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Izumi S, Iwama N, Hamada H, Obara T, Ishikuro M, Satoh M, Murakami T, Saito M, Ohkubo T, Sugiyama T, Kuriyama S, Yaegashi N, Hoshi K, Imai Y, Metoki H. Associations of fasting plasma glucose and glycosylated hemoglobin levels at less than 24 weeks of gestation with hypertensive disorders of pregnancy: the BOSHI study. Endocr J 2024; 71:979-993. [PMID: 39069496 DOI: 10.1507/endocrj.ej23-0568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
This study aimed to evaluate the associations of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) levels at <24 weeks of gestation with hypertensive disorders of pregnancy (HDP) and compare the strengths of the associations of HDP with FPG and HbA1c levels. Totally, 1,178 participants were included in this prospective cohort study. HDP, FPG, HbA1c, and potential confounding factors were included in multiple logistic regression models. The number of HDP cases was 136 (11.5%). When FPG and HbA1c were included in the model separately, quartile 4 (Q4) of FPG (87-125 mg/dL) and HbA1c (5.2-6.3% [33-45 mmol/mol]) levels had higher odds of HDP than quartile 1. The odds ratios (ORs) were 1.334 (95% confidence interval [CI]: 1.002-1.775) for Q4 of FPG and 1.405 (95% CI: 1.051-1.878) for Q4 of HbA1c. When the participants were divided into two categories based on the cut-off value with the maximum Youden Index of FPG or HbA1c, the ORs for high FPG (≥84 mg/dL) or high HbA1c (≥5.2% [33 mmol/mol]) were 1.223 (95% CI: 1.000-1.496) and 1.392 (95% CI: 1.122-1.728), respectively. When both FPG and HbA1c were included in the model simultaneously, the statistical significance of Q4 of FPG disappeared, whereas that of HbA1c remained. In two-category models, the same results were obtained. High FPG and HbA1c levels at <24 weeks of gestation were risk factors for HDP in pregnant Japanese women. In addition, high HbA1c levels were more strongly associated with HDP than high FPG levels.
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Affiliation(s)
- Seiya Izumi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
| | - Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Taku Obara
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi 980-8573, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Miyagi 980-8573, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Mami Ishikuro
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi 980-8573, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Miyagi 980-8573, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Miyagi 983-8536, Japan
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Miyagi 983-8512, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi 980-8573, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Miyagi 983-8536, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi 980-8573, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Miyagi 980-8574, Japan
- Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Shinichi Kuriyama
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi 980-8573, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Miyagi 980-8573, Japan
- International Research Institute of Disaster Science, Tohoku University, Miyagi 980-8572, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Miyagi 980-8574, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi 980-8573, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Miyagi 980-8573, Japan
| | | | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Miyagi 980-0802, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Miyagi 983-8536, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi 980-8573, Japan
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Maor-Sagie E, Hallak M, Haggiag N, Naeh A, Toledano Y, Gabbay-Benziv R. Timing of gestational diabetes diagnosis and progression to type 2 Diabetes: A comparative analysis. Diabetes Res Clin Pract 2024; 214:111782. [PMID: 39002931 DOI: 10.1016/j.diabres.2024.111782] [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: 04/07/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
AIM To evaluate and compare the risk of progressing to type 2 diabetes (T2DM) based on the timing of gestational diabetes (GDM) diagnosis during pregnancy. METHODS Retrospective analysis of pregnant individuals with gestational diabetes and post-pregnancy follow up. Data sourced from Meuhedet HMO's computerized laboratory system, cross-tabulated with the Israeli National Diabetes Registry. The cohort was divided into normoglycemic, early GDM (diagnosed by fasting plasma glucose 92-125 mg/dL (5.1-6.9 mM) at < 15 weeks), 2nd trimester GDM (diagnosed at 24-28 weeks), and late GDM (diagnosed after 29 weeks). Statistics included univariate analysis followed by survival analysis. Risk was further analyzed for individuals by obesity status. RESULTS 75,459 entered the analysis: 90 % normoglycemic, 7.9 % early GDM, 1.4 % 2nd trimester GDM, and 0.7 % late GDM. Median post-pregnancy follow-up time was 4.3 (IQR 3.3-5.1). 2nd trimester GDM showed the highest T2DM risk annually after pregnancy. Cox regression analysis, adjusted for confounders, revealed a significantly higher T2DM risk for 2nd-trimester GDM compared to early and late GDM. Late GDM did not confer additional significant T2DM risk. Stratification by obesity status highlighted that early GDM increased the risk of T2DM only in individuals without obesity. CONCLUSIONS GDM diagnosis timing significantly impacts T2DM risk. 2nd trimester GDM carries the highest T2DM risk.
