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Catic A, Heinzl F, Göbl C, Yerlikaya-Schatten G, Reischer T. Risk Stratification in Twin Pregnancies Complicated by GDM. J Diabetes Res 2024; 2024:5203116. [PMID: 39346677 PMCID: PMC11438509 DOI: 10.1155/2024/5203116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/27/2024] [Accepted: 08/05/2024] [Indexed: 10/01/2024] Open
Abstract
Aims: This study was aimed at assessing the association of oral glucose tolerance test (OGTT) glucose threshold levels and the requirement of insulin therapy in twin pregnancies with gestational diabetes mellitus (GDM). Methods: In this post hoc analysis of a cohort study spanning 18 years, 446 patients with twin pregnancy and GDM (246 managed with lifestyle modification and 200 requiring pharmacotherapy) were included. We collected and evaluated maternal characteristics, as well as fasting, 1-h, and 2-h glucose concentrations from a standardized 75-g OGTT. The assessment methods included logistic regression analysis, positive and negative predictive values, area under the curve (AUC), and random forest analysis. Results: The fasting (p < 0.01, OR: 1.03 [95% CI 1.01-1.05]) and 1-h (p < 0.01; OR: 1.01 [95% CI 1.00-1.02]) glucose levels during the OGTT were significantly associated with the subsequent need for insulin therapy, with thresholds of 95 mg/dL for fasting glucose and 184 mg/dL for the 1-h OGTT. Additionally, indications for insulin therapy were marked by thresholds of 108 mg/dL at G0, 215 mg/dL at G60, and 86 mg/dL at G120. Conclusion: Identifying threshold values for insulin therapy and risk stratification in twin pregnancy are crucial for optimal patient management.
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Affiliation(s)
- Anja Catic
- Department of Obstetrics and GynecologyDivision of Feto-Maternal MedicineMedical University of Vienna 1090, Vienna, Austria
| | - Florian Heinzl
- Department of Obstetrics and GynecologyDivision of Feto-Maternal MedicineMedical University of Vienna 1090, Vienna, Austria
| | - Christian Göbl
- Department of Obstetrics and GynecologyDivision of ObstetricsMedical University of Graz 8010, Graz, Austria
| | - Gülen Yerlikaya-Schatten
- Department of Obstetrics and GynecologyDivision of Feto-Maternal MedicineMedical University of Vienna 1090, Vienna, Austria
| | - Theresa Reischer
- Department of Obstetrics and GynecologyDivision of Feto-Maternal MedicineMedical University of Vienna 1090, Vienna, Austria
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Salvatori B, Wegener S, Kotzaeridi G, Herding A, Eppel F, Dressler-Steinbach I, Henrich W, Piersanti A, Morettini M, Tura A, Göbl CS. Identification and validation of gestational diabetes subgroups by data-driven cluster analysis. Diabetologia 2024; 67:1552-1566. [PMID: 38801521 PMCID: PMC11343786 DOI: 10.1007/s00125-024-06184-7] [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: 03/20/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024]
Abstract
AIMS/HYPOTHESIS Gestational diabetes mellitus (GDM) is a heterogeneous condition. Given such variability among patients, the ability to recognise distinct GDM subgroups using routine clinical variables may guide more personalised treatments. Our main aim was to identify distinct GDM subtypes through cluster analysis using routine clinical variables, and analyse treatment needs and pregnancy outcomes across these subgroups. METHODS In this cohort study, we analysed datasets from a total of 2682 women with GDM treated at two central European hospitals (1865 participants from Charité University Hospital in Berlin and 817 participants from the Medical University of Vienna), collected