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Christie HE, Winter M, Meyer BJ, Francois ME. Diagnosis to Delivery: A Randomized Clinical Trial of Postmeal Walking in Women with Gestational Diabetes. Med Sci Sports Exerc 2024; 56:860-867. [PMID: 38233988 DOI: 10.1249/mss.0000000000003382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE The aim of this study was to determine whether advice to perform postmeal walking could be an effective and feasible alternate to standard care continuous walking for the management of gestational diabetes (GDM). METHODS Forty women with GDM were randomized between 28 and 30 wk of gestation into either standard care (CTL; 30-min continuous walking, most days per week) or standard care with advice to PMW (daily 10-min walks after three main meals) for ~7 wk. The primary outcome for this randomized controlled trial was postprandial glucose assessed by continuous glucose monitors. Continuous glucose monitor and ActivPAL inclinometers (physical activity parameters) were each worn for 7 d at ~28 and ~35 wk gestation. Delivery outcomes were also collected. A linear mixed model compared the changes across time between groups. RESULTS Twenty-six women (PMW: n = 12, CTL: n = 14; age 34 ± 5 y) completed the trial. Mean 3 h postprandial glucose at dinner was higher in the PMW versus CTL group at baseline and across the intervention (main effect group, P = 0.04). Twenty-four hours, nocturnal, and fasting glucose were similar between groups. The PMW group spent ~57 min·d -1 more time sedentary and ~11 min·d -1 less time stepping versus CTL (main effect group: P = 0.02 and 0.05). Adherence to the prescribed 30 min·d -1 of physical activity was high, regardless of whether accumulated as 3 × 10-min or one single bout of walking. CONCLUSIONS Distributing activity as 10-min bouts after main meals did not improve postprandial glucose outcomes compared with standard-care control. More research on the optimal duration and intensity of postmeal walks to improve postprandial responses are needed. Strategies that mitigate sedentary time and increase the minutes of physical activity accumulated across the day in pregnancy are also warranted.
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Affiliation(s)
| | - Meagan Winter
- Illawarra Shoalhaven Local Health District Diabetes Service, Wollongong, New South Wales, AUSTRALIA
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2
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Aung NL. A1C: Episode 2. Clin Diabetes 2024; 42:333-336. [PMID: 38694251 PMCID: PMC11060610 DOI: 10.2337/cd24-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
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3
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S282-S294. [PMID: 38078583 PMCID: PMC10725801 DOI: 10.2337/dc24-s015] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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4
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Koyama M, Taki M, Okamoto H, Kawamura Y, Ueda Y, Chigusa Y, Mandai M, Mogami H. Characteristics of pregnancy complicated with type 1 and type 2 diabetes. Taiwan J Obstet Gynecol 2023; 62:655-660. [PMID: 37678991 DOI: 10.1016/j.tjog.2023.07.005] [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] [Accepted: 02/21/2022] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Diabetes in pregnancy is a major risk factor for adverse perinatal outcomes such as congenital anomalies, hypertensive disorders of pregnancy (HDP), and macrosomia. For the mechanism of onset of type 1 and type 2 diabetes are different, we focused on the difference in perinatal outcomes between the type 1 and type 2 diabetes groups. MATERIALS AND METHODS We retrospectively reviewed 22 pregnancies with type 1 diabetes and 15 pregnancies with type 2 diabetes, who were managed in our single center, with regard to maternal diabetes conditions during pregnancy and neonatal birthweight and blood glucose level. Furthermore, we checked the effect of continuous glucose monitoring and continuous subcutaneous insulin injection in pregnancies with type 1 diabetes. RESULTS Type 1 diabetes in pregnancy was less controllable and increased neonatal birth weight and neonatal hypoglycemia within 2 h after birth after neonatal care unit admission. Continuous glucose monitoring and continuous subcutaneous insulin injection that are convenient to use, had a similar effect in the management of type 1 diabetes during pregnancy, compared with conventional diabetes treatment. In contrast, maternal BMI and HDP were increased in women with type 2 diabetes. CONCLUSION In the management of pregnancy with diabetes, we should pay attention to the difference in pregnancy prognosis between type 1 and type 2 diabetes.
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Affiliation(s)
- Misaki Koyama
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Mana Taki
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Haruko Okamoto
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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5
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Sushko K, Menezes HT, Butt M, Nerenberg K, Strachan P, Usman MA, Sherifali D. Trends and Self-Management Predictors of Glycemic Control During Pregnancy in Women With Preexisting Type 1 or Type 2 Diabetes: A Cohort Study. Diabetes Spectr 2023; 36:182-192. [PMID: 37193202 PMCID: PMC10182963 DOI: 10.2337/ds22-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Because much of diabetes management during pregnancy occurs at home, self-management factors such as self-efficacy, self-care activities, and care satisfaction may affect glycemia. Our objective was to explore trends in glycemic control during pregnancy in women with type 1 or type 2 diabetes; assess self-efficacy, self-care, and care satisfaction; and examine these factors as predictors of glycemic control. Methods We conducted a cohort study from April 2014 to November 2019 at a tertiary center in Ontario, Canada. Self-efficacy, self-care, care satisfaction, and A1C were measured three times during pregnancy (T1, T2, and T3). Linear mixed-effects modeling explored trends in A1C and examined self-efficacy, self-care, and care satisfaction as predictors of A1C. Results We recruited 111 women (55 with type 1 diabetes and 56 with type 2 diabetes). Mean A1C significantly decreased by 1.09% (95% CI -1.38 to -0.79) from T1 to T2 and by 1.14% (95% CI -1.43 to -0.86) from T1 to T3. Self-efficacy significantly predicted glycemic control for women with type 2 diabetes and was associated with a mean change in A1C of -0.22% (95% CI -0.42 to -0.02) per unit increase in scale. The exercise subscore of self-care significantly predicted glycemic control for women with type 1 diabetes and was associated with a mean change in A1C of -0.11% (95% CI -0.22 to -0.01) per unit increase in scale. Conclusion Self-efficacy significantly predicted A1C during pregnancy in a cohort of women with preexisting diabetes in Ontario, Canada. Future research will continue to explore the self-management needs and challenges in women with preexisting diabetes in pregnancy.
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Affiliation(s)
- Katelyn Sushko
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Michelle Butt
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patricia Strachan
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Ali Usman
- Faculty of Health Sciences, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Jardine IR, Christie HE, Oetsch K, Sabag A, Kennedy M, Meyer BJ, Francois ME. Physical Activity, but Not Glycaemic Load, Is Associated with Lower Real-Time Glycaemic Control in Free-Living Women with Gestational Diabetes Mellitus. Nutrients 2023; 15:nu15081974. [PMID: 37111193 PMCID: PMC10142701 DOI: 10.3390/nu15081974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Maintaining blood glucose within the target range is the primary treatment goal for women with gestational diabetes mellitus (GDM). Foods with low glycaemic loads are recommended in clinical practice; however, the relative importance of other key lifestyle variables is unexplored. This pilot study explored the associations of glycaemic load, carbohydrates and physical activity parameters on blood glucose concentrations in free-living women with GDM. Twenty-nine women (28-30 weeks gestation, 34 ± 4 years) with GDM were enrolled. Continuous glucose monitoring, physical activity (ActivPAL inclinometer) and dietary intake and dietary quality were measured concurrently for 3 days. Pearson correlation analyses determined the association between glucose levels and lifestyle variables. Despite all receiving the same nutrition education, only 55% of women were following a low glycaemic load diet with a large range of carbohydrate intakes (97-267 g/day). However, the glycaemic load did not correlate with 3-hr postprandial glucose (r2 = 0.021, p = 0.56) or 24-h glucose iAUC (r2 = 0.021, p = 0.58). A significant relationship between total stepping time and lower 24-h glucose iAUC (r2 = 0.308, p = 0.02) and nocturnal glucose (r2 = 0.224, p = 0.05) was found. In free-living women with diet-controlled GDM, more physical activity, i.e., steps accumulated across the day, may be a simple and effective strategy for improving maternal blood glucose concentrations.
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Affiliation(s)
- Isabelle R Jardine
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
| | - Hannah E Christie
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Kate Oetsch
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Angelo Sabag
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia
| | - Meredith Kennedy
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Shoalhaven Local Health District, Diabetes Service, Wollongong, NSW 2500, Australia
| | - Barbara J Meyer
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Monique E Francois
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
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7
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Sushko K, Menezes HT, Wang QR, Nerenberg K, Fitzpatrick-Lewis D, Sherifali D. Patient-reported Benefits and Limitations of Mobile Health Technologies for Diabetes in Pregnancy: A Scoping Review. Can J Diabetes 2023; 47:102-113. [PMID: 36182614 DOI: 10.1016/j.jcjd.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/28/2022] [Accepted: 08/02/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES For women with pre-existing and gestational diabetes, pregnancy involves specialized and intensive medical care to optimize maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. COVID-19-induced barriers to face-to-face care have identified the need for high-quality, patient-centred virtual health-care modalities, such as mobile health (mHealth) technologies. Our aim in this review was to identify the patient-reported benefits and limitations of mHealth technologies among women with diabetes in pregnancy. We also aimed to determine how the women's experiences aligned with the best practice standards for patient-centred communication. METHODS The framework presented by Arksey and O'Malley for conducting scoping reviews, with refinements by Levac et al, was used to guide this review. Relevant studies were identified through comprehensive database searches of MEDLINE, Embase, Emcare and PsycINFO. Thomas and Harden's methods for the thematic synthesis of qualitative research in systematic reviews guided the synthesis of patient-reported benefits and limitations of mHealth technology. RESULTS Overall, 19 studies describing the use of 16 unique mHealth technologies among 742 women were included in the final review. Patient-reported benefits of mHealth included convenience, support of psychosocial well-being and facilitation of diabetes self-management. Patient-reported limitations included lack of important technological features, perceived burdensome aspects of mHealth and lack of trust in virtual health care. CONCLUSIONS Women with diabetes report some benefits from mHealth use during pregnancy. Codesigning future technologies with end users may help address the perceived limitations and effectiveness of mHealth technologies.
