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Sarma S, Bhatia D, Yu C, Wu W, Lowe J, Ray J, Feig DS, Lipscombe LL. Readiness for behaviour change after gestational diabetes mellitus: A prospective cohort study. Diabet Med 2024:e15433. [PMID: 39276386 DOI: 10.1111/dme.15433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/15/2024] [Accepted: 08/21/2024] [Indexed: 09/17/2024]
Abstract
AIMS Women with gestational diabetes mellitus (GDM) have a high risk of developing type 2 diabetes (T2D). Readiness for behaviour change to mitigate this risk may be low after pregnancy and may further decrease over time without appropriate interventions. This study aimed to evaluate readiness for behaviour change in the first and second postpartum years in women with recent GDM to determine the best timing for lifestyle interventions to prevent T2D. METHODS This study included a subset of women with GDM between 2009 and 2013 in Ontario, Canada from a larger prospective cohort study who completed a survey in the first and second postpartum years (N = 329). The primary outcome was stage of readiness for behaviour change for diet and physical activity, compared between the first and second postpartum years. RESULTS The mean age was 34.3 ± 4.4 standard deviation (SD) years and mean pre-pregnancy body-mass index (BMI) was 26.7 ± 6.9 kg/m2. In the first postpartum year, 86% of women reported a pre-action stage of change, which was 87% by the second postpartum year (p = 0.646). Non-Caucasian ethnicity was associated with lower odds of being in the action stage of readiness for behaviour change overall and for physical activity in both time periods. CONCLUSIONS Most postpartum women with recent GDM are in a pre-action stage of change after delivery, which does not increase by the second postpartum year. Behavioural interventions should continue to be prioritized in postpartum women with GDM to optimize this slim window of opportunity for T2D prevention.
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Affiliation(s)
- Shohinee Sarma
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Dominika Bhatia
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Christina Yu
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Julia Lowe
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Joel Ray
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Denice S Feig
- Division of Endocrinology and Metabolism, Leadership Centre for Diabetes, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, Hivert MF, Immanuel J, Meek C, Oppermann ML, Nolan CJ, Ram U, Schmidt MI, Simmons D, Chivese T, Benhalima K. Epidemiology and management of gestational diabetes. Lancet 2024; 404:175-192. [PMID: 38909620 DOI: 10.1016/s0140-6736(24)00825-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.
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Affiliation(s)
- Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Wesley Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Friedman School of Nutrition Science and Policy, Tufts University School of Medicine, Tufts University, Boston, MA, USA
| | - Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Willliam H Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marie-France Hivert
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Pilgrim Health Care Institute, Harvard Medical School, Harvard University, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Sydney, NSW, Australia; Texas Woman's University, Denton, TX, USA
| | - Claire Meek
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Maria Lucia Oppermann
- Department of Obstetrics and Gynecology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Department of Endocrinology, Canberra Health Services, Woden, ACT, Australia
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, India
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Simmons D, Gupta Y, Hernandez TL, Levitt N, van Poppel M, Yang X, Zarowsky C, Backman H, Feghali M, Nielsen KK. Call to action for a life course approach. Lancet 2024; 404:193-214. [PMID: 38909623 DOI: 10.1016/s0140-6736(24)00826-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes remains the most common medical disorder in pregnancy, with short-term and long-term consequences for mothers and offspring. New insights into pathophysiology and management suggest that the current gestational diabetes treatment approach should expand from a focus on late gestational diabetes to a personalised, integrated life course approach from preconception to postpartum and beyond. Early pregnancy lifestyle intervention could prevent late gestational diabetes. Early gestational diabetes diagnosis and treatment has been shown to be beneficial, especially when identified before 14 weeks of gestation. Early gestational diabetes screening now requires strategies for integration into routine antenatal care, alongside efforts to reduce variation in gestational diabetes care, across settings that differ between, and within, countries. Following gestational diabetes, an oral glucose tolerance test should be performed 6-12 weeks postpartum to assess the glycaemic state. Subsequent regular screening for both dysglycaemia and cardiometabolic disease is recommended, which can be incorporated alongside other family health activities. Diabetes prevention programmes for women with previous gestational diabetes might be enhanced using shared decision making and precision medicine. At all stages in this life course approach, across both high-resource and low-resource settings, a more systematic process for identifying and overcoming barriers to preventative care and treatment is needed to reduce the current global burden of gestational diabetes.
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Affiliation(s)
- David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Teri L Hernandez
- College of Nursing, University of Colorado, Aurora, CO, USA; Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mireille van Poppel
- Department of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, University of Montréal, Montréal, QC, Canada; CReSP Public Health Research Centre, Montréal, QC, Canada
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, PA, USA
| | - Karoline Kragelund Nielsen
- Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen, Herlev, Denmark
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4
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Liang W, Sun FF. Does gestational diabetes mellitus increase the risk of cardiovascular disease? A Mendelian randomization study. J Endocrinol Invest 2024; 47:1155-1163. [PMID: 37952233 DOI: 10.1007/s40618-023-02233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/21/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE In recent years, epidemiological studies have revealed the relationship between gestational diabetes mellitus (GDM) and cardiovascular disease (CVD). In this study, we utilized Mendelian randomization (MR) to investigate the potential causal impact of GDM on cardiovascular disease for the first time. METHODS We retrieved summary statistics from published genome-wide association studies. MR was first performed using significant SNPs extracted from the eighth data release of the FinnGen study. Next, a replication analysis for coronary artery disease (CAD) was conducted in another European ancestry population to validate our findings. Finally, mediation analysis was carried out to assess potential mediation effects. RESULTS Our data analysis revealed that genetically predicted GDM was significantly associated with increased CAD risk (OR 1.10, 95% CI 1.02-1.18, p 0.006). Replication analysis confirmed a significant genetic association between GDM and CAD (OR 1.07, 95% CI 1.02-1.12, p 0.003) in another European ancestry population. Mediation analysis indicated no significant mediation effect by type 2 diabetes mellitus (T2DM) on the GDM-CAD relationship (mediation effect β [95% CI]: 0.005 [-0.003, -0.017]). CONCLUSION Women with a prior history of GDM face an elevated risk of future CAD. This increased risk of CAD cannot be solely attributed to the subsequent onset of diabetes. Regular CAD risk assessment and primary prevention strategies are of paramount importance for women with a history of GDM.
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Affiliation(s)
- W Liang
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
| | - F F Sun
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, Cancer Institute, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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5
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Marschner S, Cheung NW, Wing‐Lun E, Kazi S, Trivedi R, Chow CK. Primary care management post gestational diabetes in Australia. Intern Med J 2024; 54:164-171. [PMID: 37151178 PMCID: PMC10952553 DOI: 10.1111/imj.16106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/03/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Women with a history of gestational diabetes (GD) have a high risk of developing diabetes and subsequent cardiovascular disease (CVD). AIM To assess whether diabetes screening and CVD risk screening occurred in general practice (GP) among postpartum women with GD. METHODS This is a retrospective study of clinical record data of women with GD, under active GP management, from the MedicineInsight programme, run by Australia's National Prescribing Service MedicineWise, with GP sites located in Australia from January 2015 to March 2021. Documentation of screening for diabetes, assessment of lipids and measurement of blood pressure (BP) was assessed using proportions and mixed-effects logistic regression with a log follow-up time offset. RESULTS There were 10 413 women, with a mean age of 37.9 years (standard deviation, 7.6), from 406 clinics with a mean follow-up of 4.6 years (interquartile range, 1.8-6.2 years) A total of 29.41% (3062/10 413; 95% confidence interval [CI], 28.53-30.28) had not been assessed for diabetes, 37.40% (3894/10 413; 95% CI, 36.47-38.32) were not assessed for lipids and 2.19% (228/10 413; 95% CI, 1.91-2.47) had no BP documented. In total, 51.82% (5396/10 413; 95% CI, 50.86-52.78) were screened for all three (diabetes + lipids + BP) at least once. Obesity, comorbidities and dyslipidaemia were associated with increased likelihood of screening. New diabetes diagnosis was documented in 5.73% (597/10 413; 95% CI, 5.29-6.18) of the cohort. CONCLUSION Screening for diabetes and hyperlipidaemia was suboptimal in this high-risk cohort of women with prior GD. Improved messaging that women with a GD diagnosis are at high cardiovascular risk may improve subsequent screening.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
| | - N. Wah Cheung
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
- Department of Diabetes & EndocrinologyWestmead HospitalSydneyNew South WalesAustralia
| | - Edwina Wing‐Lun
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
- Royal Darwin Hospital, Menzies School of Health ResearchUniversity of SydneySydneyNew South WalesAustralia
| | - Samia Kazi
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
| | - Ritu Trivedi
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
| | - Clara K. Chow
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
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6