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Affiliation(s)
- Esther Maor-Sagie
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Mehuedet HMO, Israel
| | - Mordechai Hallak
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Mehuedet HMO, Israel
| | - Noa Haggiag
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Amir Naeh
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | | | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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Bhattacharya S, Nagendra L, Dutta D, Mondal S, Bhat S, Raj JM, Boro H, Kamrul-Hasan ABM, Kalra S. First-trimester fasting plasma glucose as a predictor of subsequent gestational diabetes mellitus and adverse fetomaternal outcomes: A systematic review and meta-analysis. Diabetes Metab Syndr 2024; 18:103051. [PMID: 38843646 DOI: 10.1016/j.dsx.2024.103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The implication of intermediately elevated fasting plasma glucose (FPG) in the first trimester of pregnancy is uncertain. PURPOSE The primary outcome of the meta-analysis was to analyze if intermediately elevated first-trimester FPG could predict development of GDM at 24-28 weeks. The secondary outcomes were to determine if the commonly used FPG cut-offs 5.1 mmol/L (92 mg/dL), 5.6 mmol/L (100 mg/dL), and 6.1 mmol/L (110 mg/dL) correlated with adverse pregnancy events. DATA SOURCES Databases were searched for articles published from 2010 onwards for studies examining the relationship between first-trimester FPG and adverse fetomaternal outcomes. STUDY SELECTION A total of sixteen studies involving 115,899 pregnancies satisfied the inclusion criteria. DATA EXTRACTION AND DATA SYNTHESIS Women who developed GDM had a significantly higher first-trimester FPG than those who did not [MD 0.29 mmoL/l (5 mg/dL); 95 % CI: 0.21-0.38; P < 0.00001]. First-trimester FPG ≥5.1 mmol/L (92 mg/dL) predicted the development of GDM at 24-28 weeks [RR 3.93 (95 % CI: 2.67-5.77); P < 0.0000], pre-eclampsia [RR 1.55 (95%CI:1.14-2.12); P = 0.006], gestational hypertension [RR1.47 (95%CI:1.20-1.79); P = 0.0001], large-for-gestational-age (LGA) [RR 1.32 (95%CI:1.13-1.54); P = 0.0004], and macrosomia [RR1.29 (95%CI:1.15-1.44); P < 0.001]. However, at the above threshold, the rates of preterm delivery, lower-segment cesarean section (LSCS), small-for gestational age (SGA), and neonatal hypoglycemia were not significantly higher. First-trimester FPG ≥5.6 mmol/L (100 mg/dL) correlated with occurrence of macrosomia [RR1.47 (95 % CI:1.22-1.79); P < 0.0001], LGA [RR 1.43 (95%CI:1.24-1.65); P < 0.00001], and preterm delivery [RR1.51 (95%CI:1.15-1.98); P = 0.003], but not SGA and LSCS. LIMITATIONS Only one study reported outcomes at first-trimester FPG of 6.1 mmol/L (110 mg/dL), and hence was not analyzed. CONCLUSION The risk of development of GDM at 24-28 weeks increased linearly with higher first-trimester FPG. First trimester FPG cut-offs of 5.1 mmol/L (92 mg/dL) and 5.6 mmol/L (100 mg/dL) predicted several adverse pregnancy outcomes.
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Affiliation(s)
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India.
| | - Deep Dutta
- Department of Endocrinology, Center for Endocrinology, Diabetes, Arthritis & Rheumatism, Sector 12A Dwarka, New Delhi, India
| | - Sunetra Mondal
- Department of Endocrinology, Nil Ratan Sarkar Medical College, Kolkata, India
| | - Sowrabha Bhat
- Department of Endocrinology, Yenepoya Medical College, Mangalore, India
| | - John Michael Raj
- Department of Biostatistics, St. John's Medical College, Bangalore, India
| | - Hiya Boro
- Department of Endocrinology, Aadhar Health Institute, Hisar, India
| | - A B M Kamrul-Hasan
- Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospitals, Karnal, India
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Rayas MS, Munoz JL, Boyd A, Kim J, Mangold C, Moreira A. Impact of Race/Ethnicity and Insurance Status on Obstetric Outcomes: Secondary Analysis of the NuMoM2b Study. Am J Perinatol 2024; 41:e2907-e2918. [PMID: 37935375 PMCID: PMC11074238 DOI: 10.1055/s-0043-1776345] [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: 11/09/2023]
Abstract
OBJECTIVE This study aimed to investigate the impact of race/ethnicity and insurance status on obstetric outcomes in nulliparous women. STUDY DESIGN Secondary analysis of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-To-Be. Obstetric outcomes included the development of a hypertensive event during pregnancy, need for a cesarean section, delivery of a preterm neonate, and postpartum hemorrhage. RESULTS Of 7,887 nulliparous women, 64.7% were non-Hispanic White (White), 13.4% non-Hispanic Black (Black), 17.8% Hispanic, and 4.1% were Asian. Black women had the highest rates of developing new-onset hypertension (32%) and delivering preterm (11%). Cesarean deliveries were the highest in Asian (32%) and Black women (32%). Individuals with government insurance were more likely to deliver preterm (11%) and/or experience hemorrhage after delivery. In multivariable analyses, race/ethnicity was associated with hypertension and cesarean delivery. More important, the adjusted odds ratios for preventable risk factors, such as obesity, diabetes, and severe anemia were greater than the adjusted odds ratios for race/ethnicity in terms of poor maternal outcome. CONCLUSION Although disparities were observed between race/ethnicity and obstetric outcomes, other modifiable risk factors played a larger role in clinical differences. KEY POINTS · Race or insurance alone had mixed associations with maternal morbidities.. · Race and insurance had low associations with maternal morbidities.. · Other, modifiable risk factors may be more important.. · Both social and biological factors impact health disparities..