between 2015 and 2022. We evaluated various clustering models, including k-means, k-medoids and agglomerative hierarchical clustering. Internal validation techniques were used to guide best model selection, while external validation on independent test sets was used to assess model generalisability. Clinical outcomes such as specific treatment needs and maternal and fetal complications were analysed across the identified clusters. RESULTS Our optimal model identified three clusters from routinely available variables, i.e. maternal age, pre-pregnancy BMI (BMIPG) and glucose levels at fasting and 60 and 120 min after the diagnostic OGTT (OGTT0, OGTT60 and OGTT120, respectively). Cluster 1 was characterised by the highest OGTT values and obesity prevalence. Cluster 2 displayed intermediate BMIPG and elevated OGTT0, while cluster 3 consisted mainly of participants with normal BMIPG and high values for OGTT60 and OGTT120. Treatment modalities and clinical outcomes varied among clusters. In particular, cluster 1 participants showed a much higher need for glucose-lowering medications (39.6% of participants, compared with 12.9% and 10.0% in clusters 2 and 3, respectively, p<0.0001). Cluster 1 participants were also at higher risk of delivering large-for-gestational-age infants. Differences in the type of insulin-based treatment between cluster 2 and cluster 3 were observed in the external validation cohort. CONCLUSIONS/INTERPRETATION Our findings confirm the heterogeneity of GDM. The identification of subgroups (clusters) has the potential to help clinicians define more tailored treatment approaches for improved maternal and neonatal outcomes.
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Affiliation(s)
| | - Silke Wegener
- Department of Obstetrics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Grammata Kotzaeridi
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Annika Herding
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Florian Eppel
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Iris Dressler-Steinbach
- Department of Obstetrics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Agnese Piersanti
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Micaela Morettini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Tura
- CNR Institute of Neuroscience, Padua, Italy.
| | - Christian S Göbl
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.
- Department of Obstetrics and Gynaecology, Division of Obstetrics, Medical University of Graz, Graz, Austria.
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Ortega-Montiel J, Martinez-Juarez LA, Montoya A, Morales-Juárez L, Gallardo-Rincón H, Galicia-Hernández V, Garcia-Cerde R, Ríos-Blancas MJ, Álvarez-Hernández DA, Lomelin-Gascon J, Martínez-Silva G, Illescas-Correa LM, Diaz Martinez DA, Magos Vázquez FJ, Vargas Ávila E, Carmona-Ramos MC, Mújica‐Rosales R, Reyes-Muñoz E, Tapia-Conyer R. Gestational Diabetes Mellitus Subtypes Classified by Oral Glucose Tolerance Test and Maternal and Perinatal Outcomes: Results of a Mexican Multicenter Prospective Cohort Study "Cuido Mi Embarazo". Diabetes Metab Syndr Obes 2024; 17:1491-1502. [PMID: 38559615 PMCID: PMC10981421 DOI: 10.2147/dmso.s450939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes. Patients and Methods This multicenter prospective cohort study (May 2019-December 2022) included participants from the Mexican multicenter cohort study Cuido mi Embarazo (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the t-test, chi-square test, or Fisher's exact test. Results Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%). Conclusion GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes.
