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Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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2
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Muñoz-Mayorga D, Tovar A, Díaz-Muñoz M, Morales T. Lactation attenuates pro-oxidant reactions in the maternal brain. Mol Cell Endocrinol 2023; 565:111888. [PMID: 36804275 DOI: 10.1016/j.mce.2023.111888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 01/28/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
Reactive oxygen species (ROS) are intimately linked to bioenergetics and redox biology, contributing to cellular functioning and physiological signaling, but also acting as toxic agents during oxidative stress. Hence, the balance between pro-oxidant reactions and the activity of antioxidant defenses sustains a basal oxidative status, controls the increase of redox signaling, and mediates potential pathological events during oxidative stress. Maternal experience, especially during nursing, requires high energetic demands and expenditure to ensure the well-being of the offspring. The mother must adapt from satisfying her own needs to additionally fulfilling those of her descendants. Oxidative stress has been proposed as one of the reproductive trade-off hallmarks. However, the oxidative shielding hypothesis has also been proposed in the context of reproduction. The reproductive experience induces a wide range of well-documented changes in the female brain, which potentially lead to protection against the enhanced oxidative activity. To date, the metabolic and cellular mechanisms that underlie lactation-induced neuroprotection against oxidants are unknown. The neuroendocrine changes in the brain of the lactating dam promote diminished propensity to excitotoxic brain injury and stress, as well as enhanced neuroprotection and plasticity. In addition to review studies on the oxidant balance due to motherhood, we included new data from our laboratory, addressing the importance of measuring pro-oxidant reactions in separated brain regions. The hippocampus of lactating rats exhibits lower levels of pro-oxidant reactions than that of virgin rats, supporting the oxidative shielding hypothesis in lactation.
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Affiliation(s)
- Daniel Muñoz-Mayorga
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Adriana Tovar
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Mauricio Díaz-Muñoz
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Teresa Morales
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico.
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3
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Markers of Cardiovascular Risk Associated with Pregnancy. Curr Cardiol Rep 2023; 25:77-87. [PMID: 36745273 DOI: 10.1007/s11886-022-01830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize the unique cardiovascular disease (CVD) risk factors encountered during pregnancy and to provide the reader with a framework for acquiring a comprehensive obstetric history during the cardiovascular (CV) assessment of women. RECENT FINDINGS Individuals with a history of pregnancies complicated by hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm delivery, low birth weight, and fetal growth restriction during pregnancy are at a higher risk of developing short- and long-term CV complications compared to those without adverse pregnancy outcomes (APOs). Women with a history of APOs can be at increased risk of CVD even after achieving normoglycemia and normal blood pressure control postpartum. Risk assessment and stratification in women must account for these APOs as recommended by the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the primary prevention of CVD. Early recognition, monitoring, and treatment of APOs are key to limiting CVD complications late in maternal life. Recognition of APOs as female-specific cardiovascular risk factors is critical for risk stratification for women and birthing persons. Further research is needed to understand the complex interplay between genetics, environmental, behavioral, and maternal vascular health, and the association between APOs and CVD risk.
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Pathirana MM, Ali A, Lassi ZS, Arstall MA, Roberts CT, Andraweera PH. Protective Influence of Breastfeeding on Cardiovascular Risk Factors in Women With Previous Gestational Diabetes Mellitus and Their Children: A Systematic Review and Meta-Analysis. J Hum Lact 2022; 38:501-512. [PMID: 34609211 DOI: 10.1177/08903344211034779] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is evidence that breastfeeding may provide protection against cardiovascular risk factors in mothers with a history of gestational diabetes mellitus and their children who were exposed in utero. RESEARCH AIM To perform a systematic review and meta-analysis of observational studies to ascertain the effects of breastfeeding on cardiovascular risk factors in women with previous gestational diabetes mellitus and their children exposed in utero. METHODS Studies assessing conventional cardiovascular risk factors in women with previous gestational diabetes mellitus and children exposed in utero stratified by breastfeeding/no breastfeeding or breastfed/not breastfed were included. Gestational diabetes mellitus was defined based on the International Association of Diabetes in Pregnancy Study Group definition or previous accepted definitions. Breastfeeding was defined as reported in each study. RESULTS The literature search yielded 260 titles, of which 17 studies were selected to be in the review. Women with previous gestational diabetes mellitus who did not breastfeed had higher blood glucose (SMD: 0.32, 95% CI [0.12, 0.53]) and a greater risk of developing Type 2 diabetes mellitus (RR: 2.08 95% CI [1.44, 3.00]) compared to women with no history. There were not enough studies to conduct a meta-analysis on the effects of breastfeeding on risk factors for cardiovascular disease among children exposed to gestational diabetes mellitus in utero. CONCLUSION Breastfeeding appears to be protective against cardiovascular risk factors among women who experience gestational diabetes mellitus.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Health Performance and Policy Research Unit, Basil Hetzel Institute, University of Adelaide, Woodville South, SA, Australia.,Adelaide G-TRAC Centre & CRE Frailty & Healthy Ageing Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Zohra S Lassi
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Margaret A Arstall
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Prabha H Andraweera
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
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Ren X, Jin J, Chen Y, Jin J. Research on the Effect of Nursing Methods for Gestational Diabetes Mellitus Based on Comprehensive Nursing Intervention. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2396658. [PMID: 35872957 PMCID: PMC9303124 DOI: 10.1155/2022/2396658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022]
Abstract
In order to explore the effective way of gestational diabetes care, this paper applies comprehensive nursing to gestational diabetes care. In terms of nursing intervention for pregnant women with gestational diabetes mellitus, combining the phased changes of pregnant women's physiological and psychological needs during pregnancy, this paper comprehensively implements health education, diet intervention, exercise intervention, pregnancy monitoring, psychological intervention, infection prevention, and perinatal monitoring and other nursing interventions in a selective and focused manner. This makes the intervention measures at each stage focused, intersecting, interpenetrating, and continuing to play a role, which can effectively improve the implementation effect of the intervention measures and better promote the effective improvement of pregnancy outcomes. In addition, this paper studies the effect of gestational diabetes care based on comprehensive nursing intervention through a controlled trial, and the study verifies that comprehensive nursing has a good effect in gestational diabetes care.