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Hofer OJ, Martis R, Alsweiler J, Crowther CA. Different intensities of glycaemic control for women with gestational diabetes mellitus. Cochrane Database Syst Rev 2023; 10:CD011624. [PMID: 37815094 PMCID: PMC10563388 DOI: 10.1002/14651858.cd011624.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has major short- and long-term implications for both the mother and her baby. GDM is defined as a carbohydrate intolerance resulting in hyperglycaemia or any degree of glucose intolerance with onset or first recognition during pregnancy from 24 weeks' gestation onwards and which resolves following the birth of the baby. Rates for GDM can be as high as 25% depending on the population and diagnostic criteria used, and overall rates are increasing globally. There is wide variation internationally in glycaemic treatment target recommendations for women with GDM that are based on consensus rather than high-quality trials. OBJECTIVES To assess the effect of different intensities of glycaemic control in pregnant women with GDM on maternal and infant health outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (26 September 2022), and reference lists of the retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs. Trials were eligible for inclusion if women were diagnosed with GDM during pregnancy and the trial compared tighter and less-tight glycaemic targets during management. We defined tighter glycaemic targets as lower numerical glycaemic concentrations, and less-tight glycaemic targets as higher numerical glycaemic concentrations. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for carrying out data collection, assessing risk of bias, and analysing results. Two review authors independently assessed trial eligibility for inclusion, evaluated risk of bias, and extracted data for the four included studies. We assessed the certainty of evidence for selected outcomes using the GRADE approach. Primary maternal outcomes included hypertensive disorders of pregnancy and subsequent development of type 2 diabetes. Primary infant outcomes included perinatal mortality, large-for-gestational-age, composite of mortality or serious morbidity, and neurosensory disability. MAIN RESULTS This was an update of a previous review completed in 2016. We included four RCTs (reporting on 1731 women) that compared a tighter glycaemic control with less-tight glycaemic control in women diagnosed with GDM. Three studies were parallel RCTs, and one study was a stepped-wedged cluster-RCT. The trials took place in Canada, New Zealand, Russia, and the USA. We judged the overall risk of bias to be unclear. Two trials were only published in abstract form. Tight glycaemic targets used in the trials ranged between ≤ 5.0 and 5.1 mmol/L for fasting plasma glucose and ≤ 6.7 and 7.4 mmol/L postprandial. Less-tight targets for glycaemic control used in the included trials ranged between < 5.3 and 5.8 mmol/L for fasting plasma glucose and < 7.8 and 8.0 mmol/L postprandial. For the maternal outcomes, compared with less-tight glycaemic control, the evidence suggests a possible increase in hypertensive disorders of pregnancy with tighter glycaemic control (risk ratio (RR) 1.16, 95% confidence interval (CI) 0.80 to 1.69, 2 trials, 1491 women; low certainty evidence); however, the 95% CI is compatible with a wide range of effects that encompass both benefit and harm. Tighter glycaemic control likely results in little to no difference in caesarean section rates (RR 0.98, 95% CI 0.82 to 1.17, 3 studies, 1662 women; moderate certainty evidence) or induction of labour rates (RR 0.96, 95% CI 0.78 to 1.18, 1 study, 1096 women; moderate certainty evidence) compared with less-tight control. No data were reported for the outcomes of subsequent development of type 2 diabetes, perineal trauma, return to pre-pregnancy weight, and postnatal depression. For the infant outcomes, it was difficult to determine if there was a difference in perinatal mortality (RR not estimable, 2 studies, 1499 infants; low certainty evidence), and there was likely no difference in being large-for-gestational-age (RR 0.96, 95% CI 0.72 to 1.29, 3 studies, 1556 infants; moderate certainty evidence). The evidence suggests a possible reduction in the composite of mortality or serious morbidity with tighter glycaemic control (RR 0.84, 95% CI 0.55 to 1.29, 3 trials, 1559 infants; low certainty evidence); however, the 95% CI is compatible with a wide range of effects that encompass both benefit and harm. There is probably little difference between groups in infant hypoglycaemia (RR 0.92, 95% CI 0.72 to 1.18, 3 studies, 1556 infants; moderate certainty evidence). Tighter glycaemic control may not reduce adiposity in infants of women with GDM compared with less-tight control (mean difference -0.62%, 95% CI -3.23 to 1.99, 1 study, 60 infants; low certainty evidence), but the wide CI suggests significant uncertainty. We found no data for the long-term outcomes of diabetes or neurosensory disability. Women assigned to tighter glycaemic control experienced an increase in the use of pharmacological therapy compared with women assigned to less-tight glycaemic control (RR 1.37, 95% CI 1.17 to 1.59, 4 trials, 1718 women). Tighter glycaemic control reducedadherence with treatment compared with less-tight glycaemic control (RR 0.41, 95% CI 0.32 to 0.51, 1 trial, 395 women). Overall the certainty of evidence assessed using GRADE ranged from low to moderate, downgraded primarily due to risk of bias and imprecision. AUTHORS' CONCLUSIONS This review is based on four trials (1731 women) with an overall unclear risk of bias. The trials provided data on most primary outcomes and suggest that tighter glycaemic control may increase the risk of hypertensive disorders of pregnancy. The risk of birth of a large-for-gestational-age infant and perinatal mortality may be similar between groups, and tighter glycaemic targets may result in a possible reduction in composite of death or severe infant morbidity. However, the CIs for these outcomes are wide, suggesting both benefit and harm. There remains limited evidence regarding the benefit of different glycaemic targets for women with GDM to minimise adverse effects on maternal and infant health. Glycaemic target recommendations from international professional organisations vary widely and are currently reliant on consensus given the lack of high-certainty evidence. Further high-quality trials are needed, and these should assess both short- and long-term health outcomes for women and their babies; include women's experiences; and assess health services costs in order to confirm the current findings. Two trials are ongoing.
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Affiliation(s)
- Olivia J Hofer
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ruth Martis
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Institute for Health Science, University of Luebeck, Luebeck, Germany
| | - Jane Alsweiler
- Neonatal Intensive Care Unit, Auckland Hospital, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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7
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Marschner S, Mukherjee S, Watts M, Min H, Beale AL, O'Brien J, Juneja A, Tremmel JA, Zaman S. Prevention of Cardiovascular Disease in Women With Pregnancy-Related Risk Factors: A Prospective Women's Heart Clinic Study. J Am Heart Assoc 2023; 12:e030015. [PMID: 37642017 PMCID: PMC10547318 DOI: 10.1161/jaha.123.030015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023]
Abstract
Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small-for-gestational-age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy-related conditions is lacking. Methods and Results A 6-month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small-for-gestational age baby in Melbourne, Australia. The co-primary end points were (1) blood pressure <140/90 mm Hg or <130/80 mm Hg if diabetes and (2) total cholesterol to high-density lipoprotein cholesterol ratio <4.5. The study recruited 156 women with a mean age of 41.0±4.2 years, 3.9±2.9 years from last delivery, 68.6% White, 20.5% South/East Asian, and 80.5% university-educated. The proportion meeting blood pressure target increased (69.2% to 80.5%, P=0.004), with no significant change in lipid targets (80.6% to 83.7%, P=0.182). Systolic blood pressure (-6.9 mm Hg [95% CI, -9.1 to -4.7], P<0.001), body mass index (-0.6 kg/m2 [95% CI, -0.8 to -0.3], P<0.001), low-density lipoprotein cholesterol (-4.2 mg/dL [95% CI, -8.2 to -0.2], P=0.042), and total cholesterol (-4.6 mg/dL [95% CI, -9.1 to -0.2] P=0.042) reduced. Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, P=0.012), decreased fast food consumption (33.8% to 11.0%, P<0.001), and increased physical activity (84.0% to 92.9%, P=0.025). Conclusions Women at high risk for cardiovascular disease due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors after attending a Women's Heart Clinic, potentially improving long-term cardiovascular disease outcomes. Registration URL: https://www.anzctr.org.au; Unique identifier: ACTRN12622000646741.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Swati Mukherjee
- Department of CardiologyCabrini HealthMelbourneAustralia
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medicine, Nursing & Health SciencesMonash UniversityMelbourneAustralia
| | - Monique Watts
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medical EducationUniversity of MelbourneMelbourneAustralia
| | - Haeri Min
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Anna L. Beale
- Department of CardiologyAlfred HospitalMelbourneAustralia
| | | | - Aashima Juneja
- Department of MedicineThe Northern HospitalMelbourneAustralia
| | - Jennifer A. Tremmel
- Department of Medicine (Cardiovascular)Stanford University School of MedicineStanfordCA
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneAustralia
- Department of CardiologyWestmead HospitalSydneyAustralia
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8
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Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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9
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Mousavi S, Safari A, Nateghian H, Ghojazadeh M, Nikniaz L. Comparing the detection rate of postpartum diabetes in early and 4-12 week postpartum screening tests in women with gestational diabetes mellitus: A systematic review and meta-analysis. Taiwan J Obstet Gynecol 2023; 62:396-401. [PMID: 37188442 DOI: 10.1016/j.tjog.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 05/17/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) is one of the critical risk factors for diabetes mellitus (DM). An early postpartum test done in the first few postpartum days can increase the screening rate in women with GDM. Therefore, this systematic review and meta-analysis aimed to combine and analyze data from different studies reporting the detection rate of postpartum diabetes in early and 4-12 week postpartum screening tests in women with GDM. ProQuest, Web of Science, EMBASE, PubMed, Cochrane, and Scopus were searched for English articles from January 1985 to January 2021. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for diagnostic test accuracy studies. Sensitivity and specificity, negative likelihood ratio (NLR), and positive likelihood ratio (PLR) were calculated for the early postpartum oral glucose tolerance test (OGTT). Of 1944 initially identified articles, four studies were included. The sensitivity and specificity of the early test were 74% and 56%, respectively, and the PLR and NLR were calculated as 1.7 and 0.4, respectively. The sensitivity of the early test was higher than the specificity. Based on this sensitivity and specificity, normal cases could be distinguished from abnormal cases, including diabetes and glucose intolerance. Early postpartum OGTT can be advised before hospital discharge. Early testing is a practical option in patients with GDM. Further studies are required to evaluate the early test detection rate for DM and glucose intolerance separately.
