Associations between Gestational Diabetes and Anxiety or Depression: A Systematic Review

A holistic lifestyle mobile health intervention for the prevention of type 2 diabetes and common mental disorders in Asian women with a history of gestational diabetes: a randomised control trial with 3-year follow-up protocol

BACKGROUND

Women with a history of gestational diabetes mellitus (GDM) are 12-fold more likely to develop type 2 diabetes (T2D) 4-6 years after delivery than women without GDM. Similarly, GDM is associated with the development of common mental disorders (CMDs) (e.g. anxiety and depression). Evidence shows that holistic lifestyle interventions focusing on physical activity (PA), dietary intake, sleep, and mental well-being strategies can prevent T2D and CMDs. This study aims to assess the effectiveness of a holistic lifestyle mobile health intervention (mHealth) with post-GDM women in preventing T2D and CMDs in a community setting in Singapore.

METHODS

The study consists of a 1-year randomised controlled trial (RCT) with a 3-year follow-up period. Post-GDM women with no current diabetes diagnosis and not planning to become pregnant will be eligible for the study. In addition, participants will complete mental well-being questionnaires (e.g. depression, anxiety, sleep) and their child's socio-emotional and cognitive development. The participants will be randomised to either Group 1 (Intervention) or Group 2 (comparison). The intervention group will receive the "LVL UP App", a smartphone-based, conversational agent-delivered holistic lifestyle intervention focused on three pillars: Move More (PA), Eat Well (Diet), and Stress Less (mental wellbeing). The intervention consists of health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), slow-paced breathing exercises, a step tracker (including brisk steps), a low-burden food diary, and a journaling tool. Women from both groups will be provided with an Oura ring for tracking physical activity, sleep, and heart rate variability (a proxy for stress), and the "HAPPY App", a mHealth app which provides health promotion information about PA, diet, sleep, and mental wellbeing, as well as display body mass index, blood pressure, and results from the oral glucose tolerance tests. Short-term aggregate effects will be assessed at 26/27 weeks (midpoint) and a 1-year visit, followed by a 2, 3, and 4-year follow-up period.

DISCUSSION

High rates of progression of T2D and CMDs in women with post-GDM suggest an urgent need to promote a healthy lifestyle, including diet, PA, sleep, and mental well-being. Preventive interventions through a holistic, healthy lifestyle may be the solution, considering the inextricable relationship between physical and psychological health. We expect that holistic lifestyle mHealth may effectively support behavioural changes among women with a history of GDM to prevent T2D and CMDs.

TRIAL STATUS

The protocol study was approved by the National Healthcare Group in Singapore, Domain Specific Review Board (DSRB) [2023/00178]; June 2023. Recruitment began on October 18, 2023.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05949957. The first submission date is June 08, 2023.

Effects of Mindfulness-Based Interventions on Cardiometabolic-Related Adverse Pregnancy Outcomes: A Systematic Review

BACKGROUND

Growing evidence suggests maternal stress contributes to the development of adverse pregnancy outcomes that are associated with cardiovascular and cardiometabolic risk in birthing persons. Mindfulness-based interventions may positively affect psychological stress in pregnancy and, in turn, reduce stress. However, few study authors have examined the effects of mindfulness-based interventions on adverse pregnancy outcomes that heighten cardiovascular risk.

OBJECTIVE

The aim of this study was to appraise available literature examining the effects of mindfulness-based interventions delivered during pregnancy on adverse pregnancy outcomes associated with future cardiovascular and cardiometabolic disease risk.

METHODS

In this systematic review, multiple electronic databases were searched using major keywords, including "mindfulness-based intervention," "pregnancy," "preterm delivery," "gestational diabetes," "small for gestational age," "preeclampsia," and "hypertension in pregnancy" during February 2023.

RESULTS

Six studies using mindfulness-based interventions during pregnancy were included. The review indicated that these interventions were largely effective at reducing prenatal stress; however, the overall effects of interventions were mixed concerning their impact on pregnancy complications. Study authors examining the effects on gestational diabetes-related outcomes reported significant improvements in blood glucose levels, hemoglobin A 1c , and oral glucose tolerance. Outcomes were mixed or inconclusive related to the effects of interventions on the incidence of preterm birth, birth of a small-for-gestational-age newborn, and preeclampsia.

CONCLUSIONS

Mitigating cardiovascular and cardiometabolic risk-associated adverse pregnancy outcomes through mindfulness-based approaches may represent an emerging field of study. The few studies and limited, mixed findings synthesized in this review indicate that high-validity studies are warranted to examine the effects of mindfulness-based interventions on pregnancy complications that contribute to cardiovascular-related maternal morbidity and suboptimal life course health for diverse birthing persons.

Perceived stress, marital satisfaction, and prenatal depression among couples with gestational diabetes mellitus

OBJECTIVE

This study aimed to explore the prevalence of prenatal depression and to determine the dyadic relationship between perceived stress, marital satisfaction, and prenatal depression in pregnant women with gestational diabetes mellitus (GDM) and their partners.

BACKGROUND

GDM during pregnancy is a very stressful event for couples. However, previous studies have largely focused on pregnant women, with few including their partners.

METHODS

A cross-sectional study was conducted in Guangzhou, China, from 30 July to 2 December 2021. Three hundred fourteen couples with GDM completed the Perceived Stress Scale, Locke-Wallace Marital Adjustment Scale, and Edinburgh Postnatal Depression Scale. Dyadic analysis was conducted using the actor-partner interdependence mediation model.

RESULTS

The prevalence of depressive symptoms was 13.4% in pregnant women with GDM and 8.3% in their partners. Regarding the actor effects, perceived stress was positively associated with prenatal depression in pregnant women with GDM and their partners, respectively, and marital satisfaction acted as a mediating role. Regarding the partner effects, paternal perceived stress was negatively associated with maternal marital satisfaction, and maternal marital satisfaction mediated the association between paternal perceived stress and maternal prenatal depression.

CONCLUSIONS

Dyadic effects of perceived stress, marital satisfaction, and prenatal depression exist in couples with GDM.

The Influence of Perinatal Psychological Changes on Infant Neurodevelopment in Shanghai, China: A Longitudinal Group-based Trajectory Analysis

OBJECTIVE

This prospective cohort study, conducted at the Fenglin Community Health Service Center (FCHC) in Xuhui District, Shanghai, aimed to investigate the impact of maternal psychological status on offspring neurodevelopment.

METHODS

A total of 430 mother-child pairs were included, with pregnant women enrolled between February 18, 2020, and April 19, 2021. Face-to-face interviews and electronic data collection on demographic characteristics, health conditions and medical history were employed at various stages of pregnancy and postpartum. Maternal depression and anxiety were assessed using the PHQ-9 and GAD-7 scales, while offspring neurodevelopment was measured at six months using the Ages and Stages Questionnaire 3rd Edition (ASQ-3). In statistical analyses, group-based trajectory modeling (GBTM) was employed to identify the latent groups for maternal psychological trajectories, including depression and anxiety, and logistic regression was used to explore associations between maternal psychological trajectories and offspring neurodevelopment, adjusting for potential confounders.

RESULTS

Five latent trajectory groups were identified for both depression and anxiety, exhibiting distinct patterns over time. Results indicated that maternal psychological trajectories were associated with various domains of offspring neurodevelopment, including communication, problem-solving, personal-social, and gross motor skills. Specifically, mothers in trajectory groups characterized by the highest level of depression or anxiety showed increased odds of offspring neurodevelopmental delays compared to reference groups.

CONCLUSION

Our findings underscore the importance of maternal mental health during the perinatal period and highlight the potential implications for offspring neurodevelopment. Further research is warranted to elucidate underlying mechanisms and inform targeted interventions to support maternal mental well-being and optimize offspring outcomes.

Increased Risk of Gestational Hypertension by Periconceptional Exposure to Ambient Air Pollution and Effect Modification by Prenatal Depression

BACKGROUND

Air pollution has been associated with gestational hypertension (GH) and preeclampsia, but susceptible windows of exposure and potential vulnerability by comorbidities, such as prenatal depression, remain unclear.

METHODS

We ascertained GH and preeclampsia cases in a prospective pregnancy cohort in Los Angeles, CA. Daily levels of ambient particulate matters (with a diameter of ≤10 μm [PM10] or ≤2.5 μm [PM2.5]), nitrogen dioxide, and ozone were averaged for each week from 12 weeks preconception to 20 gestational weeks. We used distributed lag models to identify susceptible exposure windows, adjusting for potential confounders. Analyses were additionally stratified by probable prenatal depression to explore population vulnerability.

RESULTS

Among 619 participants, 60 developed preeclampsia and 42 developed GH. We identified a susceptible window for exposure to PM2.5 from 1 week preconception to 11 weeks postconception: higher exposure (5 µg/m3) within this window was associated with an average of 8% (95% CI, 1%-15%) higher risk of GH. Among participants with probable prenatal depression (n=179; 32%), overlapping sensitive windows were observed for all pollutants from 8 weeks before to 10 weeks postconception with increased risk of GH (PM2.5, 16% [95% CI, 3%-31%]; PM10, 39% [95% CI, 13%-72%]; nitrogen dioxide, 65% [95% CI, 17%-134%]; and ozone, 45% [95% CI, 9%-93%]), while the associations were close to null among those without prenatal depression. Air pollutants were not associated with preeclampsia in any analyses.

