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Riaz M, Waris N, Saadat A, Fawwad A, Basit A. Gestational diabetes mellitus as a risk factor for future Type-2 diabetes mellitus: An experience from a tertiary care diabetes hospital, Karachi - Pakistan. Pak J Med Sci 2024; 40:851-856. [PMID: 38827883 PMCID: PMC11140359 DOI: 10.12669/pjms.40.5.7507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 06/05/2024] Open
Abstract
Objective To evaluate the history of gestational diabetes mellitus and other risk factors in women presenting with Type-2 diabetes mellitus at a tertiary care hospital. Methods This cross-sectional study was carried out at Baqai Institute of Diabetology & Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from July 2019 to May 2022. Women with Type-2 diabetes mellitus (T2DM) visiting outpatient department of BIDE with a previous history of GDM were recruited. Details were obtained on pre-designed questionnaire after taking informed written consent. Results A total of 378 women who had a prior history of GDM were included. Mean age (years) was 43.53±10.17. Mostly women were obese (BMI = 30.53±6.08) and have sedentary lifestyle. Mean HbA1c (%) was 9.08±2.24. This study found family history of T2DM and hypertension were common risk factors in women with GDM history. Mostly, women were diagnosed as GDM during 2nd trimester 153(42%) and was mainly seen in multiparous women (occur in 4th and above pregnancy). We found hypertension as common complication during pregnancy. Around 46% women developed T2DM within one year of GDM diagnosis, and 29.6% between one to five years. Conclusion Majority of women with GDM developed T2DM within five years of diagnosis. The potential associated risk factors were age, family history of diabetes, insulin use during pregnancy, trimester of GDM diagnosis, and hypertension during pregnancy. Awareness and life style modifications along with regular post-partum follow up with screening for T2DM should be part of GDM management to prevent or delay the occurrence of this serious complication.
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Affiliation(s)
- Musarrat Riaz
- Musarrat Riaz, FCPS. Associate Professor, Department of Medicine, Consultant Endocrinologist, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Nazish Waris
- Nazish Waris, Ph.D. Senior Lecturer, Department of Biochemistry, Research Associate, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Akifa Saadat
- Akifa Saadat, B.S. Research Officer, Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Asher Fawwad
- Asher Fawwad, Ph.D. Professor & Head of the Biochemistry Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Abdul Basit
- Abdul Basit, FRCP. Professor of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
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Sartorao Filho CI, Nunes SK, Magyori ABM, Calderon IMP, Barbosa AMP, Rudge MVC. The role of Gestational Diabetes Mellitus and pelvic floor 3D-ultrasound assessment during pregnancy predicting urinary incontinence: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:637. [PMID: 37670226 PMCID: PMC10478418 DOI: 10.1186/s12884-023-05932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Postpartum urinary incontinence may have a severe impact on women's health. Despite pregnancy and parturition being the most recognized risk factors, methods to identify new pregnant predictor risk factors are needed. Our study investigated the Gestational Diabetes Mellitus, clinical and pelvic floor 3D-ultrasound markers in pregnant women as predictors for 6-18 months of urinary incontinence. This prospective cohort study included nulliparous pregnant women submitted to Gestational Diabetes Mellitus screening in the second trimester. Pelvic floor 3D Ultrasound was performed at the second and third trimesters of gestation to evaluate the pelvic floor muscles and functions. Clinical data, the ICIQ-SF, and ISI questionnaires for urinary incontinence were applied in the third trimester and 6-18 months postpartum. Univariate analysis (P < .20) to extract risk factors variables and multivariate logistic regression analysis (P < .05) to obtain the adjusted relative ratio for urinary incontinence were performed. A total of 93 participants concluded the follow-up. Using the variables obtained by univariate analysis and after adjustments for potential confounders, multivariate analysis revealed that Gestational Diabetes Mellitus exposure was a solid and independent risk factor for 6-18 months of urinary incontinence (Adjusted RR 8.08; 95%CI 1.17-55.87; P:0.034). In addition, a higher Hiatal area observed in distension maneuver from the second to third trimester was negatively associated (Adjusted RR 0.96; 95%CI 0.93-0.99; P:0.023). In conclusion, Gestational Diabetes Mellitus was positively associated with 6-18 months of urinary incontinence, and higher Hiatal area distension was negatively associated.
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Affiliation(s)
- Carlos Izaias Sartorao Filho
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil.
