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Chen S, Zhao Z, Luo M, Gao Y, Zhou T, Hu J, Luo L, Liu W, Zhang G. Environmental tobacco smoke increased risk of gestational diabetes mellitus: A birth cohort study in Sichuan, China. Diabetes Metab Res Rev 2024; 40:e3724. [PMID: 37727006 DOI: 10.1002/dmrr.3724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/11/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Studies on the relationship between environmental tobacco smoke (ETS) and gestational diabetes mellitus (GDM) are limited. In this study, we aimed to clarify the association between ETS at different trimesters of pregnancy and the risk of GDM among non-smoking pregnant women. METHODS A total of 16,893 non-smoking mothers from the Southwest Birth Cohort, China, were included in the final analyses. Exposure and outcome measures included self-reported ETS status at different trimesters of pregnancy and GDM diagnosis. Multivariable logistic regression models were constructed to estimate the association between ETS and GDM. RESULTS The prevalence of ETS exposure was 25.7%. Compared with no ETS, ever ETS had an increased risk of GDM, with an adjusted odds ratio (95% confidence intervals) of 1.21 (1.09, 1.33). The association remained consistent at different trimesters of pregnancy ETS exposure. In the last trimester and with continuous ETS exposure, the risk of GDM increased significantly with the increase in the duration of the exposure. The risk of GDM associated with ever ETS during pregnancy significantly increased in mothers over 30 years old and pre-pregnancy overweight (P for interaction <0.05). CONCLUSIONS ETS exposure at different trimesters of pregnancy was associated with an increased risk of GDM among non-smoking pregnant women. These findings emphasise the importance of preventing ETS exposure during pregnancy.
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Affiliation(s)
- Shiqi Chen
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Ziling Zhao
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Min Luo
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Yan Gao
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Tianjin Zhou
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Jinnuo Hu
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Liwei Luo
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Weixin Liu
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
| | - Gang Zhang
- Department of Obstetrics, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China
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Costa SMB, Hallur RLS, Reyes DRA, Floriano JF, de Barros Leite Carvalhaes MA, de Carvalho Nunes HR, Sobrevia L, Valero P, Barbosa AMP, Rudge MCV. Role of dietary food intake patterns, anthropometric measures, and multiple biochemical markers in the development of pregnancy-specific urinary incontinence in gestational diabetes mellitus. Nutrition 2024; 117:112228. [PMID: 37948994 DOI: 10.1016/j.nut.2023.112228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The aim of this study was to assess maternal dietary food intake patterns, anthropometric measures, and multiple biochemical markers in women with gestational diabetes mellitus and pregnancy-specific urinary incontinence and to explore whether antedating gestational diabetes mellitus environment affects the pregnancy-specific urinary incontinence development in a cohort of pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence. METHODS Maternal dietary information and anthropometric measurements were collected. At 24 wk of gestation, with a fasting venipuncture sample, current blood samples for biochemical markers of hormones, vitamins, and minerals were analyzed. The groups were compared in terms of numerical variables using analysis of variance for independent samples followed by multiple comparisons. RESULTS Of the 900 pregnant women with complete data, pregnant women in the gestational diabetes mellitus pregnancy-specific urinary incontinence group had higher body mass index during pregnancy, arm circumference, and triceps skinfold than the non-gestational diabetes mellitus continent and non-gestational diabetes mellitus pregnancy-specific urinary incontinence groups, characterizing an obesogenic maternal environment. Regarding dietary food intake, significant increases in aromatic amino acids, branched-chain amino acids, dietary fiber, magnesium, zinc, and water were observed in pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus continent group. Serum vitamin C was reduced in the gestational diabetes mellitus pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus pregnancy-specific urinary incontinence group. CONCLUSIONS This study emphasizes the necessity for a comprehensive strategy for gestational diabetes mellitus women with pregnancy-specific urinary incontinence in terms of deviation in maternal adaptation trending toward obesity and maternal micronutrients deficiencies.
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Affiliation(s)
- Sarah Maria Barneze Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Raghavendra Lakshmana Shetty Hallur
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil; College of Biosciences and Technology, Pravara Institute of Medical Sciences (DU), Loni-413736, Rahata Taluka, Ahmednagar District, Maharashtra State, India
| | - David Rafael Abreu Reyes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Juliana Ferreira Floriano
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | | | | | - Luis Sobrevia
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil; Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Institute for Obesity Research, School of Medicine and Health Sciences, Monterrey Institute of Technology and Higher Education, Monterrey, Mexico
| | - Paola Valero
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil; Faculty of Health Sciences, Universidad de Talca, Talca, Chile
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil; Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University, Marília, Brazil
| | - Marilza Cunha Vieira Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil.
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Athanasiadou KI, Paschou SA, Papakonstantinou E, Vasileiou V, Kanouta F, Kazakou P, Stefanaki K, Kassi GN, Psaltopoulou T, Goulis DG, Anastasiou E. Smoking during pregnancy and gestational diabetes mellitus: a systematic review and meta-analysis. Endocrine 2023; 82:250-262. [PMID: 37347387 PMCID: PMC10543648 DOI: 10.1007/s12020-023-03423-6] [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: 03/18/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To investigate whether maternal cigarette smoking during pregnancy is a risk factor for developing GDM. METHODS MEDLINE, Scopus, CENTRAL and Google Scholar databases were searched from inception to December 2022 to identify eligible original articles. A systematic review and meta-analysis (weighted data, random-effects model) were performed. The primary outcome was the development of GDM in pregnant women. The results were expressed as odds ratios (OR) with 95% confidence interval (CI) (inverse variance method). Subgroup analysis was planned according to the maternal smoking status and GDM diagnostic criteria. Statistical heterogeneity was checked with the Chi-squared (Chi2) test and the I2 index was used to quantify it. The studies were evaluated for publication bias. RESULTS Thirty-five studies, including 23,849,696 pregnant women, met the inclusion criteria. The pooled OR of smoking during pregnancy compared with non-smoking (never smokers and former smokers) was 1.06 (95% CI 0.95-1.19), p = 0.30; I2 = 90%; Chi2 = 344; df=34; p < 0.001. Subgroup analysis was performed according to the two-step Carpenter-Coustan diagnostic criteria, due to the high heterogeneity among the other applied methods. The pooled OR for the Carpenter-Coustan subgroup was 1.19 (95% CI 0.95-1.49), p = 0.12; I2 = 63%; Chi2 = 27; df=10; p < 0.002. Further subgroup analysis according to maternal smoking status was not performed due to missing data. CONCLUSION There is no evidence to support an association between maternal cigarette smoking during pregnancy and the risk for GDM. Universally accepted diagnostic criteria for GDM must be adopted to reduce heterogeneity and clarify the association between smoking and GDM.
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Affiliation(s)
- Kleoniki I Athanasiadou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Fotini Kanouta
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Paraskevi Kazakou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Stefanaki
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia N Kassi
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Theodora Psaltopoulou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abdulkadir M, Tischfield JA, Heiman GA, Hoekstra PJ, Dietrich A. Polygenic and environmental determinants of tics in the Avon Longitudinal Study of Parents and Children. Am J Med Genet B Neuropsychiatr Genet 2023; 192:73-84. [PMID: 36479979 PMCID: PMC10247895 DOI: 10.1002/ajmg.b.32924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
Tourette syndrome (TS) is caused by multiple genetic and environmental factors. Yet, little is known about the interplay of these factors in the occurrence of tics. We investigated whether polygenic risk score (PRS) of TS and pregnancy-related factors together enhance the explained variance of tic occurrence in the Avon Longitudinal Study of Parents and Children (Ncases = 612; Ncontrols = 4,201; 50% male; mean age 13.8 years). We included a cumulative adverse pregnancy risk score, maternal anxiety and depression, and maternal smoking and alcohol use during pregnancy. We investigated possible joint effects of genetic and pregnancy-related risk factors using a multivariable approach, and explored mediation effects between the pregnancy-related risk factors in explaining tic presence. The PRS and the cumulative adverse pregnancy risk score, maternal anxiety, or maternal depression explained significantly more variance of tic presence compared to models including only the PRS. Furthermore, we found that the cumulative adverse pregnancy risk score mediated the association between several pregnancy-related factors (maternal anxiety, depression, and smoking) and tics. The combination of a PRS and pregnancy-related risk factors explained more variance of tics in a general population cohort compared to studying these factors in isolation.
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Affiliation(s)
- Mohamed Abdulkadir
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands
- Rutgers, the State University of New Jersey, Department of Genetics and the Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Jay A. Tischfield
- Rutgers, the State University of New Jersey, Department of Genetics and the Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Gary A. Heiman
- Rutgers, the State University of New Jersey, Department of Genetics and the Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Pieter J. Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Andrea Dietrich
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands
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Ratsch A, Bogossian F, Burmeister EA, Ryu B, Steadman KJ. Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies. BMC Public Health 2022; 22:2157. [PMID: 36419022 PMCID: PMC9685874 DOI: 10.1186/s12889-022-14609-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships between maternal self-reported tobacco use and maternal and neonatal outcomes. METHODS Central Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites. RESULTS A sample of 73 women were enrolled who self-reported: no-tobacco use (n = 31), tobacco chewing (n = 19), or smoking (n = 23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group. CONCLUSIONS This research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in a wide range of maternal and neonatal biological samples and that exposure may be associated with adverse maternal and neonatal outcomes. Screening for the use of all tobacco and nicotine products during pregnancy rather than focusing solely on smoking would provide a more comprehensive assessment and contribute to a more accurate determination of tobacco and nicotine exposure. This knowledge will better inform maternal and foetal care, direct attention to targeted cessation strategies and ultimately improve long-term clinical outcomes, not only in this vulnerable population, but also for the wider population. NOTE TO READERS In this research, the central Australian Aboriginal women chose the term 'Aboriginal' to refer to themselves, and 'Indigenous' to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.
