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Liu X, Nianogo RA, Janzen C, Fei Z, Seamans MJ, Wen R, Li X, Chen L. Association Between Gestational Diabetes Mellitus and Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies With a Quantitative Bias Analysis of Uncontrolled Confounding. Hypertension 2024; 81:1257-1268. [PMID: 38501243 DOI: 10.1161/hypertensionaha.123.22418] [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] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Whether individuals with gestational diabetes mellitus (GDM) had an increased risk of hypertension remains unclear. We conducted a systematic literature review and meta-analysis to examine the association between GDM and hypertension and performed a quantitative bias analysis to quantify the impact of uncontrolled confounding due to antenatal psychological stress. METHODS We searched databases (PUBMED, EMBASE, and Web of Science) through 2022/11. Eligible studies were cohort studies that reported the association of GDM with hypertension. We assessed the risk of bias using the Newcastle-Ottawa Scale for cohort studies. We pooled adjusted risk ratios with 95% CIs using a random effects model. We performed the quantitative bias analysis using the bias formula. RESULTS We included 15 cohort studies, with a total of 3 959 520 (GDM, 175 378; non-GDM, 3 784 142) individuals. During the follow-up of 2 to 20 years, 106 560 cases of hypertension were reported. We found that GDM was associated with a higher risk of hypertension (pooled risk ratio, 1.78 [95% CI, 1.47, 2.17]). The risk ratio was lower among cohorts assessing incident (1.58 [95% CI, 1.29, 1.95]) than prevalent hypertension (2.60 [95% CI, 2.40, 2.83]). However, other subgroup analyses showed no differences. The quantitative bias analysis revealed that if the uncontrolled confounder of antenatal psychological stress was additionally adjusted, the positive association between GDM and hypertension would attenuate slightly (≤18%) but remains positive. CONCLUSIONS Limitations of this study included residual confounding and discrepancies in GDM and hypertension ascertainments. Our findings indicate that GDM is positively associated with hypertension after the index pregnancy.
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Affiliation(s)
- Xinyue Liu
- Department of Epidemiology, Fielding School of Public Health (X. Liu, R.A.N., M.J.S., X. Li, L.C.), University of California, Los Angeles
| | - Roch A Nianogo
- Department of Epidemiology, Fielding School of Public Health (X. Liu, R.A.N., M.J.S., X. Li, L.C.), University of California, Los Angeles
- California Center for Population Research (R.N.), University of California, Los Angeles
| | - Carla Janzen
- Department Obstetrics and Gynecology, David Geffen School of Medicine (C.J.), University of California, Los Angeles
| | - Zhe Fei
- Department of Statistics, University of California, Riverside (Z.F.)
| | - Marissa J Seamans
- Department of Epidemiology, Fielding School of Public Health (X. Liu, R.A.N., M.J.S., X. Li, L.C.), University of California, Los Angeles
| | - Renee Wen
- Department of Biology (R.W.), University of California, Los Angeles
| | - Xiang Li
- Department of Epidemiology, Fielding School of Public Health (X. Liu, R.A.N., M.J.S., X. Li, L.C.), University of California, Los Angeles
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health (X. Liu, R.A.N., M.J.S., X. Li, L.C.), University of California, Los Angeles
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Quansah DY, Lewis R, Savard K, Harris L, Visintini S, Coutinho T, Mullen KA. Cardiovascular Disease Risk Factor Interventions in Women With Prior Gestational Hypertensive Disorders or Diabetes in North America: A Rapid Review. CJC Open 2024; 6:153-164. [PMID: 38487059 PMCID: PMC10935679 DOI: 10.1016/j.cjco.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
Women with previous hypertensive disorders of pregnancy (HDP) or gestational diabetes mellitus (GDM) have a 2- to 3-fold increased risk of cardiovascular disease (CVD). The goal of this rapid review was to summarize evidence of the effectiveness of CVD risk factor interventions for postpartum women with a history of HDP or GDM. A comprehensive search strategy was used to search articles published in 5 databases-Ovid MEDLINE, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Embase). Observational and intervention studies that identified CVD prevention, screening, and/or risk factor management interventions among postpartum women with prior HDP or GDM in Canada and the US were included. The quality of observational and interventional studies, and their risk of bias, were assessed using appropriate critical appraisal checklists. Eight studies, including 4 observational cohorts, 3 randomized controlled trials, and 1 quasi-experimental study, merited inclusion for analysis. A total of 2449 participants were involved in the included studies. The most effective CVD risk factor intervention was comprised of postpartum transition and follow-up, CVD risk factor education, and advice on lifestyle changes. Most of the observational studies led to improvements in CVD risk factors, including improvements in CVD lifetime risk scores. However, none of the RCTs led to improvements in cardiometabolic risk factors. Few studies have investigated CVD risk factor interventions in the postpartum in women with previous HDP or GDM in North America. Further studies of higher quality are needed.
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Affiliation(s)
- Dan Yedu Quansah
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebekah Lewis
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karine Savard
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Laura Harris
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerri-Anne Mullen
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Mietus-Snyder M, Perak AM, Cheng S, Hayman LL, Haynes N, Meikle PJ, Shah SH, Suglia SF. Next Generation, Modifiable Cardiometabolic Biomarkers: Mitochondrial Adaptation and Metabolic Resilience: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1827-1845. [PMID: 37902008 DOI: 10.1161/cir.0000000000001185] [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] [Indexed: 10/31/2023]
Abstract
Cardiometabolic risk is increasing in prevalence across the life span with disproportionate ramifications for youth at socioeconomic disadvantage. Established risk factors and associated disease progression are harder to reverse as they become entrenched over time; if current trends are unchecked, the consequences for individual and societal wellness will become untenable. Interrelated root causes of ectopic adiposity and insulin resistance are understood but identified late in the trajectory of systemic metabolic dysregulation when traditional cardiometabolic risk factors cross current diagnostic thresholds of disease. Thus, children at cardiometabolic risk are often exposed to suboptimal metabolism over years before they present with clinical symptoms, at which point life-long reliance on pharmacotherapy may only mitigate but not reverse the risk. Leading-edge indicators are needed to detect the earliest departure from healthy metabolism, so that targeted, primordial, and primary prevention of cardiometabolic risk is possible. Better understanding of biomarkers that reflect the earliest transitions to dysmetabolism, beginning in utero, ideally biomarkers that are also mechanistic/causal and modifiable, is critically needed. This scientific statement explores emerging biomarkers of cardiometabolic risk across rapidly evolving and interrelated "omic" fields of research (the epigenome, microbiome, metabolome, lipidome, and inflammasome). Connections in each domain to mitochondrial function are identified that may mediate the favorable responses of each of the omic biomarkers featured to a heart-healthy lifestyle, notably to nutritional interventions. Fuller implementation of evidence-based nutrition must address environmental and socioeconomic disparities that can either facilitate or impede response to therapy.