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Affiliation(s)
- Katelyn Sushko
- Faculty of Health Sciences, School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada.
| | - Holly Tschirhart Menezes
- Faculty of Health Sciences, School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Qi Rui Wang
- Faculty of Health Sciences, School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna Fitzpatrick-Lewis
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- Faculty of Health Sciences, School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Diabetes Care and Research Program, The Boris Clinic, McMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
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8
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Jeffrie Seley J, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S254-S266. [PMID: 36507645 PMCID: PMC9810465 DOI: 10.2337/dc23-s015] [Citation(s) in RCA: 119] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Gadgil MD, Ingram KH, Appiah D, Rudd J, Whitaker KM, Bennett WL, Shikany JM, Jacobs DR, Lewis CE, Gunderson EP. Prepregnancy Protein Source and BCAA Intake Are Associated with Gestational Diabetes Mellitus in the CARDIA Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114142. [PMID: 36361016 PMCID: PMC9658365 DOI: 10.3390/ijerph192114142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 06/03/2023]
Abstract
Diet quality and protein source are associated with type 2 diabetes, however relationships with GDM are less clear. This study aimed to determine whether prepregnancy diet quality and protein source are associated with gestational diabetes mellitus (GDM). Participants were 1314 Black and White women without diabetes, who had at least one birth during 25 years of follow-up in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. The CARDIA A Priori Diet Quality Score (APDQS) was assessed in the overall cohort at enrollment and again at Year 7. Protein source and branched-chain amino acid (BCAA) intake were assessed only at the Year 7 exam (n = 565). Logistic regression analysis was used to determine associations between prepregnancy dietary factors and GDM. Women who developed GDM (n = 161) were more likely to have prepregnancy obesity and a family history of diabetes (p < 0.05). GDM was not associated with prepregnancy diet quality at enrollment (Year 0) (odds ratio [OR]: 1.01; 95% confidence interval [CI] 0.99, 1.02) or Year 7 (odds ratio [OR]: 0.97; 95% confidence interval [CI] 0.94, 1.00) in an adjusted model. Conversely, BCAA intake (OR:1.59, 95% CI 1.03, 2.43) and animal protein intake (OR: 1.06, 95% CI 1.02, 1.10) as a proportion of total protein intake, were associated with increased odds of GDM, while proportion of plant protein was associated with decreased odds of GDM (OR: 0.95, 95% CI 0.91, 0.99). In conclusion, GDM is strongly associated with source of prepregnancy dietary protein intake but not APDQS in the CARDIA study.
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Affiliation(s)
- Meghana D. Gadgil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Katherine H. Ingram
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center of Statistics and Analytical Sciences, Lubbock, TX 79409, USA
| | - Jessica Rudd
- Department of Statistics and Analytical Sciences, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Kara M. Whitaker
- Department of Health and Human Physiology, Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
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10
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Sekitoleko I, Tino S, Mubiru M, Nansubuga F, Zaake D, Nakabuye B, Ayiko B, Kalema H, Nakubulwa S, Sekikubo M, Milln J, Nakanga WP, Nakimuli A, Webb EL, Nyirenda MJ. The influence of fasting and post-load glucose levels on maternal and neonatal outcomes in women with hyperglycaemia in pregnancy in Uganda: A prospective observational cohort study. Diabetes Res Clin Pract 2022; 191:110049. [PMID: 36029888 DOI: 10.1016/j.diabres.2022.110049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 06/17/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
Abstract
AIMS The study aims to evaluate the strength of fasting versus post-load glucose levels in predicting adverse outcomes in women with hyperglycaemia in pregnancy (HIP). METHODS Women attending antenatal clinics in urban and peri-urban Uganda had oral glucose tolerance test between 24 and 28 weeks of gestation to screen for HIP, and were followed up to collect data on maternal and neonatal outcomes. Univariable and multivariable Poisson regression models were used to estimate the relative risk adverse outcome associated with fasting hyperglycaemia alone post-load hyperglycaemia alone, or elevation of both fasting and post-load glucose levels. RESULTS We included 3206 participants in the final analysis. HIP was associated with increased risk of Caesarean section, large for gestaional age babies, and neonatal intensive care admission. The risk was highest (2.54-fold compared to normal glycaemic women) when both FBG and post-load glucose levels were elevated. After adjustment for potential confounders, having elevated post-load glucose alone was not associated with increased risk of any of the outcomes, but elevated FBG alone increased the risk of Caesarian section by 1.36-fold. CONCLUSION Fasting hyperglycemia appears to be more strongly associated with adverse pregnancy outcomes than post-load hyperglycaemia, but the risk is even higher in women with elevation of both fasting and post-load glucose levels.
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Affiliation(s)
- Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Salome Tino
- MRC/UVRI and LSHTM Uganda Research Unit, Uganda
| | | | | | | | | | - Ben Ayiko
- Entebbe Grade B Hospital, Entebbe, Uganda
| | | | - Sarah Nakubulwa
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Kawempe Specialized National Referral Hospital, Kampala, Uganda
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Kawempe Specialized National Referral Hospital, Kampala, Uganda
| | - Jack Milln
- Queen Mary University of London, London, United Kingdom
| | - Wisdom P Nakanga
- National Insititute for Health Research (NIHR), Exeter Clinical Research Faculty, University of Exeter, Exeter, United Kindgom
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Kawempe Specialized National Referral Hospital, Kampala, Uganda
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Moffat J Nyirenda
- MRC/UVRI and LSHTM Uganda Research Unit, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Salcedo-Tacuma D, Bonilla L, Montes MCG, Gonzalez JEN, Gutierrez SMS, Chirivi M, Contreras GA. Transcriptome dataset of omental and subcutaneous adipose tissues from gestational diabetes patients. Sci Data 2022; 9:344. [PMID: 35715414 PMCID: PMC9205947 DOI: 10.1038/s41597-022-01457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/23/2022] [Indexed: 11/27/2022] Open
Abstract
Gestational diabetes (GD) is one of the most prevalent metabolic diseases in pregnant women worldwide. GD is a risk factor for adverse pregnancy outcomes, including macrosomia and preeclampsia. Given the multifactorial etiology and the complexity of its pathogenesis, GD requires advanced omics analyses to expand our understanding of the disease. Next generation RNA sequencing (RNA-seq) was used to evaluate the transcriptomic profile of subcutaneous and omental adipose tissues (AT) collected from patients with gestational diabetes and matched controls. Samples were harvested during cesarean delivery. Results show differences based on anatomical location and provide whole-transcriptome data for further exploration of gene expression patterns unique to GD patients.
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Affiliation(s)
- David Salcedo-Tacuma
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | | | | | | | | | - Miguel Chirivi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - G Andres Contreras
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, 48824, USA.
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12
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Zapater JL, Wicksteed B, Layden BT. Enterocyte HKDC1 Modulates Intestinal Glucose Absorption in Male Mice Fed a High-fat Diet. Endocrinology 2022; 163:6569855. [PMID: 35435980 PMCID: PMC9078327 DOI: 10.1210/endocr/bqac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 11/24/2022]
Abstract
Hexokinase domain containing protein-1, or HKDC1, is a widely expressed hexokinase that is genetically associated with elevated 2-hour gestational blood glucose levels during an oral glucose tolerance test, suggesting a role for HKDC1 in postprandial glucose regulation during pregnancy. Our earlier studies utilizing mice containing global HKDC1 knockdown, as well as hepatic HKDC1 overexpression and knockout, indicated that HKDC1 is important for whole-body glucose homeostasis in aging and pregnancy, through modulation of glucose tolerance, peripheral tissue glucose utilization, and hepatic energy storage. However, our knowledge of the precise role(s) of HKDC1 in regulating postprandial glucose homeostasis under normal and diabetic conditions is lacking. Since the intestine is the main entry portal for dietary glucose, here we have developed an intestine-specific HKDC1 knockout mouse model, HKDC1Int-/-, to determine the in vivo role of intestinal HKDC1 in regulating glucose homeostasis. While no overt glycemic phenotype was observed, aged HKDC1Int-/- mice fed a high-fat diet exhibited an increased glucose excursion following an oral glucose load compared with mice expressing intestinal HKDC1. This finding resulted from glucose entry via the intestinal epithelium and is not due to differences in insulin levels, enterocyte glucose utilization, or reduction in peripheral skeletal muscle glucose uptake. Assessment of intestinal glucose transporters in high-fat diet-fed HKDC1Int-/- mice suggested increased apical GLUT2 expression in the fasting state. Taken together, our results indicate that intestinal HKDC1 contributes to the modulation of postprandial dietary glucose transport across the intestinal epithelium under conditions of enhanced metabolic stress, such as high-fat diet.
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Affiliation(s)
- Joseph L Zapater
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
- Jesse Brown VA Medical Center, Medical Research Service, Chicago, IL 60612, USA
| | - Barton Wicksteed
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Brian T Layden
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
- Jesse Brown VA Medical Center, Medical Research Service, Chicago, IL 60612, USA
- Correspondence: Brian T. Layden, MD, PhD, 835 South Wolcott Avenue, Suite 625E (M/C 640), Chicago, IL, 60612, USA.
