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Gonzalez-Canas C, Ding Q, Simpson VL, Hass Z. Testing Race Differences in Risk of Gestational Diabetes Mellitus Associated with Household Food Insecurity (Using NHANES 2007-2018). Am J Perinatol 2024; 41:e3008-e3017. [PMID: 37913781 DOI: 10.1055/s-0043-1776351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aimed to estimate the association of household food insecurity with gestational diabetes mellitus (GDM) risk by race and ethnic group. STUDY DESIGN The study was a secondary analysis from the National Health and Nutrition Examination Survey from 2007 to 2018. A survey-weighted logistic regression model was constructed with self-reported GDM as the response. The primary independent variable was a four-level food security indicator, defined as the inability to obtain food in a socially acceptable way due to the lack of financial resources and controlled for several established risk factors. Analyses were stratified by race (White and Black) and ethnicity (Hispanic) to provide insight into how gestational diabetes risk differs by subpopulation. RESULTS Results indicated that family history of diabetes is a risk factor across all races (adjusted odds ratio [aOR]: 4.22-16.26), while household food insecurity is a significant risk factor for only Hispanic women living with a partner (aOR: 8.50 for very low food security). CONCLUSION In the United States, Hispanic women's GDM risk may be uniquely impacted by food insecurity. KEY POINTS · This study provides a national estimate of the GDM risk from food insecurity by race and ethnicity.. · The results in this study suggest a statistically significant relationship between household food insecurity and an increasing risk of developing GDM for Hispanic individuals.. · White women who live alone (without spouse or partner) were also at elevated risk of GDM.. · Age at delivery, poverty ratio, and family history of diabetes are also risk factors for the disease..
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Affiliation(s)
| | - Qinglan Ding
- School of Nursing, Purdue, West Lafayette, Indiana
| | | | - Zachary Hass
- School of Industrial Engineering, Purdue, West Lafayette, Indiana
- School of Nursing, Purdue, West Lafayette, Indiana
- Regenstrief Center for Healthcare Engineering, Purdue, West Lafayette, Indiana
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Jamal WZ, Khan FR, Zuberi N, Kazmi SMR, Rozi S. Association of periodontal disease with gestational diabetes mellitus among postpartum women at a private tertiary care hospital of Karachi, Pakistan: a cross-sectional study. Sci Rep 2024; 14:9951. [PMID: 38688972 PMCID: PMC11061300 DOI: 10.1038/s41598-024-60659-6] [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: 08/15/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
Due to the overlapping aetiology of Gestational Diabetes Mellitus (GDM) and Periodontal disease (PD), which are prevalent metabolic disorder and chronic inflammatory disorder in pregnant women respectively, they are often at risk of developing both diseases simultaneously. This study aims to evaluate the association of periodontal disease and gestational diabetes mellitus among post-partum women who delivered within 24 h at private tertiary care hospital, Karachi, Pakistan. Analytical cross sectional study with sample size of 178 by non- probability purposive sampling, a total of 101 postpartum women (57%) were diagnosed with periodontal disease and 50 (28%) were GDM positive. Of those who had PD, 35% (n = 35/101) were GDM positive. An insignificant association of the prevalence ratio of GDM in women with periodontal disease was found. [PR = 1.7; 95% CI: 0.2-3.2; p-value 0.07] A statistically significant association was found between the prevalence ratio of GDM in women with obesity. It was 2.6 times compared to women who were not obese (p value < 0.01, 95% CI: 1.3-5.1). There is insignificant association found between the prevalence ratio of GDM in women with periodontal disease in our setting. Women who are overweight or tend to gain weight should be closely monitored and guided to take dietary measures.
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Affiliation(s)
- Wafa Zehra Jamal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | | | - Nadeem Zuberi
- Department of Obstetrics & Gynecology, Aga Khan University, Karachi, Pakistan
| | | | - Shafquat Rozi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Daly BM, Wu Z, Nirantharakumar K, Chepulis L, Rowan JA, Scragg RKR. Increased risk of cardiovascular and renal disease, and diabetes for all women diagnosed with gestational diabetes mellitus in New Zealand-A national retrospective cohort study. J Diabetes 2024; 16:e13535. [PMID: 38599878 PMCID: PMC11006618 DOI: 10.1111/1753-0407.13535] [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: 06/08/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus increases the risk of developing type 2 diabetes. The aim of this study is to compare cardiometabolic and renal outcomes for all women in New Zealand with gestational diabetes (2001-2010) with women without diabetes, 10-20 years following delivery. METHODS A retrospective cohort study, utilizing a national dataset providing information for all women who gave birth between 1 January 2001 and 31 December 2010 (n = 604 398). Adolescent girls <15 years, women ≥50 years and women with prepregnancy diabetes were excluded. In total 11 459 women were diagnosed with gestational diabetes and 11 447 were matched (for age and year of delivery) with 57 235 unexposed (control) women. A national hospital dataset was used to compare primary outcomes until 31 May 2021. RESULTS After controlling for ethnicity, women with gestational diabetes were significantly more likely than control women to develop diabetes-adjusted hazard ratio (HR) 20.06 and 95% confidence interval (CI) 18.46-21.79; a first cardiovascular event 2.19 (1.86-2.58); renal disease 6.34 (5.35-7.51) and all-cause mortality 1.55 (1.31-1.83), all p values <.0001. The HR and 95% CI remained similar after controlling for significant covariates: diabetes 18.89 (17.36-20.56), cardiovascular events 1.79 (1.52-2.12), renal disease 5.42 (4.55-6.45), and all-cause mortality 1.44 (1.21-1.70). When time-dependent diabetes was added to the model, significance remained for cardiovascular events 1.33 (1.10-1.61), p = .003 and renal disease 2.33 (1.88-2.88), p < .0001 but not all-cause mortality. CONCLUSIONS Women diagnosed with gestational diabetes have an increased risk of adverse cardiometabolic and renal outcomes. Findings highlight the importance of follow-up screening for diabetes, cardiovascular risk factors, and renal disease.
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Affiliation(s)
- Barbara M. Daly
- Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Zhenqiang Wu
- Department of Geriatric MedicineUniversity of AucklandAucklandNew Zealand
| | - Krishnarajah Nirantharakumar
- Professor in Health Data Science and Public Health, Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Lynne Chepulis
- School of HealthUniversity of WaikatoHamiltonWaikatoNew Zealand
| | - Janet A. Rowan
- National Women Health at Auckland City HospitalAucklandNew Zealand
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Ohene‐Agyei P, Gamble GD, Harding JE, Crowther CA. Prevalence and determinants of perinatal mental disorders in women with gestational diabetes in New Zealand: Findings from a national longitudinal study. Acta Obstet Gynecol Scand 2024; 103:459-469. [PMID: 38063006 PMCID: PMC10867385 DOI: 10.1111/aogs.14738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Concurrent diagnosis of gestational diabetes mellitus and mental disorders is associated with adverse outcomes for mother and child, but there is limited information about prevalence or which women are at risk. MATERIAL AND METHODS This study was a prospective cohort study of women with gestational diabetes from 10 hospitals in New Zealand who reported anxiety (6-item Spielberger State-Trait Anxiety Inventory), depression (Edinburgh Postnatal Depression Scale) and health-related quality of life (36-Item Short-Form General Health Survey) at time of gestational diabetes diagnosis (baseline), 36 weeks' gestation, and 6 months postpartum. Potential predictors were assessed using multivariable logistic regression. RESULTS Among 414 respondents, 17% reported anxiety, 16% vulnerability to depression and 27% poor mental health-related quality of life at time of gestational diabetes diagnosis. At 36 weeks' gestation, prevalence decreased for vulnerability to depression (8%) and poor mental health-related quality of life (20%). Younger maternal age, Pacific ethnicity, previous history of gestational diabetes, and older gestational age at time of gestational diabetes diagnosis were associated with poorer mental health outcomes. At 6 months postpartum the prevalence of mental disorders did not differ from in late pregnancy and they were associated with later gestational age at time of gestational diabetes diagnosis and elevated 2-hour postprandial glucose concentrations. CONCLUSIONS Perinatal mental disorders are common at time of diagnosis among women with gestational diabetes in New Zealand and had decreased by late pregnancy and at 6 months after birth. These disorders are more common among women with specific risk factors who may therefore benefit from additional support.