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Johnstone AM, Pudwell J, Ackerman-Banks CM, Lundsberg LS, Lipkind HS, Smith GN. High-sensitivity C-reactive protein use in cardiovascular risk screening at 6 to 12 months postpartum following hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM 2023; 5:100776. [PMID: 36273813 DOI: 10.1016/j.ajogmf.2022.100776] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with a hypertensive disorder of pregnancy are more likely to have underlying cardiovascular risk factors and are at increased risk of future cardiovascular disease. These patients are more likely to be diagnosed with new-onset chronic hypertension and meet the criteria for metabolic syndrome postpartum. High-sensitivity C-reactive protein is a marker of general inflammation and may be used to identify increased risk for cardiovascular disease. OBJECTIVE This collaborative data-sharing study between Yale University, United States (Yale Hearts Moms study) and Queen's University, Canada (Maternal Health Clinic) aimed to study the utility of high-sensitivity C-reactive protein in postpartum cardiovascular risk screening, as determined by 30-year risk (Framingham) and metabolic syndrome 6 to 12 months postpartum. STUDY DESIGN Patients with a hypertensive disorder of pregnancy (n=478) or an uncomplicated, term pregnancy (n=90) had cardiovascular risk screening and risk scoring performed at 6 to 12 months postpartum. Patients were excluded if they had a multiple gestation or chronic hypertension, diabetes mellitus, or cardiovascular disease diagnosed before pregnancy. Patients were categorized according to high-sensitivity C-reactive protein (mg/L) into Normal (<3.0), High (3.1 to <10.0), and Acute (≥10.0) groups. The primary outcome of the study was risk for future cardiovascular events, calculated through surrogate measures such as hypertension and cholesterol. Kruskal-Wallis and chi-square tests were used to compare groups, with post hoc tests corrected using the Bonferroni method. Multivariable logistic regression was used to assess the association between high-sensitivity C-reactive protein and cardiovascular risk, adjusting for relevant medical and sociodemographic variables. Analysis was completed with IBM SPSS Statistics, version 27. RESULTS Patients in the High and Acute high-sensitivity C-reactive protein groups were more likely to have a body mass index ≥30, to have experienced a hypertensive disorder of pregnancy, to have a lower household income, and to have not breastfed or to have breastfed for <6 months, when compared with the Normal high-sensitivity C-reactive protein group (all P<.05). Patients in the High and Acute high-sensitivity C-reactive protein groups had higher 30-year cardiovascular risk scores and were more likely to have metabolic syndrome when compared with the Normal high-sensitivity C-reactive protein group (all P<.05). Patients with High high-sensitivity C-reactive protein had 2-fold odds of metabolic syndrome 6 to 12 months after delivery, compared with those in the Normal high-sensitivity C-reactive protein group (adjusted odds ratio, 2.85 [95% confidence interval, 1.66-4.91]), adjusting for hypertensive disorder of pregnancy, body mass index, clinic site, breastfeeding, income, and family history of cardiovascular disease. Those with Acute high-sensitivity C-reactive protein also seemed to have elevated odds of metabolic syndrome compared with the Normal high-sensitivity C-reactive protein group (adjusted odds ratio, 2.52 [95% confidence interval, 1.24-5.12]). The odds of chronic hypertension were significantly higher (P<.05) in the High high-sensitivity C-reactive protein group (adjusted odds ratio, 1.72 [95% confidence interval, 1.12-2.65]) compared with the Normal group. CONCLUSION Individuals with elevated postpartum high-sensitivity C-reactive protein are at increased risk of cardiovascular disease 6 to 12 months postpartum after a pregnancy complicated by a hypertensive disorder of pregnancy. Future research is critical to determine the most comprehensive and accurate method and timing of postpartum cardiovascular risk screening to decrease the incidence of preventable cardiovascular mortality among women.
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Affiliation(s)
- Ainsley M Johnstone
- From the Queen's Faculty of Health Sciences, Queen's University, Kingston, Canada (Ms Johnstone)
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston, Canada (Ms Pudwell and Dr Smith)
| | | | - Lisbet S Lundsberg
- Yale School of Medicine, New Haven, CT (Drs Ackerman-Banks, Lundsberg, and Lipkind)
| | - Heather S Lipkind
- Yale School of Medicine, New Haven, CT (Drs Ackerman-Banks, Lundsberg, and Lipkind)
| | - Graeme N Smith
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston, Canada (Ms Pudwell and Dr Smith).
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Gupta M, Yadav P, Yaqoob F. A Prospective Study to Determine the Predictive Ability of HDP-Gestosis Score for the Development of Pre-eclampsia. J Obstet Gynaecol India 2022; 72:485-491. [PMID: 36158863 PMCID: PMC9483246 DOI: 10.1007/s13224-022-01704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background HDP-gestosis score is a risk scoring system (score 1-3) for the development of pre-eclampsia. When a pregnant woman's total score is equal to or greater than 3, she is labelled as "at risk for pre-eclampsia" and is managed accordingly. Objectives To determine the sensitivity, specificity, Positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of HDP-gestosis score for predicting pre-eclampsia. Methods This prospective study included 473 pregnant women who presented at the department of Obstetrics and Gynaecology, from June 2020 to December 2021. After 20 weeks of pregnancy, the patients were assessed for the development of pre-eclampsia. Details of age, gravida, obstetric history, menstrual cycle regularity, polycystic ovarian disease history, duration of marriage, parity, past medical and surgical intervention, previous/present medication, and family history were taken. Gestosis score was calculated and classified into mild (score of 1), moderate (score of 2) and high risk (score of ≥ 3) for the development of Pre-eclampsia (PE). Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of HDP-gestosis score for predicting the development of PE were determined. Results The mean age, gestational age, and BMI of the women were 28.4 ± 6.8 years, 11.5 ± 2.04 weeks, and 24.5 ± 3.7 kg/m2, respectively. The gestosis score was 2 in 43.13% of the participants, 1 in 42.28%, and ≥ 3 in 14.59% of the women. PE developed in 15.01% (n = 71) participants. The Sensitivity, Specificity, PPV, NPV, and Diagnostic accuracy of HDP-gestosis score for predicting PE were 83.1%, 97.51%, 85.51%, 97.03% and 95.35%, respectively. Conclusion Gestosis score is a novel early marker for prediction of the development of PE allowing for a prompt management for the patients, thereby curbing the adverse consequences.