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13
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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14
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Sushko K, Wang QR, Tschirhart Menezes H, Fitzpatrick-Lewis D, Sherifali D. Patient-Reported Benefits and Limitations of Mobile Health Technologies for Diabetes in Pregnancy: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e29727. [PMID: 34714251 PMCID: PMC8590183 DOI: 10.2196/29727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background For women with pre-existing and gestational diabetes mellitus, pregnancy involves specialized and intensive medical care to improve maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. Barriers to face-to-face care during the COVID-19 pandemic have signaled the need for high-quality, patient-centered virtual health care modalities, such as mobile health (mHealth). Objective The objective of the proposed scoping review is to identify the patient-reported benefits and limitations of mHealth technology among women with diabetes in pregnancy. We also aim to determine how the women’s experiences align with the best practice standards for patient-centered communication. Methods Arksey and O’Malley’s framework for conducting scoping reviews with refinements by Levac et al will be used to guide the conduct of this scoping review. Relevant studies will be identified through comprehensive database searches of MEDLINE, Embase, Emcare, and PsycINFO. Following database searches, studies will be screened for eligibility at the title, abstract, and full-text level by two independent reviewers, with the inclusion of a third reviewer if required to reach consensus. Data charting of included studies will be conducted by one reviewer using a standardized data extraction form and verified independently by a second reviewer. Synthesis of results will be guided by Thomas and Harden’s “Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews.” Results As of August 2020, we have carried out the qualitative searches in the electronic databases MEDLINE, Embase, Emcare, and PsycINFO (Ovid interface) for a combined total of 8207 articles. Next, we plan to conduct the quantitative searches in the electronic databases MEDLINE, Embase, and Emcare (Ovid interface). We also plan to review the reference lists of relevant studies to identify additional eligible studies. Conclusions With the results of this review, we hope to describe the patient-reported benefits and limitations of mHealth technology for women with diabetes in pregnancy. Furthermore, we aim to determine how women’s experiences align with the best practice standards for patient-centered communication. Ultimately, our review can provide valuable information for guideline developers, policy makers, and clinicians related to mobile technologies to support virtual care delivery for women with diabetes in pregnancy. International Registered Report Identifier (IRRID) PRR1-10.2196/29727
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Affiliation(s)
- Katelyn Sushko
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Qi Rui Wang
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | | | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, ON, Canada
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15
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Andersen MB, Fuglsang J, Ostenfeld EB, Poulsen CW, Daugaard M, Ovesen PG. Postprandial interval walking-effect on blood glucose in pregnant women with gestational diabetes. Am J Obstet Gynecol MFM 2021; 3:100440. [PMID: 34216833 DOI: 10.1016/j.ajogmf.2021.100440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND During pregnancy, postprandial hyperglycemia may increase the risk of complications such as fetal macrosomia. However, evidence on beneficial effects of physical activity on postprandial hyperglycemia is sparse. OBJECTIVE This study aimed to investigate the effect of 20 minutes of postprandial interval walking on glycemic control and glycemic variability in pregnant women diagnosed as having gestational diabetes mellitus. STUDY DESIGN A crossover controlled trial including 14 pregnant women (gestational age 31.8±1.3 weeks) diagnosed as having gestational diabetes mellitus (75 g oral glucose load with 2-hour venous plasma glucose of ≥9.0 mmol/L) was conducted. Participants completed a 4-day intervention period and a 4-day control period with 3 days in between. In each study period, participants received a fixed and identical diet. In the intervention period, participants engaged in 20 minutes of postprandial interval walking after breakfast, lunch, and dinner. Interval walking comprised alternating 3 minutes of slow and fast intervals. Interstitial glucose concentrations were determined during both study periods with a continuous glucose monitor. The mixed effects model was used to compare differences between exercise and no exercise. RESULTS Of note, 20 minutes of postprandial interval walking significantly reduced glycemic control during daytime hours relative to the control period (4-day mean glucose, 5.31 [5.04-5.59] vs 5.53 [5.25-5.81] mmol/L [95.6 (90.7-100.6) vs 99.5 (94.5-104.6) mg/dL]; P<.05). On each individual trial day, interval walking significantly reduced glycemic control during daytime hours on day 1 (mean glucose, 5.19 [4.92-5.47] vs 5.55 [5.27-5.83] mmol/L [93.4 (88.6-98.5) vs 99.9 (94.9-104.9) mg/dL]; P=.00), day 2 (mean glucose, 5.32 [5.05-5.60] vs 5.57 [5.29-5.84] mmol/L [95.8 (90.9-100.8) vs 100.3 (95.2-105.1) mg/dL]; P=.00), and day 3 (mean glucose, 5.27 [5.00-5.54] vs 5.46 [5.19-5.74] mmol/L [94.9 (90.0-99.7) vs 98.3 (93.4-103.3) mg/dL]; P=.00), but not on day 4. CONCLUSION A total of 20 minutes of postprandial interval walking seems to be an effective way to control postprandial glucose excursions in women with gestational diabetes mellitus.
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Affiliation(s)
- Mette B Andersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
| | - Jens Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Eva B Ostenfeld
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte W Poulsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Daugaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Per G Ovesen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Thomakos P, Kepaptsoglou O, Korantzis A, Trouva A, Sklavounos I, Trouvas D, Taraoune N, Barreto C, Zoupas CS. The diagnosis of Gestational Diabetes Mellitus and its impact on In Vitro Fertilization pregnancies. A pilot study. J Diabetes Complications 2021; 35:107914. [PMID: 33773900 DOI: 10.1016/j.jdiacomp.2021.107914] [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] [Received: 12/27/2020] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND In Vitro Fertilization (IVF) is increasingly becoming a necessary mode of reproduction. This high risk group is prone to Gestational Diabetes Mellitus (GDM) which further exposes these pregnancies to an increased risk of adverse outcomes. In light of the limited data in the current literature, further investigation is needed regarding the time of GDM diagnosis in IVF pregnancies as well as the outcome of IVF pregnancies complicated by GDM. METHODS In this three center pilot cross sectional study, the data of 101 singleton IVF pregnancies complicated by GDM were analyzed. Prompt GDM diagnosis in IVF pregnancies was accomplished by self-blood glucose monitoring (SMBG) from the first antenatal visit and confirmed by an OGTT. To evaluate pregnancy outcome, maternal and fetal complications in the 101 GDM IVF group was compared to 101 IVF as well as 101 spontaneous conceptions (SC). The three groups were matched by age. The effect of demographic and glycemic parameters on the outcome of GDM IVF pregnancies was investigated. RESULTS GDM diagnosis was made before the 24th week in 37.6% of the GDM IVF group. The week of delivery was earlier for the GDM IVF group (37 ± 1.7) relative to the IVF (37.9 ± 0.9, p < 0.001) and the SC group (38.1 ± 0.8, p < 0.001). GDM IVF pregnancies exhibited greater preeclampsia rates and 84.8% underwent caesarian section. No significant difference regarding LGA and SGA birth weights was found. Complications of GDM IVF pregnancies were associated with the 1-h postprandial BG (r = 0.267, p = 0.007). CONCLUSION GDM screening in IVF pregnancies may be considered earlier than the 24th week. IVF pregnancies affected by GDM are prone to increased maternal and fetal complications which are associated with 1-h postprandial BG.
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Affiliation(s)
- Petros Thomakos
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece.
| | - Olga Kepaptsoglou
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece.
| | - Asteris Korantzis
- IASO Maternity Hospital, 37-39 Kifisias Avenue, 151 23 Marousi, Athens, Greece.
| | - Anastasia Trouva
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - Ioannis Sklavounos
- Mitera Maternity Hospital, 6 Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - Dimitris Trouvas
- Mitera Maternity Hospital, 6 Erythrou Stavrou, 151 23 Marousi, Athens, Greece.
| | - Nadia Taraoune
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - Carol Barreto
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - Christos Sp Zoupas
- Diabetes Center and Clinic, Hygeia General Hospital, 4 Erythrou Stavrou, 151 23 Marousi, Athens, Greece.
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Chawla R, Mukherjee JJ, Chawla M, Kanungo A, Shunmugavelu MS, Das AK. Expert Group Recommendations on the Effective Use of Bolus Insulin in the Management of Type 2 Diabetes Mellitus. Med Sci (Basel) 2021; 9:38. [PMID: 34071359 PMCID: PMC8162981 DOI: 10.3390/medsci9020038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Evidence suggests a major contribution of postprandial glucose (PPG) excursions to the increased risk of micro- and macro-vascular complications in individuals with type 2 diabetes mellitus (T2DM). Administration of bolus insulin remains a very effective therapeutic option for PPG control. The aim of this expert group recommendation document was to provide practical and easy-to-execute guidelines for physicians on the appropriate use of bolus insulin in the management of T2DM. A panel of key opinion leaders from India reviewed and discussed the available clinical evidence and guideline recommendations on the following topics: (1) optimum control of PPG; (2) choice of bolus insulin; and (3) special situations and practical considerations. The expert panel critically analyzed the current literature and clinical practice guidelines and factored their rich clinical experience to develop a set of nine expert group recommendations for the effective use of bolus insulin. These recommendations will not only result in a more evidence-based application of bolus insulin in the clinical setting but also trigger further research and provide a valuable base for the development of future guidelines on the use of bolus insulin in the management of individuals with T2DM.
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Affiliation(s)
- Rajeev Chawla
- Department of Diabetology, North Delhi Diabetes Centre, 180, Jai Apartments, Sec 9, Rohini 110085, India;
| | - Jagat Jyoti Mukherjee
- Division of Endocrinology, Department of Medicine, Apollo Gleneagles Hospitals, 58, Canal Circular Road, Kolkata 700054, India
| | - Manoj Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, 704, Cosmos Plaza, Opp. Indian Oil Nagar, J.P. Road, Andheri (W), Mumbai 400053, India;
| | - Alok Kanungo
- Department of Diabetology, Kanungo Institute of Diabetes Specialities Pvt. Ltd., 1120, Dumduma, Bhubaneswar 751019, India;
| | - Meenakshi Sundaram Shunmugavelu
- Department of Diabetology, Trichy Diabetes Speciality Centre (P) Ltd. B-37, Sasthri Road, VII Cross East, Thillai Nagar, Trichy 620018, India;
| | - Ashok Kumar Das
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Kalathumettupathai, Ganapathichettikulam Village, No 20, Kalapet, Puducherry 6050146, India;
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18
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Abstract
Continuous glucose monitoring (CGM) is being used with increasing frequency as an adjunct to self-monitoring of blood glucose in pregnancy, and novel targets based on CGM data are becoming standardized. This adoption of CGM is the result of its improving accuracy, patient preference, and evolving data demonstrating associations of novel targets such as time in range (TIR) with pregnancy and neonatal outcomes. A greater understanding of the relationship of various CGM metrics to outcomes in pregnancy complicated by diabetes is needed. It is clear that TIR parameters need to be uniquely lower for pregnant women than for nonpregnant individuals. CGM technology is also an integral part of hybrid closed-loop insulin delivery systems. These insulin delivery systems will be a significant advance in the management of diabetes during pregnancy if they can achieve the pre- and postprandial targets required for pregnancy and optimize TIR.
