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Kusinski LC, Richards R, Jones DL, Turner E, Hughes DJ, Dyson P, Ahern AL, Meek CL. Dietary intervention in gestational diabetes: a qualitative study of the acceptability and feasibility of a novel whole-diet intervention in healthcare professionals. Br J Nutr 2024; 131:219-228. [PMID: 37642175 PMCID: PMC10751936 DOI: 10.1017/s0007114523001666] [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: 02/01/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
Gestational diabetes is treated with medical nutrition therapy, delivered by healthcare professionals; however, the optimal diet for affected women is unknown. Randomised controlled trials, such as the DiGest (Dietary Intervention in Gestational Diabetes) trial, will address this knowledge gap, but the acceptability of whole-diet interventions in pregnancy is unclear. Whole-diet approaches reduce bias but require high levels of participant commitment and long intervention periods to generate meaningful clinical outcomes. We aimed to assess healthcare professionals' views on the acceptability of the DiGest dietbox intervention for women with gestational diabetes and to identify any barriers to adherence which could be addressed to support good recruitment and retention to the DiGest trial. Female healthcare professionals (n 16) were randomly allocated to receive a DiGest dietbox containing 1200 or 2000 kcal/d including at least one weeks' food. A semi-structured interview was conducted to explore participants' experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo software. Based on the findings of qualitative interviews, modifications were made to the dietboxes. Participants found the dietboxes convenient and enjoyed the variety and taste of the meals. Factors which facilitated adherence included participants having a good understanding of study aims and sufficient organisational skills to facilitate weekly meal planning in advance. Barriers to adherence included peer pressure during social occasions and feelings of deprivation or hunger (affecting both standard and reduced calorie groups). Healthcare professionals considered random allocation to a whole-diet replacement intervention to be acceptable and feasible in a clinical environment and offered benefits to participants including convenience.
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Affiliation(s)
- Laura Caroline Kusinski
- Wellcome-Trust MRC Institute of Metabolic Science Metabolic Research Laboratories, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Rebecca Richards
- MRC Epidemiology Unit, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Danielle L. Jones
- Wellcome-Trust MRC Institute of Metabolic Science Metabolic Research Laboratories, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Elizabeth Turner
- Wellcome-Trust MRC Institute of Metabolic Science Metabolic Research Laboratories, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
- Cambridge Universities NHS Foundation Trust, Cambridge, Hills Road, CambridgeCB2 0QQ, UK
| | - Deborah J Hughes
- Wellcome-Trust MRC Institute of Metabolic Science Metabolic Research Laboratories, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
- Cambridge Universities NHS Foundation Trust, Cambridge, Hills Road, CambridgeCB2 0QQ, UK
| | - Pamela Dyson
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, OxfordOX3 9DU, UK
- Oxford Centre for Diabetes, Endocrinology & Metabolism, Churchill Hospital, University of Oxford, Headington, OxfordOX3 7LE, UK
| | - Amy L. Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Claire Louise Meek
- Wellcome-Trust MRC Institute of Metabolic Science Metabolic Research Laboratories, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
- Cambridge Universities NHS Foundation Trust, Cambridge, Hills Road, CambridgeCB2 0QQ, UK
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Meek CL. An unwelcome inheritance: childhood obesity after diabetes in pregnancy. Diabetologia 2023; 66:1961-1970. [PMID: 37442824 PMCID: PMC10541526 DOI: 10.1007/s00125-023-05965-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023]
Abstract
Diabetes in pregnancy affects 20 million women per year and is associated with increased risk of obesity in offspring, leading to insulin resistance and cardiometabolic disease. Despite the substantial public health ramifications, relatively little is known about the pathophysiological mechanisms underlying obesity in these high-risk children, which creates a barrier to successful intervention. While maternal glucose itself is undeniably a major stimulus upon intrauterine growth, the degree of offspring hyperinsulinism and disturbed lipid metabolism in mothers and offspring are also likely to be implicated in the disease process. The aim of this review is to summarise current understanding of the pathophysiology of childhood obesity after intrauterine exposure to maternal hyperglycaemia and to highlight possible opportunities for intervention. I present here a new unified hypothesis for the pathophysiology of childhood obesity in infants born to mothers with diabetes, which involves self-perpetuating twin cycles of pancreatic beta cell hyperfunction and altered lipid metabolism, both acutely and chronically upregulated by intrauterine exposure to maternal hyperglycaemia.