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Affiliation(s)
- Meeta Gupta
- Department of Obstetrics and Gynaecology, AIIMS, F-311, Sainik Colony, Jammu, India
| | - Poonam Yadav
- Department of Obstetrics and Gynaecology, S.N Medical College, Agra, U.P India
| | - Farhana Yaqoob
- Department of Obstetrics and Gynaecology, ASCOMS, Jammu, Jammu and Kashmir 180011 India
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Li W, Kim CS, Howell EA, Janevic T, Liu B, Shi L, Li Y. Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2062-2080. [PMID: 35989155 PMCID: PMC9669139 DOI: 10.1016/j.jval.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research. METHODS Electronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list. RESULTS Among the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP. CONCLUSIONS Existing economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.
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Affiliation(s)
- Weixin Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chi-Son Kim
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lizheng Shi
- Department of Global Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Echouffo Tcheugui JB, Guan J, Fu L, Retnakaran R, Shah BR. Association of Concomitant Gestational Hypertensive Disorders and Gestational Diabetes With Cardiovascular Disease. JAMA Netw Open 2022; 5:e2243618. [PMID: 36416822 PMCID: PMC9685489 DOI: 10.1001/jamanetworkopen.2022.43618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Accruing evidence suggests that gestational hypertensive disorders (GHTD) and gestational diabetes (GD) are each associated with an increased risk of cardiovascular disease (CVD). However, the extent to which the co-occurrence of GHTD and GD is associated with the risk of CVD remains largely unknown. OBJECTIVE To estimate the individual and joint associations of GHTD and GD with incident CVD. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used the Ministry of Health and Long-Term Care of Ontario (Canada) health care administrative databases. All women in Ontario with a GHTD and/or GD diagnosis, and a live-birth singleton delivery between July 1, 2007, and March 31, 2018, were considered for inclusion. Women with pregravid diabetes, hypertension, or cardiovascular disease were excluded. Statistical analysis was performed from November 2021 to September 2022. EXPOSURES GD and/or GHTD, defined using diagnosis coding. MAIN OUTCOMES AND MEASURES Individual and joint associations of GHTD and GD with incident CVD (including a composite of myocardial infarction, acute coronary syndrome, stroke, coronary artery bypass grafting, percutaneous coronary intervention, or carotid endarterectomy), estimated using Cox regression models, adjusting for relevant cardiometabolic risk factors. The follow-up extended from the index pregnancy until March 31, 2020. RESULTS Among 886 295 eligible women (mean [SD] age, 30 [5.6] years; 43 861 [4.9%] with isolated GHTD, 54 061 [6.1%] with isolated GD, and 4975 [0.6%] with GHTD and GD), there were 1999 CVD events over 12 years of follow-up. In the early postpartum phase (first 5 years post partum), there was no association of co-occurrence of GTHD and GD (adjusted hazard ratio [aHR], 1.42, 95% CI, 0.78-2.58) or GD alone (aHR, 0.80; 95% CI, 0.60-1.06) with CVD; there was an association between isolated GTHD and incident CVD compared with no GTHD and no GD (aHR, 1.90; 95% CI, 1.51-2.35). In the late postpartum period (after the initial 5 years post partum), compared with no GD and no GHTD, isolated GHTD (aHR, 1.41, 95% CI, 1.12-1.76) and co-occurrence of GHTD and GD (aHR, 2.43, 95% CI, 1.60-3.67) were each associated with a higher risk of incident CVD. There was no association between isolated GD and incident CVD. CONCLUSIONS AND RELEVANCE In this cohort study, GHTD was associated with a high risk of CVD post partum, and the co-occurrence of GD and GHTD was associated with a much greater postpartum CVD risk. These findings suggest that CVD preventive care is particularly needed in the aftermath of combined GD and GHTD.
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Affiliation(s)
- Justin B. Echouffo Tcheugui
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Longdi Fu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R. Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Saei Ghare Naz M, Sheidaei A, Azizi F, Ramezani Tehrani F. Gestational diabetes mellitus and hypertensive disorder of pregnancy play as spouse-pair risk factors of diabetes and hypertension: Insights from Tehran Lipid and Glucose Study. J Diabetes Complications 2022; 36:108311. [PMID: 36201894 DOI: 10.1016/j.jdiacomp.2022.108311] [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: 06/17/2022] [Revised: 08/27/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Complicated pregnancies by gestational diabetes mellitus (GDM) and hypertensive disorder of pregnancy (HDP) are relatively common worldwide. The evidence is still inconclusive regarding the role of GDM and HDP as spousal risk factor of diabetes (DM) and hypertension (HTN). This study aimed to determine the spousal risk of development of DM and/or HTN in the context of GDM and/or HDP. METHODS This population-based cohort study involved couples who participated in Tehran Lipid and Glucose Study. A total of 3650 pairs of spouses were identified, and among them, 2820 met the inclusion criteria. Included participants, followed up 3-year intervals visits from 1999 to 2018. All pairs underwent standard data collection. GDM and HDP were the main exposure of interest in females, and DM and HTN were the main outcomes in both females and their spouses. Cox proportional hazard regression models were used for both females and their spouses, adjusting for age, consanguinity, waist-to-height ratio, physical activity, smoking, and parity. RESULTS Of 2820 females, 558 (19.79 %) had histories of GDM or HDP, and 72 (2.55 %) experienced both. Among females who experienced GDM and HDP, 24 (33 %) and 31 (33 %) developed DM and HTN during the follow-up. The corresponding numbers were 89 (16 %) and 191 (34 %) for those who experienced GDM or HPD, and 274 (13 %) and 623 (28 %) for the non-risk factors group. The incidences of DM were 9 (12 %), 100 (18 %), and 373 (17 %) for males whose spouses experienced both GDM and HDP, either one or none of them, respectively. Among males in these groups, 20 (28 %), 150 (27 %), and 630 (29 %) developed HTN, respectively. Females who never had history of GDM and HDP have 34 % (95 % CI: 21, 45) less hazard of being diabetic than their spouses if they have the same age and waist to hip ratio. In cases with histories of both GDM and HDP, the risk of females increases to 3.05 (95 % CI: 1.43, 6.52) times of their spouses. Also, females who had experienced GDM (HR: 3.51, 95 % CI: 2.23, 5.53), or HDP (HR: 2.80, 95 % CI: 1.72, 4.56) were at higher risk of developing DM compared with females who never had GDM or HDP. We found that females with neither GDM nor HDP were more likely than males to be hypertensive in the future by the hazard ratio of 1.21 (95 % CI: 1.06, 1.39). CONCLUSIONS Complicated pregnancies by GDM and/or HDP were associated with increased risk of development DM and HTN in later life of females and their spouses. Further studies are required to confirm these results. Preventive care programs should be considered pregnancy complications as couple-based risk factors for subsequent DM and HTN.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Integrated Management of Type 2 Diabetes and Gestational Diabetes in the Context of Multi-Morbidity in Africa: A Systematic Review. Int J Integr Care 2022; 22:21. [PMID: 36213216 PMCID: PMC9503971 DOI: 10.5334/ijic.5608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