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Affiliation(s)
- Sanaz Mousavi
- Women's Reproductive Health Research, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aylar Safari
- Residency of Obstetrics and Gynecology, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hooman Nateghian
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Christensen JJ, Bogsrud MP, Holven KB, Retterstøl K, Veierød MB, Nordeng H. Use of statins and other lipid-modifying agents across pregnancy: A nationwide drug utilization study in Norway in 2005-2018. Atherosclerosis 2023; 368:25-34. [PMID: 36522216 DOI: 10.1016/j.atherosclerosis.2022.11.022] [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: 07/25/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Statins are becoming more widely used among women of reproductive age; however, nationwide data on statin use across pregnancy is scarce. We therefore aimed to describe the drug utilization patterns for statins and other lipid-modifying agents (LMAs) before, during, and after pregnancy, for all pregnancies in Norway from 2005 to 2018. METHODS We linked individual-level data from four nationwide electronic health care registries in Norway and characterized the prescription fills of statins and other LMAs across pregnancy. We also examined trends in pregnancy-related LMA use, and characterized women using statins and other LMAs on parameters of health status and co-morbidity. RESULTS In total, 822,071 pregnancies for 503,723 women were included. The number of statin prescription fills decreased rapidly during the first trimester and returned to pre-pregnancy levels about one year postpartum. Pregnancy-related statin use increased from 2005 (approx. 0.11% of all pregnancies) to 2018 (approx. 0.29% of all pregnancies); however, in total, few statin prescriptions were filled within any trimester of pregnancy (n = 331, 0.04% of all pregnancies). Statin use was more common in women with higher age, higher weight, smoking, and comorbidities such as hypertension and diabetes mellitus; also, statin users often had co-medication pertinent to these conditions. CONCLUSIONS Although statins and other LMAs were increasingly being used around the time of pregnancy among women in Norway, drug use was mostly discontinued during the first trimester. Our results suggest that pregnancy-related statin use should be monitored, and that drug safety analyses for maternal and offspring health outcomes are needed.
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Affiliation(s)
| | - Martin P Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, University of Oslo, Oslo, Norway; The Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group and PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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11
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Integrating Gestational Diabetes Screening and Care and Type 2 Diabetes Mellitus Prevention After GDM Into Community Based Primary Health Care in South Africa-Mixed Method Study. Int J Integr Care 2022; 22:20. [PMID: 36213215 PMCID: PMC9503953 DOI: 10.5334/ijic.5600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Despite high gestational diabetes mellitus (GDM) prevalence in South Africa (9.1% in 2018), its screening and management are not well integrated into routine primary health care and poorly linked to post-GDM prevention of type 2 diabetes mellitus (T2DM) in South Africa’s fragmented health system. This study explored women’s, health care providers’ and experts’ experiences and perspectives on current and potential integration of GDM screening and prevention of T2DM post-GDM within routine, community-based primary health care (PHC) services in South Africa. Methods: This study drew on the Behaviour Change Wheel (BCW) framework and used a mixed method, sequential exploratory design for data collection, analysis and interpretation. Individual semi-structured interviews were conducted with key informants (n = 5) from both national and provincial levels and health care providers (n = 18) in the public health system of the Western Cape Province. Additionally, focus group discussions (FGDs) with Community Health Workers (CHWs n = 15) working with clinics in the Western Cape province. A further four FGDs and brief individual exit interviews were conducted with women with GDM (n = 35) followed-up at a tertiary hospital: Groote Schuur Hospital (GSH). Data collection with women diagnosed and treated for GDM happened between March and August 2018. Thematic analysis was the primary analytical method with some content analysis as appropriate. Statistical analysis of quantitative data from the 35 exit interview questionnaires was conducted, and correlation with qualitative variables assessed using Cramér’s V coefficient. Results: Shortage of trained staff, ill-equipped clinics, socio-economic barriers and lack of knowledge were the major reported barriers to successful integration of GDM screening and postnatal T2DM prevention. Only 43% of women reported receiving advice about all four recommendations to improve GDM and decrease T2DM risk (improve diet, reduce sugar intake, physical exercise and regularly take medication). All participants supported integrating services within routine, community-based PHC to universally screen for GDM and to prevent or delay development of T2DM after GDM. Conclusion: GDM screening and post-GDM prevention of T2DM are poorly integrated into PHC services in South Africa. Integration is desired by stakeholders (patients and providers) and may be feasible if PHC resource, training constraints and women’s socio-economic barriers are addressed.
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12
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Zhou Y, Lan Q, Li Y, Qi L, Dong Y, Zhou H, Zhang J. Clinical Value of Echo-Tracking in Gestational Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2022; 130:783-788. [PMID: 36126933 DOI: 10.1055/a-1926-7064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vascular endothelial function plays an essential role in gestational diabetes mellitus (GDM) pathogenesis. Vascular elasticity is evaluated by the echo-tracking (ET) technique. In this study, we aimed to assess the clinical value of the ET technique in women with GDM and provide a basis for early evaluation and prevention of gestational diabetes. METHODS Sixty-five patients with GDM and 65 gestational week-matched normal glucose tolerance pregnant women were enrolled in this study. The endothelial function parameters of pressure-strain elasticity coefficient (EP), the common carotid stiffness index (β), arterial compliance (AC), single-point pulsed-wave velocity (PWVβ), and augment index (AI) of bilateral common carotid arteries, were compared between the GDM and control groups by using ET technique. The correlations between plasma glucose levels and ET parameters were also analyzed. RESULTS Our results indicated that EP, β, PWVβ, and AI were significantly higher in the GDM group (p<0.05), whereas AC was significantly lower in patients with GDM than in the control group (p<0.001). In addition, fasting plasma glucose and plasma glucose level after 2 h oral glucose tolerance test was correlated with ET parameters of EP, β, PWVβ, AI, and AC. CONCLUSIONS The application of ET technology to gestational diabetes women could provide a basis for early evaluation and prevention of gestational diabetes. It would detect early and accurate signs of diabetes in pregnant women and provide a timely and reasonable clinical treatment plan to reduce and delay the occurrence of complications.
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Affiliation(s)
- Youxia Zhou
- Department of General Internal Medicine, Shijiazhuang Fourth Hospital, Shijiazhuang, Hebei, China
| | - Qianyu Lan
- Department of General Internal Medicine, Shijiazhuang Fourth Hospital, Shijiazhuang, Hebei, China
| | - Yuan Li
- Department of General Internal Medicine, Shijiazhuang Fourth Hospital, Shijiazhuang, Hebei, China
| | - Lin Qi
- Department of General Internal Medicine, Shijiazhuang Fourth Hospital, Shijiazhuang, Hebei, China
| | - Yiming Dong
- Department of General Internal Medicine, Shijiazhuang Fourth Hospital, Shijiazhuang, Hebei, China
| | - Haixia Zhou
- Department of Diagnostic Ultrasound, Shijiazhuang Fourth Hospital, Shijiazhuang, Hebei, China
| | - Jiefang Zhang
- Department of General Internal Medicine, Shijiazhuang Fourth Hospital, Shijiazhuang, Hebei, China
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Chai TY, Deng D, Byth K, George J, Pasupathy D, Cheung NW. The prevalence of metabolic dysfunction-associated fatty liver disease and its association on adverse pregnancy outcomes in women with gestational diabetes mellitus. Diabetes Res Clin Pract 2022; 191:110038. [PMID: 35970401 DOI: 10.1016/j.diabres.2022.110038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/21/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
AIMS To determine the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its association on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). METHODS 380 women with GDM had a FibroScan® performed between 24 and 32 weeks. A Controlled Attenuation Parameter (CAP) ≥ 233.5 dB/m signified MAFLD. Gestational hypertension, pre-eclampsia and eclampsia contributed to a composite of adverse maternal outcomes. A composite of adverse neonatal outcomes included pre-term birth, hypoglycaemia, small/large-for-gestational age and admission to neonatal high dependency. Multiple logistic regression was used to determine independent associations with MAFLD. RESULTS 147 (38.7 %) women had MAFLD. Higher pre-pregnancy BMI (median 28.4, IQR 24.7-33.0 kg/m2 vs median 24.0, IQR 21.7-26.5 kg/m2, p < 0.01) and rates of insulin therapy (62.2 % vs 40.7 %, p < 0.01) occurred in MAFLD over non-MAFLD women. MAFLD was independently associated with obesity (aOR 4.73 [95 % CI 2.53-8.86]) and insulin therapy (aOR 1.79 [95 % CI 1.12-2.85]). MAFLD and non-MAFLD women had comparable rates of adverse maternal (7.7 % vs 9.5 %, p = 0.56) and neonatal outcomes (75.4 % vs 68.8 %, p = 0.18). CONCLUSIONS Within this GDM cohort, almost 40% had FibroScan®-detected MAFLD in mid-to-late gestation. MAFLD was not associated with worse pregnancy outcomes.
