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Han S, Zhang H, He Y, Chen Q. Clinical features of recurrent preeclampsia: a retrospective study of 109 recurrent preeclampsia patients. Hypertens Res 2024; 47:1410-1419. [PMID: 38438723 DOI: 10.1038/s41440-024-01623-9] [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: 11/15/2023] [Revised: 01/03/2024] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Our study aimed to investigate the clinical features of recurrent preeclampsia (rPE) and evaluate the preventive effect of low-dose aspirin (LDA) in rPE. We retrospectively analyzed the data of 109 patients who experienced preeclampsia in two consecutive pregnancies and delivered at Peking University First Hospital from January 2016 to December 2022. We analyzed the pregnancy outcomes of patients with rPE and assessed whether the use of LDA during pregnancy could improve these outcomes. Our results revealed that patients with rPE had a higher body mass index (BMI) and a higher incidence of diabetes during pregnancy compared to their first onset of preeclampsia (29.01 ± 4.70 kg/m2 vs. 27.13 ± 4.25 kg/m2, P < 0.05; 11.01% vs. 1.83%, P < 0.05). Furthermore, the incidence of severe preeclampsia was higher at recurrence in patients with rPE compared to their first onset (83.49% vs. 70.64%, P < 0.05), as well as the incidence of severe preeclampsia with chronic hypertension (34.86% vs. 8.26%, P < 0.05). Additionally, the incidence of gestational diabetes and postpartum hemorrhage was higher in patients with rPE compared to their first preeclampsia onset (25.69% vs. 5.50%, P < 0.05; 20.18% vs. 5.83%, P < 0.05). Compared to the first onset of preeclampsia, patients with rPE had an earlier gestational age at delivery (35.42 ± 3.06 weeks vs. 36.60 ± 2.74 weeks, P < 0.05), lower birth weight of neonates (2478.39 ± 828.44 g vs. 2883.71 ± 712.94 g, P < 0.05), and a higher risk of premature birth (67.00% vs. 47.19%, P < 0.05). However, in patients with rPE, the use of LDA delayed the gestational age at delivery, increased the birth weight of the neonate, reduced the premature birth rate, and increased the perinatal survival rate. In conclusion, patients with rPE are at an increased risk of adverse maternal and fetal outcomes. However, the use of LDA during pregnancy effectively improves these outcomes.
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Affiliation(s)
- Shujie Han
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, PR China
| | - Hui Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, PR China
- Department of Obstetrics and Gynecology, The First People' s Hospital of Da tong, Datong, Shanxi, PR China
| | - Yingdong He
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, PR China.
| | - Qian Chen
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, PR China
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Abu Shqara R, Nakhleh Francis Y, Or S, Lowenstein L, Frank Wolf M. Obstetrical Outcome following Diagnosis of Gestational Diabetes in the Third Trimester (>29 Weeks) versus Second Trimester (24-28 Weeks): A Retrospective Comparative Study. Am J Perinatol 2024; 41:e1053-e1060. [PMID: 36543240 DOI: 10.1055/s-0042-1759865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to compare obstetrical outcomes between women diagnosed with gestational diabetes mellitus (GDM) in the third trimester after testing negative for GDM in two-step screening in the second trimester and women diagnosed in the second trimester. STUDY DESIGN This retrospective study compared obstetrical outcomes between 375 women diagnosed with GDM in the second trimester and 125 diagnosed in the third trimester. RESULTS Among women diagnosed with GDM in the third versus second trimester, the incidences were higher of morbid obesity (body mass index ≥35 kg/m2), macrosomia, and cesarean section (CS) due to suspected macrosomia: 23.2 versus 9.8%, p < 0.001; 44.0 versus 10.1%, p < 0.001; and 24.8 versus 6.3%, p < 0.001, respectively. For those diagnosed in the third versus second trimester, the incidences were lower of hypertensive disorders of pregnancy and intrauterine growth restriction, and a lower proportion of women needed pharmacological therapy for glucose control: 2.4 versus 9.0%, p = 0.016; 0.8 versus 8.2%, p < 0.001; and 12.0 versus 29.7%, p < 0.001, respectively. Multivariate analysis supported a correlation between third-trimester-diagnosed GDM and macrosomia, and between second-trimester-diagnosed GDM and hypertensive disorders of pregnancy. CONCLUSION Among women diagnosed with GDM in the third compared with the second trimester, the incidence of morbid obesity was higher; accordingly, the risks were higher for large for gestational age infants and delivery by CS, and lower for hypertensive disorders. Guidelines regarding repeat oral glucose tolerance testing in the third trimester should be considered following prospective studies. KEY POINTS · Third-trimester GDM was 29.9% among women with normal second-trimester screening.. · Morbid obesity and macrosomia were more frequent in third- versus second-trimester GDM.. · Incidence of preeclampsia was lower in third- versus second-trimester-diagnosed GDM..
