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de Brun M, Magnuson A, Montgomery S, Patil S, Simmons D, Berntorp K, Jansson S, Wennerholm UB, Wikström AK, Strevens H, Ahlsson F, Sengpiel V, Schwarcz E, Storck-Lindholm E, Persson M, Petersson K, Ryen L, Ursing C, Hildén K, Backman H. Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: A stepped wedge cluster randomised trial. PLoS Med 2024; 21:e1004420. [PMID: 38976676 PMCID: PMC11262657 DOI: 10.1371/journal.pmed.1004420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 07/22/2024] [Accepted: 05/29/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The World Health Organisation (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) has been criticised due to the limited evidence of benefits on pregnancy outcomes in different populations when switching from previously higher glycemic thresholds to the lower WHO-2013 diagnostic criteria. The aim of this study was to determine whether the switch from previous Swedish (SWE-GDM) to the WHO-2013 GDM criteria in Sweden following risk factor-based screening improves pregnancy outcomes. METHODS AND FINDINGS A stepped wedge cluster randomised trial was performed between January 1 and December 31, 2018 in 11 clusters (17 delivery units) across Sweden, including all pregnancies under care and excluding preexisting diabetes, gastric bypass surgery, or multifetal pregnancies from the analysis. After implementation of uniform clinical and laboratory guidelines, a number of clusters were randomised to intervention (switch to WHO-2013 GDM criteria) each month from February to November 2018. The primary outcome was large for gestational age (LGA, defined as birth weight >90th percentile). Other secondary and prespecified outcomes included maternal and neonatal birth complications. Primary analysis was by modified intention to treat (mITT), excluding 3 clusters that were randomised before study start but were unable to implement the intervention. Prespecified subgroup analysis was undertaken among those discordant for the definition of GDM. Multilevel mixed regression models were used to compare outcome LGA between WHO-2013 and SWE-GDM groups adjusted for clusters, time periods, and potential confounders. Multiple imputation was used for missing potential confounding variables. In the mITT analysis, 47 080 pregnancies were included with 6 882 (14.6%) oral glucose tolerance tests (OGTTs) performed. The GDM prevalence increased from 595/22 797 (2.6%) to 1 591/24 283 (6.6%) after the intervention. In the mITT population, the switch was associated with no change in primary outcome LGA (2 790/24 209 (11.5%) versus 2 584/22 707 (11.4%)) producing an adjusted risk ratio (aRR) of 0.97 (95% confidence interval 0.91 to 1.02, p = 0.26). In the subgroup, the prevalence of LGA was 273/956 (28.8%) before and 278/1 239 (22.5%) after the switch, aRR 0.87 (95% CI 0.75 to 1.01, p = 0.076). No serious events were reported. Potential limitations of this trial are mainly due to the trial design, including failure to adhere to guidelines within and between the clusters and influences of unidentified temporal variations. CONCLUSIONS In this study, implementing the WHO-2013 criteria in Sweden with risk factor-based screening did not significantly reduce LGA prevalence defined as birth weight >90th percentile, in the total population, or in the subgroup discordant for the definition of GDM. Future studies are needed to evaluate the effects of treating different glucose thresholds during pregnancy in different populations, with different screening strategies and clinical management guidelines, to optimise women's and children's health in the short and long term. TRIAL REGISTRATION The trial is registered with ISRCTN (41918550).
