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Tan YSA, Tsang LPM, Lock SHS, Vijakumar K, Ho XYC, Seah AC, Gong PP, Koh YLE, Tan NC. Barriers to postpartum diabetes mellitus screening among mothers with a recent history of gestational diabetes mellitus: a cross-sectional study. Singapore Med J 2024:00077293-990000000-00132. [PMID: 39007356 DOI: 10.4103/singaporemedj.smj-2023-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/26/2024] [Indexed: 07/16/2024]
Affiliation(s)
| | | | | | | | | | - Ai Choo Seah
- SingHealth Polyclinics, Duke-NUS Medical School, Singapore
| | - Pei Pei Gong
- SingHealth Polyclinics, Duke-NUS Medical School, Singapore
| | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Duke-NUS Medical School, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
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Simmons D, Gupta Y, Hernandez TL, Levitt N, van Poppel M, Yang X, Zarowsky C, Backman H, Feghali M, Nielsen KK. Call to action for a life course approach. Lancet 2024; 404:193-214. [PMID: 38909623 DOI: 10.1016/s0140-6736(24)00826-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes remains the most common medical disorder in pregnancy, with short-term and long-term consequences for mothers and offspring. New insights into pathophysiology and management suggest that the current gestational diabetes treatment approach should expand from a focus on late gestational diabetes to a personalised, integrated life course approach from preconception to postpartum and beyond. Early pregnancy lifestyle intervention could prevent late gestational diabetes. Early gestational diabetes diagnosis and treatment has been shown to be beneficial, especially when identified before 14 weeks of gestation. Early gestational diabetes screening now requires strategies for integration into routine antenatal care, alongside efforts to reduce variation in gestational diabetes care, across settings that differ between, and within, countries. Following gestational diabetes, an oral glucose tolerance test should be performed 6-12 weeks postpartum to assess the glycaemic state. Subsequent regular screening for both dysglycaemia and cardiometabolic disease is recommended, which can be incorporated alongside other family health activities. Diabetes prevention programmes for women with previous gestational diabetes might be enhanced using shared decision making and precision medicine. At all stages in this life course approach, across both high-resource and low-resource settings, a more systematic process for identifying and overcoming barriers to preventative care and treatment is needed to reduce the current global burden of gestational diabetes.
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Affiliation(s)
- David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Teri L Hernandez
- College of Nursing, University of Colorado, Aurora, CO, USA; Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mireille van Poppel
- Department of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, University of Montréal, Montréal, QC, Canada; CReSP Public Health Research Centre, Montréal, QC, Canada
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, PA, USA
| | - Karoline Kragelund Nielsen
- Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen, Herlev, Denmark
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Ghanem YM, El Kassar Y, Magdy MM, Amara M, Amin NG. Potential risk of gestational diabetes mellitus in females undergoing in vitro fertilization: a pilot study. Clin Diabetes Endocrinol 2024; 10:7. [PMID: 38594776 PMCID: PMC11005244 DOI: 10.1186/s40842-024-00164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/01/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Most of the cases of hyperglycemia during pregnancy are attributed to gestational diabetes mellitus (GDM) (75-90%). Women diagnosed with GDM are at an increased risk for complications during pregnancy and delivery. This observational prospective study aimed to investigate the potential risk of GDM among Egyptian females following in vitro fertilization (IVF) pregnancies compared to spontaneous pregnancies (SC). METHODS This prospective cohort study included normoglycemic females without any history of dysglycemia before this conception. Subjects were divided according to the type of conception into two age and BMI-matched groups: (IVF group): 55 pregnant females conceived by IVF, and (SC group) spontaneous pregnancy: 55 pregnant females conceived spontaneously. A one-step oral glucose tolerance test (OGTT) was performed at gestational weeks 20 and 28 for all study subjects. RESULTS The incidence of GDM was statistically significantly higher in the IVF group compared to the spontaneous pregnancy (SC) group (20 and 5.5%, respectively), p = 0.022 at week 28. On comparing the incidence of GDM on early screening at week 20 in both groups, the incidence of GDM in the IVF group was significantly higher (16.4%) compared to (3.6%) in the spontaneous pregnancy (SC) group, p = 0.026. CONCLUSIONS IVF may have an increased potential risk for GDM. Moreover, the diagnosis of GDM may occur early (week 20), highlighting the need for precise and early screening for GDM in IVF pregnancies.
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Affiliation(s)
- Yehia Moustafa Ghanem
- Department of Internal Medicine; Unit of Diabetes Lipidology & Metabolism, Faculty of Medicine, Alexandria University, 17 Champollion Street Azarita, Alexandria, Egypt
| | - Yasser El Kassar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - May Mohamed Magdy
- Department of Internal Medicine; Unit of Diabetes Lipidology & Metabolism, Faculty of Medicine, Alexandria University, 17 Champollion Street Azarita, Alexandria, Egypt
| | - Mohamed Amara
- Department of Internal Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Noha Gaber Amin
- Department of Internal Medicine; Unit of Diabetes Lipidology & Metabolism, Faculty of Medicine, Alexandria University, 17 Champollion Street Azarita, Alexandria, Egypt.
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Doğan ME, Erkan Pota Ç. Investigation of the effects of gestational diabetes and hypertension on retinal and choroidal microvascular circulation using swept-source optical coherence tomography angiography. Microvasc Res 2024; 152:104622. [PMID: 37981229 DOI: 10.1016/j.mvr.2023.104622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE The aim of this study was to investigate the microvascular changes in the retina and choroid in gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) and to compare the results with those of healthy pregnant subjects. METHODS Twenty-nine pregnant subjects with coexisting GDM and PIH (group 1) and 36 healthy pregnant subjects (group 2) were enrolled in the study. All subjects were examined by optical coherence tomography (OCT) and angiography (OCTA). The retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), choroidal thickness (CT), superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC) vascular density (VD), and foveal avascular zone (FAZ) were measured. RESULTS We observed that the values of CT and VD were lower in group 1 than in group 2. No significant difference was found between groups in RT, FAZ area and CC VD. SCP and DCP VD values were higher in group 2 in all quadrants. We observed a significant increase in FAZ area and CC VD with increasing systolic blood pressure. No correlation was observed between diastolic blood pressure and FBS with other parameters. In group 1, FAZ area was significantly higher in the diet-treated group than in the insulin-treated group. CONCLUSION Monitoring and treatment of pregnant women with PIH and GDM is important because of the risks that may occur during pregnancy. We believe that changes in microvascular circulation can be detected noninvasively with OCTA, even in the absence of clinical or retinal findings.
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Affiliation(s)
- Mehmet Erkan Doğan
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Çisil Erkan Pota
- Department of Ophthalmology, Manavgat State Hospital, Antalya, Turkey.
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5
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Liu M, Chan SY, Eriksson JG, Chong YS, Lee YS, Yap F, Chong MFF, Tint MT, Yang J, Burgner D, Zhang C, Li LJ. Maternal glycemic status during pregnancy and mid-childhood plasma amino acid profiles: findings from a multi-ethnic Asian birth cohort. BMC Med 2023; 21:472. [PMID: 38031185 PMCID: PMC10688057 DOI: 10.1186/s12916-023-03188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Increasing maternal glycaemia across the continuum during pregnancy may predispose offspring to subsequent cardiometabolic risk later in life. However, evidence of long-term impacts of maternal glycemic status on offspring amino acid (AA) profiles is scarce. We aimed to investigate the association between maternal antenatal glycaemia and offspring mid-childhood amino acid (AA) profiles, which are emerging cardiometabolic biomarkers. METHODS Data were drawn from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study, a multi-ethnic Asian birth cohort. A subset of 422 mother-child dyads from the GUSTO study, who was followed from early pregnancy to mid-childhood, was included. Mothers underwent an oral glucose tolerance test (OGTT) at 26-28 weeks gestation, with fasting and 2-h plasma glucose concentrations measured and gestational diabetes mellitus (GDM) diagnosed per WHO 1999 guidelines. Offspring fasting plasma samples were collected at mean age 6.1 years, from which AA profiles of nine AAs, alanine, glutamine, glycine, histidine, isoleucine, leucine, valine, phenylalanine, and tyrosine were measured. Total branched-chain amino acids (BCAAs) were calculated as the sum of isoleucine, leucine, and valine concentrations. Multi-variable linear regression was used to estimate the association of maternal glycemic status and offspring mid-childhood AA profiles adjusting for maternal age, ethnicity, maternal education, parity, family history of diabetes, ppBMI, child sex, age and BMI z-scores. RESULTS Approximately 20% of mothers were diagnosed with GDM. Increasing maternal fasting glucose was significantly associated with higher offspring plasma valine and total BCAAs, whereas higher 2-h glucose was significantly associated with higher histidine, isoleucine, valine, and total BCAAs. Offspring born to mothers with GDM had higher valine (standardized mean difference 0.27 SD; 95% CI: 0.01, 0.52), leucine (0.28 SD; 0.02, 0.53), and total BCAAs (0.26 SD; 0.01, 0.52) than their counterparts. Inconsistent associations were found between maternal GDM and other amino acids among offspring during mid-childhood. CONCLUSIONS Increasing maternal fasting and post-OGTT glucose concentrations at 26-28 weeks gestation were significantly associated with mid-childhood individual and total BCAAs concentrations. The findings suggest that elevated maternal glycaemia throughout pregnancy, especially GDM, may have persistent programming effects on offspring AA metabolism which were strongly associated with adverse cardiometabolic profiles at mid-childhood.
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Affiliation(s)
- Mengjiao Liu
- School of Public Health, Nanchang University, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Jiangxi, China
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yung Seng Lee
- Departments of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Pediatric Endocrinology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Fabian Yap
- Departments of Pediatrics, and Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
- Graduate Medical School, Duke-National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mya Thway Tint
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore
| | - Jiaxi Yang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Global Centre for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Asia Centre for Reproductive Longevity & Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Burgner
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Cuilin Zhang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Global Centre for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Asia Centre for Reproductive Longevity & Equality, 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
| | - Ling-Jun Li
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Global Centre for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Asia Centre for Reproductive Longevity & Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Santanapipatkul P, Luewan S, Sittiwangkul R, Krongphaiklang N, Jatavan P, Tongsong T. Comparison of fetal and neonatal cardiac morphology between the infants of mothers with well-controlled gestational diabetes mellitus and normal controls. Diab Vasc Dis Res 2023; 20:14791641231190531. [PMID: 37463129 PMCID: PMC10357059 DOI: 10.1177/14791641231190531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To compare fetal and neonatal cardiac morphology in fetuses of mothers with gestational diabetes mellitus (GDM) with the controls. PATIENTS AND METHODS Pregnant women at average risk of GDM underwent 100-g, 3-h-OGTT at 24-28 weeks of gestation for diagnosis of GDM. Both GDM group and the control group underwent fetal echocardiography at 32-36 weeks to assess cardiac dimensions. The neonates underwent echocardiography within 48 h after birth to assess cardiac morphology. RESULTS A total of 154 pregnant women were recruited, including 60 in the GDM group and 94 in the control group. All of the study group were well controlled for GDM. Most baseline characteristics of both groups were comparable. All obstetric outcomes were not significantly different between the two groups. Morphological cardiac dimensions in the fetuses and newborns of both groups were also not significant different. Subgroup analysis in the study group showed no significantly different in cardiac morphology between the group with diet control and that of insulin control. CONCLUSION Fetal and neonatal cardiac morphologic changes among mothers with well-controlled GDM are not significantly different from those in the controls. It is possible that good control of maternal blood glucose can prevent fetal and neonatal cardiac abnormalities.
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Affiliation(s)
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rekwan Sittiwangkul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- The Northern Thailand Heart Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nopparat Krongphaiklang
- The Northern Thailand Heart Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phudit Jatavan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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7
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Ku CW, Cheng TS, Ku CO, Zhou KX, Cheung YB, Godfrey KM, Han WM, Yap F, Chan JKY, Loy SL. Distribution and association of interpregnancy weight change with subsequent pregnancy outcomes in Asian women. Sci Rep 2023; 13:4834. [PMID: 36964283 PMCID: PMC10039003 DOI: 10.1038/s41598-023-31954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
The extent of interpregnancy weight change and its association with subsequent pregnancy outcomes among Asians remain unclear. We examined changes in maternal body mass index (BMI) between the first two deliveries and outcomes in the second delivery. Medical records of women with their first two consecutive deliveries between 2015 and 2020 at KK Women's and Children's Hospital, Singapore were retrieved. Gestational-age-adjusted BMI was determined by standardising to 12 weeks gestation and interpregnancy BMI change was calculated as the difference between both pregnancies. Pregnancy outcomes were analysed using modified Poisson regression models. Of 6264 included women with a median interpregnancy interval of 1.44 years, 40.7% had a stable BMI change within ± 1 kg/m2, 10.3% lost > 1 kg/m2, 34.3% gained 1-3 kg/m2 and 14.8% gained ≥ 3 kg/m2. Compared to women with stable BMI change, those with > 1 kg/m2 loss had higher risk of low birthweight (adjusted risk ratio [RR] 1.36; 95% confidence interval 1.02-1.80), while those with 1-3 kg/m2 gain had higher risks of large-for-gestational-age birth (1.16; 1.03-1.31), gestational diabetes (1.25; 1.06-1.49) and emergency Caesarean delivery (1.16; 1.03-1.31); these risks were higher in those with ≥ 3 kg/m2 gain. Our study strengthens the case for interpregnancy weight management to improve subsequent pregnancy outcomes.