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Affiliation(s)
- Raneen Abu Shqara
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Obstetrics and Gynecology, the Azrieli faculty of medicine, Bar Ilan university, Safed, Israel
| | - Yara Nakhleh Francis
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Obstetrics and Gynecology, the Azrieli faculty of medicine, Bar Ilan university, Safed, Israel
| | - Shany Or
- Obstetrics and Gynecology, the Azrieli faculty of medicine, Bar Ilan university, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Obstetrics and Gynecology, the Azrieli faculty of medicine, Bar Ilan university, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Obstetrics and Gynecology, the Azrieli faculty of medicine, Bar Ilan university, Safed, Israel
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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.
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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
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Yang X, QimeiZhong, Huang M, Li L, Tang C, Luo S, Wang L, Qi H. Causal relationship between gestational diabetes and preeclampsia: A bidirectional mendelian randomization analysis. Diabetes Res Clin Pract 2024; 210:111643. [PMID: 38548111 DOI: 10.1016/j.diabres.2024.111643] [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: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
AIMS The study aimed to explore the potential causal link between gestational diabetes mellitus (GDM) and preeclampsia (PE) using a bidirectional mendelian randomization (MR) analysis. MATERIALS We conducted a bidirectional MR analysis to investigate the causal relationship between GDM and PE. Data from public genome-wide association studies (GWAS) for GDM and PE were obtained from the FinnGen consortium. Various MR methods were employed, including inverse-variance weighted (IVW), MR-Egger, and sensitivity analyses. Additionally, a knowledge-based approach identified genes underlying this potential connection. RESULTS The IVW method revealed a lack of significant association between GDM and PE (OR: 1.04, 95 % CI: 0.96-1.14; p = 0.275). Conversely, IVW analysis indicated a causal connection from PE to GDM (OR: 1.14, 95 % CI: 1.06-1.23; p < 0.001). Molecular pathway analysis identified 20 key genes, including ASAP2, central to the PE-GDM relationship. Tissue enrichment analysis showed pertinent gene expression in significant tissues. Moreover, lower ASAP2 expression was detected in PE patients' placentas. CONCLUSIONS Our bidirectional MR analysis offers evidence supporting a causal link between PE and GDM, elucidating their interconnected pathogenesis. Genetic and knowledge-based insights facilitate a deeper comprehension of these complex pregnancy complications.
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Affiliation(s)
- Xiaofeng Yang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China; Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - QimeiZhong
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China; Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Mengwei Huang
- Department of Obstetrics and Gynecology, Chengdu First People 's Hospital, No.18 Wanxiang North Road, Chengdu High-tech Zone, Sichuan Province 610095, China
| | - Li Li
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China; Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Chunyan Tang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China; Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Shujuan Luo
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China; Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Lan Wang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China; Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China.
| | - Hongbo Qi
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China; Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China.
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Kim C, Cathey AL, Watkins DJ, Mukherjee B, Rosario-Pabón ZY, Vélez-Vega CM, Alshawabkeh AN, Cordero JF, Meeker JD. Adverse birth outcomes are associated with circulating matrix metalloproteinases among pregnant women in Puerto Rico. J Reprod Immunol 2023; 159:103991. [PMID: 37454540 PMCID: PMC10726844 DOI: 10.1016/j.jri.2023.103991] [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: 10/07/2022] [Revised: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
Matrix metalloproteinases (MMPs) are major extracellular matrix (ECM) remodeling proteinases and regulate uterine remodeling, which is a critical process for healthy pregnancies. The goal of this study was to investigate associations between maternal blood MMPs during pregnancy and birth outcomes among 898 pregnant women in the Puerto Rico PROTECT birth cohort. MMPs (MMP1, MMP2, and MMP9) were quantified using a customized Luminex assay in blood samples collected at two gestational study visits (around 18 and 26 weeks gestation). Linear and logistic regression models were used to regress continuous and binary birth outcomes, respectively, on MMPs at each study visit separately. Sensitivity analyses were conducted to test for effect modification by fetal sex on associations between MMPs and birth outcomes. We observed significant associations between MMP2 at visit 1 and newborn length that were in the opposite direction from the associations between MMP9 at visit 3 and newborn length. MMPs were associated with increased odds of preeclampsia and gestational diabetes mellitus, though case numbers were low. We also observed significant inverse associations with gestational age for MMP9 and MMP2 at visit 1 and visit 3, respectively, and these associations were observed only in mothers carrying male fetuses. Further, MMP2 was associated with heavier female fetuses, whereas MMP9 was associated with lighter female fetuses. We observed significant associations between birth outcomes and MMPs, and the majority of these associations differed by fetal sex. This study highlighted significant MMPs-birth outcomes associations that may provide a basis to explore the impact of MMPs on endometrium health and physiology.
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Affiliation(s)
- Christine Kim
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI, United States
| | - Amber L Cathey
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI, United States
| | - Deborah J Watkins
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI, United States
| | - Bhramar Mukherjee
- University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, MI, United States
| | - Zaira Y Rosario-Pabón
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Carmen M Vélez-Vega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | | | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - John D Meeker
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI, United States.