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Affiliation(s)
- Maryam de Brun
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Snehal Patil
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - David Simmons
- School of Medical Science, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Macarthur Clinical School, Western Sydney University, Campbelltown, Australia
| | - Kerstin Berntorp
- Genetics and Diabetes Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Stefan Jansson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden
| | - Anna-Karin Wikström
- Department of Women’s and Children’s Health, Uppsala University; Uppsala University Hospital, Uppsala, Sweden
| | - Helen Strevens
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Fredrik Ahlsson
- Department of Women’s and Children’s Health, Uppsala University; Uppsala University Hospital, Uppsala, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden
| | - Erik Schwarcz
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Martina Persson
- Department of Clinical Science and Education Karolinska Institute, Department of Medicine, Clinical Epidemiology Karolinska Institutet and Sachsska Childrens’and Youth Hospital Stockholm, Stockholm, Sweden
| | - Kerstin Petersson
- Department of Obstetrics and Gynaecology Södersjukhuset, Umeå University, Umeå, Sweden
| | - Linda Ryen
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Carina Ursing
- Department of Endocrinology and Diabetology, Södersjukhuset, Stockholm, Sweden
| | - Karin Hildén
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Helena Backman
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Francis EC, Powe CE, Lowe WL, White SL, Scholtens DM, Yang J, Zhu Y, Zhang C, Hivert MF, Kwak SH, Sweeting A. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2023; 3:185. [PMID: 38110524 PMCID: PMC10728189 DOI: 10.1038/s43856-023-00393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. METHODS Systematic literature searches were performed in PubMed and EMBASE from inception to March 2022 for studies comparing perinatal outcomes among women with GDM. We searched for precision markers in the following categories: maternal anthropometrics, clinical/sociocultural factors, non-glycemic biochemical markers, genetics/genomics or other -omics, and fetal biometry. We conducted post-hoc meta-analyses of a subset of studies with data on the association of maternal body mass index (BMI, kg/m2) with offspring macrosomia or large-for-gestational age (LGA). RESULTS A total of 5905 titles/abstracts were screened, 775 full-texts reviewed, and 137 studies synthesized. Maternal anthropometrics were the most frequent risk marker. Meta-analysis demonstrated that women with GDM and overweight/obesity vs. GDM with normal range BMI are at higher risk of offspring macrosomia (13 studies [n = 28,763]; odds ratio [OR] 2.65; 95% Confidence Interval [CI] 1.91, 3.68), and LGA (10 studies [n = 20,070]; OR 2.23; 95% CI 2.00, 2.49). Lipids and insulin resistance/secretion indices were the most studied non-glycemic biochemical markers, with increased triglycerides and insulin resistance generally associated with greater risk of offspring macrosomia or LGA. Studies evaluating other markers had inconsistent findings as to whether they could be used as precision markers. CONCLUSIONS Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. Future studies examining non-glycemic biochemical, genetic, other -omic, or sociocultural precision markers among women with GDM are warranted.
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Affiliation(s)
- Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiaxi Yang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Walkowiak MJ, Jamka M, Walkowiak MP, Gutaj P, Wender-Ożegowska E. Seasonal Pattern in Gestational Diabetes Mellitus in Poland: A Retrospective Cohort Study. BIOLOGY 2023; 12:1376. [PMID: 37997974 PMCID: PMC10669897 DOI: 10.3390/biology12111376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023]
Abstract
The existing literature does not address the question of the seasonal impact on pregnancy in Central-Eastern Europe; therefore, this study was designed to investigate the seasonal variation in gestational diabetes mellitus (GDM) based on a recent Polish sample. The data of 30,205 newborns from singleton pregnancies and their mothers, including the date and gestational age of birth, neonatal sex and weight, maternal age and parity, mode of delivery, ethnicity, and a detailed list of comorbidities (including GDM), were retrospectively analysed. The prevalence of GDM was significantly (p < 0.0001) lower in spring (14.71%) than in the other seasons (16.78%). A higher incidence of GDM was observed for mothers who underwent an oral glucose tolerance test from June to August compared to those who were tested from December to February (17.34% vs. 14.75%, p < 0.0001). Similarly, there were significant differences between seasons with higher and lower insolation. The regression analysis revealed that seasonal patterns were significantly associated with the prevalence of GDM. In conclusion, this large retrospective cohort study demonstrated seasonal changes in GDM risk. The observed seasonal patterns may equally refer to mothers of babies born at term and prematurely. Further research concerning GDM risk and other seasonal and gender associations is warranted.