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19
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Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review. Int J Mol Sci 2021; 22:2965. [PMID: 33803995 PMCID: PMC7999044 DOI: 10.3390/ijms22062965] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
In spite of the huge progress in the treatment of diabetes mellitus, we are still in the situation that both pregestational (PGDM) and gestational diabetes (GDM) impose an additional risk to the embryo, fetus, and course of pregnancy. PGDM may increase the rate of congenital malformations, especially cardiac, nervous system, musculoskeletal system, and limbs. PGDM may interfere with fetal growth, often causing macrosomia, but in the presence of severe maternal complications, especially nephropathy, it may inhibit fetal growth. PGDM may also induce a variety of perinatal complications such as stillbirth and perinatal death, cardiomyopathy, respiratory morbidity, and perinatal asphyxia. GDM that generally develops in the second half of pregnancy induces similar but generally less severe complications. Their severity is higher with earlier onset of GDM and inversely correlated with the degree of glycemic control. Early initiation of GDM might even cause some increase in the rate of congenital malformations. Both PGDM and GDM may cause various motor and behavioral neurodevelopmental problems, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most complications are reduced in incidence and severity with the improvement in diabetic control. Mechanisms of diabetic-induced damage in pregnancy are related to maternal and fetal hyperglycemia, enhanced oxidative stress, epigenetic changes, and other, less defined, pathogenic mechanisms.
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Affiliation(s)
- Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Maria Becker
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
- Medical Center, Hadassah Hebrew University, Mount Scopus, Jerusalem 91240, Israel
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20
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Wahab RJ, Jaddoe VWV, Gaillard R. Associations of maternal early-pregnancy dietary glycemic index with childhood general, abdominal and ectopic fat accumulation. Clin Nutr 2021; 40:1628-1636. [PMID: 33752151 PMCID: PMC7613756 DOI: 10.1016/j.clnu.2021.02.046] [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] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
Background & aims Maternal hyperglycemia during pregnancy is an important risk factor for childhood adiposity. Maternal dietary glycemic index during pregnancy directly influences maternal and fetal glucose concentrations. We examined the associations of maternal early-pregnancy dietary glycemic index with offspring general, abdominal and ectopic fat accumulation among normal weight and overweight or obese pregnant women and their offspring. Methods In a population-based cohort study among 2488 Dutch pregnant women and their children, we assessed maternal dietary glycemic index by food frequency questionnaire at median 13.4 (95% range 10.7; 21.1) weeks gestation. Dietary glycemic index was used continuously and categorized into low (≤55), normal (56–69) and high (≥70) glycemic index diet. We measured offspring BMI, total fat mass and android/gynoid fat mass ratio by DXA, and visceral fat mass and liver fat fraction by MRI at 10 years. Results No associations of maternal early-pregnancy dietary glycemic index with offspring adiposity were present among normal weight women and their children. Among overweight and obese women and their children, 1-Standard Deviation Score (SDS) increase in maternal early-pregnancy dietary glycemic index was associated with higher childhood BMI (0.10 SDS, 95% Confidence Interval (CI) 0.01; 0.19), total fat mass index (0.13 SDS, 95% CI 0.05; 0.22), visceral fat mass index (0.19 SDS, 95% CI 0.07; 0.32) and tended to be associated with a higher android/gynoid fat mass ratio (0.09 SDS, 95% CI −0.01; 0.19) and higher risk of childhood overweight (Odds Ratio (OR) 1.20, 95% CI 0.97; 1.48). Overweight and obese women consuming an early-pregnancy low-glycemic index diet, as compared to an early-pregnancy normal-glycemic index diet, had children with lower BMI, total fat mass index, visceral fat mass index and android/gynoid fat mass ratio at 10 years (p-values<0.05). No women consumed a high-glycemic index diet. No associations were explained by maternal socio-economic, lifestyle and dietary characteristics, birth or childhood characteristics. No associations with liver fat fraction were present. Conclusions In overweight or obese women and their children, a higher maternal early-pregnancy dietary glycemic index is associated with childhood general, abdominal and visceral fat accumulation, but not with liver fat. Intervention studies among overweight and obese pregnant women may need to target the dietary glycemic index to prevent childhood adiposity.
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Affiliation(s)
- Rama J Wahab
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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21
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Abstract
PURPOSE OF REVIEW The goal of this article is to review recent research of technology use, including insulin pumps, continuous glucose monitors, and smartpens, for pregnant women with preexisting type 1 diabetes. RECENT FINDINGS Recent research shows that there may be benefits from technology use in type 1 diabetes pregnancies given the changes in insulin sensitivity throughout the span of pregnancy as well as allowing for more monitoring to allow for sooner titration of insulin doses. SUMMARY There may be utility in incorporation of technology during pregnancy with appropriate medical guidance. Additional research would be helpful to further assess the ability of newer automated insulin systems to aid in tight glucose management goals during pregnancy and show value in receiving FDA approval.
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22
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Sever O, Sarsmaz K, Ozgu-Erdinc AS, Yucel A. Comparison of postprandial 90th-minute plasma glucose level with 60th- and 120th-minute levels in patients with gestational diabetes: a prospective cohort study. Endocrine 2021; 71:69-75. [PMID: 32767192 DOI: 10.1007/s12020-020-02447-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/28/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE The objective of the present study is to compare postprandial 90th-minute plasma glucose measurement with fasting, postprandial 60 and 120 min in gestational diabetes mellitus (GDM). METHODS One hundred and thirty-one pregnant women with GDM were hospitalized for regulation of maternal plasma glucose levels. Plasma glucose levels were daily recorded for every patient and treatment option arranged without considering the 90th-minute plasma glucose level. All patients were followed up until birth and pregnancy results were compared. RESULT At the admission, 69% of our patients were on diet and 31% were on insulin with diet therapy. The highest postprandial mean plasma glucose was seen at 90 min after breakfast (137.50 mg/dl), at 60 min after lunch (137.80 mg/dl), and 60 min after dinner (134.50 mg/dl). The cut-off level for postprandial glucose at 90th minute was determined as 130 mg/dl. The upper limit plasma glucose levels were most frequently exceeded at 90th minute for each meal. High plasma glucose levels and the need for neonatal intensive care unit were correlated (p < 0.05). CONCLUSIONS The highest plasma glucose level was seen at 90 min after breakfast, 60 min after lunch, and 60 min after dinner. The upper limit plasma glucose levels were most frequently exceeded at the 90 min.
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Affiliation(s)
- Ozge Sever
- University of Health Sciences, Etlik Zubeyde Hanim Woman's Health Care, Training and Research Hospital, Perinatology Department, Ankara, Turkey
| | - Kemal Sarsmaz
- University of Health Sciences, Etlik Zubeyde Hanim Woman's Health Care, Training and Research Hospital, Perinatology Department, Ankara, Turkey
| | | | - Aykan Yucel
- University of Health Sciences, Etlik Zubeyde Hanim Woman's Health Care, Training and Research Hospital, Perinatology Department, Ankara, Turkey.
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23
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Bayraktar B, Balikoglu M, Bayraktar M, Kanmaz A. Number of relationships between abnormal values in oral glucose tolerance test and adverse pregnancy outcome. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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25
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Chen T, Liu D, Yao X. Progress of Clinical Trials for the Treatment of Gestational Diabetes Mellitus. Diabetes Metab Syndr Obes 2021; 14:315-327. [PMID: 33519220 PMCID: PMC7837562 DOI: 10.2147/dmso.s290749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/31/2020] [Indexed: 01/09/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common and severe complications of pregnancy, which is not only associated with perinatal complications but also has a long-term adverse effect on maternal and their offsprings. At present, the treatment of GDM focuses on the control of maternal blood glucose. Although lifestyle changes, hypoglycemic drugs, blood glucose monitoring, and other medicines that can improve maternal blood glucose to a certain extent, there are still some patients affected and have adverse pregnancy outcomes. The prevention of GDM and the treatment of improving pregnancy outcomes are urgently needed. This review summarized recently published clinical trials related with the treatment of GDM, aiming to provide additional options for the treatment of GDM.
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Affiliation(s)
- Tong Chen
- Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People’s Republic of China
| | - Dan Liu
- Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People’s Republic of China
- Correspondence: Dan Liu Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Zhongshan Str. 222, Dalian116011, People’s Republic of China Email
| | - Xiaofeng Yao
- Department of Preventive Medicine, Dalian Medical University, Dalian, Liaoning, People’s Republic of China
- Xiaofeng Yao Department of Preventive Medicine, Dalian Medical University, 9 W Lushun South Road, Dalian116044, People’s Republic of China Email
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Singh C, Gupta Y, Goyal A, Kalaivani M, Garg V, Bharti J, Singhal S, Kachhawa G, Kulshrestha V, Kumari R, Mahey R, Sharma JB, Bhatla N, Khadgawat R, Gupta N, Tandon N. Glycemic profile of women with normoglycemia and gestational diabetes mellitus during early pregnancy using continuous glucose monitoring system. Diabetes Res Clin Pract 2020; 169:108409. [PMID: 32882343 DOI: 10.1016/j.diabres.2020.108409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
AIM We studied women between 8 and 20 weeks of gestation with the aim of evaluating and comparing those having normoglycemia and GDM according to WHO 2013 criteria. METHODS In this cross-sectional study (2017-2019), eligible pregnant women underwent a 75-g OGTT, followed by placement of a CGMS. RESULTS Women (n = 96, 58 with normoglycemia and 38 with GDM) were enrolled at 14.0 ± 3.2 weeks of gestation. Mean preprandial, 1-h and 2-h postprandial and peak glucose values were significantly higher in women with GDM. Peak glucose value was achieved 60.0 ± 12.3 and 64.3 ± 11.6 min after meal in the normoglycemia and GDM group, respectively. 24-h mean glucose (5.8 ± 0.6 vs. 5.3 ± 0.4 mmol/L), mean daytime glucose (6.0 ± 0.6 vs. 5.5 ± 0.4 mmol/L) and mean nocturnal glucose (5.4 ± 0.7 vs. 5.0 0 ± 0.5 mmol/L) were significantly higher in women with GDM. Total time spent in range was significantly lower in the GDM group compared to the normoglycemia group (92.1 vs. 98.2%). CONCLUSIONS This study highlights differences in glycemic patterns between women with normoglycemia and GDM in the context of a South Asian population where burden of GDM is high but good quality data in early pregnancy are limited.