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Affiliation(s)
- Thora Y Chai
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Difei Deng
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Karen Byth
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Western Sydney Local Health District Research Education Network, Westmead, NSW, Australia.
| | - Jacob George
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Storr Liver Centre, Westmead Millennium Institute for Medical Research, Westmead, NSW, Australia; Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, NSW, Australia.
| | - Dharmintra Pasupathy
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Ngai Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Cheung NW, Thiagalingam A, Smith BJ, Redfern J, Barry T, Mercorelli L, Chow CK. Text messages promoting healthy lifestyle and linked with activity monitors stimulate an immediate increase in physical activity among women after gestational diabetes. Diabetes Res Clin Pract 2022; 190:109991. [PMID: 35835256 DOI: 10.1016/j.diabres.2022.109991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/13/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the immediate effect of text messages promoting healthy lifestyle and supporting parenting on physical activity amongst women with recent gestational diabetes (GDM). METHODS Analysis of data from a pilot randomised controlled trial of a healthy lifestyle program for women with recent GDM. Intervention subjects received text messages providing motivation, reminders, information and feedback as well as an activity monitor. This sub-study examined step count in the 4 h after receipt of a text message, compared to the same time of day on other days among intervention subjects. RESULTS Data from 7326 days where step counts were recorded, from 31 women were analysed. The median steps in the 4 h following a text message was 1237 (IQR 18-2240) and it was 1063 (IQR 0-2038) over the same time period on comparison days where there was no message (p < 0.001). The effect was similar whether the messages pertained to physical activity or not. There was no attenuation of the response over 36-38 weeks. CONCLUSIONS Women with recent GDM increase their step count in the hours following positive and supportive text messages. This suggests that text messaging programs can facilitate healthy lifestyle and diabetes prevention in this population.
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Affiliation(s)
- N Wah Cheung
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Ben J Smith
- School of Public Health, University of Sydney, NSW 2006, Australia.
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Tony Barry
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Louis Mercorelli
- Sydney Informatics Hub, University of Sydney, Darlington, NSW 2008, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
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15
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Reutrakul S, Martyn-Nemeth P, Quinn L, Rydzon B, Priyadarshini M, Danielson KK, Baron KG, Duffecy J. Effects of Sleep-Extend on glucose metabolism in women with a history of gestational diabetes: a pilot randomized trial. Pilot Feasibility Stud 2022; 8:119. [PMID: 35659776 PMCID: PMC9166192 DOI: 10.1186/s40814-022-01076-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Women with a history of gestational diabetes (GDM) are at 7-fold increase in the risk of developing diabetes. Insufficient sleep has also been shown to increase diabetes risk. This study aimed to explore the feasibility of a sleep extension in women with a history of GDM and short sleep, and effects on glucose metabolism. Methods Women age 18–45 years with a history of GDM and actigraphy confirmed short sleep duration (<7 h/night) on weekdays were randomized at a ratio of 1 control (heathy living information) to 2 cases (6 weeks of “Sleep-Extend” intervention: use of a Fitbit, weekly digital content, and weekly coaching to increase sleep duration). An oral glucose tolerance test (OGTT), 7-day actigraphy recording, and questionnaires were obtained at baseline and 6 weeks. Mean differences between baseline and end-of-intervention parameters were compared using independent samples t-tests. Results Mean (SD) sleep duration increased within the Sleep-Extend group (n=9, +26.9 (42.5) min) but decreased within the controls (n=5, − 9.1 (20.4) min), a mean difference (MD) of 35.9 min (95% confidence interval (CI) − 8.6, 80.5). Fasting glucose increased, but less in Sleep-Extend vs. control groups (1.6 (9.4) vs 10.4 (8.2) mg/dL, MD − 8.8 mg/dL (95% CI − 19.8, 2.1), while 2-h glucose levels after an OGTT did not differ. Compared to controls, Sleep-Extend had decreased fatigue score (MD − 10.6, 95%CI − 20.7, − 0.6), and increased self-report physical activity (MD 5036 MET- minutes/week, 95%CI 343, 9729. Fitbit compliance and satisfaction in Sleep-Extend group was high. Conclusion Sleep extension is feasible in women with a history of GDM, with benefits in fatigue and physical activity, and possibly glucose metabolism. These data support a larger study exploring benefits of sleep extension on glucose metabolism in these high-risk women. Trial registration ClinicalTrials.gov, NCT03638102 (8/20/2018)
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625, Chicago, IL, 60612, USA.
| | - Pamela Martyn-Nemeth
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Lauretta Quinn
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Brett Rydzon
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625, Chicago, IL, 60612, USA
| | - Medha Priyadarshini
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625, Chicago, IL, 60612, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott, Suite E625, Chicago, IL, 60612, USA
| | - Kelly G Baron
- Division of Public Health, Department of Family and Preventive Medicine, The University of Utah, 375 Chipeta Way, Salt Lake City, USA.,Departments of Psychology and Psychiatry, The University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood Street, Chicago, IL, 60612, USA
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Pretorius M, Huang C. Beta-Cell Adaptation to Pregnancy - Role of Calcium Dynamics. Front Endocrinol (Lausanne) 2022; 13:853876. [PMID: 35399944 PMCID: PMC8990731 DOI: 10.3389/fendo.2022.853876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
During pregnancy, the mother develops insulin resistance to shunt nutrients to the growing fetus. As a result, the maternal islets of Langerhans undergo several changes to increase insulin secretion in order to maintain glucose homeostasis and prevent the development of gestational diabetes. These changes include an increase in β-cell proliferation and β-cell mass, upregulation of insulin synthesis and insulin content, enhanced cell-to-cell communication, and a lowering of the glucose threshold for insulin secretion, all of which resulting in an increase in glucose-stimulated insulin secretion. Emerging data suggests that a change in intracellular calcium dynamics occurs in the β-cell during pregnancy as part of the adaptive process. Influx of calcium into β-cells is crucial in the regulation of glucose-stimulated insulin secretion. Calcium fluxes into and out of the cytosol, endoplasmic reticulum, and mitochondria are also important in controlling β-cell function and survival. Here, we review calcium dynamics in islets in response to pregnancy-induced changes in hormones and signaling molecules, and how these changes may enhance insulin secretion to stave off gestational diabetes.
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17
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Lee KW, Tan SF, Omar A, Nasir NH, Ching SM, Mohd Noor MK, Masdor NA, Lee YS, Noordin S, Mohamed H. Effectiveness of system-based intervention in reducing incidence of type 2 diabetes and to improve the postnatal metabolic profiles in women with gestational diabetes mellitus: a randomized controlled study. Gynecol Endocrinol 2022; 38:55-62. [PMID: 34636710 DOI: 10.1080/09513590.2021.1988561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIM The objective of this study was to determine the effectiveness of system-based intervention in reducing the incidence of diabetes and to improve the postnatal metabolic profiles among women with gestational diabetes mellitus (GDM). MATERIALS AND METHODS For women in the intervention arm (n = 130), they received one session of individualized health education at 36 gestational weeks, a booklet of diabetes prevention, five-session of postpartum booster educational program which were conducted including 1 session of dietary and exercise counseling by dietician and physiotherapist at 6 weeks postpartum. For women in the control group (n = 168), standard treatment whereby they had received group therapy on diet and physical activity modification by dietician and staff nurses during the antenatal period. RESULTS There were no significant differences in baseline characteristics between groups for most of the variables examined except for educational level which the control group had a higher education than the intervention group. The women assigned to system-based intervention have a significant difference to GDM women who were assigned to the control group for LDL and HDL but not in anthropometric measurements, blood pressure, glucose index, total cholesterol, and triglyceride. In addition, it was found that the incidence of Type 2 diabetes mellitus (T2DM) 2 years after delivery was 20% in the intervention arm compared to 17% in the control arm. CONCLUSION The system-based intervention was not statistically superior to the control intervention as there is no difference in terms of incidence of T2DM between the intervention and control group. We, therefore, suggested that more intensive interventions are needed to prevent GDM from developing into T2DM.