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Affiliation(s)
- Angela Ratsch
- Research Services, Wide Bay Hospital and Health Services, Nissen Street, Hervey Bay, QLD 4655 Australia
| | - Fiona Bogossian
- University of the Sunshine Coast, Maroochydore, QLD 4558 Australia
| | - Elizabeth A. Burmeister
- Research Services, Wide Bay Hospital and Health Services, Nissen Street, Hervey Bay, QLD 4655 Australia
| | - BoMi Ryu
- Department of Marine Life Science, Jeju National University, Jeju, 63243 Republic of Korea
| | - Kathryn J. Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102 Australia
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Morales-Suárez-Varela M, Peraita-Costa I, Perales-Marín A, Llopis-Morales A, Llopis-González A. Risk of Gestational Diabetes Due to Maternal and Partner Smoking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020925. [PMID: 35055745 PMCID: PMC8775944 DOI: 10.3390/ijerph19020925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/27/2022]
Abstract
Pregnant women are among the most vulnerable to environmental exposure to tobacco smoke (EET); which has been linked to problems in the mothers’ health; one of the most frequent is gestational diabetes (GD). For this reason, there are specific interventions and prevention strategies designed to reduce this exposure risk. However, currently, they are mostly aimed only at aiding the pregnant women with smoking cessation during pregnancy and do not assess or address the risk from passive exposure due to partner smoking. The aim of this work is to study the exposure to EET of pregnant women considering active and passive smoking and to evaluate its effect on the development of GD. This is an observational case-control study within a retrospective cohort of pregnant women. Information on smoking habits was obtained from both personal interviews and recorded medical history. In total, 16.2% of mothers and 28.3% of partners declared having been active smokers during pregnancy; 36.5% of the women presented EET during pregnancy when both active and passive smoking were considered. After adjustments, the association with the EET and GD of the mother was (aOR 1.10 95% CI: 0.64–1.92); for the EET of the partner, it was (aOR 1.66 95% CI: 1.01–2.77); for both partners, it was (aOR 1.82 95% CI: 1.15–2.89), adjusted by the mother’s age and body mass index. There is a lack of education regarding the effects of passive exposure to tobacco smoke. It is essential that pregnant women and their partners are educated on the risks of active and passive smoking; this could improve the effectiveness of other GD prevention strategies.
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Affiliation(s)
- María Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-96-3544951
| | - Isabel Peraita-Costa
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Alfredo Perales-Marín
- Department of Obstetrics, La Fe University Polytechnic Hospital, 46026 Valencia, Spain;
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain
| | - Agustín Llopis-Morales
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
| | - Agustín Llopis-González
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Feng Q, Tang LJ, Luo DH, Wang Y, Wu N, Chen H, Chen MX, Jiang L, Jin R. Metabolic Syndrome-Related Hyperuricemia is Associated with a Poorer Prognosis in Patients with Colorectal Cancer: A Multicenter Retrospective Study. Cancer Manag Res 2021; 13:8809-8819. [PMID: 34866939 PMCID: PMC8633709 DOI: 10.2147/cmar.s338783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/12/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose Hyperuricemia and metabolic syndrome (MetS) have been shown to correlate with prognosis in patients with malignant tumors. The present study evaluated the relationship between preoperative hyperuricemia and MetS in colorectal cancer (CRC) patients and analyzed the effect of this combination on prognosis within 5 years. Patients and Methods The study enrolled patients who had undergone radical CRC resection at three independent medical centers from January 2014 to December 2016. Patients were preoperatively categorized into four groups, those with hyperuricemia alone (H), those with MetS alone (MS), those with MetS-related hyperuricemia (MSH), and those with neither condition (control [C] group). The disease-free survival (DFS) and overall survival (OS) rates of these four groups were compared. Results The study population consisted of 1271 patients, with 114, 201, 101, and 855 patients categorized into the H, MS, MSH and C groups, respectively. Preoperative MetS was found to be significantly associated with hyperuricemia (P < 0.001). Multivariate Cox regression analysis showed that MetS-related hyperuricemia (hazard ratio [HR] = 2.728; P < 0.001) and MetS alone (HR = 1.631; P < 0.001) were independent predictors of death, whereas simple hyperuricemia was not (P > 0.1). Relative to the C group, the MSH group had the highest rate of tumor recurrence or metastasis (HR = 5.103, P < 0.001), followed by the MS (HR = 2.231, P < 0.001) group. In contrast, prognosis did not differ significantly in the H and C groups (P > 0.1). MetS was significantly associated with poor prognosis, with MetS-related hyperuricemia resulting in a significantly poorer prognosis. In contrast, hyperuricemia alone had no effect on the long-term prognosis of CRC patients. Conclusion This study highlights the prognostic importance of MetS-related hyperuricemia on the survival of patients with CRC.
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Affiliation(s)
- Qian Feng
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Liang-Jie Tang
- NAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Ding-Hai Luo
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Taizhou, 317000, People's Republic of China
| | - Ying Wang
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Nan Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Hao Chen
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Meng-Xia Chen
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Lei Jiang
- Central Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Rong Jin
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.,Department of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
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Ratsch A, Bogossian F, Burmeister EA, Steadman K. Central Australian Aboriginal women's placental and neonatal outcomes following maternal smokeless tobacco, cigarette or no tobacco use. Aust N Z J Public Health 2021; 46:186-195. [PMID: 34821425 DOI: 10.1111/1753-6405.13186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/01/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the placental characteristics and neonatal outcomes of Central Australian Aboriginal women based on maternal self-report of tobacco use. METHODS Placental and neonatal variables were collected from a prospective maternal cohort of 19 smokeless tobacco chewers, 23 smokers and 31 no-tobacco users. RESULTS Chewers had the lowest placental weight (460 g) while the no-tobacco group had the heaviest placental weight (565 g). Chewers and the no-tobacco group had placental areas of similar size (285 cm2 and 288 cm2 , respectively) while the placentas of smokers were at least 13 cm2 smaller (272 cm2 ). There were two stillbirths in the study and more than one-third (36%) of neonates (newborns) were admitted to the Special Care Nursery, with the chewers' neonates having a higher admission rate compared with smokers' neonates (44% vs. 23%). The cohort mean birthweight (3348 g) was not significantly different between the groups. When stratified for elevated maternal glucose, the chewers' neonates had the lowest mean birthweight (2906 g) compared to the neonates of the no-tobacco group (3242 g) and smokers (3398 g). CONCLUSIONS This research is the first to demonstrate that the maternal use of Australian Nicotiana spp. (pituri) as smokeless tobacco may negatively impact placental and neonatal outcomes. Implications for public health: Maternal smokeless tobacco use is a potential source of placental and foetal nicotine exposure. Maternal antenatal screening should be expanded to capture a broader range of tobacco and nicotine products, and appropriate cessation support is required.
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Affiliation(s)
- Angela Ratsch
- Wide Bay Hospital and Health Services, Queensland.,Rural Clinical School, The University of Queensland, Queensland
| | - Fiona Bogossian
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland.,School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland
| | - Elizabeth A Burmeister
- Wide Bay Hospital and Health Services, Queensland.,School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland
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Sawanny R, Pramanik S, Agarwal U. Role of Phytochemicals in the Treatment of Breast Cancer: Natural Swords Battling Cancer Cells. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394716666210106123255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Breast cancer is the most common type of malignancy among ladies (around 30% of
newly diagnosed patients every year). To date, various modern treatment modalities for breast cancer,
such as radiotherapy, surgical method, hormonal therapy, and chemotherapeutic drug utilisation,
are available. However, adverse drug reactions, therapeutic resistance, metastasis, or cancer reoccurrence
chances remain the primary causes of mortality for breast cancer patients. To overcome
all the potential drawbacks, we need to investigate novel techniques and strategies that are not considered
previously to treat breast cancer effectively with safety and efficacy. For centuries, we
utilise phytochemicals to treat various diseases because of their safety, low-cost, and least or no
side effects. Recently, naturally produced phytochemicals gain immense attention as potential
breast cancer therapeutics because of their ideal characteristics; for instance, they operate via modulating
molecular pathways associated with cancer growth and progression. The primary mechanism
involves inhibition of cell proliferation, angiogenesis, migration, invasion, increasing anti-oxidant
status, initiation of the arrest of the cell cycle, and apoptosis. Remedial viability gets effectively enhanced
when phytochemicals work as adjuvants with chemotherapeutic drugs. This comprehensive
review revolves around the latest chemopreventive, chemotherapeutic, and chemoprotective treatments
with their molecular mechanisms to treat breast cancer by utilising phytochemicals such as
vinca alkaloids, resveratrol, curcumin, paclitaxel, silibinin, quercetin, genistein, and epigallocatechin
gallate. The authors wish to extend the field of phytochemical study for its scientific validity
and its druggability.
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Affiliation(s)
- Rajni Sawanny
- Noida Institute of Engineering and Technology (Pharmacy Institute), Knowledge Park-II, Institutional Area, Greater Noida, Uttar Pradesh-201306, India
| | - Sheersha Pramanik
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, Tamil Nadu-600036, India
| | - Unnati Agarwal
- School of Bioengineering and Biosciences, Lovely Professional University, Jalandhar, Delhi, Grand Trunk Road, Phagwara, Punjab-144001, India
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Ratsch A, Bogossian F, Steadman K. Central Australian Aboriginal women's pregnancy, labour and birth outcomes following maternal smokeless tobacco (pituri) use, cigarette use or no-tobacco use: a prospective cohort study. BMC Public Health 2021; 21:814. [PMID: 33910555 PMCID: PMC8082654 DOI: 10.1186/s12889-021-10872-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Outcomes related to maternal smoked tobacco (cigarette) use have been substantially examined over the past 50 years with resultant public health education targeted towards the reduction of use during pregnancy. However, worldwide the effects of maternal smokeless tobacco use have been less well explored and in Australia, there has been no examination of maternal outcomes in relation to the use of Australian Nicotiana spp. (tobacco plant) as a smokeless tobacco, colloquially known as pituri. The aim of this study is to describe the maternal outcomes of a group of central Australian Aboriginal women in relation to their self-reported tobacco use. METHODS Eligible participants were > 18 years of age, with a singleton pregnancy, > 28 weeks gestation, and who planned to birth at the Alice Springs Hospital (the major regional hospital for central Australia, in the Northern Territory, Australia). The sample consisted of 73 conveniently recruited women categorized by tobacco-use status as no-tobacco users (n = 31), pituri chewers (n = 19), and smokers (n = 23). RESULTS There were differences in the groups in relation to teenage pregnancies; 35% of no-tobacco users, compared with 5% of pituri users, and 13% of smokers were < 20 years of age. The chewers had a higher rate (48%) of combined pre-existing and pregnancy-related elevated glucose concentrations compared with smokers (22%) and no-tobacco users (16%).The pituri chewers had the lowest rate (14%) of clinically significant post-partum hemorrhage (> 1000 ml) compared with 22% of smokers and 36% of the no-tobacco users. CONCLUSIONS This is the first research to examine pituri use in pregnancy and the findings indicate possible associations with a range of adverse maternal outcomes. The use of smokeless tobacco needs to be considered in maternal healthcare assessment to inform antenatal, intrapartum and postpartum care planning. IMPLICATIONS FOR PUBLIC HEALTH Female smokeless tobacco use is a global phenomenon and is particularly prevalent in low and middle income countries and in Indigenous populations. The findings contribute to the developing knowledge around maternal smokeless tobacco use and maternal outcomes. Maternal screening for a broader range of tobacco and nicotine products is required. NOTE TO READERS In this research, the central Australian Aboriginal women chose the term 'Aboriginal' to refer to themselves, and 'Indigenous' to refer to the broader First Peoples. That choice has been maintained in the reporting of the research findings.
