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Zou L, Wei Q, Pan S, Xiao F, Jiang Y, Zhong Y, Xie Y. Comparison of the Effects of Combined Femoral and Sciatic Nerves Block versus General Anesthesia on Hemodynamic Stability and Postoperative Complication in Patients with Diabetic Foot: A Prospective, Double-Blind and Randomized Controlled Trial. Diabetes Metab Syndr Obes 2024; 17:2243-2257. [PMID: 38854443 PMCID: PMC11162629 DOI: 10.2147/dmso.s465814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024] Open
Abstract
Background Perioperative anesthetic management of patients with diabetic foot undergoing surgical treatment is challenging due to their poor cardiovascular health status. According to previous literature, general anesthesia and peripheral nerve block have their own advantages and disadvantages for such patients. We reported the effect of these two anesthesia techniques on perioperative hemodynamics and prognosis in these patients. Methods This study employed a prospective randomized controlled design, where patients meeting the inclusion criteria were assigned to two groups: the general anesthesia group (GA group) and the peripheral nerve block group (PNB group). The primary outcomes were the differences in intraoperative hemodynamic stability and the incidence of postoperative complications between the two groups. The second outcomes were postoperative numerical rating scale scores, analgesic drug remedies, postoperative sleep conditions monitored by sleep bracelets and health status assessed by EQ-5D-5 L scores. Results One hundred and nine subjects were enrolled in this study, including 54 in the GA group and 55 in the PNB group. The baseline parameters of the two groups were comparable. The GA group exhibited a significantly higher incidence of hypotension, and Colloid intake and total fluid intake were significantly higher in the GA group than in the PNB group. Additionally, a larger proportion of patients in the GA group. The scores of postoperative pain during the 48 hours after surgery were significantly higher, and more patients needed tramadol for postoperative analgesia during the 24 h after surgery in the GA group than in the PNB group. Patients in the PNB group slept better, first feeding time, earlier out-of-bed activity and earlier discharge from the hospital, compared to the GA group. However, there was no obvious difference in postoperative complications between the two groups except pharyngeal pain. Conclusion Peripheral nerve block is a better option in patients with diabetes undergoing elective below-knee surgery than general anesthesia.
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Affiliation(s)
- Liyun Zou
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Qiufeng Wei
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Sining Pan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Fei Xiao
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yage Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yu Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
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Wang YX, Mitsunami M, Manson JE, Gaskins AJ, Rich-Edwards JW, Wang L, Zhang C, Chavarro JE. Association of Gestational Diabetes With Subsequent Long-Term Risk of Mortality. JAMA Intern Med 2023; 183:1204-1213. [PMID: 37695588 PMCID: PMC10495928 DOI: 10.1001/jamainternmed.2023.4401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/14/2023] [Indexed: 09/12/2023]
Abstract
Importance Gestational diabetes has been associated with numerous chronic diseases. However, few studies have examined the association of gestational diabetes with long-term mortality risk. Objective To investigate the associations between gestational diabetes and long-term risks of total and cause-specific mortality. Design, Setting, and Participants This cohort study analyzed participants of the Nurses' Health Study II who were followed for 30 years (1989-2019). Participants included US female nurses aged 25 to 42 years who reported at least 1 pregnancy (≥6 months) at 18 years or older across their reproductive life span. Data were analyzed from May 1, 2022, to May 25, 2023. Exposure Gestational diabetes across the reproductive life span. Main Outcomes and Measures Hazard ratios (HRs with 95% CIs) for total and cause-specific mortality were estimated by Cox proportional hazards regression models. Results A total of 91 426 parous participants were included, with a mean (SD) age of 34.9 (4.7) years and a body mass index of 24.1 (4.7) at baseline. During a follow-up period of 2 609 753 person-years, 3937 deaths were documented, including 255 deaths from cardiovascular disease and 1397 from cancer. Participants with a history of gestational diabetes had a higher crude mortality rate than those without a history of gestational diabetes (1.74 vs 1.49 per 1000 person-years; absolute difference = 0.25 per 1000 person-years). The corresponding HR for total mortality was 1.28 (95% CI, 1.13-1.44), which did not materially change after additional adjustment for potential confounders and lifestyle factors during the reproductive life span (HR, 1.25; 95% CI, 1.11-1.41). The association persisted regardless of the subsequent development of type 2 diabetes and was more robust among participants who adopted less healthy lifestyles; experienced gestational diabetes in 2 or more pregnancies (HR, 1.48; 95% CI, 0.99-2.19); had gestational diabetes both in the initial and subsequent pregnancies (HR, 1.71; 95% CI, 1.11-2.63); and concurrently reported hypertensive disorders in pregnancy (HR, 1.80; 95% CI, 1.21-2.67), preterm birth (HR, 2.46; 95% CI, 1.66-3.64), or low birth weight (HR, 2.11; 95% CI, 1.21-3.68). Cause-specific mortality analyses revealed that gestational diabetes was directly associated with the risk of mortality due to cardiovascular disease (HR, 1.59; 95% CI, 1.03-2.47). Additionally, gestational diabetes was inversely associated with cancer mortality (HR, 0.76; 95% CI, 0.59-0.98); however, it was only evident among participants who later developed type 2 diabetes. Conclusions and Relevance Results of this cohort study suggest that participants who reported a history of gestational diabetes exhibited a small but elevated risk of subsequent mortality over 30 years. The findings emphasize the importance of considering gestational diabetes as a critical factor in later-life mortality risk.