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Affiliation(s)
- Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Siow Foon Tan
- Klinik Kesihatan Pelabuhan Klang, Ministry of Health Malaysia, Klang, Malaysia
| | - Azahadi Omar
- National Institute of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | | | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Noor Azreen Masdor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Yeow Siong Lee
- Klinik Kesihatan Selayang Baru, Ministry of Health Malaysia, Batu Caves, Malaysia
| | - Salmah Noordin
- Klinik Kesihatan Cheras Batu 9, Ministry of Health Malaysia, Cheras, Malaysia
| | - Hazlin Mohamed
- Klinik Kesihatan Teluk Panglima Garang, Ministry of Health Malaysia, Teluk Panglima Garang, Malaysia
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Pathirana MM, Lassi Z, Ali A, Arstall M, Roberts CT, Andraweera PH. Cardiovascular risk factors in women with previous gestational diabetes mellitus: A systematic review and meta-analysis. Rev Endocr Metab Disord 2021; 22:729-761. [PMID: 33106997 DOI: 10.1007/s11154-020-09587-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
This systematic review and meta-analysis aimed to synthesize evidence on conventional cardiovascular disease (CVD) risk factors among women with previous Gestational Diabetes Mellitus (GDM). The review protocol is registered with PROSPERO (CRD42019118149). PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Studies reporting on CVD risk factors in women with previous GDM compared to women without previous GDM were selected. A total of 139 studies were eligible, of which 93 were included in the meta-analysis. Women with previous GDM have significantly higher systolic blood pressure (2.47 mmHg 95% CI 1.74 to 3.40, n = 48, 50,118 participants) diastolic blood pressure (1.89 mmHg 95% CI 1.32 to 2.46, n = 48, 49,495 participants), BMI (1.54 kg/m2 95% CI 1.32 to 2.46, n = 78, 255,308 participants), total cholesterol (0.26 SMD 95% CI 0.15 to 0.37, n = 48, 38,561 participants), LDL cholesterol (0.19 SMD 95% CI 0.08 to 0.30, n = 44, 16,980 participants), triglycerides (0.56 SMD 95% CI 0.42 to 0.70, n = 46, 13,175 participants), glucose (0.69 SMD 95% CI 0.56 to 0.81, n = 55, 127,900 participants), insulin (0.41 SMD 95% CI 0.23 to 0.59, n = 32, 8881 participants) and significantly lower HDL cholesterol (-0.28 SMD 95% CI -0.39 to -0.16, n = 56, 35,882 participants), compared to women without previous GDM. The increased blood pressure, total cholesterol, triglycerides and glucose are seen as early as <1 year post-partum.Women with previous GDM have a higher risk of CVD based on significant increases in conventional risk factors. Some risk factors are seen as early as <1 year post-partum. Women with GDM may benefit from early screening to identify modifiable CVD risk factors.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Zohra Lassi
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Adelaide G-TRAC Centre & CRE Frailty & Healthy Ageing Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Margaret Arstall
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Prabha H Andraweera
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
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Sun J, Kim GR, Lee SJ, Kim HC. Gestational diabetes mellitus and the role of intercurrent type 2 diabetes on long-term risk of cardiovascular events. Sci Rep 2021; 11:21140. [PMID: 34707209 PMCID: PMC8551203 DOI: 10.1038/s41598-021-99993-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/01/2021] [Indexed: 01/01/2023] Open
Abstract
Recent studies have shown that gestational diabetes mellitus (GDM) is associated with an increased risk for cardiovascular disease. GDM has also been shown to be a risk factor for type 2 diabetes (T2DM) after pregnancy. However, there is limited evidence regarding the role of intercurrent T2DM on the relationship between GDM and future CVD. Thus, we investigated the risks of incident cardiovascular events among women with GDM during pregnancy compared to women without GDM and whether the increased CVD risk is dependent on intercurrent development of T2DM. We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service claims database. Outcomes were the first occurrence of any CVD (myocardial infarction, treatment with coronary revascularization, heart failure, and cerebrovascular disease). Cox proportional hazard models were used to assess the association between GDM and incident CVD events, using landmark analysis at 4 years. A total of 1,500,168 parous women were included in the analysis, of which 159,066 (10.60%) had GDM. At a median follow-up of 12.8 years, 13,222 incident cases of total CVD were observed. Multivariable-adjusted hazard ratio for total CVD among women with prior GDM, compared with those without GDM, was 1.08 (95% CI 1.02-1.14). Further classifying GDM by progression to T2DM in relation to total CVD risk indicated a positive association for GDM with progression to T2DM vs no GDM or T2DM (HR 1.74; 95% CI 1.40-2.15), and no statistically significant association for GDM only (HR 1.06; 95% CI 1.00-1.12). GDM with subsequent progression to T2DM were linked with an increased risk of cardiovascular diseases. These findings highlight the need for more vigilant postpartum screening for diabetes and the implementation of diabetes interventions in women with a history of GDM to reduce future CVD risk.
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Affiliation(s)
- Jiyu Sun
- Medical Research Collaborating Center, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Gyu Ri Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Su Jin Lee
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Korea.
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Marschner S, Chow C, Thiagalingam A, Simmons D, McClean M, Pasupathy D, Smith BJ, Flood V, Padmanabhan S, Melov S, Ching C, Cheung NW. Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2). BMJ Open 2021; 11:e054756. [PMID: 34535488 PMCID: PMC8451310 DOI: 10.1136/bmjopen-2021-054756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes (GDM) contributes substantially to the population burden of type 2 diabetes (T2DM), with a high long-term risk of developing T2DM. This study will assess whether a structured lifestyle modification programme for women immediately after a GDM pregnancy, delivered via customised text messages and further individualised using data from activity monitors, improves T2DM risk factors, namely weight, physical activity (PA) and diet. METHODS AND ANALYSIS This multicentre randomised controlled trial will recruit 180 women with GDM attending Westmead, Campbelltown or Blacktown hospital services in Western Sydney. They will be randomised (1:1) on delivery to usual care with activity monitor (active control) or usual care plus activity monitor and customised education, motivation and support delivered via text messaging (intervention). The intervention will be customised based on breastfeeding status, and messages including their step count achievements to encourage PA. Messages on PA and healthy eating will encourage good lifestyle habits. The primary outcome of the study is healthy lifestyle composed of weight, dietary and PA outcomes, to be evaluated at 6 months. The secondary objectives include the primary objective components, body mass index, breastfeeding duration and frequency, postnatal depression, utilisation of the activity monitor, adherence to obtaining an oral glucose tolerance test post partum and the incidence of dysglycaemia at 12 months. Relative risks and their 95% CIs will be presented for the primary objective and the appropriate regression analysis, adjusting for the baseline outcome results, will be done for each outcome. ETHICS AND DISSEMINATION Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee (2019/ETH13240). All patients will provide written informed consent. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12620000615987; Pre-results.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Penrith South, New South Wales, Australia
- Macarthur Diabetes School, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Mark McClean
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Dharmintra Pasupathy
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben J Smith
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Flood
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Suja Padmanabhan
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Melov
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Cellina Ching
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| | - N Wah Cheung
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
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21
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Chai TYL, Rajaratnam RM, Deng D, George J, Pasupathy D, Cheung NW. The prevalence of gestational diabetes mellitus in women diagnosed with non-alcoholic fatty liver disease during pregnancy: A systematic review and meta-analysis. J Diabetes Complications 2021; 35:107991. [PMID: 34219018 DOI: 10.1016/j.jdiacomp.2021.107991] [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: 04/28/2021] [Revised: 06/16/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
AIMS To further explore the relationship between non-alcoholic fatty liver disease (NAFLD) and gestational diabetes mellitus (GDM) by determining the prevalence of GDM in women diagnosed with NAFLD antepartum. METHODS Electronic databases were searched using specific keywords. Original studies of adult women reporting NAFLD (confirmed on imaging) and GDM (confirmed via oral glucose tolerance test) prevalence were included. Studies involving women with pre-gestational pre-diabetes, type 1/type 2 diabetes, chronic liver disease/cirrhosis unrelated to NAFLD were excluded. The prevalence of GDM occurring in women with NAFLD was calculated along with pooled odds ratios and 95% confidence intervals (CI) using the random effects model. RESULTS Seven studies (total 2299 participants) were included. The prevalence of GDM in women with NAFLD was 26.0% (95% CI 20.9-31.7%, I2 = 48%, τ2 = 0.06). The odds of having GDM were 2.9 times higher in pregnant women diagnosed with NAFLD compared with non-NAFLD women, although a high degree of heterogeneity existed (unadjusted OR 2.9, 95% CI 1.0-8.4, I2 = 81%, τ2 = 0.83, p < 0.05). CONCLUSION Our study provides further insight into the prevalence of GDM in pregnant women diagnosed with NAFLD. There is a current lack of well-conducted studies examining this complex association between NAFLD and GDM.