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Affiliation(s)
- Angela Ratsch
- Wide Bay Hospital and Health Services, Hervey Bay, Queensland 4655 Australia
| | - Fiona Bogossian
- Professor of Practice Education in Health at the University of the Sunshine Coast (USC) and USC Academic Lead at the Sunshine Coast Health Institute (SCHI), Birtinya, Queensland 4575 Australia
| | - Kathryn Steadman
- Associate Professor School of Pharmacy, The University of Queensland, Brisbane, Queensland 4102 Australia
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11
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Pugliese NR, Mengozzi A, Virdis A, Casiglia E, Tikhonoff V, Cicero AFG, Ungar A, Rivasi G, Salvetti M, Barbagallo CM, Bombelli M, Dell'Oro R, Bruno B, Lippa L, D'Elia L, Verdecchia P, Mallamaci F, Cirillo M, Rattazzi M, Cirillo P, Gesualdo L, Mazza A, Giannattasio C, Maloberti A, Volpe M, Tocci G, Georgiopoulos G, Iaccarino G, Nazzaro P, Parati G, Palatini P, Galletti F, Ferri C, Desideri G, Viazzi F, Pontremoli R, Muiesan ML, Grassi G, Masi S, Borghi C. The importance of including uric acid in the definition of metabolic syndrome when assessing the mortality risk. Clin Res Cardiol 2021; 110:1073-1082. [PMID: 33604722 PMCID: PMC8238697 DOI: 10.1007/s00392-021-01815-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/01/2021] [Indexed: 12/18/2022]
Abstract
Introduction Serum uric acid (SUA) has been depicted as a contributory causal factor in metabolic syndrome (MS), which in turn, portends unfavourable prognosis. Aim We assessed the prognostic role of SUA in patients with and without MS. Methods We used data from the multicentre Uric Acid Right for Heart Health study and considered cardiovascular mortality (CVM) as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. Results A total of 9589 subjects (median age 58.5 years, 45% males) were included in the analysis, and 5100 (53%) patients had a final diagnosis of MS. After a median follow-up of 142 months, we observed 558 events. Using a previously validated cardiovascular SUA cut-off to predict CVM (> 5.1 mg/dL in women and 5.6 mg/dL in men), elevated SUA levels were significantly associated to a worse outcome in patients with and without MS (all p < 0.0001) and provided a significant net reclassification improvement of 7.1% over the diagnosis of MS for CVM (p = 0.004). Cox regression analyses identified an independent association between SUA and CVM (Hazard Ratio: 1.79 [95% CI, 1.15–2.79]; p < 0.0001) after the adjustment for MS, its single components and renal function. Three specific combinations of the MS components were associated with higher CVM when increasing SUA levels were reported, and systemic hypertension was the only individual component ever-present (all p < 0.0001). Conclusion Increasing SUA levels are associated with a higher CVM risk irrespective of the presence of MS: a cardiovascular SUA threshold may improve risk stratification. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01815-0.
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Affiliation(s)
- Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | | | - Valerie Tikhonoff
- Department of Medicine and Studium Patavinum, University of Padua, Padua, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Science, Hypertension and Cardiovascular Risk Factors Research Center, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Berardino Bruno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luciano Lippa
- Italian Society of General Medicine, Avezzano, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | | | - Francesca Mallamaci
- Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, CNR-IFC, Reggio Calabria, Italy
| | - Massimo Cirillo
- Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Marcello Rattazzi
- Department of Medicine, Medicina Interna 1°, Ca' Foncello University Hospital, University of Padova, Treviso, Italy
| | - Pietro Cirillo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
| | - Cristina Giannattasio
- Cardiology IV, A. De Gasperis Department, Health Science Department, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
| | - Alessandro Maloberti
- Cardiology IV, A. De Gasperis Department, Health Science Department, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Georgios Georgiopoulos
- First Department of Cardiology, Medical School, Hippokration Hospital, University of Athens, Athens, Greece
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS S. Luca Hospital, Lucca, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Paolo Palatini
- Department of Medicine, University of Padua, Padua, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Science, Hypertension and Cardiovascular Risk Factors Research Center, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Kim MK, Han K, You SY, Kwon HS, Yoon KH, Lee SH. Prepregnancy smoking and the risk of gestational diabetes requiring insulin therapy. Sci Rep 2020; 10:13901. [PMID: 32807828 PMCID: PMC7431589 DOI: 10.1038/s41598-020-70873-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/03/2020] [Indexed: 12/04/2022] Open
Abstract
The relationship between maternal smoking and gestational diabetes mellitus (GDM) is inconclusive. We investigated whether prepregnancy smoking is a risk factor for insulin-requiring GDM in Korean women. Using the National Health Insurance Service database, 325,297 women who delivered between 2011 and 2015 and who received a health examination within 52 weeks before pregnancy were included. Insulin-requiring GDM was defined as no claims for diabetes mellitus and a fasting blood glucose level of < 126 mg/dL before pregnancy, and initiation of insulin treatment during pregnancy. Smoking status was identified in a self-reported questionnaire completed during the health examination. There were 2,114 women (0.65%) with GDM who required insulin therapy. Compared with nonsmokers, the fully adjusted odd ratios (ORs) of former smokers and current smokers for insulin-requiring GDM were 1.55 (95% confidence interval [CI] 1.27–1.90) and 1.73 (1.42–2.09), respectively. The ORs (95% CIs) of insulin-requiring GDM among women who reported ≤ 2, 2–≤ 4, 4–≤ 6, 6–≤ 8, 8–≤ 10, and > 10 pack-years of smoking were 1.50 (1.22–1.84), 1.71 (1.31–2.22), 1.60 (1.13–2.26), 1.97 (1.14–3.40), 2.34 (1.22–4.51), and 2.29 (1.25–4.22), respectively, compared with nonsmokers (P for trend < 0.001). This association was similar in women with or without obesity and abdominal obesity. In conclusions, women who smoke have a significantly higher risk of GDM requiring insulin therapy, which may be proportional to the cumulative exposure to smoking. Cessation of smoking should be emphasized in women of childbearing age for the prevention of GDM.
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Affiliation(s)
- Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, South Korea
| | - Sang Youn You
- College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, South Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu,, Seoul, 06591, South Korea.,Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu,, Seoul, 06591, South Korea. .,Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea.
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Huang Y, Li X, Zhang W, Su W, Zhou A, Xu S, Li Y, Chen D. Aluminum Exposure and Gestational Diabetes Mellitus: Associations and Potential Mediation by n-6 Polyunsaturated Fatty Acids. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:5031-5040. [PMID: 32204592 DOI: 10.1021/acs.est.9b07180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As the earth's third most abundant element with various industrial applications, aluminum (Al) has received increasing concerns over its potential adverse health effects. Although Al exposure has been suggested to increase the risks of type 2 diabetes, little has been done to explore Al exposure in pregnant women and potential impact on the incidence of gestational diabetes mellitus (GDM). Our present study demonstrated positive associations between Al concentrations in maternal plasma collected in the first trimester of pregnancy and GDM risks (Ptrend < 0.001) based on a nested case-control study from Wuhan, China, including 305 GDM cases and 305 healthy controls. The highest tertile of plasma Al concentrations corresponded to an odds ratio of 4.03 (95% confidence interval: [2.14, 7.58]) relative to the lowest tertile, after the adjustment for established GDM risk factors and other plasma metals. We also observed significant correlations between plasma Al and several plasma polyunsaturated fatty acids (PUFA; e.g., linoleic acid 18:2 n-6) levels. In addition, mediation effects on the associations of Al exposure with GDM risks were observed for n-6 PUFAs (estimated mediation percentage: 48.3%) and total PUFAs (48.9%). Our study is not only by far the largest study of its kind to demonstrate maternal Al exposure and the association with GDM risks, but it also offers an insight into the potential mediation roles of n-6 PUFAs in an epidemiological setting. These findings contribute to a better understanding of perinatal Al exposure and GDM risks.
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Affiliation(s)
- Yichao Huang
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, Guangdong, China
| | - Xinping Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Wenxin Zhang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Weijie Su
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, Guangdong, China
| | - Aifen Zhou
- Wuhan Medical & Healthcare Center for Women and Children, Wuhan, Hubei 430015, China
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Da Chen
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, Guangdong, China
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15
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Konstantakou P, Paschou SA, Patinioti I, Vogiatzi E, Sarantopoulou V, Anastasiou E. The effect of smoking on the risk of gestational diabetes mellitus and the OGTT profile during pregnancy. Diabetes Res Clin Pract 2019; 158:107901. [PMID: 31669407 DOI: 10.1016/j.diabres.2019.107901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/05/2019] [Accepted: 10/24/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the relationship between smoking and the risk of GDM, as well as with the OGTT profile during pregnancy. PATIENTS AND METHODS A total of 7437 pregnant women were studied. OGTT was performed at the 3rd trimester. Women were categorized as non-smokers (A), as those who ceased smoking at pregnancy (B), and as smokers (C). RESULTS 5434 (73.1%) women were group A, 1191 (16%) group B and 812 (10.9%) group C. The rates of GDM among the groups were: A 33.7%, B 34.2%, C 34.2% (ns). However, the number of individuals requiring insulin treatment was significantly different: A 39.2%, B 47.5%, C 50.6% (p < 0.001). Regarding OGTT, fasting glucose levels were significantly higher in group C (89 ± 13 vs 86 ± 12 mg/dl) compared to A, whereas 3-h glucose values were significantly lower (104 ± 33 vs 112 ± 32 mg/dl) (p < 0.001). Group B demonstrated intermediate glucose concentrations. Similar findings were observed in women without GDM. In women with GDM, higher 1-h glucose levels were measured in group C (210 ± 31 vs 205 ± 28 mg/dl) compared with A (p = 0.024). Further, group C sub-analysis found that those who smoked more than 10 cigarettes showed significantly lower 3-h glucose levels (111 ± 31 vs 128 ± 40 mg/dl) compared to those who smoked less than 10 (p = 0.006). HbA1c in women with GDM was higher in group C (4.6 ± 0.6 vs 4.5 ± 0.6%) compared with A (p = 0.027). CONCLUSIONS The present study did not show any correlation between smoking and GDM risk. However, OGTT profile and HbA1c differed according to smoking status in women with and without GDM.