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Affiliation(s)
- Maria S. Rayas
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Jessian L. Munoz
- Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Angela Boyd
- Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Jennifer Kim
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Cheyenne Mangold
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, Texas
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Hojeij B, Rousian M, Sinclair KD, Dinnyes A, Steegers-Theunissen RPM, Schoenmakers S. Periconceptional biomarkers for maternal obesity: a systematic review. Rev Endocr Metab Disord 2023; 24:139-175. [PMID: 36520252 PMCID: PMC10023635 DOI: 10.1007/s11154-022-09762-5] [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] [Accepted: 10/01/2022] [Indexed: 12/23/2022]
Abstract
Periconceptional maternal obesity is linked to adverse maternal and neonatal outcomes. Identifying periconceptional biomarkers of pathways affected by maternal obesity can unravel pathophysiologic mechanisms and identify individuals at risk of adverse clinical outcomes. The literature was systematically reviewed to identify periconceptional biomarkers of the endocrine, inflammatory and one-carbon metabolic pathways influenced by maternal obesity. A search was conducted in Embase, Ovid Medline All, Web of Science Core Collection and Cochrane Central Register of Controlled Trials databases, complemented by manual search in PubMed until December 31st, 2020. Eligible studies were those that measured biomarker(s) in relation to maternal obesity, overweight/obesity or body mass index (BMI) during the periconceptional period (14 weeks preconception until 14 weeks post conception). The ErasmusAGE score was used to assess the quality of included studies. Fifty-one articles were included that evaluated over 40 biomarkers. Endocrine biomarkers associated with maternal obesity included leptin, insulin, thyroid stimulating hormone, adiponectin, progesterone, free T4 and human chorionic gonadotropin. C-reactive protein was associated with obesity as part of the inflammatory pathway, while the associated one-carbon metabolism biomarkers were folate and vitamin B12. BMI was positively associated with leptin, C-reactive protein and insulin resistance, and negatively associated with Free T4, progesterone and human chorionic gonadotropin. Concerning the remaining studied biomarkers, strong conclusions could not be established due to limited or contradictory data. Future research should focus on determining the predictive value of the optimal set of biomarkers for their use in clinical settings. The most promising biomarkers include leptin, adiponectin, human chorionic gonadotropin, insulin, progesterone and CRP.
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Affiliation(s)
- Batoul Hojeij
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, 3015GD, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, 3015GD, The Netherlands
| | - Kevin D Sinclair
- School of Biosciences, Sutton Bonnington Campus, University of Nottingham, Leicestershire, LE12 6HD, UK
| | - Andras Dinnyes
- BioTalentum Ltd., Godollo, 2100, Hungary
- Department of Cell Biology and Molecular Medicine, University of Szeged, Szeged, 6720, Hungary
- Department of Physiology and Animal Health, Institute of Physiology and Animal Nutrition, Hungarian University of Agriculture and Life Sciences, Godollo, 2100, Hungary
| | | | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, 3015GD, The Netherlands.
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Ortíz-García SG, Torres-Sánchez LE, Muñoz-Rocha TV, Mercado-García A, Peterson KE, Hu H, Osorio-Yáñez C, Téllez-Rojo MM. Maternal urinary fluoride during pregnancy and birth weight and length: Results from ELEMENT cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156459. [PMID: 35660617 DOI: 10.1016/j.scitotenv.2022.156459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Epidemiological studies assessing prenatal fluoride exposure and anthropometry at birth are scarce, inconsistent and with methodological limitations. The aim of this study was to evaluate associations between maternal urinary fluoride (MUF) at each trimester of pregnancy and birth weight and length in 536 mother-child pairs in the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort study. MUF (mg/L) was measured using microdiffusion/fluoride-specific electrode from at least one trimester of pregnancy. Non-linear associations were assessed through segmented regression models (MUF and birth weight Z-score) and we used linear regression models for MUF and birth length Z-score. Models were adjusted for potential confounders including urinary creatinine concentrations as a covariate. Non-creatinine adjusted MUF levels at each trimester of pregnancy were 0.81, 0.86, and 0.82 mg/L, mean concentrations for first, second and third trimester, respectively. For birth weight, we identified a MUF breakpoint at 0.99, 0.68 and 0.58 mg/L, for first, second and third trimester of pregnancy, respectively. In the first trimester, an increase of 1 mg/L in MUF concentrations ≥0.99 mg/L was associated with an increase in weight Z-score at birth (β = 0.79; 95% CI: 0.10, 1.48; p = 0.02). Second trimester MUF (≥0.68 mg/L) was marginally associated with birth weight decrease (β = -0.25; 95% CI: -0.55, 0.04; p = 0.09) and third trimester MUF (≥0.58 mg/L) was significantly associated with birth weight decrease (β = -0.33; 95% CI: -0.63, -0.03; p = 0.03). We observed a linear and significant association between MUF and Z-score of length at birth only for the first trimester of pregnancy (β = 0.55; 95% CI: 0.07, 1.04; p < 0.02). Prenatal fluoride exposure was associated with birthweight z-score with different susceptibility windows. Our findings reinforce the hypothesis that maternal fluoride exposure may affect birth anthropometry.
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Affiliation(s)
| | | | | | | | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Howard Hu
- University of Washington, School of Public Health, Seattle, WA, USA
| | - Citlalli Osorio-Yáñez
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Apartado Postal 70228, Ciudad de México 04510, Mexico; Laboratorio de Fisiología Cardiovascular y Trasplante Renal, Unidad de Investigación UNAM-INCICH, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico, Mexico.