CONCLUSIONS

We identified periconception through early pregnancy as a susceptible window of air pollution exposure with an increased risk of GH. Prenatal depression increases vulnerability to air pollution exposure and GH.

Influence of mHealth-Based Lifestyle Interventions on Symptoms of Anxiety and Depression of Women With Gestational Diabetes: A Meta-Analysis

BACKGROUND

Symptoms of anxiety and depression are common in women with gestational diabetes mellitus (GDM). Mobile health (mHealth)-based lifestyle interventions have been shown to be effective in improving glycemic control of these women.

PURPOSE/OBJECTIVE

The aim of the study was to evaluate the influence of mHealth-based lifestyle interventions on symptoms of anxiety and depression in women with GDM.

DESIGN

A systematic review and meta-analysis or randomized controlled trials.

SETTING

Clinical or community-based settings.

SAMPLE

Nine studies involving 1,168 pregnant women with GDM were included.

INTERVENTION

mHealth-based lifestyle interventions.

MEASURES

Symptoms of anxiety and depression quantitatively analyzed in clinical scales.

ANALYSIS

A systematic literature search was performed in electronic databases, including PubMed, Cochrane library, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure to obtain relevant randomized controlled studies. A random-effects model was used to pool the results by incorporating the impact of the potential heterogeneity.

RESULTS

Findings revealed that when compared to usual care, women who received mHealth-based lifestyle interventions had significant improvements in symptoms of anxiety (standardized mean difference [SMD]: -0.55, 95% CI [-0.77, -0.33], p < .001; I2 = 67%) and depression (SMD: -0.51, [-0.72, -0.29], p < .001; I2 = 65%). Sensitivity analyses by excluding one study at a time showed consistent results. Subgroup analyses showed similar results in mHealth achieved by phone, websites, and applications, in mHealth targeting diet and exercise with and without psychological support, in mHealth lead by nurse with and without other clinical specialists, and in studies with different evaluating tools for anxiety and depression.

CONCLUSIONS

mHealth-based lifestyle interventions could significantly improve the symptoms of anxiety and depression in women with GDM.

Understanding the role of childhood nurture, abuse, and stability on gestational diabetes in the Coronary Artery Risk Development in Young Adults study (CARDIA)

BACKGROUND

To estimate associations between facets of the maternal childhood family environment with gestational diabetes (GDM) and to test mediation by pre-pregnancy waist circumference.

METHODS

We used data from CARDIA, a cohort of individuals aged 18-30 years at baseline (1985-86), followed over 30 years (2016). We included participants with one or more pregnancies ≥ 20 weeks after baseline, without pre-pregnancy diabetes. The primary exposure was the Childhood Family Environment Scale (assessed year 15), including the total score and abuse, nurture, and stability subscales as continuous, separate exposures. The outcome was GDM (self-reported at each visit for each pregnancy). We fit log binomial models with generalized estimating equations to calculate risk ratios (RR) and 95% confidence intervals (CI), adjusting for age at delivery, parity, race (Black or White), and parental education. We used regression models with bootstrapped CIs to test mediation and effect modification by excess abdominal adiposity at the last preconception CARDIA visit (waist circumference ≥ 88 cm).

RESULTS

We included 1033 individuals (46% Black) with 1836 pregnancies. 130 pregnancies (7.1%) were complicated by GDM. For each 1 point increase on the abuse subscale (e.g., from "rarely or never" to "some or little of the time") there was a 30% increased risk of GDM (RR: 1.3, 95% CI: 1.0, 1.7). There was evidence of effect modification but not mediation by preconception abdominal adiposity.

CONCLUSIONS

A more adverse childhood family environment was associated with increased risk of GDM, with a stronger association among individuals with preconception waist circumference ≥ 88 cm.

The holistic maternity care needs of women with Gestational Diabetes Mellitus: A systematic review with thematic synthesis

PROBLEM

Models of care for women with gestational diabetes mellitus (GDM) have evolved in an ad hoc way and do not meet women's needs.

BACKGROUND

GDM affects 50,000 Australian women per annum with prevalence quadrupling in the last ten years. Many health services are struggling to provide a quality service. People with diabetes are calling for care that focuses on their wellbeing more broadly.

AIM

To examine the holistic (emotional, social, economic, and spiritual) care needs of women with GDM.

METHODS

Qualitative and mixed-methods studies capturing the healthcare experiences of women with GDM were searched for in CINAHL, Medline, Web of Science and Scopus. English-language studies published between 2011 and 2023 were included. Quality of studies was assessed using Crowe Critical Appraisal Tool and NVIVO was used to identify key themes and synthesise data.

FINDINGS

Twenty-eight studies were included, representing the experiences of 958 women. Five themes reflect women's holistic needs through their journey from initial diagnosis to postpartum: psychological impact, information and education, making change for better health, support, and care transition.

DISCUSSION

The biomedical, fetal-centric model of care neglects the woman's holistic wellbeing resulting in high levels of unmet need. Discontinuity between tertiary and primary services results in a missed opportunity to assist women to make longer term changes that would benefit themselves (and their families) into the future.

CONCLUSIONS

The provision of holistic models of care for this cohort is pivotal to improving clinical outcomes and the experiences of women with GDM.

Trajectories and associations of symptoms of mental health and well-being with insulin resistance and metabolic health in women with gestational diabetes

BACKGROUND

Gestational diabetes mellitus (GDM) is characterized by increased insulin resistance and carries perinatal and long-term risks for the mother and her offspring. There is a link between perinatal depression or anxiety and GDM. Mental health problems are associated with higher insulin resistance and could explain the underlying association between GDM and depression or anxiety symptoms. We investigated the trajectories and associations between symptoms of mental health and well-being with insulin resistance and metabolic health in women with GDM.

METHODS

This study included the control group (n = 106) of a randomized controlled trial in women with GDM that were followed-up during pregnancy and up to 1-year postpartum. We measured symptoms of mental health (Edinburgh Postnatal Depression Scale (EPDS), Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), well-being (The World Health Organization Well-Being Index (WHO-5)) and metabolic health, including insulin resistance variables (HOMA-insulin resistance (IR) and Matsuda Index of insulin sensitivity) as well as weight during pregnancy and in the postpartum.

RESULTS

Participants' pre pregnancy weight and BMI were 69.7 kg ± 16.1 and 25.9 kg/m2 ± 5.5 respectively. HOMA-IR was higher during pregnancy compared to 6-8 weeks postpartum and increased between 6-8 weeks and 1-year postpartum (all p < 0.05). Matsuda index decreased between 6-8 weeks and 1-year postpartum (p < 0.001). EPDS scores decreased between pregnancy and both 6-8 weeks and 1-year postpartum (all p < 0.05). HADS-A scores did not change between pregnancy and the postpartum. WHO-5 scores improved significantly from pregnancy and both 6-8 weeks and 1-year postpartum (p < 0.001). Correlation coefficients within outcome at the three different time points were high for metabolic measures and ranged between 0.94 and 0.96 for weight, from 0.77 to 0.89 for HOMA-IR and 0.64 for the Matsuda index (all p < 0.001). Mental health and well-being variables were moderately correlated in all three time points including r = 0.36-0.55 for the EPDS (p < 0.001), r = 0.58 for HADS (p < 0.001), and r = 0.43-0.52 for the WHO-5 (p < 0.01). After adjustment for age and pre-pregnancy BMI, Matsuda index was negatively associated with EPDS scores and positively associated to WHO-5 scores at 6-8 weeks postpartum. No other association between insulin resistance and mental health or well-being outcomes were found.

CONCLUSION

While insulin resistance fluctuated with values being lowest in the early postpartum and increasing thereafter, both depression and well-being scores decreased between pregnancy and the postpartum and did not change in the postpartum period. Intraindividual variability was larger for mental health and well-being than for metabolic health outcomes at different time points, indicating a higher plasticity for mental health and well-being outcomes that could be acted upon. We found only few associations between mental health and well-being and metabolic health outcomes.

Predictors of anxiety among pregnant women with gestational diabetes mellitus and their partners: The mediating role of marital satisfaction

AIMS

This study aims to examine the prevalence of anxiety symptoms and identify predictors of anxiety among pregnant women with gestational diabetes mellitus and their partners and explore the mediating role of marital satisfaction between maternal and paternal anxiety.

DESIGN

A cross-sectional study was conducted in Guangzhou, China, from July 2021 to May 2022.

METHODS

A total of 306 dyads of pregnant women with gestational diabetes mellitus and their partners completed the State-Trait Anxiety Inventory, Locke-Wallace Marital Adjustment Test and the socio-demographic and clinical data sheet.