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Affiliation(s)
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Patinioti
- Department of Endocrinology and Diabetes, "Alexandra" Hospital, Athens, Greece
| | - Evangelia Vogiatzi
- Department of Endocrinology and Diabetes, "Alexandra" Hospital, Athens, Greece
| | | | - Eleni Anastasiou
- Department of Endocrinology and Diabetes, "Alexandra" Hospital, Athens, Greece.
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Can a Simple Dietary Screening in Early Pregnancy Identify Dietary Habits Associated with Gestational Diabetes? Nutrients 2019; 11:nu11081868. [PMID: 31405206 PMCID: PMC6722606 DOI: 10.3390/nu11081868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/04/2019] [Accepted: 08/09/2019] [Indexed: 12/05/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is predominantly a lifestyle disease, with diet being an important modifiable risk factor. A major obstacle for the prevention in clinical practice is the complexity of assessing diet. In a cohort of 1651 Icelandic women, this study examined whether a short 40-item dietary screening questionnaire administered in the 1st trimester could identify dietary habits associated with GDM. The dietary variables were aggregated into predefined binary factors reflecting inadequate or optimal intake and stepwise backward elimination was used to identify a reduced set of factors that best predicted GDM. Those binary factors were then aggregated into a risk score (range: 0–7), that was mostly characterised by frequent consumption of soft drinks, sweets, cookies, ice creams and processed meat. The women with poor dietary habits (score ≥ 5, n = 302), had a higher risk of GDM (RR = 1.38; 95%CI = 3, 85) compared with women with a more optimal diet (score ≤ 2, n = 407). In parallel, a pilot (n = 100) intervention was conducted among overweight and obese women examining the effect of internet-based personalized feedback on diet quality. Simple feedback was given in accordance with the answers provided in the screening questionnaire in 1st trimester. At the endpoint, the improvements in diet quality were observed by, as an example, soft drink consumption being reduced by ~1 L/week on average in the intervention group compared to the controls. Our results suggest that a simple dietary screening tool administered in the 1st trimester could identify dietary habits associated with GMD. This tool should be easy to use in a clinical setting, and with simple individualized feedback, improvements in diet may be achieved.
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Gortazar L, Flores-Le Roux JA, Benaiges D, Sarsanedas E, Payà A, Mañé L, Pedro-Botet J, Goday A. Trends in prevalence of gestational diabetes and perinatal outcomes in Catalonia, Spain, 2006 to 2015: the Diagestcat Study. Diabetes Metab Res Rev 2019; 35:e3151. [PMID: 30865356 DOI: 10.1002/dmrr.3151] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/24/2019] [Accepted: 03/09/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND No recent epidemiologic studies on gestational diabetes mellitus (GDM) have been conducted in Spain. The present study aimed to explore trends in the prevalence of GDM and ascertain whether the risk of adverse perinatal outcomes changed between 2006 and 2015 in Catalonia. METHODS In this population-based study, all hospital admissions for singleton births in Catalonia for the period 2006 to 2015 were collected from the Spanish Minimum Basic Data Set. Cases of GDM were identified from hospital delivery discharge reports using ICD-9-CM codes. Data regarding maternal characteristics and perinatal outcomes were analysed. Crude and age-adjusted annual prevalences were calculated. The Poisson regression model was used to assess trends in prevalence and perinatal outcomes, adjusted for age and smoking habit; however, they could not be adjusted for body mass index (BMI) and ethnicity. RESULTS Data from 743 762 deliveries were collected. GDM prevalence over the study period was 4.80% (95% CI 4.75-4.85%). Crude GDM prevalence rose from 3.81% (95% CI 3.67-3.95%) in 2006 to 6.53% (95% CI 6.33-6.72%) in 2015 (P < 0.001). Women with GDM showed a stable trend in rates of preeclampsia (2.56%), prematurity (15.7%), and large-for-gestational age (LGA) newborns (18.3%), whereas a lower rate of macrosomia was observed during the study period (from 9.16% to 7.84%). Caesarean deliveries rose from 28% to 31%; however, significance was lost after adjustment. CONCLUSIONS The prevalence of GDM in Catalonia almost doubled between 2006 and 2015. During the study period, the frequency of macrosomia decreased whereas pre-eclampsia, prematurity, LGA, and age-adjusted Caesarean rates remained stable.
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Affiliation(s)
- Lucía Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Eugènia Sarsanedas
- Health Information Management Department, Hospital del Mar, Barcelona, Spain
| | - Antonio Payà
- Department of Gynecology and Obstetrics, Hospital del Mar, Barcelona, Spain
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Alberto Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
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18
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Bawah AT, Ngala RA, Alidu H, Seini MM, Wumbee JDK, Yeboah FA. Gestational diabetes mellitus and obstetric outcomes in a Ghanaian community. Pan Afr Med J 2019; 32:94. [PMID: 31223385 PMCID: PMC6560956 DOI: 10.11604/pamj.2019.32.94.17334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION This study was aimed at evaluating effect of Gestational diabetes mellitus (GDM) and maternal characteristics on pregnancy outcome. GDM has several risk factors including; advanced maternal age, ethnic background, obesity and family history of diabetes mellitus. These pregnancy complications are associated with fetal morbidity and mortality and may lead to macrosomia and shoulder dystocia. Others are stillbirth, miscarriages, preterm and small for gestational age babies. METHODS This was a retrospective case-case control study which compared maternal characteristics and pregnancy outcome among pregnant women with and without GDM. Diagnosis of GDM was done in accordance with the American Diabetes Association (ADA) criteria. Weight and height were determined and Body mass index (BMI) calculated. Pregnancy outcome was determined at the end of pregnancy and information on maternal characteristics obtained using questionnaire and patient folders. RESULTS Those who developed GDM were significantly older (OR= 1.772; 95% CI =1.432-2.192; P<0.0001) and had higher BMI (OR=1.637; 95% CI=1.004-1.289; P=0.044) than those who did not. A significant number of those who developed GDM also had stillbirths OR= 5.188; 95% CI=1.093-24.613; p=0.038) and cesarean deliveries (OR=14.362; 95% CI=3.661-56.335; p= 0.001). CONCLUSION Women who develop GDM are more likely to deliver stillborn or macrosmic babies and may require surgical intervention in order to have normal deliveries.
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Affiliation(s)
- Ahmed Tijani Bawah
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Health and Allied Health Sciences, Ho, Ghana
| | - Robert Amadu Ngala
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Huseini Alidu
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Health and Allied Health Sciences, Ho, Ghana
| | | | | | - Francis Agyemang Yeboah
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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19
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Passive smoking at home increased the risk of gestational diabetes mellitus in China. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-1002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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20
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Wang JW, Cao SS, Hu RY, Wang M. Association between cigarette smoking during pregnancy and gestational diabetes mellitus: a meta-analysis. J Matern Fetal Neonatal Med 2018; 33:758-767. [PMID: 30001664 DOI: 10.1080/14767058.2018.1500547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aims: Several studies have been carried out to examine the association between cigarette smoking during pregnancy and risk of developing gestational diabetes mellitus (GDM), yet the findings are mixed. Therefore, we aimed to estimate the relationship between cigarette smoking during pregnancy and GDM risk.Material and methods: PubMed, ScienceDirect, and Cochrane Library databases were searched up to December 2017. Studies on cigarette smoking during pregnancy and GDM were retrieved. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) for highest versus lowest level of cigarette smoking were calculated using a random-effects model.Results: Compared to nonsmoking, the pooled ORs of cigarette smoking during pregnancy were 0.98 (95% CI: 0.88-1.10) for GDM. Specifically, the pooled ORs of light smoking and heavy smoking during pregnancy for GDM were 1.10 (95% CI: 0.97-1.25) and 1.02 (95% CI: 0.67-1.53), respectively.Conclusions: Our findings suggest that there is no significant association between cigarette smoking during pregnancy and risk of GDM.
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Affiliation(s)
- Jian-Wei Wang
- Shandong Province, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Shuang-Shuang Cao
- Shandong Province, Yidu Central Hospital of Weifang, Qingzhou, China
| | - Ru-Ying Hu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Meng Wang
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Mustaniemi S, Vääräsmäki M, Eriksson JG, Gissler M, Laivuori H, Ijäs H, Bloigu A, Kajantie E, Morin-Papunen L. Polycystic ovary syndrome and risk factors for gestational diabetes. Endocr Connect 2018; 7:859-869. [PMID: 29858213 PMCID: PMC6026881 DOI: 10.1530/ec-18-0076] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the roles of self-reported symptoms and/or prior diagnosis of polycystic ovary syndrome (PCOS) and other potential risk factors for gestational diabetes mellitus (GDM) and to clarify whether the screening of GDM in early pregnancy is beneficial for all women with PCOS. DESIGN The FinnGeDi multicentre case-control study including 1146 women with singleton pregnancies diagnosed with GDM and 1066 non-diabetic pregnant women. There were 174 women with PCOS (symptoms and/or diagnosis self-reported by a questionnaire) and 1767 women without PCOS (data missing for 271). METHODS The study population (N = 1941) was divided into four subgroups: GDM + PCOS (N = 105), GDM + non-PCOS (N = 909), non-GDM + PCOS (N = 69), and controls (N = 858). The participants' characteristics and their parents' medical histories were compared. RESULTS The prevalence of PCOS was 10.4% among GDM women and 7.4% among non-diabetics (odds ratios (OR) 1.44, 95% CI: 1.05-1.97), but PCOS was not an independent risk for GDM after adjustments for participants' age and pre-pregnancy BMI (OR 1.07, 95% CI: 0.74-1.54). In a multivariate logistic regression analysis, the most significant parameters associated with GDM were overweight, obesity, age ≥35 years, participant's mother's history of GDM, either parent's history of type 2 diabetes (T2D) and participant's own preterm birth. CONCLUSIONS The increased risk of GDM in women with PCOS was related to obesity and increased maternal age rather than to PCOS itself, suggesting that routine early screening of GDM in PCOS women without other risk factors should be reconsidered. Instead, family history of GDM/T2D and own preterm birth were independent risk factors for GDM.
