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Mora-Ortiz M, Rivas-García L. Gestational Diabetes Mellitus: Unveiling Maternal Health Dynamics from Pregnancy Through Postpartum Perspectives. OPEN RESEARCH EUROPE 2024; 4:164. [PMID: 39355538 PMCID: PMC11443192 DOI: 10.12688/openreseurope.18026.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 10/03/2024]
Abstract
Gestational Diabetes Mellitus (GDM) is the most frequent pregnancy-related medical issue and presents significant risks to both maternal and foetal health, requiring monitoring and management during pregnancy. The prevalence of GDM has surged globally in recent years, mirroring the rise in diabetes and obesity rates. Estimated to affect from 5% to 25% of pregnancies, GDM impacts approximately 21 million live births annually, according to the International Diabetes Federation (IDF). However, consensus on diagnostic approaches remains elusive, with varying recommendations from international organizations, which makes the comparison between research complicated. Compounding concerns are the short-term and long-term complications stemming from GDM for mothers and offspring. Maternal outcomes include heightened cardiovascular risks and a notable 70% risk of developing Type 2 Diabetes Mellitus (T2DM) within a decade postpartum. Despite this, research into the metabolic profiles associated with a previous GDM predisposing women to T2D remains limited. While genetic biomarkers have been identified, indicating the multifaceted nature of GDM involving hormonal changes, insulin resistance, and impaired insulin secretion, there remains a dearth of exploration into the enduring health implications for both mothers and their children. Furthermore, offspring born to mothers with GDM have been shown to face an increased risk of obesity and metabolic syndrome during childhood and adolescence, with studies indicating a heightened risk ranging from 20% to 50%. This comprehensive review aims to critically assess the current landscape of Gestational Diabetes Mellitus (GDM) research, focusing on its prevalence, diagnostic challenges, and health impacts on mothers and offspring. By examining state-of-the-art knowledge and identifying key knowledge gaps in the scientific literature, this review aims to highlight the multifaceted factors that have hindered a deeper understanding of GDM and its long-term consequences. Ultimately, this scholarly exploration seeks to promote further investigation into this critical area, improving health outcomes for mothers and their children.
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Affiliation(s)
- Marina Mora-Ortiz
- Lipids and Atherosclerosis Unit, Internal Medicine, Reina Sofia University Hospital, Córdoba, Andalucía, 14004, Spain
- GC09-Nutrigenomics and Metabolic Syndrome, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Andalucía, 14004, Spain
- Department of Medical and Surgical Sciences, Universidad de Cordoba, Córdoba, Andalucía, 14004, Spain
| | - Lorenzo Rivas-García
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix Verdú”, Biomedical Research Centre, Universidad de Granada, Armilla, Granada, Andalucia, 18016, Spain
- Sport and Health Research Centre, Universidad de Granada, Armilla, Granada, Andalucia, 18016, Spain
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Ontiveros J, Gunnarsdóttir J, Einarsdóttir K. Trends in gestational diabetes in Iceland before and after guideline changes in 2012: a nationwide study from 1997 to 2020. Eur J Public Health 2024; 34:794-799. [PMID: 38905590 PMCID: PMC11293813 DOI: 10.1093/eurpub/ckae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Abstract
Internationally accepted diagnostic criteria recommendations for gestational diabetes (GDM) in 2010 resulted in a rise in global prevalence of GDM. Our aim was to describe the trends in GDM before and after Icelandic guideline changes in 2012 and the trends in pregestational diabetes (PGDM). The study included all singleton births (N = 101 093) in Iceland during 1997-2020. Modified Poisson regression models were used to estimate prevalence ratios (PRs) with 95% confidence intervals (CIs) for risk of GDM overall and by maternal age group, as well as overall risk of PGDM, according to time period of birth. The overall prevalence of GDM by time period of birth ranged from 0.6% (N = 101) in 1997-2000 to 16.2% (N = 2720) in 2017-2020, and the prevalence of PGDM ranged from 0.4% (N = 57) in 1997-2000 to 0.7% (N = 120) in 2017-2020. The overall relative GDM prevalence rate difference before and after 2012 was 380%, and the largest difference was found among women aged <25 years at 473%. Risk of GDM increased in 2017-2020 (PR 14.21, CI 11.45, 17.64) compared to 1997-2000 and was highest among women aged >34 years with PR 19.46 (CI 12.36, 30.63) in 2017-2020. Prevalence rates of GDM and PGDM increased during the study period. An accelerated rate of increase in GDM was found after 2012, overall, and among all maternal age groups. Women aged >34 years had the greatest risk of GDM throughout all time periods, while women aged <25 years appear to have a higher relative rate difference after 2012.
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Affiliation(s)
- Jamie Ontiveros
- Centre of Public Health Sciences, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jóhanna Gunnarsdóttir
- Centre of Public Health Sciences, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Obstetrics and Gynecology, Landspítali – The National University Hospital of Iceland, Reykjavík, Iceland
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Australia
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Chakraborty A, Yadav S. Prevalence and determinants of gestational diabetes mellitus among pregnant women in India: an analysis of National Family Health Survey Data. BMC Womens Health 2024; 24:147. [PMID: 38424617 PMCID: PMC10902981 DOI: 10.1186/s12905-024-02936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a type of diabetes with its first recognition during pregnancy. GDM is a high-risk maternal and neonatal condition which increases the risk of Type 2 diabetes in mothers and their infants. It is essential to detect and treat GDM since its inception when mothers suffer from Type 1 diabetes while carrying the foetus during the gestational period. METHODS The study analysed individual data from the National Family Health Survey (NFHS) surveyed in 2015-2016 (4th round) and 2019-2021 (5th round) covering a total of approximately 6 lakhs and 7 lakhs women, respectively. Among them, 32,072 women in 2015-2016 and 28,187 in 2019-2021 were pregnant, of whom 180 women in 2014-2015 and 247 women in 2019-2021 had diabetes during their gestational periods, allowing the percentage prevalence calculation of GDM. The analysis of Poisson regression estimates examined the socioeconomic and demographic risk factors for GDM among pregnant women. RESULTS The overall prevalence of GDM in women showed an increase from 0.53% in 2015-16 to 0.80% in 2019-20 at the national level, and a similar increase in many states of India was witnessed, with a few exceptions. The GDM prevalence has shown a gradient over age, with a low prevalence in 15-19- and 25-29-year-olds and the highest prevalence in 40-44-year-olds. Concerning the rural and urban divide, its prevalence in both urban and rural areas has increased from 0.61 to 0.85% and 0.51 to 0.78% between 2015 and 16 and 2019-21. The results of the Poisson regression analysis reveal that older adults with high Body Mass Index (BMI), thyroid disorder, and heart disease have a greater risk of GDM among pregnant women in India. The states of Kerala, Meghalaya, and Goa show a high prevalence of GDM. CONCLUSION The low prevalence of GDM may not be clinically significant but has negative repercussions on the mother and her child cannot be overlooked. Thus, it is essential to curb GDM since its inception and save a generation ahead from the risk of diabetes and other diseases.