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Lara-Barea A, Sánchez-Lechuga B, Aguilar-Diosdado M, López-Tinoco C. Higher daytime systolic BP, prepregnancy BMI and an elevated sFlt-1/PlGF ratio predict the development of hypertension in normotensive pregnant women. Reprod Biol Endocrinol 2022; 20:175. [PMID: 36564806 PMCID: PMC9783759 DOI: 10.1186/s12958-022-01050-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The risk of hypertensive disorders of pregnancy (HDP) varies in women with gestational diabetes mellitus (GDM), depending on the degree of insulin resistance and is also influenced by obesity. The aim of this study was to evaluate clinical features, blood pressure (BP) profiles and inflammatory markers, to identify patients with an elevated risk of developing HDP. METHODS A total of 146 normotensive pregnant women were studied. We analysed the relationships of BP profiles detected by ambulatory blood pressure monitoring (ABPM) with serum biomarkers and angiogenic factors and their association with the development of HDP. RESULTS Fourteen (9.6%) women developed HDP, of which 11 had GDM and 8 had obesity. Women with HDP had higher values of 24-h and daytime systolic/diastolic BP (113/69 vs. 104/64; 115/72 vs. 106/66 mmHg, respectively; p < 0.05). Higher levels of leptin (10.97 ± 0.82 vs. 10.2 ± 1.11; p = 0.018) andmonocyte chemoattractant protein-1 (MCP-1) (5.24 ± 0.60 vs. 4.9 ± 0.55; p = 0.044) and a higher soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio (4.37 ± 2.2 vs. 2.2 ± 1.43; p = 0.003) were also observed in the HDP patients. Multivariate analysis showed that a higher sFlt-1/PlGF ratio was associated with an increased risk of developing HDP [OR = 2.02; IC 95%: 1.35-3.05]. Furthermore, higher daytime systolic BP [OR = 1.27; IC 95% 1.00-1.26] and prepregnancy body mass index (BMI) [OR = 1.14; IC 95%: 1.01-1.30] significantly increased the risk of developing HDP. CONCLUSIONS Higher daytime systolic BP values, prepregnancy BMI and the sFlt-1/PlGF ratio are useful for identifying normotensive pregnant women with an increased risk of developing HDP.
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Affiliation(s)
- Almudena Lara-Barea
- Department of Endocrinology and Nutrition, Puerta del Mar Hospital, 11009 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar Hospital, 11009 Cádiz, Spain
| | | | - Manuel Aguilar-Diosdado
- Department of Endocrinology and Nutrition, Puerta del Mar Hospital, 11009 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar Hospital, 11009 Cádiz, Spain
- Department of Medicine, Cadiz University (UCA), 11003 Cádiz, Spain
| | - Cristina López-Tinoco
- Department of Endocrinology and Nutrition, Puerta del Mar Hospital, 11009 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar Hospital, 11009 Cádiz, Spain
- Department of Medicine, Cadiz University (UCA), 11003 Cádiz, Spain
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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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8
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Yang Y, Wu N. Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors. Front Cardiovasc Med 2022; 9:831297. [PMID: 35252402 PMCID: PMC8889031 DOI: 10.3389/fcvm.2022.831297] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) and preeclampsia (PE) are common pregnancy complications with similar risk factors and pathophysiological changes. Evidence from previous studies suggests that the incidence of PE is significantly increased in women with GDM, but whether GDM is independently related to the occurrence of PE has remained controversial. GDM complicated by PE further increases perinatal adverse events with greater impact on the future maternal and offspring health. Identify factors associated with PE in women with GDM women, specifically those that are controllable, is important for improving pregnancy outcomes. This paper provides the findings of a review on the correlation between GDM and PE, factors associated with PE in women with GDM, possible mechanisms, and predictive markers. Most studies concluded that GDM is independently associated with PE in singleton pregnancy, and optimizing the treatment and management of GDM can reduce the incidence of PE, which is very helpful to improve pregnancy outcomes.
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Affiliation(s)
- Ying Yang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Na Wu
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Broni EK, Ndumele CE, Echouffo-Tcheugui JB, Kalyani RR, Bennett WL, Michos ED. The Diabetes-Cardiovascular Connection in Women: Understanding the Known Risks, Outcomes, and Implications for Care. Curr Diab Rep 2022; 22:11-25. [PMID: 35157237 DOI: 10.1007/s11892-021-01444-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) complications constitute about 50-70% of mortality in people with diabetes. However, there remains a persistently greater relative increase in CVD morbidity and mortality in women with diabetes than in their male counterparts. This review presents recent evidence for the risks, outcomes, and management implications for women with diabetes. RECENT FINDINGS Compared to men, women have higher BMI and more adverse cardiovascular risk profile at time of diabetes diagnosis with greater risk for coronary heart disease, stroke, vascular dementia, and heart failure. Pregnancy-specific risk factors of gestational diabetes and pre-eclampsia are associated with future type 2 diabetes (T2D) and CVD. Women with T2D may experience greater benefits than men from GLP-1 receptor agonists. Women with diabetes are at greater relative risk for CVD complications than men, with poorer outcomes, superimposed on preexisting gender disparities in social determinants of health, lower likelihood of being offered cardioprotective interventions, and enrollment in trials. Further research and the utilization of SGLT-2 inhibitors, GLP-1 receptor agonists, and other CVD prevention strategies will help reduce morbidity and mortality.