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Affiliation(s)
- Xueqiong Ren
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Jianing Jin
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Yaer Chen
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Jing Jin
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
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Rassie KL, Giri R, Melder A, Joham A, Mousa A, Teede HJ. Lactogenic hormones in relation to maternal metabolic health in pregnancy and postpartum: protocol for a systematic review. BMJ Open 2022; 12:e055257. [PMID: 35190436 PMCID: PMC8860010 DOI: 10.1136/bmjopen-2021-055257] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Maternal metabolic disease states (such as gestational and pregestational diabetes and maternal obesity) are reaching epidemic proportions worldwide and are associated with adverse maternal and fetal outcomes. Despite this, their aetiology remains incompletely understood. Lactogenic hormones, namely, human placental lactogen (hPL) and prolactin (PRL), play often overlooked roles in maternal metabolism and glucose homeostasis during pregnancy and (in the case of PRL) postpartum, and have clinical potential from a diagnostic and therapeutic perspective. This paper presents a protocol for a systematic review which will synthesise the available scientific evidence linking these two hormones to maternal and fetal metabolic conditions/outcomes. METHODS AND ANALYSIS MEDLINE (via OVID), CINAHL and Embase will be systematically searched for all original observational and interventional research articles, published prior to 8 July 2021, linking hPL and/or PRL levels (in pregnancy and/or up to 12 months postpartum) to key maternal metabolic conditions/outcomes (including pre-existing and gestational diabetes, markers of glucose/insulin metabolism, postpartum glucose status, weight change, obesity and polycystic ovary syndrome). Relevant fetal outcomes (birth weight and placental mass, macrosomia and growth restriction) will also be included. Two reviewers will assess articles for eligibility according to prespecified selection criteria, followed by full-text review, quality appraisal and data extraction. Where possible, meta-analysis will be performed; otherwise, a narrative synthesis of findings will be presented. ETHICS AND DISSEMINATION Formal ethical approval is not required as no primary data will be collected. The results will be published in a peer-reviewed journal and presented at conference meetings, and will be used to inform future research directions. PROSPERO REGISTRATION NUMBER CRD42021262771.
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Affiliation(s)
- Kate Louise Rassie
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
- Department of Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Rinky Giri
- Department of Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Angela Melder
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
- Department of Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
- Department of Diabetes, Monash Health, Clayton, Victoria, Australia
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Nicolaou V, Soepnel L, Huddle K, Klipstein-Grobusch K, Levitt NS, Norris SA. Cardiometabolic outcomes of women exposed to hyperglycaemia first detected in pregnancy at 3-6 years post-partum in an urban South African setting. PLoS One 2022; 17:e0263529. [PMID: 35139085 PMCID: PMC8827431 DOI: 10.1371/journal.pone.0263529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hyperglycaemia first detected during pregnancy(HFDP) has far-reaching maternal consequences beyond the pregnancy. Our study evaluated the cardiometabolic outcomes in women with prior HFDP versus women without HFDP 3-6 years post-partum in urban South Africa. DESIGN AND METHODS A prospective cohort study was performed of 103 black African women with prior HFDP and 101 without HFDP, 3-6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto. Index pregnancy data was obtained from medical records. Post-partum, participants were re-evaluated for anthropometric measurements, body composition utilizing dual energy X-ray absorptiometry(DXA) and biochemical analysis (two-hour 75gm OGTT fasting insulin, lipids, creatinine levels and glucose levels). Cardiovascular risk was assessed by Framingham risk score(FRS). Carotid intima media thickness(cIMT) was used as a surrogate marker for subclinical atherosclerosis. Factors associated with progression to cardiometabolic outcomes were assessed using multivariable logistic and linear regression models. RESULTS Forty-six(45.1%) HFDP women progressed to diabetes compared to 5(4.9%) in non HFDP group(p<0.001); only 20(43.4%) were aware of their diabetic status in the whole group. The odds(OR, 95% confidence interval(CI)) of progressing to type 2 diabetes(T2DM) and metabolic syndrome(MetS) after correcting for confounders in the HFDP group was 10.5(95% CI 3.7-29.5) and 6.3(95%CI 2.2-18.1), respectively. All visceral fat indices were found to be significantly higher in the HFDP group after adjusting for baseline body mass index. Ten-year estimated cardiovascular risk(FRS) and mean cIMT was statistically higher in the HFDP group(8.46 IQR 4.9-14.4; 0.48 mm IQR 0.44-0.53 respectively) compared to the non-HFDP group(3.48 IQR 2.1-5.7; 0.46mm IQR 0.42-0.50) respectively and this remained significant for FRS but was attenuated for cIMT after correcting for confounders. HIV did not play a role in progression to any of these outcomes. CONCLUSION Women with a history of HFDP have a higher risk of cardiometabolic conditions within 6 years post-partum in an urban sub-Saharan African setting.