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Affiliation(s)
- Aditi Chakraborty
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India.
| | - Suryakant Yadav
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
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Chib S, Devi S, Chalotra R, Mittal N, Singh TG, Kumar P, Singh R. Cross Talks between CNS and CVS Diseases: An Alliance to Annihilate. Curr Cardiol Rev 2024; 20:63-76. [PMID: 38441007 PMCID: PMC11284694 DOI: 10.2174/011573403x278550240221112636] [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: 08/22/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 03/06/2024] Open
Abstract
Cardiovascular and neurological diseases cause substantial morbidity and mortality globally. Moreover, cardiovascular diseases are the leading cause of death globally. About 17.9 million people are affected by cardiovascular diseases and 6.8 million people die every year due to neurological diseases. The common neurologic manifestations of cardiovascular illness include stroke syndrome which is responsible for unconsciousness and several other morbidities significantly diminished the quality of life of patients. Therefore, it is prudent need to explore the mechanistic and molecular connection between cardiovascular disorders and neurological disorders. The present review emphasizes the association between cardiovascular and neurological diseases specifically Parkinson's disease, Alzheimer's disease, and Huntington's disease.
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Affiliation(s)
- Shivani Chib
- Department of Pharmacology, Central University of Punjab, Bathinda, Punjab, India
| | - Sushma Devi
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Rishabh Chalotra
- Department of Pharmacology, Central University of Punjab, Bathinda, Punjab, India
| | - Neeraj Mittal
- Department of Pharmacology, Central University of Punjab, Bathinda, Punjab, India
| | - Thakur Gurjeet Singh
- Department of Pharmacology, Central University of Punjab, Bathinda, Punjab, India
| | - Puneet Kumar
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Randhir Singh
- Department of Pharmacology, Central University of Punjab, Bathinda, Punjab, India
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
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Shriyan P, Koya S, Lobo E, van Schayck OCP, Babu GR. Psychosocial and sociodemographic factors associated with gestational blood glucose levels in women attending public hospitals: Results from baseline of MAASTHI cohort. PLoS One 2023; 18:e0293414. [PMID: 37883514 PMCID: PMC10602325 DOI: 10.1371/journal.pone.0293414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Understanding psychosocial environment is important for improving maternal and fetal health outcomes during pregnancy. We aimed to identify the association between gestational blood glucose levels and psychosocial and demographic factors in pregnant women. METHODS In the MAASTHI pregnancy cohort in Bengaluru, we assessed depressive symptoms, and social support using validated scales at baseline in first trimester. A 2-hour 75 g oral glucose tolerance test (OGTT) was administered between 24-36 weeks of gestation. We examined the relation between psychosocial factors assessed at baseline and gestational blood glucose levels in second/third trimester using multivariate linear regression and explored association between serum cortisol and gestational blood glucose levels in subgroup samples. RESULTS We found that 9% of pregnant women had depressive symptoms and 14.3% had Gestational Diabetes Mellitus (GDM). Psychosocial factors, including depressive symptoms, have a significant correlation with gestational fasting(β = 0.12, p-value<0.05) and postprandial blood sugar level(β = 0.23, p-value<0.05) and poor social support were found to have a significant association with gestational fasting blood glucose levels(β = 1.45, p-value <0.05) and postprandial blood sugar levels(β = 2.60, p-value <0.05). The sociodemographic factors such as respondent education, occupation, social and economic status were associated with gestational blood sugar after adjusting for potential confounder variables. CONCLUSION Depressive symptoms and poor social support earlier in pregnancy were significantly associated with increased gestational blood glucose levels. Early detection and recognition of modifiable psychosocial risk factors can reduce glucose intolerance during pregnancy. Evaluating the benefits of screening for psychosocial factors and timely management of gestational diabetes mellitus can be helpful in India.
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Affiliation(s)
- Prafulla Shriyan
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India, Bengaluru, India
| | - Srinidhi Koya
- School of Social Sciences, Humanities, and Law, Teesside University, Middlesbrough, United Kingdom
| | - Eunice Lobo
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India, Bengaluru, India
| | - Onno CP van Schayck
- Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Giridhara R. Babu
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India, Bengaluru, India
- DBT- Wellcome Trust- India Alliance Senior Research Fellow in Public Health, Hyderabad, India
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Guevara-Ramírez P, Paz-Cruz E, Cadena-Ullauri S, Ruiz-Pozo VA, Tamayo-Trujillo R, Felix ML, Simancas-Racines D, Zambrano AK. Molecular pathways and nutrigenomic review of insulin resistance development in gestational diabetes mellitus. Front Nutr 2023; 10:1228703. [PMID: 37799768 PMCID: PMC10548225 DOI: 10.3389/fnut.2023.1228703] [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: 05/30/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
Gestational diabetes mellitus is a condition marked by raised blood sugar levels and insulin resistance that usually occurs during the second or third trimester of pregnancy. According to the World Health Organization, hyperglycemia affects 16.9% of pregnancies worldwide. Dietary changes are the primarily alternative treatment for gestational diabetes mellitus. This paper aims to perform an exhaustive overview of the interaction between diet, gene expression, and the metabolic pathways related to insulin resistance. The intake of foods rich in carbohydrates can influence the gene expression of glycolysis, as well as foods rich in fat, can disrupt the beta-oxidation and ketogenesis pathways. Furthermore, vitamins and minerals are related to inflammatory processes regulated by the TLR4/NF-κB and one carbon metabolic pathways. We indicate that diet regulated gene expression of PPARα, NOS, CREB3L3, IRS, and CPT I, altering cellular physiological mechanisms and thus increasing or decreasing the risk of gestational diabetes. The alteration of gene expression can cause inflammation, inhibition of fatty acid transport, or on the contrary help in the modulation of ketogenesis, improve insulin sensitivity, attenuate the effects of glucotoxicity, and others. Therefore, it is critical to comprehend the metabolic changes of pregnant women with gestational diabetes mellitus, to determine nutrients that help in the prevention and treatment of insulin resistance and its long-term consequences.