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Affiliation(s)
- Thora Ying Li Chai
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | | | - Difei Deng
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Diabetes and Endocrinology, Nepean Hospital, Kingswood, Australia
| | - Jacob George
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Storr Liver Centre, Westmead Millennium Institute for Medical Research, Westmead, Australia; Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
| | - Dharmintra Pasupathy
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Specialty of Obstetrics, Gynaecology and Neonatology, Westmead Hospital, Westmead, Australia
| | - Ngai Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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22
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Glucose tolerance test with a single abnormal value in pregnancy and the risk of type-2 diabetes mellitus. Arch Gynecol Obstet 2021; 305:869-875. [DOI: 10.1007/s00404-021-06207-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
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Kousta E, Kontogeorgi A, Robinson S, Johnston DG. Long-Term Metabolic Consequences in Patients with a History of Gestational Diabetes. Curr Pharm Des 2021; 26:5564-5572. [PMID: 33155900 DOI: 10.2174/1381612826666201106092423] [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: 02/19/2020] [Accepted: 08/15/2020] [Indexed: 11/22/2022]
Abstract
Gestational diabetes mellitus is a common metabolic complication of pregnancy. Universal guidelines on gestational diabetes have been impeded by the long-term controversies on its definition and screening strategies. The prevalence of gestational diabetes is rising all over the world, is significantly influenced by ethnicity and its rise is mainly attributed to increasing maternal obesity and age. Gestational diabetes mellitus has important long-term implications, including gestational diabetes recurrence, increased risk for developing type 2 diabetes, metabolic syndrome and cardiovascular disease for the mother. Gestational diabetes mellitus may be viewed as a chronic metabolic disorder that is identified in women during gestation and may provide a unique opportunity for the early identification and primary prevention of type 2 diabetes mellitus and cardiovascular disease in these women. In this mini-review, the evolution of screening tests for gestational diabetes and guidelines are briefly described and metabolic and cardiovascular long-term consequences of women with a history of gestational diabetes are summarized. A summary of our own St. Mary's Hospital-UK Research series on long-term metabolic consequences of 368 women with a history of gestational diabetes of 3 different ethnic groups and 482 control women is also included. We found that approximately 2 years following delivery, 37% of women with a history of gestational diabetes had abnormal glucose concentrations, but, most importantly, even those who were normoglycaemic, postpartum displayed metabolic abnormalities on detailed testing. Future research needs to focus on the prevention of gestational diabetes long-term complications, but also in identification of pre-pregnancy predictors and risk reduction before conception.
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Affiliation(s)
- Eleni Kousta
- Research in Female Reproduction Postgraduate Course, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Adamantia Kontogeorgi
- Research in Female Reproduction Postgraduate Course, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Stephen Robinson
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom
| | - Desmond G Johnston
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom
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24
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Deng D, George J, Pasupathy D, Wah Cheung N. The prevalence of metabolic associated fatty liver detected by FibroScan® in women with gestational diabetes in a multiethnic population. Diabetes Res Clin Pract 2021; 174:108757. [PMID: 33744378 DOI: 10.1016/j.diabres.2021.108757] [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: 05/12/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 02/08/2023]
Abstract
AIMS Metabolic associated fatty liver disease (MAFLD) is a leading cause of chronic liver disease and has been increasingly associated with gestational diabetes (GDM). This study aimed to assess the prevalence of MAFLD in women with GDM in the antenatal period. METHODS 108 pregnant women with GDM diagnosed on a 75-gram oral glucose tolerance test were enrolled from a multiethnic cohort attending a large obstetrics clinic in Sydney, Australia and had a single FibroScan® assessment after 24 weeks gestation to assess for hepatic steatosis and fibrosis. A control attenuated parameter (CAP) cut-off score of ≥ 233.5 dB/m was chosen to signify presence of hepatic steatosis which indicates MAFLD. Obstetric, anthropometric and metabolic measures were analysed. RESULTS 29 (26.9%) women had evidence of FibroScan®-detected MAFLD, whilst none had evidence of hepatic fibrosis. Increased maternal BMI (aOR 1.12, 95% CI: 1.04-1.20) was associated with the finding of MAFLD in this cohort. CONCLUSIONS We found a significant antenatal prevalence of FibroScan®-detected MAFLD in this cohort of multiethnic women with GDM. FibroScan® is a safe and rapid assessment tool which may have a role in screening for MAFLD in pregnancy in appropriate at-risk women.
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Affiliation(s)
- Difei Deng
- University of Sydney, Sydney, NSW, Australia; Dept of Diabetes & Endocrinology, Westmead Hospital, Sydney, NSW, Australia.
| | - Jacob George
- University of Sydney, Sydney, NSW, Australia; Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia.
| | - Dharmintra Pasupathy
- University of Sydney, Sydney, NSW, Australia; Institute of Reproduction, Westmead Clinical School, University of Sydney, NSW, Australia.
| | - N Wah Cheung
- University of Sydney, Sydney, NSW, Australia; Dept of Diabetes & Endocrinology, Westmead Hospital, Sydney, NSW, Australia.
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25
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Seyhanli Z, Seyhanli A, Aksun S, Pamuk BO. Evaluation of serum Angiopoietin-like protein 2 (ANGPTL-2), Angiopoietin-like protein 8 (ANGPTL-8), and high-sensitivity C-reactive protein (hs-CRP) levels in patients with gestational diabetes mellitus and normoglycemic pregnant women. J Matern Fetal Neonatal Med 2021; 35:5647-5652. [PMID: 33615956 DOI: 10.1080/14767058.2021.1888919] [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] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In the present study, we aimed to investigate the role of the fasting serum levels of Anjiopoetın 2 - like protein (ANGPTL2), Anjiopoetın 8-like protein (ANGPTL8), and high-sensitivity C-reactive protein (hs-CRP) in the etiopathogenesis of gestational diabetes mellitus (GDM), and analyze the relationships between insulin resistance parameters. MATERIAL AND METHOD The 90 individuals admitted to İzmir Katip Celebi University Hospital Internal Medicine, Endocrinology and Obstetrics, and gynecology outpatient clinic were included in the study of similar ages and similar demographic characteristics. Forty-five women with diet-controlled GDM and 45 women with normoglycemic pregnancy were enrolled. ANGPTL-2, ANGPTL-8, hs-CRP, creatinine, ALT, GGT, lipid profile, HBA1c(%), and serum insülin, c-peptide levels were studied in the fasting serum samples of research groups. All individuals had 75-g OGTT testing. GDM screening was performed at 24-28 weeks' gestation. Exclusion criteria were as follows: Age <18 years or >40 years, pregestational diabetes (type 1 or 2), drug or alcohol abuse, thyroid dysfunction, Hepatitis B, and other infectious diseases (Herpes virus, Streptococcus B carriers, Chlamydia and Candida), Thalassemia carriers or other significant medical conditions, the use of any medication that interferes with lipid or glucose metabolism that would affect glucose regulation. RESULT Forty-five women with GDM and for the control group, 45 women with normoglycemic pregnant women were identified. The mean gestational age was 30.7 (18-38) for GDM and 29.6 (24-39) for the control group. Serum ANGPTL-8 (GDM =19.5 ± 93 Control = 0.73 ± 3.78 p = <.001). There was a statistically significant difference between the case and control groups for serum ANGPTL-8 levels. Serum ANGPTL-2 (GDM =19.9 ± 23.1 Control = 26.0 ± 23.4 p = .105) and serum hs-CRP(GDM =106 ± 65.1 Control =98.2 ± 87.3 p = .768). There was no statistically significant difference between the case and control groups for serum ANGPTL-2 and hsCRP levels. Serum ANGPTL8 levels were positively correlated with FPG (r = 0.391, p = <.001), FPI (r = 0.212, p = .045), 1-h PPG (r = 0.514, p = <.001), 2-h PPG (r = 0.502, p = <.001), HOMA-IR) score (r = 0.310, p = .003), TG (r = 0.245, p = .020); they were not except for BMI, hs-CRP levels and ANGPTL2 levels. CONCLUSIONS ANGPTL8 levels were significantly higher in GDM than in healthy control group. ANGPTL2 levels and hs-CRP levels were similar to the healthy control group. Elevated serum ANGPTL8 levels were correlated significantly with insulin resistance parameters, the main component of GDM pathophysiology. Our data showed that ANGPTL8 could be a new biomarker for diagnosing GDM.
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Affiliation(s)
- Zeynep Seyhanli
- Obstetrics and Gynaecology, Izmir Gaziemir Nevvar Salih Isgoren State Hospital, Izmir, Turkey
| | - Ahmet Seyhanli
- Department of Internal Medicine (Hematology), Sivas Numune Hastanesi, Sivas, Turkey
| | - Saliha Aksun
- Biochemistry Department, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Baris Onder Pamuk
- Endocrine and Metabolic Diseases Department Izmir, Izmir Katip Celebi University, Atatürk Training and Research Hospital, Izmir, Turkey
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Li X, Zheng J, Ma X, Zhang B, Zhang J, Wang W, Sun C, Wang Y, Zheng J, Chen H, Tao J, Wang H, Zhang F, Wang J, Zhang H. The oral microbiome of pregnant women facilitates gestational diabetes discrimination. J Genet Genomics 2021; 48:32-39. [PMID: 33663937 DOI: 10.1016/j.jgg.2020.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022]
Abstract
The oral microbiota plays an important role in the development of various diseases, whereas its association with gestational diabetes mellitus (GDM) remains largely unclear. The aim of this study is to identify biomarkers from the oral microbiota of GDM patients by analyzing the microbiome of the saliva and dental plaque samples of 111 pregnant women. We find that the microbiota of both types of oral samples in GDM patients exhibits differences and significantly varies from that of patients with periodontitis or dental caries. Using bacterial biomarkers from the oral microbiota, GDM classification models based on support vector machine and random forest algorithms are constructed. The area under curve (AUC) value of the classification model constructed by combination of Lautropia and Neisseria in dental plaque and Streptococcus in saliva reaches 0.83, and the value achieves a maximum value of 0.89 by adding clinical features. These findings suggest that certain bacteria in either saliva or dental plaque can effectively distinguish women with GDM from healthy pregnant women, which provides evidence of oral microbiome as an informative source for developing noninvasive biomarkers of GDM.