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Affiliation(s)
| | - Greg D. Gamble
- Liggins InstituteUniversity of AucklandAucklandNew Zealand
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Noah AI, Perez-Patron MJ, Gongalla M, Hill AV, Taylor BD. Foreign-born status and risk of gestational diabetes mellitus by years of residence in the United States. Sci Rep 2023; 13:10060. [PMID: 37344555 DOI: 10.1038/s41598-023-36789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
To explore the association between acculturation among foreign-born (FB) women, gestational diabetes (GDM) and GDM-associated adverse birth outcomes, we conducted a retrospective cohort study of 34,696 singleton pregnancies from Houston, TX, between 2011 and 2022. FB women (n = 18,472) were categorized based on years of residence in US (0-5, 6-10, and > 10 years), while US-born women (n = 16,224) were the reference group. A modified Poisson regression model determined the association between acculturative level and GDM within the entire cohort and stratified by race/ethnicity. Compared to US-born women, FB women with 0-5 years [adjusted relative risk (RRadj.) 1.27, 95% confidence interval [CI] 1.14-1.42)], 6-10 years (RRadj. 1.89, 95%CI 1.68-2.11) and > 10 years in the US (RRadj. 1.85, 95%CI 1.69-2.03) had higher risk of GDM. Results were consistent for all racial/ethnic groups, although associations were not significant at 0-5 years. FB women had lower risk of other adverse pregnancy outcomes, except for preeclampsia with severe features at higher levels of acculturation. Results were similar among those with and without GDM. In conclusion, FB status increases risk of GDM among all racial/ethnic groups but is elevated with higher acculturation levels.
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Affiliation(s)
- Akaninyene I Noah
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch, MRB, 11.158A, 301 University Blvd, Galveston, TX, 77555, USA
| | - Maria J Perez-Patron
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Megha Gongalla
- Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | - Ashley V Hill
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Brandie DePaoli Taylor
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch, MRB, 11.158A, 301 University Blvd, Galveston, TX, 77555, USA.
- Department of Population Health and Health Disparities, University of Texas Medical Branch, Galveston, TX, USA.
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Razo-Azamar M, Nambo-Venegas R, Meraz-Cruz N, Guevara-Cruz M, Ibarra-González I, Vela-Amieva M, Delgadillo-Velázquez J, Santiago XC, Escobar RF, Vadillo-Ortega F, Palacios-González B. An early prediction model for gestational diabetes mellitus based on metabolomic biomarkers. Diabetol Metab Syndr 2023; 15:116. [PMID: 37264408 DOI: 10.1186/s13098-023-01098-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) represents the main metabolic alteration during pregnancy. The available methods for diagnosing GDM identify women when the disease is established, and pancreatic beta-cell insufficiency has occurred.The present study aimed to generate an early prediction model (under 18 weeks of gestation) to identify those women who will later be diagnosed with GDM. METHODS A cohort of 75 pregnant women was followed during gestation, of which 62 underwent normal term pregnancy and 13 were diagnosed with GDM. Targeted metabolomics was used to select serum biomarkers with predictive power to identify women who will later be diagnosed with GDM. RESULTS Candidate metabolites were selected to generate an early identification model employing a criterion used when performing Random Forest decision tree analysis. A model composed of two short-chain acylcarnitines was generated: isovalerylcarnitine (C5) and tiglylcarnitine (C5:1). An analysis by ROC curves was performed to determine the classification performance of the acylcarnitines identified in the study, obtaining an area under the curve (AUC) of 0.934 (0.873-0.995, 95% CI). The model correctly classified all cases with GDM, while it misclassified ten controls as in the GDM group. An analysis was also carried out to establish the concentrations of the acylcarnitines for the identification of the GDM group, obtaining concentrations of C5 in a range of 0.015-0.25 μmol/L and of C5:1 with a range of 0.015-0.19 μmol/L. CONCLUSION Early pregnancy maternal metabolites can be used to screen and identify pregnant women who will later develop GDM. Regardless of their gestational body mass index, lipid metabolism is impaired even in the early stages of pregnancy in women who develop GDM.
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Affiliation(s)
- Melissa Razo-Azamar
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México
- Laboratorio de Envejecimiento Saludable del INMEGEN en el Centro de Investigación sobre Envejecimiento (CIE-CINVESTAV Sede Sur), 14330, Mexico City, México
| | - Rafael Nambo-Venegas
- Laboratorio de Bioquímica de Enfermedades Crónicas Instituto Nacional de Medicina Genómica (INMEGEN), 14610, Mexico City, Mexico
| | - Noemí Meraz-Cruz
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México
| | - Martha Guevara-Cruz
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", 14080, Mexico City, Mexico
| | | | - Marcela Vela-Amieva
- Laboratorio de Errores Innatos del Metabolismo, Instituto Nacional de Pediatría (INP), 04530, Mexico City, México
| | - Jaime Delgadillo-Velázquez
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México
| | - Xanic Caraza Santiago
- Centro de Salud T-III Dr. Gabriel Garzón Cossa, Jurisdicción Sanitaria Gustavo A. Madero, SSA de la Ciudad de México, Mexico City, México
| | - Rafael Figueroa Escobar
- Centro de Salud T-III Dr. Gabriel Garzón Cossa, Jurisdicción Sanitaria Gustavo A. Madero, SSA de la Ciudad de México, Mexico City, México
| | - Felipe Vadillo-Ortega
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México
| | - Berenice Palacios-González
- Unidad de Vinculación Científica, Facultad de Medicina UNAM en Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Tlalpan, Arenal Tepepan, 14610, Mexico City, México.
- Laboratorio de Envejecimiento Saludable del INMEGEN en el Centro de Investigación sobre Envejecimiento (CIE-CINVESTAV Sede Sur), 14330, Mexico City, México.
