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Ghanem YM, El Kassar Y, Magdy MM, Amara M, Amin NG. Potential risk of gestational diabetes mellitus in females undergoing in vitro fertilization: a pilot study. Clin Diabetes Endocrinol 2024; 10:7. [PMID: 38594776 PMCID: PMC11005244 DOI: 10.1186/s40842-024-00164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/01/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Most of the cases of hyperglycemia during pregnancy are attributed to gestational diabetes mellitus (GDM) (75-90%). Women diagnosed with GDM are at an increased risk for complications during pregnancy and delivery. This observational prospective study aimed to investigate the potential risk of GDM among Egyptian females following in vitro fertilization (IVF) pregnancies compared to spontaneous pregnancies (SC). METHODS This prospective cohort study included normoglycemic females without any history of dysglycemia before this conception. Subjects were divided according to the type of conception into two age and BMI-matched groups: (IVF group): 55 pregnant females conceived by IVF, and (SC group) spontaneous pregnancy: 55 pregnant females conceived spontaneously. A one-step oral glucose tolerance test (OGTT) was performed at gestational weeks 20 and 28 for all study subjects. RESULTS The incidence of GDM was statistically significantly higher in the IVF group compared to the spontaneous pregnancy (SC) group (20 and 5.5%, respectively), p = 0.022 at week 28. On comparing the incidence of GDM on early screening at week 20 in both groups, the incidence of GDM in the IVF group was significantly higher (16.4%) compared to (3.6%) in the spontaneous pregnancy (SC) group, p = 0.026. CONCLUSIONS IVF may have an increased potential risk for GDM. Moreover, the diagnosis of GDM may occur early (week 20), highlighting the need for precise and early screening for GDM in IVF pregnancies.
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Affiliation(s)
- Yehia Moustafa Ghanem
- Department of Internal Medicine; Unit of Diabetes Lipidology & Metabolism, Faculty of Medicine, Alexandria University, 17 Champollion Street Azarita, Alexandria, Egypt
| | - Yasser El Kassar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - May Mohamed Magdy
- Department of Internal Medicine; Unit of Diabetes Lipidology & Metabolism, Faculty of Medicine, Alexandria University, 17 Champollion Street Azarita, Alexandria, Egypt
| | - Mohamed Amara
- Department of Internal Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Noha Gaber Amin
- Department of Internal Medicine; Unit of Diabetes Lipidology & Metabolism, Faculty of Medicine, Alexandria University, 17 Champollion Street Azarita, Alexandria, Egypt.
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Sachdev D, Sauer MV, Ananth CV. Gestational diabetes mellitus in pregnancies conceived after infertility treatment: a population-based study in the United States, 2015-2020. F S Rep 2024; 5:102-110. [PMID: 38524205 PMCID: PMC10958713 DOI: 10.1016/j.xfre.2023.11.008] [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: 02/09/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To evaluate the risk of gestational diabetes mellitus (GDM) in singleton pregnancies conceived using infertility treatment and examine the influence of race and ethnicity as well as prepregnancy body mass index (BMI). Design Cross-sectional study using the US vital records data of women that delivered singleton births. Setting United States, 2015-2020. Interventions Any infertility treatment was divided into two groups: those that used fertility-enhancing drugs, artificial insemination, or intrauterine insemination, and those that used assisted reproductive technology (ART). Main Outcome Measuress Gestational diabetes mellitus, defined as a diagnosis of diabetes mellitus during pregnancy, includes both diet-controlled GDM and medication-controlled GDM in singleton pregnancies conceived with infertility treatment or spontaneously and delivered between 20- and 44-weeks' gestation. We also examined whether the infertility treatment-GDM association was modified by maternal race and ethnicity as well as prepregnancy BMI. Associations were expressed as a rate ratio (RR) and 95% confidence interval (CI), derived from log-linear models after adjustment for potential confounders. Results A total of 21,943,384 singleton births were included, with 1.5% (n = 318,086) undergoing infertility treatment. Rates of GDM among women undergoing infertility treatment and those who conceived spontaneously were 11.0% (n = 34,946) and 6.5% (n = 1,398,613), respectively (adjusted RR 1.24, 95% CI 1.23, 1.26). The RRs were adjusted for maternal age, parity, education, race and ethnicity, smoking, BMI, chronic hypertension, and year of delivery. The risk of GDM was modestly increased for those using fertility-enhancing drugs (adjusted RR 1.28, 95% CI 1.27, 1.30) compared with ART (adjusted RR 1.18, 95% CI 1.17, 1.20), and this risk was especially apparent for non-Hispanic White women (adjusted RR 1.29, 95% CI 1.26, 1.31) and Hispanic women (adjusted RR 1.35, 95% CI 1.29, 1.41). The number of women who needed to be exposed to infertility treatment to diagnose one case of GDM was 46. Prepregnancy BMI did not modify the infertility treatment-GDM association overall and within strata of race and ethnicity. These general patterns were stronger after potential corrections for misclassification of infertility treatment and unmeasured confounding. Conclusions Infertility treatment, among those who received fertility-enhancing drugs, is associated with an increased GDM risk. The persistently higher risk of GDM among women who seek infertility treatment, irrespective of prepregnancy weight classification, deserves attention. Infertility specialists must be vigilant with preconception counseling and ensure that all patients, regardless of race and ethnicity or BMI, are adequately tested for GDM early in pregnancy using a fasting blood glucose level or a traditional 50-g oral glucose tolerance test. Testing may be completed by the infertility specialist or deferred to the primary prenatal care provider at the first prenatal visit.
