1
|
Bakiris E, Luiro K, Jokelainen J, Morin‐Papunen L, Keinänen‐Kiukaanniemi S, Kaikkonen K, Piltonen T, Tapanainen JS, Auvinen J. Women with a history of gestational diabetes mellitus present an accumulation of cardiovascular risk factors at age 46-A birth cohort study. Acta Obstet Gynecol Scand 2024; 103:1318-1328. [PMID: 38725232 PMCID: PMC11168273 DOI: 10.1111/aogs.14861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION The incidence of gestational diabetes mellitus (GDM) is globally increasing, and it has been associated with later type 2 diabetes, metabolic syndrome (MetS), and cardiovascular disease (CVD). However, long-term population-based studies investigating common CVD risk factors years after pregnancy are lacking. To evaluate the future mortality and morbidity in cardiovascular and metabolic diseases, we conducted a thorough investigation of midlife risk factors in women with and without previous GDM. MATERIAL AND METHODS A prospective population-based cohort study was conducted of 3173 parous women from the Northern Finland Birth Cohort, 1966. Study participants were obtained from the national register or patient records. Those with a GDM diagnosis formed the GDM cohort (n = 271), and those without a previous GDM diagnosis formed the control cohort (n = 2902). Clinical examinations were performed on participants at the age of 46 and included anthropometric measurements, oral glucose tolerance test (OGTT), biochemical measurements, and cardiovascular assessment. RESULTS At the age of 46, women in the GDM cohort had a higher body mass index (BMI, 29.0 kg/m2 vs 26.3 kg/m2, p < 0.001) and greater waist circumference (94.1 cm vs 86.5 cm, p < 0.001) than the control cohort. In the GDM cohort, a higher incidence of impaired glucose tolerance (12.6% vs 7.3%, p = 0.002), more previously diagnosed and OGTT-detected type 2 diabetes (23.3% vs 3.9%, p < 0.001), lower high-density lipoprotein (1.53 mmol/L vs 1.67 mmol/L, p = 0.011), higher triglycerides (1.26 mmol/L vs 1.05 mmol/L, p = 0.002) and a higher fatty liver index (6.82 vs 2.47, p < 0.001), were observed even after adjusting for BMI, polycystic ovary syndrome, parity, level of education, physical activity, smoking, and alcohol consumption. The women in the GDM cohort also had more MetS (42.6% vs 21.9%, p < 0.001) and higher risk scores for CVD and fatal events (Framingham 4.95 vs 3.60, p < 0.001; FINRISK 1.71 vs 1.08, p < 0.001). CONCLUSIONS Women with a previous diagnosis of GDM exhibit more risk factors for CVD in midlife and are at a higher risk for cardiovascular events later in life.
Collapse
Affiliation(s)
- Evi Bakiris
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Department of Obstetrics and GynecologyUniversity Hospital of OuluOuluFinland
| | - Kaisu Luiro
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Jari Jokelainen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of MedicineUniversity of OuluOuluFinland
| | - Laure Morin‐Papunen
- Department of Obstetrics and GynecologyUniversity Hospital of OuluOuluFinland
- Research Unit of Clinical MedicineMedical Research Center Oulu, University of OuluOuluFinland
| | - Sirkka Keinänen‐Kiukaanniemi
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Healthcare and Social Services of SelännePyhäjärviFinland
| | - Kari Kaikkonen
- Research Unit of Internal MedicineMedical Research Center OuluOuluFinland
| | - Terhi Piltonen
- Department of Obstetrics and GynecologyUniversity Hospital of OuluOuluFinland
- Research Unit of Clinical MedicineMedical Research Center Oulu, University of OuluOuluFinland
| | - Juha S. Tapanainen
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of Obstetrics and GynecologyHFR – Cantonal Hospital of Fribourg and University of FribourgFribourgSwitzerland
| | - Juha Auvinen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Research Unit of Clinical MedicineMedical Research Center Oulu, University of OuluOuluFinland
| |
Collapse
|
2
|
Weir TL, Majumder M, Glastras SJ. A systematic review of the effects of maternal obesity on neonatal outcomes in women with gestational diabetes. Obes Rev 2024; 25:e13747. [PMID: 38679418 DOI: 10.1111/obr.13747] [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: 12/07/2022] [Revised: 10/03/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
Maternal obesity and gestational diabetes mellitus (GDM) prevalence are increasing, with both conditions associated with adverse neonatal outcomes. This review aimed to determine the risk of adverse outcomes in women with obesity and GDM, compared with women with obesity alone. A systematic search identified 28 eligible articles. Meta-analysis was conducted using a random effects model, to generate pooled estimates (odds ratios, OR, or mean difference, MD). Compared with normal-weight controls, women with obesity had increased risks of large for gestational age (LGA, OR 1.98, 95% CI: 1.56, 2.52) and macrosomia (OR 2.93, 95% CI: 1.71, 5.03); the latter's risk almost double in women with obesity than GDM. Birth weight (MD 113 g, 95% CI: 69, 156) and shoulder dystocia (OR 1.23, 95% CI: 0.85, 1.78) risk was also higher. GDM significantly amplified neonatal risk in women with obesity, with a three- to four-fold risk of LGA (OR 3.22, 95% CI: 2.17, 4.79) and macrosomia (OR 3.71, 95% CI: 2.76, 4.98), as well as higher birth weights (MD 176 g, 95% CI: 89, 263), preterm delivery (OR 1.49, 95% CI: 1.25, 1.77), and shoulder dystocia (OR 1.99, 95% CI: 1.31, 3.03), when compared with normal-weight controls. Our findings demonstrate that maternal obesity increases serious neonatal adverse risk, magnified by the presence of GDM. Effective strategies are needed to safeguard against neonatal complications associated with maternal obesity, regardless of GDM status.
