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Oğlak SC, Yılmaz EZ, Budak MŞ. Abdominal subcutaneous fat thickness combined with a 50-g glucose challenge test at 24-28 weeks of pregnancy in predicting gestational diabetes mellitus. J OBSTET GYNAECOL 2024; 44:2329880. [PMID: 38516715 DOI: 10.1080/01443615.2024.2329880] [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: 11/20/2023] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND This investigation aimed to analyse the efficacy of abdominal subcutaneous fat thickness (ASFT) value >18.1 mm combined with a 50-g glucose challenge test (GCT) between 24-28 weeks of gestation in predicting gestational diabetes mellitus (GDM) cases. METHODS This cross-sectional study was carried out from February 2021 to December 2022. All pregnant women received a 50-g GCT at 24-28 weeks of pregnancy for the GDM screening. Pregnant women with a blood glucose value between 140-190 mg/dl experienced 100 g OGTT. Even if 50-g GCT was normal, 100-g OGTT was offered to patients with an ASFT value above 18.1 mm. RESULTS Among the 728 pregnant women we enrolled, 154 (21.2%) cases were screened as positive. The number of patients who first screened positive and determined to be GDM after the 100-g oral glucose tolerance test (OGTT) was 43 (5.9%). A total of 67 cases (9.2%) had an ASFT measurement above 18.1 mm. Two cases with a negative 50-g GCT and ASFT <18.1 mm were diagnosed as GDM in the later weeks of pregnancy. A 50-g GCT combined with ASFT measurement above 18.1 mm predicted GDM with a sensitivity of 87.9%, a specificity of 88.7%, a positive predictive value (PPV) of 36.0%, and a negative PV (NPV) of 99.7%. CONCLUSIONS A 50-g GCT combined with ASFT measurement that can be easily and accurately obtained during routine antenatal care in the second trimester might be a beneficial indicator for predicting GDM cases.
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Affiliation(s)
- Süleyman Cemil Oğlak
- Department of Obstetrics and Gynaecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Emine Zeynep Yılmaz
- Department of Obstetrics and Gynaecology, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Mehmet Şükrü Budak
- Department of Obstetrics and Gynaecology, Private Can Hospital, Izmir, Turkey
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Rahnemaei FA, Abdi F, Pakzad R, Sharami SH, Mokhtari F, Kazemian E. Association of body composition in early pregnancy with gestational diabetes mellitus: A meta-analysis. PLoS One 2022; 17:e0271068. [PMID: 35969611 PMCID: PMC9377632 DOI: 10.1371/journal.pone.0271068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/22/2022] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Body composition as dynamic indices constantly changes in pregnancy. The use of body composition indices in the early stages of pregnancy has recently been considered. Therefore, the current meta-analysis study was conducted to investigate the relationship between body composition in the early stages of pregnancy and gestational diabetes. METHOD Valid databases searched for papers published from 2010 to December 2021 were based on PRISMA guideline. Newcastle Ottawa was used to assess the quality of the studies. For all analyses, STATA 14.0 was used. Mean difference (MD) of anthropometric indices was calculated between the GDM and Non-GDM groups. Pooled MD was estimated by "Metan" command, and heterogeneity was defined using Cochran's Q test of heterogeneity, and I 2 index was used to quantify heterogeneity. RESULTS Finally, 29 studies with a sample size of 56438 met the criteria for entering the meta-analysis. Pooled MD of neck circumference, hip circumference, waist hip ratio, and visceral adipose tissue depth were, respectively, 1.00 cm (95% CI: 0.79 to 1.20) [N = 5; I^2: 0%; p: 0.709], 7.79 cm (95% CI: 2.27 to 13.31) [N = 5; I2: 84.3%; P<0.001], 0.03 (95% CI: 0.02 to 0.04) [N = 9; I2: 89.2%; P<0.001], and 7.74 cm (95% CI: 0.11 to 1.36) [N = 4; I^2: 95.8%; P<0.001]. CONCLUSION Increased neck circumference, waist circumference, hip circumference, arm circumference, waist to hip ratio, visceral fat depth, subcutaneous fat depth, and short stature increased the possibility of developing gestational diabetes. These indices can accurately, cost-effectively, and affordably assess the occurrence of gestational diabetes, thus preventing many consequences with early detection of gestational diabetes.
