1
|
He Y, Liu X, Yang X. Effects of multidimensional exercise management on self-efficacy, blood glucose control, and delivery outcomes in pregnant women with gestational diabetes mellitus. Front Physiol 2024; 15:1407569. [PMID: 39219840 PMCID: PMC11362062 DOI: 10.3389/fphys.2024.1407569] [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: 04/02/2024] [Accepted: 07/08/2024] [Indexed: 09/04/2024] Open
Abstract
Objective This study aimed to evaluate the effects of multidimensional quantitative exercise management on self-efficacy, blood glucose control, and delivery outcomes in pregnant women with gestational diabetes mellitus (GDM). Methods A randomized controlled trial was conducted with 150 pregnant women diagnosed with gestational diabetes mellitus (GDM). Participants were randomly assigned to either the experimental group (Exp), which received a multidimensional quantitative exercise management intervention, or the control group (Con), which received standard GDM management. Results were compared between the groups included self-efficacy scores, blood glucose levels, and delivery outcomes. Results Exp group of pregnant women exhibited drastically superior self-efficacy scores as well as more stable blood glucose levels during pregnancy relative to Con group (P < 0.05). Moreover, visual analogue scale (VAS) of pregnant women and Apgar scores of infants in Exp group were considerably better than those in Con group (P < 0.05). In contrast to Con group, pregnant women in Exp group had considerably better labor outcomes along neonatal complication rates (P < 0.05). Conclusion Multidimensional quantitative exercise management had a positive impact on pregnant women with GDM. This intervention method can improve self-efficacy levels along better blood glucose control, and enhance delivery outcomes. These findings suggested that multidimensional quantitative exercise management has potential clinical value in the management of GDM, providing an effective management strategy to improve the health conditions of both pregnant women and infants.
Collapse
Affiliation(s)
| | - Xin Liu
- Nursing College, Ningxia Medical University, Yinchuan, China
| | | |
Collapse
|
2
|
Özkan S, Dereli ML, Sucu S, Varlı EN, Akay A, Uzlu SE, Çağlar AT, Engin-Ustun Y. Isolated polyhydramnios in the third trimester or polyhydramnios secondary to late-onset gestational diabetes: is it worth distinguishing? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231390. [PMID: 38896735 PMCID: PMC11185861 DOI: 10.1590/1806-9282.20231390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/03/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE The aim of this study was to compare pregnancy outcomes of patients with polyhydramnios due to late-onset gestational diabetes mellitus and patients with isolated polyhydramnios. METHODS Of the women who fully participated in prenatal examinations at Etlik Lady Zübeyde Hospital between January 1, 2018, and December 31, 2019, women with polyhydramnios of nonfetal-placental origin manifesting in the third trimester were retrospectively reviewed. Women with normal 75-g oral glucose tolerance test results between 24 and 28 weeks gestation who met the inclusion criteria were enrolled in the study and divided into two groups based on the results of rescreening with the 75-g oral glucose tolerance test for polyhydramnios in the third trimester: women with isolated polyhydramnios (group 1) and women with late-onset polyhydramnios due to gestational diabetes mellitus (group 2). RESULTS There were a total of 295 participants, of whom 35 (11.8%) were diagnosed with polyhydramnios due to late-onset gestational diabetes mellitus. There were no differences in the main outcomes. Birthweight and gestational age at birth were identified as independent risk factors for predicting composite maternal outcome {[odds ratio (OR)=1.273, 95% confidence interval (CI) 1.063-1.524, p=0.009]} and composite neonatal outcome (OR=0.606, CI 0.494-0.744, p<0.001), respectively. CONCLUSION Polyhydramnios in late pregnancy without evidence of pregnancy-related causes leading to polyhydramnios may be a sign of late-onset gestational diabetes mellitus in women with a normal prior oral glucose tolerance test. As pregnancy outcomes and management were indifferent, it does not seem necessary or useful to diagnose whether or not late-onset gestational diabetes mellitus is present.
Collapse
Affiliation(s)
- Sadullah Özkan
- Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Department of Obstetrics and Gynaecology – Ankara, Turkey
| | - Murat Levent Dereli
- Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Department of Obstetrics and Gynaecology – Ankara, Turkey
| | - Sadun Sucu
- Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Department of Obstetrics and Gynaecology – Ankara, Turkey
| | - Erol Nadi Varlı
- Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Department of Obstetrics and Gynaecology – Ankara, Turkey
| | - Arife Akay
- Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Department of Obstetrics and Gynaecology – Ankara, Turkey
| | - Safiye Elif Uzlu
- Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Department of Neonatology – Ankara, Turkey
| | - Ali Turhan Çağlar
- Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Department of Obstetrics and Gynaecology – Ankara, Turkey
| | - Yaprak Engin-Ustun
- Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Department of Obstetrics and Gynaecology – Ankara, Turkey
| |
Collapse
|
3
|
Ravi H, Das S, Devi Rajeswari V, Venkatraman G, Choudhury AA, Chakraborty S, Ramanathan G. Hormonal regulation in diabetes: Special emphasis on sex hormones and metabolic traits. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2024; 142:257-291. [PMID: 39059988 DOI: 10.1016/bs.apcsb.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Diabetes constitutes a significant global public health challenge that is rapidly reaching epidemic proportions. Among the non-communicable diseases, the incidence of diabetes is rising at an alarming rate. The International Diabetes Federation has documented a 9.09% prevalence of diabetes among individuals aged between 20 and 79 years. The interplay of gonadal hormones and gender differences is critical in regulating insulin sensitivity and glucose tolerance, and this dynamic is particularly crucial because of the escalating incidence of diabetes. Variations in insulin sensitivity are observed across genders, levels of adiposity, and age groups. Both estrogen and testosterone are seen to influence glucose metabolism and insulin sensitivity. This chapter surveys the present knowledge of sex differences, sex hormones, and chromosomes on insulin imbalance and diabetes development. It further highlights the influence of metabolic traits in diabetes and changes in sex hormones during diabetic pregnancy. Notably, even stressful lifestyles have been acknowledged to induce hormonal imbalances. Furthermore, it discusses the potential of hormonal therapy to help stabilize sex hormones in diabetic individuals and focuses on the most recent research investigating the correlation between sex hormones and diabetes.
Collapse
Affiliation(s)
- Harini Ravi
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Soumik Das
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - V Devi Rajeswari
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Ganesh Venkatraman
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Abbas Alam Choudhury
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Shreya Chakraborty
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Gnanasambandan Ramanathan
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India.
| |
Collapse
|
4
|
Tola A, Assefa N, Dessie Y, Oljira L, Regassa LD, Gure T, Gobena T. Epidemiology of hyperglycemia during pregnancy in Ethiopia: prevalence, associated factors, and feto-maternal outcomes: systematic review and meta-analysis. Syst Rev 2024; 13:116. [PMID: 38685068 PMCID: PMC11057183 DOI: 10.1186/s13643-024-02526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/13/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Hyperglycemia in pregnancy (HIP) is a significant medical complication affecting pregnant women globally and is considered a public health burden due to the negative outcomes it can cause for both mother and infant. The aim of this systematic review and meta-analysis was to examine the prevalence, risk factors, and feto-maternal outcomes of HIP in Ethiopia. METHODS To gather relevant information for this study, both published and unpublished studies were searched for in several major databases, including PubMed, Embase, HINARI, Web of Science direct, and Google Scholar, as well as other sources. The Joanna Briggs Institute (JBI) tool was used to evaluate the methodological quality of the findings from these studies. Data was then extracted and summarized using a template in Microsoft Excel software, and the extracted data was analyzed using Stata software version 16.0. If significant heterogeneity was found between studies, subgroup analyses were conducted to further examine the data. RESULT Eighteen studies were included in this systematic review and meta-analysis, involving a total sample size of 50,816 pregnant women in Ethiopia. The prevalence of HIP among pregnant women varied considerably across the primary studies, ranging from 0.4 to 26.2%. The pooled prevalence of HIP among pregnant women in Ethiopia was found to be 6.9% (95% C 2.2-11.6). Pregnant women with a family history of diabetes had 2.5 times higher odds of developing HIP compared to those without a family history of diabetes (OR = 2.49; 95% CI = 2.02, 2.96). However, there was no significant association found between HIP and maternal obesity (OR 2.31, 95% CI = 0.85, 3.78) or previous history of abortion (OR 3.89; 95% CI 0.85, 6.94). The common fetal outcomes associated with HIP were admission to the intensive care unit (46.2; 95% CI 27.4, 65.1), macrosomia (27.3%; 95% CI 9.4%, 45.1%), and preterm birth (16.9; 95% CI 12.5, 21.3). Additionally, hypertensive disorders of pregnancy (28.0%; 95% CI 15.2, 40.8) and operative delivery (51.4%; 95% CI 35.9, 66.8) were more common among women with HIP in Ethiopia. CONCLUSION Although there was some variation between studies, the meta-analysis revealed that approximately seven out of 100 pregnant women in Ethiopia had HIP. A family history of diabetes was found to be a significant predictor of HIP in Ethiopia. Additionally, HIP was associated with various serious adverse outcomes for both mothers and infants in Ethiopia. These findings highlight the need for national guidelines to ensure that pregnant women are uniformly screened for HIP.
Collapse
Affiliation(s)
- Assefa Tola
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Gure
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
5
|
Alshomrany A, Miskeen E, Alfaifi J, Alshamrani H, Alshahrani A. Maternal Diabetes Mellitus and Neonatal Outcomes in Bisha: A Retrospective Cohort Study. Med Sci (Basel) 2024; 12:21. [PMID: 38651415 PMCID: PMC11036221 DOI: 10.3390/medsci12020021] [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: 02/23/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Maternal diabetes mellitus (MDM) is associated with increased risks for adverse neonatal outcomes. However, the impact of MDM on neonatal outcomes in Bisha, a city in Saudi Arabia, is not well documented. This study aims to investigate the impact of MDM on neonatal outcomes in the Maternity and Children's Hospital (MCH), Bisha, Saudi Arabia. METHODS A retrospective cohort study was conducted on 181 pregnant women with diabetes and their neonates who were diagnosed at the Maternity and Children's Hospital (MCH), Bisha, Saudi Arabia, between 5 October 2020 and 5 November 2022. The primary outcome was a composite of adverse neonatal outcomes, including stillbirth, neonatal death, macrosomia, preterm birth, respiratory distress syndrome, hypoglycemia, and congenital anomalies. Logistic regression analyses were used to adjust for potential confounders. RESULTS The total sample size was 181. The average age of patients was 34 years (SD = 6.45). The majority of the patients were diagnosed with GDM, 147 (81.2%), and pre-GDM, 34 (18.8%). Neonates born to mothers with MDM had a higher risk of adverse neonatal outcomes compared to those born to mothers without MDM (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.25-1.70). The risks of macrosomia (aOR = 1.74, 95% CI: 1.38-2.19), LBW (aOR = 1.32, 95% CI: 1.06-1.66), and RDS (aOR = 1.57, 95% CI: 1.28-1.93) were significantly higher among neonates born to mothers with MDM. The types of DM were statistically significant in terms of their correlation with the following neonatal outcomes: hypoglycemia (p-value = 0.017), macrosomia (p-value = 0.050), and neonatal death (p-value = 0.017). CONCLUSIONS MDM is associated with an increased risk of adverse neonatal outcomes in Bisha. The early identification and management of MDM may improve neonatal outcomes and reduce the burden of neonatal morbidity and mortality in this population.
Collapse
Affiliation(s)
- Abdullah Alshomrany
- College of Medicine, University of Bisha, Bisha 67714, Saudi Arabia; (H.A.); (A.A.)
| | - Elhadi Miskeen
- Department of Obstetrics and Gynaecology, College of Medicine, University of Bisha, Bisha 67714, Saudi Arabia;
| | - Jaber Alfaifi
- Department of Pediatrics and Child Health, College of Medicine, University of Bisha, Bisha 67714, Saudi Arabia;
| | - Hassan Alshamrani
- College of Medicine, University of Bisha, Bisha 67714, Saudi Arabia; (H.A.); (A.A.)
| | | |
Collapse
|
6
|
Lis-Kuberka J, Berghausen-Mazur M, Orczyk-Pawiłowicz M. Gestational Diabetes Mellitus and Colostral Appetite-Regulating Adipokines. Int J Mol Sci 2024; 25:3853. [PMID: 38612666 PMCID: PMC11011253 DOI: 10.3390/ijms25073853] [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: 03/02/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a complex metabolic disorder that has short- and long-term effects on maternal and offspring health. This study aimed to assess the impact of maternal hyperglycemia severity, classified as GDM-G1 (diet treatment) and GDM-G2 (insulin treatment) on colostral appetite-regulating molecules. Colostrum samples were collected from hyperglycemic (N = 30) and normoglycemic (N = 21) mothers, and the concentrations of milk hormones were determined by immunoenzymatic assay. A difference was found for milk ghrelin, but not for molecules such as adiponectin, leptin, resistin, or IGF-I levels, in relation to maternal hyperglycemia. The colostral ghrelin in the GDM-G1 cohort (0.21 ng/mL) was significantly lower than for GDM-G2 (0.38 ng/mL) and non-GDM groups (0.36 ng/mL). However, colostral resistin was higher, but not significantly, for GDM-G1 (13.33 ng/mL) and GDM-G2 (12.81 ng/mL) cohorts than for normoglycemic mothers (7.89 ng/mL). The lack of difference in relation to hyperglycemia for milk leptin, adiponectin, leptin-adiponectin ratio, resistin, and IGF-I levels might be the outcome of effective treatment of GDM during pregnancy. The shift between ghrelin and other appetite-regulating hormones might translate into altered ability to regulate energy balance, affecting offspring's metabolic homeostasis.