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Affiliation(s)
- Sanna Mustaniemi
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marja Vääräsmäki
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health CareUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research CentreHelsinki, Finland
| | - Mika Gissler
- Information Services DepartmentNational Institute for Health and Welfare, Helsinki, Finland
- Division of Family MedicineDepartment of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hannele Laivuori
- Medical and Clinical GeneticsUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and GynaecologyTampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life SciencesUniversity of Tampere, Tampere, Finland
- Institute for Molecular Medicine FinlandHelsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Hilkka Ijäs
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aini Bloigu
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Children's HospitalUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laure Morin-Papunen
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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22
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Bellavia A, Cantonwine DE, Meeker JD, Hauser R, Seely EW, McElrath TF, James-Todd T. Pregnancy urinary bisphenol-A concentrations and glucose levels across BMI categories. ENVIRONMENT INTERNATIONAL 2018; 113:35-41. [PMID: 29421405 PMCID: PMC6583793 DOI: 10.1016/j.envint.2018.01.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND Pregnancy exposure to bisphenol-A (BPA) may be associated with gestational diabetes (GDM), but evidence from human studies is limited. Moreover, adiposity is associated with both higher BPA concentrations and GDM risk, and may act as a confounder or an effect modifier of the association. METHODS We included 350 term births from the Lifecodes pregnancy cohort (Boston, MA), who had 1st and 2nd trimester measures of urinary BPA concentrations available. BPA measures were SG-adjusted and categorized into quartiles (Q). Multivariable-adjusted linear regressions were used to determine the association between BPA, at both 1st and 2nd trimester, and glucose, in the overall population and by categories of 1st trimester BMI. RESULTS No clear associations were seen between BPA and glucose levels in the overall population. From stratified analyses there was suggestive evidence of effect modification by maternal 1st trimester BMI, with significant associations observed among obese/overweight participants (1st trimester BPA concentrations for Q3 vs Q1: adj.β = 14.1 mg/dL; 95% CI: 1.5, 26.6) (2nd trimester BPA concentrations for Q2 vs Q1: adj. β = 16.9 mg/dL; 95% CI: 2.6, 31.2). CONCLUSION No associations were found between BPA and glucose levels in the overall population. However, moderately high BPA concentrations were associated with increased glucose levels among overweight/obese women-a subgroup at high-risk of elevated glucose levels in pregnancy.
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Affiliation(s)
- Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - David E Cantonwine
- Division of Maternal Fetal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, United States
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States
| | - Ellen W Seely
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | - Thomas F McElrath
- Division of Maternal Fetal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States; Division of Women's Health, Department of Medicine, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, United States.
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Abstract
PURPOSE OF REVIEW This review aimed to examine the latest evidence linking cigarette smoking and cessation to risk of incident diabetes and its complications. RECENT FINDINGS Abundant evidence has demonstrated that smoking is associated with increased risk of type 2 diabetes and cardiovascular disease among diabetic patients, while its relationship with microvascular complications is more limited to diabetic nephropathy and neuropathy in type 1 diabetes. In addition, diabetes risk remains high in the short term after smoking cessation, while it reduces gradually in the long term. Risk of cardiovascular complications also substantially decreases after quitting smoking, but results for microvascular complications are not consistent. Smoking is associated with increased risks of incident diabetes in the general population and cardiovascular complications among diabetic patients. Although the short-term post-cessation diabetes risk needs to be acknowledged, this review calls for urgent action to implement population-wide policies and individual pharmaceutical and lifestyle interventions (if evidence accumulated in future) to aid smoking cessation and prevent diabetes and its complications.
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Affiliation(s)
- Ping Zhu
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China
| | - Liting Sheng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China
| | - Henggui Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China.
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24
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Loeken MR. Passive smoking as an independent risk factor for gestational diabetes that synergizes with prepregnancy obesity in urban Chinese women. Diabetes Metab Res Rev 2017; 33:10.1002/dmrr.2910. [PMID: 28580761 PMCID: PMC5639702 DOI: 10.1002/dmrr.2910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/23/2017] [Accepted: 06/01/2017] [Indexed: 01/15/2023]
Abstract
There are high-priority public health and legislative efforts around the world to reduce smoking and to reduce the spaces where smoking is allowable. These efforts are aimed at minimizing not only the adverse health effects of active smoking but also the adverse health effects of passive cigarette smoke exposure. While many cultures and societies make protection of a pregnant woman and her about-to-be-born-newborn a priority, the importance of protecting them from passive smoking that is prevalent in many modern societies has not been reported. The article by Leng et al, "Passive smoking increased risk of gestational diabetes mellitus independently and synergistically with prepregnancy obesity in Tianjin, China," newly published in Diabetes Metabolism Research and Reviews, provides evidence that passive smoke inhalation during pregnancy makes gestational diabetes more likely, bringing with it negative health consequences for the mother and her baby. This study will hopefully add support to public health officials' efforts to curb cigarette use, especially in public domains.
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Affiliation(s)
- Mary R Loeken
- Section on Islet and Regenerative Cell Biology, Joslin Diabetes Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
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25
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Badon SE, Enquobahrie DA, Wartko PD, Miller RS, Qiu C, Gelaye B, Sorensen TK, Williams MA. Healthy Lifestyle During Early Pregnancy and Risk of Gestational Diabetes Mellitus. Am J Epidemiol 2017; 186:326-333. [PMID: 28481961 DOI: 10.1093/aje/kwx095] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/13/2016] [Indexed: 12/25/2022] Open
Abstract
Previous studies have found associations between individual healthy behaviors and reduced risk of gestational diabetes mellitus (GDM); however, the association of composite healthy lifestyle during pregnancy with GDM has not been examined. Participants in the Omega Study (n = 3,005), a pregnancy cohort study conducted in Washington State (1996-2008), reported information on diet, physical activity, smoking, and stress during early pregnancy. Lifestyle components were dichotomized into healthy/unhealthy and then combined into a total lifestyle score (range, 0-4). Regression models were used to determine relative risk of GDM (n = 140 cases) in relation to healthy lifestyle. Twenty percent of participants had a healthy diet, 66% were physically active, 95% were nonsmokers, and 55% had low stress. Each 1-point increase in lifestyle score was associated with a 21% lower risk of GDM (95% confidence interval: 0.65, 0.96) after adjustment for age, race, and nulliparity. Adjustment for prepregnancy body mass index, prepregnancy physical activity, and prepregnancy smoking attenuated the associations slightly. Associations were similar in normal-weight and overweight/obese women. In this study, a composite measure of healthy lifestyle during early pregnancy was associated with substantially lower GDM risk. Public health messaging and interventions promoting multiple aspects of a healthy lifestyle during early pregnancy should be considered for GDM prevention.
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26
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Maddatu J, Anderson-Baucum E, Evans-Molina C. Smoking and the risk of type 2 diabetes. Transl Res 2017; 184:101-107. [PMID: 28336465 PMCID: PMC5429867 DOI: 10.1016/j.trsl.2017.02.004] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/19/2017] [Accepted: 02/25/2017] [Indexed: 01/18/2023]
Abstract
Despite accumulating evidence demonstrating strong epidemiologic and mechanistic associations between cigarette smoking, hyperglycemia, and the development of type 2 diabetes, tobacco abuse has not been uniformly recognized as a modifiable risk factor in diabetes prevention or screening strategies. In this review, we highlight population-based studies that have linked cigarette smoking with an increased risk of type 2 diabetes and summarize clinical and preclinical studies offering insight into mechanisms through which cigarette smoking and nicotine exposure impact body composition, insulin sensitivity, and pancreatic β cell function. Key questions for future studies are identified and strategies for smoking cessation as a means to decrease diabetes risk are discussed.
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Affiliation(s)
- Judith Maddatu
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind
| | | | - Carmella Evans-Molina
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind; Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Ind; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Ind; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Ind; Roudebush VA Medical Center, Indianapolis, Ind.
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27
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Leng J, Wang P, Shao P, Zhang C, Li W, Li N, Wang L, Nan H, Yu Z, Hu G, Chan JCN, Yang X. Passive smoking increased risk of gestational diabetes mellitus independently and synergistically with prepregnancy obesity in Tianjin, China. Diabetes Metab Res Rev 2017; 33. [PMID: 27667672 DOI: 10.1002/dmrr.2861] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 08/30/2016] [Accepted: 09/07/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Passive smoking increased type 2 diabetes mellitus risk, but it is uncertain whether it also increased gestational diabetes mellitus (GDM) risk. We aimed to examine the association of passive smoking during pregnancy and its interaction with maternal obesity for GDM. METHODS From 2010 to 2012, 12 786 Chinese women underwent a 50-g 1-hour glucose challenge test at 24 to 28 weeks of gestation and further underwent a 75-g 2-hour oral glucose tolerance test if the glucose challenge test result was ≥7.8 mmol/L. GDM was defined by the International Association of Diabetes and Pregnancy Study Group's cut points. Self-reported passive smoking during pregnancy was collected by a questionnaire. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between maternal obesity and passive smoking was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). Significant RERI > 0, AP > 0, or S > 1 indicated additive interaction. RESULTS A total of 8331 women (65.2%) were exposed to passive smoking during pregnancy. More women exposed to passive smoking developed GDM than nonexposed women (7.8% versus 6.3%, P = 0.002) with an adjusted OR of 1.29 (95%CI, 1.11 to 1.50). Compared with nonobesity and nonpassive smoking, prepregnancy obesity and passive smoking was associated with GDM risk with an adjusted OR of 3.09 (95%CI, 2.38-4.02) with significant additive interaction (P < .05 for RERI and AP). CONCLUSIONS Passive smoking during pregnancy increased GDM risk in Chinese women independently and synergistically with prepregnancy obesity.
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Affiliation(s)
- Junhong Leng
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Peng Wang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Ping Shao
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Cuiping Zhang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Weiqin Li
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Nan Li
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Leishen Wang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Hairong Nan
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Zhijie Yu
- Population Cancer Research Program and Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and The Chinese University of Hong Kong-Prince of Wales Hospital-International Diabetes Federation Centre of Education, Hong Kong, SAR, China
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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Aulinas A, Colom C, García Patterson A, Ubeda J, María MA, Orellana I, Adelantado JM, de Leiva A, Corcoy R. Smoking affects the oral glucose tolerance test profile and the relationship between glucose and HbA1c in gestational diabetes mellitus. Diabet Med 2016; 33:1240-4. [PMID: 26416345 DOI: 10.1111/dme.12966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 11/30/2022]
Abstract
AIMS Current smokers in the general population have a lower 2 h plasma glucose after an oral glucose tolerance test (OGTT) and a higher HbA1c than non-smokers, but the relationships between OGTT/HbA1c and smoking status have not been addressed in pregnancy. We analysed glycaemic measurements in women with gestational diabetes mellitus in relation to smoking status. METHODS We performed a review of the prospectively collected database of the diabetes and pregnancy clinic. We included women with gestational diabetes mellitus and a singleton pregnancy who delivered between 1986 and 2006. Bivariate and multivariate analyses were used to evaluate patient characteristics in relation to smoking status. RESULTS A total of 2361 women met the inclusion criteria: 556 (23.5%) were active smokers, 266 (11.3%) quit during pregnancy and 1539 (65.2%) were non-smokers. Most baseline characteristics were similar across groups. Diagnostic OGTT was performed at a gestational age of [median (25th, 75(th) centiles)] 29 weeks (26, 33). Women who smoked at the beginning of pregnancy had a higher 1-h plasma glucose than non-smokers [11.8 (11, 12.7), 11.6 (11, 12.6) and 11.5 (10.8, 12.5) mmol/l, for active smokers, those who quit during pregnancy and non-smokers, respectively, P < 0.001] and a lower 3-h plasma glucose [7.3 (5.9, 8.4), 7.6 (6.4, 8.7) and 8.0 (6.8, 9.0) mmol/l, respectively, P < 0.001]. HbA1c was higher in women who smoked at the beginning of pregnancy. Multiple regression analysis confirmed the independent association of smoking status with HbA1c and OGTT plasma glucose. CONCLUSIONS In women with gestational diabetes mellitus who smoke at the beginning of pregnancy, the shape of the OGTT is consistent with accelerated glucose absorption, and HbA1c is higher than expected for glycaemic values.