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Affiliation(s)
- Eric K Broni
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chiadi E Ndumele
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Rita R Kalyani
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Abstract
OBJECTIVE This study aimed to compare maternal and neonatal outcomes in women with severe preeclampsia before and after implementation of the American College of Obstetricians and Gynecologists (ACOG) taskforce hypertensive guidelines. STUDY DESIGN Single-center retrospective cohort study of women with severe preeclampsia delivering live nonanomalous singletons 23 to 342/7 weeks from 2013 to 2017. In 2015, the ACOG guidelines for expectant management of severe preeclampsia were implemented at our institution. Based on this, patients were categorized as preguideline (January 2013-December 2015) or postguideline adoption (January 2016-December 2017). Primary outcomes included composite maternal morbidity and composite neonatal morbidity; secondary outcomes included composite components, length of stay, birth weight, and delivery gestational age. Groups were compared with Student's t-test, Chi-square, and Wilcoxon's rank-sum tests; adjusted odds ratios (aOR; 95% confidence intervals [CIs]) were calculated. Yearly composite outcomes were compared using the Cochran-Armitage trend test. We estimated a sample size of 250 per group would provide 80% power at α = 0.05 to detect a 50% reduction in neonatal morbidity from a baseline rate of 21.5%. RESULTS From 2013 to 2017, a total of 543 women with severe preeclampsia were identified: 278 (51%) preguideline and 265 (49%) postguideline. Baseline characteristics were overall similar between groups. There were no significant differences in maternal (aOR = 0.96, 95% CI: 0.6-1.41) or neonatal (aOR = 0.88, 95% CI: 0.61-1.28) composite morbidity between groups. Furthermore, there were no differences in composite maternal or neonatal morbidity over time. CONCLUSION Perinatal outcomes were similar before and after implementation of severe preeclampsia management guidelines at our institution. Studies to evaluate if benefits are limited to subsets of this population, such as earlier gestational ages, are needed. KEY POINTS · Expectant management of severe preeclampsia has yet to be fully evaluated outside of trial conditions.. · We did not see a significant improvement in neonatal composite morbidity/mortality.. · We also did not see a worsened composite maternal morbidity/mortality..
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Naicker T, Padayachee S, Govender N. Gestational diabetes mellitus and preeclampsia: An increased risk to COVID-19? ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_288_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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12
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Insulin-mediated immune dysfunction in the development of preeclampsia. J Mol Med (Berl) 2021; 99:889-897. [PMID: 33768298 DOI: 10.1007/s00109-021-02068-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 02/08/2023]
Abstract
Epidemiological observations implicate insulin resistance as a predisposing factor in the development of preeclampsia (PE). It is also well established that PE manifests in the context of a dysregulated immune response at the maternal-foetal interface, though all the underlying drivers of such immune dysregulation remains to be accounted for. Although it has long been known that various immune cells express insulin receptors following immune activation, it is only recently that insulin signalling has been shown to play a key role in immune cell differentiation, survival and effector function through its canonical activation of the PI3K/Akt/mTOR pathway. Here we argue that hyperinsulinemia, manifesting either from insulin resistance or from intensive insulin therapy, likely plays a direct role in driving immune cell dysfunction which plays a central role in the development of PE. This line of reasoning also explains the superior results of insulin-sparing interventions compared to intensive insulin therapy as monotherapy.
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Yoles I, Sheiner E, Wainstock T. First pregnancy risk factors and future gestational diabetes mellitus. Arch Gynecol Obstet 2021; 304:929-934. [PMID: 33811260 DOI: 10.1007/s00404-021-06024-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/11/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) affect about 17% of all pregnancies and is associated with significant short- and long-term health consequences for the mother and her offspring. Early diagnosis and prompt interventions may reduce these adverse outcomes. We aimed to identify first pregnancy characteristics as risk factors for GDM in subsequent pregnancy. MATERIALS AND METHODS A population-based nested case-control study was conducted in a large tertiary hospital. The study population included all women with two singleton consecutive pregnancies and deliveries, without GDM in the first pregnancy. Characteristics and complications of the first pregnancy were compared among cases and controls. A multivariable logistic regression model was used to study the association between pregnancy complications (in the first pregnancy) and GDM in the subsequent pregnancy, while adjusting for confounding variables. RESULTS A total of 38,750 women were included in the study, of them 1.9% (n = 728) had GDM in their second pregnancy. Mothers with GDM in their second pregnancy were more likely to have the following first pregnancy complications: hypertensive disorders, perinatal mortality, maternal obesity and fetal macrosomia. Results remained significant after adjustment for maternal age and inter-pregnancy interval. Having either one of the complications increased the risk for GDM by 2.33 (adjusted OR = 2.33; 95% CI 1.93-2.82) while a combination of two complications increased GDM risk by 5.38 (adjusted OR = 5.38; 95% CI 2.85-10.17). CONCLUSIONS First pregnancy without GDM complicated by hypertensive disorders, perinatal mortality, maternal obesity and fetal macrosomia was associated with an increased risk for GDM in the subsequent pregnancy. Women with these complications may benefit from early detection of GDM in their subsequent pregnancy.
