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Wang J, Cheng X, Li ZH, Mao YC, Wang XQ, Zhang KD, Yu WJ, Li YQ, Zhao JW, Chen ML, Gao GP, Hu CY, Zhang XJ. The effects of gestational diabetes mellitus on fetal growth: is it different for low-risk and medium-high-risk pregnant women? Arch Gynecol Obstet 2024; 310:833-842. [PMID: 37773466 DOI: 10.1007/s00404-023-07229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND It has been suggested that gestational diabetes mellitus (GDM) alters the growth trajectory of a fetus and increases the risk of abnormal birth weight. In spite of this, there is still a significant debate regarding the mode and optimal timing of diagnosing this condition. Our aim was to determine fetal growth velocity and birth biometry in pregnant women with GDM at varying risk levels. METHODS We conducted a cohort study involving 1023 pregnant women at a maternity hospital in Ma'anshan, China. All women completed an oral glucose tolerance test at 24-28 weeks' gestation. We measured fetal head circumference (HC), femoral length (FL), abdominal circumference (AC), biparietal diameter (BPD), and estimate fetal weight (EFW) by ultrasound at 17, 24, 31, and 35 weeks' gestation, respectively. RESULTS Overall, 5115 ultrasound scans were performed. Among both low-risk and medium-high-risk pregnant women at 17-24 weeks' gestation, GDM exposure was associated with an increase in fetal growth velocity. Neonates born to women with GDM at medium-high risk had significantly larger birth weights than those born to women without GDM, while this was not observed in women at low risk. CONCLUSION In medium-high-risk pregnant women, exposure to GDM has a greater effect on the fetus, leading to abnormal fetal growth velocity that lasts beyond week 24. It is evident from our results that the effects of GDM on fetal growth differ between medium-high-risk pregnant women and low-risk pregnant women, and therefore a different screening program based on the risk factor for GDM is warranted.
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Affiliation(s)
- Jie Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xin Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zhen-Hua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Yi-Cheng Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xin-Qiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kang-Di Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Wen-Jie Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Ying-Qing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jia-Wen Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Mao-Lin Chen
- Department of Gynecology and Obstetrics, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243000, China
| | - Guo-Peng Gao
- Department of Gynecology and Obstetrics, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243000, China
| | - Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei, 230032, China.
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Sun Q, Ye F, Liu J, Yang Y, Hui Q, Chen Y, Liu D, Guo J, Wang C, Lv D, Tang L, Zhang Q. Outdoor artificial light at night exposure and gestational diabetes mellitus: a case-control study. Front Public Health 2024; 12:1396198. [PMID: 38660366 PMCID: PMC11039930 DOI: 10.3389/fpubh.2024.1396198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
Objective This study aims to explore the association between outdoor artificial light at night (ALAN) exposure and gestational diabetes mellitus (GDM). Methods This study is a retrospective case-control study. According with quantiles, ALAN has been classified into three categories (Q1-Q3). GDM was diagnosed through oral glucose tolerance tests. Conditional logistic regression models were used to evaluate the association between ALAN exposure and GDM risk. The odds ratio (OR) with 95% confidence interval (CI) was used to assess the association. Restricted cubic spline analysis (RCS) was utilized to investigate the no liner association between ALAN and GDM. Results A total of 5,720 participants were included, comprising 1,430 individuals with GDM and 4,290 matched controls. Pregnant women exposed to higher levels of ALAN during the first trimester exhibited an elevated risk of GDM compared to those with lower exposure levels (Q2 OR = 1.39, 95% CI 1.20-1.63, p < 0.001); (Q3 OR = 1.70, 95% CI 1.44-2.00, p < 0.001). Similarly, elevated ALAN exposure during the second trimester also conferred an increased risk of GDM (second trimester: Q2 OR = 1.70, 95% CI 1.45-1.98, p < 0.001; Q3 OR = 2.08, 95% CI 1.77-2.44, p < 0.001). RCS showed a nonlinear association between ALAN exposure and GDM risk in second trimester pregnancy, with a threshold value of 4.235. Conclusion Outdoor ALAN exposure during pregnancy is associated with an increased risk of GDM.
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Affiliation(s)
- Qi Sun
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Precision and Smart Imaging Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fang Ye
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Liu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Yang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qin Hui
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuanmei Chen
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Die Liu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianning Guo
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Wang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Di Lv
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lijuan Tang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Department of Pediatrics, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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de Souza Lima B, Sanches APV, Ferreira MS, de Oliveira JL, Cleal JK, Ignacio-Souza L. Maternal-placental axis and its impact on fetal outcomes, metabolism, and development. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166855. [PMID: 37633470 DOI: 10.1016/j.bbadis.2023.166855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/23/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
Maternal obesity could impact offspring's health. During "critical period" such as pregnancy insults have a significant role in developing chronic diseases later in life. Literature has shown that diet can play a major role in essential metabolic and development processes on fetal outcomes. Moreover, the placenta, an essential organ developed in pregnancy, seems to have its functions impaired based on pre-gestational and gestational nutritional status. Specifically, a high-fat diet has been shown as a potential nutritional insult that also affects the maternal-placental axis, which is involved in offspring development and outcome. Moreover, some classes of nutrients are associated with pregnancy complications such as reduced intake of micronutrients and diabetes, preeclampsia, and preterm delivery. Thus, we will summarize the current literature on maternal environment factors that impacts the placental development and consequently the fetal an offspring health, or the maternal-placental axis, and this on fetal outcomes, metabolism, and development.
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Affiliation(s)
- Bruna de Souza Lima
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil.
| | - Ana Paula Varela Sanches
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil
| | - Maíra Schuchter Ferreira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil
| | - Josilene Lopes de Oliveira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil
| | - Jane K Cleal
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Letícia Ignacio-Souza
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil.