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Affiliation(s)
- Marek J. Walkowiak
- Department of Reproduction, Poznan University of Medical Sciences, Polna Str. 33, 60-535 Poznan, Poland;
| | - Małgorzata Jamka
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznan, Poland;
| | - Marcin Piotr Walkowiak
- Department of Preventive Medicine, Poznan University of Medical Sciences, Święcickiego Str. 6, 60-781 Poznan, Poland;
| | - Paweł Gutaj
- Department of Reproduction, Poznan University of Medical Sciences, Polna Str. 33, 60-535 Poznan, Poland;
| | - Ewa Wender-Ożegowska
- Department of Reproduction, Poznan University of Medical Sciences, Polna Str. 33, 60-535 Poznan, Poland;
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Teyton A, Sun Y, Molitor J, Chen JC, Sacks D, Avila C, Chiu V, Slezak J, Getahun D, Wu J, Benmarhnia T. Examining the Relationship Between Extreme Temperature, Microclimate Indicators, and Gestational Diabetes Mellitus in Pregnant Women Living in Southern California. Environ Epidemiol 2023; 7:e252. [PMID: 37304340 PMCID: PMC10256373 DOI: 10.1097/ee9.0000000000000252] [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: 11/07/2022] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Abstract
Few studies have assessed extreme temperatures' impact on gestational diabetes mellitus (GDM). We examined the relation between GDM risk with weekly exposure to extreme high and low temperatures during the first 24 weeks of gestation and assessed potential effect modification by microclimate indicators. Methods We utilized 2008-2018 data for pregnant women from Kaiser Permanente Southern California electronic health records. GDM screening occurred between 24 and 28 gestational weeks for most women using the Carpenter-Coustan criteria or the International Association of Diabetes and Pregnancy Study Groups criteria. Daily maximum, minimum, and mean temperature data were linked to participants' residential address. We utilized distributed lag models, which assessed the lag from the first to the corresponding week, with logistic regression models to examine the exposure-lag-response associations between the 12 weekly extreme temperature exposures and GDM risk. We used the relative risk due to interaction (RERI) to estimate the additive modification of microclimate indicators on the relation between extreme temperature and GDM risk. Results GDM risks increased with extreme low temperature during gestational weeks 20--24 and with extreme high temperature at weeks 11-16. Microclimate indicators modified the influence of extreme temperatures on GDM risk. For example, there were positive RERIs for high-temperature extremes and less greenness, and a negative RERI for low-temperature extremes and increased impervious surface percentage. Discussion Susceptibility windows to extreme temperatures during pregnancy were observed. Modifiable microclimate indicators were identified that may attenuate temperature exposures during these windows, which could in turn reduce the health burden from GDM.
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Affiliation(s)
- Anais Teyton
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
- School of Public Health, San Diego State University, La Jolla, California
| | - Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, California
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Jiu-Chiuan Chen
- Departments of Population & Public Health Sciences and Neurology, University of Southern California, Los Angeles, California
| | - David Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, California
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California
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Stalheim AM, Iversen MM, Jenum AK, Sletner L, Stafne SN, Qvigstad E, Sagedal L, Nilsen RM, Aasheim V, Strandberg RB. Seasonal variation in gestational diabetes mellitus among women in Norway: a national population-based study. BMJ Open 2023; 13:e063725. [PMID: 36918247 PMCID: PMC10016255 DOI: 10.1136/bmjopen-2022-063725] [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] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES Previous research on seasonal variation in the incidence of gestational diabetes mellitus (GDM) has shown inconclusive results. Furthermore, little is known about whether a seasonal variation in GDM might be associated with the maternal country of birth. We examined whether there was seasonal variation in GDM incidence by the maternal country background. DESIGN National population-based registry study. SETTING AND PARTICIPANTS We used national population-based data from the Medical Birth Registry of Norway (MBRN), n=1 443 857 (1990-2016) and data from four merged community-based studies (4GDM) with universal screening for GDM, n=2 978 (2002-2013). OUTCOME MEASURES The association between season of pregnancy onset with incidence of GDM was examined separately in both datasets using logistic regression analyses, stratified by the mother's country background using two broad geographical categories (MBRN: Norwegian and immigrant; 4GDM: European and African/Asian ethnicity). Winter season was used as reference category. RESULTS The incidence of GDM in MBRN was highest when the pregnancy started during the winter (Norwegian-born: 1.21%; immigrants: 3.32%) and lowest when pregnancy started during the summer for both Norwegian and immigrant women (Norwegian-born: 1.03% (OR 0.85, 95% CI 0.81 to 0.98); immigrants: 2.99% (OR 0.90, 95% CI 0.84 to 0.96)). The 4GDM data showed that women with European ancestry had the highest incidence of GDM when pregnancy started during autumn (10.7%, OR 1.01, 95% CI 0.69 to 1.46) and winter (10.6%), while ethnic African and Asian women had the highest incidence when pregnancy onset was during the summer (15.3%, OR 1.17, 95% CI 0.54 to 2.53). CONCLUSIONS Based on national population-based data, this study suggests that GDM incidence varies by season in both Norwegian-born and immigrant women. The 4GDM dataset did not show a clear seasonal variation in GDM incidence, possibly due to the relatively small sample. Causes for the seasonal variation in GDM should be explored further.