Collapse
Affiliation(s)
- Jolanta Lis-Kuberka
- Division of Chemistry and Immunochemistry, Department of Biochemistry and Immunochemistry, Wroclaw Medical University, M. Skłodowskiej-Curie 48/50, 50-369 Wroclaw, Poland;
| | - Marta Berghausen-Mazur
- Department of Neonatology, J. Gromkowski Provincial Specialist Hospital, Koszarowa 5, 51-149 Wroclaw, Poland
- Faculty of Medicine, Wroclaw University of Science and Technology, Hoene-Wrońskiego 13c, 58-376 Wroclaw, Poland
| | - Magdalena Orczyk-Pawiłowicz
- Division of Chemistry and Immunochemistry, Department of Biochemistry and Immunochemistry, Wroclaw Medical University, M. Skłodowskiej-Curie 48/50, 50-369 Wroclaw, Poland;
| |
Collapse
|
7
|
Yang H, Xiao C, Tu J. The effect of gestational diabetes mellitus on pregnancy outcomes in advanced primiparous women: A retrospective study. Medicine (Baltimore) 2024; 103:e37570. [PMID: 38552062 PMCID: PMC10977535 DOI: 10.1097/md.0000000000037570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
Gestational diabetes mellitus (GDM) could have a variable degree of adverse effects on pregnancy outcomes for both pregnant women and newborns. The purpose of the study was to explore the effect of GDM on pregnancy outcomes in advanced primiparous women. A total of 1076 advanced primiparous women were included between January 2020 and December 2022. All these women were divided into the GDM group (n = 434) and the non-GDM group (n = 642). Variables included baseline characteristics, maternal, and newborn outcomes were collected. The risk of each adverse outcome was analyzed by multivariate logistic regression models. The effect of blood glucose control on pregnancy outcomes was further analyzed among GDM women with good glycaemic control (n = 381) and poor glycaemic control (n = 53). Analysis of baseline characteristics demonstrated a significant difference in prepregnancy body mass index (median, IQR: 22.27 [20.58-24.44] vs 21.17 [19.53-22.86], P < .01) between the GDM group and the non-GDM group. A significantly higher incidence rate of adverse pregnancy outcomes was found in advanced primiparous women with GDM, such as polyhydramniosis, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission (all P < .05). Compared with the non-GDM group, the risk of polyhydramniosis was nearly twice as high in the GDM group (adjusted odds ratio: 1.94, 95% confidence interval: 1.01-3.72, P = .04) after adjusted baseline characteristics. Among the GDM group, the women with poor glycaemic control showed a significantly higher incidence rate of polyhydramnios, hypertensive disorders of pregnancy, cesarean delivery, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission was significant than the women with good glycaemic control (all P < .05). GDM was an independent risk factor for polyhydramnios in advanced primiparous women. At the same time, good glycaemic control in diabetics advanced primiparous women could reduce adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Hong Yang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| | - Chanyun Xiao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| | - Jiahui Tu
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, P.R. China
| |
Collapse
|
8
|
Zeidan RS, McElroy T, Rathor L, Martenson MS, Lin Y, Mankowski RT. Sex differences in frailty among older adults. Exp Gerontol 2023; 184:112333. [PMID: 37993077 DOI: 10.1016/j.exger.2023.112333] [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: 08/21/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.
Collapse
Affiliation(s)
- Rola S Zeidan
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Taylor McElroy
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Laxmi Rathor
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Matthew S Martenson
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Yi Lin
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Robert T Mankowski
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| |
Collapse
|
9
|
Chen XQ, Zheng Q, Liao YP, Jiang XM, Gao XX, Pan YQ, Li J, Liu R. Association between plant-based or animal-based dietary pattern and plasma glucose during oral glucose tolerance test among Chinese women with gestational diabetes mellitus: a prospective cohort study. BMJ Open 2023; 13:e075484. [PMID: 37879688 PMCID: PMC10603417 DOI: 10.1136/bmjopen-2023-075484] [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: 05/10/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This study explored whether plant-based and animal-based dietary patterns are associated with plasma glucose levels during oral glucose tolerance test in women with gestational diabetes mellitus (GDM). DESIGN A prospective cohort study was conducted using a Food Frequency Questionnaire to collect dietary data. Dietary patterns were derived using principal component analysis. Multivariate logistic regression analysis was performed to explore the association between dietary patterns and plasma glucose levels. Stratified analyses were conducted according to maternal age, prepregnancy body mass index (BMI) and other confounders. SETTING AND PARTICIPANTS The study, conducted in January 2022 in two hospitals in Fujian, China, involved 424 women diagnosed with GDM using a 75 g 2-hour oral glucose tolerance test at 24-28 gestational weeks. RESULTS Six maternal dietary patterns (plant based and animal based) were identified. Participants with plant-based pattern had lower 2-hour plasma glucose levels than those with animal-based pattern (β=-0.314; 95% CI (-0.596 to -0.032)). After adjusting the regression model covariates, this significant association remained (β=-0.288; 95% CI (-0.568 to -0.008)) and appeared more pronounced in women aged 30 years or above and those with prepregnancy BMI<24 kg/m2. CONCLUSIONS Plant-based pattern is associated with lower plasma glucose levels in women with GDM, which is valuable information for dietary counselling and intervention.
Collapse
Affiliation(s)
- Xiao Qian Chen
- Nursing department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
- Nursing department, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Qingxiang Zheng
- Nursing department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
- Nursing department, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Yan Ping Liao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiu Min Jiang
- Nursing department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiao Xia Gao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yu-Qing Pan
- Nursing department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
- Nursing department, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - JiaNing Li
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - RuLin Liu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| |
Collapse
|
10
|
Dissassa HD, Tufa DG, Geleta LA, Dabalo YA, Oyato BT. Knowledge on gestational diabetes mellitus and associated factors among pregnant women attending antenatal care clinics of North Shewa zone public hospitals, Oromia region, Central Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e073339. [PMID: 37751960 PMCID: PMC10533783 DOI: 10.1136/bmjopen-2023-073339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Globally, the prevalence of gestational diabetes mellitus (GDM) is currently rising. Assessing GDM knowledge and taking various public health actions will help pregnant women know more about the condition, resulting in its prevention. OBJECTIVE To assess pregnant women's knowledge of GDM and associated factors at antenatal care clinics of public hospitals in the North Shewa zone, Oromia region, Central Ethiopia. DESIGN Cross-sectional study. SETTING Five public hospitals of North Shewa zone, Oromia regional state, Central Ethiopia. PARTICIPANTS A total of 417 pregnant women. METHODS A face-to-face interview was conducted. A 13-items tool was used to measure GDM knowledge. Multivariable binary logistic regression was fitted to identify factors associated with the knowledge of GDM. The adjusted OR (AOR) with 95% CI and a p<0.05 was used to determine statistical significance. RESULTS Overall, 48% (95% CI 43.4% to 52.8%) of pregnant women had sufficient knowledge about GDM. The level of sufficient knowledge for GDM risk factors, screening/treatment and its consequences were 48%, 54.4% and 99%, respectively. Age group 15-24 years (AOR 3.49, 95% CI 1.05 to 11.59), attending secondary and above education (AOR 4.27, 95% CI 1.29 to 14.070, women whose partners attended primary school (AOR 3.83, 95% CI 1.36 to 10.78), history of GDM (AOR 3.36, 95% CI 1.68 to 6.71), history of hypertension (AOR 2.42, 95% CI 1.21 to 4.84), receiving preconception care (AOR 3.02, 95% CI 1.74 to 5.22) and being multigravida (AOR 3.19, 95% CI 1.52 to 6.67) were factors significantly associated with sufficient knowledge about GDM. CONCLUSION Overall, more than half of pregnant women have insufficient knowledge about GDM. Significant association between GDM knowledge and women's age, women's and partners' educational status, preconception care, history of GDM and hypertension, and the number of pregnancies were detected. Therefore, to increase pregnant women's GDM knowledge, health education programmes in the community and healthcare facilities should target the identified factors.
Collapse
Affiliation(s)
- Hiwot Dejene Dissassa
- College of Health Sciences, Public Health Department, Salale University, Fitche, Ethiopia
| | - Derara Girma Tufa
- College of Health Sciences, Public Health Department, Salale University, Fitche, Ethiopia
| | - Leta Adugna Geleta
- College of Health Sciences, Public Health Department, Salale University, Fitche, Ethiopia
| | - Yohannes Amsalu Dabalo
- Salale University Comprehensive Specialized Hospital, Department of Surgery and Obstetrics, Salale University, Fitche, Ethiopia
| | - Befekadu Tesfaye Oyato
- College of Health Sciences, Department of Midwifery, Salale University, Fitche, Ethiopia
| |
Collapse
|
11
|
Li J, Yan J, Ma L, Huang Y, Zhu M, Jiang W. Effect of gestational diabetes mellitus on pregnancy outcomes among younger and older women and its additive interaction with advanced maternal age. Front Endocrinol (Lausanne) 2023; 14:1158969. [PMID: 37234802 PMCID: PMC10206299 DOI: 10.3389/fendo.2023.1158969] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Background The prevalence of gestational diabetes mellitus (GDM) and advanced maternal age (AMA, ≥ 35 years) has shown an increasing trend worldwide. This study aimed to evaluate the risk of pregnancy outcomes among younger (20-34 years) and older (≥ 35 years) women with GDM and further analyze the epidemiologic interaction of GDM and AMA on these outcomes. Methods This historical cohort study included 105 683 singleton pregnant women aged 20 years or older between January 2012 and December 2015 in China. Stratified by maternal age, the associations between GDM and pregnancy outcomes were analyzed by performing logistic regression. Epidemiologic interactions were assessed by using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) with their 95% confidence intervals (95%CIs). Results Among younger women, individuals with GDM had a higher risk of all maternal outcomes, preterm birth (relative risk [RR] 1.67, 95%CI 1.50-1.85), low birthweight (RR 1.24, 95%CI 1.09-1.41), large for gestational age (RR 1.51, 95%CI 1.40-1.63), macrosomia (RR 1.54, 95%CI 1.31-1.79), and fetal distress (RR 1.56, 95%CI 1.37-1.77) than those without GDM. Among older women, GDM increased the risk of gestational hypertension (RR 2.17, 95%CI 1.65-2.83), preeclampsia (RR 2.30, 95%CI 1.81-2.93), polyhydramnios (RR 3.46, 95%CI 2.01-5.96), cesarean delivery (RR 1.18, 95%CI 1.10-1.25), preterm birth (RR 1.35, 95%CI 1.14-1.60), large for gestational age (RR 1.40, 95%CI 1.23-1.60), macrosomia (RR 1.65, 95%CI 1.28-2.14) and fetal distress (RR 1.46, 95%CI 1.12-1.90). Additive interactions of GDM and AMA on polyhydramnios and preeclampsia were found, with RERI of 3.11 (95%CI 0.05-6.16) and 1.43 (95%CI 0.09-2.77), AP of 0.51 (95%CI 0.22-0.80) and 0.27 (95%CI 0.07-0.46), and SI of 2.59 (95%CI 1.17-5.77) and 1.49 (95%CI 1.07-2.07), respectively. Conclusion GDM is an independent risk factor for multiple adverse pregnancy outcomes, and may exert additive interactions with AMA on the risk of polyhydramnios and preeclampsia.