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North SM, Crofts C, Zinn C. Hyperinsulinaemia in pregnancy and gestational outcomes: A case series. JOURNAL OF INSULIN RESISTANCE 2022. [DOI: 10.4102/jir.v5i1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Pathological insulin resistance in pregnancy is associated with an increased risk for complications such as gestational diabetes mellitus and pre-eclampsia. Individuals with pathological insulin resistance also exhibit hyperinsulinaemia. Currently, there are no diagnostic criteria for pathological hyperinsulinaemia in pregnancy that may be used to indicate risk of adverse outcomes.Aim: This case series aimed to explore the relationship between first trimester insulin response patterns and gestational outcomes.Setting: Auckland, New Zealand.Methods: Participants included four pregnant women with prepregnancy body mass index ≥ 25 kg/m2 and aged 25–35 years. Glucose and insulin response patterns were examined following a 120 min oral glucose tolerance test (OGTT) at 12–15 weeks of gestation using a modified Kraft methodology. Outcomes assessed at 25 and 35 weeks of gestation included gestational weight gain (GWG), blood pressure, fasting capillary blood glucose and foetal growth. Lifestyle and medical information were collected at each trimester. After delivery, total GWG, infant size, delivery method and clinical outcomes were recorded.Results: Kraft pattern IIB hyperinsulinaemia was identified in two cases. Amongst them, Case #1 experienced excessive GWG, induction of labour and surgically assisted delivery. Case #4 delivered by emergency caesarean, and the neonate required intensive care admission for 17 h. No cases developed hyperglycaemia or hypertension. Infant weights were between 3.75 kg and 3.86 kg.Conclusion: Dynamic insulin assay provides a promising template to assess metabolic risk in the first trimester of pregnancy. Diagnosing hyperinsulinaemia early in pregnancy means that lifestyle-based initiatives could be introduced earlier to mitigate excess GWG and potential adverse outcomes.
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Hannah W, Bhavadharini B, Beks H, Deepa M, Anjana RM, Uma R, Martin E, McNamara K, Versace V, Saravanan P, Mohan V. Global burden of early pregnancy gestational diabetes mellitus (eGDM): A systematic review. Acta Diabetol 2022; 59:403-427. [PMID: 34743219 DOI: 10.1007/s00592-021-01800-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/07/2021] [Indexed: 01/02/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) diagnosed during the first trimester of pregnancy is called 'early pregnancy Gestational Diabetes Mellitus' (eGDM). The burden of eGDM has only been studied sporadically. This review aims to understand the global burden of eGDM in terms of prevalence, risk factors, pregnancy outcomes, treatment and postpartum dysglycemia. METHODS: A review of epidemiologic studies reporting on early GDM screening as per Joanna Briggs Institute (JBI) methodology for prevalence reviews was conducted. A customized search strategy was used to search electronic databases namely, PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, MEDLINE, Ovid, ScienceDirect, and Google Scholar. Three independent reviewers reviewed studies using Covidence software. Observational studies irrespective of study design and regardless of diagnostic criteria were included. Quality of evidence was appraised, and findings were synthesized. RESULTS Of 58 included studies, 41 reported a prevalence of eGDM, ranging from 0.7 to 36.8%. Body mass index (BMI), previous history of GDM, family history of diabetes and multiparity were reported as eGDM risk factors. Adverse pregnancy outcomes associated with eGDM were macrosomia, caesarean delivery, induction of labour, hypertension, preterm delivery, and shoulder dystocia. The incidence of postpartum dysglycemia and the need for insulin was higher in women with eGDM. The risk of bias was moderate. Heterogeneity of studies is a limitation. Meta-analysis was not performed. CONCLUSIONS There is heterogeneity in the prevalence of eGDM and intrapartum and postpartum ill effects for the mother and the offspring. There is a need to develop a universal screening protocol for eGDM.
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Affiliation(s)
- Wesley Hannah
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
- Deakin University, Geelong, Australia
| | | | | | - Mohan Deepa
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ram Uma
- Seethapathy Clinic & Hospital, Chennai, India
| | | | | | | | - Ponnusamy Saravanan
- Populations, Evidence and Technologies, Warwick Medical School, Gibbet Hill, Division of Health Sciences, University of Warwick, Coventry, UK
- Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital NHS Trust, Nunetaon, UK
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
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Tan X, Huang Y. Magnesium supplementation for glycemic status in women with gestational diabetes: a systematic review and meta-analysis. Gynecol Endocrinol 2022; 38:202-206. [PMID: 34907820 DOI: 10.1080/09513590.2021.1988558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The effect of magnesium supplementation on glycemic status in women with gestational diabetes remains controversial and this meta-analysis aims to explore the efficacy of magnesium supplementation for gestational diabetes. METHODS We have searched PubMed, Excerpta Medica database, Web of science, Elton B. Stephens. Company, and Cochrane library databases. The meta-analysis included randomized controlled trials (RCTs) assessing the effect of magnesium supplementation for gestational diabetes and was performed using the random-effect model. RESULTS Four RCTs were included in the meta-analysis. Overall, compared with placebo in gestational diabetes, magnesium supplementation was associated with significantly reduced fasting plasma glucose (standard mean difference [SMD] = -0.99; 95% confidence interval [CI] = -1.28 to -0.70; p < .00001), serum insulin (SMD = -0.75; 95% CI = -1.24 to -0.26; p = .003), homeostasis model assessment of insulin resistance (SMD = -0.74; 95% CI = -1.10 to -0.39; p < .0001) and increased quantitative insulin sensitivity check index (SMD = 0.47; 95% CI = 0.12 to 0.82; p = .008). In addition, low-density lipoprotein-cholesterol (SMD = -0.39; 95% CI = -0.73 to -0.04; p = .03) and total cholesterol (SMD = -0.62; 95% CI = -0.97 to -0.27; p = .0005) were also obviously decreased in the magnesium group than those in the control group. CONCLUSION Magnesium supplementation benefits glycemic control for gestational diabetes.