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Affiliation(s)
- Xiaoqing Li
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Jiayong Zheng
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Xiuling Ma
- Computational Genomics Lab, Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Bing Zhang
- Computational Genomics Lab, Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jinyang Zhang
- Computational Genomics Lab, Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wenhuan Wang
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Congcong Sun
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Yeping Wang
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Jianqiong Zheng
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Haiying Chen
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Jiejing Tao
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Hai Wang
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China
| | - Fengyi Zhang
- Computational Genomics Lab, Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jinfeng Wang
- Computational Genomics Lab, Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Hongping Zhang
- Wenzhou People's Hospital/Wenzhou Maternal and Child Health Care Hospital/The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325000, China.
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The Predictive Value of miR-16, -29a and -134 for Early Identification of Gestational Diabetes: A Nested Analysis of the DALI Cohort. Cells 2021; 10:cells10010170. [PMID: 33467738 PMCID: PMC7830355 DOI: 10.3390/cells10010170] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 12/13/2022] Open
Abstract
Early identification of gestational diabetes mellitus (GDM) aims to reduce the risk of adverse maternal and perinatal outcomes. Currently, no circulating biomarker has proven clinically useful for accurate prediction of GDM. In this study, we tested if a panel of small non-coding circulating RNAs could improve early prediction of GDM. We performed a nested case-control study of participants from the European multicenter ‘Vitamin D and lifestyle intervention for GDM prevention (DALI)’ trial using serum samples from obese pregnant women (BMI ≥ 29 kg/m2) entailing 82 GDM cases (early- and late- GDM), and 41 age- and BMI-matched women with normal glucose tolerance (NGT) throughout pregnancy (controls). Anthropometric, clinical and biochemical characteristics were obtained at baseline (<20 weeks of gestation) and throughout gestation. Baseline serum microRNAs (miRNAs) were measured using quantitative real time PCR (qPCR). Elevated miR-16-5p, -29a-3p, and -134-5p levels were observed in women, who were NGT at baseline and later developed GDM, compared with controls who remained NGT. A combination of the three miRNAs could distinguish later GDM from NGT cases (AUC 0.717, p = 0.001, compared with fasting plasma glucose (AUC 0.687, p = 0.004)) as evaluated by area under the curves (AUCs) using Receiver Operator Characteristics (ROC) analysis. Elevated levels of individual miRNAs or a combination hereof were associated with higher odds ratios of GDM. Conclusively, circulating miRNAs early in pregnancy could serve as valuable predictive biomarkers of GDM.
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Coetzee A, Sadhai N, Mason D, Hall DR, Conradie M. Evidence to support the classification of hyperglycemia first detected in pregnancy to predict diabetes 6-12 weeks postpartum: A single center cohort study. Diabetes Res Clin Pract 2020; 169:108421. [PMID: 32920101 DOI: 10.1016/j.diabres.2020.108421] [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: 04/03/2020] [Revised: 06/24/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022]
Abstract
AIMS Diagnostic criteria for type 2 diabetes mellitus (T2DM) applied to women with gestational diabetes mellitus (GDM) may predict postpartum T2DM but requires validation. METHODS Women with GDM aged ≥ 18-years were prospectively evaluated 6-12 weeks after delivery at Tygerberg Hospital, Cape Town, South-Africa (November 2015- December 2018). Glucose status at GDM diagnosis was categorized into i) International Association for Diabetes in Pregnancy Study Group (IADPSG) T2DM (fasting glucose ≥ 7 mmol/L and/or 2hr-glucose ≥ 11.1 mmol/L) or ii) modified National Institute for Care Excellence (NICE) GDM (fasting glucose ≥ 5.6 mmol/L-6.9 mmol/L and/or 2hr-glucose ≥ 7.8 mmol/L-11 mmol/L) and compared with postpartum OGTT. RESULTS IADPSG T2DM and NICE GDM was present in 35% (n = 64) and 65% (n = 117) of the 181 women who completed the 8 ± 2 weeks postpartum evaluation respectively. Postpartum, the prevalence of T2DM and prediabetes was 26% (n = 47/181) and 15% (n = 28). Antenatal IADPSG T2DM categorization identified 31/47 women with postpartum T2DM (sensitivity 75%; specificity 48%). All of the modified NICE GDM category women who developed T2DM (n = 16/117) had elevations of both fasting and 2hr-glucose values antenatally. CONCLUSION The utility of the IADPSG T2DM criteria to predict T2DM postpartum is confirmed. Women with both fasting and 2hr-glucose values above GDM cut-offs emerged as another high-risk category.
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Affiliation(s)
- Ankia Coetzee
- Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, PO Box 19063 Tygerberg 7505, Cape Town, South Africa.
| | - Nishendra Sadhai
- Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Deidre Mason
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - David R Hall
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, PO Box 19063 Tygerberg 7505, Cape Town, South Africa.
| | - Magda Conradie
- Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, PO Box 19063 Tygerberg 7505, Cape Town, South Africa.
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Davis DW, Crew J, Planinic P, Alexander JM, Basu A. Associations of Dietary Bioactive Compounds with Maternal Adiposity and Inflammation in Gestational Diabetes: An Update on Observational and Clinical Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7528. [PMID: 33081175 PMCID: PMC7589556 DOI: 10.3390/ijerph17207528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy that adversely affects maternal and offspring health. Maternal obesity, oxidative stress, and inflammation have been implicated in GDM. In non-pregnant adults, intakes of dietary bioactive compounds inversely associate with insulin resistance and inflammation. However, associations of dietary bioactive compounds with biomarkers of adiposity, antioxidant vitamin and mineral status, oxidative stress, and inflammation in GDM have not been fully elucidated. We addressed this gap by conducting a semi-quantitative review of observational studies and randomized controlled trials published between 2010 and 2020 and retrieved from Google Scholar, Medline, and PubMed. Our analysis revealed that women with GDM are more likely to consume a pro-inflammatory diet before pregnancy and tend to consume fewer antioxidant vitamins and minerals during pregnancy than healthy pregnant women. Women with GDM also have lower blood levels of vitamins A, C, and D and certain adipokines. Several dietary bioactive compounds were noted to improve antioxidant status and biomarkers of inflammation. The Dietary Approaches to Stop Hypertension (DASH) diet and soybean oligosaccharides increased antioxidant enzyme levels. Supplementing n-3 fatty acids, probiotics, synbiotics, and trace elements increased antioxidant enzymes and reduced hs-CRP and MDA. Improvements in inflammation by vitamin D may be contingent upon co-supplementation with other dietary bioactive compounds.
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Affiliation(s)
- Dustin W. Davis
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
| | - Jeannette Crew
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
| | - Petar Planinic
- Department of Obstetrics & Gynecology, School of Medicine, University of Nevada at Las Vegas, Las Vegas, NV 89154, USA; (P.P.); (J.M.A.)
| | - James M. Alexander
- Department of Obstetrics & Gynecology, School of Medicine, University of Nevada at Las Vegas, Las Vegas, NV 89154, USA; (P.P.); (J.M.A.)
| | - Arpita Basu
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
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Matos ALS, Moreira JPDL, Luiz RR, da Silva EP, Rodacki M, Gómez JFB, Zajdenverg L. Comparison of glucose measurement on dried blood spots versus plasma samples in pregnant women with and without anemia. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:454-461. [PMID: 32267357 PMCID: PMC10522073 DOI: 10.20945/2359-3997000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Objective Compare the concordance degree between plasma glucose and glucose measurements on Dried Blood Spots (DBS) during pregnancy. Subjects and methods Glucose measurement was performed in pregnant women after a fast of 8-12 hours. Venous blood was collected with sodium fluoride, the plasma was separated, and glucose measured by the enzymatic oxidase glucose method. Capillary blood samples were collected and analyzed by DBS. For statistics, the paired Student's t test, interclass correlation coefficient (ICC), graphic approach of Altman and Bland, and survival - concordance plot were used. Results 307 pregnant women were evaluated, 88.6% without diabetes and 11.4% with previous diabetes. The glucose ranged from 66 to 190 mg/dL [3.66 to 10.55 mmol/L] in plasma and from 53 to 166 mg/dL [2.94 to 9.21 mmol/L] in DBS. The glucose average values were 88.1 ± 12 mg/dL [4.98 ± 0.67 mmol/L] in plasma and 89.2 ±11,5 mg/dL, [4.95 ± 0.64 mmol/L] in DBS - p-value = 0.084. The ICC value was moderate (0.510), and Pearson's correlation coefficient was r = 0.507 p < 0.001. Altman and Bland's graph showed that difference between the values obtained by both methods is -24.62 to 22.3 mg/dL [-1.37 to 1.24 mmol/L]. Significant fixed bias (-1,16 average difference) and proportional bias (r = 0.056; p = 0.33) were not observed. Anemia was associated with differences between plasma glucose and DBS measurements (p = 0.031). Conclusion Capillary glucose in DBS correlates with plasma glucose; however, the methods do not present good concordance. The presence of anemia worsens this result.