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Sukmanee J, Liabsuetrakul T. Risk of future cardiovascular diseases in different years postpartum after hypertensive disorders of pregnancy: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29646. [PMID: 35905265 PMCID: PMC9333537 DOI: 10.1097/md.0000000000029646] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE There are limited data on the optimal timing and frequency of postpartum follow-up visits after hypertensive disorders of pregnancy (HDP) for primary prevention and early detection of cardiovascular diseases (CVDs) in high-risk women. We aimed to evaluate the risk of cardiovascular outcomes later in life in women with prior HDP in different years postpartum and in preeclamptic women with severe features, or early onset of preeclampsia. METHODS We searched MEDLINE, Cochrane Library, Web of Science, and Scopus without language restriction for relevant articles published from inception to March 16, 2022. We included prospective and retrospective cohort studies assessing hypertension, ischemic heart disease, heart failure, venous thromboembolism, peripheral vascular disease, stroke, dementia, composite cardiovascular and/or cerebrovascular diseases, and mortality after 6 weeks postpartum, in women with prior HDP compared with controls. Two authors independently selected and appraised the studies. Article quality was independently assessed using the Newcastle-Ottawa Scale (NOS). Random-effect models were used for meta-analysis. Stratified analyses based on years postpartum, severity, and onset of preeclampsia were performed. RESULTS We included 59 studies for qualitative review, of which 56 were included in quantitative meta-analysis, involving 1,262,726 women with prior HDP and 14,711,054 controls. Women with prior HDP had increased risks of hypertension (relative risk [RR] 3.46, 95% confidence interval [CI]: 2.67-4.49), ischemic heart disease (RR 2.06, 95% CI: 1.38-3.08), and heart failure (RR 2.53, 95% CI: 1.28-5.00) later in life, compared with those with normotensive pregnancies. The risk of hypertension was highest during 5 years postpartum (RR 5.34, 95% CI: 2.74-10.39). Compared with normotensive pregnancies, the risk of future CVDs significantly increased in preeclamptic women. DISCUSSION A history of HDP is associated with approximately 2- to 4-fold increase in the risk of CVDs. Screening for CVDs and their risk factors in women with prior HDP since delivery, especially the first 5 years after delivery is suggested for early detection and appropriate management. Evidence on the risks of CVDs in preeclampsia with severe features and early onset of preeclampsia is limited due to having few studies and high heterogeneity. FUNDING The Royal Golden Jubilee PhD Program-RGJ (PHD/0183/2561); Thailand Science Research and Innovation (TSRI) Research Career Development Grant-RSA (RSA6180009); Targeted Research Grants Program of the Faculty of Medicine, Prince of Songkla University, Thailand. REGISTRATION CRD42020191550.
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Affiliation(s)
- Jarawee Sukmanee
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Tippawan Liabsuetrakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- * Correspondence: Tippawan Liabsuetrakul, MD, PhD, Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand (e-mail: )
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11
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Burger RJ, Delagrange H, van Valkengoed IGM, de Groot CJM, van den Born BJH, Gordijn SJ, Ganzevoort W. Hypertensive Disorders of Pregnancy and Cardiovascular Disease Risk Across Races and Ethnicities: A Review. Front Cardiovasc Med 2022; 9:933822. [PMID: 35837605 PMCID: PMC9273843 DOI: 10.3389/fcvm.2022.933822] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
Pregnancy is often considered to be a "cardiometabolic stress-test" and pregnancy complications including hypertensive disorders of pregnancy can be the first indicator of increased risk of future cardiovascular disease. Over the last two decades, more evidence on the association between hypertensive disorders of pregnancy and cardiovascular disease has become available. However, despite the importance of addressing existing racial and ethnic differences in the incidence of cardiovascular disease, most research on the role of hypertensive disorders of pregnancy is conducted in white majority populations. The fragmented knowledge prohibits evidence-based targeted prevention and intervention strategies in multi-ethnic populations and maintains the gap in health outcomes. In this review, we present an overview of the evidence on racial and ethnic differences in the occurrence of hypertensive disorders of pregnancy, as well as evidence on the association of hypertensive disorders of pregnancy with cardiovascular risk factors and cardiovascular disease across different non-White populations, aiming to advance equity in medicine.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands
| | - Hannelore Delagrange
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Irene G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | - Christianne J M de Groot
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Atherosclerosis and Ischemic Syndromes, Amsterdam, Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands
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12
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Lis-Kuberka J, Orczyk-Pawiłowicz M. Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910409. [PMID: 34639709 PMCID: PMC8508017 DOI: 10.3390/ijerph181910409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022]
Abstract
Gestational diabetes mellitus (GDM) is a multifaceted disease and is associated with complications for newborns and mothers. The aim of the study was to assess Polish women’s knowledge concerning GDM and their attitude to breastfeeding. As a research tool, an anonymous online survey that included 33 questions, grouped into three main sections—sociodemographic and obstetric variables, risk factors for GDM and neonatal adverse outcomes, and knowledge about breastfeeding—was used and administered online. A total of 410 women aged from 18 to 45 participated in this study. Based on the survey, it was demonstrated that the women had moderate knowledge concerning the maternal risk factors and adverse neonatal outcomes associated with GDM and, additionally, the short- and long-term effects of breastfeeding. Significantly deeper knowledge about GDM, including breastfeeding by GDM mothers, was observed among hyperglycemic mothers in comparison to normoglycemic mothers. However, knowledge concerning the health benefits of breastfeeding was not related to the mothers’ glycemic status. In conclusion, educational programs must include pre-pregnancy education of women and place emphasis on explaining the mechanism of development of GDM and the transformation of GDM to type 2 diabetes. This is crucial for changing the public’s perception of GDM as a temporary, reversible clinical entity.