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Affiliation(s)
- Xiaoqing Tan
- Department of Obstetrics and Gynecology, Chongqing General Hospital, University of Chinese Academy of Sciences, China
| | - Yi Huang
- Department of Obstetrics and Gynecology, Chongqing General Hospital, University of Chinese Academy of Sciences, China
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Bhattacharya S, Nagendra L, Krishnamurthy A, Lakhani OJ, Kapoor N, Kalra B, Kalra S. Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications. Med Sci (Basel) 2021; 9:59. [PMID: 34698239 PMCID: PMC8544345 DOI: 10.3390/medsci9040059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/16/2022] Open
Abstract
Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hyperglycemia thus diagnosed. We have used the term early gestational DM (eGDM) for this condition and reviewed the currently available literature. Fasting plasma glucose (FPG), oral glucose tolerance test, and glycated hemoglobin (HbA1c) are the commonly employed screening tools in early pregnancy. Observational studies suggest that early pregnancy FPG and Hba1c correlate with the risk of cGDM and adverse perinatal outcomes. However, specific cut-offs, including those proposed by the International Association of the Diabetes and Pregnancy Study Group, do not reliably predict the development of cGDM. Emerging data, though indicate that FPG ≥ 92 mg/dL (5.1 mmol/L), even in the absence of cGDM, signals the risk for perinatal complication. Elevated HbA1c, especially a level ≥ 5.9%, also correlates with the risk of cGDM and worsened outcome. HbA1c as a diagnostic test is however besieged with the usual caveats that occur in pregnancy. The studies that explored the effects of intervention present conflicting results, including a possibility of fetal malnutrition and small-for-date baby in the early treatment group. Diagnostic thresholds and glycemic targets in eGDM may differ, and large multicenter randomized controlled trials are necessary to define the appropriate strategy.
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Affiliation(s)
| | - Lakshmi Nagendra
- Department of Endocrinology, K.S Hegde Medical Academy, Mangalore 575018, India;
| | | | - Om J. Lakhani
- Department of Endocrinology, Zydus Hospital, Ahmedabad 380058, India;
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, India;
| | - Bharti Kalra
- Department of Obstetrics, Bharti Hospital, Karnal 132001, India;
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, India;
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Luo C, Wan J, Rao Z, Zhang Y. Synbiotic supplementation for glycemic status in pregnant women: a meta-analysis of randomized clinical trials. Gynecol Endocrinol 2021; 37:146-151. [PMID: 33356677 DOI: 10.1080/09513590.2020.1853696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The effect of synbiotic supplementation on glycemic status in pregnant women remained controversial and this meta-analysis aimed to explore the efficacy of synbiotic supplementation on glycemic status in pregnant women. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases and randomized controlled trials (RCTs) assessing the effect of synbiotic on glycemic status in pregnant women were included. The meta-analysis was performed using the random-effect model. RESULTS Four RCTs were included in the meta-analysis. Overall, compared with control intervention in pregnant women, synbiotic supplementation was associated with significantly reduced serum insulin (SMD = -0.69; 95%CI = -1.06 to -0.32; p = .0002) and homoeostasis model assessment of insulin resistance (HOMA-IR, SMD = -0.53; 95%CI = -0.87 to -0.18; p = .003), but had no significant effect on fasting plasma glucose (FPG, SMD = -0.16; 95%CI = -0.43 to 0.11; p = .24), quantitative insulin sensitivity check index (QUICKI, SMD = 0.54; 95%CI = -0.10 to 1.18; p = .10) or CRP (SMD = -0.29; 95%CI = -1.23 to 0.64; p = .54). CONCLUSIONS Synbiotic supplementation was beneficial to glycemic control in pregnant women.
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Affiliation(s)
- Cheng Luo
- Department of Endocrinology, Quzhou People's Hospital, Quzhou, P. R. China
| | - Jinxing Wan
- Department of Endocrinology, Quzhou People's Hospital, Quzhou, P. R. China
| | - Zichen Rao
- Department of Endocrinology, Quzhou People's Hospital, Quzhou, P. R. China
| | - Yiming Zhang
- Department of Endocrinology, Quzhou People's Hospital, Quzhou, P. R. China
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12
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Ding Z, Zhou H, McCauley N, Ko G, Zhang KK, Xie L. In ovo hyperglycemia causes congenital limb defects in chicken embryos via disruption of cell proliferation and apoptosis. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165955. [PMID: 32877749 DOI: 10.1016/j.bbadis.2020.165955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/05/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
While the correlation between diabetes during pregnancy and birth defects is well-established, how hyperglycemia causes developmental abnormalities remains unclear. In this study, we developed a novel "hyperglycemic" chicken embryonic model by administrating various doses of glucose to fertilized eggs at embryonic stages HH16 or HH24. When the embryos were collected at HH35, the LD50 was 1.57 g/Kg under HH16 treatment and 0.93 g/Kg under HH24 treatment, indicating that "hyperglycemic" environments can be lethal for the embryos. When exposed to a dose equal to or higher than 1 g/Kg glucose at HH16 or HH24, more than 40% of the surviving chicken embryos displayed heart defects and/or limb defects. The limb defects were associated with proliferation defects of both the wing and leg buds indicated by reduced numbers of p-H3S10 labeled cells. These limb defects were also associated with ectopic apoptosis in the leg bud and expression changes of key apoptotic genes. Furthermore, glucose treatment induced decreased expression of genes involved in Shh-signaling, chondrogenesis, and digit patterning in the limb bud. In summary, our data demonstrated that a high-glucose environment induces congenital heart and limb defects associated with disrupted cell proliferation and apoptosis, possibly through depressed Shh-signaling.