Collapse
Affiliation(s)
| | | | | | | | | | - Wu Jiang
- *Correspondence: Wu Jiang, ; Maoling Zhu,
| |
Collapse
|
12
|
HAWKINS M, FEGHALI M, ABEBE KZ, SCIFRES CM, LALAMA CM, COSTACOU T, CATALANO P, SIMHAN H, ORRIS S, MENDEZ D, BUYSSE DJ, DAVIS EM. Mid-pregnancy sleep disturbances are not associated with mid-pregnancy maternal glycemia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.21.23288767. [PMID: 37163085 PMCID: PMC10168493 DOI: 10.1101/2023.04.21.23288767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background In pregnancy, epidemiological data have consistently shown strong associations between sleep quality and duration and maternal glycemia. However, other sleep disturbances such as difficulty falling asleep and staying asleep are common in pregnancy. They may contribute to impaired maternal glycemia through sympathetic nervous system activity, systemic inflammation, and hormonal pathways. However, there is little research examining associations between these specific sleep disturbances and maternal glycemia. Objective This study aimed to investigate the associations of sleep disturbances during mid-pregnancy and mid-pregnancy maternal glycemia and gestational diabetes subtypes. Study Design This is a secondary data analysis of the Comparison of Two Screening Strategies for Gestational Diabetes trial. Participants (n = 828) self-reported the frequency of sleep disturbances (i.e., trouble falling asleep, trouble staying asleep, waking several times per night, and waking feeling tired or worn out) in mid-pregnancy. Gestational diabetes was diagnosed using either the International Associations of Diabetes and Pregnancy Study Groups or Carpenter-Coustan approach. We defined gestational diabetes subtypes based on the degree of insulin resistance and beta-cell dysfunction. We used multinomial logistic regression to examine associations of sleep disturbances with gestational diabetes status (i.e., normal, mild glycemic dysfunction, and gestational diabetes) and gestational diabetes subtypes (i.e., neither insulin resistance or beta-cell dysfunction, insulin resistance only, beta-cell dysfunction only, and insulin resistance and beta-cell dysfunction). Results A total of 665 participants (80%) had normal glycemia, 81 (10%) mild hyperglycemia, and 80 (10%) had gestational diabetes. Among participants with gestational diabetes, 62 (78%) had both insulin resistance and beta-cell dysfunction, 15 (19 %) had insulin resistance only, and 3 had beta-cell dysfunction only or neither insulin resistance nor beta-cell dysfunction. Sleep disturbance frequency was not associated with maternal glycemia or gestational diabetes subtypes. Conclusions Sleep disturbances in mid-pregnancy were not associated with maternal glycemia during mid-pregnancy. Future research should collect data on sleep disturbances at multiple time points in pregnancy and in combination with other sleep disturbances to determine whether sleep plays any role in maternal glycemic control.
Collapse
Affiliation(s)
- Marquis HAWKINS
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA
| | - Maisa FEGHALI
- University of Pittsburgh, Department of Obstetrics, Gynecology & Reproductive Sciences, Pittsburgh, PA
| | - Kaleab Z ABEBE
- University of Pittsburgh, Department of Medicine, Pittsburgh, PA
| | - Christina M. SCIFRES
- Indiana University School of Medicine, Department of Obstetrics and Gynecology, Indianapolis, IN
| | | | - Tina COSTACOU
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA
| | - Patrick CATALANO
- Tufts University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA
| | - Hyagriv SIMHAN
- University of Pittsburgh, Department of Obstetrics, Gynecology & Reproductive Sciences, Pittsburgh, PA
| | - Steve ORRIS
- University of Pittsburgh, Department of Medicine, Pittsburgh, PA
| | - Dara MENDEZ
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA
| | - Daniel J. BUYSSE
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA
| | - Esa M DAVIS
- University of Pittsburgh, Department of Medicine, Pittsburgh, PA
| |
Collapse
|
13
|
Akinyemi OA, Omokhodion OV, Fasokun ME, Makanjuola D, Ade-Ojo IP, Adeniyi AA. Screening for Gestational Diabetes Mellitus: Is There a Need for Early Screening for All Women in Developing Countries? Cureus 2023; 15:e35533. [PMID: 37007361 PMCID: PMC10054911 DOI: 10.7759/cureus.35533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with significant adverse pregnancy outcomes. Early diagnosis and treatment have been proven to reduce adverse pregnancy outcomes among women diagnosed with GDM. Current guidelines recommend routine screening for GDM at 24-28 weeks of pregnancy, with early screening offered to those considered high risk. However, risk stratification may not always be helpful for those who would benefit from early screening, especially in non-Western settings. AIM To determine the need for early screening for GDM among pregnant women attending antenatal clinics in two tertiary hospitals in Nigeria. METHODS We conducted a cross-sectional study from December 2016 to May 2017. We identified women who presented at the antenatal clinics of the Federal Teaching Hospital Ido-Ekiti and Ekiti State University Teaching Hospital, Ado Ekiti. A total of 270 women who fulfilled the study inclusion criteria were enrolled. The 75 g oral glucose tolerance test was used to screen participants for GDM before 24 weeks and between 24 and 28 weeks for those who screened negative before 24 weeks. Pearson's chi-square test, Fisher's exact test, independent t-test, and Mann-Whitney U test were utilized in the final analysis. RESULTS The median age of the women in the study was 30 (interquartile range: 27-32) years. Of our study participants, 40 (14.8%) were obese, 27 (10%) had a history of diabetes mellitus in a first-degree relative, and three (1.1%) women had a previous history of GDM. Twenty-one women (7.8%) were diagnosed with GDM, and six (28.6%) were diagnosed before 24 weeks. Women diagnosed with GDM before 24 weeks were older (37 years; interquartile range: 34-37) and more likely to be obese (80.0%). A significant number of these women also had identifiable risk factors for GDM: previous GDM (20.0%), family history of diabetes mellitus in a first-degree relative (80.0%), prior delivery of fetal macrosomia (60.0%), and previous history of congenital fetal anomaly (20.0%). CONCLUSION The findings from the present study did not justify universal screening for GDM in all pregnant women. Patients diagnosed before the 24-28 weeks of universal screening are more likely to have significant risk factors for GDM and, therefore, would have been selected for screening based on the risk factor screening.
Collapse
|
14
|
Ejaz Z, Azhar Khan A, Sebghat Ullah S, Aamir Hayat M, Maqbool MA, Amin Baig A. The Effects of Gestational Diabetes on Fetus: A Surveillance Study. Cureus 2023; 15:e35103. [PMID: 36938248 PMCID: PMC10023128 DOI: 10.7759/cureus.35103] [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: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Gestational diabetes is an intolerance to glucose diagnosed during pregnancy that goes away postpartum. Gestational diabetes may result in outcomes such as birth trauma, increased rates of cesarean sections, and macrosomia. This study aims to determine the outcomes of gestational diabetes mellitus (GDM) on maternal and fetal health in a tertiary care hospital setting. MATERIALS AND METHODS This is a retrospective study of 52 patients who presented with gestational diabetes mellitus (GDM) and were treated at Tentishev Satkynbai Memorial Asian Medical Institute, Kyrgyzstan, between April 2021 and January 2022. The information was taken from the medical records of the patients. The baby's age, the mother's body mass index (BMI), history of pregnancy, deaths, birth weight, and the number of births were all taken into account. RESULTS Out of all the cases during the study period at the Tentishev Satkynbai Memorial Asian Medical Institute, Kyrgyzstan, 52 were found to be complicated with gestational diabetes mellitus, which is 2.7% of the total deliveries. There was a significant difference found among both study groups in gestational age and history of GDM. The neonatal intensive care unit (NICU) admission rate of neonates born to GDM mothers was found to be significant with a difference of 10.9% (p < 0.0003), which is higher compared to the control group. CONCLUSION Incidences of macrosomia, NICU admissions of preterm babies, and large for gestational age (LGA) and increased rates of hypertensive disorders were found among GDM pregnancies compared to control cases. The study shows higher rates of maternal and fetal/neonatal complications in females with GDM.
Collapse
Affiliation(s)
- Zahra Ejaz
- Department of Gynecology and Obstetrics, Tentishev Satkynbai Memorial Asian Medical Institute, Kant, KGZ
| | - Ayesha Azhar Khan
- Department of Obstetrics and Gynecology, Arif Memorial Teaching Hospital, Rashid Latif Medical Complex, Lahore, PAK
| | | | - Muhammad Aamir Hayat
- Department of Public Health, Tentishev Satkynbai Memorial Asian Medical Institute, Kant, KGZ
| | - Muhammad Arslan Maqbool
- Department of Medicine, Arif Memorial Teaching Hospital, Rashid Latif Medical Complex, Lahore, PAK
| | - Asma Amin Baig
- Department of Obstetrics and Gynecology, Arif Memorial Teaching Hospital, Rashid Latif Medical Complex, Lahore, PAK
| |
Collapse
|
15
|
Bogdanet D, Castillo MT, Doheny H, Dervan L, Luque-Fernandez MA, Halperin JA, O’Shea PM, Dunne FP. The ability of pGCD59 to predict adverse pregnancy outcomes: a prospective study of non-diabetic pregnant women in Ireland. Acta Diabetol 2023; 60:211-223. [PMID: 36309618 PMCID: PMC9617525 DOI: 10.1007/s00592-022-01983-z] [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: 07/12/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023]
Abstract
AIM Even though most pregnancies are uneventful, occasionally complications do occur. Gestational diabetes is linked to an increased risk of adverse pregnancy outcomes. Early identification of women at risk of experiencing adverse outcomes, ideally through a single blood test, would facilitate early intervention. Plasma glycated CD59 (pGCD59) is an emerging biomarker which has shown promise in identifying hyperglycaemia during pregnancy and has been associated with the risk of delivering an LGA infant. The aim of this study was to explore the ability of the first- and second-trimester pGCD59 to predict adverse pregnancy outcomes. METHODS This was a prospective study of 378 pregnant women. Samples for pGCD59 were taken at the first antenatal visit and at the time of the 2 h 75 g OGTT (24-28 weeks of gestation). Adjusted receiver operating characteristic curves were used to evaluate the ability of pGCD59 to predict maternal and neonatal outcomes. RESULTS First-trimester pGCD59 levels were higher in women with gestational diabetes who delivered a macrosomic infant (4.2 ± 0.7 vs. 3.5 ± 1.0 SPU, p < 0.01) or an LGA infant (4.3 ± 0.3 vs. 3.6 ± 1.0 SPU, p = 0.01) compared to women with GDM that did not experience these outcomes. Second-trimester pGCD59 levels were higher in women that developed polyhydramnios (2.9 ± 0.4 vs. 2.5 ± 1.1 SPU, p = 0.03). First- and second-trimester pGCD59 predicted pregnancy-induced hypertension with good accuracy (AUC:0.85, 95%CI:0.78-0.91; AUC: 0.80, 95%CI: 0.73-0.88, respectively) and neonatal hypoglycaemia with fair to good accuracy (AUC:0.77, 95%CI: 0.54-0.99, AUC:0.81, 95%CI:0.62-0.99). CONCLUSIONS This study has shown that pGCD59 has the potential to predict adverse pregnancy outcomes. Prospective studies with a larger number of cases are necessary to fully explore and validate the potential of this emerging biomarker in predicting adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Delia Bogdanet
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
| | - Michelle Toth Castillo
- Divisions of Haematology, Brigham & Women’s Hospital, Harvard Medical School, Boston, USA
| | - Helen Doheny
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Louise Dervan
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
| | - Miguel Angel Luque-Fernandez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jose A. Halperin
- Divisions of Haematology, Brigham & Women’s Hospital, Harvard Medical School, Boston, USA
| | - Paula M. O’Shea
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Fidelma P. Dunne
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
| |
Collapse
|
16
|
Peng YQ, Qiu X, Wang L, Li X, Huo XY. Left atrial shortening fraction to predict fetal cardiac abnormalities and dysfunction in gestational diabetes mellitus. Front Cardiovasc Med 2022; 9:1026587. [PMID: 36588551 PMCID: PMC9800860 DOI: 10.3389/fcvm.2022.1026587] [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: 08/24/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the diagnostic efficiency of left atrial shortening fraction (LASF) in the detection of fetal cardiac abnormalities and dysfunction in patients with gestational diabetes mellitus (GDM). Methods In this study, we enrolled 256 pregnant women and divided them into GDM group (n = 156) and control group (n = 100). Fetal echocardiography was performed at 24-28 weeks of gestation to measure the LASF and interventricular septum (IVS) thickness. Based on IVS thickness, the GDM group was subdivided into the septal hypertrophy group (GDM I, n = 62) and non-septal hypertrophy group (GDM II, n = 94). LASF and IVS thickness were compared between the GDM and control groups and between GDM I and GDM II groups. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic accuracy of LASF in predicting septal hypertrophy. Results The GDM group had a larger IVS thickness (P < 0.05) but a lower LASF level (P < 0.001) than those of the control group. GDM I group had significantly lower LASF level than that in the GDM II group (P < 0.001). At 38.41% as the cutoff value, the LASF can predict septal hypertrophy with diagnostic sensitivity and specificity of 96.7% and 65.2%, respectively. Conclusion Fetal GDM are more likely to induce septal hypertrophy and ventricular dysfunction. LASF is a good indicator of septal hypertrophy or early diastolic dysfunction without septal hypertrophy.