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Affiliation(s)
- Fatemeh Alsadat Rahnemaei
- Department of Obstetrics & Gynecology, Midwifery, Reproductive Health Research Center, Al-zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Abdi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Reza Pakzad
- Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyedeh Hajar Sharami
- Department of Obstetrics & Gynecology, Reproductive Health Research Center, Al-zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Mokhtari
- Department of Midwifery, Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Kazemian
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, Unites States of America
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Ghorbani A, Hashemipour S, Mohammadi Z, Zohal M, Lalooha F. Appropriate neck/waist circumference cut-off points for gestational diabetes prediction in Iranian pregnant women: The baseline analysis of the Qazvin maternal and neonatal metabolic study (QMNMS), Iran. Diabetes Metab Syndr 2022; 16:102579. [PMID: 35921767 DOI: 10.1016/j.dsx.2022.102579] [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] [Received: 12/08/2021] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gestational diabetes is the most common complication during pregnancy and it is essential to identify the high-risk groups for gestational diabetes mellitus (GDM) in the first trimester. A large neck circumference (NC) in the first trimester is a measure of obesity. OBJECTIVE The present study investigated whether pregnant women's first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis. MATERIALS AND METHODS This longitudinal cohort study was conducted on 676 pregnant women aged ≥20 years. Pregnant women at 12-14th (baseline) gestational weeks underwent measurement of neck and other anthropometric indices. GDM was diagnosed with 75-g oral glucose tolerance test at 24-28th gestational week. RESULTS GDM was developed in 110 (16.3%) pregnant women. The logistic regression analysis showed that baseline NC > 33.5 cm (OR: 2.037, 95% CI: 1.313-3.161; P = 0.002) and WC > 90.5 (OR: 2.299, 95% CI: 1.510-3.501; p < 0.001) were independent predictors of GDM. The area under the receiver operating characteristic (ROC) curve analysis of baseline NC and WC for GDM prediction respectively yielded 0.614 (95% CI: 0.558-0.670, p < 0.001) and 0.641 (CI: 0.583-0.698, p < 0.001). The optimal cut-off level of maternal baseline NC was >33.5 cm, with 68.5% sensitivity and 48.3% specificity, and for baseline WC it was >90.5.50 cm, with 57% sensitivity and 63.4% specificity. CONCLUSION Pregnant women with an NC > 33.5 cm and a WC > 90.5 cm at baseline (12-14th gestational weeks) had a higher chance of developing GDM. first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis.
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Affiliation(s)
- Azam Ghorbani
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sima Hashemipour
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zahrasadat Mohammadi
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammadali Zohal
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Lalooha
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran.
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Di Filippo D, Wanniarachchi T, Wei D, Yang JJ, Mc Sweeney A, Havard A, Henry A, Welsh A. The diagnostic indicators of gestational diabetes mellitus from second trimester to birth: a systematic review. Clin Diabetes Endocrinol 2021; 7:19. [PMID: 34635186 PMCID: PMC8504031 DOI: 10.1186/s40842-021-00126-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is glucose intolerance first recognised during pregnancy. Both modalities and thresholds of the GDM diagnostic test, the Oral Glucose Tolerance Test (OGTT), have varied widely over time and among countries. Additionally, OGTT limitations include inconsistency, poor patient tolerability, and questionable diagnostic reliability. Many biological parameters have been reported to be modified by GDM and could potentially be used as diagnostic indicators. This study aimed to 1) systematically explore biomarkers reported in the literature as differentiating GDM from healthy pregnancies 2) screen those indicators assessed against OGTT to propose OGTT alternatives. MAIN BODY A systematic review of GDM diagnostic indicators was performed according to PRISMA guidelines (PROSPERO registration CRD42020145499). Inclusion criteria were full-text, comprehensible English-language articles published January 2009-January 2021, where a biomarker (from blood, ultrasound, amniotic fluid, placenta) was compared between GDM and normal glucose tolerance (NGT) women from the second trimester onward to immediately postpartum. GDM diagnostic method had to be clearly specified, and the number of patients per study higher than 30 in total or 15 per group. Results were synthesised by biomarkers. RESULTS Of 13,133 studies identified in initial screening, 174 studies (135,801 participants) were included. One hundred and twenty-nine studies described blood analytes, one amniotic fluid analytes, 27 ultrasound features, 17 post-natal features. Among the biomarkers evaluated in exploratory studies, Adiponectin, AFABP, Betatrophin, CRP, Cystatin-C, Delta-Neutrophil Index, GGT, TNF-A were those demonstrating statistically and clinically significant differences in substantial cohorts of patients (> 500). Regarding biomarkers assessed versus OGTT (i.e. potential OGTT alternatives) most promising were Leptin > 48.5 ng/ml, Ficolin3/adiponectin ratio ≥ 1.06, Chemerin/FABP > 0.71, and Ultrasound Gestational Diabetes Score > 4. These all demonstrated sensitivity and specificity > 80% in adequate sample sizes (> / = 100). CONCLUSIONS Numerous biomarkers may differentiate GDM from normoglycaemic pregnancy. Given the limitations of the OGTT and the lack of a gold standard for GDM diagnosis, advanced phase studies are needed to triangulate the most promising biomarkers. Further studies are also recommended to assess the sensitivity and specificity of promising biomarkers not yet assessed against OGTT. TRIAL REGISTRATION PROSPERO registration number CRD42020145499.