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Khalil WJ, Akeblersane M, Khan AS, Moin ASM, Butler AE. Environmental Pollution and the Risk of Developing Metabolic Disorders: Obesity and Diabetes. Int J Mol Sci 2023; 24:8870. [PMID: 37240215 PMCID: PMC10219141 DOI: 10.3390/ijms24108870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/25/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
To meet the increased need for food and energy because of the economic shift brought about by the Industrial Revolution in the 19th century, there has been an increase in persistent organic pollutants (POPs), atmospheric emissions and metals in the environment. Several studies have reported a relationship between these pollutants and obesity, and diabetes (type 1, type 2 and gestational). All of the major pollutants are considered to be endocrine disruptors because of their interactions with various transcription factors, receptors and tissues that result in alterations of metabolic function. POPs impact adipogenesis, thereby increasing the prevalence of obesity in exposed individuals. Metals impact glucose regulation by disrupting pancreatic β-cells, causing hyperglycemia and impaired insulin signaling. Additionally, a positive association has been observed between the concentration of endocrine disrupting chemicals (EDCs) in the 12 weeks prior to conception and fasting glucose levels. Here, we evaluate what is currently known regarding the link between environmental pollutants and metabolic disorders. In addition, we indicate where further research is required to improve our understanding of the specific effects of pollutants on these metabolic disorders which would enable implementation of changes to enable their prevention.
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Affiliation(s)
- William Junior Khalil
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen 15503, Bahrain
| | - Meriem Akeblersane
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen 15503, Bahrain
| | - Ana Saad Khan
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen 15503, Bahrain
| | - Abu Saleh Md Moin
- Research Department, Royal College of Surgeons in Ireland Bahrain, Busaiteen 15503, Bahrain
| | - Alexandra E. Butler
- Research Department, Royal College of Surgeons in Ireland Bahrain, Busaiteen 15503, Bahrain
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Tocariu R, Stan D, Mitroi RF, Căldăraru DE, Dinulescu A, Dobre CE, Brătilă E. Incidence of complications among in vitro fertilization pregnancies. J Med Life 2023; 16:399-405. [PMID: 37168314 PMCID: PMC10165528 DOI: 10.25122/jml-2023-0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/01/2023] [Indexed: 05/13/2023] Open
Abstract
The use of assisted reproductive technology has increased in Romania in the past several years. Although most of these pregnancies are uncomplicated, in vitro fertilization is associated with an increased risk for adverse perinatal outcomes primarily caused by the increased risks of prematurity, gestational diabetes mellitus, and hypertensive disorders. Infertility can be caused by a variety of factors, including both male and female factors, and in some cases, the cause remains unknown. In our clinic, the etiology of infertility was known in most cases and was equally distributed between male and female factors. Women with gestational hypertension were significantly older. Patients with twin pregnancies were significantly younger than those with a single pregnancy. The prevalence of preterm newborns was 2.5 times higher than the global prevalence for prematurity.
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Affiliation(s)
- Raluca Tocariu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sîrbu, Bucharest, Romania
| | - Daniela Stan
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sîrbu, Bucharest, Romania
- Corresponding Author: Daniela Stan, Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Department of Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sîrbu, Bucharest, Romania. E-mail:
| | - Raluca Florina Mitroi
- Department of Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sîrbu, Bucharest, Romania
| | - Daniela Elena Căldăraru
- Department of Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sîrbu, Bucharest, Romania
| | - Alexandru Dinulescu
- Department of Pediatrics, Grigore Alexandrescu Emergency Hospital for Children, Bucharest, Romania
| | - Claudia Elena Dobre
- Department of General Nursing, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elvira Brătilă
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sîrbu, Bucharest, Romania
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Scheuer CM, Andersen MH, Mathiesen ER, Ringholm L, Müller CL, Truong JM, Lie-Olesen MM, Overgaard M, McIntyre HD, Jensen DM, Damm P, Clausen TD. Regional divergence and time trends in the prevalence of gestational diabetes mellitus: a national Danish cohort study. Acta Diabetol 2023; 60:379-386. [PMID: 36539623 PMCID: PMC9931790 DOI: 10.1007/s00592-022-02013-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIMS To evaluate the prevalence and time trends of gestational diabetes mellitus (GDM) across the five regions of Denmark with uniform national guidelines for screening and diagnosing GDM. METHODS This register-based national cohort study included 287,684 births from 2013 to 2017. Trends in GDM prevalence over time and differences between the five regions were evaluated. Crude and adjusted odd ratios (ORs) for GDM were calculated including potential confounding clinical risk factors as age, BMI, educational level, marital status, parity, country of origin and assisted reproduction. RESULTS From 2013 to 2017, GDM prevalence in Denmark increased by 7% per year (OR 1.07, 95% CI 1.06-1.09, P < 0.001). GDM prevalence varied considerably between regions and ranged from 3.0 to 5.9% in 2017, corresponding to a maximal regional difference of 97%. In crude analyses, the risk of GDM in 2017 was significantly different in four of five regions compared to the remaining regions (OR ranging from 0.60 to 1.55), and these differences persisted after adjusting for confounding clinical risk factors (adjusted OR: 0.59-1.45). CONCLUSION The prevalence of GDM increased over time in all Danish regions with substantial regional divergence. Up to a 97%, difference in GDM prevalence was observed between Danish regions, which was not explained by available clinical risk factors. This occurred despite national guidelines and raises the question of whether regional variations in screening efficacy, diagnostic procedures or inequality in clinical health care access may explain the observed differences.
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Affiliation(s)
- Cathrine M Scheuer
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
| | - Maria H Andersen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Elisabeth R Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
| | - Clara L Müller
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Jun-Mei Truong
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - H David McIntyre
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hsu S, Selen DJ, James K, Li S, Camargo CA, Kaimal A, Powe CE. Assessment of the Validity of Administrative Data for Gestational Diabetes Ascertainment. Am J Obstet Gynecol MFM 2023; 5:100814. [PMID: 36396038 PMCID: PMC10071626 DOI: 10.1016/j.ajogmf.2022.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Administrative data, including International Classification of Diseases codes and birth certificate records, are often used for retrospective gestational diabetes research investigations to describe associations of gestational diabetes with perinatal complications and long-term outcomes, and to determine gestational diabetes prevalence. Research investigating the validity of using International Classification of Diseases codes and birth certificates for gestational diabetes ascertainment shows varying degrees of reliability. OBJECTIVE This study aimed to evaluate the accuracy of both International Classification of Diseases codes and birth certificate diagnosis for gestational diabetes ascertainment in a large hospital-based cohort of pregnant individuals, using laboratory criteria for gestational diabetes mellitus as the reference. STUDY DESIGN We studied individuals who received prenatal care at an academic hospital and affiliated community health centers between 1998 and 2016. In the setting of universal 2-step screening for gestational diabetes, pregnant individuals were classified as having gestational diabetes if ≥2 oral glucose tolerance test values met or exceeded National Diabetes Data Group thresholds. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for International Classification of Diseases code and birth certificate ascertainment of gestational diabetes, and their exact binomial 95% confidence intervals. RESULTS In a cohort of 51,059 pregnancies with complete glucose screening, 1303 (2.6%) met National Diabetes Data Group laboratory criteria for gestational diabetes. Gestational diabetes International Classification of Diseases codes had moderate sensitivity of 70.5% (95% confidence interval, 67.9-72.9), high specificity of 99.3% (95% confidence interval, 99.3-99.4), a positive predictive value of 73.3% (95% confidence interval, 70.8-75.8), and a negative predictive value of 99.2% (95% confidence interval, 99.1-99.3). In the 46,512 pregnancies linked to birth certificate data, birth certificate diagnosis had moderate sensitivity (66.3% [95% confidence interval, 63.6-69.0]), high specificity (98.9% [95% confidence interval, 98.8-99.0]), moderate positive predictive value (62.1% [95% confidence interval, 59.8-64.4]), and high negative predictive value (99.1% [95% confidence interval, 99.0-99.2]). CONCLUSION Ascertainment of gestational diabetes using administrative data, including International Classification of Diseases codes or birth certificates, has moderate sensitivity, moderate positive predictive value, high specificity, and high negative predictive value. Our findings provide context for interpreting the validity of studies that depend on administrative data for ascertainment of gestational diabetes and comparing them with prospective studies that use laboratory-based gestational diabetes criteria.