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Affiliation(s)
- Veronique Nicolaou
- Faculty of Health Sciences, SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Larske Soepnel
- Faculty of Health Sciences, SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kenneth Huddle
- Faculty of Health Sciences, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculty of Health Sciences, Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Naomi S. Levitt
- Faculty of Health Sciences, Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shane A. Norris
- Faculty of Health Sciences, SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
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8
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Cherubini KA, Schmidt MI, Vigo Á, Drehmer M. Breastfeeding rates and related factors at one year postpartum in women with gestational diabetes initially recruited for a diabetes prevention program. Can J Diabetes 2022; 46:441-448. [DOI: 10.1016/j.jcjd.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/02/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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9
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Rassie K, Giri R, Joham AE, Mousa A, Teede H. Prolactin in relation to gestational diabetes and metabolic risk in pregnancy and postpartum: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:1069625. [PMID: 36619539 PMCID: PMC9813437 DOI: 10.3389/fendo.2022.1069625] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Pre-clinical evidence suggests that prolactin has important metabolic functions in pregnancy and postpartum, in addition to lactogenic actions. OBJECTIVE To explore the relationship between prolactin and maternal metabolic outcomes in human pregnancy and postpartum, particularly in relation to gestational diabetes mellitus (GDM). DATA SOURCES MEDLINE via OVID, CINAHL plus, Embase. STUDY SELECTION Eligible studies included women who were pregnant or up to 12 months postpartum, reporting at least one maternal serum prolactin level in relation to key metabolic outcomes including GDM, glycaemic parameters, obesity, and gestational weight gain. DATA EXTRACTION Two independent reviewers extracted data. DATA SYNTHESIS Twenty-six articles were included. Meta-analysis showed no relationship between maternal prolactin levels and GDM status, with a weighted mean difference of -2.14 ng/mL (95% CI -12.54 to 8.27 ng/mL, p=0.7) between GDM and controls in early pregnancy (n=3 studies) and -3.89 ng/mL (95% CI, -15.20 to 7.41 ng/mL, p=0.5) in late pregnancy (n=11 studies). In narrative synthesis of other outcomes (due to study heterogeneity and/or lack of data), prolactin levels were not associated with maternal glycaemic or weight-related parameters during pregnancy, but in the postpartum period (particularly with lactation) a high-prolactin environment was associated with low circulating insulin and beta-cell function, and increased insulin sensitivity. CONCLUSIONS Current evidence from human studies does not clearly support a relationship between prolactin and metabolic parameters during pregnancy, including with GDM status. Elevated prolactin was associated with lower insulin and beta-cell function and higher insulin sensitivity in the post-partum period, but the direction of causality remains unclear. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier [CRD42021262771].
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Affiliation(s)
- Kate Rassie
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Departments of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Rinky Giri
- Departments of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Anju E. Joham
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Departments of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Departments of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia
- *Correspondence: Helena Teede,
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Rassie K, Mousa A, Joham A, Teede HJ. Metabolic Conditions Including Obesity, Diabetes, and Polycystic Ovary Syndrome: Implications for Breastfeeding and Breastmilk Composition. Semin Reprod Med 2021; 39:111-132. [PMID: 34433215 DOI: 10.1055/s-0041-1732365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Breastfeeding is internationally recognized as the recommended standard for infant nutrition, informed by evidence of its multiple benefits for both mother and baby. In the context of common metabolic conditions such as polycystic ovary syndrome, diabetes (type 1, type 2, and gestational), and obesity, breastfeeding may be particularly beneficial for both mother and infant. However, there is evidence of delayed lactogenesis and reduced breastfeeding rates and duration in women with these conditions, and the effects of altered maternal metabolic environments on breastmilk composition (and potentially infant outcomes) are incompletely understood. In this review, we explore the relationships between maternal metabolic conditions, lactogenesis, breastfeeding, and breastmilk composition. We examine relevant potential mechanisms, including the central role of insulin both in lactogenesis and as a milk-borne hormone. We also describe the bioactive and hormonal components of breastmilk and how these may link maternal and infant health.
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Affiliation(s)
- Kate Rassie
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Diabetes, Monash Health, Melbourne, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Diabetes, Monash Health, Melbourne, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Diabetes, Monash Health, Melbourne, Australia
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11
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Pinho-Gomes AC, Morelli G, Jones A, Woodward M. Association of lactation with maternal risk of type 2 diabetes: A systematic review and meta-analysis of observational studies. Diabetes Obes Metab 2021; 23:1902-1916. [PMID: 33908692 DOI: 10.1111/dom.14417] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
AIM To investigate the association between lactation and maternal risk of type 2 diabetes, including a potential graded association according to lactation duration. METHODS A systematic review and meta-analysis of observational studies that investigated the reported association between lactation (irrespective of duration, intensity or mode) and maternal risk of type 2 diabetes was conducted. RESULTS A total of 22 studies (17 cohort studies and five cross-sectional studies) were included in this systematic review, and 16 contributed to the meta-analysis. Studies that investigated the association of lactation with risk of type 2 diabetes in the first months after birth in women with gestational diabetes reported conflicting results. Studies with a longer follow-up showed a graded protective association for lactation and the risk of type 2 diabetes, with a potentially larger risk reduction in women with gestational diabetes than in those without gestational diabetes. Overall, ever versus never lactation was associated with a 27% lower risk of type 2 diabetes (RR 0.73, 95% CI [0.65, 0.83]). Each additional month of lactation was associated with a 1% lower risk of type 2 diabetes (RR 0.99, 95% CI [0.98, 0.99]). However, the overall quality of the studies was modest. CONCLUSIONS Lactation is associated with a significantly reduced risk of maternal type 2 diabetes over the life course, particularly in women with gestational diabetes. The protective effect seems to increase with longer duration of lactation. Further research is warranted to understand whether this association is modified by exposure to other risk factors.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- King's College London, London, UK
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgia Morelli
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Welch Center for Epidemiology, Prevention and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
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Trigo S, Gonzalez K, Valiquette N, Verma S. Creating a Lactation-Friendly Learning Environment for Medical Students and Residents: A Northern Canadian Perspective. Breastfeed Med 2021; 16:511-515. [PMID: 33728982 DOI: 10.1089/bfm.2020.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Lactation is a normal postpartum physiological process that can continue in excess of 3 years and is often the sole nutritional source for infants in the first 6 months of life. Breastfeeding not only provides infant nutrition, but also facilitates maternal-infantile bonding. Lactating mothers separated from their children face multiple challenges in finding and accessing appropriate spaces and time for milk expression. Maternal employment is a great barrier to breastfeeding and accordingly has led to multiple advancements in the area of breastfeeding policy. One example of a policy is the Baby-Friendly Initiative. This initiative focused on breastfeeding promotion, support, and protection. However, the impact of such campaigns on lactating medical students and residents is thought to be low. Furthermore, breastfeeding rates differ vastly according to geographic locations in North America. Trends indicate decreased rates of breastfeeding in northern rural areas in comparison with southern urban counterparts. This highlights the need for increased protection, support, and creation of safe-lactation spaces for all working mothers including medical students and residents, and especially those in rural areas. Goals: To review challenges of breastfeeding as a medical trainee and delineate the creation of a lactation policy for medical learners and residents. Methodology: We conducted a literature review of breastfeeding policy and experiences of breastfeeding while in the learning environment. Results: Challenges of breastfeeding in medical school and residency include the complex, high-paced medical working environment where taking breaks or time off is often difficult. Few medical schools across North America have any breastfeeding policy. Conclusion: The Northern Ontario School of Medicine's lactation policy serves as a possible solution to the barriers medical students and residents face when breastfeeding in the academic environment. This policy creates lactation-friendly medical learning spaces through the entitlement of dedicated space and time for milk expression.