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Affiliation(s)
- Yi-Xin Wang
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Makiko Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - JoAnn E. Manson
- 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
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Janet W. Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
| | - Cuilin Zhang
- Global Center for Asian Women’s Health and Bia-Echo Asia Centre for Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jorge E. 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
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Ozyildirim S, Barman HA, Dogan O, Ersanli MK, Dogan SM. The Relationship between Coronary Flow Reserve and the TyG Index in Patients with Gestational Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1811. [PMID: 37893529 PMCID: PMC10608421 DOI: 10.3390/medicina59101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder characterized by glucose intolerance during pregnancy. The triglyceride glucose (TyG) index, a marker of insulin resistance, and coronary flow reserve (CFR), a measure of coronary microvascular function, are emerging as potential indicators of cardiovascular risk. This study aims to investigate the association between CFR and the TyG index in GDM patients. Materials and Methods: This cross-sectional study of 87 GDM patients and 36 healthy controls was conducted. The participants underwent clinical assessments, blood tests, and echocardiographic evaluations. The TyG index was calculated as ln(triglycerides × fasting glucose/2). CFR was measured using Doppler echocardiography during rest and hyperemia induced by dipyridamole. Results: The study included 87 individuals in the GDM group and 36 individuals in the control group. There was no significant difference in age between the two groups (34.1 ± 5.3 years for GDM vs. 33.1 ± 4.9 years for the control, p = 0.364). The TyG index was significantly higher in the GDM group compared to the controls (p < 0.001). CFR was lower in the GDM group (p < 0.001). A negative correlation between the TyG index and CFR was observed (r = -0.624, p < 0.001). Linear regression revealed the TyG index as an independent predictor of reduced CFR. Conclusions: The study findings reveal a significant association between the TyG index and CFR in GDM patients, suggesting their potential role in assessing cardiovascular risk.
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Affiliation(s)
| | - Hasan Ali Barman
- Institute of Cardiology, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul 34320, Turkey; (S.O.); (O.D.); (M.K.E.); (S.M.D.)
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Pei L, Lai F, Chen W, Zeng R, Chen N, Li Y, Xiao H, Cao X. Pancreatic-derived factor predicts remission of impaired glucose tolerance women with history of gestational diabetes. Diabetes Res Clin Pract 2023; 204:110892. [PMID: 37657647 DOI: 10.1016/j.diabres.2023.110892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/03/2023]
Abstract
AIM To clarify whether pancreatic derived factor (PANDER) predicts the remission of impaired glucose tolerance (IGT) due to lifestyle intervention among women with history of gestational diabetes mellitus (GDM). METHODS IGT women with GDM history in a prospective cohort study were enrolled at 4-12 weeks postpartum and grouped based on PANDER level at recruitment. After lifestyle intervention, glucose metabolism examined was performed at one year postpartum. The relation between PANDER level and glycemic outcome was analyzed with logistic regression and receiver operating characteristic (ROC) curves. RESULTS In total, 48.7% (55/113) of subjects returned to normal glucose tolerance at one year postpartum. Compared to those with low PANDER group, women among high PANDER group and very high PANDER group were associated with a lower remission of IGT. These associations remained in multivariable logistic regression. The area under the ROC curve (AUC) of PANDER level for the remission of IGT was 0.702 (95% CI 0.595-0.809). When PANDER level was combined with clinical information, the AUC reached 0.812 (95% CI 0.725-0.899; P < 0.001). CONCLUSION Circulating PANDER concentration is inversely associated with the remission of IGT in women with GMD history at one year postpartum.