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Affiliation(s)
- Patricia Guevara-Ramírez
- Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación Genética y Genómica, Universidad UTE, Quito, Ecuador
| | - Elius Paz-Cruz
- Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación Genética y Genómica, Universidad UTE, Quito, Ecuador
| | - Santiago Cadena-Ullauri
- Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación Genética y Genómica, Universidad UTE, Quito, Ecuador
| | - Viviana A. Ruiz-Pozo
- Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación Genética y Genómica, Universidad UTE, Quito, Ecuador
| | - Rafael Tamayo-Trujillo
- Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación Genética y Genómica, Universidad UTE, Quito, Ecuador
| | - Maria L. Felix
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Daniel Simancas-Racines
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, Ecuador
| | - Ana Karina Zambrano
- Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación Genética y Genómica, Universidad UTE, Quito, Ecuador
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Role of Adenotonsillectomy and Tonsillectomy in Children with Down Syndrome Who Develop Obstructive Sleep Apnea by Obesity as a Risk Factor. Int J Pediatr 2022; 2022:8074094. [PMID: 35574039 PMCID: PMC9106504 DOI: 10.1155/2022/8074094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/17/2022] Open
Abstract
Down syndrome (DS) or trisomy 21 is caused due to the presence of additional chromosome 21 in humans. DS can exist either as free trisomy 21 (nondisjunction), Robertsonian translocated DS, or as mosaic DS. Obstructive sleep apnea (OSA) is a complex condition with serious health implications for pediatric individuals with DS. OSA is common in DS, and when it is present, it appears to be extreme. Obesity and snoring are some of the OSA risk factors for children associated with DS and OSA. Adenotonsillectomy is one of the surgical protocols applied in children, which is useful in lowering the OSA in which obesity is commonly connected within normal and DS children. Tonsillectomy is the alternative procedure of surgery connected with postoperative respiratory complications, and adenotonsillectomy was found to be a safe surgical method in children and improves the quality of life. The main aim of this review is to bridge the gap between the role of OSA in normal children (46, XX/XY) and DS children (47, XX/XY+21) characterized by the presence of chromosomes and exactly what is the involvement with adenotonsillectomy and tonsillectomy when obesity is a risk factor. The treatment for OSA and obesity is rehabilitative and reversible; however, DS can be managed but not resolved because the disorder occurs from the existence of an extra chromosome during the failure of homologous chromosomal pairing separation during maternal meiosis I. This review concludes that there is a treatment for OSA and obesity and that DS children can be prevented from being obese or experiencing OSA but cannot be turned to normal chromosomes due to an extra trisomy 21. According to this review, children with DS and OSA/OSAS, as well as concomitant complications, can be treated.
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Boadu WIO, Kugblenu P, Senu E, Opoku S, Anto EO. Prevalence and Risk Factors Associated With Gestational Diabetes Mellitus Among Pregnant Women: A Cross-Sectional Study in Ghana. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:854332. [PMID: 36992739 PMCID: PMC10012159 DOI: 10.3389/fcdhc.2022.854332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022]
Abstract
Gestational diabetes mellitus (GDM) is a global public health issue that have serious consequences on mother and her child’s health. However, limited data is available on the prevalence of GDM and its associated risk factors in Ghana. This study investigated the prevalence and associated risk factors of GDM among women attending selected antenatal clinics in Kumasi, Ghana. This cross-sectional study included 200 pregnant women who attended antenatal clinics from Three-selected health facilities in the Ashanti Region, Ghana. Women already diagnosed of GDM were identified through their medical records and were confirmed based on the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), which uses a fasting blood glucose of ≥ 5.1 mmol/L. A well-structured questionnaire was used to collect data on socio-demographic, obstetric, clinical and lifestyle risk factors. Multivariate logistic regression models were used to determine the independent risk factors of GDM. The overall prevalence of GDM among study participants was 8.5%. GDM was prevalent among age 26 and 30 years (41.2%), married participants (94.1%) with basic education (41.2%) and being Akan by ethnicity (52.9%). Previous history of oral contraceptive use (aOR: 13.05; 95% CI: 1.43–119.23, p=0.023), previous history of preeclampsia (aOR: 19.30; 95% CI: 2.15-71.63; p=0.013) and intake of soda drinks (aOR: 10.05, 95% CI: 1.19–84.73, p=0.034) were found to be independent risk factors of GDM. The prevalence of GDM was found to be 8.5% and this was associated with the previous use of oral contraceptives, history of preeclampsia and intake of soda drinks. Public health education and dietary lifestyle modification may be required for pregnant women who are at risk of GDM.