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Affiliation(s)
- Chee Wai Ku
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Tuck Seng Cheng
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus Box 285, Cambridge, CB2 0QQ, UK
| | - Chee Onn Ku
- Faculty of Science, National University of Singapore, Singapore, 119077, Singapore
| | - Kathy Xinzhuo Zhou
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research and Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, 169857, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, 33014, Tampere, Finland
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK
| | - Wee Meng Han
- Department of Dietetics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
- Duke-NUS Medical School, Singapore, 169857, Singapore.
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Poo ZX, Sim WS, Tan LK. Unexpected case of postnatal pancreatitis: first presentation of autoimmune diabetes. BMJ Case Rep 2022; 15:e253133. [PMID: 36593615 PMCID: PMC9730374 DOI: 10.1136/bcr-2022-253133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as the first onset of glucose intolerance in pregnancy without prior known diabetes. While it is commonly associated with metabolic risk factors such as obesity and hypertension, a small percentage of women with GDM have underlying autoimmune causes, with presence of islet-cell antibodies resulting in autoimmune-mediated destruction of the pancreas. We present a case of idiopathic postpartum pancreatitis precipitating fulminant diabetic ketoacidosis in a patient with otherwise well-controlled GDM during pregnancy, and subsequent findings of positive anti-glutamic acid decarboxylase antibody. This is the first presentation of autoimmune diabetes diagnosed postnatally in a woman who has no previous medical or family history.
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Affiliation(s)
- Zi Xi Poo
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Wen Shan Sim
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Lay Kok Tan
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
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9
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Wei Y, He A, Tang C, Liu H, Li L, Yang X, Wang X, Shen F, Liu J, Li J, Li R. Risk prediction models of gestational diabetes mellitus before 16 gestational weeks. BMC Pregnancy Childbirth 2022; 22:889. [PMID: 36456970 PMCID: PMC9714187 DOI: 10.1186/s12884-022-05219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) can lead to adverse maternal and fetal outcomes, and early prevention is particularly important for their health, but there is no widely accepted approach to predict it in the early pregnancy. The aim of the present study is to build and evaluate predictive models for GDM using routine indexes, including maternal clinical characteristics and laboratory biomarkers, before 16 gestational weeks. METHODS A total of 2895 pregnant women were recruited and maternal clinical characteristics and laboratory biomarkers before 16 weeks of gestation were collected from two hospitals. All participants were randomly stratified into the training cohort and the internal validation cohort by the ratio of 7:3. Using multivariable logistic regression analysis, two nomogram models, including a basic model and an extended model, were built. The discrimination, calibration, and clinical validity were used to evaluate the models in the internal validation cohort. RESULTS The area under the receiver operating characteristic curve of the basic and the extended model was 0.736 and 0.756 in the training cohort, and was 0.736 and 0.763 in the validation cohort, respectively. The calibration curve analysis showed that the predicted values of the two models were not significantly different from the actual observations (p = 0.289 and 0.636 in the training cohort, p = 0.684 and 0.635 in the internal validation cohort, respectively). The decision-curve analysis showed a good clinical application value of the models. CONCLUSIONS The present study built simple and effective models, indicating that routine clinical and laboratory parameters can be used to predict the risk of GDM in the early pregnancy, and providing a novel reference for studying the prediction of GDM.
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Affiliation(s)
- Yiling Wei
- grid.412601.00000 0004 1760 3828Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Andong He
- grid.412601.00000 0004 1760 3828Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Chaoping Tang
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 China
| | - Haixia Liu
- grid.412601.00000 0004 1760 3828Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Ling Li
- Department of Obstetrics and Gynecology, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, 529000 China
| | - Xiaofeng Yang
- grid.412601.00000 0004 1760 3828Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Xiufang Wang
- grid.412601.00000 0004 1760 3828Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Fei Shen
- Department of Obstetrics and Gynecology, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, 529000 China
| | - Jia Liu
- grid.412601.00000 0004 1760 3828Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
| | - Jing Li
- Department of Obstetrics and Gynecology, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, 529000 China
| | - Ruiman Li
- grid.412601.00000 0004 1760 3828Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630 China
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10
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Kumar M, Chen L, Tan K, Ang LT, Ho C, Wong G, Soh SE, Tan KH, Chan JKY, Godfrey KM, Chan SY, Chong MFF, Connolly JE, Chong YS, Eriksson JG, Feng M, Karnani N. Population-centric risk prediction modeling for gestational diabetes mellitus: A machine learning approach. Diabetes Res Clin Pract 2022; 185:109237. [PMID: 35124096 PMCID: PMC7612635 DOI: 10.1016/j.diabres.2022.109237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022]
Abstract
AIMS The heterogeneity in Gestational Diabetes Mellitus (GDM) risk factors among different populations impose challenges in developing a generic prediction model. This study evaluates the predictive ability of existing UK NICE guidelines for assessing GDM risk in Singaporean women, and used machine learning to develop a non-invasive predictive model. METHODS Data from 909 pregnancies in Singapore's most deeply phenotyped mother-offspring cohort study, Growing Up in Singapore Towards healthy Outcomes (GUSTO), was used for predictive modeling. We used a CatBoost gradient boosting algorithm, and the Shapley feature attribution framework for model building and interpretation of GDM risk attributes. RESULTS UK NICE guidelines showed poor predictability in Singaporean women [AUC:0.60 (95% CI 0.51, 0.70)]. The non-invasive predictive model comprising of 4 non-invasive factors: mean arterial blood pressure in first trimester, age, ethnicity and previous history of GDM, greatly outperformed [AUC:0.82 (95% CI 0.71, 0.93)] the UK NICE guidelines. CONCLUSIONS The UK NICE guidelines may be insufficient to assess GDM risk in Asian women. Our non-invasive predictive model outperforms the current state-of-the-art machine learning models to predict GDM, is easily accessible and can be an effective approach to minimize the economic burden of universal testing & GDM associated healthcare in Asian populations.
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Affiliation(s)
- Mukkesh Kumar
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Li Chen
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Karen Tan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Li Ting Ang
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Cindy Ho
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Gerard Wong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kok Hian Tan
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Republic of Singapore; Obstetrics and Gynecology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Republic of Singapore
| | - Jerry Kok Yen Chan
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of Reproductive Medicine, KK Women's and Children's Hospital, Republic of Singapore; Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Mary Foong Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - John E Connolly
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of General Practice and Primary Health Care, University of Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Mengling Feng
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Republic of Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
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11
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Chen L, Tan KML, Gong M, Chong MFF, Tan KH, Chong YS, Meaney MJ, Gluckman PD, Eriksson JG, Karnani N. Variability in newborn telomere length is explained by inheritance and intrauterine environment. BMC Med 2022; 20:20. [PMID: 35073935 PMCID: PMC8787951 DOI: 10.1186/s12916-021-02217-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Telomere length (TL) and its attrition are important indicators of physiological stress and biological aging and hence may vary among individuals of the same age. This variation is apparent even in newborns, suggesting potential effects of parental factors and the intrauterine environment on TL of the growing fetus. METHODS Average relative TLs of newborns (cord tissue, N = 950) and mothers (buffy coat collected at 26-28 weeks of gestation, N = 892) were measured in a birth cohort. This study provides a comprehensive analysis of the effects of heritable factors, socioeconomic status, and in utero exposures linked with maternal nutrition, cardiometabolic health, and mental well-being on the newborn TL. The association between maternal TL and antenatal maternal health was also studied. RESULTS Longer maternal TL (β = 0.14, P = 1.99E-05) and higher paternal age (β = 0.10, P = 3.73E-03) were positively associated with newborn TL. Genome-wide association studies on newborn and maternal TLs identified 6 genetic variants in a strong linkage disequilibrium on chromosome 3q26.2 (Tag SNP-LRRC34-rs10936600: Pmeta = 5.95E-08). Mothers with higher anxiety scores, elevated fasting blood glucose, lower plasma insulin-like growth factor-binding protein 3 and vitamin B12 levels, and active smoking status during pregnancy showed a higher risk of giving birth to offspring with shorter TL. There were sex-related differences in the factors explaining newborn TL variation. Variation in female newborn TL was best explained by maternal TL, mental health, and plasma vitamin B12 levels, while that in male newborn TL was best explained by paternal age, maternal education, and metabolic health. Mother's TL was associated with her own metabolic health and nutrient status, which may have transgenerational effects on offspring TL. CONCLUSIONS Our findings provide a comprehensive understanding of the heritable and environmental factors and their relative contributions to the initial setting of TL and programing of longevity in early life. This study provides valuable insights for preventing in utero telomere attrition by improving the antenatal health of mothers via targeting the modifiable factors. TRIAL REGISTRATION ClinicalTrials.gov , NCT01174875. Registered on 1 July 2010.
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Affiliation(s)
- Li Chen
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore.
| | | | - Min Gong
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore.,Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michael J Meaney
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore.,Sackler Program for Epigenetics & Psychobiology at McGill University, Montréal, Canada.,Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montréal, Canada
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore.,Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore.,Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montréal, Canada.,Folkhalsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore. .,Bioinformatics Institute, A*STAR, Singapore, Singapore. .,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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12
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Quah PL, Tan LK, Lek N, Thain S, Tan KH. Glycemic Variability in Early Pregnancy May Predict a Subsequent Diagnosis of Gestational Diabetes. Diabetes Metab Syndr Obes 2022; 15:4065-4074. [PMID: 36597491 PMCID: PMC9805730 DOI: 10.2147/dmso.s379616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/30/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE This study examined the prospective association between CGM-derived glycemic variability (GV) and glycemic control (GC) parameters in the first and second trimester, with subsequent diagnosis of GDM in the early third trimester. METHODS In a longitudinal observational study, 60 study participants in the first trimester (9-13 weeks' gestation), and 53 participants (18-23 weeks' gestation) in the second trimester of pregnancy had CGM data extracted after a minimum of 8 days' wear time (up to 14 days). At 24-31 weeks' gestation, participants underwent a 75 g, 2-hour oral glucose-tolerance test as per IADPSG criteria to diagnose GDM. GV parameters examined in both first and second trimesters were mean amplitude of glycemic excursion (MAGE), standard deviation (SD), mean glucose, and coefficient of variation (CV). GC parameters measured were J-Index and percentage of time spent in glucose target ranges. RESULTS The first trimester SD and MAGE were significantly higher in participants subsequently diagnosed with GDM (SD adjusted median 1.31 [interquartile range 1.2-1.3] mmol/L; MAGE 3.26 [3.2-3.3] mmol/L) than those who were not (SD 1.01 [0.9-1.0] mmol/L, MAGE 2.59 [2.4-2.6] mmol/L; p<0.05). Similarly, second trimester SD and MAGE were also significantly higher in participants subsequently diagnosed with GDM (SD 1.35 [1.3-1.4] mmol/L; MAGE 3.32 (3.31-3.41) mmol/L) than those who were not (SD 0.99 [0.98-1.01] mmol/L, MAGE 2.42 [2.42-2.55] mmol/L; p<0.05). Associations between SD and MAGE with GDM outcomes were adjusted for prepregnancy BMI and ethnicity. There were nonsignificant trends of higher J-Index scores in the first and second trimester, higher CV in the first trimester only, and higher mean in the second trimester only in participants diagnosed with GDM. Other study parameters measured were not significantly different between groups (p>0.003). CONCLUSION Our study suggests the potential value of CGM-derived SD and MAGE in early pregnancy as potential predictors of subsequent GDM diagnosis.
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Affiliation(s)
- Phaik Ling Quah
- Deparment of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
- Correspondence: Phaik Ling Quah, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital (KKH), 100 Bukit Timah Road, 229899, Singapore, Tel +65 9773-2543, Email
| | - Lay Kok Tan
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Ngee Lek
- Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore
- OBGYN ACP, Duke-NUS Medical School, Singapore
| | - Serene Thain
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Kok Hian Tan
- Deparment of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
- OBGYN ACP, Duke-NUS Medical School, Singapore
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13
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Hewage SS, Aw S, Chi C, Yoong J. Factors Associated with Intended Postpartum OGTT Uptake and Willingness to Receive Preventive Behavior Support to Reduce Type 2 Diabetes Risk Among Women with Gestational Diabetes in Singapore: An Exploratory Study. Nutr Metab Insights 2021; 14:11786388211016827. [PMID: 34035651 PMCID: PMC8132084 DOI: 10.1177/11786388211016827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/15/2021] [Indexed: 11/20/2022] Open
Abstract
Aim: To assess and explore the factors affecting willingness to undergo an early postpartum oral glucose tolerance test (OGTT) and receive postpartum lifestyle modification assistance. Methods: An explanatory sequential mixed-method design was used. A prenatal cross-sectional survey questionnaire (n = 216) was given to women diagnosed with GDM in a tertiary health institution in Singapore and followed up with postpartum semi-structured interviews (n = 30). Multivariate logistic regression and thematic analysis were conducted before merging the findings. Results: Despite universal GDM education, fewer than 75% intended to take the OGTT postpartum, and only 63% felt it was very important. The plan to take the OGTT postpartum was positively associated with a prenatal care provider’s specific recommendation. In contrast, Malay women were less likely to take the test. Most women interpreted a care provider’s recommendation as implying standard practice, which encouraged intended and actual compliance with testing after giving birth. The perception of moderate to high T2DM risk in the following decade, and subsidized prenatal care, and plan to take the OGTT postpartum were positively associated with willingness to receive postpartum lifestyle behavior support. A mobile application was the preferred method to receive support. Conclusions: In the early postpartum period, women with a history of GDM were willing to receive measures to reduce T2DM risk, primarily if it was under the supervision and recommendation of a care provider. A carefully designed but simple postpartum lifestyle intervention incorporating these preferences that can be integrated into mainstream diabetes prevention programs is warranted.