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Affiliation(s)
- Claire L Meek
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Gerszi D, Orosz G, Török M, Szalay B, Karvaly G, Orosz L, Hetthéssy J, Vásárhelyi B, Török O, Horváth EM, Várbíró S. Risk Estimation of Gestational Diabetes Mellitus in the First Trimester. J Clin Endocrinol Metab 2023; 108:e1214-e1223. [PMID: 37247379 PMCID: PMC10584002 DOI: 10.1210/clinem/dgad301] [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: 11/02/2022] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 05/31/2023]
Abstract
CONTEXT There is no early, first-trimester risk estimation available to predict later (gestational week 24-28) gestational diabetes mellitus (GDM); however, it would be beneficial to start an early treatment to prevent the development of complications. OBJECTIVE We aimed to identify early, first-trimester prediction markers for GDM. METHODS The present case-control study is based on the study cohort of a Hungarian biobank containing biological samples and follow-up data from 2545 pregnant women. Oxidative-nitrative stress-related parameters, steroid hormone, and metabolite levels were measured in the serum/plasma samples collected at the end of the first trimester from 55 randomly selected control and 55 women who developed GDM later. RESULTS Pregnant women who developed GDM later during the pregnancy were older and had higher body mass index. The following parameters showed higher concentration in their serum/plasma samples: fructosamine, total antioxidant capacity, testosterone, cortisone, 21-deoxycortisol; soluble urokinase plasminogen activator receptor, dehydroepiandrosterone sulfate, dihydrotestosterone, cortisol, and 11-deoxycorticosterone levels were lower. Analyzing these variables using a forward stepwise multivariate logistic regression model, we established a GDM prediction model with a specificity of 96.6% and sensitivity of 97.5% (included variables: fructosamine, cortisol, cortisone, 11-deoxycorticosterone, SuPAR). CONCLUSION Based on these measurements, we accurately predict the development of later-onset GDM (24th-28th weeks of pregnancy). Early risk estimation provides the opportunity for targeted prevention and the timely treatment of GDM. Prevention and slowing the progression of GDM result in a lower lifelong metabolic risk for both mother and offspring.
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Affiliation(s)
- Dóra Gerszi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest H-1082, Hungary
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest H-1094, Hungary
| | - Gergő Orosz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Debrecen H-4032, Hungary
| | - Marianna Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest H-1082, Hungary
- Workgroup for Science Management, Doctoral School, Semmelweis University, Budapest H-1085, Hungary
| | - Balázs Szalay
- Department of Laboratory Medicine, Semmelweis University, Budapest H-1083, Hungary
| | - Gellért Karvaly
- Laboratory of Mass Spectrometry and Separation Technology, Department of Laboratory Medicine, Semmelweis University, Budapest H-1089, Hungary
| | - László Orosz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Debrecen H-4032, Hungary
| | - Judit Hetthéssy
- Workgroup for Science Management, Doctoral School, Semmelweis University, Budapest H-1085, Hungary
| | - Barna Vásárhelyi
- Department of Laboratory Medicine, Semmelweis University, Budapest H-1083, Hungary
| | - Olga Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Debrecen H-4032, Hungary
| | - Eszter M Horváth
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest H-1094, Hungary
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest H-1082, Hungary
- Workgroup for Science Management, Doctoral School, Semmelweis University, Budapest H-1085, Hungary
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Chatzakis C, Floros D, Liberis A, Gerede A, Dinas K, Pitsianis N, Sotiriadis A. STORK: Collaborative Online Monitoring of Pregnancies Complicated with Gestational Diabetes Mellitus. Healthcare (Basel) 2022; 10:653. [PMID: 35455831 PMCID: PMC9027268 DOI: 10.3390/healthcare10040653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: A novel digital platform, named STORK, was developed in the COVID-19 pandemic when clinic visits were restricted. A study of its clinical use during the pandemic was conducted. The study aims to advance the state of the art in monitoring and care of pregnancies complicated with gestational diabetes mellitus (GDM) via online collaboration between patients and care providers. Methods: This study involved 31 pregnant women diagnosed with GDM and 5 physicians. Statistical comparisons were made in clinic-visit frequency and adverse outcomes between the STORK group and a historical control group of 32 women, compatible in size, demographics, anthropometrics and medical history. Results: The average number of submitted patient measurements per day was 3.6±0.4. The average number of clinic visits was 2.9±0.7 for the STORK group vs. 4.1±1.1 for the control group (p<0.05). The number of neonatal macrosomia cases was 2 for the STORK group vs. 3 for the control group (p>0.05); no other adverse incidents. Conclusions: The patient compliance with the pilot use of STORK was high and the average number of prenatal visits was reduced. The results suggest the general feasibility to reduce the average number of clinic visits and cost, with enhanced monitoring, case-specific adaptation, assessment and care management via timely online collaboration.
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Affiliation(s)
- Christos Chatzakis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (C.C.); (A.L.); (A.G.); (K.D.)
| | - Dimitris Floros
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.F.); (N.P.)
| | - Anastasios Liberis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (C.C.); (A.L.); (A.G.); (K.D.)
| | - Aggeliki Gerede
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (C.C.); (A.L.); (A.G.); (K.D.)
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (C.C.); (A.L.); (A.G.); (K.D.)
| | - Nikos Pitsianis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.F.); (N.P.)
- Department of Computer Science, Duke University, Durham, NC 27708, USA
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (C.C.); (A.L.); (A.G.); (K.D.)