Collapse
Affiliation(s)
- Yu-Qing Peng
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xuan Qiu
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Li Wang
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Xin Li
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,*Correspondence: Xin Li,
| | - Xiao-Yan Huo
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,Xiao-Yan Huo,
| |
Collapse
|
17
|
Atlaw D, Sahiledengle B, Assefa T, Negash W, Tahir A, Regasa T, Tekalegn Y, Mamo A, Enegeda ZT, Solomon D, Gezahegn H, Bekele K, Zenbaba D, Desta F, Tasew A, Nugusu F, Beressa G, Shiferaw Z, Feleke Z, Regassa Z, Duguma N, Chattu VK. Incidence and risk factors of gestational diabetes mellitus in Goba town, Southeast Ethiopia: a prospective cohort study. BMJ Open 2022; 12:e060694. [PMID: 36167396 PMCID: PMC9516079 DOI: 10.1136/bmjopen-2021-060694] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 09/02/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is becoming a public health concern in low/middle-income countries, and is known to cause severe morbidity and mortality for mothers and newborns. However, evidence reported for the incidence and risk factors of GDM is scant in Ethiopia. We aimed to assess the incidence of, and risk factors for, GDM in Goba town, Southeast Ethiopia. DESIGN Prospective cohort study. SETTING Goba town, Southeast Ethiopia. PARTICIPANTS Four hundred eighty pregnant women on antenatal care follow-up from 30 April to 30 September 2021. PRIMARY AND SECONDARY OUTCOMES Incidence and risk factors of GDM using fasting capillary blood glucose. Log-binomial model was used to identify the risk factors of GDM. Adjusted relative risk (aRR), along with 95% CIs, were calculated to estimate the strength of associations. RESULTS The cumulative incidence rate of GDM in this study was 15.7% (95% CI: 12.3% to 19.2%). Being unemployed (aRR=2.73; 95% CI: 1.36 to 5.47), having a family history of diabetes mellitus (DM) (3.01; 2.09 to 4.35), low physical activity (2.43; 1.11 to 5.32), inadequate dietary diversity (1.48; 1.29 to 1.92), anaemia (2.51; 1.32 to 3.54) and antenatal depression (4.95; 3.35 to 7.31) were significantly associated with GDM. CONCLUSION The cumulative incidence of GDM was relatively high among the study participants. Having antenatal depression symptoms, low physical activity, inadequate dietary diversity, being unemployed, anaemia and a family history of DM were significant risk factors for GDM.
Collapse
Affiliation(s)
- Daniel Atlaw
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Biniyam Sahiledengle
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Tesfaye Assefa
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Wogene Negash
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Anwar Tahir
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Tadele Regasa
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Yohannes Tekalegn
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Ayele Mamo
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Zinash Teferu Enegeda
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Damtew Solomon
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Habtamu Gezahegn
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Kebebe Bekele
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Demisu Zenbaba
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Fikreab Desta
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Alelign Tasew
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Fikadu Nugusu
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Girma Beressa
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
- Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Zerihun Shiferaw
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Zegeye Feleke
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Zegeye Regassa
- School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Negesso Duguma
- School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Oromia, Ethiopia
| | - Vijay Kumar Chattu
- Center for Transdisciplinary Research, Saveetha Medical College and Hospitals, SIMATS, Saveetha University, Chennai 600077, India
- Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences, Wardha 442107, India
- Department of OS& OT, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G1V7, Canada
| |
Collapse
|
18
|
Dias S, Willmer T, Adam S, Pheiffer C. The role of maternal DNA methylation in pregnancies complicated by gestational diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:982665. [PMID: 36992770 PMCID: PMC10012132 DOI: 10.3389/fcdhc.2022.982665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022]
Abstract
Diabetes in pregnancy is associated with adverse pregnancy outcomes and poses a serious threat to the health of mother and child. Although the pathophysiological mechanisms that underlie the association between maternal diabetes and pregnancy complications have not yet been elucidated, it has been suggested that the frequency and severity of pregnancy complications are linked to the degree of hyperglycemia. Epigenetic mechanisms reflect gene-environment interactions and have emerged as key players in metabolic adaptation to pregnancy and the development of complications. DNA methylation, the best characterized epigenetic mechanism, has been reported to be dysregulated during various pregnancy complications, including pre-eclampsia, hypertension, diabetes, early pregnancy loss and preterm birth. The identification of altered DNA methylation patterns may serve to elucidate the pathophysiological mechanisms that underlie the different types of maternal diabetes during pregnancy. This review aims to provide a summary of existing knowledge on DNA methylation patterns in pregnancies complicated by pregestational type 1 (T1DM) and type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). Four databases, CINAHL, Scopus, PubMed and Google Scholar, were searched for studies on DNA methylation profiling in pregnancies complicated with diabetes. A total of 1985 articles were identified, of which 32 met the inclusion criteria and are included in this review. All studies profiled DNA methylation during GDM or impaired glucose tolerance (IGT), while no studies investigated T1DM or T2DM. We highlight the increased methylation of two genes, Hypoxia‐inducible Factor‐3α (HIF3α) and Peroxisome Proliferator-activated Receptor Gamma-coactivator-Alpha (PGC1-α), and the decreased methylation of one gene, Peroxisome Proliferator Activated Receptor Alpha (PPARα), in women with GDM compared to pregnant women with normoglycemia that were consistently methylated across diverse populations with varying pregnancy durations, and using different diagnostic criteria, methodologies and biological sources. These findings support the candidacy of these three differentially methylated genes as biomarkers for GDM. Furthermore, these genes may provide insight into the pathways that are epigenetically influenced during maternal diabetes and which should be prioritized and replicated in longitudinal studies and in larger populations to ensure their clinical applicability. Finally, we discuss the challenges and limitations of DNA methylation analysis, and the need for DNA methylation profiling to be conducted in different types of maternal diabetes in pregnancy.
Collapse
Affiliation(s)
- Stephanie Dias
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Tarryn Willmer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sumaiya Adam
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Diabetes Research Center, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Carmen Pheiffer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
19
|
Böhme Kristensen C, Ide M, Forbes A, Asimakopoulou K. Psychologically informed oral health interventions in pregnancy and type 2 diabetes: a scoping review protocol. BMJ Open 2022; 12:e062591. [PMID: 36123100 PMCID: PMC9486353 DOI: 10.1136/bmjopen-2022-062591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Periodontal health is becoming a recognised component in managing gestational diabetes. Gestational diabetes is characterised as raised blood glucose levels first discovered in pregnancy and managed similarly to type 2 diabetes. Currently, the standard intervention for gestational diabetes in the UK entails dietary modifications and physical activity interventions. However, considering the literature discussed in this review, it is argued that oral health advice and support should also become an integrated part of gestational diabetes management. OBJECTIVE The objective of this scoping review is to map out psychologically informed oral health interventions in pregnancy and type 2 diabetes. This will inform the development of a new behavioural intervention to promote oral health-related behaviours in women with gestational diabetes. As no literature exists on oral health interventions in gestational diabetes, it was deemed appropriate to synthesise the evidence on oral health interventions designed for pregnant women and individuals with type 2 diabetes. METHODOLOGY The scoping review will be conducted using the Joanna Briggs Institute's methodology for scoping reviews. Studies including pregnant women and individuals with type 2 diabetes over 18 years of age will be included. Only studies including a psychologically informed oral health intervention will be considered. The authors will consider experimental and quasi-experimental research designs. The Ovid Interface including EMBASE, Medline, Global Health, APA PsychInfo, Health Management Information, Maternity, Infant Care Database and the Cochrane Library will be used as information sources. The planned searches will commence on the week of the 25 July 2022. Only articles in Danish and English will be considered. The study selection will follow the Preferred Reporting Items for Scoping Reviews process. The data will be presented using narrative synthesis. ETHICS AND DISSEMINATION No ethical approval is needed for this review. The results will be published in a relevant scientific journal.
Collapse
Affiliation(s)
| | - Mark Ide
- Centre for Host-Microbiome Interactions, King's College London, London, UK
| | - Angus Forbes
- Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | |
Collapse
|
20
|
Thiele GA, Ryan DM, Oberlander TF, Hanley GE. Preconception mental health and the relationship between antenatal depression or anxiety and gestational diabetes mellitus: a population-based cohort study. BMC Pregnancy Childbirth 2022; 22:670. [PMID: 36045319 PMCID: PMC9429302 DOI: 10.1186/s12884-022-05002-5] [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: 05/18/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Background Antenatal depression and anxiety are highly prevalent conditions that have been associated with increased risk for myriad adverse outcomes. Current literature exploring the connection between antenatal mental health and gestational diabetes mellitus (GDM) is limited, presenting conflicting evidence. We sought to evaluate the association between antenatal depression/anxiety (DEP-ANX) and GDM using population-based, administrative data, accounting for aspects of preconception mental health. Methods In this population-based retrospective cohort study, we included all singleton births in British Columbia, Canada from April 1, 2000, to December 31, 2014. We identified instances of DEP-ANX from outpatient and inpatient records that included relevant diagnostic codes and stratified our cohort by preconception DEP-ANX persistence. Logistic regression models were run to estimate odds of GDM given antenatal DEP-ANX. Models were adjusted for the birthing person’s socio-demographics and pregnancy characteristics. Using an expanded cohort, we ran conditional logistic regression models that matched birthing people to themselves (in a subsequent pregnancy) based on discordance of exposure and outcome. Results Out of the 228,144 births included in this study, 43,664 (19.1%) were to birthing people with antenatal health service use for DEP-ANX. There were 4,180 (9.6%) cases of GDM among those antenatal exposure to DEP-ANX compared to 15,102 (8.2%) among those without exposure (SMD 0.049). We observed an unadjusted odds ratio (OR) of 1.19 (95% CI: 1.15 – 1.23) and fully adjusted OR of 1.15 (95% CI: 1.11 – 1.19) overall. Apparent risk for GDM given antenatal DEP-ANX was highest among the no DEP-ANX history stratum, with a fully adjusted OR of 1.24 (95% CI: 1.15 – 1.34). Associations estimated by matched sibling analysis were non-significant (fully adjusted OR 1.19 [95% CI: 0.86 – 1.63]). Conclusions Results from this population-based study suggest an association between antenatal DEP-ANX and GDM that varied based on mental health history. Our analysis could suggest that incident cases of DEP-ANX within pregnancy are more closely associated with GDM compared to recurring or chronic cases. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05002-5.
Collapse
|
21
|
Simard C, Gerstein L, Cafaro T, Filion KB, Douros A, Malhamé I, Tagalakis V. Bleeding in women with venous thromboembolism during pregnancy: A systematic review of the literature. Res Pract Thromb Haemost 2022; 6:e12801. [PMID: 36051542 PMCID: PMC9424506 DOI: 10.1002/rth2.12801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Venous thromboembolism (VTE) represents an important cause of maternal morbidity and mortality. Estimates of bleeding associated with therapeutic-dose anticoagulation are variable. We describe the frequency of bleeding in pregnant women receiving therapeutic anticoagulation for VTE by means of a systematic review of the literature. Data Sources Medical Literature Analysis and Retrieval System, Embase, Scopus, Web of Science, and ClinicalTrials.gov were searched. Databases were searched from inception to February 27, 2022. There was no language or geographic location restriction. Methods of Study Selection The search yielded 2773 articles with 2212 unique citations. Studies were included if they described pregnant women treated for an acute VTE with therapeutic-dose anticoagulation and a defined bleeding outcome was reported. Tabulation Integration and Results Five studies met inclusion criteria. Included studies were judged to have a serious to critical risk of bias using the Risk of Bias in Nonrandomized Studies of Intervention tool. The rate of bleeding, as defined by respective studies, ranged between 2.9% and 30.0%. Two studies included control groups, one of which found no significant difference in the risk of bleeding between groups, while the other found a significantly increased bleeding risk associated with therapeutic anticoagulation. Conclusion Among pregnant women anticoagulated for VTE, the reported bleeding risk is variable. The ability to draw definite conclusions is limited by the scarcity and low quality of the studies, the small number of included patients, and the heterogeneity of bleeding definitions used. Large-scale studies with standardized bleeding definitions are required to provide acute bleeding estimates and optimize the care of these patients. Systematic Review Registration PROSPERO, CRD42021276771.