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Affiliation(s)
- Sumali S Hewage
- Saw Swee School of Public Health, National University of Singapore, Singapore
| | - Su Aw
- Saw Swee School of Public Health, National University of Singapore, Singapore
| | - Claudia Chi
- Astra Women's Specialists, Singapore.,Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Joanne Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
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14
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Liu G, Wang F. Macular vascular changes in pregnant women with gestational diabetes mellitus by optical coherence tomography angiography. BMC Ophthalmol 2021; 21:170. [PMID: 33836718 PMCID: PMC8034184 DOI: 10.1186/s12886-021-01927-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background Retinal capillary is vulnerable to diabetes, whether gestational diabetes mellitus (GDM) eyes without clinical retinopathy have capillary abnormalities has not been well studied. To observe the microvasculature changes in eyes of GDM women compared with normoglycemic pregnant women and non-pregnant women by optical coherence tomography-angiography (OCT-A). Methods GDM women, age-matched normoglycemic pregnant women and non-pregnant women were included in this study. All subjects were examined by OCT-A, vascular density and macular foveal parameters were measured automatically. Results Thirty eight non-pregnant women (NC group), thirty pregnant women without GDM (PC group), and thirty one GDM women (GDM group) were included in this study. There was a significant reduction of vascular density in superficial capillary layer, but an increase in deep capillary layer in PC and GDM groups (P < 0.001). When in terms of the average vascular density, the difference was insignificant among these three groups. Although all the measurements were similar between PC and GDM groups, more capillary “dropout” changes were detected in GDM group. Unexpectedly, the abnormal changes of central macular thickness thinning and foveal avascular zone enlargement seen during pregnancy were improved when compared to PC group. Conclusions The changes of vascular density implied the redistribution of capillary network from superficial to deep layer under pregnancy and GDM states. Although the transient hyperglycemia aggravates the changes of capillary “dropout”, GDM group revealed the improvement of central macular thickness thinning and foveal avascular zone enlargement during pregnancy.
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Affiliation(s)
- Guodong Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital affiliated with Tongji University, 301 Middle Yan Chang Road, Shanghai, 200072, People's Republic of China
| | - Fang Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital affiliated with Tongji University, 301 Middle Yan Chang Road, Shanghai, 200072, People's Republic of China.
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15
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Shanmuganathan M, Kroezen Z, Gill B, Azab S, de Souza RJ, Teo KK, Atkinson S, Subbarao P, Desai D, Anand SS, Britz-McKibbin P. The maternal serum metabolome by multisegment injection-capillary electrophoresis-mass spectrometry: a high-throughput platform and standardized data workflow for large-scale epidemiological studies. Nat Protoc 2021; 16:1966-1994. [PMID: 33674789 DOI: 10.1038/s41596-020-00475-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 01/31/2023]
Abstract
A standardized data workflow is described for large-scale serum metabolomic studies using multisegment injection-capillary electrophoresis-mass spectrometry. Multiplexed separations increase throughput (<4 min/sample) for quantitative determination of 66 polar/ionic metabolites in serum filtrates consistently detected (coefficient of variance (CV) <30%) with high frequency (>75%) from a multi-ethnic cohort of pregnant women (n = 1,004). We outline a validated protocol implemented in four batches over a 7-month period that includes details on preventive maintenance, sample workup, data preprocessing and metabolite authentication. We achieve stringent quality control (QC) and robust batch correction of long-term signal drift with good mutual agreement for a wide range of metabolites, including serum glucose as compared to a clinical chemistry analyzer (mean bias = 11%, n = 668). Control charts for a recovery standard (mean CV = 12%, n = 2,412) and serum metabolites in QC samples (median CV = 13%, n = 202) demonstrate acceptable intermediate precision with a median intraclass coefficient of 0.87. We also report reference intervals for 53 serum metabolites from a diverse population of women in their second trimester of pregnancy.
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Affiliation(s)
- Meera Shanmuganathan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Zachary Kroezen
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Biban Gill
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Sandi Azab
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Koon K Teo
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Atkinson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dipika Desai
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada.
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16
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Lim K, Chan SY, Lim SL, Tai BC, Tsai C, Wong SR, Ang SM, Yew TW, Tai ES, Yong EL. A Smartphone App to Restore Optimal Weight (SPAROW) in Women With Recent Gestational Diabetes Mellitus: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e22147. [PMID: 33724204 PMCID: PMC8088857 DOI: 10.2196/22147] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background Women with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited. Objective This trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes. Methods In this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI≤23 kg/m2 or weight loss of at least 5% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group. Results In total, 40% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8% (SD 33.9%). Conclusions Although a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management. Trial Registration ClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-7691-3
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Affiliation(s)
- Karen Lim
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cammy Tsai
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Su Ren Wong
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Siew Min Ang
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Tong Wei Yew
- Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Eu Leong Yong
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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17
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Chen LW, Soh SE, Tint MT, Loy SL, Yap F, Tan KH, Lee YS, Shek LPC, Godfrey KM, Gluckman PD, Eriksson JG, Chong YS, Chan SY. Combined analysis of gestational diabetes and maternal weight status from pre-pregnancy through post-delivery in future development of type 2 diabetes. Sci Rep 2021; 11:5021. [PMID: 33658531 PMCID: PMC7930020 DOI: 10.1038/s41598-021-82789-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/21/2021] [Indexed: 01/14/2023] Open
Abstract
We examined the associations of gestational diabetes mellitus (GDM) and women’s weight status from pre-pregnancy through post-delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4–6 years post-delivery. Using Poisson regression with confounder adjustments, we assessed associations of standard categorisations of prospectively ascertained pre-pregnancy overweight and obesity (OWOB), gestational weight gain (GWG) and substantial post-delivery weight retention (PDWR) with post-delivery dysglycaemia (n = 692). Women with GDM had a higher risk of later T2D [relative risk (95% CI) 12.07 (4.55, 32.02)] and dysglycaemia [3.02 (2.19, 4.16)] compared with non-GDM women. Independent of GDM, women with pre-pregnancy OWOB also had a higher risk of post-delivery dysglycaemia. Women with GDM who were OWOB pre-pregnancy and had subsequent PDWR (≥ 5 kg) had 2.38 times (1.29, 4.41) the risk of post-delivery dysglycaemia compared with pre-pregnancy lean GDM women without PDWR. No consistent associations were observed between GWG and later dysglycaemia risk. In conclusion, women with GDM have a higher risk of T2D 4–6 years after the index pregnancy. Pre-pregnancy OWOB and PDWR exacerbate the risk of post-delivery dysglycaemia. Weight management during preconception and post-delivery represent early windows of opportunity for improving long-term health, especially in those with GDM.
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Affiliation(s)
- Ling-Wei Chen
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Mya-Thway Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Fabian Yap
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Pediatric Endocrinology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Liggins Institute, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Department of General Practice and Primary Health Care, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.,Folkhälsan Research Center, Topeliusgatan 20, 00250, Helsinki, Finland
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore. .,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Yew TW, Chi C, Chan SY, van Dam RM, Whitton C, Lim CS, Foong PS, Fransisca W, Teoh CL, Chen J, Ho-Lim ST, Lim SL, Ong KW, Ong PH, Tai BC, Tai ES. A Randomized Controlled Trial to Evaluate the Effects of a Smartphone Application-Based Lifestyle Coaching Program on Gestational Weight Gain, Glycemic Control, and Maternal and Neonatal Outcomes in Women With Gestational Diabetes Mellitus: The SMART-GDM Study. Diabetes Care 2021; 44:456-463. [PMID: 33184151 PMCID: PMC7818327 DOI: 10.2337/dc20-1216] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/04/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE SMART-GDM examined whether Habits-GDM, a smartphone application (app) coaching program, can prevent excessive gestational weight gain (EGWG) and improve glycemic control and maternal and neonatal outcomes in gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS In this randomized controlled trial, women diagnosed with GDM between 12 and 30 weeks were randomly assigned to usual care (control) or to additional support from Habits-GDM that integrated dietary, physical activity, weight, and glucose monitoring (intervention). The primary outcome was the proportion of participants with EGWG. Secondary outcomes included absolute gestational weight gain (GWG), glycemic control, and maternal, delivery, and neonatal outcomes. RESULTS In total, 340 women were randomized (170 intervention, 170 control; mean ± SD age 32.0 ± 4.2 years; mean BMI 25.6 ± 5.6 kg/m2). There were no statistically significant differences in the proportions of women with EGWG, absolute GWG, or maternal and delivery outcomes between experimental groups. Average glucose readings were lower in the intervention group (mean difference -0.15 mmol/L [95% CI -0.26; -0.03], P = 0.011) as were the proportions of glucose above targets (premeal: 17.9% vs. 23.3%, odds ratio 0.68 [95% CI 0.53; 0.87], P = 0.003; 2-h postmeal: 19.9% vs. 50%, 0.54 [0.42; 0.70], P < 0.001). When regarded as a composite (although not prespecified), the overall neonatal complications (including birth trauma, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress, neonatal intensive care unit admission, and perinatal death) were significantly lower in the intervention group (38.1% vs. 53.7%, 0.53 [0.34; 0.84], P = 0.006). CONCLUSIONS When added to usual care, Habits-GDM resulted in better maternal glycemic control and composite neonatal outcomes (nonprespecified) but did not reduce EGWG among women with GDM.
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Affiliation(s)
- Tong Wei Yew
- Department of Medicine, National University Hospital, Singapore .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Claudia Chi
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynecology, National University Hospital, Singapore.,Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Clare Whitton
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chang Siang Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pin Sym Foong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Winni Fransisca
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chieu Leng Teoh
- Department of Nursing, National University Hospital, Singapore
| | - Jeannie Chen
- Department of Nursing, National University Hospital, Singapore
| | - Su Tin Ho-Lim
- Department of Nursing, National University Hospital, Singapore
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore
| | - Kai Wen Ong
- Department of Dietetics, National University Hospital, Singapore
| | | | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - E Shyong Tai
- Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Kunasegaran T, Balasubramaniam VRMT, Arasoo VJT, Palanisamy UD, Ramadas A. Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031272. [PMID: 33572656 PMCID: PMC7908368 DOI: 10.3390/ijerph18031272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute’s methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.
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20
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Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study. Nutrients 2021; 13:nu13020408. [PMID: 33525398 PMCID: PMC7912373 DOI: 10.3390/nu13020408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022] Open
Abstract
(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; p = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; p = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.
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Tan KML, Chu AHY, Loy SL, Rajadurai VS, Ho CKM, Chong YS, Karnani N, Lee YS, Yap FKP, Chan SY. Association of Cord Blood Thyroid-Stimulating Hormone Levels with Maternal, Delivery and Infant Factors. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2020471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Introduction: This study examined maternal, delivery and infant factors associated with
cord thyroid-stimulating hormone (TSH) concentrations in an Asian population.
Methods: The Growing Up in Singapore Towards healthy Outcomes (GUSTO) study is
a mother–offspring birth cohort from 2 major hospitals in Singapore. Cord serum TSH
was measured using the Abbott ARCHITECT TSH Chemiluminescent Microparticle
Immunoassay and the ADVIA Centaur TSH-3 Immunoassay. After excluding infants with
a maternal history of thyroid disease, screening cord TSH results from 604 infants were
available for multivariable regression analysis in relation to the factors of interest.
Results: Babies born by vaginal delivery had significantly higher cord serum TSH
concentrations than babies born by caesarean section. Cord serum TSH concentrations
differed significantly by measurement method. There was no association of cord TSH
concentrations with ethnicity, sex, birth weight, gestational age, maternal body mass index,
gestational weight gain, gestational diabetes mellitus status and other maternal, delivery
and infant factors studied.
Conclusion: Interpretation of cord serum TSH results may need to take into account mode
of delivery and measurement method.