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Affiliation(s)
| | - Luis A Martinez-Juarez
- Carlos Slim Foundation, Mexico City, Mexico
- Johns Hopkins Center for Humanitarian Health, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Héctor Gallardo-Rincón
- Carlos Slim Foundation, Mexico City, Mexico
- Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | | | | | | | | | | | | | - Edwin Vargas Ávila
- Ministry of Health of the State of Guanajuato, Tamazuca, Guanajuato, Mexico
| | | | | | - Enrique Reyes-Muñoz
- Coordinatión of Gynecological and Perinatal Endocrinology, National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Roberto Tapia-Conyer
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
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Catic A, Reischer T, Heinzl F, Göbl C, Yerlikaya-Schatten G. Clinical Factors for Predicting Pharmacotherapy in Twin Pregnancies Complicated by Gestational Diabetes Mellitus. J Clin Med 2023; 12:6856. [PMID: 37959321 PMCID: PMC10649756 DOI: 10.3390/jcm12216856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Controlling blood glucose levels is the main target in pregnant women with gestational diabetes mellitus (GDM). Twin pregnancies are offered the same screening selection and have the same diagnostic criteria as well as treatment of gestational diabetes as singleton pregnancies, even though the risks for pregnancy complications are increased. The aim of this study was to assess the association between predicting factors, OGTT glucose levels and pharmacotherapy requirements in twin pregnancies with GDM. This retrospective cohort study included 446 GDM patients with twin pregnancies (246 managed with lifestyle modifications and 200 requiring pharmacotherapy) over a time period of 18 years. An evaluation of maternal characteristics and a standardized 75 g oral glucose test (OGGT) for glucose concentrations at fasting, 1 h and 2 h were conduced. OGTT glucose levels at fasting (=0 min, p < 0.01) and 1 h (p < 0.01) were significantly associated with the later requirement of pharmacotherapy. Also, clinical risk factors (pre-pregnancy BMI p < 0.01, multiparity p < 0.05, GDM in previous pregnancy p < 0.01, assisted reproduction p < 0.05) showed a predictive accuracy for insulin therapy in twin pregnancies complicated by GDM, whereas age and chorionicity had no effect. OGTT glucose measures in addition to clinical risk factors are promising variables for risk stratification in mothers with GDM and twin pregnancy.
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Affiliation(s)
- Anja Catic
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (F.H.); (C.G.); (G.Y.-S.)
| | - Theresa Reischer
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (F.H.); (C.G.); (G.Y.-S.)
- Fetal Medicine Unit, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
| | - Florian Heinzl
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (F.H.); (C.G.); (G.Y.-S.)
| | - Christian Göbl
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (F.H.); (C.G.); (G.Y.-S.)
| | - Gülen Yerlikaya-Schatten
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (F.H.); (C.G.); (G.Y.-S.)
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Hao Y, Qu L, Guo Y, Ma L, Guo M, Zhu Y, Jin Y, Gu Q, Zhang Y, Sun W. Association of pre-pregnancy low-carbohydrate diet with maternal oral glucose tolerance test levels in gestational diabetes. BMC Pregnancy Childbirth 2022; 22:734. [PMID: 36162989 PMCID: PMC9511732 DOI: 10.1186/s12884-022-05059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Limited evidence exists on the correlation between the pre-pregnancy low-carbohydrate (LC) diet and maternal oral glucose tolerance test (OGTT) levels during pregnancy. Our aim was to compare the differences in maternal OGTT levels among women who had been diagnosed with gestational diabetes mellitus (GDM) during pregnancy and adopted different dietary patterns in the pre-pregnancy period. Methods A case–control study was conducted in 20 women with GDM who adhering to an LC diet (carbohydrate intake < 130 g/d) during pre-conception (LC/GDM,cases). Control subjects, who were matched in a 4:1 ratio, were 80 women with GDM and conventional diet (Con/GDM,control), and 80 women with conventional diet but without GDM (Con/Healthy,control). Women diagnosed with GDM using 75-g OGTT between 24 and 28 weeks of gestation. We used unadjusted raw data to compare the dietary composition data and biomarkers of the three study groups. Results The average pre-conception BMI in each group suggested a similar body size from the three study groups(19.12 ± 2.00 LC/GDM, 19.65 ± 2.32 Con/GDM, 19.53 ± 2.30 Con/Healthy; P = 0.647). Compared with the Con/GDM group, the OGTT-1 h and OGTT-2 h values in LC/GDM group were significantly higher (10.36 ± 1.28 mmol/L vs. 9.75 ± 0.98 mmol/L; 9.12 ± 0.98 mmol/L vs. 8.29 ± 1.06 mmol/L). Furthermore, the percentage of women who had more than one abnormal OGTT value (OGTT-1 h and OGTT-2 h) was 40% in the LC/GDM group, which was significantly higher than in the Con/GDM group (16.3%). Conclusions We observed a relationship between the pre-pregnancy LC diet and more detrimental OGTT values in patients with GDM. This finding warrants further studies to understand the effect of pre-pregnancy LC diet practice on maternal glucose tolerance. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05059-2.