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Affiliation(s)
- Wina Ivy Ofori Boadu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- *Correspondence: Wina Ivy Ofori Boadu,
| | - Philomina Kugblenu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ebenezer Senu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen Opoku
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Enoch Odame Anto
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medical and Health Sciences, Centre for Precision Health, Edith Cowan University, Perth, WA, Australia
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Placental Insulin Receptor Transiently Regulates Glucose Homeostasis in the Adult Mouse Offspring of Multiparous Dams. Biomedicines 2022; 10:biomedicines10030575. [PMID: 35327377 PMCID: PMC8945682 DOI: 10.3390/biomedicines10030575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 02/04/2023] Open
Abstract
In pregnancies complicated by maternal obesity and gestational diabetes mellitus, there is strong evidence to suggest that the insulin signaling pathway in the placenta may be impaired. This may have potential effects on the programming of the metabolic health in the offspring; however, a direct link between the placental insulin signaling pathway and the offspring health remains unknown. Here, we aimed to understand whether specific placental loss of the insulin receptor (InsR) has a lasting effect on the offspring health in mice. Obesity and glucose homeostasis were assessed in the adult mouse offspring on a normal chow diet (NCD) followed by a high-fat diet (HFD) challenge. Compared to their littermate controls, InsR KOplacenta offspring were born with normal body weight and pancreatic β-cell mass. Adult InsR KOplacenta mice exhibited normal glucose homeostasis on an NCD. Interestingly, under a HFD challenge, adult male InsR KOplacenta offspring demonstrated lower body weight and a mildly improved glucose homeostasis associated with parity. Together, our data show that placenta-specific insulin receptor deletion does not adversely affect offspring glucose homeostasis during adulthood. Rather, there may potentially be a mild and transient protective effect in the mouse offspring of multiparous dams under the condition of a diet-induced obesogenic challenge.
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Mallardo M, Ferraro S, Daniele A, Nigro E. GDM-complicated pregnancies: focus on adipokines. Mol Biol Rep 2021; 48:8171-8180. [PMID: 34652617 PMCID: PMC8604848 DOI: 10.1007/s11033-021-06785-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/15/2021] [Indexed: 12/27/2022]
Abstract
Gestational diabetes mellitus (GDM) is a serious complication of pregnancy and is defined as a state of glucose intolerance that is first diagnosed and arises during gestation. Although the pathophysiology of GDM has not yet been thoroughly clarified, insulin resistance and pancreatic β-cell dysfunction are considered critical components of its etiopathogenesis. To sustain fetus growth and guarantee mother health, many significant changes in maternal metabolism are required in normal and high-risk pregnancy accompanied by potential complications. Adipokines, adipose tissue-derived hormones, are proteins with pleiotropic functions including a strong metabolic influence in physiological conditions and during pregnancy too. A growing number of studies suggest that various adipokines including adiponectin, leptin, visfatin, resistin and tumor necrosis factor α (TNF-α) are dysregulated in GDM and might have pathological significance and a prognostic value in this pregnancy disorder. In this review, we will focus on the current knowledge on the role that the aforementioned adipokines play in the development and progression of GDM.
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Affiliation(s)
- Marta Mallardo
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania "Luigi Vanvitelli", Via G. Vivaldi 42, 81100, Caserta, Italy
- CEINGE-Biotecnologie Avanzate S.c.a r.l., Via G. Salvatore 486, 80145, Naples, Italy
| | - Sara Ferraro
- CEINGE-Biotecnologie Avanzate S.c.a r.l., Via G. Salvatore 486, 80145, Naples, Italy
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli "Federico II", Via Pansini 5, 80145, Naples, Italy
| | - Aurora Daniele
- CEINGE-Biotecnologie Avanzate S.c.a r.l., Via G. Salvatore 486, 80145, Naples, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Naples "Federico II", Naples, Italy
| | - Ersilia Nigro
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania "Luigi Vanvitelli", Via G. Vivaldi 42, 81100, Caserta, Italy.
- CEINGE-Biotecnologie Avanzate S.c.a r.l., Via G. Salvatore 486, 80145, Naples, Italy.
- CEINGE-Biotecnologie Avanzate, Via Gaetano Salvatore, 486, 80145, Naples, Italy.
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Griffith RJ, Alsweiler J, Moore AE, Brown S, Middleton P, Shepherd E, Crowther CA. Interventions to prevent women from developing gestational diabetes mellitus: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2020; 6:CD012394. [PMID: 32526091 PMCID: PMC7388385 DOI: 10.1002/14651858.cd012394.pub3] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) is increasing, with approximately 15% of pregnant women affected worldwide, varying by country, ethnicity and diagnostic thresholds. There are associated short- and long-term health risks for women and their babies. OBJECTIVES We aimed to summarise the evidence from Cochrane systematic reviews on the effects of interventions for preventing GDM. METHODS We searched the Cochrane Database of Systematic Reviews (6 August 2019) with key words 'gestational diabetes' OR 'GDM' to identify reviews pre-specifying GDM as an outcome. We included reviews of interventions in women who were pregnant or planning a pregnancy, irrespective of their GDM risk status. Two overview authors independently assessed eligibility, extracted data and assessed quality of evidence using ROBIS and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm (GRADE moderate- or high-quality evidence with a confidence interval (CI) that did not cross the line of no effect); clear evidence of no effect or equivalence (GRADE moderate- or high-quality evidence with a narrow CI crossing the line of no effect); possible benefit or harm (low-quality evidence with a CI that did not cross the line of no effect or GRADE moderate- or high-quality evidence with a wide CI); or unknown benefit or harm (GRADE low-quality evidence with a wide CI or very low-quality evidence). MAIN RESULTS We included 11 Cochrane Reviews (71 trials, 23,154 women) with data on GDM. Nine additional reviews pre-specified GDM as an outcome, but did not identify GDM data in included trials. Ten of the 11 reviews were judged to be at low risk of bias and one review at