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Sesmilo G, Prats P, Álvarez M, Romero I, Guerrero M, Rodríguez I, Rodríguez-Melcón A, Garcia S, Serra Also B. Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART). ENDOCRINOL DIAB NUTR 2022; 69:837-843. [PMID: 36526354 DOI: 10.1016/j.endien.2022.11.016] [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: 09/21/2021] [Accepted: 11/14/2021] [Indexed: 06/17/2023]
Abstract
UNLABELLED Infertility affects millions worldwide and use of assisted reproductive techniques (ART) is in high demand. AIMS To investigate whether women that underwent ART at our hospital had a higher incidence of GDM than women who conceived spontaneously, if the ART subtype affects the GDM rate and to study obstetrical outcomes in women with GDM in both groups. METHODS This was a retrospective analysis of prospectively collected data of singleton pregnancies attended at Hospital Universitari Dexeus between 2008 and 2019. Age<18 years, pregestational diabetes, metformin prior to pregnancy and multiple pregnancies were excluded. RESULTS A total of 29,529 patients were included. Pregnancy was achieved by ART in 2596 (8.8%): in vitro fertilisation (IVF/ICSI) 32.8%, frozen embryo transfer (FET) 37.7%, oocyte donor receptors (ODR) 17.2% and insemination 12.2%. The GDM rate was 8.9% (12.7% in ART vs 8.5% in non-ART, p<0.001). The GDM was 11.2% in IVF/ICSI, 17.7% in ODR, 13% in FET and 9.1% in the insemination group (p=0.001). In a multivariable analysis adjusting for age, parity and BMI, ART was not associated with GDM [OR 1.03 (0.90-1.19)], nor was type of ART. Pregnancy outcomes in GDM patients were similar in both groups except for C-section rates (30.0% in ART vs 15.9% in non-ART (p<0.001). CONCLUSIONS Despite a higher prevalence of GDM in ART pregnancies, ART was not associated with an increased risk of GDM when adjusting for age, parity and BMI. The prognosis of GDM in ART and non-ART was similar except for C-section rates.
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Affiliation(s)
- Gemma Sesmilo
- Endocrine Unit, Dexeus University Hospital, Barcelona, Spain
| | - Pilar Prats
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain.
| | - Manuel Álvarez
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Irene Romero
- Endocrine Unit, Dexeus University Hospital, Barcelona, Spain
| | - Mireia Guerrero
- Endocrine Unit, Dexeus University Hospital, Barcelona, Spain
| | - Ignacio Rodríguez
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Alberto Rodríguez-Melcón
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Sandra Garcia
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Bernat Serra Also
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
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He M, Sun X, Wang C, Sui Y. Analysis of the risk of complications during pregnancy in pregnant women with assisted reproductive technology: a retrospective study using registry linkage from 2013 to 2018 in Shanghai, China. BMC Pregnancy Childbirth 2022; 22:526. [PMID: 35764962 PMCID: PMC9241204 DOI: 10.1186/s12884-022-04846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background To evaluate the differences in pregnancy outcomes between assisted reproductive technology (ART) patients and natural pregnant women in Shanghai, China in the past 6 years objectively. And to assess the feasibility of the research method of registry-database linkage in mainland China. Methods This retrospective study was conducted using registry-database linkage. A total of 8102 pregnancies with ART and 8096 parturients with spontaneous conception (SC) from 10 reproductive centers and 111 hospitals composed our retrospective study. The primary outcomes were the rates of obstetric complications (pregnancy-induced hypertention [PIH], gestational diabetes mellitus [GDM], placenta previa, mode of delivery, preterm birth [PTB], low birth weight [LBW], and macrosomia). The prenatal outcomes were compared between ART and SC parturients, frozen-thawed embryo transfer (FET) and fresh embryo transfer, and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). We calculated odds ratios (ORs) and 95% confidence intervals (CIs). Results The final matching rate of the target population was 92% by using registry linkage. ART resulted in a higher rate of multiple birth, PTB, LBW, cesarean section, placenta previa and GDM compared with SC in the singleton cohort. In ART patients, pregnant women with FET had a significantly higher risk of PIH than those with fresh embryo transfer (14.1% Vs 9.3%, AOR1.528, 95% CI 1.303–1.793), but there was no difference between IVF and ICSI. FET is also related to the severity of PIH. Conclusions ART increased the rate of complications during pregnancy, the risk and severity of PIH in patients with FET was higher than that in patients with fresh embryo transfer. The registry-database linkage study is an objective and feasible research method in mainland China. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04846-1.