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Francis EC, Powe CE, Lowe WL, White SL, Scholtens DM, Yang J, Zhu Y, Zhang C, Hivert MF, Kwak SH, Sweeting A. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2023; 3:185. [PMID: 38110524 PMCID: PMC10728189 DOI: 10.1038/s43856-023-00393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. METHODS Systematic literature searches were performed in PubMed and EMBASE from inception to March 2022 for studies comparing perinatal outcomes among women with GDM. We searched for precision markers in the following categories: maternal anthropometrics, clinical/sociocultural factors, non-glycemic biochemical markers, genetics/genomics or other -omics, and fetal biometry. We conducted post-hoc meta-analyses of a subset of studies with data on the association of maternal body mass index (BMI, kg/m2) with offspring macrosomia or large-for-gestational age (LGA). RESULTS A total of 5905 titles/abstracts were screened, 775 full-texts reviewed, and 137 studies synthesized. Maternal anthropometrics were the most frequent risk marker. Meta-analysis demonstrated that women with GDM and overweight/obesity vs. GDM with normal range BMI are at higher risk of offspring macrosomia (13 studies [n = 28,763]; odds ratio [OR] 2.65; 95% Confidence Interval [CI] 1.91, 3.68), and LGA (10 studies [n = 20,070]; OR 2.23; 95% CI 2.00, 2.49). Lipids and insulin resistance/secretion indices were the most studied non-glycemic biochemical markers, with increased triglycerides and insulin resistance generally associated with greater risk of offspring macrosomia or LGA. Studies evaluating other markers had inconsistent findings as to whether they could be used as precision markers. CONCLUSIONS Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. Future studies examining non-glycemic biochemical, genetic, other -omic, or sociocultural precision markers among women with GDM are warranted.
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Affiliation(s)
- Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiaxi Yang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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5
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Rodolaki K, Pergialiotis V, Iakovidou N, Boutsikou T, Iliodromiti Z, Kanaka-Gantenbein C. The impact of maternal diabetes on the future health and neurodevelopment of the offspring: a review of the evidence. Front Endocrinol (Lausanne) 2023; 14:1125628. [PMID: 37469977 PMCID: PMC10352101 DOI: 10.3389/fendo.2023.1125628] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Maternal health during gestational period is undoubtedly critical in shaping optimal fetal development and future health of the offspring. Gestational diabetes mellitus is a metabolic disorder occurring in pregnancy with an alarming increasing incidence worldwide during recent years. Over the years, there is a growing body of evidence that uncontrolled maternal hyperglycaemia during pregnancy can potentially have detrimental effect on the neurodevelopment of the offspring. Both human and animal data have linked maternal diabetes with motor and cognitive impairment, as well as autism spectrum disorders, attention deficit hyperactivity disorder, learning abilities and psychiatric disorders. This review presents the available data from current literature investigating the relationship between maternal diabetes and offspring neurodevelopmental impairment. Moreover, possible mechanisms accounting for the detrimental effects of maternal diabetes on fetal brain like fetal neuroinflammation, iron deficiency, epigenetic alterations, disordered lipid metabolism and structural brain abnormalities are also highlighted. On the basis of the evidence demonstrated in the literature, it is mandatory that hyperglycaemia during pregnancy will be optimally controlled and the impact of maternal diabetes on offspring neurodevelopment will be more thoroughly investigated.
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Affiliation(s)
- Kalliopi Rodolaki
- First Department of Pediatrics, “Aghia Sophia” Children’s Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoleta Iakovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoe Iliodromiti
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, “Aghia Sophia” Children’s Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Galdikaitė G, Simanauskaitė A, Ramonienė G, Savukynė E, Malakauskienė L, Tarasevičienė V. The Effect of Timing and Methods for the Diagnosis of Gestational Diabetes Mellitus on Obstetric Complications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050854. [PMID: 37241086 DOI: 10.3390/medicina59050854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Aim. To compare the impact of the time and method of diagnosis on gestational diabetes mellitus (GDM) in women who gave birth at the Hospital of the Lithuanian University of Health Sciences (LUHS) Kauno klinikos. Methods. A retrospective study was performed using data from the Department of Obstetrics and Gynecology of the LUHS Birth Registry to analyze the data of women who gave birth and had GDM in 2020-2021. The subjects were divided based on the type of diagnosis: GDM was diagnosed either at the first antenatal visit when fasting plasma glycemia (FPG) was ≥5.1 mmol/L (early diagnosis group) or after OGTT at 24 + 0 - 28 + 6 weeks of gestation when at least one pathological glycemic index was observed: fasting glycemia 5.1-6.9 mmol/L or 1-h glycemia ≥10.0 mmol/L or 2 h glycemia 8.5-11.0 mmol/L (late diagnosis group). The results were processed using IBM SPSS. Results. The early diagnosis group had 1254 (65.7%) women, the late diagnosis group had 654 (34.3%). More primigravida women were in the late diagnosis group (p = 0.017) while more multigravida were in the early diagnosis group (p = 0.033). The early diagnosis group had more obese women (p = 0.001), including those with a BMI > 40 (p = 0.001). In the early diagnosis group, GDM was more frequently diagnosed in women who gained <11 kg (p = 0.005), while in the late diagnosis group->16 kg (p = 0.001). FPG was higher in the early diagnosis group (p = 0.001). Glycemia was more commonly corrected with lifestyle changes in the late diagnosis group (p = 0.001), and with additional insulin therapy in the early diagnosis group (p = 0.001). Polyhydramnios and preeclampsia were more common in the late diagnosis group (p = 0.027 and p = 0.009). There were more large-for-gestational-age neonates in the late diagnosis group (p = 0.005). Macrosomia was more common in the late diagnosis group (p = 0.008). Conclusions. GDM is more commonly diagnosed with OGTT in primigravida women. Higher pregestational weight and BMI has an impact on the early diagnosis of GDM and need for insulin therapy with lifestyle changes. Late diagnosis of GDM is connected with obstetric complications.