unclear risk of bias. Interventions assessed included diet, exercise, a combination of diet and exercise, dietary supplements, pharmaceuticals, and management of other health problems in pregnancy. The quality of evidence ranged from high to very low. Diet Unknown benefit or harm: there was unknown benefit or harm of dietary advice versus standard care, on the risk of GDM: risk ratio (RR) 0.60, 95% CI 0.35 to 1.04; 5 trials; 1279 women; very low-quality evidence. There was unknown benefit or harm of a low glycaemic index diet versus a moderate-high glycaemic index diet on the risk of GDM: RR 0.91, 95% CI 0.63 to 1.31; 4 trials; 912 women; low-quality evidence. Exercise Unknown benefit or harm: there was unknown benefit or harm for exercise interventions versus standard antenatal care on the risk of GDM: RR 1.10, 95% CI 0.66 to 1.84; 3 trials; 826 women; low-quality evidence. Diet and exercise combined Possible benefit: combined diet and exercise interventions during pregnancy versus standard care possibly reduced the risk of GDM: RR 0.85, 95% CI 0.71 to 1.01; 19 trials; 6633 women; moderate-quality evidence. Dietary supplements Clear evidence of no effect: omega-3 fatty acid supplementation versus none in pregnancy had no effect on the risk of GDM: RR 1.02, 95% CI 0.83 to 1.26; 12 trials; 5235 women; high-quality evidence. Possible benefit: myo-inositol supplementation during pregnancy versus control possibly reduced the risk of GDM: RR 0.43, 95% CI 0.29 to 0.64; 3 trials; 502 women; low-quality evidence. Possible benefit: vitamin D supplementation versus placebo or control in pregnancy possibly reduced the risk of GDM: RR 0.51, 95% CI 0.27 to 0.97; 4 trials; 446 women; low-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of probiotic with dietary intervention versus placebo with dietary intervention (RR 0.37, 95% CI 0.15 to 0.89; 1 trial; 114 women; very low-quality evidence), or probiotic with dietary intervention versus control (RR 0.38, 95% CI 0.16 to 0.92; 1 trial; 111 women; very low-quality evidence) on the risk of GDM. There was unknown benefit or harm of vitamin D + calcium supplementation versus placebo (RR 0.33, 95% CI 0.01 to 7.84; 1 trial; 54 women; very low-quality evidence) or vitamin D + calcium + other minerals versus calcium + other minerals (RR 0.42, 95% CI 0.10 to 1.73; 1 trial; 1298 women; very low-quality evidence) on the risk of GDM. Pharmaceutical Possible benefit: metformin versus placebo given to obese pregnant women possibly reduced the risk of GDM: RR 0.85, 95% CI 0.61 to 1.19; 3 trials; 892 women; moderate-quality evidence. Unknown benefit or harm:eight small trials with low- to very low-quality evidence showed unknown benefit or harm for heparin, aspirin, leukocyte immunisation or IgG given to women with a previous stillbirth on the risk of GDM. Management of other health issues Clear evidence of no effect: universal versus risk based screening of pregnant women for thyroid dysfunction had no effect on the risk of GDM: RR 0.93, 95% CI 0.70 to 1.25; 1 trial; 4516 women; moderate-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of using fractional exhaled nitrogen oxide versus a clinical algorithm to adjust asthma therapy on the risk of GDM: RR 0.74, 95% CI 0.31 to 1.77; 1 trial; 210 women; low-quality evidence. There was unknown benefit or harm of pharmacist led multidisciplinary approach to management of maternal asthma versus standard care on the risk of GDM: RR 5.00, 95% CI 0.25 to 99.82; 1 trial; 58 women; low-quality evidence. AUTHORS' CONCLUSIONS No interventions to prevent GDM in 11 systematic reviews were of clear benefit or harm. A combination of exercise and diet, supplementation with myo-inositol, supplementation with vitamin D and metformin were of possible benefit in reducing the risk of GDM, but further high-quality evidence is needed. Omega-3-fatty acid supplementation and universal screening for thyroid dysfunction did not alter the risk of GDM. There was insufficient high-quality evidence to establish the effect on the risk of GDM of diet or exercise alone, probiotics, vitamin D with calcium or other vitamins and minerals, interventions in pregnancy after a previous stillbirth, and different asthma management strategies in pregnancy. There is a lack of trials investigating the effect of interventions prior to or between pregnancies on risk of GDM.
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Affiliation(s)
- Rebecca J Griffith
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Abigail E Moore
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Stephen Brown
- School of Interprofessional Health Studies, Auckland University of Technology, Auckland, New Zealand
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Emily Shepherd
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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12
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Wang C, Jin L, Tong M, Zhang J, Yu J, Meng W, Jin L. Prevalence of gestational diabetes mellitus and its determinants among pregnant women in Beijing. J Matern Fetal Neonatal Med 2020; 35:1337-1343. [PMID: 32316796 DOI: 10.1080/14767058.2020.1754395] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To investigate the prevalence of gestational diabetes mellitus (GDM) and its determinants among pregnant women in the Tongzhou district of Beijing, China.Methods: This study was performed on data collected in the routine work of the prenatal health care system from 27,119 pregnant women in the Tongzhou district of Beijing during 2013-2018. Univariate and multivariate logistic regression analyses were used to assess the factors associated with GDM.Results: The overall prevalence of GDM was 24.24%, and it showed an increasing trend over the 6 years. A univariate analysis showed that the prevalence of GDM increased with age (p < .001). In multivariate analysis, it was found that women with a non-local household registration, as well as those without a local household registration but whose husbands had one, had a lower risk for GDM than both spouses who had local registration. Women who were overweight/obese had a higher risk for GDM than women with a normal pre-pregnancy body mass index. Multipara women had a lower likelihood of developing GDM.Conclusions: We found a slightly higher prevalence of GDM in the Tongzhou district of Beijing than has been found in other studies, and the prevalence rose over the 6 years of the study. Advanced age, pre-pregnancy overweight or obesity, and local household registration were important risk factors for GDM. Multiparity may be a protective factor against developing GDM. Intensive health education on related determinants should be strengthened for the prevention and control of GDM, especially in high-risk women.
