were obese (BMI 34.4 +/- 1.2 vs. 33.7 +/- 0.6 kg/m(2)), women with prior GDM were more likely to have metabolic syndrome (86.6 vs. 73.5%; P < 0.001) and type 2 diabetes (93.4 vs. 63.3%; P < 0.001). Moreover, they had a higher prevalence of CVD (15.5 vs. 12.4%; adjusted odds ratio 1.85 [95% CI 1.21-2.82];P = 0.005) that occurred at a younger age (45.5 +/- 2.2 vs. 52.5 +/- 1.9 years;P = 0.02) and was independent of metabolic syndrome (1.74 [1.10-2.76]; P = 0.02) and type 2 diabetes (1.56 [1.002-2.43];P < 0.05). CONCLUSIONS Among women with a family history of type 2 diabetes, those with prior GDM were even more likely to not only have CVD risk factors, including metabolic syndrome and type 2 diabetes, but also to have experienced CVD events, which occurred at a younger age. Thus, women with both a family history of type 2 diabetes and personal history of GDM may be especially suitable for early interventions aimed at preventing or reducing their risk of CVD and diabetes.
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Affiliation(s)
- Darcy B Carr
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195-6460, USA.
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Eroglu D, Zeyneloglu HB. Metabolic disorders in patients with recent gestational diabetes mellitus. J Obstet Gynaecol Res 2006; 32:408-15. [PMID: 16882267 DOI: 10.1111/j.1447-0756.2006.00418.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine metabolic disorders in patients with recent gestational diabetes mellitus (GDM) compared with controls. METHODS Thirty-six patients with recent GDM and treated with a diabetic diet only, and 33 controls with normal pregnancies, were included in the study. An oral glucose tolerance test, with corresponding insulin and hormone levels, was performed; the homeostatic model assessment scores were calculated to estimate insulin resistance; prevalence of polycystic ovarian morphology on ultrasound scan was assessed; and results were recorded 10-15 months after delivery. RESULTS Waist : hip ratio and fasting cholesterol and triglyceride levels were significantly higher in women with recent GDM; high-density lipoprotein cholesterol did not differ between groups. Fasting, 1-h and 2-h plasma glucose levels were significantly higher in the GDM group; no statistically significant difference was found between groups regarding fasting insulin levels, 1-h and 2-h insulin response, and homeostatic model assessment scores. Serum hormone levels did not differ between groups. The prevalence of polycystic ovarian morphology was greater in women with GDM. There was no difference in any metabolic parameter between women in the GDM group with polycystic ovaries and those with normal ovaries. CONCLUSIONS We found a higher prevalence of polycystic ovarian morphology in women with GDM than in controls. Among women with recent GDM, higher waist : hip ratios and fasting plasma glucose and triglyceride levels may indicate metabolic syndrome. In women with recent GDM managed by diet only, insulin resistance may not be detected in the short term.
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Affiliation(s)
- Derya Eroglu
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
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Tarim E, Yigit F, Kilicdag E, Bagis T, Demircan S, Simsek E, Haydardedeoglu B, Yanik F. Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:177-82. [PMID: 16435313 DOI: 10.1002/uog.2687] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Common carotid artery intima-media thickness (CIMT) is a non-invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM). METHODS Thirty women with GDM and 40 unaffected women (as a control group) were included in the study. Blood samples were drawn from each woman in the morning after they had fasted for at least 8 h, and levels of fasting glucose, insulin, homocysteine, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and very low-density lipoprotein (VLDL) cholesterol were measured, along with the CIMT in the two groups. RESULTS The mean triglyceride (P = 0.016) and VLDL cholesterol (P = 0.011) levels in the GDM group were significantly higher than those in the unaffected women. There were no significant differences between the groups with respect to plasma levels of total cholesterol, HDL cholesterol, LDL cholesterol and insulin. The mean homocysteine (P = 0.027) and fasting glucose (P = 0.019) levels in women with GDM were significantly higher than those in the control group. Patients with GDM had significantly higher CIMT than did the unaffected women (0.582 +/- 0.066 mm vs. 0.543 +/- 0.049 mm, P = 0.006). CIMT correlated positively with maternal age (r = 0.316, P = 0.008), body mass index (BMI) at the time of a 50-g oral glucose load test (r = 0.414, P = 0.001) and homocysteine levels (r = 0.332, P = 0.008), and fasting glucose (r = 0.265, P = 0.031) and 1-h glucose value (r = 0.410, P = 0.001) at the time of the oral glucose tolerance test. There was a positive correlation between the presence of GDM and CIMT (r = 0.372, P = 0.001). However, stepwise multiple regression analysis showed that GDM/no GDM (95% CI +0.012 to +0.076, P = 0.008) and BMI at the time of the 50-g test (95% CI +0.001 to +0.009, P = 0.011) were independent parameters related to CIMT. CONCLUSION Women with GDM have increased CIMT compared with unaffected women.