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13
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Mistry SK, Das Gupta R, Alam S, Kaur K, Shamim AA, Puthussery S. Gestational diabetes mellitus (GDM) and adverse pregnancy outcome in South Asia: A systematic review. Endocrinol Diabetes Metab 2021; 4:e00285. [PMID: 34505412 PMCID: PMC8502223 DOI: 10.1002/edm2.285] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 06/19/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The prevalence of gestational diabetes mellitus (GDM) is increasing in developing countries including the South Asian Nations. The current study aimed to examine the association of GDM with adverse pregnancy outcomes from foetal and maternal perspectives in South Asia. METHODS A systematic review was conducted including primary studies published since January 2020 from South Asian countries. Following electronic databases were searched to locate the articles: MEDLINE, EMBASE and EMCARE. Data were extracted using a customized extraction tool and methodological quality of the included studies was assessed using modified Effective Public Health Practice Project (EPHPP) quality assessment tool. Narrative synthesis was performed as statistical pooling was not possible due to the heterogeneous nature of the studies. RESULTS Eight studies were included in the review. Overall, the review found a positive correlation between GDM and adverse foetal outcomes such as macrosomia, neonatal hyperglycaemia, intrauterine growth retardation (IUGR), stillbirths and low birthweight (LBW), but the findings were not conclusive. GDM was also positively associated with preeclampsia but the association between GDM and C-section delivery was not conclusive. CONCLUSION Policymakers, public health practitioners and researchers in South Asia should take in to account the link between GDM and adverse pregnancy outcomes while designing interventions to promote maternal health in South Asia. Researchers should focus on conducting longitudinal studies in future to clearly understand the epidemiology and pathobiology of this issue.
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Affiliation(s)
- Sabuj Kanti Mistry
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
- Centre for Primary Health Care and EquityUNSWSydneyNSWAustralia
| | - Rajat Das Gupta
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Sabiha Alam
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
| | | | - Abu Ahmed Shamim
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Shuby Puthussery
- Maternal and Child Health Research CentreInstitute for Health ResearchUniversity of BedfordshireLutonUK
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14
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Metabolic signatures in the conversion from gestational diabetes mellitus to postpartum abnormal glucose metabolism: a pilot study in Asian women. Sci Rep 2021; 11:16435. [PMID: 34385555 PMCID: PMC8361021 DOI: 10.1038/s41598-021-95903-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 01/07/2023] Open
Abstract
We aimed to identify serum metabolites related to abnormal glucose metabolism (AGM) among women with gestational diabetes mellitus (GDM). The study recruited 50 women diagnosed with GDM during mid-late pregnancy and 50 non-GDM matchees in a Singapore birth cohort. At the 5-year post-partum follow-up, we applied an untargeted approach to investigate the profiles of serum metabolites among all participants. We first employed OPLS-DA and logistic regression to discriminate women with and without follow-up AGM, and then applied area under the curve (AUC) to assess the incremental indicative value of metabolic signatures on AGM. We identified 23 candidate metabolites that were associated with postpartum AGM among all participants. We then narrowed down to five metabolites [p-cresol sulfate, linoleic acid, glycocholic acid, lysoPC(16:1) and lysoPC(20:3)] specifically associating with both GDM and postpartum AGM. The combined metabolites in addition to traditional risks showed a higher indicative value in AUC (0.92–0.94 vs. 0.74 of traditional risks and 0.77 of baseline diagnostic biomarkers) and R2 (0.67–0.70 vs. 0.25 of traditional risks and 0.32 of baseline diagnostic biomarkers) in terms of AGM indication, compared with the traditional risks model and traditional risks and diagnostic biomarkers combined model. These metabolic signatures significantly increased the AUC value of AGM indication in addition to traditional risks, and might shed light on the pathophysiology underlying the transition from GDM to AGM.
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15
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Tranidou A, Dagklis T, Tsakiridis I, Siargkas A, Apostolopoulou A, Mamopoulos A, Goulis DG, Chourdakis M. Risk of developing metabolic syndrome after gestational diabetes mellitus - a systematic review and meta-analysis. J Endocrinol Invest 2021; 44:1139-1149. [PMID: 33226626 DOI: 10.1007/s40618-020-01464-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/30/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE A systematic review and meta-analysis were conducted to quantitatively synthesize the current evidence regarding the risk of developing metabolic syndrome (MetS) in women with a personal history of gestational diabetes mellitus (GDM), without pre-existing diabetes, compared with those without a history of GDM. METHODS Four electronic databases [MEDLINE (via PubMed), Scopus, Cochrane Library, PROSPERO] were searched for relevant literature until July 29th 2020. Cochran's Q test was applied for the assessment of heterogeneity. The random-effects model was applied by calculating the odds ratio (OR) and 95% confidence interval (CI) for each study. Publication bias was estimated with Egger's linear regression test. RESULTS The results from 23 studies (10,230 pregnant women; 5169 cases, 5061 controls), indicated that women with a history of GDM had a higher risk of developing MetS compared with those without such a history (OR 3.45; 95% CI 2.80-4.25, p < 0.0001). This risk remained higher, independently of maternal age and ethnicity (although the risk was not as high in Asians; OR 2.11; 95% CI 1.27-3.52). The risk of developing MetS was even higher in studies where women with GDM had increased body mass index (BMI) compared with the controls (OR 4.14; 95% CI 3.18-5.38). CONCLUSIONS The risk for developing MetS following delivery is higher in women with a history of GDM compared with women without such a history. Timely recognition and appropriate intervention are critical to halt progression to MetS and its associated morbidity.