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Affiliation(s)
- Cheng Wang
- Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Institute of Reproductive and Child Health, Peking University, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lei Jin
- Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Mingkun Tong
- Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Institute of Reproductive and Child Health, Peking University, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jie Zhang
- Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Institute of Reproductive and Child Health, Peking University, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jinhui Yu
- Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Institute of Reproductive and Child Health, Peking University, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenying Meng
- Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Lei Jin
- Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Institute of Reproductive and Child Health, Peking University, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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13
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Mensah GP, ten Ham‐Baloyi W, van Rooyen D(R, Jardien‐Baboo S. Guidelines for the nursing management of gestational diabetes mellitus: An integrative literature review. Nurs Open 2020; 7:78-90. [PMID: 31871693 PMCID: PMC6918019 DOI: 10.1002/nop2.324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 12/13/2022] Open
Abstract
Aims and objectives An integrative literature review searched for, selected, appraised, extracted and synthesized data from existing available guidelines on the nursing management of gestational diabetes mellitus as no such analysis has been found. Background Early screening, diagnosis and management of gestational diabetes mellitus are important to prevent or reduce complications during and postpregnancy for both mother and child. A variety of guidelines exists, which assist nurses and midwives in the screening, diagnosis and management of gestational diabetes mellitus. Design An integrative literature review. Methods The review was conducted in June 2018 following an extensive search of available guidelines according to an adaptation of the stages reported by Whittemore and Knafl (2005, Journal of Advanced Nursing, 52, 546). Thus, a five-step process was used, namely formulation of the review question, literature search, critical appraisal of guidelines identified, data extraction and data analysis. All relevant guidelines were subsequently appraised for rigour and quality by two independent reviewers using the AGREE II tool. Content analysis was used analysing the extracted data. Results Following extraction and analysis of data, two major themes were identified from eighteen (N = 18) guidelines. These were the need for early screening and diagnosis of gestational diabetes mellitus and for nursing management of gestational diabetes mellitus (during pregnancy, intra- and postpartum management). Various guidelines on the nursing management of gestational diabetes mellitus were found; however, guidelines were not always comprehensive, sometimes differed in their recommended practices and did not consider a variety of contextual barriers to the implementation of the recommendations. Conclusion Critically, scrutiny of the guidelines is required, both in terms of the best evidence used in their development and in terms of the feasibility of implementation for its context. Relevance to clinical practice This study provides a summary of best practices regarding the diagnosis, screening and nursing management of gestational diabetes mellitus that provide guidance for nurse-midwives on maternal and postpartum follow-up care for women at risk or diagnosed with gestational diabetes mellitus.
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Affiliation(s)
| | | | | | - Sihaam Jardien‐Baboo
- Department of Nursing ScienceNelson Mandela UniversityPort ElizabethSouth Africa
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14
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Mensah GP, van Rooyen DRM, Ten Ham-Baloyi W. Nursing management of gestational diabetes mellitus in Ghana: Perspectives of nurse-midwives and women. Midwifery 2019; 71:19-26. [PMID: 30640135 DOI: 10.1016/j.midw.2019.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/22/2018] [Accepted: 01/02/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is observed in the beginning of, or first acknowledged during pregnancy. The prevalence of GDM is estimated to be approximately 15% globally and is expected to increase due to growing numbers of overweight and obesity in women in their reproductive age. The nursing management of GDM in terms of lifestyle modifications (exercise, diet and nutrition) and the taking of diabetes medication, if required, and adherence thereto is crucial to prevent maternal and neonatal-perinatal complications. This qualitative study therefore aimed to explore and describe the experiences of women regarding the nursing management they received after being diagnosed with GDM; and the perceptions of nurse-midwives on their nursing management of GDM in Ghana. SETTING This study was conducted in the military health institutions in Ghana, which includes one hospital and nine satellite clinics referred to as Medical Reception Stations providing antenatal and postnatal care to both military as well as civilian patients. Research on GDM in Ghana is extremely limited. DESIGN We used a descriptive phenomenological approach to conduct 15 unstructured individual interviews with women that have been diagnosed with GDM (n = 7) and nurse-midwives (n = 8) providing nursing management of GDM during a six months period (December 2014 to May 2015). Audio-recorded data was transcribed, coded and analyzed using an adapted version of Tesch's eight steps for coding. PARTICIPANTS Seven (n = 7) women between 28 and 45 years of age, with 1 to 3 offspring each, participated. Most women (n = 5) did not have a family history of diabetes. The eight (n = 8) nurse-midwives that participated were between 32 and 50 years old with between 2 and 12 years of experience. FINDINGS Participants in this study reported similar issues that could assist in better management of GDM. The majority of participants indicated the need for education on GDM, but both women and nurse-midwives acknowledged that this education is hugely lacking. Participants generally felt that emotional support for women is critical and it was included in the nursing management of GDM. Both groups of participants acknowledged that involving women and their significant others in the nursing management of GDM is important. Cultural and socio-economic issues, such as cultural beliefs that clashed with diabetic diets, lack of financial and social grants and limited nurse-midwifery staff were mentioned by both groups to affect the nursing management of GDM. KEY CONCLUSIONS The results demonstrate that, despite the reported challenges experienced by nurse-midwives and women, it was evident that the aim of nurse-midwives was to manage GDM as optimally as possible for women diagnosed with GDM, while considering the constraints established in the results. The challenges identified, specifically in terms of lack of education and cultural and socio-economic issues that affect the quality of and adherence to the nursing management of GDM, need to be addressed in order to optimize care for women diagnosed with GDM in Ghana. IMPLICATIONS FOR PRACTICE Based on our findings, recommendations are provided that can assist nurse-midwives and other health practitioners to provide comprehensive nursing management to women that have been diagnosed with GDM.
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Affiliation(s)
- Gwendolyn Patience Mensah
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Ghana; Nelson Mandela University, Faculty of Health Sciences, Summerstrand, 6031, Port Elizabeth, South Africa.
| | - Dalena R M van Rooyen
- Nelson Mandela University, Faculty of Health Sciences, Summerstrand, 6031, Port Elizabeth, South Africa
| | - Wilma Ten Ham-Baloyi
- Nelson Mandela University, Faculty of Health Sciences, Summerstrand, 6031, Port Elizabeth, South Africa.