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Affiliation(s)
- Sarah Hsu
- Diabetes Unit, Massachusetts General Hospital, Boston, MA (Ms Hsu and Drs Selen and Powe); Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA (Ms Hsu and Dr Powe)
| | - Daryl J Selen
- Diabetes Unit, Massachusetts General Hospital, Boston, MA (Ms Hsu and Drs Selen and Powe); Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe)
| | - Kaitlyn James
- Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Drs James, Kaimal, and Powe)
| | - Sijia Li
- Department of Medicine, Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, RI (Dr. Selen), Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (Ms Li and Dr Camargo)
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe); Department of Medicine, Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, RI (Dr. Selen), Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (Ms Li and Dr Camargo)
| | - Anjali Kaimal
- Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Drs James, Kaimal, and Powe)
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA (Ms Hsu and Drs Selen and Powe); Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA (Ms Hsu and Dr Powe); Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Drs James, Kaimal, and Powe).
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11
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Easton ZJW, Luo X, Li L, Regnault TRH. The impact of hyperglycemia upon BeWo trophoblast cell metabolic function: A multi-OMICS and functional metabolic analysis. PLoS One 2023; 18:e0283118. [PMID: 36930661 PMCID: PMC10022812 DOI: 10.1371/journal.pone.0283118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
Pre-existing and gestationally-developed diabetes mellitus have been linked with impairments in placental villous trophoblast cell metabolic function, that are thought to underlie the development of metabolic diseases early in the lives of the exposed offspring. Previous research using placental cell lines and ex vivo trophoblast preparations have highlighted hyperglycemia is an important independent regulator of placental function. However, it is poorly understood if hyperglycemia directly influences aspects of placental metabolic function, including nutrient storage and mitochondrial respiration, that are altered in term diabetic placentae. The current study examined metabolic and mitochondrial function as well as nutrient storage in both undifferentiated cytotrophoblast and differentiated syncytiotrophoblast BeWo cells cultured under hyperglycemia conditions (25 mM glucose) for 72 hours to further characterize the direct impacts of placental hyperglycemic exposure. Hyperglycemic-exposed BeWo trophoblasts displayed increased glycogen and triglyceride nutrient stores, but real-time functional readouts of metabolic enzyme activity and mitochondrial respiratory activity were not altered. However, specific investigation into mitochondrial dynamics highlighted increased expression of markers associated with mitochondrial fission that could indicate high glucose-exposed trophoblasts are transitioning towards mitochondrial dysfunction. To further characterize the impacts of independent hyperglycemia, the current study subsequently utilized a multi-omics approach and evaluated the transcriptomic and metabolomic signatures of BeWo cytotrophoblasts. BeWo cytotrophoblasts exposed to hyperglycemia displayed increased mRNA expression of ACSL1, HSD11B2, RPS6KA5, and LAP3 and reduced mRNA expression of CYP2F1, and HK2, concomitant with increased levels of: lactate, malonate, and riboflavin metabolites. These changes highlighted important underlying alterations to glucose, glutathione, fatty acid, and glucocorticoid metabolism in BeWo trophoblasts exposed to hyperglycemia. Overall, these results demonstrate that hyperglycemia is an important independent regulator of key areas of placental metabolism, nutrient storage, and mitochondrial function, and these data continue to expand our knowledge on mechanisms governing the development of placental dysfunction.
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Affiliation(s)
- Zachary J W Easton
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Xian Luo
- The Metabolomics Innovation Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Liang Li
- The Metabolomics Innovation Centre, University of Alberta, Edmonton, Alberta, Canada
- Department of Chemistry, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy R H Regnault
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
- Department of Obstetrics and Gynaecology, London Health Science Centre-Victoria Hospital, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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12
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Babović IR, Dotlić J, Sparić R, Jovandaric MZ, Andjić M, Marjanović Cvjetićanin M, Akšam S, Bila J, Tulić L, Kocijančić Belović D, Plešinac V, Plesinac J. Gestational Diabetes Mellitus and Antenatal Corticosteroid Therapy-A Narrative Review of Fetal and Neonatal Outcomes. J Clin Med 2022; 12:323. [PMID: 36615121 PMCID: PMC9820953 DOI: 10.3390/jcm12010323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/17/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There, we review the pathogenesis of gestational diabetes mellitus (GDM), its influence on fetal physiology, and neonatal outcomes, as well as the usage of antenatal corticosteroid therapy (ACST) in pregnancies complicated by GDM. METHODS MEDLINE and PubMed search was performed for the years 1990-2022, using a combination of keywords on such topics. According to the aim of the investigation, appropriate articles were identified and included in this narrative review. RESULTS GDM is a multifactorial disease related to unwanted pregnancy course and outcomes. Although GDM has an influence on the fetal cardiovascular and nervous system, especially in preterm neonates, the usage of ACST in pregnancy must be considered taking into account maternal and fetal characteristics. CONCLUSIONS GDM has no influence on neonatal outcomes after ACST introduction. The ACST usage must be personalized and considered according to its gestational age-specific effects on the developing fetus.
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Affiliation(s)
- Ivana R. Babović
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Dotlić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Radmila Sparić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Miljana Z Jovandaric
- Department of Neonatology, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Mladen Andjić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Mirjana Marjanović Cvjetićanin
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Slavica Akšam
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jovan Bila
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Lidija Tulić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dušica Kocijančić Belović
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Vera Plešinac
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Jovana Plesinac
- University Clinical Centre of Serbia, 11000 Belgrade, Serbia
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13
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The Effects of Race and Socioeconomics on the Relationship Between Gestational Diabetes Mellitus and Birth Outcomes: An Analysis of Southern US PRAMS data. Matern Child Health J 2022; 26:2476-2484. [PMID: 36346568 DOI: 10.1007/s10995-022-03513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/02/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Abstract
Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Uncontrolled GDM increases the risk of negative pregnancy outcomes for both the pregnant individual and the infant. African Americans (AAs) have higher maternal morbidity and infant mortality rates than non-Hispanic whites (NHWs). The goal of the current study was to examine racial differences in the effect of GDM on birth outcomes. The data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was analyzed with a focus on four states in the southern U.S. (Alabama, Georgia, Louisiana, and Mississippi). The results presented suggest that AAs are at lower risk of GDM than NHW individuals. Even with the lower risk of GDM, AAs are at higher risk of pre-term births. In addition, socioeconomic factors and access to prenatal care play a role in birth outcomes including moderating the effect of GDM on outcomes. A discussion of potential policy interventions that may improve pregnancy outcomes is discussed including increased use of doulas to support pregnant people.