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Affiliation(s)
- Mulan He
- Obstetrics and Gynecology Hospital of Fudan University, 352#, Dalin Road, Shanghai, 200011, China
| | - Xiaoxi Sun
- Obstetrics and Gynecology Hospital of Fudan University, 352#, Dalin Road, Shanghai, 200011, China. .,Shanghai JiAi Genetics & IVF Institute, Shanghai, 200011, China. .,Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China.
| | - Chunfang Wang
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yilun Sui
- Shanghai JiAi Genetics & IVF Institute, Shanghai, 200011, China
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Alvarez-Silvares E, Bermúdez-González M, Vilouta-Romero M, García-Lavandeira S, Seoane-Pillado T. Prediction of insulin therapy in women with gestational diabetes: a systematic review and meta-analysis of observational studies. J Perinat Med 2022; 50:608-619. [PMID: 35313096 DOI: 10.1515/jpm-2021-0247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 02/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify antenatal risk factors that may predict the need for insulin treatment upon diagnosis of gestational diabetes (GDM), that is, to identify the specific characteristics of women diagnosed with GDM who did not achieve good glycemic control through lifestyle modifications. METHODS We performed a comprehensive literature search in PubMed, Science Direct, Ebsco, and Scielo for studies evaluating the associations between antenatal factors and the need for insulin treatment published until January 28th, 2021. Random-effects models were used to estimate risk ratios and their 95% confidence interval. The quality of studies was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to estimate outcomes, and effects reported as risk ratio and their 95% confidence interval. The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews. RESULTS Eighteen observational studies were selected, reporting 14,951 women with GDM of whom 5,371 received insulin treatment. There were statistically significant associations between the need for insulin treatment and BMI ≥ 30 (RR:2.2; 95%CI: 1.44-3.41), family history of type 2 diabetes mellitus (RR:1.74; 95%CI: 1.56-1.93), prior personal history of GDM (RR:2.10; 95%CI: 1.56-2.82), glycated hemoglobin value at GDM diagnosis (RR:2.12; 95%CI: 1.77-2.54), and basal glycemia obtained in the diagnostic curve (RR: 1.2; 95%CI: 1.12-1.28). Nulliparity and maternal age were not determinants factor. There was moderate-to-high heterogeneity among the included studies. CONCLUSIONS the strong causal association between BMI ≥ 30, family history of type 2 diabetes mellitus, prior history of GDM and glycosylated hemoglobin with the need for insulin treatment was revealed.
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Badr DA, Kassem C, Carlin A, Dobrescu O, Iconaru L, Baleanu F, Taujan GC, Jani JC. Antenatal insulin therapy in gestational diabetes mellitus: validation of the new Brugmann scores. Gynecol Endocrinol 2022; 38:411-415. [PMID: 35277105 DOI: 10.1080/09513590.2022.2048296] [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] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Following the adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) diagnosis by the World Health Organization (WHO) in 2014, many investigators have tried to identify independent risk factors for antenatal insulin therapy (AIT). The purpose of the current study is to build and validate a score that stratifies patients according to their need for AIT. METHODS All pregnant women diagnosed with GDM according to the IADPSG definition were included. Group 1 comprised patients of 2018, and group 2 comprised patients of 2019. Each group was divided into two subgroups: subgroup A comprised patients diagnosed according to the 75-g oral glucose tolerance test (OGTT), and subgroup B comprised patients diagnosed according to fasting plasma glucose (FPG). RESULTS A total of 1298 patients were included; 19.3% of those diagnosed by OGTT and 40.9% by FPG required AIT. The risk for AIT was stratified as low, moderate, and high. Brugmann FPG score comprised six risk factors and Brugmann OGTT score 12. Higher scores were associated with higher risk for AIT. The use of these scores in the two subgroups of group 2 showed no statistical differences compared to group 1. CONCLUSIONS Both Brugmann FPG and OGTT scores may be useful to stratify patients with GDM according to their need for AIT. Future studies should be conducted to prospectively validate these scores, and to examine whether or not using oral anti-hyperglycemic agents in a high-risk group may decrease the need for AIT.