RESULTS

The prevalence of anxiety symptoms was 32.4% and 36.6% in pregnant women with gestational diabetes mellitus and their partners, respectively. The predictors of maternal anxiety were paternal anxiety, maternal marital satisfaction, maternal monthly salary, fasting glucose value and 1-h glucose value. By contrast, the predictors of paternal anxiety were maternal anxiety, paternal marital satisfaction and paternal monthly salary. Moreover, the relationship between maternal and paternal anxiety was mediated by marital satisfaction.

CONCLUSIONS

The anxiety symptoms of pregnant women with gestational diabetes mellitus and their partners influence each other, and this relationship was mediated by marital satisfaction. Every couple should be screened for anxiety symptoms and treated as a team rather than focusing solely on the pregnant woman.

A qualitative study exploring partner involvement in the management of gestational diabetes mellitus: The experiences of women and partners

AIMS

The aims of the study were to explore the experiences of women with gestational diabetes mellitus (GDM) and their partners and examine the factors influencing partner involvement in GDM management, seeking to inform a targeted couple-based intervention.

DESIGN

A descriptive qualitative study.

METHODS

We conducted semi-structured interviews with 14 women with GDM and their partners. Participants were recruited through convenience sampling from a tertiary hospital in Xi'an, China. Data were analysed using thematic analysis.

RESULTS

Three themes and 12 subthemes were identified. Theme I: Women's expectations of their partner's involvement in GDM management-practical support and emotional support. Theme II: Partner involvement in GDM management-constructive involvement, unhelpful involvement with good intentions and insufficient involvement. Theme III: Factors that influence partner involvement in GDM-knowledge of GDM, GDM risk perception, health consciousness, attitudes towards the treatment plan, couple communication regarding GDM management, family roles and appraisal of GDM management responsibility.

CONCLUSION

Women desired practical and emotional support from partners. The types of partner involvement in GDM management varied. Some partners provided constructive support, while some partners' involvement was limited, non-existent or actively unhelpful. By combining these results with the factors influencing partner involvement, our findings may help healthcare professionals develop strategies to involve partners in GDM care and enhance women's ability to manage GDM.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Partner involvement in GDM care may help them understand and better attend to women's needs, thus improving their experience and potential outcomes. This study highlights novel factors that need to be considered in developing couple-based interventions for this population.

REPORTING METHOD

The reporting follows the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

Some patients were involved in data interpretation. There is no public contribution.

The COVID-19 pandemic and its impact on the development of gestational diabetes mellitus (GDM) in West Virginia

OBJECTIVE

To examine the rate of gestational diabetes mellitus (GDM) prevalence before and during the COVID-19 pandemic.

RESULTS

Analysis revealed that GDM prevalence was significantly higher during the COVID-19 pandemic compared to pre-pandemic (8.59 % vs 7.77 %). The risk of GDM was 12 % higher during the pandemic vs. pre-pandemic (aRR = 1.12, 95 % CI 1.06, 1.19) and the aRD = 0.95 % (95 % CI 0.56 %, 1.33 %) adjusting for maternal age and substance use in pregnancy.

CONCLUSIONS

GDM rates in WV increased from the period directly before the COVID-19 pandemic to during the COVID-19 pandemic. More research is needed to understand the pathophysiological mechanisms of pandemics and pandemic-related risk factors for this observed association. Supporting pregnant individuals during such events is critical to both maternal and child health.

PsyNBIOsis: Investigating the Association between Maternal Gestational Diabetes, Mental Health, Diet and Childhood Obesity Risk: Protocol for a Prospective, Longitudinal, Observational Study

BACKGROUND

Gestational diabetes mellitus (GDM) is associated with poorer maternal mental health (depression and anxiety). Maternal mental health and GDM are likely to influence diet, which in turn impacts the course of GDM. Maternal diet may also be directly or indirectly associated with changes in infant anthropometry. The aims of this study are to (1) examine the associations between maternal GDM, mental health and diet, and (2) evaluate the associations between these maternal factors, breastmilk composition and infant anthropometry.

METHODS

This prospective, observational, longitudinal cohort study compares a cohort of women with and without GDM. Maternal mental health and diet are assessed using validated questionnaires. Breastmilk composition is measured with the Human Milk Analyzer, and infant body composition is measured with air displacement plethysmography.

SIGNIFICANCE AND IMPACT

Once data have been collected, PsyNBIOsis will provide evidence for the associations between maternal mental health, GDM status and diet, and their impact on breastmilk composition and early infant growth. The results may inform the Developmental Origins of Health and Disease framework and provide data on which to build cost-effective interventions to prevent both the development of mental health issues in mothers and adverse growth patterns in infants.

Joint effects of prenatal exposure to air pollution and pregnancy-related anxiety on birth weight: A prospective birth cohort study in Ma'anshan, China

BACKGROUND

A growing number of studies have shown that prenatal exposure to chemical and non-chemical stressors has effects on fetal growth. The co-exposure of both better reflects real-life exposure patterns. However, no studies have included air pollutants and pregnancy-related anxiety (PrA) as mixtures in the analysis.

METHOD

Using the birth cohort study method, 576 mother-child pairs were included in the Ma'anshan Maternal and Child Health Hospital. Evaluate the exposure levels of six air pollutants during pregnancy using inverse distance weighting (IDW) based on the pregnant woman's residential address and air pollution data from monitoring stations. Prenatal anxiety levels were assessed using the PrA Questionnaire. Generalized linear regression (GLR), quantile g-computation (QgC) and bayesian kernel machine regression (BKMR) were used to assess the independent or combined effects of air pollutants and PrA on birth weight for gestational age z-score (BWz).

RESULT

The results of GLR indicate that the correlation between the six air pollutants and PrA with BWz varies depending on the different stages of pregnancy and pollutants. The QgC shows that during trimester 1, when air pollutants and PrA are considered as a whole exposure, an increase of one quartile is significantly negatively correlated with BWz. The BKMR similarly indicates that during trimester 1, the combined exposure of air pollutants and PrA is moderately correlated with a decrease in BWz.

CONCLUSION

Using the method of analyzing mixed exposures, we found that during pregnancy, the combined exposure of air pollutants and PrA, particularly during trimester 1, is associated with BWz decrease. This supports the view that prenatal exposure to chemical and non-chemical stressors has an impact on fetal growth.

Latent profile analysis and influencing factors of quality of life in pregnant women with gestational diabetes mellitus

PURPOSE

Gestational diabetes mellitus (GDM) negatively affects the quality of life of pregnant women and is influenced by several factors. Research to date treats pregnant women with gestational diabetes as a homogeneous group based on their quality of life. We attempted to identify subgroups based on self-reported quality of life and explored variables associated with subgroups.

METHODS

From September 1, 2020 to November 29, 2020, pregnant women with GDM from two hospitals in Guangdong Province were selected as subjects by convenience sampling method. Medical records provided sociodemographic data, duration of GDM, pregnancy status, and family history of diabetes. Participants completed validated questionnaires for quality of life, anxiety and depression. Latent profile analysis was used to identify profiles of quality of life in pregnant women with GDM, and then a mixed regression method was used to analyze the influencing factors of different profiles.

RESULTS

A total of 279 valid questionnaires were collected. The results of the latent profile analysis showed that the quality of life of pregnant women with GDM could be divided into two profiles: C1 "high worry-high support" group (75.6%) and C2 "low worry-low support" group (24.4%). Daily exercise duration and depression degree are negative influencing factors, making it easier to enter the C1 group (p < 0.05). Disease duration and family history of diabetes are positive influencing factors, making it easier to enter the C2 group (p < 0.05).

CONCLUSION

The quality of life of pregnant women with GDM had obvious classification characteristics. Pregnant women with exercise habits and depression are more likely to enter the "high worry-high support" group, and health care providers should guide their exercise according to exercise guidelines during pregnancy and strengthen psychological intervention. Pregnant women with a family history of diabetes and a longer duration of the disease are more likely to fall into the "low worry-low support" group. Healthcare providers can strengthen health education for them and improve their disease self-management abilities.

Pathway analysis of the impact of health literacy, social support and self-efficacy on self-management behaviors in pregnant women with gestational diabetes mellitus

Objective

The purpose of this study was to investigate the pathways by which health literacy (HL), social support, and self-efficacy influence self-management behaviors of pregnant women with Gestational diabetes mellitus (GDM) and the interrelationships between the variables.

Methods

A total of 565 pregnant women with GDM was recruited. The Demographic Characteristics Form, Health Literacy Scale, Perceived Social Support Scale, General Self-efficacy Scale and GDM Self-management Behavior Scale were used for data collection. Descriptive statistics, zero-ordered correlation analysis, and multiple linear regression analysis were performed on the variables; Structural Equation Model (SEM) were constructed for pathway analysis.