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15
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Carroll X, Liang X, Zhang W, Zhang W, Liu G, Turner N, Leeper-Woodford S. Socioeconomic, environmental and lifestyle factors associated with gestational diabetes mellitus: A matched case-control study in Beijing, China. Sci Rep 2018; 8:8103. [PMID: 29802340 PMCID: PMC5970220 DOI: 10.1038/s41598-018-26412-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/10/2018] [Indexed: 12/19/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a common health problem during pregnancy and its prevalence is increasing globally, especially in China. The aim of this study was to investigate socioeconomic, environmental and lifestyle factors associated with GDM in Chinese women. A matched pair case-control study was conducted with 276 GDM women and 276 non-GDM women in two hospitals in Beijing, China. Matched factors include age and pre-pregnancy body mass index (BMI). GDM subjects were defined based on the International Association of Diabetes Study Group criteria for GDM. A conditional logistic regression model with backward stepwise selection was performed to predict the odds ratio (OR) for associated factors of GDM. The analyses of data show that passive smoking at home (OR = 1.52, p = 0.027), passive smoking in the workplace (OR = 1.71, p = 0.01), and family history of diabetes in first degree relatives (OR = 3.07, p = 0.004), were significant factors associated with GDM in Chinese women. These findings may be utilized as suggestions to decrease the incidence of GDM in Chinese women by improving the national tobacco control policy and introducing public health interventions to focus on the social environment of pregnant women in China.
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Affiliation(s)
- Xianming Carroll
- Department of Community Medicine, Mercer University School of Medicine, Macon, USA
| | - Xianhong Liang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Wenyan Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang District Hospital of Maternal and Child Health, Beijing, China
| | - Wenjing Zhang
- Department of Obstetrics, Beijing Chuiyangliu Hospital, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Nannette Turner
- Department of Public Health, Mercer University College of Health Professions, Atlanta, USA
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16
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Hossain N, Shah T, Rajar S, Sehtoo A, Riaz M, Fawwad A, Basit A. Comparison of venous plasma glucose and capillary whole blood glucose in diagnosis of gestational diabetes: Study from Karachi, Pakistan. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2017. [DOI: 10.1016/j.cegh.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Joseph M, Das Gupta R, Shetty S, Ramachandran R, Antony G, Mathews J, Benjamin S, Anoop S, Rani JV, Thomas N. How Adequate are Macro- and Micronutrient Intake in Pregnant Women with Diabetes Mellitus? A Study from South India. J Obstet Gynaecol India 2017; 68:400-407. [PMID: 30224846 DOI: 10.1007/s13224-017-1069-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. Aim To determine the adequacy of the nutrient intake of pregnant women with diabetes mellitus. Methods This is a cross-sectional study of 85 pregnant women who met the diagnostic inclusion criteria for diabetes mellitus (gestational and pre-gestational diabetes mellitus) and who were being managed at the outpatient clinic of a tertiary care teaching hospital. Their demography, clinical characteristics (from updated medical records), anthropometric measures (using standard procedures), nutrient intake and meal pattern (obtained using 24 h recall, food frequency and their log diaries) were collected. Results The mean age of the group was 29.9 + 4.5 years, 54% were in the second trimester of pregnancy with a mean glycosylated haemoglobin level of 6.3 + 1.4%. The mean BMI indicated that 47% of them were in the obese grade 1 category. Insulin was used in one-third of the population. The overall macronutrient and micronutrient intakes of the population were below the recommended daily allowances for Indians (60-70% of RDA). There was a deficit in the intake of calories, fibre, proteins, iron, calcium, carotene, folic acid, thiamine, riboflavin and niacin. Between the two groups, the pre-GDM women had a significantly better nutrient intake and this could be attributed to a greater exposure to nutrition counselling that they have received during the earlier part of their diabetes care. Conclusion The gestational period should be viewed as a window of opportunity to modify dietary patterns and introduce healthy lifestyle practices for the woman and her family.
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Affiliation(s)
- Mini Joseph
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Riddhi Das Gupta
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Sahana Shetty
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Roshna Ramachandran
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Geethu Antony
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Jiji Mathews
- 2Department of Gynaecology and Obstetrics, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Santhosh Benjamin
- 2Department of Gynaecology and Obstetrics, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Shajith Anoop
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Jansi Vimala Rani
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Nihal Thomas
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
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Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is glucose intolerance first recognized during pregnancy. The objective of this study was to identify the determinant factors of GDM. METHODS An unmatched case-control study was conducted. Descriptive statistics were used to describe the profile of study participants and binary logistic regression was used to identify the determinants of GDM. RESULTS GDM was associated with history of abortion (AOR 5.05 [95% CI: 2.65-9.63]), family history of diabetes mellitus (AOR 8.63 [95% CI: 5.19-14.35]), chronic hypertension (AOR 4.63 [95% CI: 1.27-16.86]), dietary diversification score (AOR 2.96 [95% CI: 2-4.46]), regular physical exercise (AOR 0.03 [95% CI: 0.01-0.04]), history of infertility (AOR 6.19 [95%CI: 1.86-20.16]), history of Caesarean section (AOR 3.24 [95% CI: 1.58-6.63]), previous history of GDM (AOR 8.21 [95% CI: 3.18-21.24]), previous history of intrauterine fetal death (AOR 3.96 [95% CI: 1.56-10.04]), literacy (AOR 0.6 [95% CI: 0.43-0.85]), body mass index (AOR 2.96 [95% CI: 2.08-4.2]), parity (AOR 1.78 [95% CI: 1.3-2.49]). CONCLUSIONS Regular physical exercise should be used as the main tool in preventing GDM.
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Affiliation(s)
- Berhanu Elfu Feleke
- a Department of Epidemiology & Biostatistics , University of Bahir Dar , Bahir Dar , Ethiopia
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19
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Aziz S, Munim TF, Fatima SS. Post-partum follow-up of women with gestational diabetes mellitus: effectiveness, determinants, and barriers. J Matern Fetal Neonatal Med 2017; 31:1607-1612. [PMID: 28423981 DOI: 10.1080/14767058.2017.1321630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite the recommendations for postpartum blood glucose monitoring post gestational diabetes mellitus (GDM); scientific evidence reveals that these recommendations may not be fully complied to. This study aimed to follow-up women up to 2 years post-delivery with pregnancies complicated by GDM and healthy controls to assess this fact. METHODS Women with GDM (n = 78) and normal glucose tolerant (n = 89) delivered in 2014 were followed up for 2 years. They were informed and enquired via telephone about their blood glucose screening, physical activity, postpartum complications, and current weight status of mother and baby. RESULTS Women with previous GDM were older and reported higher body weight 2 years post-delivery. At the 2 year follow-up, n = 11 (14.1%) participants had developed diabetes, all with previous GDM. Both weight at birth (3.8 ± 0.5 kg) and at 2-year (10.7 ± 2.3 kg) for the babies born to GDM mothers was significantly higher than the NGT group babies (2.6 ± 0.63 and 7.1 ± 1.4 kg; p < .05). Only 27 women regularly opted for T2DM screening via monitoring blood glucose or HbA1c levels postpartum. The top reason for failed screening included: believing that GDM would disappear after delivery, and being occupied with the baby. CONCLUSIONS The high incidence of T2DM in women with previous GDM is an alarming finding. Given this trend, systematic follow-up programs are needed to reduce obesity and diabetes risk.