Collapse
Affiliation(s)
- Camille Simard
- Division of General Internal MedicineDepartment of MedicineJewish General HospitalMcGill UniversityMontrealQuebecCanada
| | | | - Teresa Cafaro
- Division of General Internal MedicineDepartment of MedicineJewish General HospitalMcGill UniversityMontrealQuebecCanada
| | - Kris B. Filion
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical ResearchJewish General HospitalMontrealQuebecCanada
| | - Antonios Douros
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical ResearchJewish General HospitalMontrealQuebecCanada
| | - Isabelle Malhamé
- Division of General Internal MedicineDepartment of MedicineMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
- Research Institute of the McGill University Health CentreMontrealQuebecCanada
| | - Vicky Tagalakis
- Division of General Internal MedicineDepartment of MedicineJewish General HospitalMcGill UniversityMontrealQuebecCanada
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical ResearchJewish General HospitalMontrealQuebecCanada
| | | |
Collapse
|
22
|
Tehrani FR, Naz MSG, Bidhendi-Yarandi R, Behboudi-Gandevani S. Effect of Different Types of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Neonatal Outcomes: A Systematic Review, Meta-Analysis, and Meta-Regression. Diabetes Metab J 2022; 46:605-619. [PMID: 35255550 PMCID: PMC9353558 DOI: 10.4093/dmj.2021.0178] [Citation(s) in RCA: 4] [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: 07/31/2021] [Accepted: 10/02/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Evidence supporting various diagnostic criteria for diagnose gestational diabetes mellitus (GDM) are consensus-based, needs for additional evidence related to outcomes. Therefore, the aim of this systematic-review and meta-analysis was to assess the impact of different GDM diagnostic-criteria on the risk of adverse-neonatal-outcomes. METHODS Electronic databases including Scopus, PubMed, and Web of Sciences were searched to retrieve English original, population-based studies with the universal GDM screening approach, up to January-2020. GDM diagnostic criteria were classified in seven groups and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) was considered as reference one. We used the Mantel-Haenszel method to calculate the pooled odds of events. The possibility of publication bias was examined by Begg's test. RESULTS A total of 55 population-based studies consisting of 1,604,391 pregnant women with GDM and 7,770,855 non-GDM counterparts were included. Results showed that in all diagnostic-criteria subgroups, the risk of adverse neonatal outcomes including macrosomia, hyperbilirubinemia, respiratory distress syndrome, neonatal hypoglycemia, neonatal intensive care unit admission, preterm birth, and birth-trauma were significantly higher than the non-GDM counterparts were significantly higher than non-GDM counterparts. Meta-regression analysis revealed that the magnitude of neonatal risks in all diagnostic-criteria subgroups are similar. CONCLUSION Our results showed that the risk of adverse-neonatal-outcome increased among women with GDM, but the magnitude of risk was not different among those women who were diagnosed through more or less intensive strategies. These findings may help health-care-providers and policy-makers to select the most cost-effective approach for the screening of GDM among pregnant women.
Collapse
Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | | |
Collapse
|
23
|
Parveen N, Hassan SUN, Zahra A, Iqbal N, Batool A. Early-Onset of Gestational Diabetes vs. Late-Onset: Can We Revamp Pregnancy Outcomes? IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:1030-1039. [PMID: 36407740 PMCID: PMC9643226 DOI: 10.18502/ijph.v51i5.9418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/06/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND We assessed risk factors, antenatal and intrapartum complications associated with early-onset Gestational diabetes mellitus (GDM) in comparison with late-onset GDM. METHODS This retrospective study included 161 GDM women having singleton pregnancies, without previous medical disorder and delivered at a tertiary care Hospital in Ha'il City, KSA from Dec 2020 till Jun 2021. Women diagnosed at < 24 weeks of pregnancy were grouped as early-onset GDM (n=71) and those diagnosed at ≥ 24 weeks as late-onset GDM (n=90). Both groups were matched for background variables. Chi-square and binary logistic regression analysis were applied with P-value significance at 0.05. RESULTS Past history of GDM, macrosomia and stillbirth were significant predictors for early-onset GDM (P value 0.000, 0.002 and 0.040 respectively). Regression analysis showed early-onset GDM significantly increases the risk for recurrent urinary tract infections (AOR 2.35), polyhydramnios (AOR 2.81), reduced fetal movements (AOR 2.13), intrauterine fetal demise (AOR 8.06), macrosomia (AOR 2.16), fetal birth trauma (2.58), low APGAR score at birth (AOR 8.06), and neonatal ICU admissions (AOR 2.65). Rate of preterm birth, hypertensive disorders, labor onset (natural vs. induced) and cesarean section and intrapartum maternal complications were same in both groups. CONCLUSION Early-onset GDM significantly increases certain maternal (recurrent urinary tract infections, polyhydramnios and reduced fetal movements) and fetal complications (intrauterine fetal demise, macrosomia fetal birth trauma, low APGAR score at birth and neonatal ICU admissions). Most of these adverse pregnancy outcomes can be prevented through early registration and screening, close follow up, growth ultrasounds, and provision of efficient emergency and neonatal care services.
Collapse
Affiliation(s)
- Nuzhat Parveen
- Department of Obstetrics and Gynecology, College of Medicine, University of Ha’il, Ha’il-81451, Saudi Arabia
| | - Sehar-un-Nisa Hassan
- Department of Public Health, College of Public Health and Health Informatics, University of Ha’il, Ha’il-81451, Saudi Arabia
| | - Aqeela Zahra
- Department of Family and Community Medicine, College of Medicine, University of Ha’il, Ha’il-81451, Saudi Arabia
| | - Naveed Iqbal
- Department of Obstetrics and Gynecology, College of Medicine, University of Ha’il, Ha’il-81451, Saudi Arabia
| | - Asma Batool
- Maternity and Children Hospital Ha’il, Ha’il, Saudi Arabia
| |
Collapse
|
24
|
Frank RW, Rodrigues DE, Kaipangala R, Leena KC, Cunha PD. Glycemic Status and Maternal Outcome among Women with Gestational Diabetes Mellitus. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1744358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Introduction Maternal gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. GDM can adversely affect the short- and long-term health of mothers and their newborns.
Aim This study aims to determine the association between maternal glycemic parameters with adverse maternal outcomes and baseline characteristics among women with GDM.
Settings and Design Observational, prospective study.
Materials and Methods Sixty-six pregnant women visiting outpatient department of a parent hospital who were diagnosed with GDM by an obstetrician were included in the study. Glycemic parameters were documented at the time of diagnosis (at 24 weeks of pregnancy). The maternal outcomes were studied after 24 hours of delivery.
Results The mean age of the women was 29.05 ± 3.98 years and 36.4% of the women were primipara. Among 66 women, 47% had a family history of diabetes mellitus, and that 48.28% of them belonged to first-degree relatives. Body mass index indicated in prepregnancy status 39.4% of them were overweight. In glycemic parameters, 63.6 and 93.9% of the women had increased fasting blood sugar and postprandial blood sugar values, respectively. Hemoglobin A1c (HbA1c) was elevated in 45.5% of the women. The maternal outcome showed that 30.30% of the women underwent cesarean section, 18.18% had preeclampsia, and 15.16% of them had increased weight gain (>11kg). There was a significant association between HbA1c and preeclampsia, p = 0.044.
Conclusions The study reiterates that GDM has a poor maternal outcome, the mother is at risk to develop preeclampsia, increased maternal weight gain, and interference of cesarean section is more.
Clinical Significance During the antenatal period among GDM mothers' glycemic control is very essential. Any variation in the glycemic parameters of the mother will lead to poor maternal outcomes.
Collapse
Affiliation(s)
- Reena Wilma Frank
- Department of OBG Nursing, Yenepoya Deemed to be University, Mangaluru, Karnataka, India
| | - Devina E. Rodrigues
- Department of Community Health Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
| | - Rajagopal Kaipangala
- Department of Obstetrics and Gynaecology, Srinivas Institute of Medical Science and Research Center, Mangaluru, Karnataka, India
| | - Kunnath Chacko Leena
- Yenepoya College of Nursing, Yenepoya Deemed to be University, Deralakatte, Mangaluru, Karnataka, India
| | - Prema D. Cunha
- Department of Obstetrics and Gynaecology, Srinivas Institute of Medical Science and Research Center, Mangaluru, Karnataka, India
| |
Collapse
|
25
|
Saei Ghare Naz M, Sheidaei A, Aflatounian A, Azizi F, Ramezani Tehrani F. Does Adding Adverse Pregnancy Outcomes Improve the Framingham Cardiovascular Risk Score in Women? Data from the Tehran Lipid and Glucose Study. J Am Heart Assoc 2022; 11:e022349. [PMID: 35016530 PMCID: PMC9238524 DOI: 10.1161/jaha.121.022349] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022]
Abstract
Background Limited and conflicting evidence is available regarding the predictive value of adding adverse pregnancy outcomes (APOs) to established cardiovascular disease (CVD) risk factors. Hence, the objective of this study was to determine whether adding APOs to the Framingham risk score improves the prediction of CVD events in women. Methods and Results Out of 5413 women who participated in the Tehran Lipid and Glucose Study, 4013 women met the eligibility criteria included for the present study. The exposure and the outcome variables were collected based on the standard protocol. Cox proportional hazard model was used to evaluate the association of APOs and CVDs. The variant of C-statistic for survivals and reclassification of subjects into Framingham risk score categories after adding APOs was reported. Out of the 4013 eligible subjects, a total of 1484 (36.98%) women reported 1 APO, while 395 (9.84%) of the cases reported multiple APOs. Univariate proportional hazard Cox models showed the significant relations between CVD events and APOs. The enhanced model had a higher C-statistic indicating more acceptable discrimination as well as a slight improvement in discrimination (C-statistic differences: 0.0053). Moreover, we observed a greater risk of experiencing a CVD event in women with a history of multiple APOs compared with cases with only 1 APO (1 APO: hazard ratio [HR] = 1.22; 2 APOs: HR; 1.94; ≥3 APOs: HR = 2.48). Conclusions Beyond the established risk factors, re-estimated CVDs risk by adding APOs to the Framingham risk score may improve the accurate risk estimation of CVD. Further observational studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Ali Sheidaei
- Reproductive Endocrinology Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Ali Aflatounian
- Reproductive Endocrinology Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
- Fertility and Research Centre, School of Women’s & Children’s HealthUniversity of New South Wales SydneyNSWAustralia
| | - Fereidoun Azizi
- Endocrine Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| |
Collapse
|
26
|
Phaloprakarn C, Tangjitgamol S. Glucose levels during gestational diabetes pregnancy and the risk of developing postpartum diabetes or prediabetes. BMC Pregnancy Childbirth 2022; 22:22. [PMID: 34996380 PMCID: PMC8742366 DOI: 10.1186/s12884-021-04352-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Blood glucose levels during pregnancy may reflect the severity of insulin secretory defects and/or insulin resistance during gestational diabetes mellitus (GDM) pregnancy. We hypothesized that suboptimal glycemic control in women with GDM could increase the risk of postpartum type 2 diabetes mellitus (T2DM) or prediabetes. Our objective was to evaluate the impact of plasma glucose levels throughout GDM pregnancy on the risk of postpartum T2DM or prediabetes. METHODS The medical records of 706 women with GDM who underwent a postpartum 75-g, 2-hour oral glucose tolerance test at our institution between January 2011 and December 2018 were reviewed. These women were classified into 2 groups according to glycemic control during pregnancy: ≤ 1 occasion of either fasting glucose ≥ 95 mg/dL or 2-hour postprandial glucose ≥ 120 mg/dL was defined as optimal glycemic control or else was classified as suboptimal glycemic control. Rates of postpartum T2DM and prediabetes were compared between women with optimal (n = 505) and suboptimal (n = 201) glycemic control. RESULTS The rates of postpartum T2DM and prediabetes were significantly higher in the suboptimal glycemic control group than in the optimal glycemic control group: 22.4% vs. 3.0%, P < 0.001 for T2DM and 45.3% vs. 23.5%, P < 0.001 for prediabetes. In a multivariate analysis, suboptimal glucose control during pregnancy was an independent risk factor for developing either postpartum T2DM or prediabetes. The adjusted odds ratios were 8.4 (95% confidence interval, 3.5-20.3) for T2DM and 3.9 (95% confidence interval, 2.5-6.1) for prediabetes. CONCLUSION Our findings suggest that blood glucose levels during GDM pregnancy have an impact on the risk of postpartum T2DM and prediabetes.
Collapse
Affiliation(s)
- Chadakarn Phaloprakarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand.
| | - Siriwan Tangjitgamol
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
| |
Collapse
|
27
|
Lee J, Eley VA, Wyssusek KH, Kimble RMN, Way M, van Zundert AA. Rotational thromboelastometry (ROTEM ® ) in gestational diabetes mellitus and coagulation in healthy term pregnancy: A prospective observational study in Australia. Aust N Z J Obstet Gynaecol 2022; 62:389-394. [PMID: 34994402 DOI: 10.1111/ajo.13474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rotational thromboelastometry (ROTEM® ) is a point-of-care test of coagulation. ROTEM® -defined hypercoagulability has been identified in pregnant women and in non-pregnant patients with diabetes mellitus. Pregnancy is known to be a hypercoagulable state, but the influence of gestational diabetes mellitus (GDM) on coagulation is unknown. AIM The aim of this study was to assess the combined effect of pregnancy and GDM on coagulation using ROTEM® and to compare this to healthy pregnant women presenting for elective caesarean delivery. MATERIALS AND METHODS Ethics approval was granted for recruitment of women presenting for elective caesarean delivery. Women with pre-existing conditions affecting coagulation were excluded. Group N included health pregnant women at term and Group G included pregnant women at term with GDM. Data regarding GDM management and glycaemic control were collected. Poor glycaemic control was defined by markers of accelerated fetal growth and elevated fasting or postprandial blood glucose levels. The ROTEM® parameters (extrinsically activated thromboelastometric test (EXTEM) / fibrin polymerisation test (FIBTEM) amplitude at five minutes, coagulation time, maximum clot firmness and clot formation time) were compared between the two groups using Student's t-test. RESULTS There were 75 women in Group N and 21 women in Group G. Mean age and median body mass index values were comparable for both groups. There were no statistical differences found between the EXTEM and FIBTEM parameters analysed for the two groups. CONCLUSIONS There was no association between GDM and increased hypercoagulability as demonstrated by ROTEM® parameters in healthy pregnant women presenting for elective caesarean delivery at term.