- Educational Foundation of Assis Municipality (FEMA), Medical School, Assis, Brazil.
| | - Sthefanie K Nunes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
| | - Adriely B M Magyori
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
| | - Iracema M P Calderon
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
| | - Angelica M P Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
- School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, São Paulo State University, Marília, Sao Paulo, Brazil
| | - Marilza V C Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Benedito Spinardi st 1440, Botucatu, Assis- São Paulo State, 19815-110, Brazil
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Thayer SM, Williams KJ, Lawlor ML. The role of technology in the care of diabetes mellitus in pregnancy: an expert review. AJOG GLOBAL REPORTS 2023; 3:100245. [PMID: 37645646 PMCID: PMC10461241 DOI: 10.1016/j.xagr.2023.100245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Diabetes mellitus is one of the most commonly encountered pregnancy complications and is associated with multiple adverse perinatal outcomes. Technology has progressed to address the unique challenges patients face in managing diabetes mellitus in pregnancy. Technology has bolstered diabetes mellitus education with smartphone applications focused on nutrition counseling and carbohydrate intake advice. Continuous glucose monitors and insulin infusion systems have shown benefit by simplifying glycemic monitoring and insulin administration. Improvements in glycemic control and perinatal outcomes have been seen with continuous glucose monitor use when compared with intermittent blood glucose monitoring, and more pregnant people are using insulin pumps instead of multiple daily insulin injections. Hybrid closed-loop systems are emerging and are able to integrate continuous glucose monitoring and insulin pump technologies while maximizing automated features in the nonpregnant population, but these have not been endorsed for use in pregnancy yet. Applying telehealth practices has been associated with high patient satisfaction among those with diabetes mellitus in pregnancy, and leveraging remote patient monitoring through telehealth platforms and short-range wireless technologies can reduce the burden of patient visits. As technology becomes more integrated into routine management of diabetes mellitus in pregnancy, practitioners should emphasize individualized counseling and device selection to ensure patient autonomy and safety.
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Affiliation(s)
- Sydney M. Thayer
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO (Drs Thayer and Lawlor)
| | - Kelley J. Williams
- Division of Endocrinology, Washington University in St Louis, St Louis, MO (Dr Williams)
| | - Megan L. Lawlor
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO (Drs Thayer and Lawlor)
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Sewberath Misser VH, Hindori-Mohangoo AD, Shankar A, Wickliffe JK, Lichtveld MY, Mans DRA. Prenatal Exposure to Mercury, Manganese, and Lead and Adverse Birth Outcomes in Suriname: A Population-Based Birth Cohort Study. TOXICS 2022; 10:464. [PMID: 36006143 PMCID: PMC9414742 DOI: 10.3390/toxics10080464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Globally, adverse birth outcomes are increasingly linked to prenatal exposure to environmental contaminants, such as mercury, manganese, and lead. This study aims to assess an association between prenatal exposure to mercury, manganese, and lead and the occurrence of adverse birth outcomes in 380 pregnant women in Suriname. The numbers of stillbirths, preterm births, low birth weights, and low Apgar scores were determined, as well as blood levels of mercury, manganese, lead, and relevant covariates. Descriptive statistics were calculated using frequency distributions. The associations between mercury, manganese, and lead blood levels, on the one hand, and adverse birth outcomes, on the other hand, were explored using contingency tables, tested with the χ2-test (Fisher's exact test), and expressed with a p value. Multivariate logistic regression models were computed to explore independent associations and expressed as (adjusted) odds ratios (aOR) with 95% confidence intervals (CI). The findings of this study indicate no statistically significant relationship between blood mercury, manganese, or lead levels and stillbirth, preterm birth, low birth weight, and low Apgar score. However, the covariate diabetes mellitus (aOR 5.58, 95% CI (1.38-22.53)) was independently associated with preterm birth and the covariate hypertension (aOR 2.72, 95% CI (1.081-6.86)) with low birth weight. Nevertheless, the observed high proportions of pregnant women with blood levels of mercury, manganese, and lead above the reference levels values of public health concern warrants environmental health research on risk factors for adverse birth outcomes to develop public health policy interventions to protect pregnant Surinamese women and their newborns from potential long-term effects.