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Affiliation(s)
- Sabrina Trigo
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Kaitlin Gonzalez
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | | | - Sarita Verma
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Rhodes EC, Damio G, LaPlant HW, Trymbulak W, Crummett C, Surprenant R, Pérez-Escamilla R. Promoting equity in breastfeeding through peer counseling: the US Breastfeeding Heritage and Pride program. Int J Equity Health 2021; 20:128. [PMID: 34044816 PMCID: PMC8161979 DOI: 10.1186/s12939-021-01408-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United States, Black and Hispanic mothers have lower breastfeeding rates compared with White mothers. To address breastfeeding inequities, the Breastfeeding Heritage and Pride program (BHP) provides breastfeeding support for predominately low-income minority mothers in Connecticut and Massachusetts. We described the process of designing BHP, the program model, and its impact on breastfeeding outcomes. METHODS This BHP case study is based on in-depth interviews with BHP designers and implementers, peer counselors, and clients; a literature review of BHP impact evaluation studies; and a review of BHP materials. To guide the analysis and organize results, we used the Community Energy Balance Framework, an equity-oriented, multi-level framework for fostering healthy lifestyles. RESULTS The Hispanic Health Council designed BHP to address barriers to breastfeeding identified through formative qualitative research with the Latino community, namely lack of role models, limited social support, embarrassment when breastfeeding in public, lack of breastfeeding knowledge, and a norm of formula feeding. According to the BHP model, clients receive education and support through in-person home and hospital visits supplemented by phone calls, beginning prenatally and continuing through one year postpartum. Counseling is delivered by peer counselors, women who have successfully breastfed, have similar cultural roots and life experiences as the clients they serve, and have completed intensive training on lactation management and communication skills. International Board Certified Lactation Consultants provide clinical guidance and ongoing training to peer counselors, as well as direct support to clients, if more specialized knowledge and clinical expertise is needed. Clients facing housing and food insecurity or other socio-economic obstacles that may negatively influence breastfeeding and health and well-being more broadly are connected to other health and social services needed to address their social determinants of health needs, including health care access and food and rent assistance programs. To continuously improve service delivery, BHP has a robust monitoring and evaluation system. In two randomized-controlled trials, BHP was shown to improve breastfeeding initiation and duration of any and exclusive breastfeeding. CONCLUSIONS BHP highlights the importance of community-engaged formative research for informing breastfeeding program design. It also provides an evidence-based example of a program model that offers a continuum of breastfeeding support, considers cultural-contextual influences on breastfeeding and social determinants of health, and incorporates continuous quality improvement.
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Affiliation(s)
- Elizabeth C Rhodes
- Yale School of Medicine, 333 Cedar Street, 06510, New Haven, Connecticut, USA.
- Yale School of Public Health, 135 College Street, 06510, New Haven, Connecticut, USA.
| | - Grace Damio
- Hispanic Health Council, 175 Main Street, 06106, Hartford, Connecticut, USA
| | | | - Walter Trymbulak
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, 06105, Hartford, Connecticut, USA
| | - Carrianne Crummett
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, 06105, Hartford, Connecticut, USA
| | - Rebecca Surprenant
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, 06105, Hartford, Connecticut, USA
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Hung T, Chuang Y, Chu F, Huang L, Shaw SW, Hsieh T, Chen S. Risk factors for abnormal postpartum glycemic states in women diagnosed with gestational diabetes by the International Association of Diabetes and Pregnancy Study Groups criteria. J Diabetes Investig 2021; 12:859-868. [PMID: 32916029 PMCID: PMC8089005 DOI: 10.1111/jdi.13400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION To evaluate the rate of postpartum glycemic screening tests (PGST) in women with gestational diabetes mellitus (GDM), and to investigate risk factors for abnormal PGST results. MATERIALS AND METHODS We retrospectively analyzed the obstetric data of 1,648 women with GDM who gave birth after 28 completed weeks of gestation between 1 July 2011 and 31 December 2019 at Taipei Chang Gung Memorial Hospital, Taiwan. GDM was diagnosed by the International Association of Diabetes and Pregnancy Study Groups criteria. PGST was carried out at 6-12 weeks postpartum with a 75-g, 2-h oral glucose tolerance test, and the results were classified into normal, prediabetes and diabetes mellitus. Multiple logistic regression was used to assess the associations between various risk factors and abnormal PGST results. RESULTS In total, 493 (29.9%) women underwent PGST and 162 (32.9%) had abnormal results, including 135 (27.4%) with prediabetes and 27 (5.5%) with diabetes mellitus. Significant risk factors for postpartum diabetes mellitus included insulin therapy during pregnancy (adjusted odds ratio [OR] 10.79, 95% confidence interval [CI] 4.07-28.58), birthweight >4,000 g (adjusted OR 10.22, 95% CI 1.74-59.89) and preterm birth <37 weeks' gestation (adjusted OR 3.33, 95% CI 1.09-10.22); whereas prepregnancy body mass index >24.9 kg/m2 (adjusted OR 1.99, 95% CI 1.24-3.21) was the major risk factor for postpartum prediabetes. CONCLUSIONS Less than one-third of women with GDM underwent PGST, and nearly one-third of these women had abnormal results. Future efforts should focus on reducing the barriers to PGST in women with GDM.