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14
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Baharvand P, Anbari K, Hamidi H. Perceived social support in pregnant women with gestational diabetes attending hospitals in western Iran compared to healthy controls and its relationship with perceived anxiety. J Diabetes Metab Disord 2022; 21:1549-1555. [PMID: 36404846 PMCID: PMC9672204 DOI: 10.1007/s40200-022-01100-5] [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: 04/23/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022]
Abstract
Background/purpose Due to the importance of social support in pregnant women, especially those with gestational diabetes that cause anxiety and stress in them and requires effective and enough attention, this study aims to assess perceived social support of pregnant women with gestational diabetes in western Iran compared to healthy controls and its relationship with their perceived anxiety. Methods This is a descriptive/analytical study with a cross-sectional design conducted on 180 pregnant women with gestational diabetes (n = 89) and without gestational diabetes (n = 91) referred to the obstetrics and gynecology clinics of two hospitals (Asalian and Shahid Rahimi) in Khorramabad, western Iran. Data collection tools were a demographic checklist, the Multidimensional Scale of Perceived Social Support (MSPSS), and the Beck Anxiety Inventory (BAI). Collected data were analyzed in SPSS v.20 software using chi square test, independent t-test, one-way ANOVA, and Pearson correlation test. Results The difference between the two groups was significant in terms of perceived support from family (p = 0.001), perceived support from friends (p = 0.006), and anxiety (p = 0.047). Pearson correlation test results showed a significant negative relationship between the scores of MSPSS and BAI in patients (r= -0.329, p = 0.001) and controls (r=-0.204, p = 0.006). There was a significant difference in the MSPSS score among diabetic women in terms of having fetal macrosomia (p = 0.005), occupation (p = 0.003), education (p = 0.001), and frequency of pregnancy (p = 0.010). Conclusions The perceived social support level is higher in diabetic pregnant women compared to healthy peers in western Iran. Improvement of social support from family and friends can reduce the anxiety of pregnant women with/without diabetes.
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Affiliation(s)
- Parastoo Baharvand
- Social Determinants of Health Research Center, Department of Social Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Khatereh Anbari
- Social Determinants of Health Research Center, Department of Social Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hossein Hamidi
- General Physician, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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15
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Dłuski DF, Ruszała M, Rudziński G, Pożarowska K, Brzuszkiewicz K, Leszczyńska-Gorzelak B. Evolution of Gestational Diabetes Mellitus across Continents in 21st Century. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15804. [PMID: 36497880 PMCID: PMC9738915 DOI: 10.3390/ijerph192315804] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Over the last few decades, several definitions of gestational diabetes mellitus (GDM) have been described. There is currently not enough research to show which way is the best to diagnose GDM. Opinions differ in terms of the optimal screening and diagnostic measures, in part due to the differences in the population risks, the cost-effectiveness considerations, and the lack of an evidence base to support large national screening programs. The basic method for identifying the disease is the measurement of glucose plasma levels which may be determined when fasting, two hours after a meal, or simply at any random time. The currently increasing incidence of diabetes in the whole population, the altering demographics and the presence of lifestyle changes still require better methods of screening for hyperglycemia, especially during pregnancy. The main aim of this review is to focus on the prevalence and modifications to the screening criteria for GDM across all continents in the 21st century. We would like to show the differences in the above issues and correlate them with the geographical situation. Looking at the history of diabetes, we are sure that more than one evolution in GDM diagnosis will occur, due to the development of medicine, appearance of modern technologies, and the dynamic continuation of research.
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Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Monika Ruszała
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Gracjan Rudziński
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | - Kinga Pożarowska
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
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16
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Perceptions of Key Informant Health Professionals before implementing tighter glycaemic targets for women with gestational diabetes mellitus in New Zealand. PLoS One 2022; 17:e0271699. [PMID: 35960738 PMCID: PMC9374239 DOI: 10.1371/journal.pone.0271699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Tighter glycaemic targets may be of benefit for women with GDM and their infants. Barrier and enabler identification prior to implementation of tighter glycaemic targets for women with GDM may support a successful transition. Methods A cross-sectional questionnaire survey was conducted among Key Informant Health Professionals in ten hospitals in New Zealand. The survey assessed what was currently working using less tight glycaemic targets; what barriers and enablers were considered likely when introducing tighter glycaemic targets and whether these perceptions differed by health professional groups. Results Sixty Key Health Informant Health Professionals completed the survey. When using the lower glycaemic targets, participants considered that women with GDM found the targets easy to use and that collaborative collegial support was effective. No significant barriers were identified. Perceived enablers identified prior to implementation of tighter targets included receiving collegial support (40, 67%), attending education sessions (38, 63%), use of pocket prompt cards (31, 52%), availability of wall charts (25, 42%) and glycaemic target reminder stickers (24, 40%). For health professionals referring into the Diabetes in Pregnancy Service effective communication (50, 83%) was considered important. Perceived barriers were confusion over glycaemic targets use (27 (45%), not being informed of the glycaemic target change (31, 52%), non-involvement with multidisciplinary decisions (29, 48%) and increased difficulty of blood glucose control for women (48, 80%). Overall, barriers and enablers between Health Professional groups did not differ. Discussion Key Informant Health Professionals reported effective communication as a key perceived enabler and that woman would find it more difficult to control their blood glucose concentrations. Education sessions, multidisciplinary engagement, wall charts and stickers were considered effective to overcome the perceived barriers. Further research is needed to assess if the barriers perceived were realised and if the perceived enablers supported the implementation of the tighter glycaemic targets effectively.
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17
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A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally. BMC Pregnancy Childbirth 2022; 22:627. [PMID: 35941555 PMCID: PMC9361509 DOI: 10.1186/s12884-022-04931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women’s GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has been conducted into the healthcare experiences of women with GDM. Methods A systematic search of primary research using a number of databases was conducted in September 2021. Studies were included if they had an explicit aim of focusing on GDM and included direct reporting of participants’ experiences of healthcare. Key data from each study was extracted into a purposely-designed form and synthesised using descriptive statistics and thematic analysis. Results Fifty-seven articles were included in the analysis. The majority of studies used qualitative methodology, and did not have an explicit theoretical orientation. Most studies were conducted in urban areas of high-income countries and recruitment and research was almost fully conducted in clinical and other healthcare settings. Women found inadequate information a key challenge, and support from healthcare providers a critical factor. Experiences of prescribed diet, medication and monitoring greatly varied across settings. Additional costs associated with managing GDM was cited as a problem in some studies. Overall, women reported significant mental distress in relation to their experience of GDM. Conclusions This scoping review draws together reported healthcare experiences of pregnant women with GDM from around the world. Commonalities and differences in the global patient experience of GDM healthcare are identified. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04931-5.