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Affiliation(s)
- A Aulinas
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - C Colom
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A García Patterson
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Ubeda
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M A María
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I Orellana
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J M Adelantado
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A de Leiva
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research on Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - R Corcoy
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research on Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
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Fleisch AF, Kloog I, Luttmann-Gibson H, Gold DR, Oken E, Schwartz JD. Air pollution exposure and gestational diabetes mellitus among pregnant women in Massachusetts: a cohort study. Environ Health 2016; 15:40. [PMID: 26911579 PMCID: PMC4765142 DOI: 10.1186/s12940-016-0121-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/08/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Rodent and human studies suggest an association between air pollution exposure and type 2 diabetes mellitus, but the extent to which air pollution is associated with gestational diabetes mellitus (GDM) is less clear. METHODS We used the Massachusetts Registry of Vital Records to study primiparous women pregnant from 2003-2008 without pre-existing diabetes. We used satellite-based spatiotemporal models to estimate first and second trimester residential particulate (PM2.5) exposure and geographic information systems to estimate neighborhood traffic density. We obtained GDM status from birth records. We performed logistic regression analyses adjusted for sociodemographics on the full cohort and after stratification by maternal age and smoking habits. RESULTS Of 159,373 women, 5,381 (3.4 %) developed GDM. Residential PM2.5 exposure ranged 1.3-19.3 μg/m(3) over the second trimester. None of the exposures were associated with GDM in the full cohort [e.g. OR 0.99 (95 % CI: 0.95, 1.03) for each interquartile range (IQR) increment in second trimester PM2.5]. There were also no consistent associations after stratification by smoking habits. When the cohort was stratified by maternal age, women less than 20 years had 1.36 higher odds of GDM (95 % CI: 1.08, 1.70) for each IQR increment in second trimester PM2.5 exposure. CONCLUSIONS Although we found no evidence of an association between air pollution exposure and GDM among all women in our study, greater exposure to PM2.5 during the second trimester was associated with GDM in the youngest age stratum.
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Affiliation(s)
- Abby F. Fleisch
- />Division of Endocrinology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115 USA
| | - Itai Kloog
- />Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Heike Luttmann-Gibson
- />Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
| | - Diane R. Gold
- />Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
- />Channing Laboratory, Brigham and Women’s Hospital, Boston, MA USA
| | - Emily Oken
- />Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
- />Department of Nutrition, Harvard School of Public Health, Boston, MA USA
| | - Joel D. Schwartz
- />Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
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Romano ME, Enquobahrie DA, Simpson CD, Checkoway H, Williams MA. A Case-Cohort Study of Cadmium Body Burden and Gestational Diabetes Mellitus in American Women. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:993-8. [PMID: 25712731 PMCID: PMC4590743 DOI: 10.1289/ehp.1408282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/20/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND Environmental cadmium (Cd) exposure is associated with type 2 diabetes. However, the association of Cd and gestational diabetes mellitus (GDM) is unknown. OBJECTIVES We examined the association between body burden of Cd and GDM risk. METHODS We used 140 GDM cases and 481 randomly selected noncase subcohort members from the Omega Study to conduct a case-cohort study. Creatinine (Cr)-corrected Cd in early pregnancy urine (U-Cd) was measured by inductively coupled plasma mass spectrometry. Tertiles (< 0.29; 0.29-0.42; ≥ 0.43 μg/g Cr) were defined using the subcohort's U-Cd distribution. GDM was diagnosed using the 2004 American Diabetes Association guidelines. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression. RESULTS GDM cases had higher geometric mean U-Cd (0.39 μg/g Cr; 95% CI: 0.37, 0.41) than noncases (0.31 μg/g Cr; 95% CI: 0.29, 0.33). Odds ratios for GDM increased with increasing U-Cd tertile (OR = 1.64; 95% CI: 0.88, 3.05 for middle vs. low tertile; OR = 2.07; 95% CI: 1.15, 3.73 for high vs. low tertile; p-trend = 0.015). Overweight/obesity (body mass index ≥ 25 kg/m(2)) did not modify the association between U-Cd and GDM (p = 0.26). CONCLUSIONS Our findings suggest that body burden of Cd increases risk of GDM in a dose-dependent manner. Improved understanding of environmental factors influencing GDM may facilitate early identification of women at high risk of GDM.
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Affiliation(s)
- Megan E Romano
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
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Cho GJ, Kim LY, Sung YN, Kim JA, Hwang SY, Hong HR, Hong SC, Oh MJ, Kim HJ. Secular Trends of Gestational Diabetes Mellitus and Changes in Its Risk Factors. PLoS One 2015; 10:e0136017. [PMID: 26292282 PMCID: PMC4546365 DOI: 10.1371/journal.pone.0136017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 07/30/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the secular trends of incidence of gestational diabetes mellitus (GDM) and insulin treatment for GDM in a Korean population and to determine the factors that contribute to the trends in the incidence of GDM. STUDY DESIGN We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from women who had given birth from 2006 to 2010. We evaluated the trends in the incidence of GDM and GDM requiring insulin treatment and the changes in risk factors. RESULTS There were 1,824,913 births during the study period, which included 129,666 cases of GDM, an incidence of 7.11% over this period. The incidence of GDM increased from 3.86% in 2007 to 11.83% in 2010, with a continuous increase after adjustment for age. However, the number of GDM cases that required insulin treatment decreased significantly from 13.87% in 2007 to 5.94% in 2010. The proportion of patients who were at an older age and multiparity, 2 GDM risk factors, increased during the study period. CONCLUSIONS In Korea, the incidence of GDM, especially mild GDM, increased dramatically during the period from 2006 to 2010. Further efforts are needed to monitor this trend and to identify associated factors.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Log Young Kim
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Ye Na Sung
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Jee Ae Kim
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Soon Young Hwang
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea
| | - Hye-Ri Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
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Erem C, Kuzu UB, Deger O, Can G. Prevalence of gestational diabetes mellitus and associated risk factors in Turkish women: the Trabzon GDM Study. Arch Med Sci 2015; 11:724-35. [PMID: 26322083 PMCID: PMC4548030 DOI: 10.5114/aoms.2015.53291] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/09/2014] [Accepted: 02/07/2014] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate the prevalence of gestational diabetes mellitus (GDM) in Turkish pregnant women in the Trabzon Region and further to identify population-specific risk factors for GDM. MATERIAL AND METHODS In this prospective cross-sectional survey, universal screening for GDM was performed in 815 pregnant women. Screening was done with a 50-g oral glucose challenge test (GCT) with a 140 mg/dl cut-off point, then a diagnostic 100 g oral glucose tolerance test (OGTT) was performed according to Carpenter and Coustan (CC) criteria. RESULTS The GCT was positive in 182 (22.3%) cases. The OGTT was performed on the 182 screen-positive pregnant women. Thirty-five were diagnosed with GDM on the basis of their results for a prevalence of 4.3% (35/815). Of the pregnancies with negative GCT but having high risk factors for GDM (n = 31), 4 were diagnosed with GDM (0.5%). Prevalence of GDM was found to be 4.8% (n = 39) for all pregnant women. Gestational diabetes mellitus was positively associated with advanced maternal age (p < 0.001), prepregnancy body mass index (p < 0.001), cessation of cigarette smoking (p < 0.001), excessive weight gain during pregnancy (p = 0.003), previous history of GDM (p < 0.001), history of selected medical conditions (p = 0.018), family history of diabetes (FHD) (p < 0.001), and existence of at least one high risk factor for GDM (p < 0.001). In multiple logistic regression analysis, independent predictors for GDM were maternal age, cessation of cigarette smoking, increasing prepregnancy body mass index, weight gain of more than 8 kg during pregnancy, GDM history in previous pregnancies and a history of diabetes in first-degree relatives of pregnant women. CONCLUSIONS The prevalence of GDM in Trabzon province was found as moderate. Commonly recognized risk factors including older age, prepregnancy obesity, FHD and past history of GDM, are valid for our urban Turkish population. Also, excessive weight gain in pregnancy and cigarette cessation were observed to be nontradional risk factors of GDM. It was concluded that all pregnant women should be screened for GDM if prevalence was not low.
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Affiliation(s)
- Cihangir Erem
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
- The Trabzon Endocrinological Studies Group, Trabzon, Turkey
| | - Ufuk B. Kuzu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Orhan Deger
- The Trabzon Endocrinological Studies Group, Trabzon, Turkey
- Department of Medical Biochemistry, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Gamze Can
- Department of Public Health, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
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Leung YPY, Kaplan GG, Coward S, Tanyingoh D, Kaplan BJ, Johnston DW, Barkema HW, Ghosh S, Panaccione R, Seow CH. Intrapartum corticosteroid use significantly increases the risk of gestational diabetes in women with inflammatory bowel disease. J Crohns Colitis 2015; 9:223-30. [PMID: 25576754 DOI: 10.1093/ecco-jcc/jjv006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Women with inflammatory bowel disease (IBD) may be at higher risk of adverse pregnancy outcomes. This study compared perinatal outcomes in women with and without IBD. METHODS The population-based Data Integration, Measurement, and Reporting (DIMR) administrative discharge database was used to identify women (≥18 years of age) in Alberta, Canada, with IBD who delivered a baby between 2006 and 2009 inclusive. Women without IBD were randomly sampled and matched in a 3:1 ratio to IBD cases by age at conception (±1 year). Odds ratios of gestational diabetes, preterm birth, low birth weight, cesarean section, and neonatal intensive care unit admission were calculated. RESULTS One hundred and sixteen IBD patients were age-matched to 381 pregnant women without IBD. Gestational diabetes, preterm birth, and cesarean section were more common in women with IBD compared with controls (6.9 versus 1.8%, p = 0.03; 12.9 versus 0.3%, p < 0.0001; 43.1 versus 21.0%, p = 0.009, respectively). On multivariate analysis, women with IBD were independently more likely to have gestational diabetes (odds ratio [OR] = 4.3; 95% confidence interval [CI] 1.2-16.3), preterm birth (OR = 19.7, 95% CI 2.2-173.9), and to deliver by cesarean section (OR = 2.7, 95% CI 1.6-4.6) after adjusting for age and smoking status. CONCLUSION Intrapartum corticosteroid use significantly increases the risk of gestational diabetes in women with IBD. Furthermore, IBD patients are at higher risk of preterm delivery and are more likely to undergo cesarean section compared with a healthy age-matched population. The finding of a higher risk of gestational diabetes is a novel finding not previously reported in the IBD literature.