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Affiliation(s)
- Tai‐Ho Hung
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
- Department of MedicineCollege of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Obstetrics and GynecologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Ya‐Chun Chuang
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
| | - Fu‐Chieh Chu
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
| | - Lulu Huang
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
| | - Steven W Shaw
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
- Department of MedicineCollege of MedicineChang Gung UniversityTaoyuanTaiwan
| | - T’sang‐T’ang Hsieh
- Department of Obstetrics and GynecologyTaipei Chang Gung Memorial HospitalTaipeiTaiwan
| | - Szu‐Fu Chen
- Department of Physical Medicine and RehabilitationCheng Hsin General HospitalTaipeiTaiwan
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15
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Kole-White MB, Griffin L, Ding JJ, Ayala NK, Has P, Werner EF. Breastfeeding Success Among Women with Gestational Diabetes Managed by Diet Only Compared with Those Requiring Medications. Breastfeed Med 2021; 16:419-423. [PMID: 33999695 DOI: 10.1089/bfm.2020.0321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Breastfeeding is known to have a positive impact on maternal and neonatal health. Some have suggested that gestational diabetes mellitus (GDM) is associated with lower breastfeeding rates, but it is not known whether rates are further impacted by glucose control in pregnancy. Thus, we examined whether patients with GDM requiring medication (A2 GDM) were more likely to not initiate or discontinue breastfeeding compared with patients with GDM well controlled by diet (A1 GDM). Research Design and Methods: This is a secondary analysis of a prospective cohort study of 600 patients with GDM. Eligible patients were enrolled during their delivery hospitalization and followed prospectively postpartum. The primary outcome was exclusive breastfeeding at hospital discharge and secondary outcomes included breastfeeding rates at 3 months postpartum. Patients classified as A2 GDM were compared with those classified as A1 GDM. Results: Of the 600 patients enrolled, 301 had A2 GDM and 299 had A1 GDM. Patients who needed medication were observed to be older and more likely to be parous and obese. There were no significant differences in labor outcomes or neonatal complications. After adjusting for baseline differences between the two groups, adjusted odds ratios (aORs) for exclusive breastfeeding rates were similar in mothers with A2 GDM compared with those with A1 GDM at hospital discharge (aOR 0.83 [0.54-1.28]) and 3 months postpartum (aOR 0.58 [0.34-1.01]). Additionally, any breastfeeding rates were similar in mothers with A2 GDM compared with those with A1 GDM, both at hospital discharge (aOR 0.72 [0.44-1.16]) and 3 months postpartum (aOR 0.63 [0.34-1.17]). Conclusions: After adjusting for baseline differences, there was no difference in any or exclusive breastfeeding rates at hospital discharge or 3 months postpartum among patients with A2 GDM compared with those with A1 GDM.
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Affiliation(s)
- Martha B Kole-White
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laurie Griffin
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jia Jennifer Ding
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Phinnara Has
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Erika F Werner
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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16
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Hedeager Momsen AM, Høtoft D, Ørtenblad L, Friis Lauszus F, Krogh RHA, Lynggaard V, Juel Christiansen J, Terkildsen Maindal H, Vinther Nielsen C. Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00230. [PMID: 34277958 PMCID: PMC8279604 DOI: 10.1002/edm2.230] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Aims To present an overview of reviews of interventions for the prevention of diabetes in women after gestational diabetes mellitus (GDM) with the overall aim of gaining information in order to establish local interventions. Methods Six databases were searched for quantitative, qualitative or mixed‐methods systematic reviews. All types of interventions or screening programmes were eligible. The outcomes were effectiveness of reducing diabetes incidence, encouraging healthy behavioural changes and enhancing women's perceptions of their increased risks of developing type 2 diabetes following GDM. Results Eighteen reviews were included: three on screening programmes and seven on participation and risk perceptions. Interventions promoting physical activity, healthy diet, breastfeeding and antidiabetic medicine reported significantly decreased incidence of postpartum diabetes, up to 34% reduction after any breastfeeding compared to none. Effects were larger if the intervention began early after birth and lasted longer. Participation in screening rose up to 40% with face‐to‐face recruitment in a GDM healthcare setting. Interventions were mainly based in healthcare settings and involved up to nine health professions, councillors and peer educators, mostly dieticians. Women reported a lack of postpartum care and demonstrated a low knowledge of risk factors for developing type 2 diabetes. Typical barriers to participation were lack of awareness of increased risk and low levels of support from family. Conclusions Lifestyle interventions or pharmacological treatment postpartum was effective in decreasing diabetes incidence following GDM. Women's knowledge of the risk of diabetes and importance of physical activity was insufficient. Early face‐to‐face recruitment increased participation in screening. Programmes aimed at women following a diagnosis of GDM ought to provide professional and social support, promote screening, breastfeeding, knowledge of risk factors, be long‐lasting and offered early after birth, preferably by face‐to‐face recruitment.