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Affiliation(s)
- Daria Di Filippo
- School, of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Daniel Wei
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jennifer J Yang
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Aoife Mc Sweeney
- Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia
| | - Alys Havard
- National Drug and Alcohol Research Centre - Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Centre for Big Data Research in Health - Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amanda Henry
- School, of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia
| | - Alec Welsh
- School, of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW, 2031, Australia.
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Liu Y, Liu J, Gao Y, Zheng D, Pan W, Nie M, Ma L. The Body Composition in Early Pregnancy is Associated with the Risk of Development of Gestational Diabetes Mellitus Late During the Second Trimester. Diabetes Metab Syndr Obes 2020; 13:2367-2374. [PMID: 32753921 PMCID: PMC7352009 DOI: 10.2147/dmso.s245155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/22/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) causes both short- and long-term harm to mothers and fetuses. It is important to predict the occurrence of GDM as early as possible and take adequate measures to prevent it. The purpose of this study was to investigate the association between body composition of pregnant women in early pregnancy and the risk of GDM. SUBJECTS AND METHODS A total of 1318 pregnant women in the early stage of pregnancy were recruited from the Guiyang Maternal and Child Health Care Hospital. Detailed clinical data were recorded. Body composition was determined using the bioimpedance method at 13 weeks of gestation. The association between BMI before pregnancy (pre-BMI), fat mass percentage (FMP) and skeletal muscle mass percentage (SMMP) and the results of glucose tolerance screening in the second trimester of pregnancy were analyzed. Fat mass index (FMI) was calculated using fat mass in kilograms as measured using BIA at 13 weeks of pregnancy divided by the square of the woman's height in meters (kg/m2) and was analyzed to determine the predictive effect of body fat on GDM. RESULTS Of the 1318 participants, 249 were diagnosed with GDM and 1069 with normal blood glucose. The FMI and FMP in GDM were higher than in NGT (P<0.001), while the SMMP in GDM was lower than in NGT (P<0.001). Overweight women (pre-BMI≥24kg/m2) had a higher risk of developing GDM than women with normal pre-BMI (adjusted OR 2.604, 95% CI 1.846-3.673). Women with FMP greater than 28% had a higher risk of developing to GDM than women with normal-range FMP (adjusted OR 1.572, 95% CI 1.104-2.240). When FMI is used to predict the incidence of GDM, the area under the curve (AUC) is 65.8%, which is comparable to BMI (AUC=67.2%). CONCLUSION Body composition early during gestation is associated with the risk of GDM. The fat mass index in early pregnancy is a predictor of GDM, and it could be an indicator of the efficacy of any intervention to reduce the risk of GDM.
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Affiliation(s)
- Yanping Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, CAMS and PUMC, Beijing100730, People’s Republic of China
| | - Jing Liu
- Guiyang Maternal and Child Health Care Hospital, Guiyang Children’s Hospital, Beijing100730, People’s Republic of China
| | - Yinjie Gao
- NHC Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
| | - Dan Zheng
- Guiyang Maternal and Child Health Care Hospital, Guiyang Children’s Hospital, Beijing100730, People’s Republic of China
| | - Wei Pan
- Guiyang Maternal and Child Health Care Hospital, Guiyang Children’s Hospital, Beijing100730, People’s Republic of China
| | - Min Nie
- NHC Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
- Correspondence: Min Nie; Liangkun Ma Email ;
| | - Liangkun Ma
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
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