Collapse
Affiliation(s)
- Tessa L Weir
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Department of Endocrinology, Nepean-Blue Mountains Hospital, Kingswood, New South Wales, Australia
| | - Monica Majumder
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sarah J Glastras
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| |
Collapse
|
3
|
Kariniemi K, Vääräsmäki M, Männistö T, Mustaniemi S, Kajantie E, Eteläinen S, Keikkala E. Neonatal outcomes according to different glucose threshold values in gestational diabetes: a register-based study. BMC Pregnancy Childbirth 2024; 24:271. [PMID: 38609891 PMCID: PMC11010296 DOI: 10.1186/s12884-024-06473-4] [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: 12/22/2023] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Mild hyperglycaemia is associated with increased birth weight but association with other neonatal outcomes is controversial. We aimed to study neonatal outcomes in untreated mild hyperglycaemia using different oral glucose tolerance test (OGTT) thresholds. METHODS This register-based study included all (n = 4,939) singleton pregnant women participating a 75 g 2-h OGTT in six delivery hospitals in Finland in 2009. Finnish diagnostic cut-offs for GDM were fasting ≥ 5.3, 1 h ≥ 10.0 or 2-h glucose ≥ 8.6 mmol/L. Women who did not meet these criteria but met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria (fasting 5.1-5.2 mmol/L and/or 2-h glucose 8.5 mmol/L, n = 509) or the National Institute for Health and Clinical Excellence (NICE) criteria (2-h glucose 7.8-8.5 mmol/L, n = 166) were considered as mild untreated hyperglycaemia. Women who met both the Finnish criteria and the IADPSG or the NICE criteria were considered as treated GDM groups (n = 1292 and n = 612, respectively). Controls were normoglycaemic according to all criteria (fasting glucose < 5.1 mmol/L, 1-h glucose < 10.0 mmol/L and 2-h glucose < 8.5 mmol/L, n = 3031). Untreated mild hyperglycemia groups were compared to controls and treated GDM groups. The primary outcome - a composite of adverse neonatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, birth trauma or perinatal mortality - was analysed using multivariate logistic regression. RESULTS The risk for the adverse neonatal outcome in untreated mild hyperglycemia was not increased compared to controls (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 0.71-1.44, using the IADPSG criteria; aOR: 1.05, 95% CI: 0.60-1.85, using the NICE criteria). The risk was lower compared to the treated IADPSG (aOR 0.38, 95% CI 0.27-0.53) or the treated NICE group (aOR 0.32, 95% CI 0.18-0.57). DISCUSSION The risk of adverse neonatal outcomes was not increased in mild untreated hyperglycaemia compared to normoglycaemic controls and was lower than in the treated GDM groups. The OGTT cut-offs of 5.3 mmol/L at fasting and 8.6 mmol/L at 2 h seem to sufficiently identify clinically relevant GDM, without excluding neonates with a risk of adverse outcomes.
Collapse
Affiliation(s)
- Kaisa Kariniemi
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marja Vääräsmäki
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuija Männistö
- NordLab, Oulu, Finland
- Faculty of Medicine, Research Unit of Translational Medicine, University of Oulu, Oulu, Finland
| | - Sanna Mustaniemi
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Eero Kajantie
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sanna Eteläinen
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Elina Keikkala
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland.
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
| |
Collapse
|
4
|
Carter SA, Lin JC, Chow T, Martinez MP, Alves JM, Feldman KR, Qiu C, Page KA, McConnell R, Xiang AH. Maternal obesity and diabetes during pregnancy and early autism screening score at well-child visits in standard clinical practice. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:975-984. [PMID: 37646431 PMCID: PMC10902177 DOI: 10.1177/13623613231188876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
LAY ABSTRACT Early intervention and treatment can help reduce disability in children diagnosed with autism spectrum disorder. Screening for autism spectrum disorder in young children identifies those at increased likelihood of diagnosis who may need further support. Previous research has reported that exposure to maternal obesity and diabetes during pregnancy is associated with higher likelihood of autism spectrum disorder diagnosis in children. However, little is known about whether these maternal conditions are associated with how very young children score on autism spectrum disorder screening tools. This study examined associations between exposure to maternal obesity and diabetes during pregnancy and offspring scores on the Quantitative Checklist for Autism in Toddlers, an autism spectrum disorder screening questionnaire administered between 18-24 months at well-child visits. A higher score on the Quantitative Checklist for Autism in Toddlers suggests a higher likelihood of autism spectrum disorder; children with scores 3 or greater are referred to developmental pediatricians for evaluation. Our study found that children of mothers with obesity or diabetes during pregnancy had higher scores than children whose mothers did not have these conditions. Associations with maternal obesity and gestational diabetes diagnosed at or before 26 weeks of pregnancy were also present in children who did not have later autism spectrum disorder diagnoses, suggesting that exposure to these conditions during early pregnancy may be associated with a broad range of social and behavioral abilities. Identifying associations between maternal health conditions and early Quantitative Checklist for Autism in Toddlers screening scores could influence future screening and provision of support for children of mothers with these conditions.
Collapse
Affiliation(s)
- Sarah A. Carter
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jane C. Lin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Mayra P. Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jasmin M. Alves
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Klara R. Feldman
- Department of Anesthesiology & Perioperative Medicine, Kaiser Permanente Southern California, Baldwin Park, CA
| | - Chunyuan Qiu
- Department of Anesthesiology & Perioperative Medicine, Kaiser Permanente Southern California, Baldwin Park, CA
| | - Kathleen A. Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| |
Collapse
|
5
|
Greco E, Calanducci M, Nicolaides KH, Barry EVH, Huda MSB, Iliodromiti S. Gestational diabetes mellitus and adverse maternal and perinatal outcomes in twin and singleton pregnancies: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:213-225. [PMID: 37595821 DOI: 10.1016/j.ajog.2023.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE This study aimed to assess the risk of adverse maternal and perinatal complications between twin and singleton pregnancies affected by gestational diabetes mellitus and the respective group without gestational diabetes mellitus (controls). DATA SOURCES A literature search was performed using MEDLINE, Embase, and Cochrane from January 1980 to May 2023. STUDY ELIGIBILITY CRITERIA Observational studies reporting maternal and perinatal outcomes in singleton and/or twin pregnancies with gestational diabetes mellitus vs controls were included. METHODS This was a systematic review and meta-analysis. Pooled estimate risk ratios with 95% confidence intervals were generated to determine the likelihood of adverse pregnancy outcomes between twin and singleton pregnancies with and without gestational diabetes mellitus. Heterogeneity among studies was evaluated in the model and expressed using the I2 statistic. A P value of <.05 was considered statistically significant. The meta-analyses were performed using Review Manager (RevMan Web). Version 5.4. The Cochrane Collaboration, 2020. Meta-regression was used to compare relative risks between singleton and twin pregnancies. The addition of multiple covariates into the models was used to address the lack of adjustments. RESULTS Overall, 85 studies in singleton pregnancies and 27 in twin pregnancies were included. In singleton pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.85; 95% confidence interval, 1.69-2.01), induction of labor (relative risk, 1.36; 95% confidence interval, 1.05-1.77), cesarean delivery (relative risk, 1.31; 95% confidence interval, 1.24-1.38), large-for-gestational-age neonate (relative risk, 1.61; 95% confidence interval, 1.46-1.77), preterm birth (relative risk, 1.36; 95% confidence interval, 1.27-1.46), and admission to the neonatal intensive care unit (relative risk, 1.43; 95% confidence interval, 1.38-1.49). In twin pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.69; 95% confidence interval, 1.51-1.90), cesarean delivery (relative risk, 1.10; 95% confidence interval, 1.06-1.13), large-for-gestational-age neonate (relative risk, 1.29; 95% confidence interval, 1.03-1.60), preterm birth (relative risk, 1.19; 95% confidence interval, 1.07-1.32), and admission to the neonatal intensive care unit (relative risk, 1.20; 95% confidence interval, 1.09-1.32) and reduced risks of small-for-gestational-age neonate (relative risk, 0.89; 95% confidence interval, 0.81-0.97) and neonatal death (relative risk, 0.50; 95% confidence interval, 0.39-0.65). When comparing relative risks in singleton vs twin pregnancies, there was sufficient evidence to suggest that twin pregnancies have a lower relative risk of cesarean delivery (P=.003), have sufficient adjustment for confounders, and have lower relative risks of admission to the neonatal intensive care unit (P=.005), stillbirths (P=.002), and neonatal death (P=.001) than singleton pregnancies. CONCLUSION In both singleton and twin pregnancies, gestational diabetes mellitus was associated with an increased risk of adverse maternal and perinatal outcomes. In twin pregnancies, gestational diabetes mellitus may have a milder effect on some adverse perinatal outcomes and may be associated with a lower risk of neonatal death.