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Affiliation(s)
- Astrid Melteig Stalheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | | | - Anne Karen Jenum
- Department of General Practice, General Practice Unit (AFE), Insitute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Line Sletner
- Department for Paediatric and Adolescent Medicine, Akershus University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Signe N Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Sagedal
- Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway
| | - Roy Miodini Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Vigdis Aasheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Eberle C, Stichling S. Environmental health influences in pregnancy and risk of gestational diabetes mellitus: a systematic review. BMC Public Health 2022; 22:1572. [PMID: 35982427 PMCID: PMC9389831 DOI: 10.1186/s12889-022-13965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications globally. Environmental risk factors may lead to increased glucose levels and GDM, which in turn may affect not only the health of the mother but assuming hypotheses of "fetal programming", also the health of the offspring. In addition to traditional GDM risk factors, the evidence is growing that environmental influences might affect the development of GDM. We conducted a systematic review analyzing the association between several environmental health risk factors in pregnancy, including climate factors, chemicals and metals, and GDM. Methods We performed a systematic literature search in Medline (PubMed), EMBASE, CINAHL, Cochrane Library and Web of Science Core Collection databases for research articles published until March 2021. Epidemiological human and animal model studies that examined GDM as an outcome and / or glycemic outcomes and at least one environmental risk factor for GDM were included. Results Of n = 91 studies, we classified n = 28 air pollution, n = 18 persistent organic pollutants (POP), n = 11 arsenic, n = 9 phthalate n = 8 bisphenol A (BPA), n = 8 seasonality, n = 6 cadmium and n = 5 ambient temperature studies. In total, we identified two animal model studies. Whilst we found clear evidence for an association between GDM and air pollution, ambient temperature, season, cadmium, arsenic, POPs and phthalates, the findings regarding phenols were rather inconsistent. There were clear associations between adverse glycemic outcomes and air pollution, ambient temperature, season, POPs, phenols, and phthalates. Findings regarding cadmium and arsenic were heterogeneous (n = 2 publications in each case). Conclusions Environmental risk factors are important to consider in the management and prevention of GDM. In view of mechanisms of fetal programming, the environmental risk factors investigated may impair the health of mother and offspring in the short and long term. Further research is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13965-5.
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Affiliation(s)
- Claudia Eberle
- Medicine With Specialization in Internal Medicine and General Medicine, Hochschule Fulda, University of Applied Sciences, Leipziger Strasse 123, 36037, Fulda, Germany.