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Affiliation(s)
- Gintarė Galdikaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Atėnė Simanauskaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Gitana Ramonienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Eglė Savukynė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Laura Malakauskienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Viktorija Tarasevičienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
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Mirabelli M, Tocci V, Donnici A, Giuliano S, Sarnelli P, Salatino A, Greco M, Puccio L, Chiefari E, Foti DP, Brunetti A. Maternal Preconception Body Mass Index Overtakes Age as a Risk Factor for Gestational Diabetes Mellitus. J Clin Med 2023; 12:jcm12082830. [PMID: 37109166 PMCID: PMC10145909 DOI: 10.3390/jcm12082830] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction-The purpose of this study was to determine the relative impact of modifiable and non-modifiable risk factors in the development of gestational diabetes mellitus (GDM), with a particular focus on maternal preconception body mass index (BMI) and age, two important determinants of insulin resistance. Understanding the factors that contribute most to the current escalation of GDM rates in pregnant women could help to inform prevention and intervention strategies, particularly in areas where this female endocrine disorder has an elevated prevalence. Methods-A retrospective, contemporary, large population of singleton pregnant women from southern Italy who underwent 75 g OGTT for GDM screening was enrolled at the Endocrinology Unit, "Pugliese Ciaccio" Hospital, Catanzaro. Relevant clinical data were collected, and the characteristics of women diagnosed with GDM or with normal glucose tolerance were compared. The effect estimates of maternal preconception BMI and age as risk factors for GDM development were calculated through correlation and logistic regression analysis by adjusting for potential confounders. Results-Out of the 3856 women enrolled, 885 (23.0%) were diagnosed with GDM as per IADPSG criteria. Advanced maternal age (≥35 years), gravidity, reproductive history of spontaneous abortion(s), previous GDM, and thyroid and thrombophilic diseases, all emerged as non-modifiable risk factors of GDM, whereas preconception overweight or obesity was the sole potentially modifiable risk factor among those investigated. Maternal preconception BMI, but not age, had a moderate positive association with fasting glucose levels at the time of 75 g OGTT (Pearson coefficient: 0.245, p < 0.001). Abnormalities in fasting glucose drove the majority (60%) of the GDM diagnoses in this study. Maternal preconception obesity almost tripled the risk of developing GDM, but even being overweight resulted in a more pronounced increased risk of developing GDM than advanced maternal age (adjusted OR for preconception overweight: 1.63, 95% CI 1.320-2.019; adjusted OR for advanced maternal age: 1.45, 95% CI 1.184-1.776). Conclusions-Excess body weight prior to conception leads to more detrimental metabolic effects than advanced maternal age in pregnant women with GDM. Thus, in areas in which GDM is particularly common, such as southern Italy, measures aiming to counteracting maternal preconception overweight and obesity may be efficient in reducing GDM prevalence.
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Affiliation(s)
- Maria Mirabelli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
- Operative Unit of Endocrinology, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
| | - Vera Tocci
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
- Operative Unit of Endocrinology, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
| | - Alessandra Donnici
- Operative Unit of Endocrinology, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
| | - Stefania Giuliano
- Operative Unit of Endocrinology, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
| | - Paola Sarnelli
- Operative Unit of Endocrinology, "Pugliese Ciaccio" Hospital, 88100 Catanzaro, Italy
| | - Alessandro Salatino
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Marta Greco
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Luigi Puccio
- Operative Unit of Endocrinology, "Pugliese Ciaccio" Hospital, 88100 Catanzaro, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Daniela Patrizia Foti
- Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
- Operative Unit of Endocrinology, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
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8
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Atlaw D, Sahiledengle B, Assefa T, Negash W, Tahir A, Regasa T, Tekalegn Y, Mamo A, Enegeda ZT, Solomon D, Gezahegn H, Bekele K, Zenbaba D, Desta F, Tasew A, Nugusu F, Beressa G, Shiferaw Z, Feleke Z, Regassa Z, Duguma N, Chattu VK. Incidence and risk factors of gestational diabetes mellitus in Goba town, Southeast Ethiopia: a prospective cohort study. BMJ Open 2022; 12:e060694. [PMID: 36167396 PMCID: PMC9516079 DOI: 10.1136/bmjopen-2021-060694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is becoming a public health concern in low/middle-income countries, and is known to cause severe morbidity and mortality for mothers and newborns. However, evidence reported for the incidence and risk factors of GDM is scant in Ethiopia. We aimed to assess the incidence of, and risk factors for, GDM in Goba town, Southeast Ethiopia. DESIGN Prospective cohort study. SETTING Goba town, Southeast Ethiopia. PARTICIPANTS Four hundred eighty pregnant women on antenatal care follow-up from 30 April to 30 September 2021. PRIMARY AND SECONDARY OUTCOMES Incidence and risk factors of GDM using fasting capillary blood glucose. Log-binomial model was used to identify the risk factors of GDM. Adjusted relative risk (aRR), along with 95% CIs, were calculated to estimate the strength of associations. RESULTS The cumulative incidence rate of GDM in this study was 15.7% (95% CI: 12.3% to 19.2%). Being unemployed (aRR=2.73; 95% CI: 1.36 to 5.47), having a family history of diabetes mellitus (DM) (3.01; 2.09 to 4.35), low physical activity (2.43; 1.11 to 5.32), inadequate dietary diversity (1.48; 1.29 to 1.92), anaemia (2.51; 1.32 to 3.54) and antenatal depression (4.95; 3.35 to 7.31) were significantly associated with GDM. CONCLUSION The cumulative incidence of GDM was relatively high among the study participants. Having antenatal depression symptoms, low physical activity, inadequate dietary diversity, being unemployed, anaemia and a family history of DM were significant risk factors for GDM.