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Affiliation(s)
- A Tranidou
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Dagklis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Tsakiridis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Siargkas
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Apostolopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Mamopoulos
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Sun Z, Wang S, Yang R, Li X, Yang Y, Qi X, Ma Y, Xu W. Gestational diabetes mellitus and risks of gynecologic cancers: Results from a nationwide Swedish twin study. Gynecol Oncol 2021; 162:142-147. [PMID: 33934849 DOI: 10.1016/j.ygyno.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Type 2 diabetes has been associated with increased risk of gynecologic cancers, yet the effect of gestational diabetes mellitus (GDM) on gynecologic cancers is unclear. OBJECTIVES To examine associations between GDM history and subsequent gynecologic cancers in parous women, and to explore whether gestational hypertension (GH) plays a role in the associations. STUDY DESIGN The population-based cohort study included 15,941 individuals from the Swedish Twin Registry. The history of GDM and GH was ascertained based on self-reports. Incident cases of gynecologic cancers (including cancers of the cervix, uterus, ovaries and other female genitalia) were obtained from the National Patients Registry and the Swedish Cancer Registry. Generalized estimating equation models were applied to analyze associations between GDM and gynecologic cancers. Stratified analysis was used to explore whether associations between GDM and gynecologic cancers differed by GH. Additive and multiplicative interactions were calculated between GDM and GH. RESULTS Of all participants, 350 (2.2%) had GDM, and 1762 (11.1%) had incident gynecologic cancers. No statistically significant associations were found between GDM and risks of any gynecologic cancers. However, GDM was associated with an increased risk of ovarian cancer (OR = 5.29, 95% CI: 1.63-17.19) in women with GH. Interactions between GDM and GH were observed on the additive scale (Attributable proportion due to interaction: 0.86, 95% CI 0.42-1.30, P < 0.001). CONCLUSIONS The associations between GDM and risks of gynecologic cancers were not evident, but the effect of GDM on the risk of ovarian cancer was modified by GH. Further validation in larger cohorts is warranted.
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Affiliation(s)
- Zhuoyu Sun
- 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 in Environment, Nutrition and Public Health, Tianjin, China
| | - Shuqi Wang
- 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 in Environment, Nutrition and Public Health, Tianjin, China
| | - Rongrong Yang
- Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xuerui 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 in Environment, Nutrition and Public Health, Tianjin, China
| | - Yumeng 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 in Environment, Nutrition and Public Health, Tianjin, China
| | - Xiuying Qi
- 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 in Environment, Nutrition and Public Health, Tianjin, China
| | - Yaomei Ma
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.
| | - Weili Xu
- 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 in Environment, Nutrition and Public Health, Tianjin, China; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
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Pathirana MM, Lassi ZS, Ali A, Arstall MA, Roberts CT, Andraweera PH. Association between metabolic syndrome and gestational diabetes mellitus in women and their children: a systematic review and meta-analysis. Endocrine 2021; 71:310-320. [PMID: 32930949 DOI: 10.1007/s12020-020-02492-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The primary aim of this systematic review and meta-analysis was to determine the association between gestational diabetes mellitus (GDM) and metabolic syndrome (MetS) in women and children. Our secondary aim was to assess the development of MetS with respect to the elapsed time postpartum at which MetS was diagnosed. METHODS This review is registered with PROSPERO (CRD42020173319). PubMed, CINHAL, SCOPUS, and EMBASE databases were searched. Studies reporting on the rate of MetS in pregnant women with GDM, the rate of MetS in women with a history of GDM, and the rate of MetS in offspring exposed to GDM in utero compared to healthy controls were selected. RESULTS We identified 588 articles from the literature search. Fifty-one studies were included in the review and of those 35 were included in the meta-analysis. Quantitative summary measures showed that women with a history of GDM had an increased risk of developing MetS compared to those without a history of GDM (RR 2.36, 95% CI 1.77-3.14, 29 studies, 13,390 participants; heterogeneity: χ2 p < 0.00001; I2 = 93%). Offspring exposed to GDM in utero have an increased risk of developing MetS compared to those not exposed to GDM in utero. (RR 2.07, 95% CI 1.26-3.42, three studies, 4,421 participants; heterogeneity: χ2 p = 0.33; I2 = 12%). Women diagnosed with GDM have an increased risk of developing MetS during pregnancy (RR 20.51, 95% CI 5.04-83.55; three studies, 406 participants; heterogeneity: χ2 p = 0.96; I2 = 0%). Subgroup analysis revealed that MetS is diagnosed as early as <1 year postpartum in women with a history of GDM. CONCLUSIONS/INTERPRETATION Women with GDM have an increased risk of developing MetS during pregnancy. Women with a history of GDM and offspring exposed to GDM in utero have higher risks of developing MetS compared to those with no history of GDM. Metabolic syndrome in women with a history of GDM is seen as early as <1 year postpartum.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Zohra S Lassi
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Health Performance and Policy Research Unit, Basil Hetzel Institute, The University of Adelaide, Adelaide, SA, Australia
- Adelaide G-TRAC Centre and CRE Frailty and Healthy Ageing Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Margaret A Arstall
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Prabha H Andraweera
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
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Kunasegaran T, Balasubramaniam VRMT, Arasoo VJT, Palanisamy UD, Ramadas A. Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031272. [PMID: 33572656 PMCID: PMC7908368 DOI: 10.3390/ijerph18031272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute’s methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.
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Jung CH, Jung SH, Choi D, Kim BY, Kim CH, Mok JO. Gestational diabetes in Korea: Temporal trends in prevalence, treatment, and short-term consequences from a national health insurance claims database between 2012 and 2016. Diabetes Res Clin Pract 2021; 171:108586. [PMID: 33316311 DOI: 10.1016/j.diabres.2020.108586] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 10/16/2020] [Accepted: 11/26/2020] [Indexed: 11/15/2022]
Abstract
AIMS This population-based cross-sectional study aimed to investigate recent trends in the prevalence and treatment of gestational diabetes mellitus (GDM) in Korea. We also investigated trends in annual prevalence rate of pregnancy-induced hypertension (PIH) and cesarean section (C-section) in GDM patients. METHODS We used data from the Health Insurance Review and Assessment-National Patient Sample (HIRA-NPS) database, 2012-2016. Non-GDM (n = 53,698) and GDM (n = 7956) patient data were analyzed for each year. RESULTS The annual increase in the prevalence of GDM was 11.1% over 2012-2016, with a significant continuously increasing trend (p < 0.0001). Age-stratified analysis showed that the annual prevalence of GDM significantly increased in patients below 40 years of age, but was not statistically significant as an increasing trend in patients above 40 years of age. Annual PIH prevalence rate among GDM women showed decreasing trend but was not statistically significant. An annual increase in C-section rate above 5% in GDM patients was statistically significant in both unadjusted and adjusted for age and PIH models. CONCLUSIONS The prevalence of GDM in Korean women and C-section rates in women with GDM showed a significantly increasing trend, 2012-2016. There is a need for further efforts to monitor this trend and to identify associated risk factors for GDM in Korean women.