Results

A positive correlation was found between health literacy, social support, self-efficacy, and self-management behaviors among pregnant women with GDM after adjusting for age, education level, income level, work status, parity, and family history of diabetes (r ranging from 0.203 to 0.533). A further multiple linear regression analysis showed that functional HL, communicative HL, critical HL, social support, and self-efficacy were all independent influences on self-management behaviors and accounted for 36.3% of the variance. Communicative HL and critical HL explained the strongest self-management behaviors (β = 0.316 and 0.255, respectively, p < 0.001). The SEM model was suitable for χ2/DF = 2.860, RMSEA = 0.060, IFI = 0.953, TLI = 0.943, and CFI = 0.952. The results showed direct positive effects of health literacy on self-management behaviors and self-efficacy, direct positive effects of social support on health literacy and self-efficacy. Social support and self-efficacy have had no significant direct impact on self-management behaviors, but social support may indirectly influence self-management behaviors through the health literacy mediation role.

Conclusion

Healthcare providers should pay attention to the positive impacts of health literacy and social support on self-management behaviors of pregnant women with GDM. Improving the health literacy level of pregnant women with GDM should be the key point of intervention in practice, and the social support system should be fully mobilized to enhance emotional support and life support to promote the improvement of self-management behaviors.

Antenatal depression moderated the association between gestational diabetes mellitus and fetal hyperinsulinism

BACKGROUND

Gestational diabetes mellitus and antenatal depression are common comorbidities. However, the combined effects of antenatal depression and diabetes mellitus during pregnancy on fetal β-cell function are unknown.

OBJECTIVE

This study aimed to test whether the association of maternal gestational diabetes mellitus and glucose metabolism with cord blood C-peptide levels varies with antenatal depression.

STUDY DESIGN

Data on mother-child pairs (N=5734) from the Maternal and Infant Health Cohort Study in Hefei were analyzed. Gestational diabetes mellitus was diagnosed using the 75-g oral glucose tolerance test at 24 to 28 weeks of gestation. Antenatal depression was measured using the Edinburgh Postnatal Depression Scale during midpregnancy and late pregnancy. Cord blood samples were collected at delivery and tested for C-peptide levels.

RESULTS

A total of 1054 mothers (18.38%) were diagnosed with gestational diabetes mellitus. Gestational diabetes mellitus was associated with a 5.57 (95% confidence interval, 3.65-7.50) percentile higher cord blood C-peptide level. This association varied with depression severity: the differences in cord blood C-peptide percentile for gestational diabetes mellitus vs no gestational diabetes mellitus were 5.12 (95% confidence interval, 2.81-9.75) for nonantenatal depression, 7.36 (95% confidence interval, 2.85-13.38) for moderate antenatal depression, and 10.06 (95% confidence interval, 4.69-14.8) for severe antenatal depression in midpregnancy. Similar associations stratified by antenatal depression in late pregnancy were observed. Antenatal depression was significantly positively correlated with fetal hyperinsulinism in participants with gestational diabetes mellitus but not in participants without gestational diabetes mellitus.

CONCLUSION

Antenatal depression, which is related to maternal hyperglycemia, can aggravate the risk of fetal hyperinsulinism in early life.

Maternal anxiety during pregnancy and children's asthma in preschool age: The Ma'anshan birth cohort study

BACKGROUND

The fetal immune system and consequent elevated risk of asthma in childhood may be impacted by maternal anxiety during pregnancy. Limited studies have evaluated whether there was a sensitive period and cumulative effect of the relationship between prenatal anxiety and children's asthma.

METHODS

3131 mother-child pairs made up the study's sample from the Ma'anshan Birth Cohort Study in China. Maternal anxiety status was repeated three times using the pregnancy-related anxiety questionnaire in the 1st, 2nd and 3rd trimesters of pregnancy. Diagnostic information on asthma was collected three times at 24, 36, and 48 months of age.

RESULTS

After adjusting for confounders, children born to mothers with anxiety in the 1st, 2nd and 3rd trimesters of pregnancy all had an elevated risk of total asthma from 12 to 48 months of age. After further adjusting prenatal anxiety in the other trimesters, no association was observed between prenatal anxiety in any trimester and preschoolers' asthma. Children of mothers with persistently high anxiety score trajectory during pregnancy had an elevated risk of total asthma and high prevalence trajectory of asthma. Cumulative effects analysis showed that the more frequent the mother's anxiety, the higher the risk of her offspring developing a high prevalence trajectory of asthma from 12 to 48 months of age. The results of the subgroup analysis by age showed similar associations overall.

CONCLUSIONS

Maternal antenatal anxiety was associated with an elevated risk of preschool children's asthma, and a possible cumulative effect was observed. Maternal mental health conditions during pregnancy should receive constant attention throughout pregnancy, not just during one period.

The Role of the Adrenal-Gut-Brain Axis on Comorbid Depressive Disorder Development in Diabetes

Diabetic patients are more affected by depression than non-diabetics, and this is related to greater treatment resistance and associated with poorer outcomes. This increase in the prevalence of depression in diabetics is also related to hyperglycemia and hypercortisolism. In diabetics, the hyperactivity of the HPA axis occurs in parallel to gut dysbiosis, weakness of the intestinal permeability barrier, and high bacterial-product translocation into the bloodstream. Diabetes also induces an increase in the permeability of the blood-brain barrier (BBB) and Toll-like receptor 4 (TLR4) expression in the hippocampus. Furthermore, lipopolysaccharide (LPS)-induced depression behaviors and neuroinflammation are exacerbated in diabetic mice. In this context, we propose here that hypercortisolism, in association with gut dysbiosis, leads to an exacerbation of hippocampal neuroinflammation, glutamatergic transmission, and neuronal apoptosis, leading to the development and aggravation of depression and to resistance to treatment of this mood disorder in diabetic patients.

Relevance of Serum Levels and Functional Genetic Variants in Vitamin D Receptor Gene among Saudi Women with Gestational Diabetes Mellitus

Background: This study explored the association between ApaI-TaqI Single Nucleotide Polymorphisms (SNPs) in a Vitamin D receptor (VDR) and the risk of Gestational Diabetes Mellitus (GDM) in Saudi women, along with the serum levels of vitamin D. Methods: Ninety women with GDM and 90 non-GDM women were enrolled, based on the inclusion and exclusion criteria for pregnant women enrolled in a single-center study. Blood samples were retrieved from 180 pregnant women using ethylenediaminetetraacetic acid (EDTA) tubes. Serum samples were used to measure the vitamin D, 25-hydroxyvitamin D (25(OH)D or calcidiol), and lipid profiles. Blood was used to measure the hemoglobin A1c levels and to isolate the DNA. The polymerase chain reaction (PCR) was performed for the ApaI (rs79785232), BsmI (rs1544410), FokI (rs2228570), and TaqI (rs731236) SNPs in the VDR gene using restriction fragment length polymorphism analysis. Validation was performed using Sanger sequencing. Statistical analyses were performed between the patients with and without GDM using various statistical software packages. Results: The Hardy-Weinberg equilibrium analysis was statistically significant (p > 0.05). The ApaI, BsmI, and TaqI SNPs were associated with alleles, genotypes, and different genetic models (p < 0.05). Vitamin D levels were associated with deficient levels (p = 0.0002), as well as with a normal and overweight body mass index (p = 0.0004). When vitamin D levels were measured with GDM covariates, the fasting plasma glucose (FPG) (p = 0.0001), postprandial blood glucose (PPBG) (p < 0.0001), oral glucose tolerance test (OGTT)-1 h (p = 0.005), high-density lipoprotein (p = 0.022), and low-density lipoprotein cholesterol (LDLc) (p = 0.001) levels were significantly different. When similar vitamin D levels were measured for each genotype, we confirmed that the ApaI SNP was associated with sufficient levels (p < 0.0001), whereas the BsmI, FokI, and TaqI (p < 0.05) were associated with insufficient levels. The logistic regression model confirmed that the first hour of the OGTT (p = 0.005) was strongly associated with GDM, whereas the analysis of variance confirmed that FPG and PPBG (p < 0.05) were strongly associated with all the SNPs evaluated in the VDR gene. Additionally, the second hour of the OGTT (p = 0.048) and LDLc (p = 0.049) were associated with the ApaI and FokI SNP. Moreover, the first hour OGTT (p = 0.045) and lipid profile parameters (p < 0.05) were associated. Haplotype analysis revealed positive associations among the examined SNPs, which seemed compatible with the hypothesis that variants and combinations of multiple SNP genotypes enhance the risk of GDM in women. Haplotype analysis revealed that different combinations of alleles, such as AGCC, CATT, CGTC, AGTC, and CATT (p < 0.05), were strongly associated. The linkage disequilibrium (LD) analysis showed a strong association with all combinations (p < 0.05). Among the gene-gene interactions, all possible combinations showed a positive association (p < 0.05). Conclusions: Low vitamin D levels were observed in women with GDM. The ApaI, BsmI, and TaqI SNPs were associated with genotype and allele frequencies (p < 0.05). Vitamin D and the SNPs in the VDR gene were associated, according to the ANOVA, logistic regression, haplotype analysis, LD analysis, and the generalized multifactor dimensionality reduction model (p < 0.05).