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18
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Bui L, Edwards S, Hall E, Alderfer L, Round K, Owen M, Sainaghi P, Zhang S, Nallathamby PD, Haneline LS, Hanjaya-Putra D. Engineering bioactive nanoparticles to rejuvenate vascular progenitor cells. Commun Biol 2022; 5:635. [PMID: 35768543 PMCID: PMC9243106 DOI: 10.1038/s42003-022-03578-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
Fetal exposure to gestational diabetes mellitus (GDM) predisposes children to future health complications including type-2 diabetes mellitus, hypertension, and cardiovascular disease. A key mechanism by which these complications occur is through stress-induced dysfunction of endothelial progenitor cells (EPCs), including endothelial colony-forming cells (ECFCs). Although several approaches have been previously explored to restore endothelial function, their widespread adoption remains tampered by systemic side effects of adjuvant drugs and unintended immune response of gene therapies. Here, we report a strategy to rejuvenate circulating vascular progenitor cells by conjugation of drug-loaded liposomal nanoparticles directly to the surface of GDM-exposed ECFCs (GDM-ECFCs). Bioactive nanoparticles can be robustly conjugated to the surface of ECFCs without altering cell viability and key progenitor phenotypes. Moreover, controlled delivery of therapeutic drugs to GDM-ECFCs is able to normalize transgelin (TAGLN) expression and improve cell migration, which is a critical key step in establishing functional vascular networks. More importantly, sustained pseudo-autocrine stimulation with bioactive nanoparticles is able to improve in vitro and in vivo vasculogenesis of GDM-ECFCs. Collectively, these findings highlight a simple, yet promising strategy to rejuvenate GDM-ECFCs and improve their therapeutic potential. Promising results from this study warrant future investigations on the prospect of the proposed strategy to improve dysfunctional vascular progenitor cells in the context of other chronic diseases, which has broad implications for addressing various cardiovascular complications, as well as advancing tissue repair and regenerative medicine. Drug-loaded liposomal nanoparticles conjugated to endothelial colony-forming cells can improve the vasculogenic potential of vascular progenitor cells exposed to gestational diabetes mellitus.
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Affiliation(s)
- Loan Bui
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Shanique Edwards
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, 46202, USA
| | - Eva Hall
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Laura Alderfer
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Kellen Round
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Madeline Owen
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Pietro Sainaghi
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Siyuan Zhang
- Department of Biological Science, University of Notre Dame, Notre Dame, IN, 46556, USA.,Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Prakash D Nallathamby
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Laura S Haneline
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, 46202, USA.,Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.,Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Donny Hanjaya-Putra
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN, 46556, USA. .,Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, 46556, USA. .,Department of Chemical and Biomolecular Engineering, University of Notre Dame, Notre Dame, IN, 46556, USA. .,Center for Stem Cells and Regenerative Medicine, University of Notre Dame, Notre Dame, IN, 46556, USA.
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19
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Chepulis L, Morison B, Lawrenson R, Paul R. Prevalence of gestational diabetes in the Waikato region of New Zealand. Intern Med J 2022; 52:1075-1078. [PMID: 35642421 PMCID: PMC9327502 DOI: 10.1111/imj.15803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/27/2022]
Abstract
Gestational diabetes mellitus (GDM) during pregnancy is associated with health complications for both mother and infant, but patient numbers in the Waikato District Health Board region of New Zealand have not been well characterised. This study reviewed the full 2018 cohort of Waikato District Health Board hospital births (n = 4970) to report on GDM prevalence by ethnicity and age. The overall prevalence of GDM was 5.7% and is more likely to affect Asian, Pacific and Māori women as well as those of advanced maternal age.
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Affiliation(s)
- Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton
| | | | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton.,Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand
| | - Ryan Paul
- Medical Research Centre, University of Waikato, Hamilton.,Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand
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20
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Lawrence RL, Wall CR, Bloomfield FH. Adherence to Dietary Guidelines among Women with and without Gestational Diabetes: Evidence from the Growing up in New Zealand Study. Nutrients 2022; 14:nu14102145. [PMID: 35631286 PMCID: PMC9144046 DOI: 10.3390/nu14102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022] Open
Abstract
Diet is thought to play a role in the development and management of gestational diabetes mellitus (GDM). Dietary guidelines provide practical recommendations for achieving nutrient requirements and mitigating the risk of chronic disease. The aim of this study was to describe the adherence to dietary guidelines by women with and without GDM and determine whether adherence is associated with the development of GDM. Adherence to Ministry of Health food group recommendations was assessed in 5391 pregnant women participating in the Growing Up in New Zealand study. A food frequency questionnaire (FFQ) administered during pregnancy provided dietary data. The presence of GDM was determined using diagnostic coding in clinical data and blood glucose results. A quarter of women did not meet any food group recommendations. There were no significant differences in the number of food group targets met by women with or those without GDM. Meeting food group recommendations was not associated with odds of having GDM in adjusted analyses. This study found adherence to dietary recommendations is poor in both women with and without GDM and no association between adherence to food group recommendations and the development of GDM. Greater support is required to assist women to achieve food and nutrition recommendations.
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Affiliation(s)
- Robyn L. Lawrence
- The Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
| | - Clare R. Wall
- Disciple of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand;
| | - Frank H. Bloomfield
- The Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
- Correspondence: ; Tel.: +64-9-923-6107 (ext. 86107)
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21
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Chelu S, Bernad E, Craina M, Neamtu R, Mocanu AG, Vernic C, Chiriac VD, Tomescu L, Borza C. Prevalence of Gestational Diabetes in preCOVID-19 and COVID-19 Years and Its Impact on Pregnancy: A 5-Year Retrospective Study. Diagnostics (Basel) 2022; 12:1241. [PMID: 35626396 PMCID: PMC9140441 DOI: 10.3390/diagnostics12051241] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 05/13/2022] [Indexed: 12/17/2022] Open
Abstract
Gestational diabetes mellitus (GDM) affects a total of 3% to 9% of all pregnancies. It has a high impact on both mother and baby, increases the perinatal risks, and predicts the presence of long-term chronic metabolic complications. The aim of our study is to determine the incidence of GDM in tertiary hospitals in the west part of Romania to lay out the risk factors associated with GDM and to observe the evolution of pregnancy among patients with this pathology by emphasizing the state of birth of the fetus, the birth weight, and the way of birth. We also want to compare the prevalence of GDM in preCOVID-19 (Coronavirus disease) versus COVID-19 years. The study took place between January 2017 and December 2021 at the Municipal Emergency Hospital of Timisoara, Romania. The proportion of births with GDM was significantly increased during the COVID-19 period compared to the preCOVID-19 period (chi2 Fisher exact test, p < 0.001). The period 2020−2021 represents a significant risk factor for GDM births (OR = 1.87, with 95% CI = [1.30, 2.67]). COVID years represent a risk period for developing gestational diabetes, which can be explained by reduced physical activity, anxiety, or modified dietary habits, even if the follow-up period was not impacted.
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Affiliation(s)
- Sorina Chelu
- Discipline of Pathophysiology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.C.); (C.B.)
| | - Elena Bernad
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Marius Craina
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Radu Neamtu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Adelina Geanina Mocanu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Corina Vernic
- Computer Science and Medical Biostatistics Discipline, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Veronica Daniela Chiriac
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Larisa Tomescu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Claudia Borza
- Discipline of Pathophysiology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.C.); (C.B.)