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Affiliation(s)
- Devika Sachdev
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mark V. Sauer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Cande V. Ananth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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Neves RO, Rocha ADS, de Vargas BO, Kretzer DC, de Matos S, Goldani MZ, von Diemen L, Magalhães JADA, Bernardi JR. Obesity Cut-Off Points Using Prepregnancy Body Mass Index according to Cardiometabolic Conditions in Pregnancy. J Pregnancy 2023; 2023:6669700. [PMID: 38026545 PMCID: PMC10667054 DOI: 10.1155/2023/6669700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Aim To suggest cut-off points for body mass index (BMI) using gestational hypertension, preeclampsia, and gestational diabetes mellitus (GDM) as cardiometabolic conditions in pregnancy. Methods In this prospective study, singleton pregnant women from the fetal medicine service of the Brazilian Unified Health System were included. The pregnancy, perinatal, and newborn data were obtained from the clinical medical records. Maternal anthropometry included an assessment of weight and height and the prepregnancy BMI evaluation categorized according to the World Health Organization cut-off points. The area under the curve and confidence interval values from receiver operator curves were generated to identify the optimal cut-off points using prepregnancy BMI with better sensitivity and specificity. Results Data on 218 pregnancies were analyzed, with 57.9% (n = 124) being classified as overweight/obese, 11% (n = 24) with GDM, 6.9% (n = 15) with preeclampsia, and 11.0% (n = 24) with gestational hypertension. The BMI cut-off points for predicting cardiometabolic conditions were 27.52 kg/m2 (S: 66.7%; E: 63.8%) for women with GDM; 27.40 kg/m2 (S: 73.3%; E: 62.4%; S: 79.2%; E: 64.9%; S: 70.3%; E: 66.3%) for women with preeclampsia, gestational hypertension, and gestational hypertension plus preeclampsia, respectively; and 27.96 kg/m2 (S: 69.6%; E: 65.6%) for women with preeclampsia plus GDM. Conclusion The findings suggest that the optimal prepregnancy BMI cut-off point is around 27 kg/m2 for pregnant women with maternal cardiometabolic conditions.