Collapse
Affiliation(s)
- Elena Greco
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
| | - Maria Calanducci
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; The Harris Birthright Research Centre, King's College, London, United Kingdom
| | - Kypros H Nicolaides
- The Harris Birthright Research Centre, King's College, London, United Kingdom
| | - Eleanor V H Barry
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Mohammed S B Huda
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
6
|
Turunen R, Pulakka A, Metsälä J, Vahlberg T, Ojala T, Gissler M, Kajantie E, Helle E. Maternal Diabetes and Overweight and Congenital Heart Defects in Offspring. JAMA Netw Open 2024; 7:e2350579. [PMID: 38180757 PMCID: PMC10770771 DOI: 10.1001/jamanetworkopen.2023.50579] [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] [Received: 09/09/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
Importance Maternal diabetes and overweight or obesity are known to be associated with increased risk of congenital heart defects (CHDs) in offspring, but there are no large studies analyzing outcomes associated with these factors in 1 model. Objective To investigate the association of maternal diabetes and overweight or obesity with CHDs among offspring in 1 model. Design, Setting, and Participants This nationwide, population-based register study was conducted in a birth cohort from Finland consisting of all children born between 2006 and 2016 (620 751 individuals) and their mothers. Data were analyzed from January 2022 until November 2023. Exposures Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), categorized as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obesity (≥30), was assessed. Maternal diabetes status, classified as no diabetes, type 1 diabetes (T1D), type 2 or other diabetes, and gestational diabetes, was assessed. Main Outcomes and Measures Odds ratios (ORs) of isolated CHDs in children were found. In addition, 9 anatomical CHD subgroups were studied. Results Of 620 751 children (316 802 males [51.0%]; 573 259 mothers aged 20-40 years [92.3%]) born in Finland during the study period, 10 254 children (1.7%) had an isolated CHD. Maternal T1D was associated with increased odds of having a child with any CHD (OR, 3.77 [95% CI, 3.26-4.36]) and 6 of 9 CHD subgroups (OR range, 3.28 [95% CI, 1.55-6.95] for other septal defects to 7.39 [95% CI, 3.00-18.21] for transposition of great arteries) compared with no maternal diabetes. Maternal overweight was associated with left ventricular outflow tract obstruction (OR, 1.28 [95% CI, 1.10-1.49]) and ventricular septal defects (OR, 0.92 [95% CI, 0.86-0.98]), and obesity was associated with complex defects (OR, 2.70 [95% CI, 1.14-6.43]) and right outflow tract obstruction (OR, 1.31 [95% CI, 1.09-1.58]) compared with normal maternal BMI. Conclusions and Relevance This study found that maternal T1D was associated with increased risk for most types of CHD in offspring, while obesity and overweight were associated with increased risk for complex defects and outflow tract obstruction and decreased risk for ventricular septal defects. These different risk profiles of T1D and overweight and obesity may suggest distinct underlying teratogenic mechanisms.
Collapse
Affiliation(s)
- Riitta Turunen
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Pulakka
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Johanna Metsälä
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tero Vahlberg
- Department of Biostatistics, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tiina Ojala
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Eero Kajantie
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Clinical Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Emmi Helle
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Francis EC, Powe CE, Lowe WL, White SL, Scholtens DM, Yang J, Zhu Y, Zhang C, Hivert MF, Kwak SH, Sweeting A. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2023; 3:185. [PMID: 38110524 PMCID: PMC10728189 DOI: 10.1038/s43856-023-00393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. METHODS Systematic literature searches were performed in PubMed and EMBASE from inception to March 2022 for studies comparing perinatal outcomes among women with GDM. We searched for precision markers in the following categories: maternal anthropometrics, clinical/sociocultural factors, non-glycemic biochemical markers, genetics/genomics or other -omics, and fetal biometry. We conducted post-hoc meta-analyses of a subset of studies with data on the association of maternal body mass index (BMI, kg/m2) with offspring macrosomia or large-for-gestational age (LGA). RESULTS A total of 5905 titles/abstracts were screened, 775 full-texts reviewed, and 137 studies synthesized. Maternal anthropometrics were the most frequent risk marker. Meta-analysis demonstrated that women with GDM and overweight/obesity vs. GDM with normal range BMI are at higher risk of offspring macrosomia (13 studies [n = 28,763]; odds ratio [OR] 2.65; 95% Confidence Interval [CI] 1.91, 3.68), and LGA (10 studies [n = 20,070]; OR 2.23; 95% CI 2.00, 2.49). Lipids and insulin resistance/secretion indices were the most studied non-glycemic biochemical markers, with increased triglycerides and insulin resistance generally associated with greater risk of offspring macrosomia or LGA. Studies evaluating other markers had inconsistent findings as to whether they could be used as precision markers. CONCLUSIONS Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. Future studies examining non-glycemic biochemical, genetic, other -omic, or sociocultural precision markers among women with GDM are warranted.
Collapse
Affiliation(s)
- Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiaxi Yang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
8
|
Seo N, Lee YM, Kim YJ, Sung JH, Hur KY, Choi SJ, Roh CR, Oh SY. Obesity Is Associated With Higher Risk of Adverse Maternal and Neonatal Outcomes Than Supervised Gestational Diabetes. J Korean Med Sci 2023; 38:e268. [PMID: 37605501 PMCID: PMC10442500 DOI: 10.3346/jkms.2023.38.e268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/12/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Unlike gestational diabetic mellitus (GDM), which is strictly managed by most patients and physicians, obesity does not have proper management guidelines, and the importance of its management during pregnancy is often ignored. The aim of this study was to compare maternal and neonatal outcomes according to obesity and GDM, alone or in combination. METHODS This was a retrospective cohort study of 3,078 consecutive pregnant women who experienced prenatal care and delivery of a live singleton neonate between January 2016 and December 2020 at our institution. Study participants were categorized into 4 mutually exclusive groups, as follows: group 1, no GDM without obesity; group 2, GDM without obesity; group 3, no GDM with obesity; and group 4, GDM with obesity. RESULTS Compared to group 2, group 3 had higher rates of pre-eclampsia, cesarean section including emergent cesarean section rate. Also, neonates in group 3 were heavier and had lower glucose levels compared to those in group 2. Of note, there was no significant difference in maternal or neonatal outcomes except the rate of large-for-gestational-age (LGA) between group 1 and group 2. Among the GDM groups, group 4 had higher risks for pre-eclampsia, cesarean section, and LGA infant status than group 2. CONCLUSION Our data showed that obese women without GDM face higher risk of adverse pregnancy outcomes than women with supervised GDM and non-obese women. We also confirmed that adverse pregnancy outcomes associated with GDM were mainly attributable to obesity among women receiving GDM education.