Keywords: Cord blood, Growing Up in Singapore Towards healthy Outcomes,
GUSTO, perinatal
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Affiliation(s)
- Karen ML Tan
- Agency for Science, Technology and Research, Singapore
| | - Anne HY Chu
- Agency for Science, Technology and Research, Singapore
| | | | | | | | | | | | - Yung Seng Lee
- Agency for Science, Technology and Research, Singapore
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Kalok A, Ong MY, Hasrori A, Chiang KS, Yazim F, Baharuddin S, Rahman RA, Shah SA, Aziz NHA, Ahmad S, Ismail NAM. Correlation between Oral Glucose Tolerance Test Abnormalities and Adverse Pregnancy Outcomes in Gestational Diabetes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6990. [PMID: 32987806 PMCID: PMC7579185 DOI: 10.3390/ijerph17196990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/19/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is associated with maternal and neonatal complications. We aimed to evaluate the relationship between the abnormalities of the oral glucose tolerance test (OGTT) and adverse pregnancy outcomes. This was a retrospective study of GDM patients over a five-year period in a Malaysian tertiary center. The diagnosis of GDM was based on the National Institute for Health and Care Excellence (NICE) guideline. The data on patients' demographics, OGTT results, GDM treatment, and pregnancy outcomes were analyzed. A total of 1105 women were included in the final analysis. The percentage of women with isolated abnormal fasting glucose, isolated two-hour abnormality, and both abnormal values were 4.8%, 87.1%, and 8.1%, respectively. Women with both OGTT abnormalities had a higher risk of preeclampsia (odds ratio (OR) 4.73; 95% confidence interval (CI) 1.45-15.41) and neonatal hypoglycemia (OR 8.78; 95% CI 1.93-39.88). Isolated postprandial abnormality was associated with an 80% lesser risk of neonatal hypoglycemia (OR 0.19; 95% CI 0.04-0.87). Both isolated fasting and multiple OGTT abnormalities were associated with insulin therapy. Multiple OGTT abnormalities were a positive predictor of adverse pregnancy outcomes, while isolated postprandial abnormality was associated with a lesser risk of neonatal complication. Further prospective study is essential to validate these findings.
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Affiliation(s)
- Aida Kalok
- Department of Obstetrics and Gynaecology, Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (R.A.R.); (N.H.A.A.); (S.A.); (N.A.M.I.)
| | - Ming Yean Ong
- Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (M.Y.O.); (A.H.); (K.S.C.); (F.Y.); (S.B.)
| | - Aqilah Hasrori
- Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (M.Y.O.); (A.H.); (K.S.C.); (F.Y.); (S.B.)
| | - Ker Shing Chiang
- Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (M.Y.O.); (A.H.); (K.S.C.); (F.Y.); (S.B.)
| | - Fatin Yazim
- Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (M.Y.O.); (A.H.); (K.S.C.); (F.Y.); (S.B.)
| | - Salahuddin Baharuddin
- Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (M.Y.O.); (A.H.); (K.S.C.); (F.Y.); (S.B.)
| | - Rahana Abdul Rahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (R.A.R.); (N.H.A.A.); (S.A.); (N.A.M.I.)
| | - Shamsul Azhar Shah
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Nor Haslinda Abd Aziz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (R.A.R.); (N.H.A.A.); (S.A.); (N.A.M.I.)
| | - Shuhaila Ahmad
- Department of Obstetrics and Gynaecology, Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (R.A.R.); (N.H.A.A.); (S.A.); (N.A.M.I.)
| | - Nor Azlin Mohamed Ismail
- Department of Obstetrics and Gynaecology, Faculty of Medicine, National University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Kuala Lumpur, Malaysia; (R.A.R.); (N.H.A.A.); (S.A.); (N.A.M.I.)
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Hewage S, Audimulam J, Sullivan E, Chi C, Yew TW, Yoong J. Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study. JMIR Form Res 2020; 4:e14486. [PMID: 32602845 PMCID: PMC7367517 DOI: 10.2196/14486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before. Objective This study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting. Methods This mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore. Results The patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers. Conclusions A GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women.
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Affiliation(s)
- Sumali Hewage
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jananie Audimulam
- Integrated Health Promotion Unit, Ministry of Health Transformation Office, Singapore, Singapore
| | - Emily Sullivan
- Family Planning 2020, United Nations Foundation, Washington, WA, United States
| | - Claudia Chi
- Department of Obstetrics and Gynecology, National University Hospital, Singapore, Singapore
| | - Tong Wei Yew
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Joanne Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
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Anthropometric measures and HbA1c to detect dysglycemia in young Asian women planning conception: The S-PRESTO cohort. Sci Rep 2020; 10:9228. [PMID: 32514017 PMCID: PMC7280215 DOI: 10.1038/s41598-020-66147-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022] Open
Abstract
We investigated whether adding anthropometric measures to HbA1c would have stronger discriminative ability over HbA1c alone in detecting dysglycemia (diabetes and prediabetes) among Asian women trying to conceive. Among 971 Singaporean women, multiple regression models and area under receiver-operating characteristic (AUROC) curves were used to analyze associations of anthropometric (weight, height, waist/hip circumferences, 4-site skinfold thicknesses) and HbA1c z-scores with dysglycemia (fasting glucose ≥6.1 mmol/L with 2-hour glucose ≥7.8 mmol/l). The prevalence of dysglycemia was 10.9%. After adjusting for sociodemographic/medical history, BMI (Odds Ratio [OR] = 1.62 [95%CI 1.32–1.99]), waist-to-height ratio (OR = 1.74 [1.39–2.17]) and total skinfolds (OR = 2.02 [1.60–2.55]) showed the strongest associations with dysglycemia but none outperformed HbA1c (OR = 4.09 [2.81–5.94]). After adjustment for history, adding BMI, waist-to-height ratio and total skinfolds (anthropometry trio) as continuous variables to HbA1c (AUROC = 0.80 [95%CI 0.75–0.85]) performed similarly to HbA1c alone (AUROC = 0.79 [0.74–0.84]). However, using clinically-defined thresholds without considering history, as in common clinical practice, BMI ≥ 23 kg/m2 + HbA1c ≥ 5.7% (AUROC = 0.70 [0.64–0.75]) and anthropometry trio + HbA1c ≥ 5.7% (AUROC = 0.71 [0.65–0.76]) both outperformed HbA1c ≥ 5.7% alone (AUROC = 0.61 [0.57–0.65]). In a two-stage strategy, incorporating BMI ≥ 23 kg/m2 alongside HbA1c ≥ 5.7% into first-stage screening to identify high risk women for subsequent oral glucose tolerance testing improves dysglycemia detection in Asian women preconception.
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Yong HY, Mohd Shariff Z, Mohd Yusof BN, Rejali Z, Tee YYS, Bindels J, van der Beek EM. Independent and combined effects of age, body mass index and gestational weight gain on the risk of gestational diabetes mellitus. Sci Rep 2020; 10:8486. [PMID: 32444832 PMCID: PMC7244566 DOI: 10.1038/s41598-020-65251-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Abstract
This study aimed to identify the independent and combined effects of age, BMI at first prenatal visit and GWG on the risk of GDM. A retrospective cohort study of 1,951 pregnant women in Seremban district, Negeri Sembilan, Malaysia. GDM was defined as fasting plasma glucose (FPG) ≥5.6 mmol/l and/or 2-hour postprandial plasma glucose (2hPPG) ≥7.8 mmol/l. A higher percentage of women with GDM had 2 risk factors (29.0%) or >2 risk factors (8.6%) compared to non-GDM women (2 risk factors: 25.5%; >2 risk factors: 5.0%). In general, women with ≥2 risk factors were respectively 1.36-2.06 times more likely to have GDM compared to those without risk factors. Older maternal age and being overweight/obese were significantly associated with risk of GDM. Overweight/obese women with age ≥35 years had 2.45 times higher risk of GDM and having excessive GWG at second trimester further increased the risk of GDM. Age and BMI are independent risk factors for GDM but not GWG in the first and second trimester. The findings emphasize the need to focus on a healthy BMI before pregnancy and optimal GWG during pregnancy to improve pregnancy outcomes.
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Affiliation(s)
- Heng Yaw Yong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
| | - Barakatun Nisak Mohd Yusof
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zulida Rejali
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Yvonne Yee Siang Tee
- Danone Specialized Nutrition (Malaysia) Sdn Bhd, 59200, Mid Valley City, Lingkaran Syed Putra, Kuala Lumpur, Malaysia
| | - Jacques Bindels
- Danone Nutricia Research, Uppsalalaan 12, 3584, CT, Utrecht, The Netherlands
| | - Eline M van der Beek
- Danone Nutricia Research, Uppsalalaan 12, 3584, CT, Utrecht, The Netherlands
- Department of Pediatrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Implication of gut microbiota in the association between infant antibiotic exposure and childhood obesity and adiposity accumulation. Int J Obes (Lond) 2020; 44:1508-1520. [PMID: 32321980 DOI: 10.1038/s41366-020-0572-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/29/2020] [Accepted: 03/26/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND In animal studies early life antibiotic exposure causes metabolic abnormalities including obesity through microbiota disruption, but evidence from human studies is scarce. We examined involvement of gut microbiota in the associations between infant antibiotic exposure and childhood adiposity. METHODS Infant antibiotic exposure in the first year of life was ascertained using parental reports during interviewer-administered questionnaires. Primary outcomes were childhood obesity [body mass index (BMI) z-score > 95th percentile] and adiposity [abdominal circumference (AC) and skinfold (triceps + subscapular (SST)) measurements] determined from ages 15-60 months. At age 24 months, when the gut microbiota are more stable, stool samples (n = 392) were collected for the gut microbiota profiling using co-abundancy networks. Associations of antibiotic exposure with obesity and adiposity (n = 1016) were assessed using multiple logistic and linear mixed effects regressions. Key bacteria associated with antibiotics exposure were identified by partial redundancy analysis and multivariate association with linear models. RESULTS Antibiotic exposure was reported in 38% of study infants. In a fully adjusted model, a higher odds of obesity from 15-60 months of age was observed for any antibiotic exposure [OR(95% CI) = 1.45(1.001, 2.14)] and exposure to ≥3 courses of antibiotics [2.78(1.12, 6.87)]. For continuous adiposity indicators, any antibiotic exposure was associated with higher BMI z-score in boys [β = 0.15(0.01, 0.28)] but not girls [β = -0.04(-0.19, 0.11)] (P interaction = 0.026). Similarly, exposure to ≥3 courses of antibiotics was associated with higher AC in boys [1.15(0.05, 2.26) cm] but not girls [0.57(-1.32, 2.45) cm] (P interaction not significant). Repeated exposure to antibiotics was associated with a significant reduction (FDR-corrected P values < 0.05) in a microbial co-abundant group (CAG) represented by Eubacterium hallii, whose proportion was negatively correlated with childhood adiposity. Meanwhile, a CAG represented by Tyzzerella 4 was positively correlated with the repeated use of antibiotics and childhood adiposity. CONCLUSIONS Infant antibiotic exposure was associated with disruption of the gut microbiota and the higher risks of childhood obesity and increased adiposity.
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Li LJ, Zhang J, Shub A, Aris I, Tan KH. Exploring abnormal glucose metabolism in pregnancy among Australian Chinese migrants. BMJ Open Diabetes Res Care 2020; 8:e000903. [PMID: 32075811 PMCID: PMC7039593 DOI: 10.1136/bmjdrc-2019-000903] [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] [Received: 09/13/2019] [Revised: 12/26/2019] [Accepted: 01/04/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a metabolic disorder of pregnancy that is increasingly prevalent among Chinese women. Few studies have examined whether the migration status of Chinese women contributes to the risks of developing GDM during pregnancy. RESEARCH DESIGN AND METHODS In this observational, cross-sectional and hospital-based study, we examined the prevalence of GDM and glycemic levels at oral glucose tolerance test (OGTT) among 491 Australian Chinese migrants (n=491) and native Chinese (n=1000). We defined GDM using the International Association of Diabetes and Pregnancy Study Groups guidelines. We collected data on maternal age, body mass index (BMI) and gestational age (GA) at booking and GA at delivery from medical records. We used multiple logistic and linear regression models to calculate the OR of having GDM and mean differences in glycemic levels in Australian Chinese migrants, relative to native Chinese. RESULTS Age-at-booking and BMI-at-booking adjusted GDM prevalence was significantly higher in Australian Chinese migrants than native Chinese (19.7% vs 14.6%; p=0.01). After adjusting for age, BMI at booking and GA at booking, fasting glucose levels were significantly lower (β -0.08 mmol/L; 95% CI -0.14 to 0.02), while 2-hour glucose levels were significantly higher (0.22 mmol/L; 0.02 to 0.43) in Australian Chinese immigrants than native Chinese. CONCLUSIONS Migration status may be a marker for abnormal glucose metabolism during pregnancy among Australian Chinese migrants, possibly due to socio-economic disadvantages and lifestyle changes associated with migration.
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Affiliation(s)
- Ling-Jun Li
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Alexis Shub
- Perinatal Department, Mercy Women Hospital, Melbourne, Victoria, Australia
| | - Izzuddin Aris
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kok Hian Tan
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
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Yong HY, Mohd Shariff Z, Mohd Yusof BN, Rejali Z, Appannah G, Bindels J, Tee YYS, van der Beek EM. The association between dietary patterns before and in early pregnancy and the risk of gestational diabetes mellitus (GDM): Data from the Malaysian SECOST cohort. PLoS One 2020; 15:e0227246. [PMID: 31923230 PMCID: PMC6953856 DOI: 10.1371/journal.pone.0227246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/15/2019] [Indexed: 02/07/2023] Open
Abstract
Generally, dietary patterns (DP)s have been linked to the risk of diabetes mellitus, however, only few studies examined the associations between DPs in early pregnancy and the risk of gestational diabetes mellitus (GDM). This study aims to determine the association between DPs before and during pregnancy and risk of GDM in Malaysian pregnant women. DPs were derived using principal component analysis of consumed 126 food and beverage items assessed using a validated semi-quantitative food frequency questionnaire collecting data retrospectively for pre-pregnancy, but prospectively for the first and second trimester. Three different DPs were identified at each time point and labelled as DP 1–3 (pre-pregnancy), DP 4–6 (first trimester), and DP 7–9 (second trimester). About 10.6% (n = 48) of pregnant women were diagnosed with GDM in our cohort. Women with high adherence (HA) to DP 2 (adjusted OR: 0.45, 95% CI: 0.20–0.91) and DP 5 (adjusted OR: 0.28, 95% CI: 0.11–0.68) showed a significantly reduced risk of GDM compared to women with low adherence (LA). Other DPs were not significantly associated with GDM risk. Compared to women with GDM, non-GDM women showed HA scores for all DPs throughout pregnancy. Overall, a relative low percentage of women with GDM was found in this cohort. The risk was lower in women with HA to a relatively unhealthy dietary pattern, i.e. DP 2 and DP 5. The lower body mass index (BMI) status and energy intake of women showing a HA to DP 2 in the first trimester may underlie the observed association with a lower GDM risk. Additionally, genetic variance might explain the less susceptibility to GDM despite HA to unhealthy DPs among non-GDM women.