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Affiliation(s)
- Vinoj H. Sewberath Misser
- Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Kernkampweg 5-7, Paramaribo, Suriname
| | - Ashna D. Hindori-Mohangoo
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
- Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname
| | - Arti Shankar
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Jeffrey K. Wickliffe
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Dennis R. A. Mans
- Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Kernkampweg 5-7, Paramaribo, Suriname
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Luo D, Liu W, Chen T, An L. A Distribution-Free Model for Longitudinal Metagenomic Count Data. Genes (Basel) 2022; 13:1183. [PMID: 35885966 PMCID: PMC9316307 DOI: 10.3390/genes13071183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/05/2023] Open
Abstract
Longitudinal metagenomics has been widely studied in the recent decade to provide valuable insight for understanding microbial dynamics. The correlation within each subject can be observed across repeated measurements. However, previous methods that assume independent correlation may suffer from incorrect inferences. In addition, methods that do account for intra-sample correlation may not be applicable for count data. We proposed a distribution-free approach, namely CorrZIDF, which extends the current method to model correlated zero-inflated metagenomic count data, offering a powerful and accurate solution for detecting significance features. This method can handle different working correlation structures without specifying each margin distribution of the count data. Through simulation studies, we have shown the robustness of CorrZIDF when selecting a working correlation structure for repeated measures studies to enhance the efficiency of estimation. We also compared four methods using two real datasets, and the new proposed method identified more unique features that were reported previously on the relevant research.
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Affiliation(s)
- Dan Luo
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, AZ 85721, USA;
| | - Wenwei Liu
- Interdisciplinary Program of Statistics and Data Science, The University of Arizona, Tucson, AZ 85721, USA;
| | - Tian Chen
- Statistical and Quantitative Sciences, Takeda Pharmaceuticals, Cambridge, MA 02139, USA;
| | - Lingling An
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, AZ 85721, USA;
- Interdisciplinary Program of Statistics and Data Science, The University of Arizona, Tucson, AZ 85721, USA;
- Department of Biosystems Engineering, The University of Arizona, Tucson, AZ 85721, USA
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Lomakova YD, Chen X, Stein TP, Steer RA. Decreased Adiponectin Levels in Early Pregnancy Are Associated with High Risk of Prematurity for African American Women. J Clin Med 2022; 11:3213. [PMID: 35683599 PMCID: PMC9181315 DOI: 10.3390/jcm11113213] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 01/27/2023] Open
Abstract
The relationship of low maternal serum adiponectin levels with preterm delivery among a multi-ethnic group has not been extensively investigated. We examined ethnic differences in cytokine/adipokine profiles and whether they contribute to several adverse pregnancy outcomes, particularly preterm delivery. Data and samples were from a large prospective observational cohort (n = 1776) of young, generally healthy pregnant women (African American 36.4%, Hispanic 48.0%, Caucasian 15.6%). Serum cytokine/adipokine concentrations were measured at entry (mean gestational age of 16.83 weeks) using the Liminex xMap Technology. Multivariable analyses were performed. A significant difference in adiponectin level was observed among ethnic groups. African Americans had a decreased adiponectin and increased resistin levels compared to Hispanics and Caucasians (p < 0.05 to p < 0.0001 for each). Decreased adiponectin (lowest quartile) was positively associated with preterm delivery independent of usual risk factors (adjusted odds ratio (AOR) 1.46, 95% confidence interval (CI) 1.05, 2.04 for all preterm and AOR 1.84, 95% CI 1.07, 3.17 for early preterm births). The results were unchanged when women with preeclampsia were excluded. Similar results were observed in African Americans. Decreased adiponectin levels were not related to preterm birth in either Hispanics or Caucasians. Lower adiponectin levels were also significantly associated with an increased risk of developing gestational diabetes (AOR 1.72, 95% CI 1.05, 2.84) and preeclampsia (AOR 1.45, 95% CI 1.00, 2.14) in the whole cohort and in Caucasians. We did not find any consistent relationships between the other markers with outcome variables. Dysregulation in maternal adiponectin at early gestation is associated with an increased risk of preterm delivery. An ethnic difference in adiponectin levels may contribute to a higher preterm delivery rate in African American women.