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Affiliation(s)
- Charandeep Singh
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Alpesh Goyal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Garg
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai B Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Yuan WL, Lin J, Kramer MS, Godfrey KM, Gluckman PD, Chong YS, Shek LP, Tan KH, Chan SY, Eriksson JG, Yap F, Lee YS, Choo JTL, Ling LH. Maternal Glycemia During Pregnancy and Child Carotid Intima Media Thickness, Pulse Wave Velocity, and Augmentation Index. J Clin Endocrinol Metab 2020; 105:5823269. [PMID: 32315399 PMCID: PMC7343531 DOI: 10.1210/clinem/dgaa211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/19/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND In women without diabetes, little is known about the consequences of hyperglycemia during pregnancy for the offspring's cardiovascular structure and function. OBJECTIVE To investigate the association of maternal glycemia during pregnancy with cardiovascular risk markers in their children in GUSTO, a Singaporean birth cohort study. METHODS Around 26 weeks' gestation, a 75 g oral glucose tolerance test was performed and fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (PPPG) concentrations were measured. Gestational diabetes mellitus (GDM) was defined using WHO 1999 diagnostic criteria. At 6 years of age, we measured the child's carotid intima-media thickness (cIMT), carotid-femoral pulse wave velocity (cfPWV), aortic augmentation index (AIx), and blood pressure (BP). Association of maternal glycemia during pregnancy with cardiovascular risk markers in their children were analyzed using multiple linear and logistic regressions. RESULTS Analysis were performed on 479 mother-child dyads. Higher maternal FPG was associated with higher cIMT and, in males, with a higher cfPWV in the offspring (adjusted β [CI 95%], cIMT: 0.08 per 10mm increase [0.02; 0.15], cfPWV: 0.36 m/s [0.01; 0.70]). Higher 2-hour PPPG was associated with higher cfPWV and AIx. Gestational diabetes mellitus was associated with higher AIx. No association was found between maternal glycemia and their offspring blood pressure. CONCLUSIONS among mothers without pre-existing diabetes, higher glycemia during pregnancy was associated with mild structural and functional vascular changes in their children at 6 years of age across a continuum. These results support the necessity to monitor maternal glycemia during pregnancy even in the absence of pre-existing diabetes or diagnosed GDM.
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Affiliation(s)
- Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jinjie Lin
- Departments of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michael S Kramer
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Canada
- Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital, Southampton National Health Service Foundation Trust, Southampton, UK
| | - Peter D Gluckman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Yap-Seng Chong
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
- Divisions of Paediatric Allergy, Immunology, and Rheumatology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Maternal Foetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Fabian Yap
- Departments of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Jonathan T L Choo
- Departments of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lieng Hsi Ling
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
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Bayoglu Tekin Y, Baki Erin K, Yilmaz A. Evaluation of SCUBE-1 levels as a placental dysfunction marker at gestational diabetes mellitus. Gynecol Endocrinol 2020; 36:417-420. [PMID: 31668102 DOI: 10.1080/09513590.2019.1683537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: To evaluate the alteration of plasma levels of signal peptide-CUB-EGF domain-containing protein (SCUBE)-1 as a marker of endothelial dysfunction and vascular injury in gestational diabetes mellitus (GDM) in comparison to healthy pregnant controls.Methods: A prospective study conducted at an antenatal outpatient clinic of a University hospital. Fifty pregnancies with GDM and thirty healthy pregnancies as controls were enrolled in the study.Results: There was no statistically significant difference between the groups in terms of age, gravidity, weight and BMI from pre-pregnancy until delivery, total weight gain, fetal weight and other hematological and biochemical parameters. SCUBE-1 levels were significantly higher in GDM patients (p = .007).Conclusions: Hyperglycemia predisposes to endothelial injury and vascular remodeling at GDM, and therefore, SCUBE-1 could be a predictor of vascular injury during pregnancy. Our study is the first to illustrate increased SCUBE-1 levels in GDM as a marker of placental endothelial dysfunction.
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Affiliation(s)
- Yesim Bayoglu Tekin
- Department of Gynecology and Obstetrics, Sağlık Bilimleri University, School of Medicine, İstanbul, Turkey
| | - Kübra Baki Erin
- Department of Gynecology and Obstetrics, Sağlık Bilimleri University, School of Medicine, İstanbul, Turkey
| | - Adnan Yilmaz
- Department of Biochemistry, Recep Tayyip Erdogan University, School of Medicine, Rize, Turkey
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Pénager C, Bardet P, Timsit J, Lepercq J. Determinants of the persistency of macrosomia and shoulder dystocia despite treatment of gestational diabetes mellitus. Heliyon 2020; 6:e03756. [PMID: 32346630 PMCID: PMC7182725 DOI: 10.1016/j.heliyon.2020.e03756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/03/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023] Open
Abstract
Aims to identify potentially modifiable risk factors associated with the persistency of macrosomia and/or shoulder dystocia in infants born to women treated for gestational diabetes mellitus (GDM). Methods this case-control retrospective study included 113 cases complicated by macrosomia (ponderal index ≥97th percentile) and/or shoulder dystocia, and 226 controls without these complications. Factors associated with macrosomia and/or shoulder dystocia and with failure of diabetes management were assessed by multivariable analyses. Results Macrosomia and/or shoulder dystocia were associated with previous delivery of a large for gestational age (LGA) infant (adjusted odds ratio, 2.34, 95% confidence interval [1.01–5.45]), three abnormal glucose values during oral glucose tolerance test (2.83 [1.19–6.72]), a higher gestational weight gain before treatment (1.08 [1.01–1.15]), and failure of diabetes management (2.68 [1.32–5.45]). A non-Euro Caucasian origin (3.08 [1.37–6.93]), previous delivery of a LGA infant (3.21 [1.31–7.87]), institution of treatment after 32 weeks of gestation (3.92 [1.86–8.25]), and insulin therapy (2.91 [1.20–7.03]) were associated with failure of diabetes management. Conclusions supportive care in at risk women, limitation of weight gain in early pregnancy, shortened delay between diagnosis and treatment of GDM, and intensive insulin dosage adjustments might be means to improve the neonatal prognosis of GDM.
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Affiliation(s)
- Cécile Pénager
- Department of Obstetrics, Cochin-Port-Royal Hospital, AP-HP, Paris Descartes University, DHU Risks in Pregnancy, 123 boulevard de Port-Royal, 75014, Paris, France
| | - Pascal Bardet
- Department of Diabetology, Cochin-Port-Royal Hospital, AP-HP, Paris Descartes University, DHU Authors, 123 boulevard de Port-Royal, 75014, Paris, France
| | - José Timsit
- Department of Diabetology, Cochin-Port-Royal Hospital, AP-HP, Paris Descartes University, DHU Authors, 123 boulevard de Port-Royal, 75014, Paris, France
| | - Jacques Lepercq
- Department of Obstetrics, Cochin-Port-Royal Hospital, AP-HP, Paris Descartes University, DHU Risks in Pregnancy, 123 boulevard de Port-Royal, 75014, Paris, France
- Corresponding author.
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Márquez-Pardo R, Torres-Barea I, Córdoba-Doña JA, Cruzado-Begines C, García-García-Doncel L, Aguilar-Diosdado M, Baena-Nieto MG. Continuous Glucose Monitoring and Glycemic Patterns in Pregnant Women with Gestational Diabetes Mellitus. Diabetes Technol Ther 2020; 22:271-277. [PMID: 31638416 DOI: 10.1089/dia.2019.0319] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Continuous glucose monitoring (CGM) could detect certain patterns of hyperglycemia at different times of the day that may help predict the development of maternal-fetal complications and the probability of needing pharmacological treatment. Methods: This study prospectively examined 77 women with gestational diabetes mellitus (GDM) who were placed on a CGM system for 6 days after diagnosis between 26 and 32 weeks of gestation. Patterns of hyperglycemia before meals (period of time of an hour just before meal) (>95 mg/dL), after meals (time interval of 2 h and half just after meal) (>140 mg/dL), and overnight (0-7 am) (>120 mg/dL) and their association with maternal-fetal complications and pharmacological treatment were analyzed. Receiver operating characteristic curves were developed to estimate the validity of the various patterns in detecting the need for pharmacological treatment. Results: A statistically significant relationship was observed between time in hyperglycemia after lunch and macrosomia (P = 0.035) and large for gestational age infants (P = 0.010). Pharmacological treatment was required for patients with time above range (TAR; P = 0.006) and those with hyperglycemia patterns before breakfast (P < 0.001), after breakfast (P = 0.006), before dinner (P = 0.012), and overnight (P = 0.001). Every additional percentage point of TAR was associated with a 24% increase in the probability of pharmacological treatment. Conclusions: The use of CGM for the diagnosis of GDM allows the identification of those patients who would benefit from closer monitoring during pregnancy, including self-monitoring of both pre- and postprandial blood glucose levels, facilitating the initiation of early pharmacological treatment.
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Affiliation(s)
- Rosa Márquez-Pardo
- Department of Endocrinology and Nutrition and Jerez Hospital, Jerez de la Frontera, Spain
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
| | - Isabel Torres-Barea
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
- Department of Endocrinology and Nutrition, Puerta del Mar Hospital, Cádiz, Spain
| | - Juan-Antonio Córdoba-Doña
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
- Department of Preventive Medicine and Public Health, Jerez Hospital, Jerez de la Frontera, Spain
| | | | - Lourdes García-García-Doncel
- Department of Endocrinology and Nutrition and Jerez Hospital, Jerez de la Frontera, Spain
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
| | - Manuel Aguilar-Diosdado
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
- Department of Endocrinology and Nutrition, Puerta del Mar Hospital, Cádiz, Spain
| | - María-Gloria Baena-Nieto
- Department of Endocrinology and Nutrition and Jerez Hospital, Jerez de la Frontera, Spain
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
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Mustad VA, Huynh DT, López-Pedrosa JM, Campoy C, Rueda R. The Role of Dietary Carbohydrates in Gestational Diabetes. Nutrients 2020; 12:E385. [PMID: 32024026 PMCID: PMC7071246 DOI: 10.3390/nu12020385] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
Gestational diabetes (GDM) is hyperglycemia that is recognized for the first time during pregnancy. GDM is associated with a wide range of short- and long-term adverse health consequences for both mother and offspring. It is a complex disease with a multifactorial etiology, with disturbances in glucose, lipid, inflammation and gut microbiota. Consequently, its management is complex, requiring patients to self-manage their diet, lifestyle and self-care behaviors in combination with use of insulin. In addition to nutritional recommendations for all pregnant women, special attention to dietary carbohydrate (CHO) amount and type on glucose levels is especially important in GDM. Dietary CHO are diverse, ranging from simple sugars to longer-chain oligo- and poly- saccharides which have diverse effects on blood glucose, microbial fermentation and bowel function. Studies have established that dietary CHO amount and type can impact maternal glucose and nutritional recommendations advise women with GDM to limit total intake or choose complex and low glycemic CHO. However, robust maternal and infant benefits are not consistently shown. Novel approaches which help women with GDM adhere to dietary recommendations such as diabetes-specific meal replacements (which provide a defined and complete nutritional composition with slowly-digested CHO) and continuous glucose monitors (which provide unlimited monitoring of maternal glycemic fluctuations) have shown benefits on both maternal and neonatal outcomes. Continued research is needed to understand and develop tools to facilitate patient adherence to treatment goals, individualize interventions and improve outcomes.