Collapse
Affiliation(s)
- Julie Lee
- Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Victoria A Eley
- Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Kerstin H Wyssusek
- Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca M N Kimble
- The University of Queensland, Brisbane, Queensland, Australia.,Department of Obstetrics, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mandy Way
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andre A van Zundert
- Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
28
|
Elamin AA, Mohammed Ahmed MN, El Elhaj A, Ahmed Hussien TM, Abdelrahman Mohamed AA, Mohamed H, Idris SA. Vicissitudes in the Placental Cotyledon Number in a Singleton Pregnancy with Gestational Diabetes. Int J Appl Basic Med Res 2022; 12:24-29. [PMID: 35265477 PMCID: PMC8848564 DOI: 10.4103/ijabmr.ijabmr_230_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/29/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022] Open
Abstract
Background Placenta is a transient organ during pregnancy, connects the fetus to the uterine wall. Pregnancy is frequently complicated by gestational diabetes, which might cause morphological changes in the placenta (weight, diameter, and cotyledons number); consequently, it may affect both fetus and mother. Aim The aim of this study was to determine the difference in placental cotyledons number between pregnant with gestational diabetes versus without gestational diabetes, then correlate it with the weight and diameter between groups. Materials and Methods A comparative study (gestational diabetes Group A and nongestational diabetes Group B) included mothers with a singleton baby delivered at term (37-40 weeks) after acceptance of the informed consent. Women with pregestational diabetes and other chronic diseases and those with intrauterine fetal death were excluded. Postdelivery placentae were accurately prepared and examined in detail. The placental weight, diameter, and cotyledons number were recorded and analyzed by SPSS version 21. The correlation was measured between the two groups in terms of cotyledons count, placental diameter, and weight. Results The study included 385 participants (128 Group A and 257 Group B). Placental number of cotyledons, weight, and diameter in Group A were higher than in Group B, and the difference was significant (P = 0.000, P = 0.021, and P = 0.000, respectively). In Group A, there was a significant correlation between the placental weight, diameter, and number of its cotyledons (r = 0.23, P = 0.011). Cotyledon count was significantly affected by diabetic control (P = 0.021). Conclusions Gestational diabetes increases placental cotyledons number, weight, and diameter.
Collapse
Affiliation(s)
- Abdalla Ahmed Elamin
- Department of Anatomy, College of Medicine, University of Hai'l, Hail, Saudi Arabia
| | | | - Abubaker El Elhaj
- Department of Anatomy, College of Medicine, University of Hai'l, Hail, Saudi Arabia
| | | | | | - Hamza Mohamed
- Department of Obstetrics and Gynecology, College of Medicine, University of Hai'l, Hail, Saudi Arabia
| | - Saadeldin Ahmed Idris
- Department of Surgery, College of Medicine, University of Hai'l, Hail, Saudi Arabia
- Department of Surgery, Faculty of Medicine, Alzaiem Alazhari University, Khartoum North, Sudan
| |
Collapse
|
29
|
Song Z, Cheng Y, Li T, Fan Y, Zhang Q, Cheng H. Effects of obesity indices/GDM on the pregnancy outcomes in Chinese women: A retrospective cohort study. Front Endocrinol (Lausanne) 2022; 13:1029978. [PMID: 36465635 PMCID: PMC9715614 DOI: 10.3389/fendo.2022.1029978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze pregnancy complications and outcomes of mothers with obesity or gestational diabetes mellitus (GDM). METHODS 15065 mothers were categorized into four and three groups by pre-pregnancy body mass index (preBMI) and abdominal circumference (AC), respectively, or divided into GDM or non-GDM groups. Logistic regression analysis was utilized to identify independent factors associated with pregnancy complications and outcomes. RESULTS The overweight and obesity groups accounted for 16.0% and 4.0% of the total population, respectively. GDM incidence rate was 12.3%. The overweight and obesity groups (pre-pregnancy body mass index [preBMI] ≥ 24 kg/m2) were at higher risks for GDM, hypertensive disorders of pregnancy (HDP), gestational proteinuria, postpartum hemorrhage, preterm delivery, fetal malformation or stillbirth, neonatal asphyxia, large for gestational age (LGA), shoulder dystocia, and increased cesarean section rate. Similar results were obtained with AC grouping. GDM pregnant women had higher risks of HDP, preterm delivery, small for gestational age (SGA), LGA, and increased cesarean section rate. CONCLUSION People with obesity had a higher risk of adverse pregnancy outcomes. The recommended preBMI is 19.2-22.7 kg/m2. The recommended AC at 11-13+6 gestational weeks is 74.0-84.0 cm, and that value in normal preBMI is 74.0-82.0 cm.
Collapse
Affiliation(s)
- Zhimin Song
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yan Cheng
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Tingting Li
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yongfang Fan
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qingying Zhang
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- *Correspondence: Haidong Cheng, ; Qingying Zhang,
| | - Haidong Cheng
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- *Correspondence: Haidong Cheng, ; Qingying Zhang,
| |
Collapse
|
30
|
Allehdan S, Basha A, Hyassat D, Nabhan M, Qasrawi H, Tayyem R. Effectiveness of carbohydrate counting and Dietary Approach to Stop Hypertension dietary intervention on managing Gestational Diabetes Mellitus among pregnant women who used metformin: A randomized controlled clinical trial. Clin Nutr 2021; 41:384-395. [PMID: 34999333 DOI: 10.1016/j.clnu.2021.11.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy that has significant impacts on both mother and her offspring health. The present study aimed to examine the effect of carbohydrate counting, carbohydrate counting combined with DASH, and control dietary interventions on glycemic control, and maternal and neonatal outcomes. METHODS A total of 75 pregnant women with GDM at 24th - 30th week of gestation were enrolled and randomized to follow one of the three diets: control or carbohydrate counting, or carbohydrate counting combined with Dietary Approach to Stop Hypertension (DASH). Only 70 of them completed the study until delivery. Fasting blood samples were taken at baseline and the end of the study to measure fasting blood glucose (FBG), fasting insulin, glycated hemoglobin (HbA1c), and fructosamine. Homeostatic model assessment-insulin resistance (HOMA-IR) score was calculated using HOMA2 calculator program. The participants recorded at least four blood glucose readings per day. Maternal and neonatal outcomes were collected from medical records. Dietary intake was assessed by three-day food records at the baseline and the end of the study. RESULTS Adherence to the three dietary interventions, resulted in decreased FBG levels significantly among all the participants (P < 0.05). Consumption of the carbohydrate counting combined with the DASH diet showed significant reduction in serum insulin levels and HOMA-IR score compared to carbohydrate counting group and control group. Means of fructosamine and HbA1c did not differ significantly among the three intervention diet groups. Overall mean of 1-h postprandial glucose (1 h PG) level was significantly lower in the carbohydrate counting combined with DASH group compared with that in the carbohydrate counting group and the control group (P < 0.001). The number of women who were required to commence insulin therapy after dietary intervention was significantly lower in carbohydrate counting group and carbohydrate counting combined with DASH group (P = 0.026). There were no significant differences in other maternal and neonatal outcomes among the three dietary intervention groups. CONCLUSIONS The carbohydrate counting and the carbohydrate counting combined with DASH dietary interventions resulted in beneficial effects on FBG and 1 h PG compared with the control diet. The three dietary interventions produced similar maternal and neonatal outcomes in women with GDM. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov under the identification code: NCT03244579. https://clinicaltrials.gov/ct2/show/NCT03244579.
Collapse
Affiliation(s)
- Sabika Allehdan
- Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman 11942, Jordan; Department of Biology, College of Science, University of Bahrain. Zallaq, Sakhir Campus 32038, Bahrain.
| | - Asma Basha
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | - Dana Hyassat
- The National Centre for Diabetes Endocrinology and Genetics, Amman, Jordan.
| | - Mohammed Nabhan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | - Husam Qasrawi
- Department of Obstetrics and Gynaecology, Al-Bashir Hospital Amman, Jordan.
| | - Reema Tayyem
- Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman 11942, Jordan; Department of Human Nutrition, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| |
Collapse
|
31
|
Nabi T, Rafiq N, Trigotra S, Mishra S. Clinical Characteristics, Outcomes, and Progression to Type 2 Diabetes in Women with Hyperglycemia in Pregnancy. Indian J Endocrinol Metab 2021; 25:538-544. [PMID: 35355915 PMCID: PMC8959204 DOI: 10.4103/ijem.ijem_440_21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022] Open
Abstract
CONTEXT Women with hyperglycemia in pregnancy (HIP) are at increased risk of developing type 2 diabetes (T2D). AIM The present study intended to study the incidence of postpartum diabetes among HIP women and predict its risk factors. SETTINGS AND DESIGN This was a prospective observational study done on 178 women with HIP diagnosed after the first trimester, attending the tertiary care hospitals between December 2018 and March 2020. MATERIALS AND METHODS Demographics, clinical variables, and feto-maternal outcomes were recorded. The postpartum glycemic status was determined using a 75 g oral glucose tolerance test (OGTT) at 1 and 6 months. STATISTICAL ANALYSIS All analyses were performed with SPSS software (version 21.0). RESULTS The mean age of women with HIP was 30.2 ± 6.1 years, with 38% having a family history of diabetes. Eighty percent of the women delivered full-term babies and 71.3% underwent a cesarean section. Gestational hypertension was present in 21.9% of patients. Macrosomia was present in 4.6% of the babies, hypoglycemia in 6.7%, and spontaneous abortion occurred in 7.7%. Postpartum OGTT at 6 months was completed by 76.4% of participants. The incidence of diabetes and glucose intolerance postpartum was 11.7 and 16.2%, respectively at 6 months. Logistic regression analysis showed that maternal obesity, diagnosis of HIP at an earlier trimester (<24 weeks), need for insulin treatment during pregnancy, signs of insulin resistance and fasting and 2-h plasma glucose >100 (>5.6 mmol/L) and >195 mg/dL (>10.9 mmol/L), respectively, and glycated hemoglobin > 6.5% (>48 mmol/mol) increased the risk of having postpartum diabetes significantly. CONCLUSION The incidence of postpartum glucose intolerance in women with HIP is high. Prospective diabetes evaluation is required and intervention should be considered in women with HIP who have obesity, diagnosis of HIP at an earlier trimester, signs of insulin resistance, and require insulin treatment during pregnancy.
Collapse
Affiliation(s)
- Tauseef Nabi
- Department of Endocrinology, All is Well Multi Speciality Hospital, Burhanpur, Madhya Pradesh, India
| | - Nadeema Rafiq
- Department of Physiology, Govt. Medical College Baramulla, Jammu and Kashmir, India
| | - Suchet Trigotra
- Department of Physiology, Dr. B. R. Ambedkar State Institute of Medical Sciences, Mohali, Punjab, India
| | - Smriti Mishra
- Department of Gynaecology and Obstetrics, All is Well Multi Speciality Hospital, Burhanpur, Madhya Pradesh, India
| |
Collapse
|
32
|
Single Nucleotide Polymorphisms from CSF2, FLT1, TFPI and TLR9 Genes Are Associated with Prelabor Rupture of Membranes. Genes (Basel) 2021; 12:genes12111725. [PMID: 34828331 PMCID: PMC8620696 DOI: 10.3390/genes12111725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022] Open
Abstract
A prelabor rupture of membranes (PROM) and its subtypes, preterm PROM (pPROM) and term PROM (tPROM), are associated with disturbances in the hemostatic system and angiogenesis. This study was designed to demonstrate the role of single nucleotide polymorphisms (SNPs), localized in CSF2 (rs25881), FLT1 (rs722503), TFPI (C-399T) and TLR9 (rs352140) genes, in PROM. A population of 360 women with singleton pregnancy consisted of 180 PROM cases and 180 healthy controls. A single-SNP analysis showed a similar distribution of genotypes in the studied polymorphisms between the PROM or the pPROM women and the healthy controls. Double-SNP TT variants for CSF2 and FLT1 polymorphisms, CC variants for TLR9 and TFPI SNPs, TTC for CSF2, FLT1 and TLR9 polymorphisms, TTT for FLT1, TLR9 and TFPI SNPs and CCCC and TTTC complex variants for all tested SNPs correlated with an increased risk of PROM after adjusting for APTT, PLT parameters and/or pregnancy disorders. The TCT variants for the CSF2, FLT1 and TLR9 SNPs and the CCTC for the CSF2, FLT1, TLR9 and TFPI polymorphisms correlated with a reduced risk of PROM when corrected by PLT and APTT, respectively. We concluded that the polymorphisms of genes, involved in hemostasis and angiogenesis, contributed to PROM.