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Affiliation(s)
- Heng Yaw Yong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- * E-mail:
| | - Barakatun-Nisak Mohd Yusof
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Zulida Rejali
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Geeta Appannah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | | | - Eline M. van der Beek
- Danone Nutricia Research, Utrecht, The Netherlands
- Department of Pediatrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Sunny SH, Malhotra R, Ang SB, Lim CSD, Tan YSA, Soh YMB, Ho XYC, Gostelow M, Tsang LPM, Lock SHS, Kwek SY, Lim YTJ, Vijakumar K, Tan NC. Facilitators and Barriers to Post-partum Diabetes Screening Among Mothers With a History of Gestational Diabetes Mellitus-A Qualitative Study From Singapore. Front Endocrinol (Lausanne) 2020; 11:602. [PMID: 32982985 PMCID: PMC7484739 DOI: 10.3389/fendo.2020.00602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Gestational Diabetes Mellitus (GDM) affects one in six births worldwide. Mothers with GDM have an increased risk of developing post-partum Type-2 Diabetes Mellitus (T2DM). However, their uptake of post-partum diabetes screening is suboptimal, including those in Singapore. Literature reports that the patient-doctor relationship, mothers' concerns about diabetes, and family-related practicalities are key factors influencing the uptake of such screening. However, we postulate additional factors related to local society, healthcare system, and policies in influencing post-partum diabetes screening among mothers with GDM. Aim: The qualitative research study aimed to explore the facilitators and barriers to post-partum diabetes screening among mothers with GDM in an Asian community. Methods: In-depth interviews were carried out on mothers with GDM at a public primary care clinic in Singapore. Mothers were recruited from those who brought their child for vaccination appointments and their informed consent was obtained. Both mothers who completed post-partum diabetes screening within 12 weeks after childbirth and those who did not were purposively recruited. The social ecological model (SEM) provides the theoretical framework to identify facilitators and barriers at the individual, interpersonal, organizational, and policy levels. Results: Twenty multi-ethnic Asian mothers with GDM were interviewed. At the individual and interpersonal level, self-perceived risk of developing T2DM, understanding the need for screening and the benefits of early diagnosis, availability of confinement nanny in Chinese family, alternate caregivers, emotional, and peer support facilitated post-partum diabetes screening. Barriers included fear of the diagnosis and its consequences, preference for personal attention and care to child, failure to find trusted caregiver, competing priorities, and unpleasant experiences with the oral glucose tolerance test. At the organizational and public policy level, bundling of scheduled appointments, and standardization of procedure eased screening but uptake was hindered by inconvenient testing locations, variable post-partum care practices and advice in the recommendations for diabetes screening. Conclusion: Based on the SEM, facilitators and barriers towards post-partum diabetes screening exist at multiple levels, with some contextualized to local factors. Interventions to improve its uptake should be multi-pronged, targeting not only at personal but also familial, health system, and policy factors to ensure higher level of success.
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Affiliation(s)
| | | | - Seng Bin Ang
- Family Medicine Service, Kandang-Kerbau Women and Children Hospital, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | | | | | | | | | | | - L. P. Marianne Tsang
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | | | | | | | | | - Ngiap Chuan Tan
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
- SingHealth Polyclinics, Singapore, Singapore
- *Correspondence: Ngiap Chuan Tan
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Li LJ, Aris IM, Han WM, Tan KH. A Promising Food-Coaching Intervention Program to Achieve Optimal Gestational Weight Gain in Overweight and Obese Pregnant Women: Pilot Randomized Controlled Trial of a Smartphone App. JMIR Form Res 2019; 3:e13013. [PMID: 31651407 PMCID: PMC6914273 DOI: 10.2196/13013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/22/2019] [Accepted: 07/21/2019] [Indexed: 01/11/2023] Open
Abstract
Background Traditional dietary recommendations for achieving optimal gestational weight gain are ineffective for pregnant women due to the lack of real-time communication and tedious consultation processes. Objective In this pilot study, we aimed to determine the feasibility of a novel food-coaching smartphone app for controlling gestational weight gain and macronutrient intake among overweight and obese pregnant women. Methods We designed a randomized controlled trial and recruited 30 overweight and obese pregnant women (1:1 ratio) during 18-20 weeks of gestation and followed them up after 4 and 8 weeks, respectively. Both groups received standard pregnancy dietary orientation at recruitment, while the intervention group received 8 weeks of real-time food coaching via a smartphone app. This food-coaching smartphone app (Glycoleap, Holmusk, Singapore) aimed to improve care and outcomes for people with diabetes. Pregnant women using this app were able to upload food images (eg, a picture of a meal, a drink, or a dessert) and received real-time and detailed food-coaching comments and guidance provided by professional dietitians during the day (8 AM to 8 PM). We recorded detailed characteristics during recruitment and examined anthropometry at all visits. We compared the mean differences of the 8-week gestational weight gain and macronutrient intake between the two groups. Results Upon study completion, three subjects dropped out from the intervention, and one gave birth prematurely in the control group. The acceptance rate of the smartphone app was 90%. More participants achieved optimal gestational weight gain per week in the intervention group (8/12, 67%) than in the control group (5/14, 36%). After the 8-week intervention, women in the intervention group appeared to have lower gestational weight gain (mean difference=–0.08 kg; 95% CI –1.80 to 1.63) and cholesterol intake (mean difference=–31.73 mg; 95% CI –102.91 to 39.45) than those in the control group. Conclusions Our findings showed that this food-coaching smartphone app is feasible and favorable for weight gain control and cholesterol intake control among overweight and obese pregnant women. Although our results were not significant (perhaps, attributed to the small sample size), it provided proof of concept for the feasibility of applying such technology in future randomized controlled trials with a larger sample size, an earlier intervention onset, and a longer follow-up for overweight and obese pregnant women.
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Affiliation(s)
- Ling-Jun Li
- Department of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Wee Meng Han
- Department of Nutrition, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Department of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
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Lim K, Chi C, Chan SY, Lim SL, Ang SM, Yoong JS, Tsai C, Wong SR, Yew TW, Tai ES, Yong EL. Smart Phone APP to Restore Optimal Weight (SPAROW): protocol for a randomised controlled trial for women with recent gestational diabetes. BMC Public Health 2019; 19:1287. [PMID: 31615456 PMCID: PMC6792195 DOI: 10.1186/s12889-019-7691-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gestational diabetes (GDM) is a known risk factor for type 2 diabetes mellitus (T2DM), and women with a history of GDM have a 7-fold increased risk of developing the disease. Achieving a healthy weight post-delivery is key in reducing the risk of future diabetes in these women. The aim of this trial is to investigate the use of an interactive smartphone application (APP) to restore women to optimal weight following delivery. METHODS This will be an open-label randomized controlled trial. Two hundred women with gestational diabetes will be randomized to receive the intervention or standard care following delivery. Participants will be reviewed at 6 weeks and 4 months post-delivery. The intervention is an APP serving as a platform for weight, diet and physical activity tracking. The APP provides 3-5 min educational videos suggesting suitable lifestyle adjustments relevant to postnatal period such as breast feeding, diet and exercise. Lastly, the APP will allow real-time interaction between users and the team of dietitians, physiotherapists and occupational therapists to encourage restoration of optimal weight. Women in the control arm will be informed about the increased risk of developing T2DM and advised to maintain a healthy weight. Primary outcome measure is the restoration of participants' booking weight if booking BMI ≤ 23, or weight loss of at least 5% from booking weight if booking BMI > 23 over the 4 month period. Secondary outcome measures will assess serum metabolic and inflammatory markers, quality of life via questionnaires and cost-effectiveness of the intervention at each follow-up visit. DISCUSSION This will be the first randomised controlled trial investigating the use of a smartphone application for postpartum weight loss in women with gestational diabetes. The major ethnic groups in our study population represent the majority of ethnic groups in Asia, amongst which the prevalence of diabetes is high. If shown to be effective, this APP may be used in wider clinical settings to improve postpartum weight loss and reduce the risk of developing T2DM in these women. TRIAL REGISTRATION This study was registered on clintrials.gov on the 30th of October 2017, under the trial registration number: NCT03324737 .
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Affiliation(s)
- Karen Lim
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Republic of Singapore
| | - Claudia Chi
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Republic of Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Republic of Singapore
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, National University of Singapore, Republic of Singapore
| | - Siew Min Ang
- Department of Dietetics, National University Hospital, National University of Singapore, Republic of Singapore
| | - Joanne S Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Republic of Singapore
| | - Cammy Tsai
- Department of Rehabilitation, National University Hospital, National University of Singapore, Republic of Singapore
| | - Su Ren Wong
- Department of Rehabilitation, National University Hospital, National University of Singapore, Republic of Singapore
| | - Tong Wei Yew
- Department of Medicine, National University Hospital, National University of Singapore, Republic of Singapore
| | - E Shyong Tai
- Department of Medicine, National University Hospital, National University of Singapore, Republic of Singapore
| | - Eu-Leong Yong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Republic of Singapore.
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Loy SL, Cheung YB, Chong M, Müller-Riemenschneider F, Lek N, Lee YS, Tan KH, Chern B, Yap F, Chan J. Maternal night-eating pattern and glucose tolerance during pregnancy: study protocol for a longitudinal study. BMJ Open 2019; 9:e030036. [PMID: 31601588 PMCID: PMC6797284 DOI: 10.1136/bmjopen-2019-030036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Coordinating eating schedules with day-night cycles has been shown to improve glucose regulation in adults, but its association with gestational glycaemia is less clear. A better understanding on how eating time can influence glucose levels in pregnancy may improve strategies for gestational glycaemic control. This study aims to examine the association of maternal night-eating pattern with glucose tolerance in the second trimester of pregnancy, and to investigate how lifestyle factors may be related to night-eating pattern. METHODS AND ANALYSIS This is an observational longitudinal study that targets to recruit 200 pregnant women at 18-24 weeks' gestation from the KK Women's and Children's Hospital in Singapore. Data collection includes sociodemographics, lifestyle habits and obstetric information. Maternal dietary intake is collected using the 4-day food diary and food frequency questionnaire; while 24-hour physical activity, sedentary behaviour, sleep and light exposure are captured using the accelerometer at 18-24 weeks' gestation. Continuous glucose monitoring at 18-24 weeks' gestation, oral glucose tolerance test and insulin test at 24-28 weeks' gestation are performed to assess glycaemic outcomes. Multivariable generalised linear models will be used to analyse the association of maternal night-eating pattern (consumption of meal and snack during 1900-0659 hours) with glycaemic measures, and the associated factors of night-eating pattern, controlling for potential confounders. Recruitment began in March 2019 and is estimated to end in November 2020. ETHICS AND DISSEMINATION Ethical approval has been granted by the Centralised Institutional Review Board of SingHealth, Singapore (reference 2018/2529). The results will be presented at conferences and disseminated in journal articles. TRIAL REGISTRATION NUMBER NCT03803345.
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Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yin Bun Cheung
- Programme in Health Services & Systems Research and Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Center for Child Health Research, Tampere University, Tampere, Finland
| | - Mary Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre Berlin, Berlin, Germany
| | - Ngee Lek
- Duke-NUS Medical School, 8 College Road, Singapore, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Y S Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Division of Paediatric Endocrinology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, 8 College Road, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Bernard Chern
- Duke-NUS Medical School, 8 College Road, Singapore, Singapore
- Department of Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, 8 College Road, Singapore, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jerry Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, Singapore
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Chen X, de Seymour JV, Han TL, Xia Y, Chen C, Zhang T, Zhang H, Baker PN. Metabolomic biomarkers and novel dietary factors associated with gestational diabetes in China. Metabolomics 2018; 14:149. [PMID: 30830425 DOI: 10.1007/s11306-018-1445-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is impaired glucose tolerance first recognised during pregnancy; its development is associated with many adverse outcomes. Mechanisms of GDM development are not fully elucidated and few studies have used Chinese participants. OBJECTIVES The aim of this study was to investigate the maternal metabolome associated with GDM in a Chinese population, and explore the relationship with maternal diet. METHODS Ninety-three participants were recruited at 26-28 weeks' gestation from Chongqing, China. Maternal urine, serum, and hair metabolomes were analysed using gas and liquid chromatography-mass spectrometry. Dietary intake was assessed using a 96-item food frequency questionnaire. RESULTS Of the 1064 metabolites identified, 73 were significantly different between cases and controls (P < 0.05), but only 2-aminobutyric acid had both a p- and q-value < 0.05. A "snack-based-dietary-pattern" was associated with an increased likelihood of GDM (odds ratio 2·1; 95% confidence interval 1.1-3.9). The association remained significant after adjustment for calorie intake but not food volume. CONCLUSION This study provides a comprehensive characterization of the maternal metabolome. The snack-based dietary pattern associated with GDM suggests that timing and frequency of consumption are important factors in the relationship between maternal diet and GDM.