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Affiliation(s)
- Saleha Aziz
- a Medical College, Aga Khan University , Karachi , Pakistan
| | - Tazeen Fatima Munim
- b Department of Obstetrics and Gynecology , Abassi Shaheed Hospital , Karachi , Pakistan
| | - Syeda Sadia Fatima
- c Department of Biological and Biomedical Sciences , Aga Khan University , Karachi , Pakistan
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Lin PC, Hung CH, Chan TF, Lin KC, Hsu YY, Ya-Ling Tzeng. The risk factors for gestational diabetes mellitus: A retrospective study. Midwifery 2016; 42:16-20. [PMID: 27705836 DOI: 10.1016/j.midw.2016.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/15/2016] [Accepted: 09/21/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the risk factors for developing GDM among Taiwanese pregnant women. DESIGN A retrospective cohort and case-control study. SETTING At a medical centre in Southern Taiwan. PARTICIPANTS The hospitalised pregnant women who were diagnosed with either GDM or normal glucose tolerance (NGT) between 1997 and 2011. The glucose tolerance test results were interpreted according to criteria established by the National Diabetes Data Group for GDM. Participants were divided into either a GDM group (case group) or a normal glucose tolerance (NGT) group (control group) in order to determine the risk factors for GDM. MEASUREMENTS With a retrospective chart review, data regarding demographics, a family history of diabetes, history of gestation, and physiological index for pre- and postpregnancy periods were collected. χ2 tests and independent t tests were used to examine the correlations between demographic characteristics and GDM. Stepwise multivariate logistic regression was used to determine the factors associated with GDM. FINDINGS The results of the comparison between the GDM group (n=106) and the NGT group (n=406) showed that the risk factors for GDM were maternal age, education, a family history of diabetes, and prepregnancy body mass index (BMI). KEY CONCLUSION AND IMPLICATION FOR PRACTICE Older age, lower levels of education, a family history of diabetes, and higher prepregnancy BMI were significant risk factors for GDM. In addition to performing risk factor assessment, health care providers should proactively promote the importance of GDM screening to pregnant women at their first antenatal visit.
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Affiliation(s)
- Pei-Chao Lin
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan.
| | - Chich-Hsiu Hung
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan.
| | - Te-Fu Chan
- Department of Obstetrics and Gynecology, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Rd., Kaohsiung City 80756, Taiwan.
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang-Ming University, No. 155, Linong Street Sec. 2, Taipei City 11221, Taiwan.
| | - Yu-Yun Hsu
- Department of Nursing, and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan City, 70101, Taiwan.
| | - Ya-Ling Tzeng
- School of Nursing and Graduate Institute of Nursing, China Medical University, No. 91, Hsueh-Shih Rd., Taichung City 40402, Taiwan.
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Haghighat N, Hu M, Laurent O, Chung J, Nguyen P, Wu J. Comparison of birth certificates and hospital-based birth data on pregnancy complications in Los Angeles and Orange County, California. BMC Pregnancy Childbirth 2016; 16:93. [PMID: 27121857 PMCID: PMC4848813 DOI: 10.1186/s12884-016-0885-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of both gestational diabetes mellitus and preeclampsia is on the rise; however, these pregnancy complications may not be systematically reported. This study aimed to examine differences in reporting of preeclampsia and gestational diabetes between hospital records and birth certificate data, and to determine if such differences vary by maternal socioeconomic status indicators. Methods We obtained over 70,000 birth records from 2001 to 2006 from the perinatal research database of the Memorial Care system, a network of four hospitals in Los Angeles and Orange Counties, California. Memorial birth records were matched to corresponding state birth certificate records and analyzed to determine differential rates of reporting of preeclampsia and diabetes. Additionally, the influence of maternal socioeconomic factors on the reported incidence of such adverse pregnancy outcomes was analyzed. Socioeconomic factors of interest included maternal education levels, race, and type of health insurance (private or public). Results It was found that the birth certificate data significantly underreported the incidence of both preeclampsia (1.38 % vs. 3.13 %) and diabetes (1.97 % vs. 5.56 %) when compared to Memorial data. For both outcomes of interest, the degree of underreporting was significantly higher among women with lower education levels, among Hispanic women compared to Non-Hispanic White women, and among women with public health insurance. Conclusion The Memorial Care database is a more reliable source of information than birth certificate data for analyzing the incidence of preeclampsia and diabetes among women in Los Angeles and Orange Counties, especially for subpopulations of lower socioeconomic status.
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Affiliation(s)
- Nekisa Haghighat
- Program in Public Health, College of Health Sciences, University of California, Anteater Instruction & Research Bldg (AIRB) # 2034, 653 East Peltason Drive, Irvine, CA, 92697-3957, USA
| | - Maogui Hu
- Program in Public Health, College of Health Sciences, University of California, Anteater Instruction & Research Bldg (AIRB) # 2034, 653 East Peltason Drive, Irvine, CA, 92697-3957, USA
| | - Olivier Laurent
- Program in Public Health, College of Health Sciences, University of California, Anteater Instruction & Research Bldg (AIRB) # 2034, 653 East Peltason Drive, Irvine, CA, 92697-3957, USA
| | - Judith Chung
- Maternal-Fetal Medicine, School of Medicine, University of California, Irvine, CA, USA
| | - Peter Nguyen
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Jun Wu
- Program in Public Health, College of Health Sciences, University of California, Anteater Instruction & Research Bldg (AIRB) # 2034, 653 East Peltason Drive, Irvine, CA, 92697-3957, USA.
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