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22
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North S, Crofts C, Zinn C. Health professionals' views and experiences around the dietary and lifestyle management of gestational diabetes in New Zealand. Nutr Diet 2022; 79:255-264. [PMID: 35128768 DOI: 10.1111/1747-0080.12719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022]
Abstract
AIM This study aimed to investigate New Zealand health professionals' views and experiences around the dietary and lifestyle management of gestational diabetes. METHODS Semi-structured interviews were conducted remotely with health professionals; sessions were recorded and transcribed. Core themes were extracted using inductive thematic analysis using a framework method. RESULTS Twenty-seven health professionals were interviewed (13 diabetes dietitians, 8 specialist diabetes midwives, 2 community midwives, 1 antenatal clinic midwife, 1 obstetrician and 2 endocrinologists). Themes were organised into three central domains: (a) Social and cultural barriers, (b) Service provision and (c) Nutrition advice. Enabling themes included professional collaboration, innovation and creating trusting and supportive environments. Key barriers identified included accessibility, cultural barriers, overwhelmed service, fragmentation and conflicting information and nutrition resource gaps. CONCLUSIONS Findings highlight foremost a deficit in primary antenatal nutrition advice that may play a significant role in the fragmentation identified. Investment in community-inclusive services providing antenatal nutrition and diabetes education appears critical to overcome barriers associated with misinformation and poor outcomes. Pathways to include nutrition education from various primary care health providers should be investigated to ease the burden from specialist gestational diabetes clinicians and allow effective delegation of dietetic resources. Revision of current nutrition guidelines for the management of gestational diabetes in New Zealand is needed to facilitate consistent messaging and standards of care.
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Affiliation(s)
- Sylvia North
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Catherine Crofts
- School of Interprofessional Health, Auckland University of Technology, Auckland, New Zealand
| | - Caryn Zinn
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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23
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Tocantins C, Diniz MS, Grilo LF, Pereira SP. The birth of cardiac disease: Mechanisms linking gestational diabetes mellitus and early onset of cardiovascular disease in offspring. WIREs Mech Dis 2022; 14:e1555. [PMID: 35304833 DOI: 10.1002/wsbm.1555] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/10/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) is the biggest killer worldwide, composing a major economic burden for health care systems. Obesity and diabetes are dual epidemics on the rise and major risk factors predisposing for CVD. Increased obesity- and diabetes-related incidence is now observed among children, adolescents, and young adults. Gestational diabetes mellitus (GDM) is the most common metabolic pregnancy disorder, and its prevalence is rapidly increasing. During pregnancies complicated by GDM, the offspring are exposed to a compromised intrauterine environment characterized by hyperglycemic periods. Unfavorable in utero conditions at critical periods of fetal cardiac development can produce developmental adaptations that remodel the cardiovascular system in a way that can contribute to adult-onset of heart disease due to the programming during fetal life. Epidemiological studies have reported increased cardiovascular complications among GDM-descendants, highlighting the urgent need to investigate and understand the mechanisms modulated during fetal development of in utero GDM-exposed offspring that predispose an individual to increased CVD during life. In this manuscript, we overview previous studies in this area and gather evidence linking GDM and CVD development in the offspring, providing new insights on novel mechanisms contributing to offspring CVD programming by GDM, from the role of maternal-fetal interactions to their impact on fetal cardiovascular development, how the perpetuation of cardiac programming is maintained in postnatal life, and advance the intergenerational implications contributing to increased CVD premature origin. Understanding the perpetuation of CVD can be the first step to manage and reverse this leading cause of morbidity and mortality. This article is categorized under: Reproductive System Diseases > Molecular and Cellular Physiology Cardiovascular Diseases > Molecular and Cellular Physiology Metabolic Diseases > Genetics/Genomics/Epigenetics.
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Affiliation(s)
- Carolina Tocantins
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Mariana S Diniz
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Luís F Grilo
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Susana P Pereira
- CNC-Center for Neuroscience and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Laboratory of Metabolism and Exercise (LametEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
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24
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Al Hashmi I, Al Yazidi B, Al Omari O. Translation and psychometric validation of the Arabic Gestational Diabetes Management Self-Efficacy Scale (GDMSES). J Healthc Qual Res 2022; 37:231-238. [PMID: 35042678 DOI: 10.1016/j.jhqr.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The assessment of self-efficacy for adherence to healthy behaviours among women with gestational diabetes (GDM) is undermined by the unavailability of validated tools. Therefore, this study aimed at translating, culturally adapting and assessing the psychometric properties of the Arabic version of Gestational Diabetes Management Self-Efficacy Scale (GDMSES). MATERIALS AND METHODS This methodological study was conducted in the Antenatal Clinic at Sultan Qaboos University Hospital in Oman between October 2016 and January 2017. A total of 90 forms of the Arabic GDMSES tool were completed by Omani pregnant women with gestational diabetes. The study has a multiphase design: (1) cultural and linguistic validation; (2) content and face validity; (3) construct validity; (4) internal validity. RESULTS The Arabic GDMSES showed satisfactory content validity (CVI between .8 and 1), acceptable overall scale internal consistency reliability (Cronbach's alpha=0.85) and stability overtime (Pearson correlation coefficient>.6). Four factors emerged for construct validity using exploratory factor analysis: nutrition and body weight, adaptation to healthy eating, physical activity and treatment and blood sugar. Our sample size of 90 was considered adequate in determining these factors (Kaiser-Meyer-Olkin=.78). CONCLUSIONS GDMSES is a valid and reliable tool, thus providing a quick and easy self-efficacy assessment tool for antenatal nurses dealing with pregnant women with GDM.
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Affiliation(s)
- I Al Hashmi
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman.
| | - B Al Yazidi
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman
| | - O Al Omari
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman
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25
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Wander PL, Christophi CA, Araneta MRG, Boyko EJ, Enquobahrie DA, Dabelea D, Goldberg RB, Kahn SE, Kim C, Pi-Sunyer X, Knowler WC. Adiposity, related biomarkers, and type 2 diabetes after gestational diabetes: The Diabetes Prevention Program. Obesity (Silver Spring) 2022; 30:221-228. [PMID: 34796678 PMCID: PMC8692336 DOI: 10.1002/oby.23291] [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: 04/21/2021] [Revised: 07/23/2021] [Accepted: 08/15/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study investigated associations of adiposity and adiposity-related biomarkers with incident type 2 diabetes (T2D) among parous women. METHODS Among women in the Diabetes Prevention Program (DPP) who reported a previous live birth, circulating biomarkers (leptin, adiponectin, sex hormone-binding globulin, and alanine aminotransferase; n = 1,711) were measured at enrollment (average: 12 years post partum). Visceral (VAT) and subcutaneous adipose tissue areas at the L2-L3 region and the L3-L4 region were quantified by computed tomography (n = 477). Overall and stratified (by history of gestational diabetes mellitus [GDM]) adjusted Cox proportional hazards models were fit. RESULTS Alanine aminotransferase, L2-L3 VAT, and L3-L4 VAT were positively associated (hazard ratio [HR] for 1-SD increases: 1.073, p = 0.024; 1.251, p = 0.009; 1.272, p = 0.004, respectively), and adiponectin concentration was inversely associated with T2D (HR 0.762, p < 0.001). Whereas leptin concentration was not associated with T2D overall, in GDM-stratified models, a 1-SD higher leptin was positively associated with risk of T2D in women without GDM (HR: 1.126, p = 0.016) and inversely in women with a history of GDM (HR: 0.776, p = 0.013, interaction p = 0.002). CONCLUSIONS Among parous women, alanine aminotransferase and VAT are positively associated with incident T2D, whereas adiponectin is inversely associated. Leptin is associated with higher risk of T2D in women with a history of GDM but a lower risk in women without a history of GDM.