Collapse
Affiliation(s)
- Namju Seo
- Sungkyunkwan University School of Medicine, Suwon, Korea
| | - You Min Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ye-Jin Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Yeon Hur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
9
|
de Carvalho LS, de Oliveira AAD, Grabovski TCM, Renzo CC, Ribeiro E Silva R, Loz SH, Silva JC. Maternal prepregnancy obesity and gestational diabetes influence on adverse perinatal outcomes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000605. [PMID: 37252694 PMCID: PMC10665062 DOI: 10.20945/2359-3997000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/08/2022] [Indexed: 05/31/2023]
Abstract
Objective Evaluate the influence of isolated and associated prepregnancy obesity and gestational diabetes mellitus (GDM) on adverse perinatal outcomes. Materials and methods Cross-sectional observational study with women who delivered at a Brazilian Maternity Hospital, between August and December 2020. Data were collected by interview with application form, and medical records. Sample was stratified by body mass index (BMI) and GDM screening in four groups: no obesity (BMI < 30 kg/m2) no GDM - reference; isolated GDM; isolated obesity (BMI ≥ 30 kg/m2); and obesity with GDM. Preeclampsia (PE), cesarean section (CS), large-for-gestational-age (LGA) newborn and admission to neonatal intensive care unit (NICU) were analyzed by odds ratio (OR) adjusted for confounding factors, adopting 95% confidence interval (CI) and P < 0.05 statistically significant. Results From 1,618 participants, isolated obesity group (233/14.40%) had high chance of PE (OR = 2.16; CI: 1.364-3.426; P = 0.001), isolated GDM group (190/11.74%) had high chance of CS (OR = 1.736; CI: 1.136-2.652; P = 0.011) and NICU admission (OR = 2.32; CI: 1.265-4.261; P = 0.007), and obesity with GDM group (121/7.48%) had high chance of PE (OR = 1.93; CI: 1.074-3.484; P = 0.028), CS (OR = 1.925; CI: 1.124-3.298; P = 0.017) and LGA newborn (OR = 1.81; CI: 1.027-3.204; P = 0.040), compared with reference (1,074/66.38%). Conclusion Obesity and GDM enhances the chance of different negative outcomes, worsening this prognosis when associated.
Collapse
Affiliation(s)
- Leonardo Souza de Carvalho
- Programa de Mestrado em Saúde e Meio Ambiente, Universidade da Região de Joinville (Univille), Joinville, SC, Brasil,
| | | | | | - Carla Christina Renzo
- Programa de Mestrado em Saúde e Meio Ambiente, Universidade da Região de Joinville (Univille), Joinville, SC, Brasil
| | - Rodrigo Ribeiro E Silva
- Faculdade de Medicina, Universidade da Região de Joinville (Univille), Joinville, SC, Brasil
| | - Sabrina Hafemann Loz
- Faculdade de Medicina, Universidade da Região de Joinville (Univille), Joinville, SC, Brasil
| | - Jean Carl Silva
- Programa de Mestrado em Saúde e Meio Ambiente, Universidade da Região de Joinville (Univille), Joinville, SC, Brasil
- Faculdade de Medicina, Universidade da Região de Joinville (Univille), Joinville, SC, Brasil
- Maternidade Darcy Vargas, Joinville, SC, Brasil
| |
Collapse
|
10
|
Bai W, Wang H, Fang R, Lin M, Qin Y, Han H, Cui J, Zhang R, Ma Y, Chen D, Zhang W, Wang L, Yu H. Evaluating the effect of gestational diabetes mellitus on macrosomia based on the characteristics of oral glucose tolerance test. Clin Chim Acta 2023; 544:117362. [PMID: 37088117 DOI: 10.1016/j.cca.2023.117362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND GDM is always treated as a homogenous disease ignoring the different metabolic characteristics in oral glucose tolerance test (OGTT). We assessed the effect of GDM on macrosomia based on the different characteristics of OGTT. METHODS We retrospectively divided 998 GDM pregnant women into 7 groups, Group A1: abnormal OGTT0h; Group A2: abnormal OGTT1 h; Group A3: abnormal OGTT2 h; Group B1: abnormal OGTT0h+1 h; Group B2: abnormal OGTT0h+2 h; Group B3: abnormal OGTT1 h+2 h; Group C: abnormal OGTT0h+1 h+2 h; RESULTS: The incidence of macrosomia in group C (21.92%) was higher than other groups. The OR of OGTT0h+1 h+2 h was significant (OGTT1 h: OR=1.577, 95% CI: 0.791, 3.145; OGTT2 h: OR=1.151, 95% CI: 0.572, 2.313; OGTT0h+1 h: OR=1.346, 95% CI: 0.584, 3.101; OGTT0h+2 h: OR=1.327, 95% CI: 0.517, 3.409; OGTT1 h+2 h: OR=0.771, 95% CI: 0.256, 2.322; OGTT0h+1 h+2 h: OR=4.164, 95% CI: 2.095, 8.278) when comparing with OGTT0h. Subgroup analysis showed abnormal OGTT0h+1 h+2 h might contribute more to macrosomia in pre-pregnancy BMI ≥ 24 kg/m2 than those with BMI < 24 kg/m2. CONCLUSION The effect of abnormal OGTT0h+1 h+2 h on macrosomia was significantly greater than other OGTT characteristics, especially for those with pre-pregnancy BMI ≥ 24 kg/m2. Individualized management of GDM based on OGTT characteristics and pre-pregnancy BMI might be needed.
Collapse
Affiliation(s)
- Wenlin Bai
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Hui Wang
- Obstetrics Clinic, Changzhi Maternal and Child Health Care Hospital, Changzhi, 046000, China
| | - Ruiling Fang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Mengwen Lin
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Yao Qin
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Hongjuan Han
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Jing Cui
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Rong Zhang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Yifei Ma
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Durong Chen
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Wenping Zhang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Li Wang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Hongmei Yu
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China.
| |
Collapse
|
11
|
Jääskeläinen T, Klemetti MM. Genetic Risk Factors and Gene-Lifestyle Interactions in Gestational Diabetes. Nutrients 2022; 14:nu14224799. [PMID: 36432486 PMCID: PMC9694797 DOI: 10.3390/nu14224799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Paralleling the increasing trends of maternal obesity, gestational diabetes (GDM) has become a global health challenge with significant public health repercussions. In addition to short-term adverse outcomes, such as hypertensive pregnancy disorders and fetal macrosomia, in the long term, GDM results in excess cardiometabolic morbidity in both the mother and child. Recent data suggest that women with GDM are characterized by notable phenotypic and genotypic heterogeneity and that frequencies of adverse obstetric and perinatal outcomes are different between physiologic GDM subtypes. However, as of yet, GDM treatment protocols do not differentiate between these subtypes. Mapping the genetic architecture of GDM, as well as accurate phenotypic and genotypic definitions of GDM, could potentially help in the individualization of GDM treatment and assessment of long-term prognoses. In this narrative review, we outline recent studies exploring genetic risk factors of GDM and later type 2 diabetes (T2D) in women with prior GDM. Further, we discuss the current evidence on gene-lifestyle interactions in the development of these diseases. In addition, we point out specific research gaps that still need to be addressed to better understand the complex genetic and metabolic crosstalk within the mother-placenta-fetus triad that contributes to hyperglycemia in pregnancy.