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Affiliation(s)
- Daniel Atlaw
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Biniyam Sahiledengle
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Tesfaye Assefa
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Wogene Negash
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Anwar Tahir
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Tadele Regasa
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Yohannes Tekalegn
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Ayele Mamo
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Zinash Teferu Enegeda
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Damtew Solomon
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Habtamu Gezahegn
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Kebebe Bekele
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Demisu Zenbaba
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Fikreab Desta
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Alelign Tasew
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Fikadu Nugusu
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Girma Beressa
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
- Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Zerihun Shiferaw
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Zegeye Feleke
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Zegeye Regassa
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Negesso Duguma
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Vijay Kumar Chattu
- Center for Transdisciplinary Research, Saveetha Medical College and Hospitals, SIMATS, Saveetha University, Chennai 600077, India
- Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences, Wardha 442107, India
- Department of OS& OT, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G1V7, Canada
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9
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Nuwagaba J, Dave D. Management of neonatal complications of macrosomia: A case report at a tertiary hospital in a developing country. Clin Case Rep 2022; 10:e05298. [PMID: 35079394 PMCID: PMC8777164 DOI: 10.1002/ccr3.5298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022] Open
Abstract
Fetal macrosomia can present with numerous complications. We report a case of a term baby girl with a birthweight of 5.31 kg admitted with respiratory distress and suffered several complications of macrosomia. There is a need to closely monitor neonates for early diagnosis and management of complications of macrosomia.
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Affiliation(s)
- Julius Nuwagaba
- Department of PediatricsLubaga HospitalKampalaUganda
- Department of Global Health SecurityMakerere University Infectious Diseases InstituteKampalaUganda
| | - Darshit Dave
- Department of PediatricsLubaga HospitalKampalaUganda
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10
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Lemieux P, Benham JL, Donovan LE, Moledina N, Pylypjuk C, Yamamoto JM. The association between gestational diabetes and stillbirth: a systematic review and meta-analysis. Diabetologia 2022; 65:37-54. [PMID: 34676425 DOI: 10.1007/s00125-021-05579-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS Controversy exists over whether gestational diabetes increases the risk of stillbirth. The aim of this review was to examine the association between gestational diabetes and stillbirth. METHODS We performed searches of the published literature to May 2021. Study selection and data extraction were performed in duplicate by independent reviewers. Meta-analyses of summary measures were conducted using random-effect models for cohort and case-control studies separately. The study protocol was registered in PROSPERO (registration ID CRD42020166939). RESULTS From 9981 citations, 419 were identified for full-text review and 73 met inclusion criteria (n = 70,292,090). There was no significant association between gestational diabetes and stillbirth in cohort studies (pooled OR 1.04 [95% CI 0.90, 1.21]; I2 86.1%) or in case-control studies (pooled OR 1.57 [95% CI 0.83, 2.98]; I2 94.8%). Gestational diabetes was associated with lower odds of stillbirth among cohort studies presenting with an adjusted OR (pooled OR 0.78 [95% CI 0.68, 0.88]; I2 42.7%). Stratified analyses by stillbirth ≥28 weeks' gestation, studies published prior to 2013 and studies identified as low quality demonstrated a significantly higher odds of stillbirth in meta-regression (p = 0.016, 0.023 and 0.005, respectively). Egger's test for all included cohort studies (p = 0.018) suggests publication bias for the main meta-analysis. CONCLUSIONS/INTERPRETATION Given the substantial heterogeneity across studies, there are insufficient data to define the relationship between stillbirth and gestational diabetes adequately. In the main analyes, gestational diabetes was not associated with an increased risk of stillbirth. However, heterogeneity across studies means this finding should be interpreted cautiously.
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Affiliation(s)
- Patricia Lemieux
- Department of Medicine, CHU de Québec - University Laval, Quebec City, QC, Canada
| | - Jamie L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lois E Donovan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nadia Moledina
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christy Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Yamamoto
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
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11
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Zhang J, An W, Lin L. The Association of Prepregnancy Body Mass Index with Pregnancy Outcomes in Chinese Women. J Diabetes Res 2022; 2022:8946971. [PMID: 35378845 PMCID: PMC8976670 DOI: 10.1155/2022/8946971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
Our study was to evaluate the association between prepregnancy body mass index (BMI) and pregnancy outcomes. A total of 1546 women who attended prenatal care clinics and delivered at the Peking University International Hospital, Beijing, China, from October 2018 to April 2020 was included. This research explored gestational, perinatal, and postpartum outcomes, including gestational diabetes, anemia, preeclampsia, preterm premature rupture of membranes (PPROM), and postpartum hemorrhage. Participants were divided into underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI ≤ 23.9 kg/m2), overweight (24 kg/m2 ≤ BMI ≤ 27.9 kg/m2), and obese (BMI ≥ 28 kg/m2) groups. Logistic regression analysis was used to analyze the association between prepregnancy BMI and pregnancy outcomes, and odds ratio (OR) with 95% confidence interval (95% CI) was calculated. After adjusting potential confounders, the risk of PPROM was higher in the underweight group than the normal weight group (OR = 1.864, 95% CI: 1.269-2.737, P < 0.01). Prepregnancy obesity was associated with higher odds of gestational diabetes (OR = 2.649, 95% CI: 1.701-4.126, P < 0.001) and preeclampsia (OR = 3.654, 95% CI: 1.420-9.404, P < 0.01) than the normal weight group, whereas it correlated with the lower risk of anemia (OR = 0.300, 95% CI: 0.128-0.704, P < 0.01). Our findings may provide evidence for the importance of keeping normal weight for Chinese women when preparing for pregnancy.