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Affiliation(s)
- Israel Yoles
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Clalit Health Services, The Central District, 30 Hertzl St., Rishon Le Tzion, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Bojnordi TE, Hantoushzadeh S, Sabzevary M, Heidari Z. A case-control study to predict the risk of gestational diabetes mellitus by initial fasting blood sugar or past gestational history. Int J Reprod Biomed 2021; 19:381-390. [PMID: 33997597 PMCID: PMC8106815 DOI: 10.18502/ijrm.v19i4.9064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/11/2020] [Accepted: 09/21/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) deserves proper prevention, diagnosis, and management due to healthcare implications from both maternal and fetal concerns. OBJECTIVE To evaluate the rate and investigate the risk factors for developing GDM. MATERIALS AND METHODS In this case-control, universal screening for GDM between 24 and 28 wk of gestation was performed in 613 pregnant women attending a prenatal clinic in Tehran who were followed-up until delivery between March 2017 to March 2018. Of the 613 women, 143 had GDM and 470 had normal glucose tolerance test as the primary diagnosis. Some GDM risk factors were compared in two groups. RESULTS Impaired glucose tolerance test was detected in 143 (23.3%) patients. Prevalence of GDM was higher in the first-trimester fasting blood sugar (FBS) > 90 qmg/dl group (p < 0.001). Comparison of the GDM and the normal glucose tolerance test groups demonstrated significant differences in maternal age, first-trimester FBS, third-trimester vitamin D level, maternal platelet count, maternal body mass index (BMI) (before 12 wk of gestation), weight gain during pregnancy, and the history of gestational complications in previous pregnancy (p < 0.01). In logistic regression, GDM was independently associated with older maternal age, higher first-trimester FBS, the history of gestational complications in previous pregnancy, lower third-trimester vitamin D level, and higher maternal platelet count (p < 0.01). CONCLUSION Both patients with higher initial FBS and the history of gestational complications in previous pregnancy should be considered high risk for GDM and screened earlier.
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Affiliation(s)
- Tahmineh Ezazi Bojnordi
- Department of Obstetrics and Gynecology, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Department of Gynecology and Obstetrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masomeh Sabzevary
- Department of Gynecology and Obstetrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Histology, Genetic of Non-communicable Diseases Research Center, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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An association study between MiR-146a and INSR gene polymorphisms and hypertensive disorders of pregnancy in Northeastern Han Chinese population. Placenta 2020; 104:94-101. [PMID: 33310299 DOI: 10.1016/j.placenta.2020.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy(HDP) is a complex and challenging group of pregnancy complications that is one of the leading causes of maternal and fetal death worldwide. Recent studies have shown that the single nucleotide polymorphism(SNP) may play a role in the pathogenesis of HDP. This study aimed to investigate the association of MiR-146a rs2910164 and insulin receptor(INSR) rs2059806 SNPs with HDP and their associated complications in the Han population of Northeast China. METHODS A total of 240 HDP patients and 380 healthy controls were selected for genotype determination. For the most special and high incidence of HDP, we also studied the SNPs in association with pre-eclampsia(PE) patients. In addition, HDP complicated with gestational diabetes mellitus(GDM) patients was further analyzed to identify the association between SNPs and HDP-related complications. Multivariate logical regression analysis combined with 10, 000 permutation test corrections was used to analyze the association of MiR-146a and INSR SNPs with HDP. RESULTS After adjusting for relevant factors, MiR-146a rs2910164 or INSR rs2059806 SNPs were not significantly different between HDP or PE patients and healthy controls(P>0.05). Meanwhile, MiR146a rs2910164 and INSR rs2059806 SNPs were not significantly different between HDP complicated with GDM and control group. DISCUSSION Our data indicates that MiR-146a rs2910164 and INSR rs2059806 SNPs may not be significantly related with HDP in the Han population of Northeast China living in Heilongjiang Province.