Collapse
Affiliation(s)
- Tiina Jääskeläinen
- Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland
- Correspondence:
| | - Miira M. Klemetti
- Department of Medical and Clinical Genetics, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, P.O. Box 140, 00029 Helsinki, Finland
| |
Collapse
|
12
|
Kuitunen I, Huttunen TT, Ponkilainen VT, Kekki M. Incidence of obese parturients and the outcomes of their pregnancies: A nationwide register study in Finland. Eur J Obstet Gynecol Reprod Biol 2022; 274:62-67. [PMID: 35597175 DOI: 10.1016/j.ejogrb.2022.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We analyzed the incidence of obese and severely obese parturients and the impact of maternal obesity on mode of delivery, perinatal and neonatal mortality, and neonatal health. STUDY DESIGN We included all singleton births from the medical birth register of Finland from 2004 to 2018 (n = 792 437). Maternal body mass index (BMI) was categorized into three classes: non-obese (BMI < 30 kg/m2), obese (BMI 30 - 39.9 kg/m2), and morbidly obese (BMI 40 kg/m2 or more). The yearly incidence of obese and severely obese parturients per 10000 births was calculated. Logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Between 2004 and 2018, the incidence of obese and morbidly obese parturients increased by 44% and 103%, respectively. Cesarean section rates were 23.6% and 30%, respectively (aOR 1.63 CI 1.61 - 1.66 and 2.33 CI: 2.23 - 2.44). Neonates born to morbidly obese parturients had an increased need for intensive care unit treatment (aOR 2.21 CI: 2.10 - 2.32), higher perinatal mortality (aOR 1.65 CI: 1.28 - 2.14), and higher neonatal mortality (aOR 1.68 CI: 1.04 - 2.72). The need for neonatal intensive care (aOR 1.50 CI: 1.47 - 1.53), perinatal mortality (aOR 1.25 CI: 1.13 - 1.39), and neonatal mortality (aOR 1.33 CI: 1.09 - 1.62) increased also among obese parturients. CONCLUSIONS We report a worrying increase in obese and morbidly obese parturients. Neonates born to these parturients were more likely delivered by cesarean sections and had higher rates of perinatal and neonatal mortality, and intensive care unit treatment. This highlights the importance of preventing obesity among fertile-aged females.
Collapse
Affiliation(s)
- Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland; Mikkeli Central Hospital, Department of Pediatrics and Neonatology, Mikkeli, Finland.
| | - Tuomas T Huttunen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland; Mikkeli Central Hospital, Department of Pediatrics and Neonatology, Mikkeli, Finland
| | - Ville T Ponkilainen
- Tampere Heart Hospital and Tampere University Hospital, Department of Anesthesia, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland; Central Finland Hospital Nova, Department of Surgery, Jyväskylä, Finland
| | - Maiju Kekki
- Tampere University Hospital, Department of Obstetrics and Gynecology, Tampere, Finland; Tampere University Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere, Finland
| |
Collapse
|
13
|
Predictors of Adverse Pregnancy Outcomes in Pregnant Women Living with Obesity: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042063. [PMID: 35206265 PMCID: PMC8872310 DOI: 10.3390/ijerph19042063] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/22/2022]
Abstract
Obesity is a well-recognized risk factor for pregnancy complications. Most studies to date are in large cohorts, with results presented in a way that assumes all women living with obesity are at equal risk. This study investigates which women living with obesity are at higher risk of specific pregnancy complications. A systematic search of MEDLINE and Embase identified 7894 prospective or retrospective cohort studies exploring predictors of adverse outcomes among pregnant women living with obesity. Following screening, 61 studies were deemed eligible. Studies were selected if the effects of exposure to any predictor amongst pregnant women living with obesity could be collected. Maternal characteristics assessed for association with adverse outcomes included maternal age, race/ethnicity, maternal height, mode of conception, complement activation factors, and history of various comorbidities/procedures. Gestational diabetes mellitus was the most studied outcome (n = 32), followed by preterm birth (n = 29), preeclampsia (n = 27), low birthweight infants (n = 20), small for gestational age newborns (n = 12), and stillbirth (n = 7). This review identified important characteristics that should be considered during the screening and follow-up sessions of pregnant women living with obesity, including pre-existing type 1 diabetes, maternal age < 20 years or ≥35 years, non-White ethnicity, abdominal adiposity obesity, and history of bariatric surgery.
Collapse
|
14
|
Lemieux P, Benham JL, Donovan LE, Moledina N, Pylypjuk C, Yamamoto JM. The association between gestational diabetes and stillbirth: a systematic review and meta-analysis. Diabetologia 2022; 65:37-54. [PMID: 34676425 DOI: 10.1007/s00125-021-05579-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS Controversy exists over whether gestational diabetes increases the risk of stillbirth. The aim of this review was to examine the association between gestational diabetes and stillbirth. METHODS We performed searches of the published literature to May 2021. Study selection and data extraction were performed in duplicate by independent reviewers. Meta-analyses of summary measures were conducted using random-effect models for cohort and case-control studies separately. The study protocol was registered in PROSPERO (registration ID CRD42020166939). RESULTS From 9981 citations, 419 were identified for full-text review and 73 met inclusion criteria (n = 70,292,090). There was no significant association between gestational diabetes and stillbirth in cohort studies (pooled OR 1.04 [95% CI 0.90, 1.21]; I2 86.1%) or in case-control studies (pooled OR 1.57 [95% CI 0.83, 2.98]; I2 94.8%). Gestational diabetes was associated with lower odds of stillbirth among cohort studies presenting with an adjusted OR (pooled OR 0.78 [95% CI 0.68, 0.88]; I2 42.7%). Stratified analyses by stillbirth ≥28 weeks' gestation, studies published prior to 2013 and studies identified as low quality demonstrated a significantly higher odds of stillbirth in meta-regression (p = 0.016, 0.023 and 0.005, respectively). Egger's test for all included cohort studies (p = 0.018) suggests publication bias for the main meta-analysis. CONCLUSIONS/INTERPRETATION Given the substantial heterogeneity across studies, there are insufficient data to define the relationship between stillbirth and gestational diabetes adequately. In the main analyes, gestational diabetes was not associated with an increased risk of stillbirth. However, heterogeneity across studies means this finding should be interpreted cautiously.