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Affiliation(s)
- Ling Pei
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fenghua Lai
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenzhan Chen
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Zeng
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nan Chen
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haipeng Xiao
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaopei Cao
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Melero V, Arnoriaga M, Barabash A, Valerio J, Del Valle L, Martin O'Connor R, de Miguel MP, Diaz JA, Familiar C, Moraga I, Duran A, Cuesta M, Torrejon MJ, Martinez-Novillo M, Moreno M, Romera G, Runkle I, Pazos M, Rubio MA, Matia-Martín P, Calle-Pascual AL. An Early Mediterranean-Based Nutritional Intervention during Pregnancy Reduces Metabolic Syndrome and Glucose Dysregulation Rates at 3 Years Postpartum. Nutrients 2023; 15:3252. [PMID: 37513670 PMCID: PMC10383706 DOI: 10.3390/nu15143252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
A Mediterranean diet (MedDiet)-based intervention reduces the rate of immediate postpartum maternal metabolic disorders. Whether these effects persist long-term remains to be determined. A total of 2526 normoglycemic women were randomized before the 12th gestational week (GW). IG women followed a MedDiet with extra virgin olive oil (EVOO) (>40 mL/day) and a handful of nuts daily, whereas CG women had to restrict all kinds of dietary fat. At 3 months postpartum, a motivational lifestyle interview was held. The endpoint of the study evaluated the rate of abnormal glucose regulation (AGR) and metabolic syndrome (MetS) at 3 years postpartum in women of the San Carlos cohort. A total of 369/625 (59%) CG women and 1031/1603 (64.3%) IG women were finally analyzed. At 3 months and 3 years postdelivery, the IG women showed higher adherence to the MedDiet, which was associated with lower values of body mass index (BMI) and lipid and glycemic profiles. Body weight change and waist circumference were lower in the IG women. After applying multiple regression analysis, the ORs (95%CI) resulted in AGR (3.18 (2.48-4.08); p < 0.001)/MetS (3.79 (1.81-7.95); p = 0.001) for women with GDM and higher OR for development of MetS in CG women (3.73 (1.77-7.87); p = 0.001). A MedDiet-based intervention early in pregnancy demonstrated persistent beneficial effects on AGR and MetS rates at 3 years postpartum.
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Affiliation(s)
- Verónica Melero
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Maria Arnoriaga
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Ana Barabash
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Johanna Valerio
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Laura Del Valle
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Rocio Martin O'Connor
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Maria Paz de Miguel
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jose Angel Diaz
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Cristina Familiar
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Inmaculada Moraga
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Alejandra Duran
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Martín Cuesta
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - María José Torrejon
- Clinical Laboratory Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Mercedes Martinez-Novillo
- Clinical Laboratory Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Maria Moreno
- Clinical Laboratory Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Gisela Romera
- Clinical Laboratory Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Mario Pazos
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Pilar Matia-Martín
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Alfonso Luis Calle-Pascual
- Endocrinology and Nutrition Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
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Razo-Azamar M, Nambo-Venegas R, Meraz-Cruz N, Guevara-Cruz M, Ibarra-González I, Vela-Amieva M, Delgadillo-Velázquez J, Santiago XC, Escobar RF, Vadillo-Ortega F, Palacios-González B. An early prediction model for gestational diabetes mellitus based on metabolomic biomarkers. Diabetol Metab Syndr 2023; 15:116. [PMID: 37264408 DOI: 10.1186/s13098-023-01098-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) represents the main metabolic alteration during pregnancy. The available methods for diagnosing GDM identify women when the disease is established, and pancreatic beta-cell insufficiency has occurred.The present study aimed to generate an early prediction model (under 18 weeks of gestation) to identify those women who will later be diagnosed with GDM. METHODS A cohort of 75 pregnant women was followed during gestation, of which 62 underwent normal term pregnancy and 13 were diagnosed with GDM. Targeted metabolomics was used to select serum biomarkers with predictive power to identify women who will later be diagnosed with GDM. RESULTS Candidate metabolites were selected to generate an early identification model employing a criterion used when performing Random Forest decision tree analysis. A model composed of two short-chain acylcarnitines was generated: isovalerylcarnitine (C5) and tiglylcarnitine (C5:1). An analysis by ROC curves was performed to determine the classification performance of the acylcarnitines identified in the study, obtaining an area under the curve (AUC) of 0.934 (0.873-0.995, 95% CI). The model correctly classified all cases with GDM, while it misclassified ten controls as in the GDM group. An analysis was also carried out to establish the concentrations of the acylcarnitines for the identification of the GDM group, obtaining concentrations of C5 in a range of 0.015-0.25 μmol/L and of C5:1 with a range of 0.015-0.19 μmol/L. CONCLUSION Early pregnancy maternal metabolites can be used to screen and identify pregnant women who will later develop GDM. Regardless of their gestational body mass index, lipid metabolism is impaired even in the early stages of pregnancy in women who develop GDM.
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Affiliation(s)
- Melissa Razo-Azamar
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México
- Laboratorio de Envejecimiento Saludable del INMEGEN en el Centro de Investigación sobre Envejecimiento (CIE-CINVESTAV Sede Sur), 14330, Mexico City, México
| | - Rafael Nambo-Venegas
- Laboratorio de Bioquímica de Enfermedades Crónicas Instituto Nacional de Medicina Genómica (INMEGEN), 14610, Mexico City, Mexico
| | - Noemí Meraz-Cruz
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México
| | - Martha Guevara-Cruz
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", 14080, Mexico City, Mexico
| | | | - Marcela Vela-Amieva
- Laboratorio de Errores Innatos del Metabolismo, Instituto Nacional de Pediatría (INP), 04530, Mexico City, México
| | - Jaime Delgadillo-Velázquez
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México
| | - Xanic Caraza Santiago
- Centro de Salud T-III Dr. Gabriel Garzón Cossa, Jurisdicción Sanitaria Gustavo A. Madero, SSA de la Ciudad de México, Mexico City, México
| | - Rafael Figueroa Escobar
- Centro de Salud T-III Dr. Gabriel Garzón Cossa, Jurisdicción Sanitaria Gustavo A. Madero, SSA de la Ciudad de México, Mexico City, México
| | - Felipe Vadillo-Ortega
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México
| | - Berenice Palacios-González
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México.