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Affiliation(s)
- Xuyang Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing, 400016, China
| | - Jamie V de Seymour
- Liggins Institute, The University of Auckland, Auckland, 1023, New Zealand
| | - Ting-Li Han
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Liggins Institute, The University of Auckland, Auckland, 1023, New Zealand
| | - Yinyin Xia
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Chang Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Institute of Life Sciences, Chongqing Medical University, Chongqing, 400016, China
| | - Ting Zhang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing, 400016, China
| | - Hua Zhang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing, 400016, China.
| | - Philip N Baker
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
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Li LJ, Tan KH, Aris IM, Man REK, Gan ATL, Chong YS, Saw SM, Gluckman P, Wong TY, Lamoureux E. Retinal vasculature and 5-year metabolic syndrome among women with gestational diabetes mellitus. Metabolism 2018; 83:216-224. [PMID: 29051041 DOI: 10.1016/j.metabol.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/03/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) are at greater risk of metabolic syndrome (MetS). We studied the association between second-trimester retinal microvasculature and 5-year MetS incidence in women with GDM. METHODS A total of 142 mothers with GDM were recruited and followed up 5years after delivery. Retinal photography was performed at 26-28weeks gestation and metabolic outcomes were assessed at the 5-year postpartum follow-up visit. GDM and MetS were defined based on World Health Organization (WHO) guidelines and Adults Treatment Panel (ATP) III guidelines, respectively. Modified-Poisson regression was applied to study the association between second-trimester retinal microvasculature and incident 5-year maternal MetS, after adjusting for major confounders. Area under the curve (AUC) was calculated based on the final model. RESULTS Our prospective cohort reported a 9.2% incidence rate of 5-year MetS among women with GDM. After adjusting for maternal age, ethnicity, college degree, pre-pregnancy BMI and fasting glucose at 26-28week gestation, each 10μm widening in retinal venular caliber was associated with an increased relative risk of 1.6 (95% confidence interval [CI]: 1.0, 2.8) in incident MetS. In addition to traditional risks of pre-pregnancy BMI and fasting glucose level at 26-28week gestation, retinal venular caliber mildly increased the prediction of 5-year maternal MetS by 1.8%. CONCLUSIONS Second-trimester retinal venular widening was associated with incident 5-year maternal MetS in women with GDM. Our study suggests that mother with GDM at risk of future MetS development may have already presented retinal microvascular abnormalities during pregnancy.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore.
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Yap Seng Chong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
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35
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Cai S, Natarajan P, Chan JKY, Wong PC, Tan KH, Godfrey KM, Gluckman PD, Shek LPC, Yap F, Kramer MS, Chan SY, Chong YS. Maternal hyperglycemia in singleton pregnancies conceived by IVF may be modified by first-trimester BMI. Hum Reprod 2018; 32:1941-1947. [PMID: 28854717 PMCID: PMC5638004 DOI: 10.1093/humrep/dex243] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/23/2017] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION Does IVF independently increase the risk of gestational diabetes mellitus (GDM) and is this increase in risk modified by maternal body mass index? SUMMARY ANSWER IVF appears to be an independent risk factor for GDM and elevated blood glucose levels in overweight women (BMI > 25 kg/m2). WHAT IS KNOWN ALREADY IVF has been associated with increased risk of GDM, but most previous studies did not adequately assess confounding or effect modification by other risk factors. STUDY DESIGN, SIZE, DURATION Cross-sectional study using data from 1089 women with singleton pregnancies who participated in a Singaporean birth cohort study (GUSTO) and received a 75 g oral glucose tolerance test (OGTT) at 26-28 weeks gestation. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 1089 women (n = 1013 conceived spontaneously, n = 76 conceived through IVF) with singleton pregnancies received a 75 g OGTT at 26-28 weeks gestation. Fasting and 2 h postprandial blood glucose levels were assayed. World Health Organization criteria (1999) standard criteria were used to classify GDM: ≥7.0 mmol/L for fasting and/or ≥7.8 mmol/L for 2-h postprandial plasma glucose levels, which was the clinical guideline in use during the study. MAIN RESULTS AND THE ROLE OF CHANCE IVF pregnancies had nearly double the odds of GDM (OR = 1.83, 95% CI: 1.03-3.26) and elevated fasting (mean difference = 0.12 mmol/L, 95% CI: 0.00-0.24) and OGTT 2-h blood glucose levels (mean difference = 0.64 mmol/L, 95% CI: 0.27-1.01), after adjusting for commonly recognized risk factors for GDM. After stratification by first-trimester BMI, these increased risks of GDM (OR = 3.54, 95% CI: 1.44-8.72) and elevated fasting (mean difference = 0.39 mmol/L, 95% CI: 0.13-0.65) and 2-h blood (mean difference = 1.24 mmol/L, 95% CI: 0.56-1.91) glucose levels were significant only in the IVF group who is also overweight or obese (BMI > 25 kg/m2). LIMITATIONS REASONS FOR CAUTION One limitation of our study is the absence of a 1 h post-OGTT plasma glucose sample, as we were using the 1999 WHO diagnostic criteria (the clinical guideline in Singapore) at the time of our study, instead of the revised 2013 WHO diagnostic criteria. Our cohort may not be representative of the general Singapore obstetric population, although participants were recruited from the two largest maternity hospitals in the country and include both private and subsidized patients. WIDER IMPLICATIONS OF THE FINDINGS IVF appears to be an independent risk factor for GDM and elevated blood glucose levels in overweight women. Our findings reinforce the need to advise overweight or obese women contemplating IVF to lose weight before the procedure to reduce their risk of GDM and hyperglycemia-related adverse outcomes arising therefrom. In settings where universal GDM screening is not routine, overweight or obese women who conceive by IVF should be screened. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Program and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding was provided by the Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR). K.M.G. and Y.S.C. have received lecture fees from Nestle Nutrition Institute and Danone, respectively. K.M.G., Y.S.C. and S.Y.C. are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone. The other authors have nothing to disclose. The other authors have nothing to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - P Natarajan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - J K Y Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.,Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - P C Wong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - K H Tan
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore.,Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.,Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - L P C Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore 119228, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore 119074, Singapore
| | - F Yap
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - M S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada QC H3A 1A2.,Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada QC H3G 2M1
| | - S Y Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
| | - Y S Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
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36
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Hewage SS, Singh SR, Chi C, Chan JK, Yew TW, Han WM, Yoong J. Health Care Providers' Perceptions of Responsibilities and Resources to Reduce Type 2 Diabetes Risk After Gestational Diabetes Mellitus. Clin Diabetes 2018; 36:160-167. [PMID: 29686455 PMCID: PMC5898160 DOI: 10.2337/cd17-0063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IN BRIEF Gestational diabetes mellitus (GDM) increases the risk for type 2 diabetes. This qualitative study aimed to evaluate health care providers' perceptions of care responsibilities and resources related to reducing type 2 diabetes risk among women with previous GDM in Singapore. Health care providers acknowledged a shared responsibility. They felt that they had less understanding of compliance with long-term maintenance of lifestyle change, exacerbated further by fragmentation of follow-up care. The application of more integrated patient-centered care models, combined with greater health literacy, is urgently required in this area.
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Affiliation(s)
- Sumali S. Hewage
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shweta R. Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Claudia Chi
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Jerry K.Y. Chan
- Duke-NUS Medical School, Singapore
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Tong Wei Yew
- University Medicine Cluster, National University Health System, Singapore
| | - Wee Meng Han
- Nutrition and Dietetics Department, KK Women’s and Children’s Hospital, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- University of Southern California, Center for Economic and Social Research, Los Angeles, CA
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37
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Kalok A, Peraba P, Shah SA, Mahdy ZA, Jamil MA, Kampan N, Sulaiman S, Mohamed Ismail NA. Screening for gestational diabetes in low-risk women: effect of maternal age. Horm Mol Biol Clin Investig 2018; 34:hmbci-2017-0071. [PMID: 29425107 DOI: 10.1515/hmbci-2017-0071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/15/2017] [Indexed: 11/15/2022]
Abstract
Background Gestational diabetes mellitus (GDM) is on the rise globally and there are various screening guidelines with regard to patients' criteria. Materials and methods We conducted a prospective cross-sectional study to determine the prevalence of GDM amongst low-risk pregnant women above the age of 25 years. A modified glucose tolerance test (MGTT) was performed between 24 and 36 weeks of gestation. Women with GDM were divided into two groups for analysis: age between 25 and 34 years (group A) and above 35 years (group B). They were managed as per hospital protocol and followed-up until delivery. The women's demographic data, treatment and subsequent pregnancy outcomes were analysed. Results The overall prevalence of GDM in our low-risk women was 14%. GDM was less common in the younger age group (25-34 years) in comparison to those aged above 35 years (9.7% vs. 26.3%, p = 0.001). There was a non-significant increase in the induction of labour (IOL) rate amongst those aged below 35 years compared to the older group (46.7 % vs. 38.5%). The insulin requirement in the age group 25-34 years and above 35 years, were 6.7% and 23.1%, respectively. There was no significant difference between both age groups with regard to caesarean delivery, birth weight above the 95th centile and neonatal hypoglycaemia. Conclusion In low-risk women, the prevalence of GDM is significantly lower in those aged less than 35 years. Diagnosing GDM had resulted in the increment of IOL in this group, although with no significant increase in maternal and neonatal morbidity.
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Affiliation(s)
- Aida Kalok
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Pravin Peraba
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | | | - Zaleha Abdullah Mahdy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Mohamad Abdul Jamil
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Nirmala Kampan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Suraya Sulaiman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Nor Azlin Mohamed Ismail
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia, Phone: +60 391456485, Fax: +60 391456672
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38
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Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of Gestational Diabetes Mellitus in Eastern and Southeastern Asia: A Systematic Review and Meta-Analysis. J Diabetes Res 2018; 2018:6536974. [PMID: 29675432 PMCID: PMC5838488 DOI: 10.1155/2018/6536974] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/16/2017] [Indexed: 12/27/2022] Open
Abstract
AIM To review the prevalence of gestational diabetes mellitus (GDM) in Eastern and Southeastern Asia. METHODS We systematically searched for observational studies on GDM prevalence from January 2000 to December 2016. Inclusion criteria were original English papers, with full texts published in peer-reviewed journals. The quality of included studies was evaluated using the guidelines of the National Health and Medical Research Council, Australia. Fixed effects and random effects models were used to estimate the summary prevalence of GDM and the corresponding 95% confidence intervals (CI). RESULTS A total of 4415 papers were screened, and 48 studies with 63 GDM prevalence observations were included in the final review. The pooled prevalence of GDM was 10.1% (95% CI: 6.5%-15.7%), despite substantial variations across nations. The prevalence of GDM in lower- or upper-middle income countries was about 64% higher than in their high-income counterparts. Moreover, the one-step screening method was twice more likely to be used in diagnosing GDM when compared to the two-step screening procedure. CONCLUSIONS The prevalence of GDM in Eastern and Southeastern Asia was high and varied among and within countries. There is a need for international uniformity in screening strategies and diagnostic criteria for GDM.
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Affiliation(s)
- Cong Luat Nguyen
- School of Public Health, Curtin University, Perth, WA, Australia
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ngoc Minh Pham
- School of Public Health, Curtin University, Perth, WA, Australia
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Colin W. Binns
- School of Public Health, Curtin University, Perth, WA, Australia
| | | | - Andy H. Lee
- School of Public Health, Curtin University, Perth, WA, Australia
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39
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Padmapriya N, Bernard JY, Liang S, Loy SL, Cai S, Zhe IS, Kwek K, Godfrey KM, Gluckman PD, Saw SM, Chong YS, Chan JKY, Müller-Riemenschneider F. Associations of physical activity and sedentary behavior during pregnancy with gestational diabetes mellitus among Asian women in Singapore. BMC Pregnancy Childbirth 2017; 17:364. [PMID: 29047402 PMCID: PMC5648496 DOI: 10.1186/s12884-017-1537-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 10/03/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Few studies have investigated physical activity (PA) and sedentary behavior (SB) in relation to fasting (FG) and 2-h postprandial plasma glucose (2hPG) levels and gestational diabetes mellitus (GDM); we investigated these associations among Asian pregnant women. METHODS As part of the Growing Up in Singapore Towards healthy Outcomes cohort study, PA and SB (sitting and television times) were assessed by interviewer-administered questionnaire. During 75 g oral glucose tolerance tests at 26-28 weeks' gestation we measured FG, 2hPG levels and GDM (FG ≥ 7.0 mmol/L and/or 2hPG ≥ 7.8 mmol/L). Associations were analysed by multiple linear and logistic regression. RESULTS Among the 1083 women studied, 18.6% had GDM. SB was not associated with FG, 2hPG and GDM. Higher categories of PA were associated with lower 2hPG and a lower likelihood of GDM (p-trend < 0.05), but not with FG levels. Compared to insufficiently active women, highly active women had lower 2hPG levels [β (95% CI): -0.32 (-0.59, -0.05), p = 0.020) and were less likely to have GDM [OR: 0.56 (0.32-0.98), p = 0.040]. Stratified analysis revealed no associations among under/normal-weight women, but significant associations among overweight/obese women; in those with BMI ≥23 kg/m2, sufficiently active and highly active women were less likely to have GDM [OR: 0.52, (0.29-0.93), p = 0.028, and OR: 0.34, (0.15-0.77), p = 0.010, respectively]. CONCLUSION Higher PA was associated with lower 2hPG levels and a lower prevalence of GDM, particularly in overweight/obese women. Further studies are warranted to confirm these findings, and to examine the effectiveness of PA promotion strategies for the prevention of gestational hyperglycemia.