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Affiliation(s)
- Zehuan Ding
- Department of Nutrition, Texas A&M University, College Station, TX, United States of America
| | - Huijuan Zhou
- Department of Statistics, Texas A&M University, College Station, TX, United States of America
| | - Naomi McCauley
- Department of Nutrition, Texas A&M University, College Station, TX, United States of America
| | - Gladys Ko
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States of America
| | - Ke K Zhang
- Department of Nutrition, Texas A&M University, College Station, TX, United States of America; Center for Epigenetics & Disease Prevention, Institute of Biosciences & Technology, College of Medicine, Texas A&M University, Houston, TX, United States of America
| | - Linglin Xie
- Department of Nutrition, Texas A&M University, College Station, TX, United States of America.
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13
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Sáez T, Toledo F, Sobrevia L. Extracellular Vesicles and Insulin Resistance: A Potential Interaction in Vascular Dysfunction. Curr Vasc Pharmacol 2020; 17:491-497. [PMID: 30277159 DOI: 10.2174/1570161116666181002095745] [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: 05/29/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022]
Abstract
Insulin resistance plays a key role in cardiovascular complications associated with diabetes mellitus and hypertensive disorders. In states of insulin resistance several circulating factors may contribute to a defective insulin sensitivity in different tissues, including the vasculature. One of these factors influencing the vascular insulin resistance are the extracellular vesicles. The extracellular vesicles include exosomes, microvesicles, and apoptotic bodies which are released to the circulation by different vascular cells. Since the cargo of extracellular vesicles seems to be altered in metabolic complications associated with insulin resistance, these vesicles may be candidates contributing to vascular insulin resistance. Despite the studies linking insulin resistance signalling pathways with the vascular effect of extracellular vesicles, the involvement of these structures in vascular insulin resistance is a phenomenon that remains unclear.
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Affiliation(s)
- Tamara Sáez
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton T6G 2S2, AB, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton T6G 2S2, AB, Canada
| | - Fernando Toledo
- Department of Basic Sciences, Faculty of Sciences, Bio-Bio University, Chillan 3780000, Chile.,Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile.,Department of Physiology, Faculty of Pharmacy, University of Sevilla, Seville E-41012, Spain.,University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Queensland, Australia
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14
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Liu S, Liu Y, Liao S. Heterogeneous impact of type 2 diabetes mellitus-related genetic variants on gestational glycemic traits: review and future research needs. Mol Genet Genomics 2019; 294:811-847. [PMID: 30945019 DOI: 10.1007/s00438-019-01552-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 03/25/2019] [Indexed: 02/07/2023]
Abstract
Gestational glucose homeostasis influences mother's metabolic health, pregnancy outcomes, fetal development and offspring growth. To understand the genetic roles in pregnant glucose metabolism and genetic predisposition for gestational diabetes (GDM), we reviewed the recent literature up to Jan, 2018 and evaluated the influence of T2DM-related genetic variants on gestational glycemic traits and glucose tolerance. A total of 140 variants of 89 genes were integrated. Their associations with glycemic traits in and outside pregnancy were compared. The genetic circumstances underlying glucose metabolism exhibit a similarity between pregnant and non-pregnant populations. While, not all of the T2DM-associated genetic variants are related to pregnant glucose tolerance, such as genes involved in fasting insulin/C-peptide regulation. Some genetic variants may have distinct effects on gestational glucose homeostasis. And certain genes may be particularly involved in this process via specific mechanisms, such as HKDC1, MTNR1B, BACE2, genes encoding cell cycle regulators, adipocyte regulators, inflammatory factors and hepatic factors related to gestational glucose sensing and insulin signaling. However, it is currently difficult to evaluate these associations with quantitative synthesis due to inadequate data, different analytical methods, varied measurements for glycemic traits, controversies in diagnosis of GDM, and unknown ethnicity- and/or sex-related influences on pregnant maternal metabolism. In conclusion, different genetic associations with glycemic traits may exist between pregnant and non-pregnant conditions. Comprehensive research on specific genetic regulation in gestation is necessary.
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Affiliation(s)
- Shasha Liu
- Diabetes Center and Transplantation Translational Medicine, Key Laboratory of Sichuan Province, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Yihuanlu Xierduan 32#, Chengdu, 610072, China
| | - Yunqiang Liu
- Department of Medical Genetics and Division of Morbid Genomics, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Shunyao Liao
- Diabetes Center and Transplantation Translational Medicine, Key Laboratory of Sichuan Province, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Yihuanlu Xierduan 32#, Chengdu, 610072, China.