- Laboratorio de Envejecimiento Saludable del INMEGEN en el Centro de Investigación sobre Envejecimiento (CIE-CINVESTAV Sede Sur), 14330, Mexico City, México.
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Shan Y, Cui J, Kang X, Tang W, Lu Y, Gao Y, Chen L. Aquaporin-8 overexpression is involved in vascular structure and function changes in placentas of gestational diabetes mellitus patients. Open Life Sci 2022; 17:1473-1486. [DOI: 10.1515/biol-2022-0522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
To study the role and mechanism of aquaporin-8 (AQP8) in placental vascular development in gestational diabetes mellitus (GDM), hematoxylin–eosin staining and immunohistochemistry were utilized to analyze the histopathological changes in placentas in GDM patients. Transwell, CCK-8, and tube formation assays were performed to examine cell migration, proliferation, and tube formation. AQP8, vascular cell adhesion molecule 1 (VCAM-1), tumor necrosis factor alpha (TNF)-α, and vascular endothelial growth factor (VEGF)-A expression levels were investigated. Relative to the control group, the placentas in the GDM group showed morphological changes, the number of microvessels in the placental villi arterioles was significantly higher, and the area of microvessels in the arterioles of placental villi was significantly lower. The expression levels of VCAM-1, TNF-α, VEGF-A, and AQP8 in the GDM placentas and human umbilical vein endothelial cells (HUVECs) stimulated by high glucose were significantly higher than those in the control group, and AQP8 was located in placental endothelial cells. Overexpression of glucose and AQP8 inhibited tube formation, migration, and proliferation in HUVECs. High glucose levels can induce dysfunction in vascular endothelial cells and lead to pathological changes in the placental vascular structure in GDM. AQP8 overexpression in placental GDM can inhibit endothelial cell behavior, cause endothelial cell dysfunction, and further participate in the occurrence and development of GDM placental vascular lesions.
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Affiliation(s)
- Yanxing Shan
- Department of Obstetrics and Gynecology, Affiliated Hospital 2 of Nantong University , No. 6 North Road, Haierxiang, Chongchuan District , Nantong , Jiangsu, 226001 , China
| | - Jiawen Cui
- Department of Obstetrics and Gynecology, Affiliated Hospital 2 of Nantong University , No. 6 North Road, Haierxiang, Chongchuan District , Nantong , Jiangsu, 226001 , China
- Department of Obstetrics and Gynecology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Qingpu , Shanghai , 201700 , China
| | - Xinyi Kang
- Department of Obstetrics and Gynecology, Affiliated Hospital 2 of Nantong University , No. 6 North Road, Haierxiang, Chongchuan District , Nantong , Jiangsu, 226001 , China
| | - Weichun Tang
- Department of Obstetrics and Gynecology, Affiliated Hospital 2 of Nantong University , No. 6 North Road, Haierxiang, Chongchuan District , Nantong , Jiangsu, 226001 , China
| | - Yiling Lu
- Department of Obstetrics and Gynecology, Affiliated Hospital 2 of Nantong University , No. 6 North Road, Haierxiang, Chongchuan District , Nantong , Jiangsu, 226001 , China
| | - Ying Gao
- Department of Obstetrics and Gynecology, Affiliated Hospital 2 of Nantong University , No. 6 North Road, Haierxiang, Chongchuan District , Nantong , Jiangsu, 226001 , China
| | - Liping Chen
- Department of Obstetrics and Gynecology, Affiliated Hospital 2 of Nantong University , No. 6 North Road, Haierxiang, Chongchuan District , Nantong , Jiangsu, 226001 , China
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8
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Agarwal MM, Lal M, Vyas CD. Gestational Diabetes Mellitus in a Multi-Ethnic, High-Risk Population: Adequacy of Screening for Diabetes Mellitus 6 Weeks after Delivery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13946. [PMID: 36360827 PMCID: PMC9658585 DOI: 10.3390/ijerph192113946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Gestational diabetes mellitus (GDM) during pregnancy is a marker for future type 2 diabetes mellitus (T2DM); therefore, a meticulous follow-up after delivery can help identify women at risk for T2DM. In a cohort of 5504 pregnant women, the postpartum follow-up of all 1043 women with GDM for hyperglycemia in a multi-ethnic, high-risk Arab population was investigated. The prevalence of GDM was 18.9%. A total of 265 (25.4%) women returned for an oral glucose tolerance test (OGTT) 4-6 weeks after delivery, with more South Asian than Arab women (p < 0.01). The other factors associated with return were (a) family history of T2DM, (b) lower basic metabolic index, (c) higher abortions and (d) lower gravida (p < 0.05), all with minimal effect. An abnormal postpartum OGTT was statistically associated with previous GDM history and hypoglycemic drug treatment, although these effects were small. Overall, the follow-up of women with GDM postpartum was dismal, ethnicity being the major factor influencing return. Urgent public measures are needed to educate women with GDM about follow-up highlighting (a) risk awareness for T2DM and (b) a healthy lifestyle after childbirth-if we are to turn the tide on the epidemic of T2DM plaguing the Arab world.