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Affiliation(s)
- Yanhui Hao
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Lei Qu
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China
| | - Yuna Guo
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China
| | - Liying Ma
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China
| | - Muhe Guo
- Department of Nutrition, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Yiqing Zhu
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China
| | - Yan Jin
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China
| | - Qin Gu
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China
| | - Yue Zhang
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China
| | - Wenguang Sun
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910 Hengshan Road, 200030, Shanghai, China.
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Wang S, Wang Y, Gao M, Tan Y. Acceleration time to Ejection time ratio in fetal pulmonary artery system can predict neonatal respiratory disorders in gestational diabetic mellitus women. Clin Hemorheol Microcirc 2021; 80:497-507. [PMID: 34924370 DOI: 10.3233/ch-211265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few researches studied fetal pulmonary pulse wave doppler and the clinical end point disorders in gestational diabetic mellitus (GDM) cohort. OBJECTIVE To investigate fetal pulmonary artery acceleration time to ejection time ratio (PATET) in the prediction of neonatal respiratory disorders (NRD). METHODS 238 pregnant women diagnosed with GDM who attended our hospital between February 2018 and March 2020 were retrospectively included. Fetal pulmonary artery Doppler wave measurements were recorded, including main, left and right pulmonary artery blood flow, and left and right peripheral pulmonary artery blood flow. Acceleration time (At)/ejection time (Et) were calculated. RESULTS 183 GDM pregnant women and neonates were divided into NRD(+)(n = 42) and NRD(-) group (n = 141). 16 cases were neonatal pneumonia (NP) within 28 days after birth in NRD(+) group. The area under curve (AUC) of left peripheral pulmonary artery acceleration time to ejection time (LPPATET) was 0.967 (95% CI: 0.927∼1.000, P < 0.001) and the AUC of right peripheral pulmonary artery acceleration time to ejection time (RPPATET) was 0.967 (95% CI: 0.927∼1.000, P < 0.001), indicating that LPPATET and RPPATET are both predictors for NRD. The results of interobserver variabilty and intraobserver variability showed a good consistency. CONCLUSIONS The At/Et of fetal peripheral pulmonary artery (PPA) in GDM women may be predictors for NRD, and the indicator can provide assistance in clinical management of diabetes pregnant patients.
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Affiliation(s)
- Shuya Wang
- Department of Cardiac Ultrasound, Hebei Medical University, Shijiazhuang, China
| | - Yueheng Wang
- Department of Cardiac Ultrasound, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Man Gao
- Department of Ultrasound, Shijiazhuang Maternity Hospital, Shijiazhuang, China
| | - Yongpan Tan
- Department of Ultrasound, Shijiazhuang Maternity Hospital, Shijiazhuang, China
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Kotzaeridi G, Blätter J, Eppel D, Rosicky I, Linder T, Geissler F, Huhn EA, Hösli I, Tura A, Göbl CS. Characteristics of gestational diabetes subtypes classified by oral glucose tolerance test values. Eur J Clin Invest 2021; 51:e13628. [PMID: 34120352 PMCID: PMC8459269 DOI: 10.1111/eci.13628] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/01/2021] [Accepted: 04/25/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND In clinical practice, gestational diabetes mellitus (GDM) is treated as a homogenous disease but emerging evidence suggests that the diagnosis of GDM possibly comprises different metabolic entities. In this study, we aimed to assess early pregnancy characteristics of gestational diabetes mellitus entities classified according to the presence of fasting and/or post-load hyperglycaemia in the diagnostic oral glucose tolerance test performed at mid-gestation. METHODS In this prospective cohort study, 1087 pregnant women received a broad risk evaluation and laboratory examination at early gestation and were later classified as normal glucose tolerant (NGT), as having isolated fasting hyperglycaemia (GDM-IFH), isolated post-load hyperglycaemia (GDM-IPH) or combined hyperglycaemia (GDM-CH) according to oral glucose tolerance test results. Participants were followed up until delivery to assess data on pharmacotherapy and pregnancy outcomes. RESULTS Women affected by elevated fasting and post-load glucose concentrations (GDM-CH) showed adverse metabolic profiles already at beginning of pregnancy including a higher degree of insulin resistance as compared to women with normal glucose tolerance and those with isolated defects (especially GDM-IPH). The GDM-IPH subgroup had lower body mass index at early gestation and required glucose-lowering medications less often (28.9%) as compared to GDM-IFH (47.8%, P = .019) and GDM-CH (54.5%, P = .005). No differences were observed in pregnancy outcome data. CONCLUSIONS Women with fasting hyperglycaemia, especially those with combined hyperglycaemia, showed an unfavourable metabolic phenotype already at early gestation. Therefore, categorization based on abnormal oral glucose tolerance test values provides a practicable basis for clinical risk stratification.