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Affiliation(s)
- Chan-Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, South Korea
| | - Sang-Hee Jung
- Department of Obstetrics and Gynecology, Cha University School of Medicine, Bundang Hospital, South Korea
| | - Dughyun Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, South Korea
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, South Korea
| | - Chul-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, South Korea
| | - Ji-Oh Mok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, South Korea.
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Aburezq M, AlAlban F, Alabdulrazzaq M, Badr H. Risk factors associated with gestational diabetes mellitus: The role of pregnancy-induced hypertension and physical inactivity. Pregnancy Hypertens 2020; 22:64-70. [PMID: 32745722 DOI: 10.1016/j.preghy.2020.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) causes serious complications affecting the mother and fetus. Physical activity (PA) during pregnancy has positive effects on the mother and fetus. The objectives of this study were to assess GMD prevalence in Kuwait, identify its risk factors, and to evaluate its association with PA. METHODS A cross-sectional study was conducted among a randomly selected 653 post-partum women from all public maternal centers and five private centers. An anonymous self-administered questionnaire was used to collect participants' socio-demographic data, medical and obstetric history. Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess PA level. RESULTS Participants' mean age was 30.1 ± 5.3. GMD was diagnosed among 14.1% (95% CI: 11.6-17.0) of participants. Binary logistic regression revealed that poor income, having 2 + chronic diseases, past history of GDM, hypothyroidism, high systolic or diastolic blood pressure during pregnancy were independently correlated with developing GDM. For physical activity, the overall means of PPAQ total and sub-scores were below average and only PPAQ sub-score -Vigorous Intensity Activity- was significantly higher amid women without GMD than those with. However, PPAQ mean scores showed significant positive correlation with women's pre-pregnancy BMI and birth weight; and a significant negative association with gestational systolic and diastolic blood pressure. CONCLUSIONS GDM prevalence is relatively high in Kuwait, notably amid expatriates. Pregnancy-induced hypertension along with social and pre-pregnancy medical conditions correlated with developing GDM. PA helped mitigated pregnancy blood pressure, and fetal birth weight. Promoting additional medical monitoring and PA during pregnancy might aid reduce the prevalence of GDM.
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Affiliation(s)
- Maryam Aburezq
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Fatima AlAlban
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Maryam Alabdulrazzaq
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Hanan Badr
- Faculty of Science, University of Prince Edward Island (UPEI), Canada.
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21
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Fetal macrosomia in a Hispanic/Latinx predominant cohort and altered expressions of genes related to placental lipid transport and metabolism. Int J Obes (Lond) 2020; 44:1743-1752. [PMID: 32494035 PMCID: PMC7387181 DOI: 10.1038/s41366-020-0610-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Fetal overgrowth, termed fetal macrosomia when birth weight is greater than 4000 grams, is the major concern in the treatment of gestational diabetes mellitus (GDM). However, to date, the underlying mechanisms of fetal macrosomia have not been understood completely. Placental lipid metabolism is emerging as a critical player in fetal growth. In this study, we hypothesized that fatty acid transport and metabolism in the placental tissue was impaired in GDM women, dependent on fetal sex. To test this hypothesis, we analyzed the incidence of GDM, fetal macrosomia, and obesity in a large cohort consisting of 17995 pregnant subjects and majority of subjects being Hispanic/Latinx, and investigated expression of genes related to lipid transport and metabolism in placenta from obese women with or without GDM, and with or without fetal macrosomia. The main findings include: 1) There is a higher incidence of GDM and obesity in Hispanic subjects compared to non-Hispanic subjects, but not fetal macrosomia; 2) Expressions of most of genes related to placental lipid transport and metabolism are not altered by the presence of GDM, fetal macrosomia, or fetal sex; 3) Expression of FABP4 is increased in obese women with GDM and fetal macrosomia, and this occurred in male placentas; 4) Expression of LPL is decreased in obese women with GDM despite fetal macrosomia, and this occurred in male placentas; 5) Expression of ANGPTL3 is decreased in obese women with GDM and fetal macrosomia, but is not altered when fetal sex is included in the analysis. This study indicates that there is race disparity in GDM with higher incidence of GDM in obese Hispanic women, although fetal macrosomia disparity is not present. Moreover, altered placental lipid transport may contribute to fetal overgrowth in obese women with GDM.
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22
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Huang Y, Zhang W, Go K, Tsuchiya KJ, Hu J, Skupski DW, Sie SY, Nomura Y. Altered growth trajectory in children born to mothers with gestational diabetes mellitus and preeclampsia. Arch Gynecol Obstet 2020; 301:151-159. [PMID: 31965240 PMCID: PMC7335593 DOI: 10.1007/s00404-020-05436-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) and preeclampsia are leading causes of mortality and morbidity in mothers and children. High childhood body mass index (BMI) is among their myriad of negative outcomes. However, little is known about the trajectory of the child BMI exposed to GDM and co-occurring preeclampsia from early to mid-childhood. This study examined the independent and joint impact of GDM and preeclampsia on childhood BMI trajectory. METHODS A population-based sample of 356 mothers were recruited from OB/GYN clinics in New York. Their children were then followed annually from 18 to 72 months. Maternal GDM and preeclampsia status were obtained from medical records. Child BMI was calculated based on their height and weight at annual visits. RESULTS Hierarchical Linear Modeling was used to evaluate the trajectories of child BMI exposed to GDM and preeclampsia. BMI trajectory by GDM decreased (t ratio = - 2.24, [Formula: see text]0.45, 95% CI - 0.05-0.95, p = 0.07), but the trajectory by preeclampsia increased over time (t ratio = 3.153,[Formula: see text]0.65, 95% CI 0.11-1.18, p = 0.002). Moreover, there was a significant interaction between the two (t ratio = -2.24, [Formula: see text]- 1.244, 95% CI 0.15-2.33, p = 0.02), such that the BMI of children born to mothers with both GDM and preeclampsia showed consistent increases over time. CONCLUSIONS GDM and preeclampsia could be used as a marker for childhood obesity risk and the identification of a high-risk group, providing potential early intervention. These findings highlight the importance of managing obstetric complications, as an effective method of child obesity prevention.