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15
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Chen Z, Liu W, Sun X, Zhu L. Clinical study on the association between pregnancy-induced hypertension and insulin resistance. Exp Ther Med 2017; 13:2065-2070. [PMID: 28565809 DOI: 10.3892/etm.2017.4169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/28/2016] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to explore the association between pregnancy-induced hypertension (PIH) and insulin resistance (IR). A total of 50 cases of PIH and 50 healthy pregnant women with a similar gestational age were enrolled. The hyperinsulinemic-euglycemic clamp technique was used to evaluate the degree of IR and all 100 subjects were divided into an IR and a non-IR group accordingly. Subsequently, the correlation between the systolic or diastolic blood pressure was assessed; furthermore, a homeostasis model assessment of IR (HOMA-IR), a HOMA of the insulin sensitivity index (HOMA-ISI) and a HOMA of β cell function (HOMA-β%) were performed. Moreover, the effect of IR on PIH was assessed and the protein expression of insulin receptor substrate (IRS)-1, phosphorylated (p)-IRS-1, AKT and p-AKT were detected in the placental plasma by western blot analysis. The results showed that in the PIH group, the p-IRS-1/IRS-1 and p-AKT/AKT ratios were decreased compared with those in the control group. Blood flow parameters, including perfusion index, retinal resistive index and systolic maximum velocity/end-diastolic velocity ratio in the IR group were higher, while time averaged velocity was lower compared with that in the non-IR group. Furthermore, the HOMA-ISI and HOMA-β% were decreased, while the HOMA-IR was increased in the PIH group compared to that in the control group; alongside the blockage of the insulin signaling pathway, these factors may therefore cause PIH. The present study may provide novel therapeutic approaches for PIH.
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Affiliation(s)
- Zhifang Chen
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, Jiangsu 226018, P.R. China
| | - Weiling Liu
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, Jiangsu 226018, P.R. China
| | - Xiaoqin Sun
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, Jiangsu 226018, P.R. China
| | - Lingling Zhu
- Department of Obstetrics and Gynecology, Nantong Maternity and Child Health Care Hospital Affiliated to Nantong University, Nantong, Jiangsu 226018, P.R. China
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Premji SS, Yim IS, Dosani (Mawji) A, Kanji Z, Sulaiman S, Musana JW, Samia P, Shaikh K, Letourneau N, MiGHT Group. Psychobiobehavioral Model for Preterm Birth in Pregnant Women in Low- and Middle-Income Countries. BIOMED RESEARCH INTERNATIONAL 2015; 2015:450309. [PMID: 26413524 PMCID: PMC4564601 DOI: 10.1155/2015/450309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/03/2015] [Indexed: 12/19/2022]
Abstract
Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective.
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Affiliation(s)
- Shahirose S. Premji
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, Canada T2N 4Z6
| | - Ilona S. Yim
- Department of Psychology and Social Behavior, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Aliyah Dosani (Mawji)
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, Canada T3E 6K6
| | - Zeenatkhanu Kanji
- School of Nursing and Midwifery, Aga Khan University-East Africa, Opposite Aga Khan Primary School Plot (9/11), Colonel Muammar Gaddafi Road, P.O. Box 8842, Kampala, Uganda
| | - Salima Sulaiman
- School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Joseph W. Musana
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Aga Khan University-Nairobi, 3rd Parklands Avenue off Limuru Road, P.O. Box 30270, Nairobi 00100, Kenya
| | - Pauline Samia
- Department of Pediatrics, Aga Khan University-Nairobi, 2nd Parklands Avenue, East Tower Block, Room 505, Nairobi 00100, Kenya
| | - Kiran Shaikh
- School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
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Abi Salloum B, Veiga-Lopez A, Abbott DH, Burant CF, Padmanabhan V. Developmental programming: exposure to testosterone excess disrupts steroidal and metabolic environment in pregnant sheep. Endocrinology 2015; 156:2323-37. [PMID: 25763641 PMCID: PMC4430607 DOI: 10.1210/en.2014-2006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Gestational exposure to excess T leads to intrauterine growth restriction, low birth weight, and adult metabolic/reproductive disorders in female sheep. We hypothesized that as early mediators of such disruptions, gestational T disrupts steroidal and metabolic homeostasis in both the mother and fetus by both androgenic and metabolic pathways. Maternal blood samples were measured weekly for levels of insulin, glucose, and progesterone from four groups of animals: control; gestational T (twice weekly im injections of 100 mg of T propionate from d 30 to d 90 of gestation); T plus an androgen antagonist, flutamide (15 mg/kg·d oral; T-Flutamide); and T plus the insulin sensitizer, rosiglitazone (0.11 mg/kg·d oral; T-Rosi) (n = 10-12/group). On day 90 of gestation, maternal and umbilical cord samples were collected after a 48-hour fast from a subset (n = 6/group) for the measurement of steroids, free fatty acids, amino acids, and acylcarnitines. Gestational T decreased maternal progesterone levels by 36.5% (P < .05), which was prevented by flutamide showing direct androgenic mediation. Gestational T also augmented maternal insulin levels and decreased medium chained acylcarnitines, suggesting increased mitochondrial fatty acid oxidation. These changes were prevented by rosiglitazone, suggesting alterations in maternal fuel use. Gestational T-induced increases in fetal estradiol were not prevented by either cotreatment. Gestational T disrupted associations of steroids with metabolites and progesterone with acylcarnitines, which was prevented either by androgen antagonist or insulin sensitizer cotreatment. These findings suggest a future combination of these treatments might be required to prevent alteration in maternal/fetal steroidal and metabolic milieu(s).