Perceptions of primiparous women diagnosed with gestational diabetes mellitus: A descriptive qualitative study

OBJECTIVE

To understand the perceptions of primiparous women recently diagnosed with Gestational Diabetes Mellitus (GDM) in Singapore.

DESIGN

A descriptive qualitative study design.

SETTING

An outpatient women's health clinic in a tertiary hospital in Singapore.

PARTICIPANTS

Twelve English-speaking primiparous women (aged 27-44 years old) who were diagnosed with GDM were recruited via purposive sampling to participate in this study.

METHODS

Face-to-face interviews were carried out with study participants in a private room at the outpatient clinic from December 2019 to May 2021. All interviews were audio-recorded and transcribed verbatim on the same day. Data analysis was guided by Braun and Clarke's thematic analysis framework.

FINDINGS

Four main themes were identified from this study's findings: (1) Life leading to GDM: A 'hint' that something was wrong, (2) Reactions to diagnosis: Shock or acceptance, (3) Learning to cope: Facing internal and external challenges, and (4) Living with GDM: A way forward.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Primiparous women with GDM require comprehensive informational, practical, and emotional support to help them manage and accept their condition. Healthcare providers are encouraged to provide individualised and holistic care to these women using a humanistic approach. Accessible online educational resources and peer support services could be considered. Public campaigns to increase the general public's awareness of GDM would also allow future women and their families to be more familiar with the condition and hence more prepared to cope with it.

Preconceptional and prenatal exposure to air pollutants and risk of gestational diabetes in the MADRES prospective pregnancy cohort study

Background

Air pollution has been associated with gestational diabetes mellitus (GDM). We aim to investigate susceptible windows of air pollution exposure and factors determining population vulnerability.

Methods

We ascertained GDM status in the prospective Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort from Los Angeles, California, USA. We calculated the relative risk of GDM by exposure to ambient particulate matter (PM10; PM2.5), nitrogen dioxide (NO2), and ozone (O3) in each week from 12 weeks before to 24 weeks after conception, adjusting for potential confounders, with distributed lag models to identify susceptible exposure windows. We examined effect modification by prenatal depression, median-split pre-pregnancy BMI (ppBMI) and age.

Findings

Sixty (9.7%) participants were diagnosed with GDM among 617 participants (mean age: 28.2 years, SD: 5.9; 78.6% Hispanic, 11.8% non-Hispanic Black). GDM risk increased with exposure to PM2.5, PM10, and NO2 in a periconceptional window ranging from 5 weeks before to 5 weeks after conception: interquartile-range increases in PM2.5, PM10, and NO2 during this window were associated with increased GDM risk by 5.7% (95% CI: 4.6-6.8), 8.9% (8.1-9.6), and 15.0% (13.9-16.2), respectively. These sensitive windows generally widened, with greater effects, among those with prenatal depression, with age ≥28 years, or with ppBMI ≥27.5 kg/m2, than their counterparts.

Interpretation

Preconception and early-pregnancy are susceptible windows of air pollutants exposure that increased GDM risk. Prenatal depression, higher age, or higher ppBMI may increase one's vulnerability to air pollution-associated GDM risk.

Funding

National Institutes of Health, Environmental Protection Agency.

Association between common mental disorder and glycemic control in women with gestational diabetes: A mixed-method study

Background

Gestational diabetes mellitus (GDM) is associated with an increased risk of mental health disorders among pregnant women. Poor mental health can negatively impact glycemic control in women with GDM, leading to adverse outcomes for both the mother and the baby.

Aim

To determine the prevalence of common mental disorder (CMD) in women with GDM and its association with poor glycemic control. Additionally, to explore the reasons and coping strategies for CMD in women with GDM.

Methods

A sequential explanatory mixed-method study was conducted among 351 women with GDM visiting a tertiary care hospital. The prevalence of CMD was assessed using Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Perceived Stress Scale (PSS). Glycemic control was determined based on two-hour postprandial blood glucose levels. In-depth interviews were conducted with six women who screened positive for CMD and had poor glycemic control. Data were analyzed using SPSS v23 and stats v12. Chi-square test and Poisson regression were performed, and adjusted prevalence ratios (aPRs) were reported.

Results

The prevalence of CMD was found to be 19.08% (95% CI: 15.32%-23.52%), with 18.2% (95% CI: 14.5%-22.6%) anxiety symptoms 8.3% (95% CI: 5.8%-11.6%) depressive symptoms and stress each. CMD was significantly related to poor glycemic control (aPR: 1.58; 95% CI: 1.23-2.03; P value <0.001). The qualitative analysis revealed individual, family, health, and facility factors influencing mental health and glycemic control.

Conclusion

Common mental health disorders are prevalent in women with GDM. It has a negative association with glycemic control. Implementing a routine screening program in the ANC clinic can aid in early identification and prompt management of the CMD and its associated complications.

Gestational diabetes mellitus and COVID-19: The epidemic during the pandemic

During the global coronavirus disease 2019 (COVID-19) pandemic, people worldwide have experienced an unprecedented rise in psychological distress and anxiety. In addition to this challenging situation, the prevalence of diabetes mellitus (DM), a hidden epidemic, has been steadily increasing in recent years. Lower-middle-income countries have faced significant barriers in providing accessible prenatal care and promoting a healthy diet for pregnant women, and the pandemic has made these challenges even more difficult to overcome. Pregnant women are at a higher risk of developing complications such as hyper-tension, preeclampsia, and gestational diabetes, all of which can have adverse implications for both maternal and fetal health. The occurrence of gestational diabetes has been on the rise, and it is possible that the pandemic has worsened its prevalence. Although data is limited, studies conducted in Italy and Canada suggest that the pandemic has had an impact on gestational diabetes rates, especially among women in their first trimester of pregnancy. The significant disruptions to daily routines caused by the pandemic, such as limited exercise options, indicate a possible link between COVID-19 and an increased likelihood of experiencing higher levels of weight gain during pregnancy. Notably, individuals in the United States with singleton pregnancies are at a significantly higher risk of excessive gestational weight gain, making this association particularly important to consider. Although comprehensive data is currently lacking, it is important for clinical researchers to explore the possibility of establishing correlations between the stress experienced during the pandemic, its consequences such as gestational gain weight, and the increasing incidence of gestational DM. This knowledge would contribute to better preventive measures and support for pregnant individuals during challenging times.

Gestational diabetes mellitus and its impact on the mother-infant relationship: A cohort study in the postnatal period

Women with gestational diabetes mellitus (GDM) are at increased risk of poor perinatal mental health outcomes. However, the association between GDM and the mother-infant relationship is unclear. This study aimed to examine whether GDM itself impacts the mother-infant relationship and maternal mental health using a cohort study design. We used data from the Cohort of Newborns in Emilia-Romagna (CoNER) study, which included 642 women recruited in Bologna, Italy. Psychological data were collected at 6 and 15 months postnatally using a purpose designed measure to examine the mother-infant relationship. We used linear fixed effects and mixed-effects models to assess the effect of GDM on relationship scores at 6 and 15 months postpartum. Women with GDM had significantly lower relationship scores at 15 months postpartum [β - 1.75 95% CrI (-3.31; -0.21)] but not at 6 months [β - 0.27 95% CrI (-1.37; 0.81)]. Mother-infant relationship scores were significantly lower overall at 15 months compared to 6 months postpartum [β - 0.29 95% CrI (-0.56; -0.02)]. Our findings suggest that there may be a delayed effect on the mother-infant relationship in response to the experience of GDM. Future research using large birth cohorts should investigate this further to confirm these findings, and whether women with GDM would benefit from early interventions to improve relationships taking into account length of time postpartum.

SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India

Introduction

The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population.

Methods/design

This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health.

Discussion

The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.

Prevalence and clinical profile of abnormal glucose in first-episode and drug-naïve patients with major depressive disorder with comorbid abnormal thyroid function: a large-scale cross-sectional study

BACKGROUND

The associated factors of abnormal glucose in patients with major depressive disorder (MDD) with comorbid abnormal thyroid function (ATF) remain unclear. To the best of our knowledge, this is the first study with a large sample size that examines the risk factors of abnormal glucose in first-episode drug-naïve (FEDN) MDD patients comorbid with ATF and includes clinical correlates and thyroid hormone levels.

METHODS

A total of 1718 FEDN MDD patients were recruited. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) positive subscale were used to evaluate the symptoms of patients. Fasting blood glucose concentration and thyroid hormone levels were measured.

RESULTS

The prevalence of abnormal glucose in MDD patients with comorbid ATF was 47.3%, which was 4.25 times higher than that in MDD patients without ATF (17.4%). Compared to those ATF patients without abnormal glucose, ATF patients with abnormal glucose scored higher on HAMD, HAMA and PANSS positive subscale, had a higher rate of suicide attempts, severe anxiety and psychotic symptoms, and had higher levels of thyroid-stimulating hormone (TSH), and thyroid peroxidases antibody (TPOAb) which were also correlated with abnormal glucose in MDD patients comorbid ATF (all P < 0.05). The combination of HAMD score and TSH could differentiate abnormal glucose from ATF. Further, TSH was independence-related with the concentration of fasting blood glucose in MDD patients with comorbid ATF.