Collapse
Affiliation(s)
- Patricia Lemieux
- Department of Medicine, CHU de Québec - University Laval, Quebec City, QC, Canada
| | - Jamie L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lois E Donovan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nadia Moledina
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christy Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Yamamoto
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
| |
Collapse
|
15
|
Paulo MS, Abdo NM, Bettencourt-Silva R, Al-Rifai RH. Gestational Diabetes Mellitus in Europe: A Systematic Review and Meta-Analysis of Prevalence Studies. Front Endocrinol (Lausanne) 2021; 12:691033. [PMID: 34956073 PMCID: PMC8698118 DOI: 10.3389/fendo.2021.691033] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/17/2021] [Indexed: 01/14/2023] Open
Abstract
Background Gestational Diabetes Mellitus (GDM) is defined as the type of hyperglycemia diagnosed for the first-time during pregnancy, presenting with intermediate glucose levels between normal levels for pregnancy and glucose levels diagnostic of diabetes in the non-pregnant state. We aimed to systematically review and meta-analyze studies of prevalence of GDM in European countries at regional and sub-regional levels, according to age, trimester, body weight, and GDM diagnostic criteria. Methods Systematic search was conducted in five databases to retrieve studies from 2014 to 2019 reporting the prevalence of GDM in Europe. Two authors have independently screened titles and abstracts and full text according to eligibility using Covidence software. A random-effects model was used to quantify weighted GDM prevalence estimates. The National Heart, Lung, and Blood Institute criteria was used to assess the risk of bias. Results From the searched databases, 133 research reports were deemed eligible and included in the meta-analysis. The research reports yielded 254 GDM-prevalence studies that tested 15,572,847 pregnant women between 2014 and 2019. The 133 research reports were from 24 countries in Northern Europe (44.4%), Southern Europe (27.1%), Western Europe (24.1%), and Eastern Europe (4.5%). The overall weighted GDM prevalence in the 24 European countries was estimated at 10.9% (95% CI: 10.0-11.8, I2 : 100%). The weighted GDM prevalence was highest in the Eastern Europe (31.5%, 95% CI: 19.8-44.6, I2 : 98.9%), followed by in Southern Europe (12.3%, 95% CI: 10.9-13.9, I2 : 99.6%), Western Europe (10.7%, 95% CI: 9.5-12.0, I2 : 99.9%), and Northern Europe (8.9%, 95% CI: 7.9-10.0, I2 : 100). GDM prevalence was 2.14-fold increased in pregnant women with maternal age ≥30 years (versus 15-29 years old), 1.47-fold if the diagnosis was made in the third trimester (versus second trimester), and 6.79- fold in obese and 2.29-fold in overweight women (versus normal weight). Conclusions In Europe, GDM is significant in pregnant women, around 11%, with the highest prevalence in pregnant women of Eastern European countries (31.5%). Findings have implications to guide vigilant public health awareness campaigns about the risk factors associated with developing GDM. Systematic Review Registration PROSPERO [https://www.crd.york.ac.uk/PROSPERO/], identifier CRD42020161857.
Collapse
Affiliation(s)
- Marília Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Noor Motea Abdo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rita Bettencourt-Silva
- Department of Endocrinology and Nutrition, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
- Department of Endocrinology, Hospital Lusíadas Porto, Porto, Portugal
| | - Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| |
Collapse
|
16
|
Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis? J Clin Med 2021; 10:jcm10061196. [PMID: 33809287 PMCID: PMC7999215 DOI: 10.3390/jcm10061196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
Collapse
|
17
|
Alfadhli EM. Maternal obesity influences Birth Weight more than gestational Diabetes author. BMC Pregnancy Childbirth 2021; 21:111. [PMID: 33549038 PMCID: PMC7866872 DOI: 10.1186/s12884-021-03571-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Maternal obesity and gestational diabetes (GDM) are commonly encountered during pregnancy. Both conditions are independently associated with unfavorable pregnancy consequences. The objective of this study was to compare the effects of obesity and GDM on birth weight, macrosomia, and other adverse pregnancy outcomes. METHODS This cohort study involved 531 women with a singleton pregnancy attending the Maternity and Children's Hospital, Medina, Saudi Arabia, between June 2014 and June 2015. Participants underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. The International Association of Diabetes and Pregnancy Study Groups criteria were used for GDM diagnosis. BMI was assessed at the first antenatal visit, and obesity was defined as a BMI ≥30.0 kg/m2. All women were followed up until delivery. Women were divided into 4 groups: non-GDM nonobese (reference group), GDM nonobese, obese non-GDM, and obese GDM. Clinical characteristics and adverse pregnancy outcomes were compared. RESULTS The mean age and BMI of the participants were 30.5 years and 29.3 kg/m2, respectively. GDM was diagnosed in 50.2% of the participants, and obesity was diagnosed in 47.8% of the participants. Obese women with GDM were the oldest and heaviest among all women. The mean birth weight increased in order among the four groups; it was highest in the infants in the obese GDM group, followed by those in the obese non-GDM, GDM nonobese and reference groups. Obesity and GDM alone or in combination were associated with higher rates of macrosomia and cesarean deliveries than the reference group. Neonatal intensive care unit (NICU) admission was higher in infants in the GDM nonobese and obese GDM groups. The frequency of low Apgar score was significantly higher in infants in the obese GDM group than in infants in the reference group. CONCLUSIONS Maternal obesity seems to influence birth weight more than GDM, while GDM is associated with a greater risk of admission to the NICU. The combination of both conditions is associated with the greatest risk of adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Eman M Alfadhli
- Medicine department, Taibah University Medical College, PO Box 344, Girls section. Universities Road, T 0966555305170, Medina, Saudi Arabia.