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Affiliation(s)
- E Tarim
- Department of Obstetrics and Gynecology, Baskent University School of Medicine, Adana, Turkey.
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Noussitou P, Monbaron D, Vial Y, Gaillard RC, Ruiz J. Gestational diabetes mellitus and the risk of metabolic syndrome: a population-based study in Lausanne, Switzerland. DIABETES & METABOLISM 2006; 31:361-9. [PMID: 16369198 DOI: 10.1016/s1262-3636(07)70205-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS To investigate the relationships between gestational diabetes mellitus (GDM) and the metabolic syndrome (MS), as it was suggested that insulin resistance was the hallmark of both conditions. To analyse post-partum screening in order to identify risk factors for the subsequent development of type 2 diabetes mellitus (DM). METHODS A retrospective analysis of all singleton pregnancies diagnosed with GDM at the Lausanne University Hospital for 3 consecutive years. Pre-pregnancy obesity, hypertension and dyslipidaemia were recorded as constituents of the MS. RESULTS For 5788 deliveries, 159 women (2.7%) with GDM were identified. Constituents of the MS were present before GDM pregnancy in 26% (n = 37/144): 84% (n = 31/37) were obese, 38% (n = 14/37) had hypertension and 22% (n = 8/37) had dyslipidaemia. Gestational hypertension was associated with obesity (OR = 3.2, P = 0.02) and dyslipidaemia (OR = 5.4, P=0.002). Seventy-four women (47%) returned for post-partum OGTT, which was abnormal in 20 women (27%): 11% (n = 8) had type 2 diabetes and 16% (n = 12) had impaired glucose tolerance. Independent predictors of abnormal glucose tolerance in the post-partum were: having > 2 abnormal values on the diagnostic OGTT during pregnancy and presenting MS constituents (OR = 5.2, CI 1.8-23.2 and OR = 5.3, CI 1.3-22.2). CONCLUSIONS In one fourth of GDM pregnancies, metabolic abnormalities precede the appearance of glucose intolerance. These women have a high risk of developing the MS and type 2 diabetes in later years. Where GDM screening is not universal, practitioners should be aware of those metabolic risks in every pregnant woman presenting with obesity, hypertension or dyslipidaemia, in order to achieve better diagnosis and especially better post-partum follow-up and treatment.
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Affiliation(s)
- P Noussitou
- Service of Endocrinology, Diabetology and Metabolism, BH-19 CHUV 1011 Lausanne, Switzerland
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35
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Güngör ES, Danişman N, Mollamahmutoğlu L. Relationship between serum uric acid, creatinine, albumin and gestational diabetes mellitus. Clin Chem Lab Med 2006; 44:974-7. [PMID: 16879063 DOI: 10.1515/cclm.2006.173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractClin Chem Lab Med 2006;44:974–7.
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Affiliation(s)
- Emre Sinan Güngör
- Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey.