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Alejandro EU, Mamerto TP, Chung G, Villavieja A, Gaus NL, Morgan E, Pineda-Cortel MRB. Gestational Diabetes Mellitus: A Harbinger of the Vicious Cycle of Diabetes. Int J Mol Sci 2020; 21:E5003. [PMID: 32679915 PMCID: PMC7404253 DOI: 10.3390/ijms21145003] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM), characterized by a transitory form of diabetes induced by insulin resistance and pancreatic β-cell dysfunction during pregnancy, has been identified as one of the major obstacles in achieving improved maternal and child health. Approximately 9-25% of pregnancies worldwide are impacted by the acute, long-term, and transgenerational health complications of this disease. Here, we discuss how GDM affects longstanding maternal and neonatal outcomes, as well as health risks that likely persist into future generations. In addition to the current challenges in the management and diagnosis of and the complications associated with GDM, we discuss current preclinical models of GDM to better understand the underlying pathophysiology of the disease and the timely need to increase our scientific toolbox to identify strategies to prevent and treat GDM, thereby advancing clinical care.
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Affiliation(s)
- Emilyn U. Alejandro
- Department of Integrative Biology and Physiology, Medical School, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Therriz P. Mamerto
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila 1015, Philippines; (T.P.M.); (A.V.)
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines;
| | - Grace Chung
- Department of Integrative Biology and Physiology, Medical School, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Adrian Villavieja
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila 1015, Philippines; (T.P.M.); (A.V.)
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines;
| | - Nawirah Lumna Gaus
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines;
| | - Elizabeth Morgan
- Baystate Medical Center, Baystate Health, Springfield, MA 01199, USA;
| | - Maria Ruth B. Pineda-Cortel
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila 1015, Philippines; (T.P.M.); (A.V.)
- The Graduate School, University of Santo Tomas, Manila 1015, Philippines;
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila 1015, Philippines
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Beysel S, Pinarli FA, Eyerci N, Kizilgul M, Hepsen S, Alhan A, Kan S, Caliskan M, Bozkurt E, Cakal E. HNF1A gene p.I27L is associated with co-existing preeclampsia in gestational diabetes mellitus. Gynecol Endocrinol 2020; 36:530-534. [PMID: 31825269 DOI: 10.1080/09513590.2019.1698023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The association of the FTO gene and HNF1α gene on gestational diabetes mellitus (GDM) and preeclampsia remains unclear. This is the first study to examine whether HNF1α gene and FTO gene were associated with having GDM and preeclampsia in Turkish women. Healthy pregnant women (n = 101) and women with GDM (n = 169) were included. GDM was divided into two groups as GDM-only (n = 90) and GDM-preeclampsia (n = 79). Genotyping of HNF1α gene p.I27L, p.A98V, and p.S487N, and FTO gene rs9939609 SNPs were performed using RT-PCR. The frequency of p.S487N, p.A98V, and FTO genotype were similar between the groups (p > .05). p.I27L GG-wild, GT, and TT genotype were 56.5%, 36.6%, and 6.9% in controls; 40.0%, 51.1%, and 8.9% in GDM-only; and 26.6%, 51.9%, and 21.5% in GDM-preeclampsia (p = .034). TT and GT genotype was more frequent in GDM-preeclampsia than in controls (p < .05). GT genotype was increased in GDM-only compared with controls (p < .05). TT genotype was more frequent in GDM-preeclampsia than in GDM-only (p < .05). p.I27L TT genotype was independently associated with increased blood pressure (BP) and urinary protein. p.I27L TT genotype was associated with increased preeclampsia risk in patients with GDM by increasing BP and urinary protein.
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Affiliation(s)
- Selvihan Beysel
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
- Department of Medical Biology, Baskent University, Ankara, Turkey
| | - Ferda Alparslan Pinarli
- Department of Genetic Research, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Nilnur Eyerci
- Department of Genetic Research, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Sema Hepsen
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Ali Alhan
- Department of Obstetrics and Gynecology, Eskisehir State Hospital, Eskisehir, Turkey
| | - Seyfullah Kan
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Mustafa Caliskan
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Erhan Bozkurt
- Department of İnternal Medicine, Afyonkarahisar Saglik Bilimleri University, Afyon, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
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McElwain CJ, Tuboly E, McCarthy FP, McCarthy CM. Mechanisms of Endothelial Dysfunction in Pre-eclampsia and Gestational Diabetes Mellitus: Windows Into Future Cardiometabolic Health? Front Endocrinol (Lausanne) 2020; 11:655. [PMID: 33042016 PMCID: PMC7516342 DOI: 10.3389/fendo.2020.00655] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022] Open
Abstract
Placental insufficiency and adipose tissue dysregulation are postulated to play key roles in the pathophysiology of both pre-eclampsia (PE) and gestational diabetes mellitus (GDM). A dysfunctional release of deleterious signaling motifs can offset an increase in circulating oxidative stressors, pro-inflammatory factors and various cytokines. It has been previously postulated that endothelial dysfunction, instigated by signaling from endocrine organs such as the placenta and adipose tissue, may be a key mediator of the vasculopathy that is evident in both adverse obstetric complications. These signaling pathways also have significant effects on long term maternal cardiometabolic health outcomes, specifically cardiovascular disease, hypertension, and type II diabetes. Recent studies have noted that both PE and GDM are strongly associated with lower maternal flow-mediated dilation, however the exact pathways which link endothelial dysfunction to clinical outcomes in these complications remains in question. The current diagnostic regimen for both PE and GDM lacks specificity and consistency in relation to clinical guidelines. Furthermore, current therapeutic options rely largely on clinical symptom control such as antihypertensives and insulin therapy, rather than that of early intervention or prophylaxis. A better understanding of the pathogenic origin of these obstetric complications will allow for more targeted therapeutic interventions. In this review we will explore the complex signaling relationship between the placenta and adipose tissue in PE and GDM and investigate how these intricate pathways affect maternal endothelial function and, hence, play a role in acute pathophysiology and the development of future chronic maternal health outcomes.