| |
Collapse
|
18
|
Li MF, Ke JF, Ma L, Wang JW, Zhang ZH, Li JB, Li LX. Maternal Pre-Pregnancy Obesity Combined With Abnormal Glucose Metabolism Further Increases Adverse Pregnancy Outcomes in Chinese Pregnant Women. Front Endocrinol (Lausanne) 2021; 12:754406. [PMID: 35095754 PMCID: PMC8793842 DOI: 10.3389/fendo.2021.754406] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Our aim was to evaluate the separate and combined effects of maternal pre-pregnancy obesity and gestational abnormal glucose metabolism (GAGM) on adverse perinatal outcomes. METHODS A total of 2,796 Chinese pregnant women with singleton delivery were studied, including 257 women with pre-pregnancy obesity alone, 604 with GAGM alone, 190 with both two conditions, and 1,745 with neither pre-pregnancy obesity nor GAGM as control group. The prevalence and risks of adverse pregnancy outcomes were compared among the four groups. RESULTS Compared with the normal group, pregnant women with maternal pre-pregnancy obesity alone, GAGM alone, and both two conditions faced significantly increased risks of pregnancy-induced hypertension (PIH) (odds ratio (OR) 4.045, [95% confidence interval (CI) 2.286-7.156]; 1.993 [1.171-3.393]; 8.495 [4.982-14.485]), preeclampsia (2.649 [1.224-5.735]; 2.129 [1.128-4.017]; 4.643 [2.217-9.727]), cesarean delivery (1.589 [1.212-2.083]; 1.328 [1.095-1.611]; 2.627 [1.908-3.617]), preterm delivery (1.899 [1.205-2.993]; 1.358 [0.937-1.968]; 2.301 [1.423-3.720]), macrosomia (2.449 [1.517-3.954]; 1.966 [1.356-2.851]; 4.576 [2.895-7.233]), and total adverse maternal outcomes (1.762 [1.331-2.332]; 1.365 [1.122-1.659]; 3.228 [2.272-4.587]) and neonatal outcomes (1.951 [1.361-2.798]; 1.547 [1.170-2.046]; 3.557 [2.471-5.122]). Most importantly, there were no obvious risk differences in adverse pregnancy outcomes between maternal pre-pregnancy obesity and GAGM group except PIH, but pregnant women with both obesity and GAGM exhibited dramatically higher risks of adverse pregnancy outcomes than those with each condition alone. CONCLUSIONS Maternal pre-pregnancy obesity and GAGM were independently associated with increased risks of adverse pregnancy outcomes. The combination of pre-pregnancy obesity and GAGM further worsens adverse pregnancy outcomes compared with each condition alone.
Collapse
Affiliation(s)
- Mei-Fang Li
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiang-Feng Ke
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Li Ma
- Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun-Wei Wang
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Zhi-Hui Zhang
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Jing-Bo Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lian-Xi Li
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| |
Collapse
|
19
|
Cui D, Yang W, Shao P, Li J, Wang P, Leng J, Wang S, Liu E, Chan JC, Yu Z, Hu G, Yang X. Interactions between Prepregnancy Overweight and Passive Smoking for Macrosomia and Large for Gestational Age in Chinese Pregnant Women. Obes Facts 2021; 14:520-530. [PMID: 34419951 PMCID: PMC8546448 DOI: 10.1159/000517846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/07/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Previous analysis showed that passive smoking and overweight were associated with an increased risk of gestational diabetes mellitus (GDM) in a synergistic manner, while GDM increased the risk of macrosomia/large for gestational age (LGA). This study aimed to examine any interactive effects between passive smoking and overweight/obesity on risk of macrosomia/LGA. METHODS From 2010 to 2012, 22,302 pregnant women registered for pregnancy at a primary hospital in Tianjin, China. Data were collected longitudinally; that is, from their first antenatal care visit, at the glucose challenge test (GCT) time (24-28 weeks of gestation) and at delivery. Passive smoking was self-reported. Macrosomia was defined as birth weight ≥4,000 g. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction was used to test the synergistic effect. RESULTS Passive smokers accounted for 57.4% of women (n = 8,230). Using nonpassive smoking and prepregnancy body mass index (BMI) <24.0 kg/m2 as the reference, the adjusted ORs of overweight alone and passive smoking alone for macrosomia were 2.39 (95% CI: 2.11-2.71) and 1.17 (95% CI: 1.04-1.32). Copresence of passive smoking and prepregnancy BMI ≥24.0 kg/m2 increased the OR to 2.70 (95% CI: 2.28-3.20), with a significant additive interaction. After further adjustment for GDM or GCT, the OR of copresence of both risk factors was slightly attenuated to 2.52 (2.13-3.00) and 2.51 (2.11-2.98), with significant additive interaction. However, the additive interaction between prepregnancy overweight/obesity and passive smoking for LGA was nonsignificant. CONCLUSIONS Prepregnancy overweight/obesity was associated with an increased risk of macrosomia in Chinese women synergistically with passive smoking during pregnancy, and most of the association was not modified by hyperglycemia during pregnancy.
Collapse
Affiliation(s)
- Dingyu Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wen Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ping Shao
- Project Office, Tianjin Women and Children's Health Center, Tianjin, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Peng Wang
- Project Office, Tianjin Women and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Department of Child Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Shuo Wang
- Project Office, Tianjin Women and Children's Health Center, Tianjin, China
| | - Enqing Liu
- Department of Child Health, Tianjin Women and Children's Health Center, Tianjin, China
| | - Juliana C.N. Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and The Chinese University of Hong Kong-Prince of Wales Hospital-International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhijie Yu
- Population Cancer Research Program, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
- *Xilin Yang,
| |
Collapse
|
20
|
Cremona A, Saunders J, Cotter A, Hamilton J, Donnelly AE, O'Gorman CS. Maternal obesity and degree of glucose intolerance on neonatal hypoglycaemia and birth weight: a retrospective observational cohort study in women with gestational diabetes mellitus. Eur J Pediatr 2020; 179:653-660. [PMID: 31873801 DOI: 10.1007/s00431-019-03554-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is an increasing problem worldwide. Postnatal hypoglycaemia and excess foetal growth are known important metabolic complications of neonates born to women with diabetes. This retrospective cohort study aims to determine the influence of obesity and glucose intolerance on neonatal hypoglycaemia and birth weight over the 90th percentile (LGA). Data were abstracted from 303 patient medical records from singleton pregnancies diagnosed with GDM. Data were recorded during routine hospital visits. Demographic data were acquired by facilitated questionnaires and anthropometrics measured at the first antenatal appointment. Blood biochemical indices were recorded. Plasma glucose area under the curve (PG-AUC) was calculated from OGTT results as an index of glucose intolerance. OGTT results of 303 pregnant women aged between 33.6 years (29.8-37.7) diagnosed with GDM were described. Neonates of mothers with a BMI of over 30 kg/m2 were more likely to experience neonatal hypoglycaemia (24 (9.2%) vs. 23 (8.8%), p = 0.016) with odds ratio for neonatal hypoglycaemia significantly higher at 2.105, 95% CI (1.108, 4.00), p = 0.023. ROC analysis showed poor strength of association (0.587 (95% CI, .487 to .687). Neonatal LGA was neither associated with or predicted by PG-AUC nor obesity; however, multiparous women were 2.8 (95% CI (1.14, 6.78), p = 0.024) times more likely to have a baby born LGA.Conclusion: Maternal obesity but not degree of glucose intolerance increased occurrence of neonatal hypoglycaemia. Multiparous women had greater risk of neonates born LGA.What is Known:•Excess foetal growth in utero has long-term metabolic implications which track into adulthood.•Neonatal hypoglycaemia is detrimental to newborns in the acute phase with potential long-term implications on the central nervous system.What is New:•Maternal obesity but not degree of glucose intolerance in a GDM cohort increased occurrence of neonatal hypoglycaemia.•Multiparous women diagnosed had greater risk of neonates born LGA.