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Affiliation(s)
- Grammata Kotzaeridi
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Julia Blätter
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Daniel Eppel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Ingo Rosicky
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Tina Linder
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Franziska Geissler
- Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
| | - Evelyn A Huhn
- Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
| | - Irene Hösli
- Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
| | - Andrea Tura
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.,Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
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Ye G, Zhang L, Wang M, Chen Y, Gu S, Wang K, Leng J, Gu Y, Xie X. The Gut Microbiota in Women Suffering from Gestational Diabetes Mellitus with the Failure of Glycemic Control by Lifestyle Modification. J Diabetes Res 2019; 2019:6081248. [PMID: 31772944 PMCID: PMC6854930 DOI: 10.1155/2019/6081248] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/30/2019] [Accepted: 09/21/2019] [Indexed: 02/07/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is prevalent worldwide, leading to a high risk of significant morbidity for both the mother and offspring with complications. Increasing evidences suggest that gut microbiota plays a role in the pathogenesis of GDM. Lifestyle modification is the cornerstones of GDM treatment. However, a number of patients whose blood glucose is not controlled by lifestyle modification still require exogenous insulin to control blood glucose. No observational study is available about the relationship between the gut microbiota in GDM patients and lifestyle modifications. Thus, we investigated the differences in gut microbiota between GDM patients with successful glycemic control (GDM1) and failure of glycemic control (GDM2) by lifestyle modifications. We sequenced the V3-V4 regions of 16S ribosomal ribonucleic acid (rRNA) gene from stool samples of 52 singleton pregnant women with 24-28 weeks of gestation. Our results showed that Blautia, Eubacterium_hallii_group, and Faecalibacterium in the gut microbiota showed significant differences among the normoglycemic mother, GDM1, and GDM2 groups, respectively. The combined diagnostic performance of Blautia, Eubacterium_hallii_group, and Faecalibacterium in differentiating GDM2 from GDM was considered as the most reasonable identification indicator. Gut bacteria may participate in the pathological development of GDM2 through the peroxisome proliferator-activated receptor (PPAR) signaling pathway. These results indicated that Blautia, Eubacterium_hallii_group, and Faecalibacterium had important characteristic changes in the gut microbiota of women with GDM2.
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Affiliation(s)
- Guangyong Ye
- Women's Hospital, Zhejiang University School of Medicine, China
| | - Long Zhang
- Women's Hospital, Zhejiang University School of Medicine, China
| | - Min Wang
- Women's Hospital, Zhejiang University School of Medicine, China
| | - Yunbo Chen
- The First Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Silan Gu
- The First Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Keyi Wang
- Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China
| | - Jianhang Leng
- Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China
| | - Yujia Gu
- Women's Hospital, Zhejiang University School of Medicine, China
| | - Xinyou Xie
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, China
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