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Affiliation(s)
| | - Dieu T.T. Huynh
- R&D Department, Abbott Nutrition, Singapore 138668, Singapore;
| | | | - Cristina Campoy
- Department of Paediatrics, University of Granada, 18071 Granada, Spain;
- EURISTIKOS Excellence Centre for Paediatric Research, University of Granada, 18071 Granada, Spain
| | - Ricardo Rueda
- R&D Department, Abbott Nutrition, 18004 Granada, Spain;
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Bussière-Côté S, Sieffien W, Berger H, Park AL, Ray JG. Twice-Daily vs 4-Times-Daily Glucose Testing in Women With Gestational Diabetes Mellitus: A Pilot Study. Can J Diabetes 2019; 44:274-279. [PMID: 31619325 DOI: 10.1016/j.jcjd.2019.08.007] [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: 06/01/2019] [Revised: 07/12/2019] [Accepted: 08/12/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In women with gestational diabetes mellitus (GDM), glycemic control is typically assessed by capillary blood glucose (BG) self-monitoring. Currently, the standard method of monitoring is by 4-times-daily self-measurements. The goal of our study was to determine whether twice-daily capillary BG testing is comparable with 4-times-daily testing in women with GDM. METHODS Thirty-two women with GDM completed initial dietary counselling and recorded consecutive fasting and 2-h postprandial BG over a 14-day period. We randomly selected 2 of 4 BG measurements on each given day and compared mean (95% confidence interval [CI]) twice-daily vs 4-times-daily BG measurements using paired t tests and Bland-Altman plots. The proportion of 14-day BG measurements above glycemic targets was also compared between twice-daily vs 4-times-daily testing for fasting and postprandial readings. RESULTS Comparing twice-daily vs 4-times-daily mean BG, there was a small difference for fasting BG (0.09 mmol/L; 95% CI, 0.03 to 0.14), but not for 2-h postbreakfast (-0.05 mmol/L; 95% CI, -0.17 to 0.06), 2-h postlunch (-0.03 mmol/L; 95% CI, -0.13 to 0.08) or 2-h postdinner (0.05 mmol/L; 95% CI, -0.09 to 0.19) BG. Bland-Altman plots showed general agreement and minimal bias between twice-daily vs 4-times-daily BG, whether fasting or postprandial. There was no significant difference in the proportion of 14-day BG measurements above glycemic targets comparing twice-daily vs 4-times-daily testing in the fasting or postprandial states. CONCLUSIONS Twice-daily BG testing appears to generate 14-day average values similar to 4-times-daily BG testing. In women with GDM, whose BG is in target range, twice-daily BG monitoring may reduce inconvenience and cost.
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Affiliation(s)
- Sophie Bussière-Côté
- Department Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Weam Sieffien
- Department Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Howard Berger
- Department Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Alison L Park
- Department Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Joel G Ray
- Department Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
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Intensive glycemic control in gestational diabetes mellitus: a randomized controlled clinical feasibility trial. Am J Obstet Gynecol MFM 2019; 1:100050. [PMID: 33345840 DOI: 10.1016/j.ajogmf.2019.100050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/28/2019] [Accepted: 09/22/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Overweight and obese women with gestational diabetes mellitus are at increased risk for adverse perinatal outcomes, and they are also more likely to have suboptimal glycemic control. However, there is a paucity of data evaluating whether lower glycemic targets could improve outcomes. OBJECTIVE To evaluate the feasibility of intensive glycemic control in overweight and obese women with gestational diabetes mellitus. MATERIALS AND METHODS We randomized 60 overweight or obese women with gestational diabetes mellitus, diagnosed between 12 and 32 weeks' gestation to either intensive (fasting <90 mg/dL, 1 hour postprandial <120 mg/dL) or standard (fasting <95 mg/dL, 1 ho postprandial <140 mg/dL) glycemic targets. Maternal glucose was assessed in 2 ways: blinded continuous glucose monitors, worn for 5 days at 2 time points (at 12-32 weeks and again at 32-36 weeks), and self-monitored glucose measurement 4 times per day. All women underwent standardized dietary counseling, and medical therapy was prescribed as needed to achieve glycemic control. RESULTS Between December 2015 and December 2017, we randomized 60 women to either intensive (n = 30) or standard (n = 30) glycemic control. Baseline characteristics including maternal age, body mass index, and gestational age at diagnosis were similar between the intensive and standard groups. Medical therapy was more common in women in the intensive group than those in the standard group (83 vs 57%, P = .02). Women in the intensive glycemic control group had lower glucose values as assessed by continuous glucose monitors at including 24-hour mean (-8.1; 95% confidence interval, -12.0 to -4.3 mg/dL; P < .0001) and 1-h postprandial (-11.8; 95% confidence interval, -19.7 to -3.9 mg/dL, P = .004) values. Hypoglycemia <60 mg/dL was uncommon and did not differ between groups. CONCLUSION Intensive glycemic targets can be used in overweight and obese women with minimal hypoglycemia, and this approach results in improved glycemic control when compared to standard glycemic targets. Further studies are needed to determine whether intensive glycemic targets can improve maternal and neonatal outcomes in high-risk women with gestational diabetes mellitus. CLINICAL TRIAL IDENTIFIER NCT02530866; clinicaltrials.gov.
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Paleolithic diet during pregnancy-A potential beneficial effect on metabolic indices and birth weight. Eur J Obstet Gynecol Reprod Biol 2019; 242:7-11. [PMID: 31522093 DOI: 10.1016/j.ejogrb.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/29/2019] [Accepted: 08/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Paleolithic diet has recently gained popularity due to its presumed health benefits. The favorable metabolic effects of this diet were assessed in non-pregnant population but its impact during pregnancy remains to be evaluated. STUDY DESIGN A retrospective cohort study comparing two groups. Group A comprised of women with singleton low-risk pregnancy adherent to paleolithic diet throughout gestation (n = 37). Group B comprised low risk pregnant women on a regular diet (n = 39). Women were excluded if they had low adherence to diet, started paleolithic diet during pregnancy, and had pre-gestational diabetes mellitus or other types of metabolic syndrome such as pre gestational hyperlipidemia, hypertension or BMI > 35. Blood indices such as Glucose challenge test scores, hemoglobin, ferritin, and TSH levels were compared. Other pregnancy factors such as maternal weight gain, rest days during gestation and pregnancy complications such as IUGR, GDM or preeclampsia were compared. Lastly, obstetrical outcomes such as mode of delivery and complications such as high-grade tears, as well as neonatal factors such as birth weight and pH were compared between the two groups. RESULTS General maternal characteristics such as age, BMI and parity were comparable between the two groups. Women who maintained a paleolithic diet had a significant decrease in glucose challenge test scores (95.8 mg/dL vs. 123.1 mg/dL, p < 0.01) and increase in hemoglobin levels (12.1 g/dL vs. 11.05 g/dL p < 0.01) and Ferritin (32.1 vs 21.3 mg/mL, p = 0.03) compared to women maintaining regular diet. Maternal pregnancy weight gain was also slightly decreased in group A (9.3Kg vs. 10.8 kg, p = 0.03). Birthweights were lower in group A (3098 g Vs.3275 g, p = 0.046) with no difference in adverse neonatal outcomes. We found no differences in other pregnancy complications or labor outcomes such as mode of delivery, shoulder dystocia or high grade perineal tears. CONCLUSION Paleolithic diet maintained during pregnancy may have a beneficial effect on the glucose tolerance. It also may increase iron stores and hemoglobin levels. Neonates of women maintaining paleolithic diet are slightly lighter but appropriate for gestational age with no difference in neonatal outcomes.
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Abstract
Hyperglycemia is common during pregnancy, involving multisystem adaptations. Pregnancy-induced metabolic changes increase insulin resistance. Pregnancy-induced insulin resistance adds to preexisting insulin resistance. Preexisting pancreatic β-cell defect compromises the ability to enhance insulin secretion, leading to hyperglycemia. Women with type 2 DM have similar rates of major congenital malformations, stillbirth, and neonatal mortality, but an even higher risk of perinatal mortality. In utero type 2 DM exposure confers greater risk and reduces time to development of type 2 DM in offspring. Preconception care to improve metabolic control in women with type 2 diabetes is critical.