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Affiliation(s)
- Natarajan Padmapriya
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jonathan Y. Bernard
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
| | - Shen Liang
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - See Ling Loy
- KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Shirong Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Iris Shen Zhe
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kenneth Kwek
- KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore
| | - Jerry Kok Yen Chan
- KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany
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40
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Nishikawa E, Oakley L, Seed PT, Doyle P, Oteng-Ntim E. Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK. PLoS One 2017. [PMID: 28640854 PMCID: PMC5480876 DOI: 10.1371/journal.pone.0179332] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate the ethnicity-specific association between body mass index (BMI) and diabetes in pregnancy, with a focus on the appropriateness of using BMI cut-offs to identify pregnant women at risk of diabetes. Study design Analysis of routinely-collected data from a maternity unit in London, UK. Data were available on 53 264 women delivering between 2004 and 2012. Logistic regression was used to explore the association between diabetes in pregnancy and BMI among women of different ethnicities, and adjusted probability estimates were used to derive risk equivalent cut-offs. ROC curve analysis was used to assess the performance of BMI as a predictor of diabetes in pregnancy. Results The prevalence of diabetes in pregnancy was 2.3% overall; highest in South and East Asian women (4.6% and 3.7%). In adjusted analysis, BMI category was strongly associated with diabetes in all ethnic groups. Modelled as a continuous variable with a quadratic term, BMI was an acceptable predictor of diabetes according to ROC curve analysis. Applying a BMI cut-off of 30 kg/m2 would identify just over half of Black women with diabetes in pregnancy, a third of White (32%) and South Asian (35%) women, but only 13% of East Asian women. The ‘risk equivalent’ (comparable to 30 kg/m2 in White women) threshold for South Asian and East Asian women was approximately 21 kg/m2, and 27.5 kg/m2 for Black women. Conclusions This study suggests that current BMI thresholds are likely to be ineffective for diabetes screening in South and East Asian women, as many cases of diabetes will occur at low BMI levels. Our results suggest that East Asian women appear to face a similarly high risk of diabetes to South Asian women. Current UK guidelines recommend diabetes screening should be offered to all pregnant South Asian women; extending this recommendation to include women of East Asian ethnicity may be appropriate.
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Affiliation(s)
- Erin Nishikawa
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Oakley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Paul T. Seed
- Women's Health Academic Centre, King’s College London, London, United Kingdom
| | - Pat Doyle
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eugene Oteng-Ntim
- Department of Women's Health, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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41
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Pang WW, Colega M, Cai S, Chan YH, Padmapriya N, Chen LW, Soh SE, Han WM, Tan KH, Lee YS, Saw SM, Gluckman PD, Godfrey KM, Chong YS, van Dam RM, Chong MF. Higher Maternal Dietary Protein Intake Is Associated with a Higher Risk of Gestational Diabetes Mellitus in a Multiethnic Asian Cohort. J Nutr 2017; 147:653-660. [PMID: 28275101 PMCID: PMC5382972 DOI: 10.3945/jn.116.243881] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/01/2016] [Accepted: 02/06/2017] [Indexed: 12/28/2022] Open
Abstract
Background: Dietary protein may affect glucose metabolism through several mechanisms, but results from studies on dietary protein intake and risk of gestational diabetes mellitus (GDM) have been inconsistent.Objective: We examined the cross-sectional associations of dietary protein intake from different food sources during pregnancy with the risk of GDM in a multiethnic Asian population.Methods: We included 980 participants with singleton pregnancies from the Growing Up in Singapore Toward healthy Outcomes (GUSTO) cohort. Protein intake was ascertained from 24-h dietary recall and 3-d food diaries at 26-28 wk gestation. GDM was defined as fasting glucose ≥7.0 mmol/L and/or 2-h postload glucose ≥7.8 mmol/L at 26-28 wk gestation. We evaluated the association of dietary protein intake with GDM risk by substituting carbohydrate with protein in an isocaloric model with the use of multivariable logistic regression analysis.Results: The prevalence of GDM was 17.9% among our participants. After adjustment for potential confounders, a higher total dietary protein intake was associated with a higher risk of GDM; the OR comparing the highest with the lowest quartile of intake was 2.15 (95% CI: 1.27, 3.62; P-trend = 0.016). Higher intake levels of both animal protein (OR: 2.87; 95% CI: 1.58, 5.20; P-trend = 0.001) and vegetable protein (OR: 1.78; 95% CI: 0.99, 3.20; P-trend = 0.009) were associated with a higher risk of GDM. Among the animal protein sources, higher intake levels of seafood protein (OR: 2.17; 95% CI: 1.26, 3.72; P-trend = 0.023) and dairy protein (OR: 1.87; 95% CI: 1.11, 3.15; P-trend = 0.017) were significantly associated with a higher GDM risk.Conclusion: Higher intake levels of both animal and vegetable protein were associated with a higher risk of GDM in Asian women. This trial was registered at clinicaltrials.gov as NCT01174875.
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Affiliation(s)
| | - Marjorelee Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | | | | | | | | | - Shu-E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | | | - Kok Hian Tan
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Paediatrics, and.,Khoo Teck Puat-National University Children's Medical Institute.,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, Southampton, United Kingdom; and.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Yap-Seng Chong
- Departments of Obstetrics and Gynaecology.,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Rob M van Dam
- Medicine, Yong Loo Lin School of Medicine, .,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mary Ff Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; .,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
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42
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Lai JS, Pang WW, Cai S, Lee YS, Chan JKY, Shek LPC, Yap FKP, Tan KH, Godfrey KM, van Dam RM, Chong YS, Chong MFF. High folate and low vitamin B12 status during pregnancy is associated with gestational diabetes mellitus. Clin Nutr 2017; 37:940-947. [PMID: 28381340 DOI: 10.1016/j.clnu.2017.03.022] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS B-vitamins and homocysteine may contribute to the development of gestational diabetes mellitus (GDM), but existing studies are inconsistent. We examined the cross-sectional associations of plasma folate, vitamins B6, B12, and homocysteine concentrations with GDM and glycemia in a sample of multi-ethnic Asian pregnant women. METHODS Plasma concentrations of folate, vitamins B6, B12, homocysteine and glucose were measured at 26-weeks' gestation in 913 pregnant women. GDM was diagnosed using the 1999 World Health Organization criteria. Associations were examined with linear or logistic regression, adjusted for confounders and stratified by ethnicity. RESULTS Higher plasma folate was associated with higher 2-h glucose and higher odds of GDM [0.15 (0.02, 0.23) per 1-SD increment in folate, OR 1.29 (1.00, 1.60)], mainly among Indian mothers. Higher plasma vitamin B12 and homocysteine were associated with lower fasting and 2-h glucose, and lower odds of GDM [-0.04 (-0.07, -0.01) per 1-SD increment in B12 and -0.09 (-0.18, -0.003) respectively, OR: 0.81 (0.68, 0.97); -0.05 (-0.08, -0.02) per 1-SD increment in homocysteine and -0.12 (-0.21, -0.02) respectively, OR: 0.76 (0.62, 0.92)]. The highest odds of GDM were observed among women with combined vitamin B12 insufficiency and high folate concentration [OR: 1.97 (1.05, 3.68)]. An association between higher vitamin B6 and higher 2-h glucose shifted towards null adjusting for other B-vitamins. CONCLUSIONS Higher maternal folate coupled with vitamin B12 insufficiency was associated with higher GDM risk. This finding has potential implications for antenatal supplement recommendations but will require confirmation in future studies.
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Affiliation(s)
- Jun S Lai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Wei Wei Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Shirong Cai
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Jerry K Y Chan
- Duke-NUS Medical School, Singapore; Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
| | - Lynette P C Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Fabian K P Yap
- Duke-NUS Medical School, Singapore; Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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43
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Chen LW, Aris IM, Bernard JY, Tint MT, Colega M, Gluckman PD, Tan KH, Shek LPC, Chong YS, Yap F, Godfrey KM, van Dam RM, Chong MFF, Lee YS. Associations of maternal macronutrient intake during pregnancy with infant BMI peak characteristics and childhood BMI. Am J Clin Nutr 2017; 105:705-713. [PMID: 28179222 DOI: 10.3945/ajcn.116.148270] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Infant body mass index (BMI) peak characteristics and early childhood BMI are emerging markers of future obesity and cardiometabolic disease risk, but little is known about their maternal nutritional determinants.Objective: We investigated the associations of maternal macronutrient intake with infant BMI peak characteristics and childhood BMI in the Growing Up in Singapore Towards healthy Outcomes study.Design: With the use of infant BMI data from birth to age 18 mo, infant BMI peak characteristics [age (in months) and magnitude (BMIpeak; in kg/m2) at peak and prepeak velocities] were derived from subject-specific BMI curves that were fitted with the use of mixed-effects model with a natural cubic spline function. Associations of maternal macronutrient intake (assessed by using a 24-h recall during late gestation) with infant BMI peak characteristics (n = 910) and BMI z scores at ages 2, 3, and 4 y were examined with the use of multivariable linear regression.Results: Mean absolute maternal macronutrient intakes (percentages of energy) were 72 g protein (15.6%), 69 g fat (32.6%), and 238 g carbohydrate (51.8%). A 25-g (∼100-kcal) increase in maternal carbohydrate intake was associated with a 0.01/mo (95% CI: 0.0003, 0.01/mo) higher prepeak velocity and a 0.04 (95% CI: 0.01, 0.08) higher BMIpeak These associations were mainly driven by sugar intake, whereby a 25-g increment of maternal sugar intake was associated with a 0.02/mo (95% CI: 0.01, 0.03/mo) higher infant prepeak velocity and a 0.07 (95% CI: 0.01, 0.13) higher BMIpeak Higher maternal carbohydrate and sugar intakes were associated with a higher offspring BMI z score at ages 2-4 y. Maternal protein and fat intakes were not consistently associated with the studied outcomes.Conclusion: Higher maternal carbohydrate and sugar intakes are associated with unfavorable infancy BMI peak characteristics and higher early childhood BMI. This trial was registered at clinicaltrials.gov as NCT01174875.
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Affiliation(s)
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and
| | | | - Marjorelee Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Kok Hian Tan
- Departments of Maternal Fetal Medicine and.,Duke-National University of Singapore Graduate Medical School, Singapore
| | | | - Yap-Seng Chong
- Obstetrics and Gynecology, and.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and
| | - Fabian Yap
- Pediatric Endocrinology, KK Women's and Children's Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Rob M van Dam
- Medicine, Yong Loo Lin School of Medicine, and.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Department of Nutrition, Harvard School of Public Health, Boston, MA; and
| | - Mary Foong-Fong Chong
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; .,Liggins Institute, University of Auckland, Auckland, New Zealand.,Departments of Maternal Fetal Medicine and
| | - Yung Seng Lee
- Departments of Pediatrics, .,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, and.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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Cai S, Tan S, Gluckman PD, Godfrey KM, Saw SM, Teoh OH, Chong YS, Meaney MJ, Kramer MS, Gooley JJ. Sleep Quality and Nocturnal Sleep Duration in Pregnancy and Risk of Gestational Diabetes Mellitus. Sleep 2017; 40:2662319. [PMID: 28364489 DOI: 10.1093/sleep/zsw058] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/20/2022] Open
Abstract
Study Objectives To examine the influence of maternal sleep quality and nocturnal sleep duration on risk of gestational diabetes mellitus (GDM) in a multiethnic Asian population. Methods A cohort of 686 women (376 Chinese, 186 Malay, and 124 Indian) with a singleton pregnancy attended a clinic visit at 26-28 weeks of gestation as part of the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort study. Self-reported sleep quality and sleep duration were assessed using the Pittsburgh Sleep Quality Index (PSQI). GDM was diagnosed based on a 75-g oral glucose tolerance test administered after an overnight fast (1999 WHO criteria). Multiple logistic regression was used to model separately the associations of poor sleep quality (PSQI score > 5) and short nocturnal sleep duration (<6 h) with GDM, adjusting for age, ethnicity, maternal education, body mass index, previous history of GDM, and anxiety (State-Trait Anxiety Inventory score). Results In the cohort 296 women (43.1%) had poor sleep quality and 77 women (11.2%) were categorized as short sleepers; 131 women (19.1%) were diagnosed with GDM. Poor sleep quality and short nocturnal sleep duration were independently associated with increased risk of GDM (poor sleep, adjusted odds ratio [OR] = 1.75, 95% confidence interval [CI] 1.11 to 2.76; short sleep, adjusted OR = 1.96, 95% CI 1.05 to 3.66). Conclusions During pregnancy, Asian women with poor sleep quality or short nocturnal sleep duration exhibited abnormal glucose regulation. Treating sleep problems and improving sleep behavior in pregnancy could potentially reduce the risk and burden of GDM.