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Affiliation(s)
- Colm J. McElwain
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland
- *Correspondence: Colm J. McElwain
| | - Eszter Tuboly
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland
| | - Fergus P. McCarthy
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Cathal M. McCarthy
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland
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Garmendia ML, Mondschein S, Montiel B, Kusanovic JP. Trends and predictors of gestational diabetes mellitus in Chile. Int J Gynaecol Obstet 2019; 148:210-218. [PMID: 31671205 DOI: 10.1002/ijgo.13023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/04/2019] [Accepted: 10/30/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the temporal trends in gestational diabetes mellitus (GDM) prevalence in Chile, and to determine the main predictors of GDM. METHODS A secondary analysis was conducted of all birth records at Hospital Dr. Sótero del Río, Chile, from January 1, 2002, to December 31, 2015. We excluded those women with pre-existing type 2 diabetes, those with missing data, and those with unlikely data. GDM was defined as fasting glucose levels >5.55 mmol/L [>100 mg/dL] or >7.77 mmol/L [>140 mg/dL] 2 hours after glucose load in the oral glucose tolerance test. Potential predictors were selected based on prior research and ease of evaluation. RESULTS From the original database of 100 758 records, 86 362 women were included in the final cohort. The mean GDM prevalence was 7.6% (95% CI [confidence interval] 7.5%-7.8%), increasing from 4.4% (95% CI 4.0%-4.9%) in 2002 to 13.0% (95% CI 12.0%-13.9%) in 2015. Age, education, marital status, parity, family history of type 2 diabetes, personal history of GDM, hypertension and pre-eclampsia, alcohol consumption, smoking, and pre-gestational nutritional status performed well in the prediction of GDM. CONCLUSION One out of eight Chilean pregnant women of medium- to low socio-economic status were found to develop GDM. We identified a set of easy-to-capture predictors in the primary health care system that may allow for the early identification of women at high-risk for the development of GDM.
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Affiliation(s)
- María L Garmendia
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Susana Mondschein
- School of Engineering and Sciences, Adolfo Ibáñez University, Santiago, Chile
| | - Braulio Montiel
- School of Engineering and Sciences, Adolfo Ibáñez University, Santiago, Chile
| | - Juan P Kusanovic
- High Risk Pregnancy Unit, Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Dr. Sótero del Río, Santiago, Chile.,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Narvaez-Sanchez R, Calderón JC, Vega G, Trillos MC, Ospina S. Skeletal muscle as a protagonist in the pregnancy metabolic syndrome. Med Hypotheses 2019; 126:26-37. [PMID: 31010495 DOI: 10.1016/j.mehy.2019.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
The pregnant woman normally shows clinical manifestations similar to a metabolic syndrome (MS), due to her metabolic and hemodynamic adaptations in order to share nutrients with the child. If those adjustments are surpassed, a kind of pregnancy MS (PregMS) could appear, characterized by excessive insulin resistance and vascular maladaptation. Skeletal muscle (SKM) must be a protagonist in the PregMS: SKM strength and mass have been associated inversely with MS incidence in non-pregnant patients, and in pregnant women muscular activity modulates metabolic and vascular adaptations that favor better outcomes. Of note, a sedentary lifestyle affects exactly in the other way. Those effects may be explained not only by the old paradigm of SKM being a great energy consumer and store, but because it is an endocrine organ whose chronic activity or deconditioning correspondingly releases myokines modulating insulin sensitivity and cardiovascular adaptation, by direct or indirect mechanisms not well understood. In this document, we present evidence to support the concept of a PregMS and hypothesize on the role of the SKM mass, fiber types composition and myokines in its pathophysiology. Also, we discuss some exercise interventions in pregnancy as a way to test our hypotheses.