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Affiliation(s)
- Mukesh M. Agarwal
- Department of Pathology, Faculty of Medicine, California University of Science and Medicine, Colton, CA 92324, USA
| | - Madan Lal
- Department of Obstetrics and Gynecology, Saint Luke’s General Hospital, R95 FY71 Kilkenny, Ireland
| | - Chintan D. Vyas
- Department of Medicine, Burjeel Medical Center, Al Ain P.O. Box 103500, United Arab Emirates
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9
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Xie W, Wang Y, Xiao S, Qiu L, Yu Y, Zhang Z. Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. BMJ 2022; 378:e070244. [PMID: 36130740 PMCID: PMC9490552 DOI: 10.1136/bmj-2022-070244] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To quantify the risk of overall and type specific cardiovascular and cerebrovascular diseases as well as venous thromboembolism in women with a history of gestational diabetes mellitus. DESIGN Systematic review and meta-analyses. DATA SOURCES PubMed, Embase, and the Cochrane Library from inception to 1 November 2021 and updated on 26 May 2022. REVIEW METHODS Observational studies reporting the association between gestational diabetes mellitus and incident cardiovascular and cerebrovascular diseases were eligible. Data, pooled by random effects models, are presented as risk ratios (95% confidence intervals). Certainty of evidence was appraised by the Grading of Recommendations, Assessment, Development, and Evaluations. RESULTS 15 studies rated as moderate or serious risk of bias were included. Of 513 324 women with gestational diabetes mellitus, 9507 had cardiovascular and cerebrovascular disease. Of more than eight million control women without gestational diabetes, 78 895 had cardiovascular and cerebrovascular disease. Compared with women without gestational diabetes mellitus, women with a history of gestational diabetes mellitus showed a 45% increased risk of overall cardiovascular and cerebrovascular diseases (risk ratio 1.45, 95% confidence interval 1.36 to 1.53), 72% for cardiovascular diseases (1.72, 1.40 to 2.11), and 40% for cerebrovascular diseases (1.40, 1.29 to 1.51). Women with gestational diabetes mellitus showed increased risks of incident coronary artery diseases (1.40, 1.18 to 1.65), myocardial infarction (1.74, 1.37 to 2.20), heart failure (1.62, 1.29 to 2.05), angina pectoris (2.27, 1.79 to 2.87), cardiovascular procedures (1.87, 1.34 to 2.62), stroke (1.45, 1.29 to 1.63), and ischaemic stroke (1.49, 1.29 to 1.71). The risk of venous thromboembolism was observed to increase by 28% in women with previous gestational diabetes mellitus (1.28, 1.13 to 1.46). Subgroup analyses of cardiovascular and cerebrovascular disease outcomes stratified by study characteristics and adjustments showed significant differences by region (P=0.078), study design (P=0.02), source of data (P=0.005), and study quality (P=0.04), adjustment for smoking (P=0.03), body mass index (P=0.01), and socioeconomic status (P=0.006), and comorbidities (P=0.05). The risk of cardiovascular and cerebrovascular diseases was, however, attenuated but remained significant when restricted to women who did not develop subsequent overt diabetes (all gestational diabetes mellitus: 1.45, 1.33 to 1.59, gestational diabetes mellitus without subsequent diabetes: 1.09, 1.06 to 1.13). Certainty of evidence was judged as low or very low quality. CONCLUSIONS Gestational diabetes mellitus is associated with increased risks of overall and type specific cardiovascular and cerebrovascular diseases that cannot be solely attributed to conventional cardiovascular risk factors or subsequent diabetes.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China
| | - Yu Wang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Shiyu Xiao
- Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Lin Qiu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yang Yu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China
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10
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Chen X, Du Y, Xia S, Li Z, Liu J. Vitamin B 12 and gestational diabetes mellitus: a systematic review and meta-analysis. Br J Nutr 2022; 129:1-8. [PMID: 35915058 DOI: 10.1017/s000711452200246x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The relationship between vitamin B12 and gestational diabetes mellitus (GDM) remains controversial. To comprehensively evaluate the relationship between vitamin B12 and GDM, and to provide more information on GDM prevention, this study provides a systematic review and meta-analysis of vitamin B12 and GDM. As of September 22, 2021, 304 articles were searched in PubMed, Web of Science, EMBASE, and Cochrane databases, of which 15 studies met the inclusion criteria. Results presented there was no association between maternal vitamin B12 concentration during the first trimester with GDM, however, low vitamin B12 concentration in the second or third trimester of pregnancy was related to an increased risk of GDM. Compared with the non-GDM group, the vitamin B12 concentration in the GDM group was remarkably decreased (MD: -10·79; 95%CI: -21·37, -0·21), and vitamin B12 deficiency increased the risk for GDM (OR: 1·59; 95%CI: 1·10, 2·29). These effects were more significant among Asians. In addition, an increased ratio of high folate to low vitamin B12 in serum also increased the risk of GDM (OR: 1·87; 95% CI: 1·46, 2·41). These results suggest that more vitamin B12 may need to be provided during pregnancy.