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Herning Denmark.,DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark
| | - Diana Høtoft
- DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark
| | - Lisbeth Ørtenblad
- DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
| | - Finn Friis Lauszus
- Department of Gynaecology and Obstetrics Gødstrup Hospital Gødstrup Denmark
| | | | - Vibeke Lynggaard
- Steno Partner Collaboration between Gødstrup Hospital and Steno Diabetes Center Aarhus Herning Denmark.,Cardiovascular Research Unit Department of Cardiology Gødstrup Hospital Herning Denmark
| | - Jens Juel Christiansen
- Steno Partner Collaboration between Gødstrup Hospital and Steno Diabetes Center Aarhus Herning Denmark.,Department of Medicine Gødstrup Hospital Herning Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health Aarhus University Aarhus Denmark.,Steno Diabetes Center Copenhagen Health Promotion Research Gentofte Denmark
| | - Claus Vinther Nielsen
- Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Herning Denmark.,DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
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17
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Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study. Nutrients 2021; 13:nu13020408. [PMID: 33525398 PMCID: PMC7912373 DOI: 10.3390/nu13020408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022] Open
Abstract
(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; p = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; p = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.
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18
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Tarrant M, Chooniedass R, Fan HSL, Del Buono K, Masina S. Breastfeeding and Postpartum Glucose Regulation Among Women With Prior Gestational Diabetes: A Systematic Review. J Hum Lact 2020; 36:723-738. [PMID: 32877291 DOI: 10.1177/0890334420950259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gestational diabetes mellitus is associated with adverse maternal and fetal outcomes and increases subsequent risk of Type 2 diabetes. Researchers have shown that breastfeeding may reduce diabetes risk in women with recent gestational diabetes. RESEARCH AIM To assess association between infant feeding and postpartum glucose tolerance in mothers with recent gestational diabetes within 1 year postpartum. METHODS A literature search was performed up to December 31, 2019, retrieving articles related to infant feeding, gestational diabetes, and postpartum glucose regulation in four major databases (PubMed, Cochrane, CINAHL, and Embase). Methodological quality was assessed using tools from the United States National Institutes of Health and the National Heart, Lung, and Blood Institute. RESULTS The search yielded 15 cohort studies meeting the selection criteria. Of the 15 studies, 13 (86.7%) examined the influence of breastfeeding on postpartum glycemic status, and eight (53.4%) compared the mean blood glucose values between breastfeeding and non-breastfeeding participants. Of the 13 studies that compared postpartum glycemic status, nine (60%) of the research teams found that breastfeeding lowered rates of impaired glucose tolerance, and four (26.7%) showed no significant change. In eight of the studies reporting mean blood glucose values, six (75%) reported significantly lower fasting plasma glucose in breastfeeding participants, with reductions ranging from 3.7 to 7.4 mg/dL (0.2-0.4 mmol/L). CONCLUSION Breastfeeding has been associated with improved postpartum glucose regulation in mothers with gestational diabetes. In pregnant women with gestational diabetes, breastfeeding may reduce the risk of Type 2 diabetes, and women with gestational diabetes should be strongly encouraged and supported to breastfeed.
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Affiliation(s)
- Marie Tarrant
- 8166 School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Rishma Chooniedass
- 8166 School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Heidi Sze Lok Fan
- 25809 School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Katie Del Buono
- 8166 School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Stephanie Masina
- 8166 School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
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19
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Harville EW, Bazzano L, Qi L, He J, Dorans K, Perng W, Kelly T. Branched-chain amino acids, history of gestational diabetes, and breastfeeding: The Bogalusa Heart Study. Nutr Metab Cardiovasc Dis 2020; 30:2077-2084. [PMID: 32819784 PMCID: PMC7606618 DOI: 10.1016/j.numecd.2020.06.015] [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: 01/06/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS To examine the associations between history of gestational diabetes mellitus (GDM) and breastfeeding with branched-chain amino acids (BCAA) and their metabolites in later life. METHODS AND RESULTS 638 women (mean age 48.0 y) who had participated in the Bogalusa Heart Study and substudies of pregnancy history had untargeted, ultrahigh performance liquid chromatography-tandem mass spectroscopy conducted by Metabolon© on serum samples. Metabolites were identified that were BCAA or associated with BCAA metabolic pathways. History of GDM at any pregnancy (self-reported, confirmed with medical records when possible) as well as breastfeeding were examined as predictors of BCAA using linear models, controlling for age, race, BMI, waist circumference, and menopausal status. None of the BCAA differed statistically by history of either GDM or breastfeeding, although absolute levels of each of the BCAA were higher with GDM and lower with breastfeeding. Of the 27 metabolites on the leucine, isoleucine and valine metabolism subpathway, 1-carboxyethylleucine, 1-carboxyethyvaline, and 3-hydroxy-2-ethylpropionate were higher in women with a history of GDM, but lower in women in women with a history of breastfeeding. Similar results were found for alpha-hydroxyisocaproate, 1-carboxyethylisoleucine, and N-acetylleucine. CONCLUSIONS GDM and breastfeeding are associated in opposite directions with several metabolites on the BCAA metabolic pathway.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Lydia Bazzano
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Lu Qi
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Jiang He
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Kirsten Dorans
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, Denver, CO, United States
| | - Tanika Kelly
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
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20
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Doan TTD, Binns C, Pham NM, Zhao Y, Dinh TPH, Bui TTH, Tran TC, Nguyen XH, Giglia R, Xu F, Lee A. Improving Breastfeeding by Empowering Mothers in Vietnam: A Randomised Controlled Trial of a Mobile App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5552. [PMID: 32752026 PMCID: PMC7432632 DOI: 10.3390/ijerph17155552] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
Abstract
Breastfeeding provides benefits to the infant and mother; however, the rates of breastfeeding, particularly exclusive breastfeeding, remain below optimal levels in many Asian countries. The aim of this study is to review the benefits of breastfeeding to mothers and infants and current rates of breastfeeding in Vietnam, and to evaluate the effectiveness of a mobile application on exclusive breastfeeding among mothers in Vietnam. A two-arm, parallel triple-blinded randomised controlled trial will be conducted among 1000 mothers in Hanoi City, Vietnam, during 2020-2021. Eligible participants are pregnant women who will seek antenatal care from health facilities at 24-36 weeks of gestation and plan to deliver at two participating hospitals, own a smartphone, and carry a singleton foetus. Permuted-block randomisation method stratified by maternal age, education and parity will be used to ensure an equal number of participants in each group. A smartphone app will be developed to deliver breastfeeding and non-breastfeeding information to the intervention and control group, respectively. Data will be collected at baseline, before hospital discharge, and at 1, 4, and 6 months postpartum. This study envisages demonstrating whether a smartphone-based intervention can be effective at improving breastfeeding in Vietnam. Trials registration: ACTRN12619000531112.