| | - Stefanie Stichling
- Medicine With Specialization in Internal Medicine and General Medicine, Hochschule Fulda, University of Applied Sciences, Leipziger Strasse 123, 36037, Fulda, Germany
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Dalugoda Y, Kuppa J, Phung H, Rutherford S, Phung D. Effect of Elevated Ambient Temperature on Maternal, Foetal, and Neonatal Outcomes: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031771. [PMID: 35162797 PMCID: PMC8835067 DOI: 10.3390/ijerph19031771] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 02/06/2023]
Abstract
This scoping review provides an overview of the published literature, identifies research gaps, and summarises the current evidence of the association between elevated ambient temperature exposure during pregnancy and adverse maternal, foetal, and neonatal outcomes. Following the PRISMA extension for scoping reviews reporting guidelines, a systematic search was conducted on CINAHL, PubMed, and Embase and included original articles published in the English language from 2015 to 2020 with no geographical limitations. A total of seventy-five studies were included, conducted across twenty-four countries, with a majority in the USA (n = 23) and China (n = 13). Study designs, temperature metrics, and exposure windows varied considerably across studies. Of the eighteen heat-associated adverse maternal, foetal, and neonatal outcomes identified, pre-term birth was the most common outcome (n = 30), followed by low birth weight (n = 11), stillbirth (n = 9), and gestational diabetes mellitus (n = 8). Overall, papers reported an increased risk with elevated temperature exposures. Less attention has been paid to relationships between heat and the diverse range of other adverse outcomes such as congenital anomalies and neonatal mortality. Further research on these less-reported outcomes is needed to improve understanding and the effect size of these relationships with elevated temperatures, which we know will be exacerbated by climate change.
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Affiliation(s)
- Yohani Dalugoda
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia; (J.K.); (H.P.); (S.R.)
- Correspondence:
| | - Jyothi Kuppa
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia; (J.K.); (H.P.); (S.R.)
| | - Hai Phung
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia; (J.K.); (H.P.); (S.R.)
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia; (J.K.); (H.P.); (S.R.)
| | - Dung Phung
- School of Public Health, The University of Queensland, Brisbane, QLD 4006, Australia;
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Khoshhali M, Ebrahimpour K, Shoshtari-Yeganeh B, Kelishadi R. Systematic review and meta-analysis on the association between seasonal variation and gestational diabetes mellitus. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:55915-55924. [PMID: 34490580 DOI: 10.1007/s11356-021-16230-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
Recently, there is growing evidence that ambient temperature and seasonal changes are related to the incidence of gestational diabetes mellitus (GDM). Thereby, this study was conducted to evaluate the association between seasonal changes and ambient temperature and GDM. We conducted a systematic search in PubMed, ISI Web of Science, Scopus, Google Scholar, and Cochrane Collaboration for human studies available until the end of 2020. We used the following keywords to identify relevant articles: "Diabetes, Gestational" (MeSH), "Glucose Tolerance Test" (MeSH), "Glucose intolerance" (MeSH), "Pregnancy outcome" (MeSH), "Birth outcome", "Seasons" (MeSH), "Weather" (MeSH), "Ambient Temperature," "Climate Change" (MeSH). Meta-analyses by using STATA software were conducted for analyzing data. Due to the high heterogeneity between included studies, a random-effects model was used. Subgroup analysis, meta-regression, and sensitivity analysis were used to define a source of heterogeneity. We found 13 studies related to the association between ambient temperature and season changes and GDM, which 11 of them were included in meta-analyses. Despite inconsistencies in outcome assessment across studies, we found a significant positive association between seasons of GDM screening and risk of GDM (pooled OR=1.12; 95% CI (1.03, 1.21)). The funnel plot and Egger's test showed that there was no significant publication bias among these studies (p=0.51). In general, season changes showed a significant positive relationship with prevalence of GDM. However, due to the unknown exact mechanism on this association, further studies should be conducted.