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Affiliation(s)
- Xue Chen
- School of Public Health, Bengbu Medical College, Bengbu, Anhui Province, 233030, People's Republic of China
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Yushan Du
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Shuangbo Xia
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Zhiwen Li
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Jufen Liu
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
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11
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Anzoategui S, Gibbone E, Wright A, Nicolaides KH, Charakida M. Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:207-214. [PMID: 35502146 DOI: 10.1002/uog.24929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Women with gestational diabetes mellitus (GDM) and/or hypertensive disorders of pregnancy (HDP) are at increased long-term cardiovascular risk. Mild cardiac functional alterations have been detected in women with GDM or HDP in midgestation, prior to clinical onset of the disease, but these functional alterations have not been found to be useful as screening tools. In contrast, increased impedance to peripheral blood flow, measured by echocardiography or ophthalmic artery Doppler, has been shown to provide incremental value to maternal characteristics for the prediction of pre-eclampsia. However, it is unknown whether similar changes can be detected in women at risk of GDM. In this study, we performed detailed cardiovascular phenotyping in a large, unselected population of women in midgestation to identify similarities and differences in cardiovascular adaptation in women who are at risk of GDM and/or HDP. METHODS This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included assessment of flow velocity waveforms from the maternal ophthalmic arteries, echocardiography for assessment of maternal cardiovascular function and measurement of uterine artery pulsatility index and serum placental growth factor (PlGF) for assessment of placental perfusion and function. The measured indices were converted to either multiples of the median (MoM) values or deviation from the median (delta) after adjusting for maternal characteristics and elements of medical history. Biomarker delta or MoM values in the GDM and HDP groups were compared with those in the unaffected group using 95% CI and t-tests. RESULTS The study population of 5214 pregnancies contained 4429 (84.9%) that were unaffected by GDM or HDP, 509 (9.8%) complicated by GDM without HDP, 41 (0.8%) with GDM and HDP, and 235 (4.5%) with HDP without GDM. In HDP cases, with or without GDM, there was evidence of impaired placentation, with a decrease in PlGF, and increased impedance to flow in the peripheral circulation, suggested by an increase in ophthalmic artery peak systolic velocity (PSV) ratio, peripheral vascular resistance assessed on echocardiography and mean arterial pressure. In the GDM group without HDP, there was no evidence of altered placental perfusion or function and ophthalmic artery PSV ratio was not significantly different from that in the unaffected group; peripheral vascular resistance and mean arterial pressure were increased but to a lesser degree than in the HDP group. In the HDP group, there was an increase in global longitudinal systolic strain and slight increase in isovolumic relaxation time, while in the GDM group, there was an increase in mitral valve E/e', myocardial performance index and global longitudinal systolic strain. CONCLUSIONS In midgestation, women who subsequently develop HDP or GDM have a mild subclinical reduction in left ventricular function. In HDP cases, with or without GDM, there is evidence of impaired placentation and all biomarkers of impedance to peripheral blood flow are consistently increased. In contrast, in the GDM group without HDP, biomarkers of placental function are normal and those of impedance to peripheral blood flow are either marginally increased or not significantly different from those in normal pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Anzoategui
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - E Gibbone
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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12
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Mao Y, Hu W, Xia B, Liu L, Han X, Liu Q. Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases. Front Public Health 2022; 10:940335. [PMID: 35865249 PMCID: PMC9294140 DOI: 10.3389/fpubh.2022.940335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Gestational diabetes mellitus (GDM) has been linked to subsequent overall cardiovascular diseases. However, evidence on the associations of GDM with type-specific cardiovascular diseases is lacking, and findings on the potential impact of type 2 diabetes on the associations are not consistent. This study aimed to explore the associations between GDM and the risks of type-specific cardiovascular diseases. Methods Data were from 12,025 women (≥20 years) who had delivered at least one live birth in the National Health and Nutrition Examination Survey, 2007–2018. GDM history and type-specific cardiovascular diseases including coronary heart disease (CHD), heart failure and stroke were defined by self-report. We also combined our results with those from previously related publications on the associations between GDM and risks of type-specific cardiovascular diseases with a random-effect model. Results Compared with women without GDM, the multivariable-adjusted odds ratios (95% confidence intervals) were 1.82 (1.21–2.72) for CHD, 1.43 (0.80–2.53) for heart failure, and 1.19 (0.76–1.86) for stroke among women with a history of GDM. Type 2 diabetes was associated with 43.90, 67.44, and 63.16% of the excess odds of CHD, heart failure and stroke associated with GDM, respectively. Combining results from this study with those from previously related studies yielded odds ratios (95% confidence intervals) of 1.81 (1.60–2.05) for CHD (12 studies, 7,615,322 participants, I2= 72.6%), 1.66 (1.25–2.21) for heart failure (5 studies, 4,491,665 participants, I2= 88.6%), and 1.25 (1.07–1.46) for cerebrovascular disease (9 studies, 6,090,848 participants, I2= 77.8%). Conclusions GDM showed stronger associations with coronary heart diseases and heart failure than cerebrovascular disease, and the excess risks are attributable, in part, to type 2 diabetes.