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Affiliation(s)
- Shirong Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Sara Tan
- Program in Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Peter D Gluckman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust Southampton, England
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Oon Hoe Teoh
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Michael J Meaney
- Department of Psychiatry, McGill University Faculty of Medicine, Montreal, Canada
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada
| | - Joshua J Gooley
- Program in Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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45
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Li LJ, Kramer M, Tapp RJ, Man REK, Lek N, Cai S, Yap F, Gluckman P, Tan KH, Chong YS, Koh JY, Saw SM, Cheung YB, Wong TY. Gestational diabetes mellitus and retinal microvasculature. BMC Ophthalmol 2017; 17:4. [PMID: 28100181 PMCID: PMC5241913 DOI: 10.1186/s12886-016-0398-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/16/2016] [Indexed: 12/17/2022] Open
Abstract
Background Small-vessel dysfunction may be an important consequence of chronic hyperglycemia. We examined the association between gestational diabetes mellitus (GDM), a state of transient hyperglycemia during pregnancy, and retinal microvascular changes in pregnant women at 26–28 weeks of pregnancy. Methods A total of 1136 pregnant women with singleton pregnancies were recruited during their first trimester at two major Singapore maternity hospitals in an on-going birth cohort study. Participants underwent an oral glucose tolerance test and retinal imaging at 26–28 weeks gestation (n = 542). We used the 1999 World Health Organization (WHO) criteria to define GDM: ≥7.0 mmol/L for fasting glucose and/or ≥7.8 mmol/L for 2-h post-glucose. Retinal microvasculature was measured using computer software (Singapore I Vessel Analyzer, SIVA version 3.0, Singapore Eye Research Institute, Singapore) from the retinal photographs. Results In a multiple linear regression model adjusting for age, ethnicity and maternal education, mothers with GDM had narrower arteriolar caliber (−1.6 μm; 95% Confidence Interval [CI]: −3.1 μm, −0.2 μm), reduced arteriolar fractal dimension (−0.01 Df; 95% CI: −0.02 Df, −0.001 Df;), and larger arteriolar branching angle (1.8°; 95% CI: 0.3°, 3.3°) than mothers without GDM. After further adjusting for traditional risks of GDM, arteriolar branching angle remained significantly larger in mothers with GDM than those without GDM (2.0°; 95% CI: 0.5°, 3.6°). Conclusions GDM was associated with a series of retinal arteriolar abnormalities, including narrower caliber, reduced fractal dimension and larger branching angle, suggesting that transient hyperglycemia during pregnancy may cause small-vessel dysfunction.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Michael Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Robyn J Tapp
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Ngee Lek
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore, Singapore
| | - Jia Yu Koh
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. .,Department for International Health, University of Tampere, Tampere, Finland.
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore. .,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
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46
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Chen LW, Aris IM, Bernard JY, Tint MT, Chia A, Colega M, Gluckman PD, Shek LPC, Saw SM, Chong YS, Yap F, Godfrey KM, van Dam RM, Chong MFF, Lee YS. Associations of Maternal Dietary Patterns during Pregnancy with Offspring Adiposity from Birth Until 54 Months of Age. Nutrients 2016; 9:nu9010002. [PMID: 28025503 PMCID: PMC5295046 DOI: 10.3390/nu9010002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/13/2016] [Accepted: 12/16/2016] [Indexed: 02/07/2023] Open
Abstract
Most studies linking maternal diet with offspring adiposity have focused on single nutrients or foods, but a dietary pattern approach is more representative of the overall diet. We thus aimed to investigate the relations between maternal dietary patterns and offspring adiposity in a multi-ethnic Asian mother–offspring cohort in Singapore. We derived maternal dietary patterns using maternal dietary intake information at 26–28 weeks of gestation, of which associations with offspring body mass index (BMI), abdominal circumference (AC), subscapular skinfold (SS), and triceps skinfold (TS) were assessed using longitudinal data analysis (linear mixed effects (LME)) and multiple linear regression at ages 0, 3, 6, 9, 12, 15, 18, 24, 36, 48, and 54 months. Three dietary patterns were derived: (1) vegetables-fruit-and-white rice (VFR); (2) seafood-and-noodles (SfN); and (3) pasta-cheese-and-bread (PCB). In the LME model adjusting for potential confounders, each standard deviation (SD) increase in maternal VFR pattern score was associated with 0.09 mm lower offspring TS. Individual time-point analysis additionally revealed that higher VFR score was generally associated with lower postnatal offspring BMI z-score, TS, SS, and sum of skinfolds (SS + TS) at ages 18 months and older. Maternal adherence to a dietary pattern characterized by higher intakes of fruit and vegetables and lower intakes of fast food was associated with lower offspring adiposity.
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Affiliation(s)
- Ling-Wei Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
| | - Mya-Thway Tint
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Airu Chia
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Marjorelee Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand.
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Fabian Yap
- Department of Pediatric Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore.
- Duke-NUS Graduate Medical School, Lee Kong Chian School of Medicine, Singapore 169857, Singapore.
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore 117599, Singapore.
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore 119228, Singapore.
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Abu-Heija A, Al-Bash M, Ishrat N, Al-Kharausi L. 50 Grams Oral Glucose Challenge Test: Is It an Effective Screening Test for Gestational Diabetes Mellitus? J Obstet Gynaecol India 2016; 66:7-11. [PMID: 27651570 PMCID: PMC5016397 DOI: 10.1007/s13224-015-0752-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/10/2015] [Indexed: 01/07/2023] Open
Abstract
AIM To find out whether 50 g oral glucose challenge test (OGCT) is an effective screening test for all pregnant women between 24 and 28 weeks gestation. METHOD A 50 g OGCT test was administered to 307 unselected women at 24-28 weeks of gestation. When venous plasma glucose (VPG) concentration after 1 h was >7.8 mmol/l, OGCT was positive. Women with a positive OGCT underwent 2 h 75 grams oral glucose tolerance test (OGTT) as a confirmatory diagnosis of GDM. When fasting and 2 h post 75 g OGTT values were >5.5 mmol/I and >8 mmol/l, respectively, women were considered diabetic. RESULTS We screened 307 women for GDM by OGCT. Total number of women with positive OGCT was 83 (27.03 %). In the low-risk group, total number of women with GDM was 9/168 (5.35 %) while the total number of women with GDM in the high-risk group was 14/139 (10.07 %). There was no significant difference with respect to the total number of women with GDM in the groups. CONCLUSIONS A 50 g OGCT seems to be an effective screening test for both groups. More cases of GDM can be discovered when universal rather than risk-related screening is applied.
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Affiliation(s)
- Adel Abu-Heija
- Department of Obstetrics and Gynecology, Sultan Qaboos University and Hospital, Muscat, Oman
| | - Majeda Al-Bash
- Department of Obstetrics and Gynecology, Sultan Qaboos University and Hospital, Muscat, Oman
| | - Noreen Ishrat
- Department of Obstetrics and Gynecology, Sultan Qaboos University and Hospital, Muscat, Oman
| | - Lamya Al-Kharausi
- Department of Obstetrics and Gynecology, Sultan Qaboos University and Hospital, Muscat, Oman
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48
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Affiliation(s)
- Joanna D Holbrook
- NIHR Southampton Biomedical Research Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 30 Medical Drive, 117609, Singapore
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49
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Chen LW, Tint MT, Fortier MV, Aris IM, Bernard JY, Colega M, Gluckman PD, Saw SM, Chong YS, Yap F, Godfrey KM, Kramer MS, van Dam RM, Chong MFF, Lee YS. Maternal Macronutrient Intake during Pregnancy Is Associated with Neonatal Abdominal Adiposity: The Growing Up in Singapore Towards healthy Outcomes (GUSTO) Study. J Nutr 2016; 146:1571-9. [PMID: 27385763 PMCID: PMC4973884 DOI: 10.3945/jn.116.230730] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/31/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Infant body composition has been associated with later metabolic disease risk, but few studies have examined the association between maternal macronutrient intake and neonatal body composition. Furthermore, most of those studies have used proxy measures of body composition that may not reflect body fat distribution, particularly abdominal internal adiposity. OBJECTIVE We investigated the relation between maternal macronutrient intake and neonatal abdominal adiposity measured by using MRI in a multiethnic Asian mother-offspring cohort. METHODS The macronutrient intake of mothers was ascertained by using a 24-h dietary recall at 26-28 wk gestation. Neonatal abdominal adiposity was assessed by using MRI in week 2 of life. Mother-offspring dyads with complete macronutrient intake and adiposity information (n = 320) were included in the analysis. Associations were assessed by both substitution and addition models with the use of multivariable linear regressions. RESULTS Mothers (mean age: 30 y) consumed (mean ± SD) 15.5% ± 4.3% of their energy from protein, 32.4% ± 7.7% from fat, and 52.1% ± 9.0% from carbohydrate. A higher-protein, lower-carbohydrate or -fat diet during pregnancy was associated with lower abdominal internal adipose tissue (IAT) in the neonates [β (95% CI): -0.18 mL (-0.35, -0.001 mL) per 1% protein-to-carbohydrate substitution and -0.25 mL (-0.46, -0.04 mL) per 1% protein-to-fat substitution]. These associations were stronger in boys than in girls (P-interaction < 0.05). Higher maternal intake of animal protein, but not plant protein, was associated with lower offspring IAT. In contrast, maternal macronutrient intake was not associated consistently with infant anthropometric measurements, including abdominal circumference and subscapular skinfold thickness. CONCLUSIONS Higher maternal protein intake at the expense of carbohydrate or fat intake at 26-28 wk gestation was associated with lower abdominal internal adiposity in neonates. Optimizing maternal dietary balance might be a new approach to improve offspring body composition. This trial was registered at clinicaltrials.gov as NCT01174875.
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Affiliation(s)
| | - Mya-Thway Tint
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marielle V. Fortier
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
| | - Izzuddin M. Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Jonathan Y. Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Marjorelee Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore,Liggins Institute, University of Auckland, New Zealand
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Fabian Yap
- Department of Pediatric Endocrinology, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Graduate Medical School, Lee Kong Chian School of Medicine, Singapore
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
| | - Michael S. Kramer
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Canada
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Nutrition, Harvard School of Public Health, Boston, MA, United States
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore,Ling-Wei Chen, Mary Foong-Fong Chong, and Yung Seng Lee are joint corresponding authors for this work, Address correspondence and requests for reprints to: Yung Seng Lee(to whom the proofs should be sent), Department of Paediatrics, Yong Loo Lin School of Medicine, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore 119228; Phone: (65) 67724420; Fax: (65) 67797486; , Mary Foong-Fong Chong, Singapore Institute for Clinical Sciences, Brenner Centre for Molecular Medicine, 30 Medical Drive, Singapore 117609; Phone: (65) 6407 4364; Fax: (65) 6774 7134; , Ling-Wei Chen, Yong Loo Lin School of Medicine, MD1 Tahir Foundation Building, #12-02/03, 12 Science Drive 2, Singapore 117549; Phone: (65) 91181595;
| | - Yung Seng Lee
- Department of Paediatrics, Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
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50
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Genetic variants associated with gestational diabetes mellitus: a meta-analysis and subgroup analysis. Sci Rep 2016; 6:30539. [PMID: 27468700 PMCID: PMC4965817 DOI: 10.1038/srep30539] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/06/2016] [Indexed: 12/21/2022] Open
Abstract
Previous studies have demonstrated that gestational diabetes mellitus (GDM) and Type 2 diabetes mellitus (T2D) share common genetic polymorphisms. We conducted meta-analysis and subgroup analysis of all available variants and determined the effects of confounding and experimental components on the genetic association of GDM. Any case-controlled or cohort studies with genotype distribution compared GDM cases with controls were included. In total, 28 articles including 8,204 cases and 15,221 controls for 6 polymorphisms were studied. rs10830963(MTNR1B), rs7903146(TCF7L2), and rs1801278(IRS1) were significantly associated with the increased GDM risk. The association of rs4402960(IGF2BP2) and rs1800629(TNF-α) was significant only when the studies with control allele frequency deviation and publication bias were excluded. Further subgroup analysis showed the risk alleles of rs7903146(TCF7L2) and rs1801282(PPARG) were significantly associated with the GDM risk only in Asian, but not in Caucasian population. The OGTT test using 100 g, but not 75 g; and genotype detection by other assays, but not Taqman method, were also significantly associated with increased GDM risk in rs1801278(IRS1) and rs7903146(TCF7L2). Overall GDM was associated with rs10830963(MTNR1B), rs7903146(TCF7L2), and rs1801278(IRS1), but only rs7903146(TCF7L2) and rs1801282(PPARG) were significant in Asian populations. While rs1801278(IRS1) and rs7903146(TCF7L2) were significantly affected by OGTT protocol and genotyping methods.
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