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Affiliation(s)
- Thi Thuy Duong Doan
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Colin Binns
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
| | - Ngoc Minh Pham
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
- Department of Epidemiology, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 250000, Vietnam
| | - Yun Zhao
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
| | - Thi Phuong Hoa Dinh
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Thi Thu Ha Bui
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Trung Chuyen Tran
- Faculty of Information Technology, Department of Hanoi University of Mining and Geology, 18 Vien Street-Bac Tu Liem District, Hanoi 10000, Vietnam;
| | - Xuan Hoai Nguyen
- Faculty of IT, Ho Chi Minh University of Technology (HUTECH), Ho Chi Minh 700000, Vietnam;
| | | | - Fenglian Xu
- Data Analysis & Surgical Outcomes Unit (DASO), Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
| | - Andy Lee
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
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21
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LaManna JB, Quelly SB. After Gestational Diabetes: An Overlooked Care Transition in Primary Care. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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22
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Pregnancy and the Postpartum Period as an Opportunity for Cardiovascular Risk Identification and Management. Obstet Gynecol 2020; 134:851-862. [PMID: 31503139 DOI: 10.1097/aog.0000000000003363] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women. Because women generally present with more atypical symptoms of CVD than do men and because underlying CVD risk factors are often present for years before the onset of CVD, it is important to use innovative ways to identify women who should undergo CVD risk screening at a younger age. Pregnancy and the postpartum period afford us that opportunity, given that the development of certain pregnancy complications (hypertensive disorders of pregnancy, gestational diabetes, preterm birth, delivery of a neonate with fetal growth restriction, and significant placental abruption) can reliably identify women with underlying, often unrecognized, CVD risk factors. Women with one or more of these pregnancy complications should be identified at the time of delivery and referred for regular follow-up. This would ideally take the form of a multidisciplinary clinic including clinicians and allied health specialists to carry out physical and biochemical screening and counseling regarding lifestyle modification and possible therapeutic interventions. Longer-term follow-up and recommendations should be individualized based on findings and risks. There is also an opportunity for future pregnancy counseling and discussion about the importance of weight loss between pregnancies, initiation of a routine involving physical activity, use of preconception folic acid, and the potential initiation of low-dose aspirin for those women at risk for future preeclampsia and fetal growth restriction or the use of progesterone for women at risk for preterm labor. The link between pregnancy complications and future CVD affords us with the earliest opportunity for CVD risk assessment for health preservation and disease prevention.
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Hewage SS, Wu S, Neelakantan N, Yoong J. Systematic review of effectiveness and cost-effectiveness of lifestyle interventions to improve clinical diabetes outcome measures in women with a history of GDM. Clin Nutr ESPEN 2019; 35:20-29. [PMID: 31987117 DOI: 10.1016/j.clnesp.2019.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/21/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Lifestyle interventions have been shown to be both effective and cost-effective in reducing diabetes and metabolic risk in high-risk populations. We systematically reviewed the effectiveness and cost-effectiveness of lifestyle interventions on anthropometric, glycemic and cardiovascular outcomes in women with previous gestational diabetes mellitus (GDM). METHOD Relevant randomized control trials (RCT) were identified by searching multiple electronic databases through 20th June 2018. Data were pooled using random-effects models. The review protocol was registered on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42018108870). RESULTS Twenty-one studies met the inclusion criteria and 16 studies with outcome data were analyzed in the meta-analysis. No RCT studies included cost-effectiveness data on lifestyle interventions. The pooled estimate for postpartum weight showed a significant mean reduction in the intervention arm (-1.8 kg [95% CI: -2.9, -0.6; p = 0.002; I2 = 92.2%; p < 0.05]). Further, the effect of lifestyle intervention on weight change was significantly greater in studies of longer duration. Most of the other endpoints had modest improvements but only anthropometric endpoints were statistically significant. However, there was high heterogeneity between the studies. CONCLUSIONS Lifestyle interventions showed statistically and clinically significant improvements in anthropometric outcomes. However, more research is needed to explore lifestyle effects on glycemic and cardiovascular risk factors and to establish cost-effectiveness. Methodologically sound, large scale studies on diverse ethnicities and with longer follow-up would establish the real effect of lifestyle interventions to reduce diabetes risk in women with previous GDM.