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Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, 30 A, Krogshoejvej, Bagsverd 2880, Denmark; FIGO Pregnancy and NCD Committee, Jabotinski Street, Petah Tiqwa 49100, Israel.
| | - Harold David McIntyre
- FIGO Pregnancy and NCD Committee, Jabotinski Street, Petah Tiqwa 49100, Israel; UQ Mater Clinical Unit, Faculty of Medicine, Mater Health Services, University of Queensland, Raymond Terrace, South Brisbane, Brisbane, Qld 4101, Australia
| | - Moshe Hod
- FIGO Pregnancy and NCD Committee, Jabotinski Street, Petah Tiqwa 49100, Israel; Department of Obstetrics and Gynecology, Clalit Health Services, Mor Women's Health Center, Rabin Medical Center, Tel Aviv University, 18 Aba Ahimeir St., Tel Aviv 6949204, Israel
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Tabrizi R, Asemi Z, Lankarani KB, Akbari M, Khatibi SR, Naghibzadeh-Tahami A, Sanjari M, Alizadeh H, Afshari M, Khodadost M, Moosazadeh M. Gestational diabetes mellitus in association with macrosomia in Iran: a meta-analysis. J Diabetes Metab Disord 2019; 18:41-50. [PMID: 31275873 PMCID: PMC6582006 DOI: 10.1007/s40200-019-00388-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/24/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE This meta-analysis aimed to estimate the association between gestational diabetes mellitus (GDM) and occurrence of macrosomia for the first time among Iranian population. METHODS A systematic review was done of national and international databases. Lists of relevant articles were checked to increase sensitivity of the search reference. Also, access to unpublished articles and documents were accessed by negotiation with related individuals and research centers. These published epidemiological studies (cross-sectional, case-control and cohort studies) were used for comparisons to determine whether GDM was associated with macrosomia. Finally, the Mantel-Haenszel method and the fixed and random-effect models based on heterogeneity of the primary studies were used according to pool results and estimate the odds ratio of macrosomia in women with GDM. RESULTS Of 1870 articles, thirty relevant articles were eligible for the current meta-analysis. Our findings showed that 335 of 2524 women with GDM had macrosomia while only 775 of 26,592 women without GDM had macrosomia. Using random-effect model, the pooled odds ratio (OR) relation between GDM and occurrence of macrosomia was estimated as of 5.49 (95% CI: 4.27-7.04). Subgroup analysis showed no difference regarding different study designs and definitions of macrosomia. There was no evidence of publication bias based on the result of Egger's test (β = 0.1, P = 0.70). CONCLUSIONS This meta-analysis shows that GDM is directly associated with the risk of macrosomia in the Iranian population. This confirms the findings of previous studies in the wider scientific literature.
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Affiliation(s)
- Reza Tabrizi
- Health Policy Research Center, Institute of Health, Clinical Neurology Research Center, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Kamran B. Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Akbari
- Health Policy Research Center, Institute of Health, Clinical Neurology Research Center, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Seyed Reza Khatibi
- Department of Epidemiology, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Ahmad Naghibzadeh-Tahami
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mojgan Sanjari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Hosniyeh Alizadeh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahdi Afshari
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Mahmoud Khodadost
- Gastroenterology and Liver Diseases Research Center, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
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Gadgil MD, Ehrlich SF, Zhu Y, Brown SD, Hedderson MM, Crites Y, Ferrara A. Dietary Quality and Glycemic Control Among Women with Gestational Diabetes Mellitus. J Womens Health (Larchmt) 2019; 28:178-184. [PMID: 30376391 PMCID: PMC6390645 DOI: 10.1089/jwh.2017.6788] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/OBJECTIVE Poor dietary quality, measured by the Healthy Eating Index 2010 (HEI-2010), is associated with risk of gestational diabetes mellitus (GDM) and type 2 diabetes. The aim was to investigate the association between dietary quality and glycemic control in women with GDM. MATERIALS AND METHODS The study included 1220 women with GDM. Dietary quality was calculated by HEI-2010 score from a Food Frequency Questionnaire administered shortly after GDM diagnosis; higher scores indicate higher dietary quality. Subsequent glycemic control was defined as ≥80% of all capillary glucose measurements meeting recommended clinical targets below 95 mg/dL for fasting, and below 140 mg/dL 1-hour glucose after meals. RESULTS As compared with Quartile 1 of HEI-2010 score, Quartiles 2, 3, and 4 showed increased adjusted odds of overall optimal glycemic control (odds ratio [95% confidence interval] 1.90 [1.34-2.70], 1.77 [1.25-2.52], and 1.55 [1.09-2.20], respectively). Increased odds of glycemic control were observed in Quartiles 2, 3, and 4 as compared with Quartile 1 of HEI-2010 score for 1-hour postbreakfast and 1-hour postdinner. Mean capillary glucose was lower in Quartiles 2, 3, and 4 of HEI-2010 score when compared with Quartile 1 for 1-hour postdinner (p = 0.03). CONCLUSIONS Clinicians should be aware that even a small improvement in diet quality may be beneficial for the achievement of improved glycemic control in women with GDM. TRIAL REGISTRATION Clinical Trials.gov number, NCT01344278.
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Affiliation(s)
- Meghana D. Gadgil
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Samantha F. Ehrlich
- Department of Public Health, University of Tennessee Knoxville, Knoxville, Tennessee
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Susan D. Brown
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Yvonne Crites
- Division of Perinatology, Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara, California
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Toledano Y, Hadar E, Hod M. Pharmacotherapy for hyperglycemia in pregnancy - The new insulins. Diabetes Res Clin Pract 2018; 145:59-66. [PMID: 29730391 DOI: 10.1016/j.diabres.2018.04.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 02/08/2023]
Abstract
Hyperglycemia in pregnancy may lead to adverse maternal, fetal and neonatal outcomes. Tight glycemic control is prudent in order to reduce pregnancy complications. For many years, the gold standard pharmacological therapy during pregnancy was human insulin. Recently, insulin analogues were also introduced to clinical use in pregnancy. This brief review aims to summarize the information on the efficacy and safety of insulin analogue therapy during gestation. The strengths and pitfalls of insulin analogue administration during gestation, compared with human insulin, are presented. According to studies in pregnant women with type 1 diabetes, insulins lispro, aspart and detemir are efficacious and safe. Correspondingly, the FDA has reclassified them for the treatment of pregnant women with diabetes from category C to category B. Although large and prospective data on insulin glargine in gestation are still lacking, no major safety concerns were documented. No controlled trials with insulins glulisine and degludec were conducted in pregnancy. In sum, insulin analogues are practical therapeutic options for hyperglycemia in pregnancy, mainly due to their hypoglycemia risk reduction. More research for their use in pregnant women with gestational diabetes or type 2 diabetes should be conducted. Overall, their efficacy and safety is possibly comparable to human insulin.
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Affiliation(s)
- Yoel Toledano
- Division of Maternal Fetal Medicine, Helen Schneider Women's Hospital, Rabin Medical Center, Israel.
| | - Eran Hadar
- Division of Maternal Fetal Medicine, Helen Schneider Women's Hospital, Rabin Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Hod
- Division of Maternal Fetal Medicine, Helen Schneider Women's Hospital, Rabin Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
Diabetes is a common chronic condition in women of reproductive age. Preconception care is crucial to reducing the risk of adverse maternal and fetal outcomes, such as hypertensive disorders, abnormal fetal growth, traumatic delivery and stillbirth, associated with poor glycemic control. Insulin is the preferred medication to optimize glucose control in women with pregestational diabetes. Frequent dose adjustments are needed during pregnancy to achieve glycemic goals, and team-based multidisciplinary care may help. Postpartum care should include lactation support, counseling on contraceptive options, and transition to primary care.
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Affiliation(s)
- Ronan Sugrue
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Chloe Zera
- Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Drinking water with consumption of a jelly filled doughnut has a time dependent effect on the postprandial blood glucose level in healthy young individuals. Clin Nutr ESPEN 2018; 27:20-23. [PMID: 30144888 DOI: 10.1016/j.clnesp.2018.07.007] [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: 07/06/2018] [Accepted: 07/20/2018] [Indexed: 11/23/2022]
Abstract
An elevated postprandial glucose (PPG) level in plasma or blood is a risk factor for chronic disorders like obesity, diabetes mellitus type II and related cardiovascular conditions. Therefore, it is important to identify mechanisms that increase the value of postprandial glucose PPG levels. Hence in the present study we investigated the time dependent effect of drinking water during a meal on the level of PPG. Thirty-five volunteers were randomly assigned to five groups. Group A was given a jelly filled doughnut and group B, C, D and E had a similar doughnut in combination with a bottle of water along with the doughnut, thirty minutes before, thirty minutes after, and a second doughnut with water thirty minutes after the first one, respectively. Glucose was measured in capillary blood at intervals of 30 min up to 150 min (reg # FMeW 725B/17). PPG versus fasting glucose (Means ± SD, mmol/L) was for group A 5.4 ± 0.6 vs 4.6 ± 0.4, B 7.2 ± 0.7 vs 4.9 ± 0.4, C 5.5 ± 0.7 vs 4.4 ± 0.3, D 5.5 ± 0.6 vs 4.6 ± 0.3 and E 5.7 ± 0.5 vs 4.7 ± 0.2. The increase in group B was significantly higher than in all other groups (ANOVA, Dunnet's posttest). These results show that drinking water with consumption of a jelly-filled doughnut increases the postprandial blood glucose levels significantly compared to no drinking at all or thirty minutes before or after the consumption. It is therefore advisable that we should reconsider our eating and drinking habits to lower the PPG and consequently reduce the risks of abovementioned chronic disorders. Further assessment is necessary to evaluate this in more detail.
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Abstract
PURPOSE OF REVIEW To review current glycaemic targets and the potential use of newer insulin formulations in pregnancy. RECENT FINDINGS The impact of stricter glycaemic control on perinatal outcomes remains controversial, showing conflicting results. Current ongoing randomised trials investigating the role of tighter glucose targets in pregnancy should help clarify the benefit of tighter glucose control. Optimal timing for self-monitoring blood glucose (SMBG) remains debatable. Data suggest that post-prandial SMBG, particularly at 1 h, offers the best prediction of adverse perinatal outcome. To achieve these targets, insulin is the standard therapy. Novel insulin formulations offer benefits outside of pregnancy. Recent data on the use of new insulins in pregnancy (e.g. insulin degludec and glargine (U 300)) is limited to case reports. Glycaemic targets have remained unchanged in the last decade. Studies using stricter glycaemic targets may improve perinatal outcomes. Newer insulin formulations may offer increased flexibility and glycaemic control. Clinicians caring for women with diabetes striving to minimise adverse perinatal outcomes will find this review of interest.