Collapse
|
33
|
Li Y, Wang X, Jiang F, Chen W, Li J, Chen X. Serum lipid levels in relation to clinical outcomes in pregnant women with gestational diabetes mellitus: an observational cohort study. Lipids Health Dis 2021; 20:125. [PMID: 34587947 PMCID: PMC8482603 DOI: 10.1186/s12944-021-01565-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Research on dyslipidemia during pregnancy in women with gestational diabetes mellitus (GDM) has rarely been conducted in Asia. The present study aimed to evaluate maternal mid-trimester lipid profile in relation to GDM and clinical outcomes in these high-risk populations. METHODS The medical records of 632 pregnant women in the second trimester were retrospectively analyzed. Maternal fasting serum lipids were assayed for total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A1 (Apo A1) and Apo B concentrations during the second trimester. The atherogenic index of plasma (AIP) was calculated as log (TG/HDL). The clinical outcomes were collected by evaluating delivery mode, postpartum hemorrhage, prematurity, macrosomia, birth weight, body length and neonatal Apgar 5 min score. RESULTS Levels of TG and AIP were elevated while decreased HDL-C was observed in women with GDM compared with that of the control group. Significant differences were observed in gestational weeks at birth, cesarean section, postpartum hemorrhage, birth weight, body length, prematurity and macrosomia between the two groups. Compared with women with hyperlipidemia, the incidence of GDM and cesarean section was lower in normal lipid group. Women in the hyperlipidemia group had smaller gestational weeks at birth than those in the control group. According to the logistic regression analysis, each unit elevation in AIP increased the risk of GDM by 18.48 times (OR = 18.48, CI: 2.38-143.22). Besides, age (OR = 1.11, CI: 1.06-1.16) and pre-pregnancy BMI (OR = 1.15, CI: 1.07-1.24) were the risk factors of GDM. CONCLUSIONS These findings suggested that reasonable lipid control in the second trimester might reduce the incidence of GDM and be a potential strategy for improving clinical outcomes in these high-risk women.
Collapse
Affiliation(s)
- Yuan Li
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Xiaoqian Wang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Fengjuan Jiang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Wenqing Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Jie Li
- Department of Gynaecology and Obstetrics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China.
| |
Collapse
|
34
|
Ana Y, Prafulla S, Deepa R, Babu GR. Emerging and Public Health Challenges Existing in Gestational Diabetes Mellitus and Diabetes in Pregnancy. Endocrinol Metab Clin North Am 2021; 50:513-530. [PMID: 34399959 DOI: 10.1016/j.ecl.2021.05.008] [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] [Indexed: 11/30/2022]
Abstract
We review the evidence available worldwide on the various challenges in the screening, management, prevention of gestational diabetes mellitus and diabetes in pregnancy. The use of multiple screening and diagnostic tests prescribed by numerous guidelines is challenging for practitioners. Also, sociocultural, demographic and economic challenges affect the prevention and care. Life-course perspectives need to be adopted, as well as an integrated approach in public health care is essential. Tackling these challenges at each phase of life-course, with development and adherence to the country-specific guidelines by practitioners can decrease the burden of gestational diabetes mellitus and diabetes in pregnancy.
Collapse
Affiliation(s)
- Yamuna Ana
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Shriyan Prafulla
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Ravi Deepa
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Giridhara R Babu
- Lifecourse Epidemiology, Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India.
| |
Collapse
|
35
|
Lucas IM, Barr ELM, Barzi F, Longmore DK, Lee IL, Kirkwood M, Whitbread C, Connors C, Boyle JA, Simon D, Goodrem A, Brown ADH, Oats J, McIntyre HD, Shaw JE, Maple-Brown L. Gestational diabetes is associated with postpartum hemorrhage in Indigenous Australian women in the PANDORA study: A prospective cohort. Int J Gynaecol Obstet 2021; 155:296-304. [PMID: 34328645 DOI: 10.1002/ijgo.13846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non-Indigenous women, compared with normoglycemia. METHODS Data were from 1102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Age-adjusted associations of gestational diabetes mellitus (GDM) or pre-existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500 ml) were assessed using logistic regression. Multivariable-adjusted models included Indigenous ethnicity, diabetes type and their interaction. RESULTS A higher proportion of Indigenous women developed PPH than non-Indigenous women (32% versus 22%; P < 0.001). Compared with non-Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were higher (odds ratio [OR] 1.83, 95% confidence intervals [CI] 1.11-3.02, and OR 1.72, 95% CI 0.99-3.00 after age adjustment, OR 1.84, 95% CI 1.06-3.19, and OR 1.33, 95% CI 0.70-2.54 after adjustment for school education and delivery mode, and OR 1.62, 95% CI 0.95-2.77, and OR 0.99, 95% CI 0.53-1.86 after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH. CONCLUSION The significantly higher rates of PPH experienced by Indigenous women compared with non-Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.
Collapse
Affiliation(s)
- Isabelle M Lucas
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Obstetrics & Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Obstetrics & Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth L M Barr
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Danielle K Longmore
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Paediatrics, Western Health, Melbourne, Victoria, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Christine Connors
- Population & Primary Health, Top End Health Service, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Simon
- Department of Obstetrics & Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Adeliesje Goodrem
- Midwifery Group Practice, Top End Health Service, Darwin, Northern Territory, Australia
| | - Alex D H Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Harold D McIntyre
- Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | | |
Collapse
|
36
|
Bidhendi Yarandi R, Vaismoradi M, Panahi MH, Gåre Kymre I, Behboudi-Gandevani S. Mild Gestational Diabetes and Adverse Pregnancy Outcome: A Systemic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:699412. [PMID: 34291067 PMCID: PMC8286997 DOI: 10.3389/fmed.2021.699412] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/07/2021] [Indexed: 01/11/2023] Open
Abstract
Background and Objectives: Mild gestational diabetes (GDM) refers to the gestational hyperglycemia, which does not fulfill the diagnostic criteria for GDM. The results of studies on adverse pregnancy outcomes among women with mild GDM are controversial. Therefore, the aim of this systematic review and meta-analysis was to investigate the impact of mild GDM on the risk of adverse maternal and neonatal outcomes. Methods: A thorough literature search was performed to retrieve articles that investigated adverse maternal and neonatal outcomes in women with mild GDM in comparison with non-GDM counterparts. All populations were classified to three groups based on their diagnostic criteria for mild GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed/random effects models. Publication bias was assessed using the Harbord test. DerSimonian and Laird, and inverse variance methods were used to calculate the pooled relative risk of events. Subgroup analysis was performed based on mild GDM diagnostic criteria. Quality and risk of bias assessment were performed using standard questionnaires. Results: Seventeen studies involving 11,623 pregnant women with mild GDM and 53,057 non-GDM counterparts contributed to the meta-analysis. For adverse maternal outcomes, the results of meta-analysis showed that the women with mild GDM had a significantly higher risk of cesarean section (pooled RR: 1.3, 95% CI 1.2-1.5), pregnancy-induced hypertension (pooled RR: 1.4, 95% CI 1.1-1.7), preeclampsia (pooled RR: 1.3, 95% CI 1.1-1.5) and shoulder dystocia (pooled RR: 2.7, 95% CI 1.5-5.1) in comparison with the non-GDM population. For adverse neonatal outcomes, the pooled relative risk of macrosomia (pooled RR = 0.4, 95% CI: 1.1-1.7), large for gestational age (pooled RR = 1.7, 95% CI: 1.3-2.3), hypoglycemia (pooled RR = 1.6, 95% CI: 1.1-2.3), hyperbilirubinemia (pooled RR = 1.1, 95% CI: 1-1.3), 5 min Apgar <7 (pooled RR = 1.6, 95% CI: 1.1-2.4), admission to the neonatal intensive care unit (pooled RR = 1.5, 95% CI: 1.1-2.1), respiratory distress syndrome (pooled RR = 3.2, 95% CI: 1.8-5.5), and preterm birth (pooled RR = 1.4, 95% CI: 1.1-1.7) was significantly increased in the mild GDM women as compared with the non-GDM population. However, the adverse events of small for gestational age and neonatal death were not significantly different between the groups. Analysis of composite maternal and neonatal outcomes revealed that the risk of those adverse outcomes in the women with mild GDM in all classifications were significantly higher than the non-GDM population. Also, the meta-regression showed that the magnitude of those increased risks in both composite maternal and neonatal outcomes was similar. Conclusion: The risks of sever adverse neonatal outcomes including small for gestational age and neonatal mortality are not increased with mild GDM. However, the increased risks of most adverse maternal and neonatal outcomes are observed. The risks have similar magnitudes for all mild GDM diagnostic classifications.
Collapse
Affiliation(s)
- Razieh Bidhendi Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | |
Collapse
|
37
|
Grigoryan OR, Mikheev RK, Kurinova AN, Chernova MO, Sazonova DV, Akhmatova RR, Ibragimova LI, Absatarova YS, Sheremetyeva EV, Degtyareva EI, Andreeva EN. [Comparative impact analysis of risk factors on the course and outcomes of pregnancy with gestational diabetes mellitus]. ACTA ACUST UNITED AC 2021; 67:78-86. [PMID: 34297506 DOI: 10.14341/probl12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The increasing prevalence of gestational diabetes mellitus (GDM), the high probability of unfavorable pregnancy outcomes for the mother and the fetus, as well as a number of long-term consequences in GDM are a serious medical and social problem and require the need for its prevention by correcting risk factors, timely diagnosis and effective treatment. AIM Analysis of risk factors for the development of gestational diabetes mellitus (GDM), the relationship between GDM, the course and outcomes of pregnancy. MATERIALS AND METHODS Retrospective analysis of 79 case histories of patients with confirmed GDM in the period from 2015 to 2017. RESULTS In the structure of risk factors for mother and fetus, age over 30 years (73.1%), burdened heredity for type 2 diabetes mellitus (T2DM) (30.8%), mother's pre-pregnancy body mass index (BMI) (overweight / obesity (26.9%)) had the greatest impact. Among the complications of pregnancy, the most common was the caesarean section (47.4%). The incidence of other complications (macrosomia (9%), premature birth (7.7%), congenital malformations of the fetus (5.1%), preeclampsia (5.1%) was lower than the average frequency of these complications in GDM, described in the literature. Nevertheless, it is 1.5-2 times higher than the average population indicators. In the course of statistical analysis of the data it was revealed, that the higher the mother's pre-pregnancy BMI, the lower the Apgar score for the first minute in the newborn. CONCLUSION Women with GDM require intensive monitoring of the course of pregnancy and timely hospitalization for planned delivery, and the provision of competent obstetric benefits.
Collapse
Affiliation(s)
- O R Grigoryan
- Endocrinology Research Centre of the Russian Ministry of Health
| | - R K Mikheev
- Endocrinology Research Centre of the Russian Ministry of Health
| | - A N Kurinova
- Endocrinology Research Centre of the Russian Ministry of Health
| | - M O Chernova
- Endocrinology Research Centre of the Russian Ministry of Health
| | - D V Sazonova
- Endocrinology Research Centre of the Russian Ministry of Health
| | - R R Akhmatova
- Endocrinology Research Centre of the Russian Ministry of Health
| | - L I Ibragimova
- Endocrinology Research Centre of the Russian Ministry of Health
| | - Yu S Absatarova
- Endocrinology Research Centre of the Russian Ministry of Health
| | | | - E I Degtyareva
- National Medical Research Center of Obstetrics, Gynecology and Perinatology
| | - E N Andreeva
- Endocrinology Research Centre of the Russian Ministry of Health; Moscow State University of Medicine and Dentistry of A.I. Evdokimov
| |
Collapse
|
38
|
Huang F, Zhang S, Tian Y, Li L, Li Y, Chen X, Sun X, Fan Y, Ma W, Liu C, Gao L, Xue X, Ma L. Effect of mobile health based peripartum management of gestational diabetes mellitus on postpartum diabetes: A randomized controlled trial. Diabetes Res Clin Pract 2021; 175:108775. [PMID: 33771645 DOI: 10.1016/j.diabres.2021.108775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the effects of mobile health based peripartum management of gestational diabetes mellitus (GDM) on postpartum diabetes and factors associated with postpartum diabetes. METHODS Women with GDM (n = 309) were randomly assigned to receive standard management (SM) or mobile management (MM). 75-g OGTT was performed at 6 weeks postpartum. RESULTS The incidence of postpartum T2DM in the MM group was much higher than that in SM group (12.36% vs. 3.88%, P = 0.0291). The fasting, 1-h and 2 h OGTT at 24-28 weeks of gestation of T2DM women were higher than those women without T2DM (fasting, 6.08 vs. 4.90, P = 0.0052; 1-h, 13.20 vs. 10.00, P < 0.0001; 11.96 vs. 8.83, P = 0.0026) in MM group. The 1-h and 2 h OGTT at 24-28 weeks of gestation of T2DM women were higher than those women without T2DM (11.54 vs. 9.78, P = 0.0484; 10.68 vs. 8.68, P = 0.0108) in SM group. Higher OGTT values at 24-28 weeks of gestation were risk factors of postpartum T2DM. CONCLUSIONS Higher OGTT values at 24-28 weeks of gestation were risk factors to develop postpartum T2DM. Mobile health based peripartum management of GDM increased the risk of postpartum diabetes among women with GDM for lacking of postpartum management. Further studies of mobile health based postpartum management of GDM are needed. ClinicalTrials.gov registration number NCT03748576.