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Affiliation(s)
- Yuanyuan Mao
- Department of Obstetrics and Gynecology, Suzhou Medical College of Soochow University, Suzhou, China
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Wenbin Hu
- Department of Chronic and Noncommunicable Disease Control and Preventions, The Kunshan Center for Disease Control and Prevention, Suzhou, China
| | - Bin Xia
- Department of Obstetrics and Gynecology, Suzhou Medical College of Soochow University, Suzhou, China
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Li Liu
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Xia Han
- Department of Administration, Maternal and Child Health Institution, Kunshan, China
| | - Qin Liu
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
- *Correspondence: Qin Liu
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13
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Valero P, Salas R, Pardo F, Cornejo M, Fuentes G, Vega S, Grismaldo A, Hillebrands JL, van der Beek EM, van Goor H, Sobrevia L. Glycaemia dynamics in gestational diabetes mellitus. Biochim Biophys Acta Gen Subj 2022; 1866:130134. [PMID: 35354078 DOI: 10.1016/j.bbagen.2022.130134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 12/19/2022]
Abstract
Pregnant women may develop gestational diabetes mellitus (GDM), a disease of pregnancy characterised by maternal and fetal hyperglycaemia with hazardous consequences to the mother, the fetus, and the newborn. Maternal hyperglycaemia in GDM results in fetoplacental endothelial dysfunction. GDM-harmful effects result from chronic and short periods of hyperglycaemia. Thus, it is determinant to keep glycaemia within physiological ranges avoiding short but repetitive periods of hyper or hypoglycaemia. The variation of glycaemia over time is defined as 'glycaemia dynamics'. The latter concept regards with a variety of mechanisms and environmental conditions leading to blood glucose handling. In this review we summarized the different metrics for glycaemia dynamics derived from quantitative, plane distribution, amplitude, score values, variability estimation, and time series analysis. The potential application of the derived metrics from self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) in the potential alterations of pregnancy outcome in GDM are discussed.
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Affiliation(s)
- Paola Valero
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile.
| | - Rodrigo Salas
- Biomedical Engineering School, Engineering Faculty, Universidad de Valparaíso, Valparaíso 2362905, Chile; Instituto Milenio Intelligent Healthcare Engineering, Chile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Metabolic Diseases Research Laboratory, Interdisciplinary Centre of Territorial Health Research (CIISTe), Biomedical Research Center (CIB), San Felipe Campus, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, San Felipe 2172972, Chile
| | - Marcelo Cornejo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile; Faculty of Health Sciences, Universidad de Antofagasta, Antofagasta 02800, Chile; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Gonzalo Fuentes
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Sofía Vega
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil
| | - Adriana Grismaldo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Nutrition and Biochemistry, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - Jan-Luuk Hillebrands
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Eline M van der Beek
- Department of Pediatrics, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands; Nestlé Institute for Health Sciences, Nestlé Research, Societé des Produits de Nestlé, 1000 Lausanne 26, Switzerland
| | - Harry van Goor
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, 4029, Queensland, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico.