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36
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Enquobahrie DA, Williams MA, Qiu C, Luthy DA. Early pregnancy lipid concentrations and the risk of gestational diabetes mellitus. Diabetes Res Clin Pract 2005; 70:134-42. [PMID: 16188575 DOI: 10.1016/j.diabres.2005.03.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 01/03/2005] [Accepted: 03/02/2005] [Indexed: 11/26/2022]
Abstract
The objective of this study was to determine if early pregnancy maternal plasma lipid concentrations are elevated in women who later developed gestational diabetes mellitus (GDM) as compared with women who do not. Women, recruited prior to 16 weeks gestation, were followed until delivery. Maternal plasma lipid concentrations were measured in samples collected at 13 weeks gestation on average. Generalized linear models were used to estimate relative risks (RR) and 95% confidence intervals (95% CI). 5.5% of the cohort (47/851) developed GDM. Elevated triglyceride (TG) was positively associated with GDM risk (p for trend <0.001). After adjusting for maternal pre-pregnancy adiposity and other confounders, women with TG concentrations > or =137 mg/dl experienced a 3.5-fold increased risk of GDM (95% CI: 1.1-10.5) as compared with women who had concentrations <96 mg/dl. We noted a linear component of trend in risk of GDM with increasing plasma TG. Each 20mg/dl increase in TG was associated with a 10% increase in GDM risk (RR=1.1; 95% CI: 1.0-1.3). Associations between GDM risk and plasma concentrations of other lipids (i.e., total cholesterol, high-density lipoprotein, and low-density lipoprotein) were not evident. Larger prospective studies are needed to confirm our findings and to identify modifiable determinants of pregnancy-associated dyslipidemia.
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Affiliation(s)
- Daniel A Enquobahrie
- Center for Perinatal Studies, Swedish Medical Center, 747 Broadway, Suite 4 North, Seattle, WA 98122, USA.
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Paramsothy P, Knopp RH. Metabolic Syndrome in Women of Childbearing Age and Pregnancy: Recognition and Management of Dyslipidemia. Metab Syndr Relat Disord 2005; 3:250-8. [DOI: 10.1089/met.2005.3.250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Robert H. Knopp
- Department of Medicine, University of Washington, Seattle, Washington
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Albareda M, Caballero A, Badell G, Rodríguez-Espinosa J, Ordóñez-Llanos J, de Leiva A, Corcoy R. Metabolic syndrome at follow-up in women with and without gestational diabetes mellitus in index pregnancy. Metabolism 2005; 54:1115-21. [PMID: 16092064 DOI: 10.1016/j.metabol.2005.03.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We prospectively studied 262 women with prior gestational diabetes mellitus (GDM) and 66 control women to compare their prevalence of metabolic syndrome and its relationship with insulin secretion and sensitivity. A 75-g oral glucose tolerance test was scheduled 5 years after delivery along with lipid profile, anthropometrics, and blood pressure measurement. Metabolic syndrome was defined according to the National Cholesterol Education Program 2001, and insulin sensitivity and secretion were estimated with the homeostasis model assessment. Women with prior GDM had similar insulin sensitivity and lower insulin secretion than control women. In comparison with control women, women with prior GDM had higher blood pressure, waist circumference, very low-density lipoprotein cholesterol, and oral glucose tolerance test blood glucose values but, with the exception of fasting hyperglycemia, did not have an increased prevalence of metabolic syndrome or its components. The multivariate prediction of metabolic syndrome and its components was similar with age and current homeostasis model assessment-insulin secretion and resistance indexes or with age, obesity, and GDM. The main predictor was current insulin resistance in the first case and obesity in the second, obesity being the best predictor overall. We conclude that in our population and at midterm follow-up, women with prior GDM have a decreased insulin secretion and display a higher prevalence of fasting hyperglycemia but not the full-blown picture of metabolic syndrome. Obesity, a surrogate index of insulin resistance, is the best predictor of metabolic syndrome at follow-up.