Collapse
Affiliation(s)
- Feiling Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Suhan Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Ying Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Li Li
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province 450007, China
| | - Yan Li
- Shenyang Maternity and Child Health Hospital, Shenyang, Liaoning Province 110000, China
| | - Xiaoxia Chen
- QuanZhou Women's and Children's Hospital, Quanzhou, Fujian Province 362000, China
| | - Xiao Sun
- Shenyang Women's and Children's Hospital, Shenyang, Liaoning Province 110000, China
| | - Yanfeng Fan
- Xiamen Maternal and Child Health Hospital, Xiamen, Fujian Province 361003, China
| | - Weibo Ma
- Shunyi Women's & Children's Hospital of Beijing Children's Hospital, Beijing 101300, China
| | - Cuiying Liu
- Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province 250001, China
| | - Limin Gao
- Fuyang People's Hospital, Fuyang, Anhui Province 236004, China
| | - Xiaowen Xue
- Beijing Pinggu Hospital, Beijing 101200, China
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China.
| |
Collapse
|
39
|
Kiran Z, Sheikh A, Islam N. Association of thyroid antibodies status on the outcomes of pregnant women with hypothyroidism (maternal hypothyroidism on pregnancy outcomes, MHPO-4). BMC Pregnancy Childbirth 2021; 21:136. [PMID: 33588796 PMCID: PMC7885223 DOI: 10.1186/s12884-021-03594-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 01/27/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Autoimmunity increases with age and is often commonly evaluated in women of the reproductive age group. Prevalence of thyroid antibodies is common even in euthyroid pregnant women. We aim to compare the association of thyroid antibody status on the maternal and neonatal outcomes in pregnant women with hypothyroidism. METHODS We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital. Information was collected on pregnant women who have been diagnosed with hypothyroidism before conception or during their antenatal period. Laboratory data were recorded for thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and thyroid-stimulating hormone levels. Maternal and neonatal outcomes were also noted from medical file records. Data analysis was performed on Statistical Package for the Social Sciences version 20.0. RESULTS Overall, 146 out 718 cases were included for final analysis. Thyroid peroxidase antibodies were positive in 66.4% and anti-thyroglobulin was positive in 52.1% cases, whereas 43.8% of cases had both antibodies positive. Pre-gestational diabetes was significantly associated with thyroid autoimmunity. There was a 73% less chance of gestational hypertension for thyroid autoimmune groups. Gestational diabetes and maternal (chronic) hypertension were found to have an independent effect on postpartum hemorrhage. Hypertensive disorders in pregnancy were found to have an independent risk for premature birth. CONCLUSION Our study reports a 74.7% prevalence of positive thyroid antibodies in hypothyroid pregnant women, with higher association with pre-gestational diabetes. Gestational hypertension was least likely to occur in thyroid autoimmune groups. None of the outcomes were independently associated with worse outcomes.
Collapse
Affiliation(s)
- Zareen Kiran
- Section of Endocrinology, Department of Medicine, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan.
| | - Aisha Sheikh
- Section of Endocrinology, Department of Medicine, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Najmul Islam
- Section of Endocrinology, Department of Medicine, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| |
Collapse
|
40
|
Contributing Factors to Perinatal Outcome in Pregnancies with Gestational Diabetes-What Matters Most? A Retrospective Analysis. J Clin Med 2021; 10:jcm10020348. [PMID: 33477651 PMCID: PMC7831502 DOI: 10.3390/jcm10020348] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/26/2022] Open
Abstract
The aim of diabetes care of pregnant women with gestational diabetes mellitus (GDM) is to attain pregnancy outcomes including rates of large-for-gestational-age (LGA) newborns, pre-eclampsia, C-sections (CS) and other neonatal outcomes similar to those of the non-GDM pregnant population. Obesity and excessive weight gain during pregnancy have been shown to also impact perinatal outcome. Since GDM is frequently associated with elevated body mass index (BMI), we evaluated the impact of maternal prepregnancy BMI, development of GDM and gestational weight gain (GWG) during pregnancy on perinatal outcome. We compared 614 GDM patients with 5175 non-diabetic term deliveries who gave birth between 2012 and 2016. Multivariate regression analysis was used to evaluate the independent contribution of each factor on selected perinatal outcome variables. Additionally, subgroup analysis for obese (BMI ≥ 30 kg/m2) and non-obese women (BMI < 30 kg/m2) was performed. LGA was significantly influenced by BMI, GWG and GDM, while Neonatal Intensive Care Unit (NICU) admission was solely impacted by GDM. Maternal outcomes were not dependent on GDM but on GWG and prepregnancy BMI. These results remained significant in the non-obese subgroup only. Thus, GDM still affects perinatal outcomes and requires further improvement in diabetic care and patient counseling.
Collapse
|
41
|
Lin X, Yang T, Zhang X, Wei W. Lifestyle intervention to prevent gestational diabetes mellitus and adverse maternal outcomes among pregnant women at high risk for gestational diabetes mellitus. J Int Med Res 2020; 48:300060520979130. [PMID: 33342331 PMCID: PMC7756044 DOI: 10.1177/0300060520979130] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/12/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We assessed the effects of a lifestyle intervention on gestational diabetes mellitus (GDM) incidence and risk of adverse maternal outcomes among pregnant women at high risk for GDM. METHODS From July to December 2018, we enrolled 1822 eligible pregnant women; of these, 304 had at least one risk factor for GDM. Participants were randomly allocated to the intervention or control group. Usual prenatal care was offered to both groups; the intervention group also received individually modified education on diet, physical activity, and weight control. The GDM diagnosis was based on an oral glucose tolerance test at 24-28 gestational weeks. Multivariate logistic regression was used to evaluate the effects of the lifestyle intervention on risk of GDM and adverse maternal outcomes. RESULTS A total of 281 women (139 in the intervention group and 142 controls) were included. Incidences of GDM and adverse maternal outcomes were all significantly lower in the intervention than in the control group. Multivariate logistic regression indicated that women in the intervention group had a lower risk of GDM and adverse maternal outcomes, after adjusting potential confounding factors. CONCLUSION The present lifestyle intervention was associated with lower risks of GDM and adverse maternal outcomes.
Collapse
Affiliation(s)
| | | | - Xueqin Zhang
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Wei Wei
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| |
Collapse
|
42
|
Weschenfelder F, Baum N, Lehmann T, Schleußner E, Groten T. The Relevance of Fetal Abdominal Subcutaneous Tissue Recording in Predicting Perinatal Outcome of GDM Pregnancies: A Retrospective Study. J Clin Med 2020; 9:E3375. [PMID: 33096839 PMCID: PMC7594040 DOI: 10.3390/jcm9103375] [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: 09/02/2020] [Revised: 10/03/2020] [Accepted: 10/17/2020] [Indexed: 11/16/2022] Open
Abstract
Guidelines on the management of gestational diabetes (GDM) instruct physicians to involve ultrasound-based monitoring of fetal growth in addition to blood glucose. So far, glucose control besides clinical parameters like maternal body mass index (BMI) and gestational weight gain have been shown to predict neonatal outcome. We aimed to evaluate the discriminative ability of fetal abdominal subcutaneous tissue (FAST) in addition to standard ultrasound parameters like abdominal circumference (AC) and estimated fetal weight (EFW) for perinatal complications like large for gestational age (LGA), hypoglycemia, hyperbilirubinemia, mode of delivery and admission to neonatal intensive care unit (NICU). Ultrasound data and neonatal outcome was collected of 805 GDM cases from 2012 to 2016: 3205 FAST, 3195 AC-measurements and 3190 EFW calculations were included. AC, EFW and FAST increased linear with gestational age. Combining ultrasound and clinical parameters improved predictive power for LGA. In the subgroup where fetuses grow with an AC > 75th additional adding of FAST to standard ultrasound parameters increased predictive power for hypoglycemia. Our results confirm inclusion of ultrasound parameters to be beneficial in monitoring GDM pregnancies. Additional FAST determination revealed to be of potential clinical relevance in the subgroup AC > 75th percentile.
Collapse
Affiliation(s)
| | - Nadin Baum
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University Jena, 07747 Jena, Germany;
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
| |
Collapse
|
43
|
Differential Expression of miR-136 in Gestational Diabetes Mellitus Mediates the High-Glucose-Induced Trophoblast Cell Injury through Targeting E2F1. Int J Genomics 2020; 2020:3645371. [PMID: 33150164 PMCID: PMC7603599 DOI: 10.1155/2020/3645371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) seriously affects the health of mothers and infants. The high-glucose-induced inhibition in trophoblast cell viability is an important event in GDM pathogenesis. This study evaluated the expression and clinical significance of miR-136 in GDM patients, and the biological function and related mechanisms of miR-136 in the regulation of trophoblast cell proliferation were explored. Methods The expression of miR-136 in serum and placenta of GDM patients was measured using quantitative Real-Time PCR. Trophoblast cells were stimulated with high-glucose medium to mimic the pathological changes of GDM, and the effect of miR-136 was examined by CCK-8 assay. A luciferase reporter assay was used to confirm the target gene of miR-136, and the relationship of E2F transcription factor 1 (E2F1) with miR-136 in GDM was further analyzed. Results miR-136 expression was significantly elevated in GDM serum and tissue samples. By high-glucose treatment, trophoblast cell proliferation was inhibited and miR-136 expression was promoted. The knockdown of miR-136 could promote the proliferation of trophoblast cells exposed to high glucose, whereas the overexpression of miR-136 could suppress it. In addition, E2F1 was identified as a target gene of miR-136, which could mediate the regulatory effect of miR-136 on trophoblast cell proliferation. Conclusion Collectively, miR-136 expression is increased in both serum and placental tissues in GDM patients, and miR-136 mediates the inhibiting effect of high glucose on trophoblast cell viability by targeting E2F1.
Collapse
|
44
|
Li Y, Yu T, Liu Z, Chen H, Liu Y, Wei Y, Sun R, Zhang H, Wang W, Lu Y, Zhou Y, Deng G, Zhang Z. Association of Serum Uric Acid, Urea Nitrogen, and Urine Specific Gravity Levels at 16-18 Weeks of Gestation with the Risk of Gestational Diabetes Mellitus. Diabetes Metab Syndr Obes 2020; 13:4689-4697. [PMID: 33293842 PMCID: PMC7718966 DOI: 10.2147/dmso.s282403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/31/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the associations of serum uric acid (UA), urea nitrogen (UN), and urine specific gravity (USG) levels in the first trimester of pregnancy with the risk of gestational diabetes mellitus (GDM). PATIENTS AND METHODS A retrospective cohort study was conducted in 1,769 pregnant women aged 31.55 ± 3.91 years. UA, UN, and USG levels were measured during the 16-18th week of gestation. GDM was diagnosed by an oral 75 g glucose tolerance test during the 24-28th week of gestation. RESULTS A multivariate adjusted logistic regression analysis showed that UA levels in the highest quartile increased the risk of GDM by 55.7% (odds ratio [OR]: 1.557, 95% confidence interval [CI]: 1.055-2.298; p = 0.026) compared to those in the lowest quartile. USG levels in the second, third, and fourth quartiles increased the risk of GDM by 67.6% (95% CI: 1.090-2.421), 112.4% (95% CI: 1.446-3.119), and 94.5% (95% CI: 1.314-2.880), respectively, compared to those in the first quartile (p trend = 0.001). No significant association between UN levels and the GDM risk was observed. When the extreme composite biomarker score quartiles were compared, the adjusted OR (95% CI) for GDM was 1.909 (95% CI: 1.332-2.736). Age-stratified analyses revealed similar results in women aged ≤35 years only, but not in those aged >35 years. CONCLUSION Higher levels of UA and USG and a higher composite kidney function biomarker score during the 16-18th week of gestation were positively and independently associated with an increased risk of GDM.
Collapse
Affiliation(s)
- Yan Li
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, People’s Republic of China
| | - Tingwei Yu
- Department of Obstetrics, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
| | - Zengyou Liu
- Department of Obstetrics, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
| | - Hengying Chen
- Injury Prevention Research Center, Shantou University Medical College, Shantou, People’s Republic of China
| | - Yao Liu
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
| | - Yuanhuan Wei
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
| | - Ruifang Sun
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
| | - Hongmei Zhang
- Department of Obstetrics, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
| | - Wei Wang
- Department of Obstetrics, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
| | - Yihua Lu
- Department of Obstetrics, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
| | - Yingyu Zhou
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, People’s Republic of China
| | - Guifang Deng
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen, People’s Republic of China
- Guifang Deng Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, No. 89 Taoyuan Road, Shenzhen, Guangdong518052, People’s Republic of China Email
| | - Zheqing Zhang
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, People’s Republic of China
- Correspondence: Zheqing Zhang Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, No. 1023-1063, Shatai South Road, Baiyun District, Guangzhou, Guangdong510515, People’s Republic of China Email
| |
Collapse
|