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Affiliation(s)
- Yonglin Huang
- Department of Psychology, Graduate Center, City University of New York, New York, USA
| | - Wei Zhang
- Department of Psychology, New Jersey City University, Jersey City, NJ, USA
| | - Karen Go
- Department of Psychology, Graduate Center, City University of New York, New York, USA
| | - Kenji J Tsuchiya
- Research Center for Child Mental Development and United Graduate School of Child Development, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Jianzhong Hu
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Daniel W Skupski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York Presbyterian Queens, Flushing, NY, USA
| | - Sheow Yun Sie
- Department of Psychology, Queens College, City University of New York, 65-30 Kissena Blvd, Flushing, NY, 11367, USA
| | - Yoko Nomura
- Department of Psychology, Queens College, City University of New York, 65-30 Kissena Blvd, Flushing, NY, 11367, USA.
- Department of Psychology, Graduate Center, City University of New York, New York, USA.
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23
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Nwose EU, Mogbusiaghan M, Bwititi PT, Adoh G, Agofure O, Igumbor EO. Barriers in determining prevalence of type 2 diabetes mellitus among postpartum GDM: The research and retraining needs of healthcare professionals. Diabetes Metab Syndr 2019; 13:2533-2539. [PMID: 31405673 DOI: 10.1016/j.dsx.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/08/2019] [Indexed: 11/20/2022]
Abstract
AIM A large percentage of gestational diabetes (GDM) are undiagnosed, and prevalence of postpartum type 2 diabetes (T2DM) is unknown, especially in developing countries. This study assessed barriers to GDM diagnosis and postpartum follow-up; to determine educational needs. MATERIALS AND METHODS This was a clinical observational study of records and procedures of antenatal services at two hospitals. Laboratory and medical records were reviewed for availability of data on anthropometrics, blood glucose, gestational age, urinalysis, and lipid profile for GDM register. Antenatal clinic protocol was observed for GDM diagnosis. BMI was derived and data were analyzed using SPSS version 20. RESULTS Critical barriers attributable to health systems included lack of screening for blood sugar as part of routine antenatal protocol, and lack of GDM registers at both facilities. There was 6.5% registration of pregnancies in first trimester, 22% pre-pregnancy obesity, and 2.6% high blood pressure. Positive glucosuria cases were not followed-up for GDM diagnosis. CONCLUSIONS There is neither concerted effort to diagnose GDM, nor systematic records of screening and postpartum follow-up. The gap in diabetology knowledge and practice calls for re-training of antenatal healthcare professionals. GDM screening checklist needs to be established and positive results entered into GDM registers for proper management during and after delivery.
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Affiliation(s)
- E U Nwose
- School of Community Health, Charles Sturt University, Orange, Australia; Department of Public & Community Health, Novena University, Ogume, Nigeria.
| | - M Mogbusiaghan
- Department of Public & Community Health, Novena University, Ogume, Nigeria
| | - P T Bwititi
- School of Biomedical Sciences, Charles Sturt University, Orange, Australia
| | - G Adoh
- Department of Public & Community Health, Novena University, Ogume, Nigeria
| | - O Agofure
- Department of Public & Community Health, Novena University, Ogume, Nigeria
| | - E O Igumbor
- Department of Public & Community Health, Novena University, Ogume, Nigeria
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Sunjaya AP, Sunjaya AF. Diabetes in pregnancy and infant mortality: Link with glycemic control. Diabetes Metab Syndr 2018; 12:1031-1037. [PMID: 29945772 DOI: 10.1016/j.dsx.2018.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
AIMS To compare the clinical and glycemic profile as well as pregnancy complications and infant mortality among diabetic mothers in Indonesia. MATERIALS AND METHODS Data was obtained from medical records of Internal-Medicine Clinic in Hermina Podomoro General Hospital during the period January-December 2015. Subjects were grouped into good and poor outcome groups based on infant mortality. RESULTS Forty-five subjects were obtained with an average age of 31 years, 41 had gestational diabetes mellitus while 4 had pregestational diabetes. Twenty-one patients had high-risk pregnancies (age >30 years or <20 years). No maternal mortalities were reported, only 6 pregnancies were complicated with infant death. Comorbidities mainly found were preeclampsia, anemia and urinary tract infection. Most patients delivered through caesarian section. Almost all of them were treated with insulin. Comparison between both groups showed that those with poor outcomes have a significantly higher body mass index prior to pregnancy, higher body weight prior and after pregnancy as well as worse glycemic profile. CONCLUSION Diabetes in pregnancy has been found to increase rates of infant mortality. This study showed that patients with poor glycemic control are at a greater risk of infant mortality. Therefore increased monitoring and prenatal care as well as optimal glycemic control for patients with diabetes in pregnancy is recommended. Optimal glycemic control will lead to diabetic mothers with pregnancies of equal risk and similar outcomes to those of normal patients.
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Affiliation(s)
- Anthony P Sunjaya
- Faculty of Medicine, Tarumanagara University, Jl. Letjen S. Parman No.1, Jakarta, Indonesia.
| | - Angela F Sunjaya
- Faculty of Medicine, Tarumanagara University, Jl. Letjen S. Parman No.1, Jakarta, Indonesia
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25
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Patti AM, Pafili K, Papanas N, Rizzo M. Metabolic disorders during pregnancy and postpartum cardiometabolic risk. Endocr Connect 2018; 7:E1-E4. [PMID: 29712720 PMCID: PMC5970277 DOI: 10.1530/ec-18-0130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 12/15/2022]
Abstract
Hormonal changes during pregnancy can trigger gestational diabetes (GDM), which is constantly increasing. Its main characteristic is pronounced insulin resistance, but it appears to be a multifactorial process involving several metabolic factors; taken together, the latter leads to silent or clinically evident cardiovascular (CV) events. Insulin resistance and central adiposity are of crucial importance in the development of metabolic syndrome, and they appear to correlate with CV risk factors, including hypertension and atherogenic dyslipidaemia. Hypertensive disease of pregnancy (HDP) is more likely to be an accompanying co-morbidity in pregnancies complicated with GDM. There is still inconsistent evidence as to whether or not co-existent GDM and HDP have a synergistic effects on postpartum risk of cardiometabolic disease; however, this synergism is becoming more accepted since both these conditions may promote endothelial inflammation and early atherosclerosis. Regardless of the presence or absence of the synergism between GDM and HDP, these conditions need to be dealt early enough, in order to reduce CV morbidity and to improve health outcomes for both women and their offspring.
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Affiliation(s)
- Angelo Maria Patti
- Department of Internal Medicine and Medical SpecialtiesUniversity of Palermo, Palermo, Italy
| | - Kalliopi Pafili
- Diabetes CentreSecond Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes CentreSecond Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Manfredi Rizzo
- Department of Internal Medicine and Medical SpecialtiesUniversity of Palermo, Palermo, Italy
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