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Affiliation(s)
- Yvette P Y Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Coward
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Divine Tanyingoh
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Bonnie J Kaplan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - David W Johnston
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Herman W Barkema
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada
| | - Subrata Ghosh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada
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Tabatabaei N, Giguère Y, Forest JC, Rodd CJ, Kremer R, Weiler HA. Osteocalcin is higher across pregnancy in Caucasian women with gestational diabetes mellitus. Can J Diabetes 2014; 38:307-13. [PMID: 24986803 DOI: 10.1016/j.jcjd.2014.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate circulating concentrations of osteocalcin, a bone-derived protein, while accounting for 25-hydroxyvitamin D (25(OH)D) throughout pregnancy, and whether early gestation concentrations and changes in osteocalcin predict the subsequent diagnosis of gestational diabetes mellitus (GDM). METHODS This was a nested case-control study involving 48 GDM and 48 control pregnant Caucasian women (matched for age, season of conception, pre-pregnancy body mass index and pregnancy length). Maternal serum osteocalcin was measured by enzyme-linked immunosorbent assay and 25(OH)D by chemiluminescence throughout pregnancy (11-13 weeks, 24-28 weeks and predelivery). Differences between groups were compared by mixed model analysis of variance. Predictors of diagnosis of GDM were explored using generalized estimating equation models. Neonatal general health outcomes were also compared between groups. RESULTS Serum osteocalcin was higher across pregnancy (p=0.006) in women with GDM vs. controls, whereas serum 25(OH)D was not different (p=0.80). Both biomarkers increased with time across pregnancy (p<0.0001). However, serum osteocalcin during early pregnancy and changes in its concentration from early to mid gestation did not predict the development of GDM. There were no significant differences in anthropometry and APGAR (appearance, pulse, grimace, activity, respiration) scores in neonates of controls and cases. CONCLUSIONS Serum osteocalcin is elevated in Caucasian women with GDM throughout pregnancy, but was not predictive of the onset of GDM. Larger trials evaluating the role of osteocalcin and the development of GDM appear warranted.
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Affiliation(s)
- Negar Tabatabaei
- School of Dietetics and Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Yves Giguère
- Centre Hospitalier Universitaire de Québec Research Centre et Faculté de médecine, Université Laval, Québec City, Quebec, Canada
| | - Jean-Claude Forest
- Centre Hospitalier Universitaire de Québec Research Centre et Faculté de médecine, Université Laval, Québec City, Quebec, Canada
| | - Celia J Rodd
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Richard Kremer
- Department of Medicine, Calcium Research Laboratory, McGill University, Montreal, Quebec, Canada
| | - Hope A Weiler
- School of Dietetics and Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada.
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Cabacungan ET, Ngui EM, McGinley EL. Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin. Matern Child Health J 2012; 16:1455-67. [PMID: 22105738 DOI: 10.1007/s10995-011-0914-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We examined racial/ethnic disparities in maternal morbidities (MM) and the number of MM during labor and delivery among hospital discharges in Wisconsin. We conducted a retrospective cohort study of hospital discharge data for 206,428 pregnant women aged 13-53 years using 2005-2007 Healthcare Cost and Utilization Project State Inpatient Dataset (HCUP-SID) for Wisconsin. After adjustments for covariates, MM (preterm labor, antepartum and postpartum hemorrhage, hypertension in pregnancy, gestational diabetes, membrane-related disorders, infections and 3rd and 4th perineal lacerations) were examined using logistic regression models, and number of MM (0, 1, 2, >2 MM) were examined using multivariable ordered logistic regressions with partial proportional odds models. African-Americans had significantly higher likelihood of infections (OR = 1.74; 95% CI 1.60-1.89), preterm labor (OR = 1.42; 1.33-1.50), antepartum hemorrhage (OR = 1.63; 1.44-1.83), and hypertension complicating pregnancy (OR = 1.39; 1.31-1.48) compared to Whites. Hispanics, Asian/Pacific Islanders, and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders (OR = 1.53; 1.34-1.75). All minority racial/ethnic groups, except Asians, had significantly higher likelihood of having 0 versus 1, 2 or >2 MM, 0 or 1 versus 2 or >2 MM, and 0, 1 or 2 versus >2 MM than white women. Findings show significant racial/ethnic disparities in MM, and suggest the need for better screening, management, and timely referral of these conditions, particularly among racial/ethnic women. Disparities in MM may be contributing to the high infant mortality and adverse birth outcomes among different racial/ethnic groups in Wisconsin.
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Affiliation(s)
- Erwin T Cabacungan
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
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Zhang C, Ning Y. Effect of dietary and lifestyle factors on the risk of gestational diabetes: review of epidemiologic evidence. Am J Clin Nutr 2011; 94:1975S-1979S. [PMID: 21613563 PMCID: PMC3364079 DOI: 10.3945/ajcn.110.001032] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition in pregnancy, is a common pregnancy complication and a growing health concern. GDM has been related to significant short-term and long-term adverse health outcomes for both mothers and offspring. Importantly, this number is increasing with the increasing burden of obesity among women of reproductive age. Collectively, these data highlight the significance of understanding risk factors, in particular modifiable factors, for GDM and of preventing GDM among high-risk populations. Research in the past decade has identified a few diet and lifestyle factors that are associated with GDM risk. This review provides an overview of emerging diet and lifestyle factors that may contribute to the prevention of GDM. It also discusses major methodologic concerns about the available epidemiologic studies of GDM risk factors.
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Affiliation(s)
- Cuilin Zhang
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 21205, USA.
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Hosler AS, Nayak SG, Radigan AM. Stressful events, smoking exposure and other maternal risk factors associated with gestational diabetes mellitus. Paediatr Perinat Epidemiol 2011; 25:566-74. [PMID: 21980946 DOI: 10.1111/j.1365-3016.2011.01221.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The incidence of gestational diabetes mellitus (GDM) has increased significantly in the last few decades in the US. Understanding its risk factors is imperative for the prevention of GDM and its sequelae, but the roles of behavioural risk factors such as stressful events and smoking on GDM are generally not well understood. Using data obtained from the New York State (NYS) Pregnancy Risk Assessment Monitoring System survey for 2004-06 and the NYS birth certificates, we examined relationships between GDM, stressful events and smoking among 2690 women who had live singleton births and did not have pre-pregnancy diabetes. After adjustment for risk factors such as maternal age, race/ethnicity, pre-pregnancy body mass index, hypertension, as well as smoking exposure, education, parity, and gestation at first visit for prenatal care, we found that having five or more stressful events 12 months before the baby was born was significantly associated with GDM (OR = 2.49, [95% CI 1.49, 4.16]). In another model, having any stressful event(s) other than 'moved to a new address' 12 months before the baby was born was also moderately associated with GDM (OR = 1.38, [95% CI 1.04, 1.85]). Smoking exposure, assessed by combining maternal smoking and second-hand smoke exposure into six levels, had no significant association with GDM, and did not show a dose-response pattern. The present study suggests that stressful events during pregnancy may be an independent risk factor for GDM. Future studies of GDM should include this common, but potentially modifiable risk factor in analyses.
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Affiliation(s)
- Akiko S Hosler
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY 12144, USA.
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Haskins AE, Bertone-Johnson ER, Pekow P, Carbone E, Fortner RT, Chasan-Taber L. Smoking during pregnancy and risk of abnormal glucose tolerance: a prospective cohort study. BMC Pregnancy Childbirth 2010; 10:55. [PMID: 20849607 PMCID: PMC2946270 DOI: 10.1186/1471-2393-10-55] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 09/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disturbances in glucose metabolism during pregnancy are associated with negative sequalae for both mother and infant. The association between smoking and abnormal glucose tolerance (AGT) remains controversial. Therefore, the aim of this study was to examine the relationship between smoking prior to and during pregnancy and risk of AGT. METHODS We utilized data from a prospective cohort of 1,006 Hispanic (predominantly Puerto Rican) prenatal care patients in Western Massachusetts. Women reported pre- and early pregnancy smoking at recruitment (mean = 15 weeks) and mid pregnancy smoking at a second interview (mean = 28 weeks). AGT was defined as > 135 mg/dL on the routine 1-hour glucose tolerance test (1-hr OGTT). We used multivariable regression to assess the effect of pre, early, and mid-pregnancy smoking on risk of AGT and screening plasma glucose value from the 1-hr OGTT. RESULTS In age-adjusted models, women who smoked > 0-9 cigarettes/day in pre-pregnancy had an increased risk of AGT (OR = 1.90; 95% CI 1.02-3.55) compared to non-smokers; this was attenuated in multivariable models. Smoking in early (OR = 0.48; 95% CI 0.21-1.10) and mid pregnancy (OR = 0.38; 95% CI 0.13-1.11) were not associated with AGT in multivariable models. Smoking during early and mid pregnancy were independently associated with lower glucose screening values, while smoking in pre-pregnancy was not. CONCLUSIONS In this prospective cohort of Hispanic women, we did not observe an association between smoking prior to or during pregnancy and risk of AGT. Findings from this study, although based on small numbers of cases, extend prior research to the Hispanic population.