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Affiliation(s)
- Mehri Khoshhali
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Ebrahimpour
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahareh Shoshtari-Yeganeh
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Fox RA, Patient CJ, Aiken AR, Meek CL, Aiken CE. Temporal variations in maternal treatment requirements and early neonatal outcomes in patients with gestational diabetes. Diabet Med 2021; 38:e14596. [PMID: 33963609 PMCID: PMC10782837 DOI: 10.1111/dme.14596] [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: 03/27/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Abstract
AIMS There is seasonal variation in the incidence of gestational diabetes (GDM) and delivery outcomes of affected patients. We assessed whether there was also evidence of temporal variation in maternal treatment requirements and early neonatal outcomes. METHODS We performed a retrospective analysis of women diagnosed with GDM (75 g oral glucose tolerance test, 0 h ≥ 5.1; 1 h ≥ 10.0; 2 h ≥ 8.5 mmol/L) in a UK tertiary obstetric centre (2015-2019) with a singleton infant. Data regarding demographic characteristics, total insulin requirements and neonatal outcomes were extracted from contemporaneous electronic medical records. Linear/logistic regression models using month of the year as a predictor of outcomes were used to assess annual variation. RESULTS In all, 791 women (50.6% receiving pharmacological treatment) and 790 neonates were included. The likelihood of requiring insulin treatment was highest in November (p < 0.05). The average total daily insulin dose was higher at peak (January) compared to average by 19 units/day (p < 0.05). There was no temporal variation in neonatal intensive care admission, or neonatal capillary blood glucose. However, rates of neonatal hypoglycaemia (defined as <2.6 mmol/L) were highest in December (40% above average; p < 0.05). CONCLUSIONS Women with GDM diagnosed in winter are more likely to require insulin treatment and to require higher insulin doses. Neonates born to winter-diagnosed mothers had a corresponding increased risk of neonatal hypoglycaemia. Maternal treatment requirements and neonatal outcomes of GDM vary significantly throughout the year, even in a relatively temperate climate.
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Affiliation(s)
- Rachel A. Fox
- School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - Charlotte J. Patient
- School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
- Department of Obstetrics and Gynaecology, Rosie Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Abigail R. Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, USA
| | - Claire L. Meek
- Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
- Department of Clinical Biochemistry, Cambridge University Hospitals, Addenbrooke’s Hospital, Cambridge, UK
- Wolfson Diabetes and Endocrinology Clinic, Cambridge University Hospitals, Addenbrooke’s Hospital, Cambridge, UK
| | - Catherine E. Aiken
- School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
- Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
- University Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
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Kleinwechter H, Demandt N, Nolte A. Prädisposition/Phänotypen des Gestationsdiabetes mellitus. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1217-2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Jing L, Dan Z, Huiqun W, Yanping L, Yang L, Xuan Y, Mengmou Z, Didong L. Mediating effects of body composition at the first trimester on the occurrence of GDM at the early stage of the third trimester during the advanced maternal age. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-020-00845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Meek CL, Lindsay RS, Scott EM, Aiken CE, Myers J, Reynolds RM, Simmons D, Yamamoto JM, McCance DR, Murphy HR. Approaches to screening for hyperglycaemia in pregnant women during and after the COVID-19 pandemic. Diabet Med 2021; 38:e14380. [PMID: 32750184 PMCID: PMC7436759 DOI: 10.1111/dme.14380] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/12/2020] [Accepted: 07/27/2020] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA1c , during the COVID-19 pandemic. METHODS Retrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004-2008; 826 consecutive gestational diabetes pregnancies, 2014-2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large-for-gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver-operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA1c performance. RESULTS Gestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver-operating characteristic curve for both criteria 0.81 (95% CI 0.79-0.83)], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver-operating characteristic curve 0.75 (95% CI 0.65-0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver-operating characteristic curve 0.92 (95% CI 0.85-0.98)] and HbA1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75-0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77-0.91)]. Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2-5.4 mmol/l (sensitivity 18-41%; specificity 97-98%). CONCLUSIONS Random plasma glucose at 12 weeks, and fasting plasma glucose or HbA1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available.