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Affiliation(s)
- Jing Zhang
- Division of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
| | - Wensheng An
- Division of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
| | - Li Lin
- Division of Gynecology and Obstetrics, Peking University International Hospital, Beijing, China
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12
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Deischinger C, Harreiter J, Leitner K, Wattar L, Baumgartner-Parzer S, Kautzky-Willer A. Glypican-4 in pregnancy and its relation to glucose metabolism, insulin resistance and gestational diabetes mellitus status. Sci Rep 2021; 11:23898. [PMID: 34903856 PMCID: PMC8668887 DOI: 10.1038/s41598-021-03454-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022] Open
Abstract
Glypican-4 (GPC-4) is an adipokine that enhances insulin receptor signaling. Plasma concentrations were found to be elevated in patients with prediabetes but reduced in type 2 diabetes mellitus. No study on Glypican-4 in pregnancy and pregnancy-related insulin resistance has been published yet. GPC-4 levels were investigated in 59 overweight women throughout their pregnancy at the Medical University of Vienna. GPC-4 levels, fasting insulin, fasting glucose, estradiol, liver and renal parameters, and markers of bone development were assessed before the < 21st week of gestation (GW), and at GW 35-37. GPC-4 levels increased from < 21 GW (mean = 2.38 pg/ml, SD = 0.68 pg/ml) to GW 35-37 (mean = 2.96 pg/ml, SD = 0.77 pg/ml, p < 0.001). At the same time, GPC-4 levels correlated negatively with estimated glomerular filtration rate (eGFR), serum protein and serum albumin levels and were positively related to creatinine and uric acid levels at GW 35-37. Concerning glucose metabolism, GPC-4 levels were inversely related to ISSI-2, fasting insulin and HOMA-IR, however, not significantly different between women with normal glucose tolerance (NGT) and GDM (p = 0.239). In conclusion, GPC-4 levels rose significantly during pregnancy, correlated negatively with fasting insulin and HOMA-IR but might not be related to gestational diabetes mellitus status.
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Affiliation(s)
- Carola Deischinger
- Clinical Division of Endocrinology and Metabolism, Gender Medicine Unit, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jürgen Harreiter
- Clinical Division of Endocrinology and Metabolism, Gender Medicine Unit, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Karoline Leitner
- Clinical Division of Endocrinology and Metabolism, Gender Medicine Unit, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Luna Wattar
- Clinical Division of Endocrinology and Metabolism, Gender Medicine Unit, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sabina Baumgartner-Parzer
- Clinical Division of Endocrinology and Metabolism, Gender Medicine Unit, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Clinical Division of Endocrinology and Metabolism, Gender Medicine Unit, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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13
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Fetal abdominal overgrowth is already present at 20-24 gestational weeks prior to diagnosis of gestational diabetes mellitus. Sci Rep 2021; 11:23821. [PMID: 34893662 PMCID: PMC8664824 DOI: 10.1038/s41598-021-03145-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022] Open
Abstract
Fetal abdominal obesity (FAO) was detected at the time of gestational diabetes mellitus (GDM) diagnosis at 24–28 gestational weeks (GW) in older (≥ 35 years) and/or obese (≥ body mass index 25 kg/m2) women and persisted until delivery. We investigated whether FAO is already present at 20–24 GW. Medical records of 7820 singleton pregnancy including 384 GDM were reviewed. Fetal abdominal overgrowth was assessed by the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter or femur length, respectively. FAO was defined as FAOR ≥ 90th percentile. FAORs measured at 20–24 GW in older and/or obese but not in young and non-obese GDM subjects were significantly higher than those in NGT subjects. Relative to NGT subjects without FAO at 20–24 GW, odds ratios for exhibiting FAO at GDM diagnosis and large for gestational age in GDM with FAO at 20–24 GW were 10.15 and 5.57, and their primary cesarean delivery rate was significantly higher than those in GDM without FAO (44% vs. 29%). Earlier diagnosis and active interventions of GDM well before 20–24 GW might be necessary to prevent FAO in the older and/or obese women.
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14
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Lewis R, Gupta C, Punja R. Comparison of anthropometric measurements of foetuses in normal, gestational diabetes-affected, and hypertensive pregnancies. J Taibah Univ Med Sci 2021; 16:887-893. [PMID: 34899134 PMCID: PMC8626796 DOI: 10.1016/j.jtumed.2021.08.004] [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: 04/03/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Foetal anthropometry evaluates and monitors foetal development and assesses the nutritional state of the developing foetus. It is a vital indicator of the normalcy of foetal development in-utero. The most relevant parameters in foetal anthropometry are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Gestational diabetes mellitus (GDM) and gestational hypertension (GHTN) are the major reasons for variations in foetal development. In this study, we compare foetal anthropometric measurements taken using ultrasounds of normal, gestational diabetes-affected, and hypertensive pregnancies. METHOD In this study, a total of 615 anomaly scans were done between the gestational ages of 18-22 weeks from 2016 to 2018. The patients' data were collected from the register of the anomaly scanning room. The foetal anthropometric parameters measured BPD, HC, AC, and FL. RESULTS All the measurements including BPD, HC, and AC were lower in foetuses affected by GHTN, and all the measurements, including FL, were higher in foetuses affected by GDM than in normal pregnancies. A post-hoc analysis using Tukey's test showed that each foetal parameter had a significant correlation with pregnancy-related co-morbidities (p-value < 0.05). CONCLUSION It is clear from our study that the foetuses of mothers with GDM showed a consistent variation of 10 mm above the normal average in terms of the BPD, HC, AC, and FL measurements. The GHTN-affected foetuses had averages that were lower than normal for BPD, HC, and AC.
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Affiliation(s)
- Rhea Lewis
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Chandni Gupta
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Rohini Punja
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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15
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An Audit of Pre-Pregnancy Maternal Obesity and Diabetes Screening in Rural Regional Tasmania and Its Impact on Pregnancy and Neonatal Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212006. [PMID: 34831762 PMCID: PMC8619569 DOI: 10.3390/ijerph182212006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
Maternal obesity in pregnancy, a growing health problem in Australia, adversely affects both mothers and their offspring. Gestational diabetes mellitus (GDM) is similarly associated with adverse pregnancy and neonatal complications. A low-risk digital medical record audit of antenatal and postnatal data of 2132 pregnant mothers who gave birth between 2016–2018 residing in rural-regional Tasmania was undertaken. An expert advisory group guided the research and informed data collection. Fifty five percent of pregnant mothers were overweight or obese, 43.6% gained above the recommended standards for gestational weight gain and 35.8% did not have an oral glucose tolerance test. The audit identified a high prevalence of obesity among pregnant women and low screening rates for gestational diabetes mellitus associated with adverse maternal and neonatal pregnancy outcomes. We conclude that there is a high prevalence of overweight and obesity among pregnant women in rural regional Tasmania. Further GDM screening rates are low, which require addressing.