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Tsirou E, Grammatikopoulou MG, Nigdelis MP, Taousani E, Savvaki D, Assimakopoulos E, Tsapas A, Goulis DG. TIMER: A Clinical Study of Energy Restriction in Women with Gestational Diabetes Mellitus. Nutrients 2021; 13:2457. [PMID: 34371966 PMCID: PMC8308500 DOI: 10.3390/nu13072457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022] Open
Abstract
Medical nutrition therapy is an integral part of gestational diabetes mellitus (GDM) management; however, the prescription of optimal energy intake is often a difficult task due to the limited available evidence. The present pilot, feasibility, parallel, open-label and non-randomized study aimed to evaluate the effect of a very low energy diet (VLED, 1600 kcal/day), or a low energy diet (LED, 1800 kcal/day), with or without personalized exercise sessions, among women with GDM in singleton pregnancies. A total of 43 women were allocated to one of four interventions at GDM diagnosis: (1) VLED (n = 15), (2) VLED + exercise (n = 4), (3) LED (n = 16) or (4) LED + exercise (n = 8). Primary outcomes were gestational weight gain (GWG), infant birth weight, complications at delivery and a composite outcomes score. Secondary outcomes included type of delivery, prematurity, small- for-gestational-age (SGA) or large-for-gestational-age (LGA) infants, macrosomia, Apgar score, insulin use, depression, respiratory quotient (RQ), resting metabolic rate (RMR) and middle-upper arm circumference (MUAC). GWG differed between intervention groups (LED median: 12.0 kg; VLED: 5.9 kg). No differences were noted in the type of delivery, infant birth weight, composite score, prevalence of prematurity, depression, RQ, Apgar score, MUAC, or insulin use among the four groups. Regarding components of the composite score, most infants (88.4%) were appropriate-for-gestational age (AGA) and born at a gestational age of 37-42 weeks (95.3%). With respect to the mothers, 9.3% experienced complications at delivery, with the majority being allocated at the VLED + exercise arm (p < 0.03). The composite score was low (range 0-2.5) for all mother-infant pairs, indicating a "risk-free" pregnancy outcome. The results indicate that adherence to a LED or VLED induces similar maternal, infant and obstetrics outcomes.
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Affiliation(s)
- Efrosini Tsirou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
| | - Maria G. Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, GR-57400 Thessaloniki, Greece
| | - Meletios P. Nigdelis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
| | - Eleftheria Taousani
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
- Department of Midwifery, Faculty of Health Sciences, Alexander Campus, International Hellenic University, GR-57400 Thessaloniki, Greece
| | - Dimitra Savvaki
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
- School of Physical Education and Sports Science, Democritus University of Thrace, GR-69100 Komotini, Greece
| | - Efstratios Assimakopoulos
- 2nd Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, GR-54642 Thessaloniki, Greece;
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, GR-54642 Thessaloniki, Greece;
- Harris Manchester College, University of Oxford, Oxford OX1 3TD, UK
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (E.T.); (M.G.G.); (M.P.N.); (E.T.); (D.S.)
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Kajdy A, Feduniw S, Modzelewski J, Sys D, Filipecka-Tyczka D, Muzyka-Placzyńska K, Kiczmer P, Grabowski B, Rabijewski M. Growth Abnormalities as a Risk Factor of Adverse Neonatal Outcome in Hypertensive Pregnancies-A Single-Center Retrospective Cohort Study. CHILDREN-BASEL 2021; 8:children8060522. [PMID: 34205263 PMCID: PMC8234699 DOI: 10.3390/children8060522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
(1) Background: Hypertensive disorders of pregnancy (HDP) include gestational hypertension (GH), chronic hypertension (CH), preeclampsia (PE), and preeclampsia superimposed on chronic hypertension (CH with PE). HDP is associated with several short and long-term perinatal and neonatal complications, such as newborn growth restriction and death. This study aimed to establish the association between HDP, newborn growth abnormalities, and neonatal outcome. (2) Methods: This is a single-center retrospective cohort study of 63651 singleton deliveries. (3) Results: Univariate analysis showed a significantly increased risk of intrauterine and neonatal death associated with maternal hypertension and growth disorders. There were differences between growth charts used, with the highest risk of stillbirth for SGA defined by the Intergrowth chart (OR 17.2) and neonatal death for newborn growth restriction (NGR) based on Intergrowth (OR 19.1). Multivariate analysis showed that NGR is a stronger risk factor of neonatal death than SGA only. (4) Conclusions: HDP is significantly associated with growth abnormalities and is an independent risk factor of adverse outcomes. The presence of newborn growth restriction is strongly associated with the risk of neonatal death. The choice of growth chart has a substantial effect on the percentage of diagnosis of SGA and NGR.
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Affiliation(s)
- Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
- Correspondence: ; Tel.: +48-22-2559-918
| | - Stepan Feduniw
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Jan Modzelewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Dagmara Filipecka-Tyczka
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Katarzyna Muzyka-Placzyńska
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
| | - Paweł Kiczmer
- Department and Chair of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | | | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (S.F.); (J.M.); (D.S.); (D.F.-T.); (K.M.-P.); (M.R.)
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Bovbjerg ML. Current Resources for Evidence-Based Practice, July 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:485-495. [PMID: 34147485 DOI: 10.1016/j.jogn.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of how fetal monitoring may lead to overuse of birth-related interventions, commentaries on reviews focused on bedsharing, and women's lifetime estrogen exposure and risk of cardiovascular mortality.
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