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Affiliation(s)
- Mercè Albareda
- Department of Endocrinology, Hospital Sant Pau, Autonomous University of Barcelona, 08025 Barcelona, Spain
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Barden A, Singh R, Walters BN, Ritchie J, Roberman B, Beilin LJ. Factors predisposing to pre-eclampsia in women with gestational diabetes. J Hypertens 2005; 22:2371-8. [PMID: 15614032 DOI: 10.1097/00004872-200412000-00020] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lipid abnormalities occur before the onset of pre-eclampsia but their role in its pathogenesis is unclear. We tested the hypothesis that lipid abnormalities precede and contribute to the development of pre-eclampsia using women with gestational diabetes (GDM) as a focus population. METHODS One hundred and eighty-four women with a diagnosis of GDM were studied. Anthropometry, blood pressure, fasting lipids, glucose homeostasis, markers of inflammation and endothelial damage were measured and family history of disease was assessed to determine those measures at diagnosis of GDM that best predicted the development of pre-eclampsia. RESULTS Twelve percent of women with GDM developed pre-eclampsia. At diagnosis of GDM, total cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides were not different in women who subsequently developed pre-eclampsia (GDM-PE). GDM-PE had elevated body mass index, blood pressure, fasting glucose, insulin, uric acid, and C-reactive protein (CRP), which have all been linked with the 'metabolic syndrome'. They had a greater degree of microalbuminuria and more frequently reported a family history of hypertension and maternal gestational diabetes. In logistic regression, the significant independent predictors for developing pre-eclampsia were fasting glucose, CRP, a family history of hypertension and the proband's mother having gestational diabetes. CONCLUSION The results suggest that, in GDM, increased severity of insulin resistance and related features of the 'metabolic syndrome', rather than lipid abnormalities, are precursors to the development of pre-eclampsia and hence are likely to be implicated in the pathophysiology of this disorder. Moreover, these women are likely to be at particularly high risk of long-term cardiovascular disease and Type 2 diabetes.
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Affiliation(s)
- Anne Barden
- Cardiovascular Research Centre, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia.
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Al Mahroos S, Nagalla DS, Yousif W, Sanad H. A population-based screening for gestational diabetes mellitus in non-diabetic women in Bahrain. Ann Saudi Med 2005; 25:129-33. [PMID: 15977691 PMCID: PMC6147961 DOI: 10.5144/0256-4947.2005.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Maternal hyperglycemia is considered a risk factor for fetal morbidity. Since there is a high prevalence of diabetes mellitus among the population of Bahrain, we conducted a prospective population-based study of gestational diabetes mellitus (GDM) in non-diabetic pregnant women. SUBJECTS AND METHODS All non-diabetic pregnant women attending antenatal clinics during January 2001 to December 2002 (n=10,495) were screened for GDM during the 24th to 28th weeks of gestation. All positive subjects based on a 50-g glucose challenge test (GCT) were further evaluated by a diagnostic 75-g oral glucose tolerance test (OGTT). The birth weight of the child and post-delivery insulin resistance were monitored. The homeostasis model of insulin resistance (HOMA-IR) was used to assess insulin resistance. RESULTS Of 10,495 non-diabetic pregnant women screened, 32.8% (n=3443) had plasma glucose > or = 7.8 mmol/L (140 mg/dL) in the GCT. The 75-g OGTT found a prevalence of GDM of 13.5%. There were twice as many Bahrainis as expatriates. Of children born to women with GDM, 6.5% had a birth weight > 4000 g. Post-delivery evaluation of insulin resistance indicated that 33% of women with GDM had a HOMA-IR value > 2. CONCLUSION The population of Bahrain is a high-risk ethnic group for GDM. The association of insulin resistance in the post-gravid state with GDM among 33% of the study population suggests that insulin resistance, the possible cause of the pathophysiological mechanism underlying the development of gestational diabetes, continues in the post gravid state.