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16
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Recurrence of Gestational Diabetes Mellitus: To Assess Glucose Metabolism and Clinical Risk Factors at the Beginning of a Subsequent Pregnancy. J Clin Med 2021; 10:jcm10204794. [PMID: 34682918 PMCID: PMC8540668 DOI: 10.3390/jcm10204794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022] Open
Abstract
Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing hyperglycemia in a subsequent pregnancy. This study aimed to assess parameters of glucose metabolism at the beginning of a subsequent pregnancy in women with a history of GDM. This prospective cohort study included 706 women who had at least one previous pregnancy (120 with prior GDM and 586 without GDM history). All study participants received a broad risk evaluation and laboratory testing at the beginning of a subsequent pregnancy and were followed up until delivery to assess GDM status, risk factors for GDM recurrence, and pregnancy outcomes. Women with a history of GDM exhibited lower insulin sensitivity and subtle impairments in β-cell function associated with subclinical hyperglycemia already at the beginning of a subsequent pregnancy compared to women without GDM history. This was associated with a markedly increased risk for the later development of GDM (OR: 6.59, 95% CI 4.34 to 10.09, p < 0.001). Early gestational fasting glucose and HbA1c were identified as the most important predictors. Mothers with a history of GDM showed marked alterations in glucose metabolism at the beginning of a subsequent pregnancy, which explains the high prevalence of GDM recurrence in these women.
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Quaresima P, Visconti F, Interlandi F, Puccio L, Caroleo P, Amendola G, Morelli M, Venturella R, Di Carlo C. Awareness of gestational diabetes mellitus foetal-maternal risks: an Italian cohort study on pregnant women. BMC Pregnancy Childbirth 2021; 21:692. [PMID: 34627198 PMCID: PMC8502344 DOI: 10.1186/s12884-021-04172-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/01/2021] [Indexed: 01/30/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) incidence is increasing worldwide. It represents a major risk factor for adverse foetal-maternal outcomes. Awareness among women in regard to GDM-related risks (in particular foetus ones) has been proven to have an impact on compliance with recommendations. Therefore we aimed to evaluate the efficacy of our post-diagnosis counselling, that informs affected women of the GDM related risks for complications, in determining an adequate level of understanding. Method This is a cohort study involving 400 women undergoing the 24-28 weeks 75 g oral glucose tolerance test. Two hundred women diagnosed with GDM received the post-diagnosis counselling (treatment group) and two hundred women diagnosed without did not receive any counselling (control group). Both populations were surveyed with a 5 question questionnaire regarding their awareness about GDM foetal-maternal related risks. Their level of education about GDM foetal-maternal related risks, estimated according to the number of correct answers, was scored as: primary (score 0-1), secondary (score 2-3) or tertiary (score 4-5). Results Most of the women in the treatment group after receiving the post-diagnosis counselling have demonstrated a secondary level of education 132/200 (66%). Their mean level of awareness was higher in comparison to the control group 2.6 ± 1.8 (SD) versus 2.14 ± 1.8 (SD) p value = 0.012. In particular, they’ve demonstrated to be more aware of the risks for the foetus to become macrosomic (p = 0.004) or to die in utero (p = 0.0001). A high level of education and to have had previous pregnancies positively affected correct answers. Conclusions Our post-diagnosis counselling has played a role in improving women awareness about GDM foetal-maternal related risks. Future study will explore the impact of women’s level of awareness on glycaemic control.
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Affiliation(s)
- Paola Quaresima
- Unit of Obstetrics and Gynaecology, Department of Clinical and experimental Medicine, "Magna Græcia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Federica Visconti
- Unit of Obstetrics and Gynaecology, Department of Clinical and experimental Medicine, "Magna Græcia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Fabiana Interlandi
- Unit of Obstetrics and Gynaecology, Department of Clinical and experimental Medicine, "Magna Græcia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Luigi Puccio
- Complex Operative Structure Endocrinology-Diabetology, Pugliese-Ciaccio Hospital, 8100, Catanzaro, Italy
| | - Patrizia Caroleo
- Complex Operative Structure Endocrinology-Diabetology, Pugliese-Ciaccio Hospital, 8100, Catanzaro, Italy
| | - Giuseppina Amendola
- Unit of Obstetrics and Gynaecology, Department of Clinical and experimental Medicine, "Magna Græcia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Michele Morelli
- Complex Operative Structure Obstetrics and Gynaecology, Annunziata Hospital, 87100, Cosenza, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynaecology, Department of Clinical and experimental Medicine, "Magna Græcia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Costantino Di Carlo
- Unit of Obstetrics and Gynaecology, Department of Clinical and experimental Medicine, "Magna Græcia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
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Incidental diagnosis of a pancreatic adenocarcinoma in a woman affected by gestational diabetes mellitus: case report and literature review. Am J Obstet Gynecol MFM 2021; 3:100471. [PMID: 34454160 DOI: 10.1016/j.ajogmf.2021.100471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 12/17/2022]
Abstract
Pancreatic cancer is rarely diagnosed during pregnancy; it usually manifests with symptoms such as epigastric pain, vomiting, weight loss, and jaundice, rarely mimicking the hemolysis, elevated liver enzymes, and low platelet count syndrome. It has been postulated that there exists a correlation between the diagnosis of gestational diabetes mellitus and the occurrence of pancreatic cancer later in life. We conducted an expert literature review of the 31 available documented pancreatic cancer cases that were diagnosed during pregnancy. We also report pancreatic adenocarcinoma incidentally suspected in an asymptomatic woman affected by gestational diabetes mellitus; the woman was undergoing a fetal growth scan.