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Affiliation(s)
- Renata O. Neves
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre da S. Rocha
- Graduate Program in Health Sciences: Gynaecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruna O. de Vargas
- Undergraduate Nutrition Course, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela C. Kretzer
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Salete de Matos
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Z. Goldani
- Department of Pediatric, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lisia von Diemen
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José A. de A. Magalhães
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Department of Obstetrics and Gynaecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana R. Bernardi
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul, Medical School, Porto Alegre, Brazil
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Zeng M, He Y, Li M, Yang L, Zhu Q, Liu J, Mao Y, Chen Q, Du J, Zhou W. Association between maternal pregestational glucose level and adverse pregnancy outcomes: a population-based retrospective cohort study. BMJ Open 2021; 11:e048530. [PMID: 34493513 PMCID: PMC8424840 DOI: 10.1136/bmjopen-2020-048530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 08/20/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the association between maternal pregestational blood glucose level and adverse pregnancy outcomes. DESIGN Retrospective cohort study. SETTING This study was conducted in the Chongqing Municipality of China between April 2010 and December 2016. PARTICIPANTS A total of 60 222 women (60 360 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project and had pregnancy outcomes were included. PRIMARY OUTCOME MEASURES Adverse pregnancy outcomes included spontaneous abortion, induced abortion or labour due to medical reasons, stillbirth, preterm birth (PTB), macrosomia, large for gestational age, low birth weight (LBW) and small for gestational age. RESULTS Of the 60 360 pregnancies, rates of hypoglycaemic, normoglycaemia, impaired fasting glycaemia (IFG) and diabetic hyperglycaemic before conception were 5.06%, 89.30%, 4.59% and 1.05%, respectively. Compared with women with normoglycaemia, women with pregestational glucose at the diabetic level (≥7.0 mmol/L) might have a higher rate of macrosomia (6.18% vs 4.16%), whereas pregestational IFG seemed to be associated with reduced risks of many adverse outcomes, including spontaneous abortion, induced abortion due to medical reasons, PTB and LBW. After adjusting for potential confounders, pregestational diabetic hyperglycaemic was remained to be significantly associated with an increased risk of macrosomia (adjusted risk ratio 1.49, 95% CI 1.07 to 2.09). Abnormal maternal glucose levels before pregnancy (either hypoglycaemic or hyperglycaemic) seemed to have no significant negative effect on spontaneous abortion or induced abortion due to medical reasons. CONCLUSION Although without overt diabetes mellitus, women with once diabetic fasting glucose level during their preconception examinations could be associated with an increased risk for macrosomia. Uniform guidelines are needed for maternal blood glucose management during pre-pregnancy care to improve pregnancy outcomes.
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Affiliation(s)
- Mengyao Zeng
- School of Public Health, Fudan University, Shanghai, China
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Yang He
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing, China
| | - Min Li
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Liu Yang
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing, China
| | - Qianxi Zhu
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Jun Liu
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing, China
| | - Yanyan Mao
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Qing Chen
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jing Du
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Weijin Zhou
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
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Wang Y, Ge Z, Chen L, Hu J, Zhou W, Shen S, Zhu D, Bi Y. Risk Prediction Model of Gestational Diabetes Mellitus in a Chinese Population Based on a Risk Scoring System. Diabetes Ther 2021; 12:1721-1734. [PMID: 33993435 PMCID: PMC8179863 DOI: 10.1007/s13300-021-01066-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. Accurate models for early prediction of GDM are lacking. This study aimed to explore an early risk prediction model to identify women at high risk of GDM through a risk scoring system. METHODS This was a retrospective cohort study of 785 control pregnancies and 855 women with GDM. Maternal clinical characteristics and biochemical measures were extracted from the medical records. Logistic regression analysis was used to obtain coefficients of selected predictors for GDM in the training cohort. The discrimination and calibration of the risk scores were evaluated by the receiver-operating characteristic (ROC) curve and a Hosmer-Lemeshow test in the internal and external validation cohort, respectively. RESULTS In the training cohort (total = 1640), two risk scores were developed, one including predictors collected at the first antenatal care visit for early prediction of GDM, such as age, height, pre-pregnancy body mass index, educational background, family history of diabetes, menstrual history, history of cesarean delivery, GDM, polycystic ovary syndrome, hypertension, and fasting blood glucose (FBG), and the total risk score also including FBG and triglyceride values during 14-20 gestational weeks. Our total risk score yielded an area under the curve (AUC) of 0.845 (95% CI = 0.805-0.884). This performed better in an external validation cohort, with an AUC of 0.886 (95% CI = 0.856-0.916). CONCLUSION The GDM risk score, which incorporates several potential clinical features with routine biochemical measures of GDM, appears to be a sensitive and reliable screening tool for earlier detection of GDM risk.
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Affiliation(s)
- Yanmei Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, China
| | - Zhijuan Ge
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, China
| | - Lei Chen
- Department of Endocrinology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, China
| | - Jun Hu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, China
| | - Wenting Zhou
- Department of Endocrinology, Medical School of Southeast University Nanjing Drum Tower Hospital, Nanjing, China
| | - Shanmei Shen
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, China.
| | - Yan Bi
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, China.
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