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Affiliation(s)
- Amy E Haskins
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Elizabeth R Bertone-Johnson
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Penelope Pekow
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Elena Carbone
- Department of Nutrition, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Renée T Fortner
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Lisa Chasan-Taber
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
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Diet and weight gain characteristics of pregnant women with gestational diabetes. Eur J Clin Nutr 2010; 64:1433-40. [DOI: 10.1038/ejcn.2010.167] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Braun PA, Huebschmann AG, Kim CA, Lezotte DC, Shupe A, Dabelea D. Effect of Maternal Birthplace on Gestational Diabetes Prevalence in Colorado Hispanics. J Immigr Minor Health 2010; 13:426-33. [DOI: 10.1007/s10903-010-9370-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Contreras KR, Kominiarek MA, Zollinger TW. The impact of tobacco smoking on perinatal outcome among patients with gestational diabetes. J Perinatol 2010; 30:319-23. [PMID: 19907429 DOI: 10.1038/jp.2009.175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effects of tobacco use on perinatal outcomes among patients with gestational diabetes (GDM). STUDY DESIGN This was a retrospective cohort study of singleton pregnancies with GDM and live births from 2003 to 2006. The primary outcome, large for gestational age (LGA) infants, was compared between smoking and nonsmoking groups. Secondary outcomes included cesarean deliveries, shoulder dystocia, birth trauma, peripartum complications, macrosomia, 5-min Apgar score < or =3, birth defects, and neonatal intensive care unit (NICU) admissions. chi(2) and Student t-tests compared the two groups; a P-value <0.05 was statistically significant and odds ratios (OR) were reported with 95% confidence intervals (CI). A multivariate logistic regression analysis controlled for variables known to affect outcomes in GDM. RESULT We identified 915 patients with GDM, of which 130 (14.2%) smoked during pregnancy. Women who smoked during pregnancy were less likely to have LGA infants (22.4 vs 31.2%; OR, 0.61; 95% CI, 0.39 to 0.95). In a logistic regression analysis, the inverse relationship between smoking and LGA persisted (OR, 0.59; 95% CI, 0.36 to 0.97) after controlling for maternal age, multiparity, ethnicity, weight status before pregnancy, weight gain during pregnancy, and male gender. Preterm labor, preeclampsia, Cesareans, shoulder dystocia, and birth trauma were similar in both groups. PPROM was more likely to occur in nonsmokers (0 vs 4%, P=0.03), but postpartum hemorrhage was more common among smokers (OR, 2.3; 95% CI, 1.02 to 5.31). Macrosomia, low 5-min Apgar score, birth defects, and NICU admissions were similar between the groups. CONCLUSION Patients with GDM who smoke during pregnancy were 40% less likely to have LGA infants. However, smoking was not protective of other common morbidities associated with GDM.
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Affiliation(s)
- K R Contreras
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 60153, USA
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Shamsi U, Hatcher J, Shamsi A, Zuberi N, Qadri Z, Saleem S. A multicentre matched case control study of risk factors for preeclampsia in healthy women in Pakistan. BMC Womens Health 2010; 10:14. [PMID: 20433699 PMCID: PMC2881882 DOI: 10.1186/1472-6874-10-14] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 04/30/2010] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi. METHODS We conducted a hospital based matched case-control study to assess the factors associated with preeclampsia in Karachi and Rawalpindi, from January 2006 to December 2007. 131 hospital-reported cases of PE and 262 controls without history of preeclampsia were enrolled within 3 days of delivery. Cases and controls were matched on the hospital, day of delivery and parity. Potential risk factors for preeclampsia were ascertained during in-person postpartum interviews using a structured questionnaire and by medical record abstraction. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS In multivariate analysis, women having a family history of hypertension (adjusted OR 2.06, 95% CI; 1.27-3.35), gestational diabetes (adjusted OR 6.57, 95% CI; 1.94 -22.25), pre-gestational diabetes (adjusted OR 7.36, 95% CI; 1.37-33.66) and mental stress during pregnancy (adjusted OR 1.32; 95% CI; 1.19-1.46, for each 5 unit increase in Perceived stress scale score) were at increased risk of preeclampsia. However, high body mass index, maternal age, urinary tract infection, use of condoms prior to index pregnancy and sociodemographic factors were not associated with higher risk of having preeclampsia. CONCLUSIONS Development of preeclampsia was associated with gestational diabetes, pregestational diabetes, family history of hypertension and mental stress during pregnancy. These factors can be used as a screening tool for preeclampsia prediction. Identification of the above mentioned predictors would enhance the ability to diagnose and monitor women likely to develop preeclampsia before the onset of disease for timely interventions and better maternal and fetal outcomes.
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Affiliation(s)
- Uzma Shamsi
- Division of Epidemiology/Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Juanita Hatcher
- Division of Epidemiology/Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Azra Shamsi
- Combined Military Hospital, Rawalpindi, Pakistan
| | - Nadeem Zuberi
- Department of Obstetrics/Gynecology, Aga Khan University Hospital AKUH, Karachi, Pakistan
| | - Zeeshan Qadri
- Division of Epidemiology/Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Division of Epidemiology/Biostatistics, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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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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Dode MASDO, Santos IDSD. Fatores de risco para diabetes mellitus gestacional na coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004. CAD SAUDE PUBLICA 2009; 25:1141-52. [DOI: 10.1590/s0102-311x2009000500021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 11/26/2008] [Indexed: 01/04/2023] Open
Abstract
Consensos de diversos países referem idade, obesidade e história familiar de diabetes mellitus como fatores de risco para diabetes mellitus gestacional. Outros fatores permanecem controversos. O objetivo deste estudo foi investigar fatores associados ao diabetes mellitus gestacional entre mães dos recém-nascidos da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, em 2004. Foram entrevistadas 4.243 puérperas no hospital, havendo 0,5% de recusas. O diagnóstico de diabetes mellitus gestacional foi auto-referido. A prevalência de diabetes mellitus gestacional foi 2,95% (IC95%: 2,53-3,64). Análise bruta realizada por meio de testes qui-quadrado mostrou associação direta com aumento da idade, escolaridade, nível econômico e índice de massa corporal (IMC) e inversa com altura materna. Cor não branca, história familiar de diabetes mellitus, tabagismo no primeiro e segundo trimestres e atividade física antes da gestação e no primeiro trimestre mostraram-se associados. A análise ajustada hierarquizada realizada através de regressão logística mostrou associação com maior idade, cor não branca, maior escolaridade, história familiar de diabetes mellitus e maior IMC. A altura ficou no limiar da significância. Tabagismo no primeiro e segundo trimestres foi protetor.
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Dode MASDO, Santos ISD. Non classical risk factors for gestational diabetes mellitus: a systematic review of the literature. CAD SAUDE PUBLICA 2009; 25 Suppl 3:S341-59. [DOI: 10.1590/s0102-311x2009001500002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 08/19/2009] [Indexed: 12/16/2022] Open
Abstract
Age, obesity and family history of diabetes are well known risk factors for gestational diabetes mellitus. Others are more controversial. The objective of this review is to find evidence in the literature that justifies the inclusion of these other conditions among risk factors. The MEDLINE, Cochrane, LILACS and Pan American Health Organization databases were searched, covering articles dating from between 1992 and 2006. Keywords were used in combination (AND) with gestational diabetes mellitus separately and with each one of the risk factors studied. The methodological quality of the studies included was assessed, resulting in the selection of 41 papers. Most studies investigating maternal history of low birth weight, low stature, and low level of physical activity have found positive associations with gestational diabetes mellitus. Low socioeconomic levels, smoking during pregnancy, high parity, belonging to minority groups, and excessive weight gain during pregnancy presented conflicting results. Publication bias cannot be ruled out. Standardization of techniques, cutoff points for screening and diagnosis, as well as studies involving larger sample sizes would allow future meta-analyses.
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Wendland EM, Pinto ME, Duncan BB, Belizán JM, Schmidt MI. Cigarette smoking and risk of gestational diabetes: a systematic review of observational studies. BMC Pregnancy Childbirth 2008; 8:53. [PMID: 19077324 PMCID: PMC2632653 DOI: 10.1186/1471-2393-8-53] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 12/16/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational diabetes is a prevalent disease associated with adverse outcomes of pregnancy. Smoking as been associated with glucose intolerance during pregnancy in some but not all studies. Therefore, we aimed to systematically review all epidemiological evidence to examine the association between cigarette smoking during pregnancy and risk of developing gestational diabetes mellitus. METHODS We conducted a systematic review of articles published up to 2007, using PubMed, Embase, LILACS e CINAHL to identify the articles. Because this review focuses on studies of smoking during pregnancy, we excluded studies evaluating smoking outside pregnancy. Two investigators independently abstracted information on participant's characteristics, assessment of exposure and outcome, and estimates for the association under study. We evaluated the studies for publication bias and performed heterogeneity analyses. We also assessed the effect of each study individually through sensitivity analysis. RESULTS We found and critically reviewed 32 studies, of which 12 met the criteria for inclusion in the review. Most of the studies provided only unadjusted measurements. Combining the results of the individual studies, we obtained a crude odds ratio of 1.03 (99% CI 0.85-1.25). Only 4 studies presented adjusted measurements of association, and no association was found when these alone were analyzed (OR 0.95; 99% CI 0.85-1.07). Subgroup analysis could not be done due to small sample size. CONCLUSION The number of studies is small, with major heterogeneity in research design and findings. Taken together, current data do not support an association between cigarette smoking during pregnancy and the risk of gestational diabetes.
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Affiliation(s)
- Eliana M Wendland
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Eugênia Pinto
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce B Duncan
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - José M Belizán
- Department of Mother & Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Maria Inês Schmidt
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
Background Gestational diabetes mellitus (GDM) is reported to be associated with maternal but not paternal diabetes. This study examined the relative contribution of maternal and paternal diabetes among type 2 diabetic women with and without a GDM history. Materials and methods A total of 48 502 type 2 diabetic women from a national sample were interviewed by telephone. Among them, 510 reported a GDM history. Parental diabetes was compared between patients with and without a GDM history considering the confounding effects of age, body mass index, smoking, hypertension, duration of diabetes and insulin use. Results Patients with a GDM history were younger in age, had younger age of onset, longer duration of diabetes, slightly lower body mass index, higher prevalence of insulin use and lower prevalence of hypertension, but smoking rates were similar. The percentages of parental diabetes of nil, mother only, father only and both father and mother for those without a GDM history were 76.2, 15.2, 5.8 and 2.8%, respectively; and were 47.8, 26.8, 17.5 and 7.9%, respectively, for those with a GDM history (P < 0.001). The adjusted odds ratios for patients with versus without a GDM history for parental diabetes of nil, mother only, father only, and both father and mother were 1.000, 1.210 (0.948-1.544), 1.783 (1.341-2.371) and 2.094 (1.440-3.045), respectively. Conclusions Although maternal diabetes is more commonly seen, the disproportionately higher paternal diabetes in patients with a GDM history suggests an important role for paternal diabetes on the development of GDM into type 2 diabetes mellitus.
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Affiliation(s)
- C H Tseng
- National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan.
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Affiliation(s)
- Assiamira Ferrara
- Division of Research, Kaiser Permanente Medical Care Program of Northern California, Oakland, CA 94612, USA.
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