CONCLUSION

Our results demonstrate a high prevalence of abnormal glucose in MDD patients with comorbid ATF. Some clinical and thyroid function-related variables may be associated with abnormal glucose in MDD patients with comorbid ATF.

Using the COM-B model and Behaviour Change Wheel to develop a theory and evidence-based intervention for women with gestational diabetes (IINDIAGO)

BACKGROUND

In South Africa, the prevalence of gestational diabetes (GDM) is growing, concomitant with the dramatically increasing prevalence of overweight/obesity among women. There is an urgent need to develop tailored interventions to support women with GDM to mitigate pregnancy risks and to prevent progression to type 2 diabetes post-partum. The IINDIAGO study aims to develop and evaluate an intervention for disadvantaged GDM women attending three large, public-sector hospitals for antenatal care in Cape Town and Soweto, SA. This paper offers a detailed description of the development of a theory-based behaviour change intervention, prior to its preliminary testing for feasibility and efficacy in the health system.

METHODS

The Behaviour Change Wheel (BCW) and the COM-B model of behaviour change were used to guide the development of the IINDIAGO intervention. This framework provides a systematic, step-by-step process, starting with a behavioural analysis of the problem and making a diagnosis of what needs to change, and then linking this to intervention functions and behaviour change techniques to bring about the desired result. Findings from primary formative research with women with GDM and healthcare providers were a key source of information for this process.

RESULTS

Key objectives of our planned intervention were 1) to address women's evident need for information and psychosocial support by positioning peer counsellors and a diabetes nurse in the GDM antenatal clinic, and 2) to offer accessible and convenient post-partum screening and counselling for sustained behaviour change among women with GDM by integrating follow-up into the routine immunisation programme at the Well Baby clinic. The peer counsellors and the diabetes nurse were trained in patient-centred, motivational counselling methods.

CONCLUSIONS

This paper offers a rich description and analysis of designing a complex intervention tailored to the challenging contexts of urban South Africa. The BCW was a valuable tool to use in designing our intervention and tailoring its content and format to our target population and local setting. It provided a robust and transparent theoretical foundation on which to develop our intervention, assisted us in making the hypothesised pathways for behaviour change explicit and enabled us to describe the intervention in standardised, precisely defined terms. Using such tools can contribute to improving rigour in the design of behavioural change interventions.

TRIAL REGISTRATION

First registered on 20/04/2018, Pan African Clinical Trials Registry (PACTR): PACTR201805003336174.

Indirect effects of the COVID-19 pandemic on risk of gestational diabetes and factors contributing to increased risk in a multiethnic population: a retrospective cohort study

BACKGROUND

The COVID-19 pandemic has had indirect effects on pregnancy outcomes. There is limited data on the impact on gestational diabetes (GDM) in diverse populations and the possible underlying mediators. This study aimed to assess the risk of GDM pre-COVID-19 and in two distinct pandemic exposure periods, and to determine the potential factors contributing to increased risk in a multiethnic population.

METHODS

A multicentre, retrospective cohort study was performed of women with singleton pregnancy receiving antenatal care at three hospitals two years pre-COVID-19 (January 2018 - January 2020), first year of COVID-19 with limited pandemic-mitigating restrictions (February 2020 - January 2021) and second year of COVID-19 with stringent restrictions (February 2021 - January 2022). Baseline maternal characteristics and gestational weight gain (GWG) were compared between cohorts. The primary outcome was GDM, assessed using univariate and multivariate generalised estimating equations models.

RESULTS

28,207 pregnancies met the inclusion criteria, 14,663 pregnancies two years pre-COVID-19, 6,890 in COVID-19 Year 1 and 6,654 in COVID-19 Year 2. Maternal age increased across exposure periods (30.7 ± 5.0 years pre-COVID-19 vs 31.0 ± 5.0 years COVID-19 Year 1 vs 31.3 ± 5 years COVID-19 Year 2; p < 0.001). There were increases in pre-pregnancy body mass index (BMI) (25.5 ± 5.7 kg/m² vs 25.7 ± 5.6 kg/m² vs 26.1 ± 5.7 kg/m²; p < 0.001), proportion who were obese (17.5% vs 18.1% vs 20.7%; p < 0.001) and proportion with other traditional risk factors for GDM including South Asian ethnicity and prior history of GDM. Rate of GWG and proportion exceeding recommended GWG increased with pandemic exposure (64.3% vs 66.0% vs 66.6%; p = 0.009). GDM diagnosis increased across exposure periods (21.2% vs 22.9% vs 24.8%; p < 0.001). Both pandemic exposure periods were associated with increased risk of GDM on univariate analysis, only COVID-19 Year 2 remaining significantly associated after adjusting for maternal baseline characteristics and GWG (OR 1.17 [1.06, 1.28], p = 0.01).

CONCLUSIONS

Diagnosis of GDM increased with pandemic exposure. Progressive sociodemographic changes and greater GWG may have contributed to increased risk. However, exposure to the second year of COVID-19 remained independently associated with GDM after adjusting for shifts in maternal characteristics and GWG.

Prevalence and clinical correlates of abnormal glucose metabolism in young, first- episode and medication-naïve outpatients with major depressive disorder

BACKGROUNDS

The high co-morbidity of abnormal glucose metabolism in depressed patients has been extensively studied, but few studies have explored abnormal glucose metabolism in young patients with major depressive disorder (MDD). This study aimed to examine the prevalence and clinical correlates of abnormal glucose metabolism in young patients with first-episode medication-naïve (FEMN) MDD.

METHODS

A cross-sectional study was conducted on 1289 young Chinese outpatients with FEMN MDD. All subjects were assessed on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale, and their sociodemographic information was collected, and blood pressure, blood glucose, lipid and thyroid hormone levels were measured.

RESULTS

The prevalence of abnormal glucose metabolism was 12.57% in young FEMN MDD outpatients. Thyroid stimulating hormone (TSH) levels and HAMA scale scores were associated with fasting blood glucose levels in patients with FEMN MDD (P<0.05), and TSH could differentiate patients with abnormal normal glucose metabolism from those without abnormal glucose metabolism (Area Under Curve of 0.774).

CONCLUSIONS

Our study showed a high prevalence of comorbid glucose metabolism abnormalities in young FEMN MDD outpatients. TSH may be a promising biomarker of abnormal glucose metabolism in young patients with FEMN MDD.

Preconception sleep quality moderates the association between preconception hair cortisol levels and mental health in pregnant women

BACKGROUND

Poor sleep quality may elevate cortisol levels and affect prenatal mental health through altered HPA axis functioning. This study aims to examine whether subjective sleep quality during preconception moderates the association between preconception hair cortisol levels and mental health from preconception to pregnancy trimesters.

METHODS

Women from a prospective cohort study completed the Pittsburgh Sleep Quality Index (PSQI), the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI) questionnaires during preconception (T0) and at each pregnancy trimesters (T1, T2, and T3). We analyzed 266 of these women who conceived and had fully completed measures at preconception for hair cortisol, sleep quality and either EPDS or STAI-state. Changes in EPDS and STAI-state scores were derived (i.e., T1-T0, T2-T0, T3-T0). Johnson-Neyman technique identified PSQI scores with significant moderation of cortisol on mental health.

RESULTS

After adjusting for potential covariates, there was a significant positive correlation between preconception hair cortisol levels and depressive symptom at the second trimester (r_s (144) = 0.22, p = 0.008), but not the first and third trimesters (all p_s > 0.05). The positive association between preconception hair cortisol and change in depressive symptoms between third trimester and preconception was significant only among women with poor preconception sleep quality (PSQI ≥ 7).

LIMITATIONS

Sleep quality and prenatal mood were derived from self-reported questionnaires, which may be more susceptible to bias.

CONCLUSIONS

The positive association between preconception hair cortisol and change in prenatal depressive symptoms is significant among women who reported poor sleep quality during preconception. Improving preconception sleep quality can potentially mitigate the association between preconception hair cortisol and depressive symptoms during pregnancy.

Brain responses to food viewing in women during pregnancy and post partum and their relationship with metabolic health: study protocol for the FOODY Brain Study, a prospective observational study

INTRODUCTION

Food cravings are common in pregnancy and along with emotional eating and eating in the absence of hunger, they are associated with excessive weight gain and adverse effects on metabolic health including gestational diabetes mellitus (GDM). Women with GDM also show poorer mental health, which further can contribute to dysregulated eating behaviour. Food cravings can lead to greater activity in brain centres known to be involved in food 'wanting' and reward valuation as well as emotional eating. They are also related to gestational weight gain. Thus, there is a great need to link implicit brain responses to food with explicit measures of food intake behaviour, especially in the perinatal period. The aim of this study is to investigate the spatiotemporal brain dynamics to visual presentations of food in women during pregnancy and in the post partum, and link these brain responses to the eating behaviour and metabolic health outcomes in women with and without GDM.