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Affiliation(s)
- Raul Narvaez-Sanchez
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Red iberoamericana de trastornos vasculares y del embarazo, RIVATREM, Colombia.
| | - Juan C Calderón
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Gloria Vega
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Maria Camila Trillos
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Sara Ospina
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
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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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Abo-Elmatty DM, Mehanna ET. MIR146A rs2910164 (G/C) Polymorphism is Associated with Incidence of Preeclampsia in Gestational Diabetes Patients. Biochem Genet 2018; 57:222-233. [PMID: 30121885 DOI: 10.1007/s10528-018-9886-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/12/2018] [Indexed: 12/21/2022]
Abstract
Preeclampsia and gestational diabetes are common pregnancy disorders that may be interrelated. MIR146A rs2910164 (G/C) is a functional polymorphism that was associated with several diseases. This study aimed to investigate the frequency of rs2910164 polymorphism and its possible correlation with the incidence of preeclampsia in gestational diabetes patients. The study involved 250 pregnant women divided into 80 healthy control subjects, 85 gestational diabetes patients only, and 85 patients of gestational diabetes combined with preeclampsia. Systolic and diastolic blood pressures, urinary proteins, kidney and liver functions, glucose homeostasis parameters, and lipid profile were determined. Genotyping of the polymorphism was conducted by PCR-RFLP. The frequency of the minor C allele of rs2910164 polymorphism was significantly higher among patients of gestational diabetes combined with preeclampsia compared to the control group (p = 0.012) and the gestational diabetes group (p = 0.014). Patients of gestational diabetes and preeclampsia carrying CC genotype showed higher systolic and diastolic blood pressure, and increased urea, creatinine, urine protein, and dyslipidemia compared to the carriers of GG and GC genotypes. In conclusion, the results of the current study suggest that the rare CC genotype of MIR146A rs2910164 (G/C) polymorphism may be related to increased incidence of preeclampsia in gestational diabetes patients.
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Affiliation(s)
- Dina M Abo-Elmatty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522, Egypt
| | - Eman T Mehanna
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522, Egypt.
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23
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Liu XN, Pang J. A retrospective study of supplemental iron intake in singleton pregnancy women with risk of developing gestational diabetes mellitus. Medicine (Baltimore) 2018; 97:e10819. [PMID: 29952938 PMCID: PMC6039617 DOI: 10.1097/md.0000000000010819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This study investigated the effect of supplemental iron intake (SII) in early singleton pregnancy women with the risk of developing gestational diabetes mellitus (GDM) among Chinese population.This study included 259 singleton pregnancy participants. Of those, 135 women underwent SII and were assigned to an intervention group, while 124 participants received no SII and were assigned to a control group. The outcome measurements consisted of the number of patients with GDM development, the levels of hemoglobin (Hb) and ferritin, and the outcomes of infant at delivery.No significant difference in the number of patients with GDM development was found between 2 groups at delivery. However, when compared with control group, subjects in the intervention group showed greater efficacy in delivery mode choice of vaginal delivery (P = .04), and cesarean section (P = .01), as well as the birthweight of infants (P < .01). Moreover, Hb and ferritin levels were also significantly higher in the intervention group than those in the control group (P < .01).The results of this retrospective study showed that SII may not increase risk of developing GDM in singleton pregnancy women; and also may benefit both pregnancy women and infants among Chinese population.
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Affiliation(s)
- Xiao-ni Liu
- Department of Endocrinology, The People's Hospital of Yan’an
| | - Jing Pang
- Department of Endocrinology, Affiliated Hospital of Yan’an University, Yan’an, China
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24
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Vokalova L, van Breda SV, Ye XL, Huhn EA, Than NG, Hasler P, Lapaire O, Hoesli I, Rossi SW, Hahn S. Excessive Neutrophil Activity in Gestational Diabetes Mellitus: Could It Contribute to the Development of Preeclampsia? Front Endocrinol (Lausanne) 2018; 9:542. [PMID: 30298053 PMCID: PMC6161643 DOI: 10.3389/fendo.2018.00542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
Gestational diabetes mellitus is a transient form of glucose intolerance occurring during pregnancy. Pregnancies affected by gestational diabetes mellitus are at risk for the development of preeclampsia, a severe life threatening condition, associated with significant feto-maternal morbidity and mortality. It is a risk factor for long-term health in women and their offspring. Pregnancy has been shown to be associated with a subliminal degree of neutrophil activation and tightly regulated generation of neutrophil extracellular traps (NETs). This response is excessive in cases with preeclampsia, leading to the presence of large numbers of NETs in affected placentae. We have recently observed that circulatory neutrophils in cases with gestational diabetes mellitus similarly exhibit an excessive pro-NETotic phenotype, and pronounced placental presence, as detected by expression of neutrophil elastase. Furthermore, exogenous neutrophil elastase liberated by degranulating neutrophils was demonstrated to alter trophoblast physiology and glucose metabolism by interfering with key signal transduction components. In this review we examine whether additional evidence exists suggesting that altered neutrophil activity in gestational diabetes mellitus may contribute to the development of preeclampsia.
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Affiliation(s)
- Lenka Vokalova
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Institute of Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Shane V. van Breda
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Department of Rheumatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Xi Lun Ye
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Evelyn A. Huhn
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Nandor G. Than
- Systems Biology of Reproduction Momentum Research Group, Research Centre for Natural Sciences, Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary
| | - Paul Hasler
- Department of Rheumatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Olav Lapaire
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Irene Hoesli
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Simona W. Rossi
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- *Correspondence: Simona W. Rossi
| | - Sinuhe Hahn
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Sinuhe Hahn
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