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14
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Muin DA, Pfeifer B, Helmer H, Oberaigner W, Leitner H, Kiss H, Neururer S. Universal gestational diabetes screening and antepartum stillbirth rates in Austria-A population-based study. Acta Obstet Gynecol Scand 2022; 101:396-404. [PMID: 35195277 PMCID: PMC9976563 DOI: 10.1111/aogs.14334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Occult or untreated gestational diabetes (GDM) is a well-known risk factor for adverse perinatal outcomes and may contribute to antepartum stillbirth. We assessed the impact of screening for GDM on the rate of antepartum stillbirths in non-anomalous pregnancies by conducting a population-based study in 974 889 women in Austria. MATERIAL AND METHODS Our database was derived from the Austrian Birth Registry. Inclusion criteria were singleton live births and antepartum stillbirths ≥24+0 gestational weeks, excluding fetal congenital malformations, terminations of pregnancy and women with pre-existing type 1 or 2 diabetes. Main outcome measures were (a) overall stillbirth rates and (b) stillbirth rates in women at high risk of GDM (i.e., women with a body mass index ≥30 kg/m2 , history of previous intrauterine fetal death, GDM, previous macrosomic offspring) before (2008-2010, "phase I") and after (2011-2019, "phase II") the national implementation of universal GDM screening with a 75 g oral glucose tolerance test in Austrian pregnant women by 2011. RESULTS In total, 940 373 pregnancies were included between 2008 and 2019, of which 2579 resulted in intrauterine fetal deaths at 33.51 ± 5.10 gestational weeks. After implementation of the GDM screening, a statistically significant reduction in antepartum stillbirth rates among non-anomalous singletons was observed only in women at high risk for GDM (4.10‰ [95% confidence interval (CI) 3.09-5.43] in phase I vs. 2.96‰ [95% CI 2.57-3.41] in phase II; p = 0.043) but not in the general population (2.76‰ [95% CI 2.55-2.99] in phase I vs. 2.74‰ [95% CI 2.62-2.86] in phase II; p = 0.845). The number needed to screen with the oral glucose tolerance test to subsequently prevent one case of (non-anomalous) intrauterine fetal death was 880 in the high-risk and 40 000 in the general population. CONCLUSIONS The implementation of a universal GDM screening program in Austria in 2011 has not led to any significant reduction in antenatal stillbirths among non-anomalous singletons in the general population. More international data are needed to strengthen our findings.
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Affiliation(s)
- Dana A. Muin
- Department of Obstetrics and Gynecology, Division of Fetomaternal MedicineMedical University of ViennaViennaAustria
| | - Bernhard Pfeifer
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbHInnsbruckAustria
| | - Hanns Helmer
- Department of Obstetrics and Gynecology, Division of Fetomaternal MedicineMedical University of ViennaViennaAustria
| | - Wilhelm Oberaigner
- Research Unit for Diabetes Epidemiology, Institute for Public Health, Medical Decision Making and Health Technology AssessmentUMIT University for Health, Sciences, Medical Informatics and TechnologyHall in TirolAustria
| | - Hermann Leitner
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbHInnsbruckAustria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Fetomaternal MedicineMedical University of ViennaViennaAustria
| | - Sabrina Neururer
- Department of Clinical EpidemiologyTyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbHInnsbruckAustria
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15
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Lu L, Ma Y, Deng J, Xie J, Huang C. Lower ATG7 Levels are Associated with a Higher Risk of Gestational Diabetes Mellitus: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:2335-2343. [PMID: 35958873 PMCID: PMC9359373 DOI: 10.2147/dmso.s377041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/30/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This study aimed to investigate ATG7 levels in pregnant women with and without gestational diabetes mellitus (GDM) and explore the potential associations between ATG7 levels and GDM. METHODS This was a cross-sectional study conducted in a large tertiary hospital in Chengdu, China. The ATG7 levels in pregnant women at between 24 and 28 weeks of gestation with (n=84) and without GDM (n=649) were measured by using an ELISA kit. Glucose, HbA1c, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were measured by an automatic biochemistry analyser. The homeostasis model assessment of insulin resistance (HOMA-IR) and insulin secretion (HOMA-β) were calculated according to published formulas. The associations of ATG7 levels with laboratory parameters, GDM, and insulin resistance were evaluated using correlation analysis or a regression model. RESULTS The ATG7 levels were significantly lower in pregnant women with GDM than in those without GDM. The correlation analyses found that ATG7 levels correlated positively with HOMA-β but correlated negatively with HOMA-IR, oral glucose tolerance test (OGTT) glucose levels, TGs, and LDL-C. There were no significant correlations between ATG7 levels and HbA1c, HDL-C, or TC. After adjusting for potential confounders, lower ATG7 levels were shown to be associated with a higher risk of GDM. Furthermore, multiple linear regression analyses showed that ATG7 levels were negatively associated with insulin resistance. CONCLUSION ATG7 levels are significantly lower in pregnant women with GDM than in those without GDM, and lower ATG7 levels are associated with a higher risk of GDM. ATG7 levels were negatively associated with insulin resistance. Autophagy deficiency, which is caused by lower ATG7 levels, may be the underlying mechanism that mediates insulin resistance in the development of GDM.
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Affiliation(s)
- Ling Lu
- Department of Gynaecology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China
| | - Yan Ma
- Department of Obstetrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China
| | - Jie Deng
- Department of Gynaecology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China
| | - Jiaqiong Xie
- Department of Gynaecology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China
| | - Chaolin Huang
- Department of Gynaecology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China
- Correspondence: Chaolin Huang; Jiaqiong Xie, Department of Gynaecology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China, Email ;
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