METHODS AND ANALYSIS

This prospective observational study will include 20 women with and 20 without GDM, that have valid data for the primary outcomes. Data will be assessed at 24-36 weeks gestational age and at 6 months post partum. The primary outcomes are brain responses to food pictures of varying carbohydrate and fat content during pregnancy and in the post partum using electroencephalography. Secondary outcomes including depressive symptoms, current mood and eating behaviours will be assessed with questionnaires, objective eating behaviours will be measured using Auracle and stress will be measured with heart rate and heart rate variability (Actiheart). Other secondary outcome measures include body composition and glycaemic control parameters.

ETHICS AND DISSEMINATION

The Human Research Ethics Committee of the Canton de Vaud approved the study protocol (2021-01976). Study results will be presented at public and scientific conferences and in peer-reviewed journals.

Association between the history of abortion and gestational diabetes mellitus: A meta-analysis

PURPOSE

Gestational diabetes mellitus (GDM) is a common metabolic disease in pregnant women. The purpose of this study was to determine whether a history of abortion increases the risk of GDM by meta-analysis.

METHODS

A comprehensive literature search was conducted in nine databases of studies on the association between abortion history and GDM up to April 12, 2022. Fixed- or random-effects models were used to estimate the pooled odds ratio (OR) and 95% CI. The I square value (I²) was used to assess heterogeneity. Possible sources of heterogeneity were explored by conducting subgroup analysis and meta-regression. A sensitivity analysis was also performed for this meta-analysis. Publication bias was assessed by funnel plots and Egger's tests.

RESULTS

Thirty-one studies enrolling 311,900 subjects were included in this meta-analysis. The risk of GDM was higher in women who experienced abortion than in those who did not (OR = 1.41 95% CI: 1.28-1.55, I² = 66.8%). The risk of GDM increased with an increasing number of abortions (1 time: OR = 1.67, 95% CI = 1.26-2.22; 2 times: OR = 2.10, 95% CI = 1.26-3.49; ≥3 times: OR = 2.49, 95% CI = 1.24-5.01). Both spontaneous abortion (OR = 1.52, 95% CI = 1.30-1.78) and induced abortion (OR = 1.07, 95% CI = 1.03-1.11) were associated with an increased risk of GDM.

CONCLUSIONS

A history of abortion was associated with an increased risk of GDM in pregnant women, which may be a risk factor for predicting GDM.

Fear of hypoglycemia and its predictive factors among diabetic pregnant women

OBJECTIVE

The purpose of the present study was to investigate the fear of hypoglycemia (FoH) and its predictors among diabetic pregnant women.

STUDY DESIGN

Cross-sectional conducted between January to August 2022.

METHODS

In the present study, 250 diabetic pregnant women from Qazvin province participated. Demographic and fertility characteristics, FoH, adherence to treatment, self-efficacy, anxiety and depression were assessed. Data were analyzed using univariable and multivariable linear regression models.

RESULTS

The participants' mean age was 31.02 years (SD=4.72). The FoH mean score was 32.88 (out of 72). Based on the multivariable linear regression model, having a history of hypoglycemia (β = 0.44, p < 0.001), lower education (β = 0.17, p = 0.001), being treated with insulin (β = 0.22, p < 0.001), being treated with both insulin and diet (β = 0.16 p = 0.003), being of younger age (β = -0.13, p = 0.008), and depression (β = 0.16, p = 0.002) were independent predictors of FoH among pregnant women.

CONCLUSION

Diabetic pregnant women experience FoH, particularly those with a history of hypoglycemia. Therefore, providing education and counseling concerning hypoglycemia, complications, and necessary measures for this group of diabetic pregnant women are needed along with those who are younger, less educated, and have comorbid mental health conditions.

O-GlcNAc transferase contributes to sex-specific placental deregulation in gestational diabetes

INTRODUCTION

Gestational diabetes (GDM) is traditionally thought to emerge from placental endocrine dysregulations, but recent evidence suggests that fetal sex can also impact GDM development. Understanding the molecular mechanisms through which sex modulates placenta physiology can help identify novel molecular targets for future clinical care. Thus, we investigated the nutrient-sensing O-GlcNAc pathway as a potential mediator of sex-specific placenta dysfunction in GDM.

METHODS

Expression levels of O-GlcNAc enzymes were measured in male and female (n = 9+/gender) human placentas based on the maternal diagnosis of GDM. We then simulated the observed differences in both BeWo cells and human syncytiotrophoblasts primary cells (SCT) from male and female origins (n = 6/gender). RNA sequencing and targeted qPCR were performed to characterize the subsequent changes in the placenta transcriptome related to gestational diabetes.

RESULTS

O-GlcNAc transferase (OGT) expression was significantly reduced only in male placenta collected from mothers with GDM compared to healthy controls. Similar downregulation of OGT in trophoblast-like BeWo male cells demonstrated significant gene expression deregulations that overlapped with known GDM-related genes. Notably, placental growth hormone (GH) production was significantly elevated, while compensatory factors against GH-related insulin resistance were diminished. Inflammatory and immunologic factors with toxic effects on pancreatic β cell mass were also increased, altogether leaning toward a decompensatory diabetic profile. Similar changes in hormone expression were confirmed in male human primary SCTs transfected with siOGT. However, down-regulating OGT in female primary SCTs did not impact hormone production.

CONCLUSION

Our study demonstrated the significant deregulation of placental OGT levels in mothers with GDM carrying a male fetus. When simulated in vitro, such deregulation impacted hormonal production in BeWo trophoblast cells and primary SCTs purified from male placentas. Interestingly, female placentas were only modestly impacted by OGT downregulation, suggesting that the sex-specific presentation observed in gestational diabetes could be related to O-GlcNAc-mediated regulation of placental hormone production.

Anxiety among Pregnant Women in Rural-Urban Area Indonesia during the COVID-19 Pandemic in Semarang, Indonesia

BACKGROUND: About 10% of pregnant women in the world experience emotional changes. Changes that occur during the pandemic, can increase anxiety, including in pregnant women. This study aimed to analyze factors associated with anxiety levels in pregnant women during the COVID-19 pandemic in Semarang, Indonesia. METHODS: This study was an observational study with a cross-sectional design. The sampling technique was cluster sampling. The research subjects were 238 pregnant women. The research variables included the mother’s characteristics, hemoglobin, knowledge related to nutrition and COVID-19, and anxiety. Anxiety levels were measured using the Hamilton Rating Scale for Anxiety (HRSA) questionnaire. Data analysis used a multivariate logistic regression test. RESULTS: This study showed that 20.2% of subjects had mild to moderate to severe anxiety levels. The results of the multivariate analysis, subjects with low COVID-19 knowledge had higher odds of anxiety levels (OR 2.407; 95% CI: 1.202 – 4.820; p-value 0.042), and subjects with gravida in the first time or ≥ fourth times had higher odds of anxiety levels (OR 2.366; 95% CI 1.199 – 4.670; p-value 0.013). CONCLUSION: Pregnant women with low COVID-19 knowledge and gravida for the first time or ≥ fourth times were found associated with anxiety during the COVID-19 pandemic in Semarang, Indonesia.

Causality of genetically determined metabolites on anxiety disorders: a two-sample Mendelian randomization study

BACKGROUND

Although anxiety disorders are one of the most prevalent mental disorders, their underlying biological mechanisms have not yet been fully elucidated. In recent years, genetically determined metabolites (GDMs) have been used to reveal the biological mechanisms of mental disorders. However, this strategy has not been applied to anxiety disorders. Herein, we explored the causality of GDMs on anxiety disorders through Mendelian randomization study, with the overarching goal of unraveling the biological mechanisms.

METHODS

A two-sample Mendelian randomization (MR) analysis was implemented to assess the causality of GDMs on anxiety disorders. A genome-wide association study (GWAS) of 486 metabolites was used as the exposure, whereas four different GWAS datasets of anxiety disorders were the outcomes. Notably, all datasets were acquired from publicly available databases. A genetic instrumental variable (IV) was used to explore the causality between the metabolite and anxiety disorders for each metabolite. The MR Steiger filtering method was implemented to examine the causality between metabolites and anxiety disorders. The standard inverse variance weighted (IVW) method was first used for the causality analysis, followed by three additional MR methods (the MR-Egger, weighted median, and MR-PRESSO (pleiotropy residual sum and outlier) methods) for sensitivity analyses in MR analysis. MR-Egger intercept, and Cochran's Q statistical analysis were used to evaluate possible heterogeneity and pleiotropy. Bonferroni correction was used to determine the causative association features (P < 1.03 × 10^-4). Furthermore, metabolic pathways analysis was performed using the web-based MetaboAnalyst 5.0 software. All statistical analysis were performed in R software. The STROBE-MR checklist for the reporting of MR studies was used in this study.