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Affiliation(s)
- B Abi Salloum
- Departments of Pediatrics (B.A.S., A.V.-L., V.P.) and Internal Medicine (C.F.B.) and Reproductive Sciences Program (V.P.), University of Michigan, Ann Arbor, Michigan 48109; and Department of Obstetrics and Gynecology and Wisconsin National Primate Research Center (D.H.A.), University of Wisconsin, Madison, Wisconsin 53706
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18
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Salles GF, Schlüssel MM, Farias DR, Franco-Sena AB, Rebelo F, Lacerda EMA, Kac G. Blood pressure in healthy pregnancy and factors associated with no mid-trimester blood pressure drop: a prospective cohort study. Am J Hypertens 2015; 28:680-9. [PMID: 25376641 DOI: 10.1093/ajh/hpu204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/25/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The well-known mid-trimester drop in blood pressure (BP) during normal pregnancy was recently questioned. OBJECTIVE To describe longitudinal changes in BP during healthy pregnancies and to investigate factors associated with no mid-trimester drop in BP. METHODS A prospective cohort with 158 healthy pregnant women was followed up in a public health care center in Rio de Janeiro, Brazil. We used linear mixed-effects models to estimate longitudinal changes in systolic BP (SBP) and diastolic BP (DBP) during pregnancy. Poisson regression models were performed to identify factors associated with no mid-trimester drop in BP. RESULTS Significant mid-trimester increase in SBP (5.6 mm Hg; 95% confidence interval (CI) = 4.6-6.7) and DBP (4.4 mm Hg; 95% CI = 3.4-5.3) was observed in 44.3% and 39.9% of the sample, respectively. Women (37.1%) who had not a mid-trimester SBP drop still had a DBP drop. White skin color (incidence ratio (IR): 1.71; 95% CI = 1.22-2.39), family history of hypertension (IR: 1.93; 95% CI = 1.29-2.89), early pregnancy obesity (IR: 2.29; 95% CI = 1.27-4.11), outside temperature variation (IR: 1.45; 95% CI = 1.00-2.10), and gestational weight gain from the first to second trimester (IR: 1.71; 95% CI = 1.01-2.88 and IR: 2.32; 95% CI = 1.39-3.89 for second and third tertiles) were characteristics associated with no mid-trimester drop in SBP. The same characteristics were associated with no mid-trimester drop in DBP, except family history of hypertension and outside temperature variation. CONCLUSIONS Some women without a mid-trimester SBP drop still present a DBP drop. The different patterns of mid-trimester change in BP seem to be determined by preexisting and pregnancy-related factors.
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Affiliation(s)
- Gil F Salles
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michael M Schlüssel
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Dayana R Farias
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Beatriz Franco-Sena
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Rebelo
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Elisa M A Lacerda
- Department of Nutrition and Dietetics, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;
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19
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Total cholesterol and leptin concentrations are associated with prospective changes in systemic blood pressure in healthy pregnant women. J Hypertens 2014; 32:127-34. [DOI: 10.1097/hjh.0000000000000037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Saleh J, Machado L, Razvi Z. 2-Hour postload serum glucose levels and maternal blood pressure as independent predictors of birth weight in "appropriate for gestational age" neonates in healthy nondiabetic pregnancies. BIOMED RESEARCH INTERNATIONAL 2013; 2013:757459. [PMID: 24151621 PMCID: PMC3789359 DOI: 10.1155/2013/757459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/03/2013] [Accepted: 08/19/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Increased neonatal birth weight (NBW), often associated with diabetic pregnancies, is a recognized indicator of childhood obesity and future metabolic risk. Predictors of NBW in healthy non-diabetic pregnancies are not yet established. Here, we investigated the association of maternal parameters of healthy non-diabetic mothers with NBW of their "appropriate-for-gestational age" neonates. METHODS The study involved 36 healthy mother/infant pairs. Examined parameters included NBW, maternal age, first and last trimester (BMI), weight gain, fasting serum lipids and glucose, 2-hour postload glucose levels and blood pressure. RESULTS Postload-glucose levels were significantly higher in mothers of heavier neonates. ANOVA results indicated that 15% increase in postload-glucose levels corresponded to more than 0.5 Kg increase in NBW in the third tertile. NBW correlated positively with postload glucose levels, and negatively with systolic blood pressure. Regression analysis showed that the main predictors of NBW were postload-glucose levels (B = 0.455, P = 0.003), followed by systolic blood pressure (B = -0.447, P = 0.004), together predicting 31.7% NBW variation. CONCLUSION This study highlights that increased maternal postload sugar levels and blood pressure, within the normal range, highly predicts NBW of healthy mothers. These findings may provide focus for early dietary intervention measures to avoid future risks to the mother and baby.
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Affiliation(s)
- Jumana Saleh
- Biochemistry Department, College of Medicine, Sultan Qaboos University, P.O. Box 35, 123, Muscat, Oman
| | - Lovina Machado
- Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University Hospital, P.O. Box 35, 123, Muscat, Oman
| | - Zahra Razvi
- College of Medicine, Sultan Qaboos University, P.O. Box 35, 123, Muscat, Oman
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