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Affiliation(s)
- C. L. Meek
- Wellcome Trust‐MRC Institute of Metabolic ScienceMetabolic Research LaboratoriesUniversity of CambridgeCambridgeUK
- Diabetes in Pregnancy TeamCambridge University HospitalsCambridgeUK
- Department of Clinical BiochemistryCambridge University HospitalsAddenbrookes’s HospitalCambridgeUK
| | - R. S. Lindsay
- Institute of Cardiovascular and Medical SciencesBritish Heart Foundation Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - E. M. Scott
- Department of Population and Clinical SciencesLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - C. E. Aiken
- Wellcome Trust‐MRC Institute of Metabolic ScienceMetabolic Research LaboratoriesUniversity of CambridgeCambridgeUK
- Diabetes in Pregnancy TeamCambridge University HospitalsCambridgeUK
| | - J. Myers
- Maternal and Fetal Health Research CentreUniversity of ManchesterSt Mary's HospitalManchesterUK
| | - R. M. Reynolds
- Centre for Cardiovascular ScienceQueen's Medical Research InstituteEdinburghUK
| | - D. Simmons
- School of MedicineWestern Sydney UniversityCampbelltownNSWAustralia
| | - J. M. Yamamoto
- Departments of Medicine and Obstetrics and GynaecologyUniversity of CalgaryCalgaryCanada
| | - D. R. McCance
- Regional Centre for Endocrinology and DiabetesBelfastUK
| | - H. R. Murphy
- Diabetes in Pregnancy TeamCambridge University HospitalsCambridgeUK
- Norwich Medical SchoolBob Champion Research and Education BuildingUniversity of East AngliaNorwichUK
- Division of Women’s HealthKings College LondonLondonUK
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13
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Kleinwechter H. Änderung der GDM-Diagnostik für die Dauer der SARS-CoV-2-Pandemie – wie viele Schwangere fallen durchs Netz? DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1287-3219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Kleinwechter H. Fallen Schwangere mit GDM während der SARS-CoV-2-Pandemie durchs Netz? INFO DIABETOLOGIE 2020. [PMCID: PMC7720441 DOI: 10.1007/s15034-020-2211-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Preston EV, Eberle C, Brown FM, James-Todd T. Climate factors and gestational diabetes mellitus risk - a systematic review. Environ Health 2020; 19:112. [PMID: 33168031 PMCID: PMC7653781 DOI: 10.1186/s12940-020-00668-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/15/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Current and projected increases in global temperatures and extreme climate events have led to heightened interest in the impact of climate factors (i.e. ambient temperature, season/seasonality, and humidity) on human health. There is growing evidence that climate factors may impact metabolic function, including insulin sensitivity. Gestational diabetes mellitus (GDM) is a common pregnancy complication, with an estimated global prevalence of up to 14%. While lifestyle and genetic risk factors for GDM are well established, environmental factors may also contribute to GDM risk. Previous reviews have summarized the growing evidence of environmental risk factors for GDM including endocrine disrupting chemicals and ambient air pollution. However, studies of the effects of climate factors on GDM risk have not been systematically evaluated. Therefore, we conducted a systematic review to summarize and evaluate the current literature on the associations of climate factors with GDM risk. METHODS We conducted systematic searches in PubMed and EMBASE databases for original research articles on associations of climate factors (i.e. ambient temperature, season/seasonality, and humidity) with GDM and/or related glycemic outcomes for all publication dates through September 20th, 2020. RESULTS Our search identified 16 articles on the associations of ambient temperature and/or season with GDM and maternal glycemic outcomes during pregnancy, which were included in this review. Despite inconsistencies in exposure and outcome assessment, we found consistent evidence of a seasonal effect on GDM risk, with higher prevalence of GDM and higher pregnancy glucose levels in summer months. We found suggestive evidence of an association between higher ambient temperature and elevated glucose levels from GDM screening tests. CONCLUSION Climate factors may be associated with GDM risk. However, further research is needed to evaluate these associations and to elucidate the specific mechanisms involved.
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Affiliation(s)
- Emma V. Preston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Building 1, Room 1411, 677 Huntington Ave, Boston, MA 02118 USA
| | - Claudia Eberle
- Medicine with specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
| | | | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Building 1, Room 1411, 677 Huntington Ave, Boston, MA 02118 USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
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Ikomi A, Mannan S, Simon G, Khan R, Smith S, Robbins J, Kavanagh U, Crone D. Diagnosis of gestational diabetes during the pandemic: what is the risk of falling through the net? Diabet Med 2020; 37:1782-1784. [PMID: 32585723 PMCID: PMC7362157 DOI: 10.1111/dme.14346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 12/26/2022]
Affiliation(s)
- A. Ikomi
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - S. Mannan
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - G. Simon
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - R. Khan
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - S. Smith
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - J. Robbins
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - U. Kavanagh
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - D. Crone
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
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