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Affiliation(s)
- Yelizavet D. Lomakova
- Department of Obstetrics/Gynecology, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA;
| | - Xinhua Chen
- Department of Obstetrics/Gynecology, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA;
| | - T. Peter Stein
- Department of Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA;
| | - Robert A. Steer
- Department of Psychiatry, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA;
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Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2022; 377:e067946. [PMID: 35613728 PMCID: PMC9131781 DOI: 10.1136/bmj-2021-067946] [Citation(s) in RCA: 175] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the association between gestational diabetes mellitus and adverse outcomes of pregnancy after adjustment for at least minimal confounding factors. DESIGN Systematic review and meta-analysis. DATA SOURCES Web of Science, PubMed, Medline, and Cochrane Database of Systematic Reviews, from 1 January 1990 to 1 November 2021. REVIEW METHODS Cohort studies and control arms of trials reporting complications of pregnancy in women with gestational diabetes mellitus were eligible for inclusion. Based on the use of insulin, studies were divided into three subgroups: no insulin use (patients never used insulin during the course of the disease), insulin use (different proportions of patients were treated with insulin), and insulin use not reported. Subgroup analyses were performed based on the status of the country (developed or developing), quality of the study, diagnostic criteria, and screening method. Meta-regression models were applied based on the proportion of patients who had received insulin. RESULTS 156 studies with 7 506 061 pregnancies were included, and 50 (32.1%) showed a low or medium risk of bias. In studies with no insulin use, when adjusted for confounders, women with gestational diabetes mellitus had increased odds of caesarean section (odds ratio 1.16, 95% confidence interval 1.03 to 1.32), preterm delivery (1.51, 1.26 to 1.80), low one minute Apgar score (1.43, 1.01 to 2.03), macrosomia (1.70, 1.23 to 2.36), and infant born large for gestational age (1.57, 1.25 to 1.97). In studies with insulin use, when adjusted for confounders, the odds of having an infant large for gestational age (odds ratio 1.61, 1.09 to 2.37), or with respiratory distress syndrome (1.57, 1.19 to 2.08) or neonatal jaundice (1.28, 1.02 to 1.62), or requiring admission to the neonatal intensive care unit (2.29, 1.59 to 3.31), were higher in women with gestational diabetes mellitus than in those without diabetes. No clear evidence was found for differences in the odds of instrumental delivery, shoulder dystocia, postpartum haemorrhage, stillbirth, neonatal death, low five minute Apgar score, low birth weight, and small for gestational age between women with and without gestational diabetes mellitus after adjusting for confounders. Country status, adjustment for body mass index, and screening methods significantly contributed to heterogeneity between studies for several adverse outcomes of pregnancy. CONCLUSIONS When adjusted for confounders, gestational diabetes mellitus was significantly associated with pregnancy complications. The findings contribute to a more comprehensive understanding of the adverse outcomes of pregnancy related to gestational diabetes mellitus. Future primary studies should routinely consider adjusting for a more complete set of prognostic factors. REVIEW REGISTRATION PROSPERO CRD42021265837.
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Affiliation(s)
- Wenrui Ye
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Cong Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Huang
- National Clinical Research Centre for Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chenglong Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Fangkun Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
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Lis-Kuberka J, Orczyk-Pawiłowicz M. Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910409. [PMID: 34639709 PMCID: PMC8508017 DOI: 10.3390/ijerph181910409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022]
Abstract
Gestational diabetes mellitus (GDM) is a multifaceted disease and is associated with complications for newborns and mothers. The aim of the study was to assess Polish women’s knowledge concerning GDM and their attitude to breastfeeding. As a research tool, an anonymous online survey that included 33 questions, grouped into three main sections—sociodemographic and obstetric variables, risk factors for GDM and neonatal adverse outcomes, and knowledge about breastfeeding—was used and administered online. A total of 410 women aged from 18 to 45 participated in this study. Based on the survey, it was demonstrated that the women had moderate knowledge concerning the maternal risk factors and adverse neonatal outcomes associated with GDM and, additionally, the short- and long-term effects of breastfeeding. Significantly deeper knowledge about GDM, including breastfeeding by GDM mothers, was observed among hyperglycemic mothers in comparison to normoglycemic mothers. However, knowledge concerning the health benefits of breastfeeding was not related to the mothers’ glycemic status. In conclusion, educational programs must include pre-pregnancy education of women and place emphasis on explaining the mechanism of development of GDM and the transformation of GDM to type 2 diabetes. This is crucial for changing the public’s perception of GDM as a temporary, reversible clinical entity.
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Meal Timing and Glycemic Control during Pregnancy-Is There a Link? Nutrients 2021; 13:nu13103379. [PMID: 34684381 PMCID: PMC8540614 DOI: 10.3390/nu13103379] [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: 07/30/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
Hyperglycemia during pregnancy and gestational diabetes mellitus (GDM) constitute an important public health problem due to their prevalence and long-term health consequences both for the mother and offspring. Results from studies in rodents and some clinical investigations suggest that meal time manipulation may be a potential lifestyle approach against conditions involving perturbations in glucose homeostasis (e.g., hyperglycemia, insulin resistance, diabetes, etc.). The purpose of this review is to summarize and critically evaluate the current literature on the role of meal timing and daily nutrient distribution on glycemic control during pregnancy. Only a small number of mostly observational studies have assessed the role of meal timing in glucose homeostasis during pregnancy. Food consumption earlier in the day and short-term fasting with adequate nutrient intake may improve glycemic control during the second and third trimester of gestation. Considering that the field of chrononutrition is still in its infancy and many questions remain unanswered, future prospective and carefully designed studies are needed to better understand the role of meal timing in metabolic homeostasis and maternal and fetal health outcomes during pregnancy.
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