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Affiliation(s)
- Pandora L Wander
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Costas A Christophi
- Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Maria Rosario G Araneta
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Edward J Boyko
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Dana Dabelea
- Department of Preventive Medicine and Biometrics, Colorado School of Public Health, Aurora, Colorado, USA
| | | | - Steven E Kahn
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Catherine Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Xavier Pi-Sunyer
- Division of Endocrinology, Columbia University Medical Center, New York, New York, USA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
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26
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Lawrence RL, Ward K, Wall CR, Bloomfield FH. New Zealand women's experiences of managing gestational diabetes through diet: a qualitative study. BMC Pregnancy Childbirth 2021; 21:819. [PMID: 34886814 PMCID: PMC8662890 DOI: 10.1186/s12884-021-04297-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond. Methods Women diagnosed with GDM before 30 weeks’ gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women’s perceptions and experiences of dietary recommendations for the management of GDM. Results Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women’s perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term. Conclusions The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04297-0.
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Affiliation(s)
- R L Lawrence
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - K Ward
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - C R Wall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - F H Bloomfield
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
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27
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Gebremedhin AT, Tessema GA, Regan AK, Pereira GF. Association between interpregnancy interval and pregnancy complications by history of complications: a population-based cohort study. BMJ Open 2021; 11:e046962. [PMID: 34857549 PMCID: PMC8640667 DOI: 10.1136/bmjopen-2020-046962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications. DESIGN AND SETTING Population-based longitudinally linked cohort study in Western Australia (WA). PARTICIPANTS Mothers who had their first two (n=252 368) and three (n=96 315) consecutive singleton births in WA between 1980 and 2015. OUTCOME MEASURES We estimated absolute risks (AR) of preeclampsia (PE) and gestational diabetes (GDM) for 3-60 months of IPI according to history of each outcome. We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 3, 6, 12, 24, 36, 48 and 60 months, with 18 months as reference. RESULTS Risks of PE and GDM were 9.5%, 2.6% in first pregnancies, with recurrence rates of 19.3% and 41.5% in second pregnancy for PE and GDM, respectively. The AR of GDM ranged from 30% to 43% across the IPI range for mothers with previous GDM compared with 2%-8% for mothers without previous GDM. For mothers with no previous PE, greater risks were observed for IPIs at 3 months (RR 1.24, 95% CI 1.07 to 1.43) and 60 months (RR 1.40, 95% CI 1.29 to 1.53) compared with 18 months. There was insufficient evidence for increased risk of PE at shorter IPIs of <18 months for mothers with previous PE. Shorter IPIs of <18 months were associated with lower risk than at IPIs of 18 months for mothers with no previous GDM. CONCLUSIONS The associations between IPIs and risk of PE or GDM on subsequent pregnancies are modified by previous experience with these conditions. Mothers with previous complications had higher absolute, but lower RRs than mothers with no previous complications. However, IPI remains a potentially modifiable risk factor for mothers with previous complicated pregnancies.
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Affiliation(s)
- Amanuel Tesfay Gebremedhin
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health, Texas A&M University System, College Station, Texas, USA
| | - Gavin F Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, WA, Australia
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28
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Azeez TA, Abo-Briggs T, Adeyanju AS. A systematic review and meta-analysis of the prevalence and determinants of gestational diabetes mellitus in Nigeria. Indian J Endocrinol Metab 2021; 25:182-190. [PMID: 34760670 PMCID: PMC8547393 DOI: 10.4103/ijem.ijem_301_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with onset or first diagnosis in pregnancy. GDM has numerous potential complications and it is important to estimate its burden and risk factors. The objective of the meta-analysis was to determine the pooled prevalence of GDM in Nigeria and identify its determinants. METHODS The study design was a meta-analysis; therefore the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases (African Journal Online, PubMed, SCOPUS, and Google Scholar) and the gray literature were systematically searched. Statistical analysis was done with MetaXL using the random effect model. Heterogeneity was determined using the I2 statistic and the publication bias was checked with the Doi plot. RESULTS The total sample size was 46 210. The prevalence of GDM in Nigeria was 0.5 - 38% and the pooled prevalence was 11.0% (95% CI 8-13). The I2 statistic was 99%. The Doi plot suggested some degree of bias. The most frequently reported determinants of GDM were previous macrosomic babies, maternal obesity, family history of diabetes, previous miscarriage, and advanced maternal age. CONCLUSION The prevalence of GDM in Nigeria is high and efforts should be geared at modifying its risk factors so as to reduce its prevalence and prevent the associated complications.
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Affiliation(s)
| | - Tamunosaki Abo-Briggs
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
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29
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Lawrence RL, Wall CR, Bloomfield FH. Dietary Patterns and Dietary Adaptations in Women with and without Gestational Diabetes: Evidence from the Growing Up in New Zealand Study. Nutrients 2020; 12:E227. [PMID: 31952314 PMCID: PMC7019595 DOI: 10.3390/nu12010227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
Diet is a cornerstone of the management of gestational diabetes (GDM). We investigated differences in dietary patterns and dietary adaptations among pregnant women with and without GDM participating in the Growing Up in New Zealand study. Presence of GDM was determined using coded clinical data and plasma glucose results meeting the New Zealand Society for the Study of Diabetes diagnostic criteria. Women answered a food frequency questionnaire and questions regarding dietary changes and information received during pregnancy. Women with GDM had lower adherence scores than those without GDM for 'Junk' (mean (SD) score -0.28 (0.95) versus 0.02 (1.01) p < 0.0005) and 'Traditional/White bread' dietary patterns (-0.18 (0.93) versus 0.01 (1.01) p = 0.002). More women with GDM reported avoiding foods high in fat or sugar (25.3% versus 5.7%, p < 0.05) compared to women without GDM. A greater proportion of women with GDM compared with those without GDM received information from dietitians or nutritionists (27.0% versus 1.7%, p < 0.05) or obstetricians (12.6% versus 7.5%, p < 0.05). More women diagnosed before the antenatal interview received advice from dietitians or nutritionists compared with those diagnosed after (46.9% versus 6.0%, p < 0.05). Women with GDM appear to make positive changes to their diet in response to advice received from health care professionals.
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Affiliation(s)
- Robyn L. Lawrence
- The Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Clare R. Wall
- Discipline of Nutrition and Dietetics, School of Medical Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Frank H. Bloomfield
- The Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
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30
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Chioveanu M, Bălălău OD, Sima RM, Pleș L, Bălălău C, Stănescu AD. Gestational diabetes – Diagnostic and therapeutic novelties. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2019. [DOI: 10.25083/2559.5555/4.2/66.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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