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Lackovic M, Milicic B, Mihajlovic S, Filimonovic D, Jurisic A, Filipovic I, Rovcanin M, Prodanovic M, Nikolic D. Gestational Diabetes and Risk Assessment of Adverse Perinatal Outcomes and Newborns Early Motoric Development. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:741. [PMID: 34440947 PMCID: PMC8401518 DOI: 10.3390/medicina57080741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022]
Abstract
Background and Objectives: The aim of this study was to analyze the presence of gestational diabetes mellitus (GDM) on maternal and fetal perinatal parameters, as well to evaluate the influence of GDM on neonatal early motoric development. Materials and Methods: In this prospective study, we evaluated 203 eligible participants that were admitted to obstetrics department for a labor. GDM was assessed by evaluation of maternal parameters, fetal parameters, as well its impact on infants early motoric development (Alberta Infant Motor Scale-AIMS). Results: Presence of GDM was significantly positively associated with: pre-pregnancy weight, obesity degree, weight at delivery, gestational weight gain (GWG), body mass index (BMI) at delivery, GWG and increased pre-pregnancy BMI, glucose levels in mother's venous blood after the delivery, positive family history for cardiovascular disease, pregnancy-related hypertension, congenital thrombophilia, drug use in pregnancy, large for gestational age (LGA), mode of delivery (Cesarean section and instrumental delivery). Likewise, GDM association was detected for tested ultrasound parameters (biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femoral length (FL)), length at birth, birth weight, newborn's head circumference, newborn's chest circumference, AIMS supination and pronation at three months, AIMS supination, pronation, sitting and standing at six months. Only Amniotic Fluid Index and AIMS supination at three months of infant's age remained significantly associated in multivariate regression model. Conclusions: The presence of significant positive association of numerous tested parameters in our study on perinatal outcomes and early motoric development, points to the necessity of establishing appropriate clinical decision-making strategies for all pregnant woman at risk and emphasize the importance of providing adequate glycaemia control options and further regular follow ups during the pregnancy.
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Affiliation(s)
- Milan Lackovic
- Clinical Hospital Center “Dr. Dragiša Mišović”, 11000 Belgrade, Serbia; (M.L.); (S.M.); (I.F.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.F.); (A.J.); (M.R.)
| | - Biljana Milicic
- Faculty of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Sladjana Mihajlovic
- Clinical Hospital Center “Dr. Dragiša Mišović”, 11000 Belgrade, Serbia; (M.L.); (S.M.); (I.F.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.F.); (A.J.); (M.R.)
| | - Dejan Filimonovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.F.); (A.J.); (M.R.)
- Obstetrics/Gynecology Clinic “Narodni Front”, 11000 Belgrade, Serbia
| | - Aleksandar Jurisic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.F.); (A.J.); (M.R.)
- Obstetrics/Gynecology Clinic “Narodni Front”, 11000 Belgrade, Serbia
| | - Ivana Filipovic
- Clinical Hospital Center “Dr. Dragiša Mišović”, 11000 Belgrade, Serbia; (M.L.); (S.M.); (I.F.)
| | - Marija Rovcanin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.F.); (A.J.); (M.R.)
- Obstetrics/Gynecology Clinic “Narodni Front”, 11000 Belgrade, Serbia
| | - Maja Prodanovic
- Cardiology Clinic, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.F.); (A.J.); (M.R.)
- Physical Medicine and Rehabilitation Department, University Children’s Hospital, Tirsova 10, 11000 Belgrade, Serbia
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20
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Adwani N, Fouly H, Omer T. Assessing the Impact of Obesity on Pregnancy and Neonatal Outcomes among Saudi Women. NURSING REPORTS 2021; 11:279-290. [PMID: 34968205 PMCID: PMC8608084 DOI: 10.3390/nursrep11020027] [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: 03/13/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The rising prevalence of obesity has a significant impact on obstetrics practice regarding maternal and perinatal complications includes recurrent miscarriage, pregnancy-induced hypertension, preeclampsia, gestational diabetes, and prolonged labor. Objective: To assess the impact of obesity on pregnancy and neonatal outcomes among Saudi women. Methods: The study was conducted at King Abdul-Aziz Medical City, Jeddah. Design: A cross-sectional retrospective design. A total number of 186 participants were recruited from July to December 2018 according to eligibility criteria. The data were collected retrospectively by a review of the chart records of the labor and delivery department. Results: The mean (SD) age of participants was 31.94 (5.67) years old; two-thirds were in obesity class I. There was a significant association between obesity and pre-existing thyroid disease and induced hypertension class III. However, episiotomy showed that obesity class III was significantly different from obesity class II. Conclusion: This study concludes obesity affects the outcomes of pregnant Saudi associations between obesity and preeclampsia, perineal tears, and episiotomy variables, and other variables reflect no associations. Recommendations: Further studies are needed to generalize the results. This study endorses the pregnant women start the antenatal follow-up from 1st trimester so, the data will be available on the system for research.
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Affiliation(s)
- Nadia Adwani
- Al-Thagher Hospital, Jeddah 22361, Saudi Arabia;
| | - Howieda Fouly
- Faculty of Nursing, Assiut University, Asyut 71115, Egypt
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah 21423, Saudi Arabia;
- Correspondence: or
| | - Tagwa Omer
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah 21423, Saudi Arabia;
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21
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Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review. Int J Mol Sci 2021; 22:2965. [PMID: 33803995 PMCID: PMC7999044 DOI: 10.3390/ijms22062965] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
In spite of the huge progress in the treatment of diabetes mellitus, we are still in the situation that both pregestational (PGDM) and gestational diabetes (GDM) impose an additional risk to the embryo, fetus, and course of pregnancy. PGDM may increase the rate of congenital malformations, especially cardiac, nervous system, musculoskeletal system, and limbs. PGDM may interfere with fetal growth, often causing macrosomia, but in the presence of severe maternal complications, especially nephropathy, it may inhibit fetal growth. PGDM may also induce a variety of perinatal complications such as stillbirth and perinatal death, cardiomyopathy, respiratory morbidity, and perinatal asphyxia. GDM that generally develops in the second half of pregnancy induces similar but generally less severe complications. Their severity is higher with earlier onset of GDM and inversely correlated with the degree of glycemic control. Early initiation of GDM might even cause some increase in the rate of congenital malformations. Both PGDM and GDM may cause various motor and behavioral neurodevelopmental problems, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most complications are reduced in incidence and severity with the improvement in diabetic control. Mechanisms of diabetic-induced damage in pregnancy are related to maternal and fetal hyperglycemia, enhanced oxidative stress, epigenetic changes, and other, less defined, pathogenic mechanisms.