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Affiliation(s)
- Dominque A Badr
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Chirine Kassem
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Dobrescu
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Iconaru
- Department of Endocrinology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Felicia Baleanu
- Department of Endocrinology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Georgiana Cristina Taujan
- Department of Endocrinology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART). ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ganer Herman H, Marom O, Koren L, Horowitz E, Schreiber L, Okmian O, Raziel A, Kovo M. Gestational diabetes mellitus in in-vitro fertilization pregnancies - Clinical and placental histological characteristics. Placenta 2021; 117:156-160. [PMID: 34902728 DOI: 10.1016/j.placenta.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/11/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We aimed to investigate obstetric and neonatal outcomes and placental histological findings in in vitro fertilization (IVF) pregnancies complicated by gestational diabetes mellitus (GDM) as compared to unassisted pregnancies. METHODS This was a retrospective cohort of deliveries at a single university affiliated center between 12/2008 and 01/2020. Included were singleton pregnancies complicated by GDM, for which placental histopathological examination was performed. Obstetric, neonatal and placental outcomes were compared between pregnancies following IVF and unassisted pregnancies. Placental lesions were categorized according to the "Amsterdam" criteria. RESULTS Included were 688 deliveries with a diagnosis of GDM with placental examination - 69 IVF pregnancies (IVF group) and 619 unassisted pregnancies (control group). The IVF group was characterized by a significantly higher maternal age and higher rate of nulliparous women - 60.8% vs. 32.9%, p < 0.001. There were no differences in GDM type between the study groups - about two thirds of cases were GDMA1 and on third GDMA2. A higher incidence of preeclampsia was noted in the IVF group - 17.3% vs. 9.3%, p = 0.03, with no difference in cesarean deliveries and birthweight. IVF deliveries were characterized by a significantly higher rate of adverse neonatal outcomes - 18.8% vs. 8.8%, p = 0.008, although this did not attain significance after adjustment to gestational age. No differences were noted in placental histology between the groups. DISCUSSION GDM in IVF is associated with a significantly higher rate of adverse neonatal outcomes, as compared with non-assisted pregnancies complicated by GDM. Placental histology does not shed light on these clinical associations.
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Affiliation(s)
- Hadas Ganer Herman
- In-Vitro Fertilizationt, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Or Marom
- Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liron Koren
- Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Horowitz
- In-Vitro Fertilizationt, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Pathology Department, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Okmian
- Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- In-Vitro Fertilizationt, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mecacci F, Lisi F, Vannuccini S, Ottanelli S, Rambaldi MP, Serena C, Simeone S, Petraglia F. Different Gestational Diabetes Phenotypes: Which Insulin Regimen Fits Better? Front Endocrinol (Lausanne) 2021; 12:630903. [PMID: 33767671 PMCID: PMC7985539 DOI: 10.3389/fendo.2021.630903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/18/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Maternal characteristics and OGTT values of pregnancies complicated by gestational diabetes mellitus (GDM) were evaluated according to treatment strategies. The goal was to identify different maternal phenotypes in order to predict the appropriate treatment strategy. METHODS We conducted a retrospective study among 1,974 pregnant women followed up for GDM in a tertiary referral hospital for high-risk pregnancies (Careggi University Hospital, Florence, Italy) from 2013 to 2018. We compared nutritional therapy (NT) alone (n = 962) versus NT and insulin analogues (n = 1,012) group. Then, we focused on different insulin analogues groups: long acting (D), rapid acting (R), both D and R. We compared maternal characteristics of the three groups, detecting which factors may predict the use of rapid or long-acting insulin analogue alone versus combined therapy. RESULTS Among women included in the analysis, 51.3% of them needed insulin therapy for glycemic control: 61.8% D, 28.3% combined D and R, and 9.9% R alone. Age >35 years, pre-pregnancy BMI >30, family history of diabetes, previous GDM, altered fasting plasma glucose (FPG), hypothyroidism, and assisted reproductive technologies (ART) were identified as maternal variables significantly associated with the need of insulin therapy. Altered 1-h and 2-h glucose plasma glucose level at OGTT, age >35 years, and previous GDM were found as independent predicting factors for the use of combined therapy with rapid and long acting analogues for glycemic control. On the contrary, pre-pregnancy BMI <25 and normal fasting plasma glucose values at OGTT were found to be significantly associated to the use of rapid insulin analogue only. CONCLUSION A number of maternal and metabolic variables may be identified at the diagnosis of GDM, in order to identify different GDM phenotypes requiring a personalized treatment for glycemic control.
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Affiliation(s)
- Federico Mecacci
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
| | - Federica Lisi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Silvia Vannuccini
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- *Correspondence: Silvia Vannuccini,
| | - Serena Ottanelli
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
| | | | - Caterina Serena
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
| | - Serena Simeone
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
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