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Affiliation(s)
- Salwa Al Mahroos
- Department of Medicine, Salmaniya Medical Complex, Manama Kingdom of Bahrain
| | - Das S. Nagalla
- Clinical Biochemistry Section, Department of Pathology, Salamniya Medical Complex, Manama Kingdom of Bahrain
| | - Wafa Yousif
- Obstetrics and Gynecology Department, Salmaniya Medical Complex, Manama Kingdom of Bahrain
| | - Hasan Sanad
- Clinical Biochemistry Section, Department of Pathology, Salamniya Medical Complex, Manama Kingdom of Bahrain
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Bo S, Monge L, Macchetta C, Menato G, Pinach S, Uberti B, Pagano G. Prior gestational hyperglycemia: a long-term predictor of the metabolic syndrome. J Endocrinol Invest 2004; 27:629-35. [PMID: 15505985 DOI: 10.1007/bf03347494] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about the association between prior gestational hyperglycemia of different severity and the subsequent risk for the metabolic syndrome. Eighty-one women with prior gestational diabetes mellitus (GDM), 25 with one abnormal value at the oral glucose tolerance test (OGTT), and 65 with normal OGTT were studied after a mean of 8.5 yr from the index pregnancy. Patients with prior gestational hyperglycemia (both one abnormal value at the OGTT and GDM) showed a worse metabolic pattern than subjects with gestational normoglycemia [respectively higher values of body mass index (BMI), waist, blood pressure, serum glucose, insulin, C-peptide, homeostatic model assessment (HOMA), fibrinogen and lower levels of HDL-cholesterol]. Prevalence of the metabolic syndrome and its components was 2-4-fold higher in women with prior gestational hyperglycemia (and 10-fold higher if pre-pregnancy obesity coexisted) when compared to normoglycemic controls; in a Cox proportional hazard model, after adjustments for age and pre-pregnancy BMI, gestational hyperglycemia and pre-pregnancy BMI predicted subsequent metabolic syndrome [respectively: hazard ratio (HR)=4.26 and HR=1.21] and most of its components. In the same model, the highest quartile of fasting serum glucose at the OGTT of the index pregnancy was significantly associated to the metabolic syndrome and its components. Gestational hyperglycemia and fasting glucose values were also associated to subsequent fibrinogen values, but not to albumin excretion rates. In young adult women, prior gestational hyperglycemia (particularly abnormal fasting glucose values), above all in combination with pre-pregnancy obesity, anticipates a subsequent syndrome at high cardiovascular risk and, possibly, a mild chronic inflammatory response.
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Affiliation(s)
- S Bo
- Department of Internal Medicine, University of Turin, Italy.
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Tarim E, Bagis T, Kilicdag E, Erkanli S, Aslan E, Sezgin N, Kuscu E. Elevated plasma homocysteine levels in gestational diabetes mellitus. Acta Obstet Gynecol Scand 2004; 83:543-7. [PMID: 15144335 DOI: 10.1111/j.0001-6349.2004.00540.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This prospective study investigated the occurrence of hyperhomocysteinemia in a population of patients with gestational diabetes. The aim was to determine whether elevated plasma homocysteine is associated with gestational diabetes in Turkish women. STUDY DESIGN This prospective controlled study was conducted in the Department of Obstetrics and Gynecology of the Baskent University Faculty of Medicine between April 2002 and June 2003, and involved 304 Turkish women with uncomplicated pregnancies who were at 24-28 weeks gestation. The women in the study were assigned to one of three groups according to the results of the 50-g glucose screening and the oral glucose tolerance test (OGTT): group 1 comprised women who had normal glucose levels (< or = 135 mg/dL) after the 50-g challenge; group 2 comprised women with abnormal screening test results (> 135 mg/dL) but normal OGTT results; and group 3 comprised patients with gestational diabetes mellitus (GDM) according to the OGTT. Levels of fasting glucose, homocysteine, vitamin B(12) and folic acid, total cholesterol, high density lipoprotein (HDL) cholesterol, and triglycerides, low density lipoprotein (LDL) cholesterol and very low density lipoprotein (VLDL) cholesterol levels were measured in the three groups. Levels of insulin sensitivity were calculated using the homeostasis model assessment (HOMA) formula. RESULTS The mean level of homocysteine in group 1 was significantly lower than the levels in groups 2 and 3 (p < 0.001) The mean triglyceride and VLDL levels in group 3 were significantly higher than the corresponding levels in group 1 (p < 0.05 for both). There were no significant differences among the groups with respect to levels of total cholesterol, vitamin B(12), folic acid, creatinine, fasting glucose or insulin. The mean HOMA value in group 3 was significantly higher than that in group 1 (p < 0.05). Only the blood glucose level after the 50-g glucose screening [p = 0.000, 95% confidence interval (CI) 0.009-0.027] had a significant correlation with homocysteine levels. CONCLUSION In this prospective study of Turkish women, we found that patients with gestational diabetes and women with abnormal screening test results (> 135 mg/dL) but normal OGTT results have higher homocysteine levels than normal pregnant women. This increased level seems to be related to an abnormal 50-g test but not to insulin resistance. Further investigations are needed to follow up for these patients in the postpartum period and later in their life.