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Affiliation(s)
- Siobhán Bacon
- Mount Sinai Hospital, 60 Murray St, #5027, Toronto, Ontario, M5T 3L9, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Denice S Feig
- Mount Sinai Hospital, 60 Murray St, #5027, Toronto, Ontario, M5T 3L9, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
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Nahavandi S, Seah JM, Shub A, Houlihan C, Ekinci EI. Biomarkers for Macrosomia Prediction in Pregnancies Affected by Diabetes. Front Endocrinol (Lausanne) 2018; 9:407. [PMID: 30108547 PMCID: PMC6079223 DOI: 10.3389/fendo.2018.00407] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/29/2018] [Indexed: 12/16/2022] Open
Abstract
Large birthweight, or macrosomia, is one of the commonest complications for pregnancies affected by diabetes. As macrosomia is associated with an increased risk of a number of adverse outcomes for both the mother and offspring, accurate antenatal prediction of fetal macrosomia could be beneficial in guiding appropriate models of care and interventions that may avoid or reduce these associated risks. However, current prediction strategies which include physical examination and ultrasound assessment, are imprecise. Biomarkers are proving useful in various specialties and may offer a new avenue for improved prediction of macrosomia. Prime biomarker candidates in pregnancies with diabetes include maternal glycaemic markers (glucose, 1,5-anhydroglucitol, glycosylated hemoglobin) and hormones proposed implicated in placental nutrient transfer (adiponectin and insulin-like growth factor-1). There is some support for an association of these biomarkers with birthweight and/or macrosomia, although current evidence in this emerging field is still limited. Thus, although biomarkers hold promise, further investigation is needed to elucidate the potential clinical utility of biomarkers for macrosomia prediction for pregnancies affected by diabetes.
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Affiliation(s)
- Sofia Nahavandi
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Jas-mine Seah
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Alexis Shub
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Mercy Hospital for Women, Mercy Health, Melbourne, VIC, Australia
| | - Christine Houlihan
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
- Mercy Hospital for Women, Mercy Health, Melbourne, VIC, Australia
| | - Elif I. Ekinci
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Basri NI, Mahdy ZA, Ahmad S, Abdul Karim AK, Shan LP, Abdul Manaf MR, Ismail NAM. The World Health Organization (WHO) versus The International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria of gestational diabetes mellitus (GDM) and their associated maternal and neonatal outcomes. Horm Mol Biol Clin Investig 2018; 34:hmbci-2017-0077. [PMID: 29453924 DOI: 10.1515/hmbci-2017-0077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/08/2018] [Indexed: 11/15/2022]
Abstract
Background Gestational diabetes mellitus (GDM) is a common medical complication in pregnancy. The aim of this study was to compare the prevalence of GDM using the World Health Organization (WHO) criteria and the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria in our population. We further compared the incidence of adverse maternal and neonatal outcomes in women diagnosed with GDM using these criteria and determined whether the IADPSG criteria is suitable in our population. Methods This randomized controlled trial was conducted at our antenatal clinic involving 520 patients from 1st February 2015 until 30th September 2017. They were randomized into the WHO and the IADPSG groups. All eligible women underwent a standard oral glucose tolerance test with 75 g glucose, their fasting and 2 h post prandial glucose levels were taken. The primary outcome was the prevalence of GDM. The secondary outcomes were the incidence of primary cesarean section, gestational hypertension or preeclampsia, preterm delivery <37 weeks, fetal macrosomia, neonatal hypoglycemia and shoulder dystocia or birth injury. Results The prevalence of GDM in both groups were similar (37.9% vs. 38.6%). GDM women in the WHO group had a significantly higher incidence of gestational hypertension or preeclampsia (p = 0.004) and neonatal hypoglycemia (p = 0.042). In contrast, GDM women in the IADPSG group had a significantly higher incidence of fetal macrosomia (p = 0.027) and cesarean section (p = 0.012). Conclusion The IADPSG diagnostic criteria for GDM may not be suitable for use in our population as it resulted in women being diagnosed later and being undertreated, thus leading to adverse maternal and neonatal outcomes.
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Affiliation(s)
- Nurul Iftida Basri
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Zaleha Abdullah Mahdy
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shuhaila Ahmad
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Abdul Kadir Abdul Karim
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Lim Pei Shan
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nor Azlin Mohd Ismail
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, Phone: 0391455555, Fax: 0391456672
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Is dietary macronutrient composition during pregnancy associated with offspring birth weight? An observational study. Br J Nutr 2018; 119:330-339. [DOI: 10.1017/s0007114517003609] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractThere is lack of evidence on the differential impact of maternal macronutrient consumption: carbohydrates (CHO), fats and protein on birth weight. We investigated the association between maternal dietary macronutrient intakes and their sub-components such as saccharides and fatty acids and birth weight. This analyses included 1,196 women with singleton pregnancies who were part of the CAffeine and REproductive health study in Leeds, UK between 2003 and 2006. Women were interviewed in each trimester. Dietary information was collected twice using a 24-h dietary recall about 8–12 weeks and 13–27 weeks of gestation. Multiple linear regression models adjusted for alcohol and smoking in trimester 1, showed that each additional 10 g/d CHO consumption was associated with an increase of 4 g (95 % CI 1, 7;P=0·003) in birth weight. Conversely, an additional 10 g/d fat intake was associated with a lower birth weight of 8 g (95 % CI 0, 16;P=0·04) when we accounted for energy contributing macronutrients in each model, and maternal height, weight, parity, ethnicity, gestational age at delivery and sex of the baby. There was no evidence of an association between protein intake and birth weight. Maternal diet in trimester 2 suggested that higher intakes of glucose (10 g/d) and lactose (1 g/d) were both associated with higher birth weight of 52 g (95 % CI 4, 100;P=0·03) and 5 g (95 % CI 2, 7;P<0·001) respectively. These results show that dietary macronutrient composition during pregnancy is associated with birth weight outcomes. An appropriately balanced intake of dietary CHO and fat during pregnancy could support optimum birth weight.
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Naik D, Hesarghatta Shyamasunder A, Doddabelavangala Mruthyunjaya M, Gupta Patil R, Paul TV, Christina F, Inbakumari M, Jose R, Lionel J, Regi A, Jeyaseelan PV, Thomas N. Masked hypoglycemia in pregnancy. J Diabetes 2017; 9:778-786. [PMID: 27625296 DOI: 10.1111/1753-0407.12485] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/10/2016] [Accepted: 09/08/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Hypoglycemia is a major hindrance for optimal glycemic control in women with gestational diabetes mellitus (GDM) on insulin. In the present study, masked hypoglycemia (glucose <2.77mmol/L for ≥30 min) was estimated in pregnant women using a continuous glucose monitoring (CGM) system. METHODS Twenty pregnant women with GDM on insulin (cases) and 10 age-matched euglycemic pregnant women (controls) between 24 and 36 weeks gestation were recruited. Both groups performed self-monitoring of blood glucose (SMBG) and underwent CGM for 72 h to assess masked hypoglycemia. Masked hypoglycemic episodes were further stratified into two groups based on interstitial glucose (2.28-2.77 and ≤2.22 mmol/L). RESULTS Masked hypoglycemia was recorded in 35% (7/20) of cases and 40% (4/10) of controls using CGM, with an average of 1.28 and 1.25 episodes per subject, respectively. Time spent at glucose levels between 2.28 and 2.77 mmol/L did not differ between the two groups (mean 114 vs 90 min; P = 0.617), but cases spent a longer time with glucose ≤2.2 mmol/L. Babies born to women with GDM were significantly lighter than those born to controls (2860 vs 3290 g; P = 0.012). There was no significant difference in birth weight within the groups among babies born to women with or without hypoglycemia. CONCLUSION Euglycemic pregnant women and those with GDM on insulin had masked hypoglycemia. Masked hypoglycemia was not associated with adverse maternal or fetal outcomes. Therefore, low glucose levels in the hypoglycemic range may represent a physiologic adaptation in pregnancy. This response is exaggerated in women with GDM on insulin.
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Affiliation(s)
- Dukhabandhu Naik
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | | | | | - Rita Gupta Patil
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Flory Christina
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Mercy Inbakumari
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Ruby Jose
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Jessie Lionel
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Annie Regi
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | | | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
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50
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Feng H, Zhu WW, Yang HX, Wei YM, Wang C, Su RN, Hod M, Hadar E. Relationship between Oral Glucose Tolerance Test Characteristics and Adverse Pregnancy Outcomes among Women with Gestational Diabetes Mellitus. Chin Med J (Engl) 2017; 130:1012-1018. [PMID: 28469094 PMCID: PMC5421169 DOI: 10.4103/0366-6999.204928] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Hyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test (OGTT) results on adverse perinatal outcomes. METHODS This retrospective cohort study included data from 15 hospitals in Beijing from June 20, 2013 to November 30, 2013. Women with gestational diabetes mellitus (GDM) were categorized according to the number and distribution of abnormal OGTT values, and the characteristics of adverse pregnancy outcomes were evaluated. Chi-square test and logistic regression analysis were used to determine the associations. RESULTS In total, 14,741 pregnant women were included in the study population, 2927 (19.86%) of whom had GDM. As the number of hyperglycemic values in the OGTT increased, the risk of cesarean delivery, preterm births, large-for-gestational age (LGA), macrosomia, and neonatal complications significantly increased. Fasting hyperglycemia had clear associations with macrosomia (odds ratios [OR s]:1.84, 95% confidence intervals [CI s]: 1.39-2.42,P < 0.001), LGA (OR: 1.70, 95% CI: 1.29-2.25,P < 0.001), and cesarean delivery (OR: 1.33, 95% CI: 1.15-1.55,P < 0.001). The associations were stronger as fasting glucose increased. GDM diagnosed by hyperglycemia at OGTT-2 h was more likely to lead to preterm birth (OR: 1.50, 95% CI: 1.11-2.03,P < 0.01). CONCLUSIONS Various characteristics of OGTTs are associated with different adverse outcomes. A careful reconsideration of GDM with hierarchical and individualized management according to OGTT characteristics is needed.
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Affiliation(s)
- Hui Feng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Wei-Wei Zhu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
- Exchange and Cooperation Division, National Institute of Hospital Administration, Beijing 100191, China
| | - Hui-Xia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Yu-Mei Wei
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Chen Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Ri-Na Su
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Tel-Aviv 6997801, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Tel-Aviv 6997801, Israel
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