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Affiliation(s)
- Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Maria Becker
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
- Medical Center, Hadassah Hebrew University, Mount Scopus, Jerusalem 91240, Israel
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22
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Bashir M, Ibrahim I, Eltaher F, Beer S, Baagar K, Aboulfotouh M, Konje JC, Abou-Samra AB. Screening pregnant women in a high-risk population with WHO-2013 or NICE diagnostic criteria does not affect the prevalence of gestational diabetes. Sci Rep 2021; 11:5604. [PMID: 33692395 PMCID: PMC7946879 DOI: 10.1038/s41598-021-84918-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/19/2021] [Indexed: 12/12/2022] Open
Abstract
There are currently several diagnostic criteria for gestational diabetes (GDM). Both the WHO -2013 and NICE diagnose GDM based on a single step 75 g OGT; however; each uses different glucose thresholds. Previous studies have shown that the prevalence of GDM using the NICE criteria (GDM-N) is lower than that using the WHO-2013 criteria (GDM-W). Qatar has national diabetes in pregnancy program in which all pregnant women undergo OGTT screening using the WHO-2013 criteria. This study aims to define the prevalence of GDM using both criteria in a high-risk population. This retrospective study included 2000 women who underwent a 75 g (OGTT) between Jan 2016 and Apr 2016 and excluded patients with known pre-conception diabetes, multiple pregnancy, and those who did not complete the OGTT. We then classified the women into GDM-W positive, GDM-N positive but GDM-W negative, and normal glucose tolerance (NGT) population. A total of 1481 women (74%) had NGT using the NICE or the WHO-2013 criteria. The number of patients who met both criteria was 279 subjects (14%) with a good agreement (Kappa coefficient 0.67, p < 0.001). The NICE and the WHO-2013 criteria were discordant in 240 subjects (12% of the cohort); 6.7% met the WHO -2013 criteria only and only 5.3% met the NICE criteria. The frequency of pre-eclampsia, pre-term delivery, Caesarean-section, LGA and neonatal ICU admissions were significantly increased in the GDM-W group. However, the GDM-N positive but GDM-W negative had no increased risk of maternal or fetal complications apart from pregnancy-induced hypertension. The WHO-2013 and the NICE criteria classified a similar proportion of pregnant women, 21.5% and 20.1%, respectively, as having GDM; however, they were concordant in only 14% of the cases. Women who are GDM-N positive but GDM-W negative are not at increased risk of maternal and fetal pregnancy complications, except for pregnancy-induced hypertension. As the NICE criteria are more specific to the UK population, we would recommend the use of the WHO-2013 criteria to diagnose GDM in the MENA region and possibly other regions that do not have the same set-up as the UK.
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Affiliation(s)
- Mohammed Bashir
- Qatar Metabolic Institute, Endocrine Department, Hamad Medical Corporation, Doha, Qatar.
- Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar.
| | | | - Fatin Eltaher
- Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Stephen Beer
- Qatar Metabolic Institute, Endocrine Department, Hamad Medical Corporation, Doha, Qatar
- Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Baagar
- Qatar Metabolic Institute, Endocrine Department, Hamad Medical Corporation, Doha, Qatar
- Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute, Endocrine Department, Hamad Medical Corporation, Doha, Qatar
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23
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Tartaglione L, di Stasio E, Sirico A, Di Leo M, Caputo S, Rizzi A, Caneschi A, De Carolis S, Pitocco D, Lanzone A. Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy. J Diabetes Res 2021; 2021:9987646. [PMID: 34476261 PMCID: PMC8408006 DOI: 10.1155/2021/9987646] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/06/2021] [Accepted: 08/06/2021] [Indexed: 12/15/2022] Open
Abstract
Continuous glucose monitoring (CGM) might be an effective tool to improve glycemic control in gestational diabetes mellitus (GDM). Few data are available about its utilization as a diagnostic tool to find potential alterations of glycemia in subjects with normal oral glucose tolerance test (OGTT). In this preliminary prospective real-life observational study, we aimed to analyze the glycemic pattern in normal and gestational diabetes mellitus (GDM) women by continuous glucose monitoring (CGM) in order to detect potential differences between the two groups and glycemic alterations despite a normal OGTT. After the screening for GDM, subjects were connected to a CGM system for seven consecutive days. The areas under the curve of the first 60 minutes after each meal and 60 minutes before breakfast were analyzed. Women with normal OGTT that during CGM showed impaired glycemic values (more than 95 fasting or more than 140 one hour after meals or more than 120 two hours after meals) performed one week of self-monitoring of blood glucose (SMBG). After OGTT, 53 women considered normal and 46 affected by GDM were included. CGM parameters did not show any differences between the two groups with impaired glycemic excursions found in both groups. After CGM period, 33 women with normal OGTT showed abnormal glycemic patterns. These 33 women then performed one week of SMBG. After evaluation of one week of SMBG, 21 required diet therapy and 12 required insulin treatment and were followed until the delivery. An increase in gestational weight gain was observed in normal women with normal OGTT but this was not significant. No significant data were found regarding neonatal outcomes in the two groups of women. In conclusion, CGM use in pregnancy might help to detect glycemic fluctuations in women with normal OGTT, improving their treatment and outcomes.
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Affiliation(s)
- Linda Tartaglione
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico di Stasio
- Department of Clinical Biochemistry, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angelo Sirico
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Fondazione Polclinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Di Leo
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Caputo
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Agnese Caneschi
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Fondazione Polclinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sara De Carolis
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Fondazione Polclinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Fondazione Polclinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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