RESULTS

In MR analysis, 85 significant causative relationship GDMs were identified. Among them, 11 metabolites were overlapped in the four different datasets of anxiety disorders. Bonferroni correction showing1-linoleoylglycerophosphoethanolamine (OR_{fixed-effect IVW} = 1.04; 95% CI 1.021-1.06; P_{fixed-effect IVW} = 4.3 × 10^-5) was the most reliable causal metabolite. Our results were robust even without a single SNP because of a "leave-one-out" analysis. The MR-Egger intercept test indicated that genetic pleiotropy had no effect on the results (intercept = - 0.0013, SE = 0.0006, P = 0.06). No heterogeneity was detected by Cochran's Q test (MR-Egger. Q = 7.68, P = 0.742; IVW. Q = 12.12, P = 0.436). A directionality test conducted by MR Steiger confirmed our estimation of potential causal direction (P < 0.001). In addition, two significant pathways, the "primary bile acid biosynthesis" pathway (P = 0.008) and the "valine, leucine, and isoleucine biosynthesis" pathway (P = 0.03), were identified through metabolic pathway analysis.

CONCLUSION

This study provides new insights into the causal effects of GDMs on anxiety disorders by integrating genomics and metabolomics. The metabolites that drive anxiety disorders may be suited to serve as biomarkers and also will help to unravel the biological mechanisms of anxiety disorders.

Salivary Biomarkers Associated with Psychological Alterations in Patients with Diabetes: A Systematic Review

The care of individuals with diabetes needs a holistic perspective, taking into account both the physical disease and the mental health problems that may be associated. Different studies show a higher prevalence of depression or anxiety issues in diabetes patients than in the general population, which is why diabetes can be considered one of the chronic diseases in which psychological care is crucial to maintain quality of life. The objective of this review is to examine the published articles that relate the bidirectional associations between objective and subjective measures of anxiety, depressive symptomatology, stress, sleep quality, and salivary biomarkers in patients with diabetes. For this, a search was carried out in the electronic databases PubMed, Cochrane, and SCOPUS using the keywords "diabetes", "saliva", "sleep", "anxiety", "depression", and "stress" for works published up until May 2022 and limited to the English and Spanish languages. The sample comprised 14 articles, 5 of which analysed the associations between depressive symptomatology and salivary biomarkers in people with diabetes. Among the salivary biomarkers most frequently used to evaluate psychological alterations in persons with diabetes are cortisol and melatonin. Thus, significant changes in the levels of these biomarkers were observed in most studies. Four out of five studies reported a statistically significant relationship between increased salivary cortisol in the evening/midnight or the cortisol awakening response and depressive symptoms. In contrast, lower cortisol levels upon waking in the morning were observed when there was no depression or anxiety. Regarding the association between salivary cortisol values and sleep quality in patients with diabetes, lower morning cortisol values related to prolonged nighttime sleep were common in the analysed studies. Low melatonin concentrations showed a negative correlation with sleep quality. As it is an easy-to-apply and non-invasive method, the measurement of salivary biomarkers can be very useful for predicting psychological alterations in patients with diabetes. Further scientific studies are required to determine the sensitivity of these biological substances acting as biomarkers for detecting sleep disorders and psychological alterations.

Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion

Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS. The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health. PCOS is not often recognized as a risk factor for poor pregnancy and birth outcomes in pregnancy care guidelines, while its associated features are. Pregnancy-related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS. Hyperglycaemia should be screened using a 75-g oral glucose tolerance test at preconception or within the first 20 weeks of pregnancy if it has not been performed at preconception and should be repeated at 24-28 weeks of pregnancy. In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidence-based guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population. Recommended factors include blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep and mental health, emotional, and sexual health among women with PCOS. The guidelines recommend Metformin in addition to lifestyle for assisting with weight management and improving cardiometabolic risk factors, particularly in those with overweight or obesity. Letrozole is considered the first-line pharmacological treatment for anovulatory infertility in PCOS. Individualized approach should be considered in the management of pregnancy in PCOS.

Proteomics Studies in Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

Gestational Diabetes Mellitus (GDM) is the most common metabolic complication during pregnancy and is associated with serious maternal and fetal complications such as pre-eclampsia and stillbirth. Further, women with GDM have approximately 10 times higher risk of diabetes later in life. Children born to mothers with GDM also face a higher risk of childhood obesity and diabetes later in life. Early prediction/diagnosis of GDM leads to early interventions such as diet and lifestyle, which could mitigate the maternal and fetal complications associated with GDM. However, no biomarkers identified to date have been proven to be effective in the prediction/diagnosis of GDM. Proteomic approaches based on mass spectrometry have been applied in various fields of biomedical research to identify novel biomarkers. Although a number of proteomic studies in GDM now exist, a lack of a comprehensive and up-to-date meta-analysis makes it difficult for researchers to interpret the data in the existing literature. Thus, we undertook a systematic review and meta-analysis on proteomic studies and GDM. We searched MEDLINE, EMBASE, Web of Science and Scopus from inception to January 2022. We searched Medline, Embase, CINHAL and the Cochrane Library, which were searched from inception to February 2021. We included cohort, case-control and observational studies reporting original data investigating the development of GDM compared to a control group. Two independent reviewers selected eligible studies for meta-analysis. Data collection and analyses were performed by two independent reviewers. The PROSPERO registration number is CRD42020185951. Of 120 articles retrieved, 24 studies met the eligibility criteria, comparing a total of 1779 pregnant women (904 GDM and 875 controls). A total of 262 GDM candidate biomarkers (CBs) were identified, with 49 CBs reported in at least two studies. We found 22 highly replicable CBs that were significantly different (nine CBs were upregulated and 12 CBs downregulated) between women with GDM and controls across various proteomic platforms, sample types, blood fractions and time of blood collection and continents. We performed further analyses on blood (plasma/serum) CBs in early pregnancy (first and/or early second trimester) and included studies with more than nine samples (nine studies in total). We found that 11 CBs were significantly upregulated, and 13 CBs significantly downregulated in women with GDM compared to controls. Subsequent pathway analysis using Database for Annotation, Visualization and Integrated Discovery (DAVID) bioinformatics resources found that these CBs were most strongly linked to pathways related to complement and coagulation cascades. Our findings provide important insights and form a strong foundation for future validation studies to establish reliable biomarkers for GDM.

A Community Prenatal Intervention in Social Nutrition: Evaluating the Impact on Pregnancy and Birthweight Outcomes

This study aims to assess the associations between structural features of the Montreal Diet Dispensary’s social nutrition intervention and pregnancy (i.e., anemia, gestational diabetes mellitus (GDM), gestational weight gain (GWG), hypertension) and birthweight outcomes (i.e., small- or large-for-gestational-age) among pregnant women, most of them recent immigrants. The study consists of a secondary analysis of the digital client database of the Montreal Diet Dispensary (n = 2925). Logistic regressions were used to estimate the odds of pregnancy and birthweight outcomes, depending on structural features of the intervention. Pregnant women who attended a welcoming group session presented lower odds of GDM and anemia compared to those who did not attend. A longer duration of intervention was also associated with lower odds of GDM and anemia. Each additional appointment with a dietitian was associated with higher odds of excessive GWG and lower odds of insufficient GWG only among women with a pre-pregnancy BMI lower than 25 kg/m². This study emphasizes the importance of providing nutritional services early in pregnancy to reduce the risk of GDM and anemia. It also stresses the importance of using appropriate nutritional guidelines to avoid increasing the risk of excessive GWG.

Anxiety and depression in recurrent gastric cancer: Their prevalence and independent risk factors analyses

Various anxiety and depression-related risk factors have been reported in cancer patients. However, little is known about the anxiety and depression-related risk factors in recurrent gastric cancer patients. Therefore, our aim was to investigate the prevalence and risk factors for anxiety and depression in recurrent gastric cancer patients.Totally 82 recurrent gastric cancer patients were consecutively recruited, and their clinical features were collected from hospital's electronic medical records. Besides, 80 newly diagnosed gastric cancer patients and 80 healthy controls were enrolled. Their anxiety and depression status was assessed using Hospital Anxiety and Depression Scale (HADS).The HADS-anxiety score (9.1 ± 3.4, 7.2 ± 3.0, 4.8 ± 2.7, respectively) and the percentage of anxiety patients (52.4%, 33.8%, 11.3%, respectively) were increased in recurrent gastric cancer patients compared to newly diagnosed gastric cancer patients and healthy controls; Also, the HADS-depression score (7.9 ± 3.1, 6.7 ± 2.6, 4.1 ± 2.8, respectively) and the percentage of depression patients (41.5%, 25.0%, 8.8%, respectively) had similar trends. Forward stepwise multivariate logistic regression revealed that age ≥60 years, diabetes, tumor-node-metastasis (TNM) stage at diagnosis, shorter time to recurrence and distant metastasis at recurrence were independent risk factors for anxiety occurrence, whereas age ≥60 years, diabetes, tumor location at diagnosis (cardia vs gastric antrum) and shorter time to recurrence were independent risk factors for depression occurrence.The prevalence of anxiety and depression is such high, and their relevant risk factors include age ≥60 years, diabetes and shorter time to recurrence in recurrent gastric cancer patients.