Collapse
Affiliation(s)
- Alexandra Cremona
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland. .,School of Allied Health, University of Limerick, Limerick, Ireland. .,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland. .,Institute of Nutrition & Dietetics (INDI), Dublin, Ireland. .,Physical Education and Sports Science (PESS), University of Limerick, Limerick, Ireland.
| | - Jean Saunders
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Statistics Consulting Unit (SCU/CSTAR @ UL), University of Limerick, Limerick, Ireland
| | - Amanda Cotter
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Jill Hamilton
- The Division of Endocrinology, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Alan E Donnelly
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,Physical Education and Sports Science (PESS), University of Limerick, Limerick, Ireland
| | - Clodagh S O'Gorman
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland.,Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,Department of Paediatrics, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
21
|
Pereda J, Bove I, Pineyro MM. Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay. Front Endocrinol (Lausanne) 2020; 11:588443. [PMID: 33224106 PMCID: PMC7669744 DOI: 10.3389/fendo.2020.588443] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the risk of macrosomia in newborns from women with gestational diabetes, pregestational diabetes, overweight, and obesity in Uruguay in 2012, as well as its association with prolonged pregnancy, maternal age, multiparity, and excessive gestational weight gain (EGWG). METHODS We performed a cross-sectional study of 42,663 pregnant women. The risk of macrosomia was studied using logistic regression. RESULTS Mean maternal age was 26.7 ± 6.8 years. Pregestational overweight and obesity was present in 20.9% and 10.7% of women, respectively. There were 28.1% and 19.8% of women overweight and obese at the end of the pregnancy, respectively. Furthermore, 0.5% had pregestational diabetes and 8.5% were multiparous. Twenty two percent developed gestational diabetes and 44.9% had EGWG. The prevalence of macrosomia was 7.9%, significantly more prevalent in males (10.0% vs. 5.5%, p<0.005). Univariate analysis showed that obesity and overweight pre-pregnancy, obesity and overweight at the end of pregnancy, EGWG, pregestational diabetes, gestational diabetes, multiparity, prolonged pregnancy, and male newborn were strongly associated with macrosomia (p<0.0001). Maternal age >35 years did not increase the risk of macrosomia. After multiple logistic regression macrosomia was more likely in pre-gestational obese women (OR 1.24; CI 1.07-1.44), overweight women at the end of pregnancy (OR 1.66; CI 1.46-1.87), obese women at the end of pregnancy (OR 2.21; CI 1.90-2.58), women with EGWG (OR 1.78; CI 1.59-1.98), pregestational diabetes (OR 1.75; CI 1.15-2.69), gestational diabetes (OR 1.39; CI 1.25-1.53), prolonged pregnancy (OR 2.67; CI 2.28-3.12), multiparity (OR 1.24; CI 1.04-1.48), and male newborn (OR 1.89; CI 1.72-2.08). CONCLUSION Maternal overweight, obesity, EGWG, and gestational diabetes are prevalent in Uruguay, increasing the risk of macrosomia. Efforts to implement strategies to decrease the prevalence of overweight and obesity among women of reproductive age are essential to improve maternal and neonatal outcomes.
Collapse
Affiliation(s)
- Jimena Pereda
- Clinica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Isabel Bove
- Departamento de Ciencias Cognitivas y de la Salud, Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Maria M. Pineyro
- Clinica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- *Correspondence: Maria M. Pineyro, ; orcid.org/0000-0003-2083-7839
| |
Collapse
|
22
|
Pan Y, Hu J, Zhong S. The joint prediction model of pBMI and eFBG in predicting gestational diabetes mellitus. J Int Med Res 2019; 48:300060519889199. [PMID: 31875748 PMCID: PMC7783261 DOI: 10.1177/0300060519889199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore the predictive value of prepregnancy body mass index (pBMI) and early gestational fasting blood glucose (eFBG) in gestational diabetes mellitus (GDM). METHODS This case-control study enrolled pregnant women at 6 to 16 weeks of gestation. The pBMI, eFBG and glycosylated haemoglobin (HbA1c) was recorded in the first trimester of pregnancy. Receiver-operating characteristic (ROC) curve analysis was used to measure the efficacy of factors that predict GDM. RESULTS A total of 2119 pregnant women were enrolled in this study. Of these, 386 were diagnosed with GDM and 1733 did not have GDM. The age (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.13, 1.20), pBMI (OR 1.12; 95% CI 1.07, 1.17) and eFBG (OR 5.37; 95% CI 3.93, 7.34) were independent risk factors for GDM occurrence. The areas under the ROC curve of eFBG, pBMI and eFBG + pBMI were 0.68 (95% credibility interval 0.65, 0.71), 0.66 (95% credibility interval 0.63, 0.69) and 0.71 (95% credibility interval 0.69, 0.74), respectively. The area under the curve of eFBG + pBMI was significantly higher than that of eFBG or pBMI alone. CONCLUSION The combination of eFBG and pBMI had a high predictive value for GDM.
Collapse
Affiliation(s)
- Ying Pan
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Endocrinology, The Kunshan Hospital Affiliated with Jiangsu University, Suzhou, Jiangsu Province, China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Shao Zhong
- Department of Endocrinology, The Kunshan Hospital Affiliated with Jiangsu University, Suzhou, Jiangsu Province, China
| |
Collapse
|
23
|
Molecular Modelling of Islet β-Cell Adaptation to Inflammation in Pregnancy and Gestational Diabetes Mellitus. Int J Mol Sci 2019; 20:ijms20246171. [PMID: 31817798 PMCID: PMC6941051 DOI: 10.3390/ijms20246171] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM), a metabolic disease that develops with the increase in insulin resistance during late pregnancy, is currently one of the most common complications affecting pregnancy. The polygenic nature of GDM, together with the interplay between different genetic variants with nutritional and environmental factors has hindered the full understanding of the etiology of this disease. However, an important genetic overlap has been found with type 2 diabetes mellitus (T2DM) and, as in the case of T2DM, most of the identified loci are associated with β-cell function. Early detection of GDM and adequate interventions to control the maternal glycemia are necessary to avoid the adverse outcomes for both the mother and the offspring. The in utero exposure to the diabetic milieu predispose these children for future diseases, among them T2DM, originating a vicious circle implicated in the increased prevalence of both GDM and T2DM. The involvement of inflammatory processes in the development of GDM highlights the importance of pancreatic β-cell factors able to favor the adaptation processes required during gestation, concomitantly with the protection of the islets from an inflammatory milieu. In this regard, two members of the Pax family of transcription factors, PAX4 and PAX8, together with the chromatin remodeler factor HMG20A, have gained great relevance due to their involvement in β-cell mass adaptation together with their anti-inflammatory properties. Mutations in these factors have been associated with GDM, highlighting these as novel candidates for genetic screening analysis in the identification of women at risk of developing GDM.
Collapse
|