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Affiliation(s)
- Ebru Tarim
- Department of Obstetrics and Gynecology, Baskent University School of Medicine, Adana, Turkey.
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Bo S, Menato G, Gallo ML, Bardelli C, Lezo A, Signorile A, Gambino R, Cassader M, Massobrio M, Pagano G. Mild gestational hyperglycemia, the metabolic syndrome and adverse neonatal outcomes. Acta Obstet Gynecol Scand 2004; 83:335-40. [PMID: 15005779 DOI: 10.1111/j.0001-6349.2004.00314.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the prevalence of the metabolic syndrome and its effect on neonatal outcomes in pregnancies with different degrees of hyperglycemia. METHODS One hundred and fifty women with gestational diabetes, 100 with one abnormal value on the oral glucose tolerance test, 100 with a normal oral glucose challenge test and 350 with an abnormal challenge test and normal tolerance test were enrolled. RESULTS The prevalence of the metabolic syndrome was: 0%, 4.9%, 20% and 18% in the normal challenge test, abnormal challenge and normal tolerance test, one abnormal value and gestational diabetes patients, respectively. Offspring birth weights, prevalence of large-for-gestational age babies and icterus were significantly higher in women with an abnormal challenge test (both with a normal tolerance test or one abnormal value or gestational diabetes). Metabolic syndrome was the best predictor of the presence of large-for-gestational age babies in patients with an abnormal challenge and normal tolerance test (OR = 3.15), one abnormal value (OR = 3.53) and gestational diabetes (OR = 4.15). CONCLUSIONS Metabolic syndrome in mid-pregnancy was an independent predictor of macrosomia in women with any degree of gestational hyperglycemia; the oral glucose challenge test identifies pregnancies with metabolic abnormalities and adverse neonatal outcomes also in the presence of a normal oral glucose tolerance test.
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Affiliation(s)
- Simona Bo
- Department of Internal Medicine, University of Turin, Turin, Italy.
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Jairath N. Implications of gender differences on coronary artery disease risk reduction in women. AACN CLINICAL ISSUES 2001; 12:17-28. [PMID: 11288325 DOI: 10.1097/00044067-200102000-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Differences in the clinical presentation and resultant treatment of coronary artery disease (CAD) for men and women have sensitized advanced practice nurses to the importance of addressing gender issues when caring for women with CAD. Certain patient characteristics and clinical conditions may place women at higher risk of CAD development or progression. These factors include depression, African American status, menopausal status, age, type 2 diabetes, and thyroid function. In addition, female gender may adversely influence the relative benefits of cholesterol lowering in elderly women with borderline high serum cholesterol levels and response to interventions for modification of sedentary behavior and for smoking cessation. This article addresses emerging knowledge regarding gender differences in CAD risk factors and responsiveness to risk reduction interventions, issues regarding patient management, the implications of emerging knowledge on early detection of CAD risk factors more prevalent in women, and the development of targeted intervention approaches.
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Affiliation(s)
- N Jairath
- School of Nursing, University of Maryland-Baltimore, Baltimore, MD 21201, USA.
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