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Affiliation(s)
- Sumali S Hewage
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Nithya Neelakantan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; University of Southern California, Center for Economic and Social Research, USA
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Carmody E, Richards T, Hayward K, Carson G, Whitfield KC, McClure J, Grant S. In-Hospital Feeding Practices of Infants Born to Mothers With Gestational Diabetes Mellitus or Type 2 Diabetes Mellitus: Evaluating Policy Implementation Effectiveness. Can J Diabetes 2019; 43:580-586. [PMID: 31787244 DOI: 10.1016/j.jcjd.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Women with diabetes in pregnancy may experience unique breastfeeding challenges. Few studies have examined the effectiveness of hospital policy to support breastfeeding in this patient population. This study aimed 1) to describe infant feeding practices of mother-infant pairs with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy before and after introduction of an in-hospital policy and, 2) to compare feeding practices before and after policy introduction. METHODS A retrospective chart audit of mother-infant pairs (n=120) was performed: 60 at 1 year before and 60 after policy introduction. The primary outcome was provision of breast milk at discharge; a chi-square test was completed to compare pre- and postpolicy groups. Secondary outcomes included participant and infant feeding characteristics. RESULTS There was no significant difference in the number of infants receiving breast milk at discharge between pre- (58% [35 of 60]) and postpolicy (58% [35 of 60]) groups (p=0.64). The number of infants receiving breast milk exclusively throughout the hospital stay also did not differ by group (37% [22 of 60] before; and 43% [26 of 60] after; p=0.39). Information for each feed was infrequently recorded in charts for the method of feeding (34% [704 of 2,064]), infant state (96% [1,991 of 2,064]) and feeding description (96% [1,987 of 2,064]). CONCLUSIONS This practice-based research has highlighted a need for continuation of this work, examining an in-hospital policy to support breastfeeding in those with GDM or type 2 diabetes in pregnancy. Initially, feedback could be collected from health-care providers to understand perceived facilitators and barriers to policy application and the use of job aids (e.g. record keeping tools).
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Affiliation(s)
- Erin Carmody
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Tiffany Richards
- School of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kathryn Hayward
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenda Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada; Women's and Newborn Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Janine McClure
- Women's and Newborn Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Shannan Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada; Departments of Obstetrics & Gynecology and Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada; Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Lactobacillus bulgaricus improves antioxidant capacity of black garlic in the prevention of gestational diabetes mellitus: a randomized control trial. Biosci Rep 2019; 39:BSR20182254. [PMID: 31362999 PMCID: PMC6689107 DOI: 10.1042/bsr20182254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/14/2019] [Accepted: 07/30/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives:Lactobacillus bulgaricus may improve antioxidant capacity of black garlic in the prevention of gestational diabetes mellitus (GDM). Methods: Black garlic was prepared with or without L. bulgaricus. Volatile and polysaccharides were analyzed by using LC-MS, Fourier Transform infrared (FTIR) and 13C nuclear magnetic resonance (NMR). The study design was parallel randomized controlled trial and 226 GDM patients were randomly assigned into BG (black garlic and L. bulgaricus) and CG (black garlic) groups, and allocation ratio was 1:1. The treatment duration was 40 weeks. Fasting blood glucose (FBG) and 1- and 2-h blood glucose (1hBG and 2hBG) after oral glucose tolerance test (OGTT) were detected. Antioxidant function of black garlic was determined by measuring plasma malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-PX) and total antioxidant capacity (T-AOC) in GDM patients. The comparison between two groups was made using two independent samples t test. Results: The intake of nutrients was similar between two groups (P>0.05). L. bulgaricus promoted the transformation of the glucopyranoside to glucofuranoside. L. bulgaricus increased the abilities of black garlic for scavenging hydroxyl radicals, 2,2′-azino-bis (3-ethylbenzenthiazoline-6-sulfonic) acid (ABTS) and DPPH free radicals. L. bulgaricus reduced the levels of FBG, 1hBG and 2hBG, and incidence of perinatal complications (P<0.01). Plasma MDA level in the BG group was lower than in the CG group, whereas the levels of SOD, GSH-PX and T-AOC in the BG group were higher than in the CG group (P<0.01). Conclusions:L. bulgaricus improves antioxidant capacity of black garlic in the prevention of GDM.
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Bovbjerg ML. Current Resources for Evidence-Based Practice, May 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:361-371. [DOI: 10.1016/j.jogn.2019.04.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Li L, Wang S, Li H, Wan J, Zhou Q, Zhou Y, Zhang C. microRNA-96 protects pancreatic β-cell function by targeting PAK1 in gestational diabetes mellitus. Biofactors 2018; 44:539-547. [PMID: 30536654 DOI: 10.1002/biof.1461] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022]
Abstract
Gestational diabetes mellitus (GDM) is a disease condition in which a woman develops high blood sugar levels during pregnancy, which might be induced by multiple factors. Among those relative factors, microRNA (miRNA) is well-known to be involved in GDM development. In this study, we investigated the role of miRNA in GDM by analyzing miRNA expression profiling in placenta tissues from healthy or GDM pregnancies. We found that miR-96 was the most down-regulated miRNA in GDM samples. Furthermore, miRNA target gene prediction revealed that p21-activated kinase 1 (PAK1) is a potential target of miR-96. Functional assays showed that miR-96 enhanced β-cell function, whereas PAK1 inhibited β-cell function and cell viability. Our findings demonstrate that miR-96 plays a critical role in GDM development by regulating PAK1 expression, insulin secretion, and β-cell function. © 2018 BioFactors, 44(6):539-547, 2018.
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Affiliation(s)
- Lei Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shan Wang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Hongyan Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jipeng Wan
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Qian Zhou
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yu Zhou
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Abstract
PURPOSE OF THE REVIEW Women with a history of gestational diabetes mellitus (GDM) have an alarmingly high risk of developing type 2 diabetes (T2D); yet, mechanisms underlying this progression are largely unknown. RECENT FINDINGS Clinical characteristics of a GDM pregnancy and postpartum metabolomics may contribute to risk prediction of T2D to identify those women at highest risk of progression and need for intervention. Evidence for effective postpartum lifestyle interventions from observational studies include adherence to a healthy dietary pattern, increasing physical activity, and maintaining a healthy body weight. Larger clinical trials with greater participant engagement are warranted to confirm the effectiveness of lifestyle interventions in women with recent GDM. Research is needed to refine prediction models of T2D after GDM, and to determine the most effective strategies to delay or prevent T2D onset. Incorporating novel biomarkers in the postpartum period, such as metabolomics, could offer a powerful approach.
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Affiliation(s)
- Deirdre K Tobias
- Division of Preventive Medicine, 900 Commonwealth Avenue, Boston, MA, 02215, USA.
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