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Affiliation(s)
- Ana Lígia Soares Matos
- Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilMaternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Jessica Pronestino de Lima Moreira
- Instituto de Estudos de Saúde ColetivaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilInstituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde ColetivaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilInstituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Evelise Pochmann da Silva
- Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilMaternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Departamento de Medicina InternaUnidade de Diabetes e NutrologiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Medicina Interna, Unidade de Diabetes e Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | | | - Lenita Zajdenverg
- Departamento de Medicina InternaUnidade de Diabetes e NutrologiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Medicina Interna, Unidade de Diabetes e Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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31
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Osuagwu UL, Fuka F, Agho K, Khan A, Simmons D. Adverse Maternal Outcomes of Fijian Women with Gestational Diabetes Mellitus and the Associated Risk Factors. Reprod Sci 2020; 27:2029-2037. [PMID: 32548804 DOI: 10.1007/s43032-020-00222-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to determine the factors associated with adverse maternal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) in urban Fiji. This cross-sectional study used data from existing records of singleton pregnant women with GDM attending the Colonial War Memorial Hospital (CWMH) Suva Fiji between June 2013 and May 2014. Data retrieved included demographic data, antenatal and intrapartum care data, route of delivery, treatment modality, and maternal risk factors. The prevalence of GDM is 3.0%, n = 255/8698, and the most frequent maternal complications were induction of labor (66%), C-section (32%), and preeclampsia (19%), and 25% had babies with birthweight > 4 kg. Older women (≥ 36 years) and those treated with insulin were 5.2 times and 10.7 times, respectively, more likely to have labor induction during childbirth compared with younger women and those on dietary management. Family history of diabetes was associated with 2.4× and/or 2.5× higher odds of cesarean delivery and/or develop hypertension in pregnancy, respectively. Parity > 5 children and diagnoses of GDM after the first trimester reduced the odds of cesarean delivery. The odds of developing preeclampsia in GDM was 3.4 times higher (95% confidence interval (CI) of adjusted odds ratio (aOR): 1.03, 18.78) among obese women than normal-weight women, and married women were less likely to have babies with birthweight > 4 kg. The prevalence of and adverse outcomes among women with GDM attending antenatal public health care in Suva Fiji were higher than previously reported from the hospital. Older and multiparous women with GDM, those insulin treated, and with a strong family history and high body mass index (BMI) need special attention and better monitoring by health care personnel to reduce adverse outcomes during pregnancy.
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Affiliation(s)
- Uchechukwu L Osuagwu
- Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Falahola Fuka
- Ministry of Health, Vaoila Hospital, Tongatapu, Tonga
| | - Kingsley Agho
- School of Science and Health, Western Sydney University, Campbelltown, NSW, 2560, Australia.,African Vision Research Institute, University of KwaZulu-Natal Durban, Durban, South Africa
| | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David Simmons
- Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, 2560, Australia
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Johns EC, Denison FC, Reynolds RM. Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes. Acta Physiol (Oxf) 2020; 229:e13458. [PMID: 32087033 DOI: 10.1111/apha.13458] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022]
Abstract
Sleep disordered breathing (SDB) is a common obesity-related co-morbidity with strong associations to cardiometabolic disease. The risk of SDB is increased during pregnancy, particularly among obese pregnant women. Accumulating evidence suggests that an association exists between maternal SDB and the development of adverse pregnancy outcomes, particularly gestational diabetes and hypertensive disorders of pregnancy. Intermittent hypoxia, a central characteristic of SDB, has been shown in animal and clinical studies to dysregulate several biological pathways. This includes the promotion of oxidative stress, increased inflammation, activation of the hypothalamic-pituitary-adrenal axis, increased sympathetic activity and impaired glucose and insulin metabolism. This review considers how, during pregnancy, these pathophysiological processes are plausible mechanisms through which SDB may contribute to an increased risk of adverse outcomes, for the mother and perhaps also the offspring. However, a lack of robust evidence specific to the pregnant population, including limited evaluation of the placental function in affected pregnancies, limits our ability to draw definite conclusions on mechanisms contributing to adverse pregnancy outcomes and, indeed, the strength of association between SDB and certain pregnancy complications.
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Affiliation(s)
- Emma C. Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
| | - Fiona C. Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
| | - Rebecca M. Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
- BHF/University Centre for Cardiovascular Science University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
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33
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Postpartum lifestyle modifications for women with gestational diabetes: A qualitative study. Eur J Obstet Gynecol Reprod Biol 2020; 252:105-111. [PMID: 32592917 DOI: 10.1016/j.ejogrb.2020.04.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/18/2020] [Accepted: 04/24/2020] [Indexed: 01/11/2023]
Abstract
The prevalence of gestational diabetes mellitus increased to 8% in France in 2012, and the risk of developing type 2 diabetes after receiving a gestational diabetes diagnosis increases 7-fold. Education delivered during pregnancy aims to reduce this risk by reminding women to maintain dietary and lifestyle modifications after delivery. OBJECTIVE The primary objective of this study was to describe and analyze the feelings and daily lifestyle changes, including physical activity and dietary changes, among women who experienced gestational diabetes and the roles played by their general practitioners during follow-up. STUDY DESIGN We conducted a qualitative study examining women's attitudes during the 6-12 months postpartum, after receiving a gestational diabetes diagnosis and associated education. All women participated in semi-structured, individual, telephone-based interviews. RESULTS Out of 47 patients contacted, we interviewed 16 women. All interviewed women modified their behaviors, at least slightly, and described changes that included more balanced diets and the incorporation of mild physical activity. Lack of time, lack of awareness regarding the long-term risk of developing type 2 diabetes, resistance to long-term dietary changes, and cultural habits were identified as the primary barriers to long-term lifestyle modifications, whereas family support was found to be beneficial. The reported interactions between each woman and her physician appeared to be weak. CONCLUSION Our study showed that educational attitudes and preventive interventions must be reinforced, especially during the long-term, and not only during the immediate postpartum period. Raising awareness among primary care physicians regarding the need to provide continuous education for this high-risk population appears to be necessary.
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Sina M, Cade TJ, Flack J, Nolan CJ, Rajagopal R, Wong V, Burcher L, Barry A, Gianatti E, McCarthy A, McNamara C, Mickelson M, Hughes R, Jones T, Latino C, McIntyre D, Price S, Simmons D. Antenatal models of care for women with gestational diabetes mellitus: Vignettes from an international meeting. Aust N Z J Obstet Gynaecol 2020; 60:720-728. [DOI: 10.1111/ajo.13144] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/30/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Maryam Sina
- Western Sydney University Sydney New South WalesAustralia
| | | | - Jeff Flack
- Bankstown Hospital SydneyNew South WalesAustralia
| | | | | | - Vincent Wong
- Liverpool Hospital Sydney New South WalesAustralia
| | - Linda Burcher
- Flinders Medical Centre Adelaide South AustraliaAustralia
| | - Alison Barry
- Mater Medical Research Institute Brisbane QueenslandAustralia
| | | | - Ana McCarthy
- Lyell McEwin Hospital Adelaide South AustraliaAustralia
| | - Catharine McNamara
- Deakin University, Burwood, Victoria and The Mercy Hospital for Women Heidelberg VictoriaAustralia
| | | | - Ruth Hughes
- University of Otago Christchurch New Zealand
| | - Tara Jones
- Goulburn Valley Health SheppartonVictoriaAustralia
| | - Cathy Latino
- Fiona Stanley Hospital Perth Western AustraliaAustralia
| | - David McIntyre
- Mater Medical Research Institute Brisbane QueenslandAustralia
| | - Sarah Price
- University of Melbourne Melbourne Victoria Australia
| | - David Simmons
- Western Sydney University Sydney New South WalesAustralia
- Campbelltown Hospital SydneyNew South WalesAustralia
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Cui L, Qiao T, Xu F, Li Z, Chen T, Su H, Chen G, Zhang L, Xu D, Zhang X. Circulating irisin levels of prenatal and postnatal patients with gestational diabetes mellitus: A systematic review and meta-analysis. Cytokine 2019; 126:154924. [PMID: 31864100 DOI: 10.1016/j.cyto.2019.154924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/24/2019] [Accepted: 11/08/2019] [Indexed: 01/10/2023]
Abstract
AIMS At present, there are few studies on the relationship between circulating irisin levels and gestational diabetes mellitus (GDM), and the results are inconsistent. Therefore, this study conducts a systematic review and meta-analysis to comprehensively discuss the role of irisin in the occurrence and development of GDM. METHODS We searched the articles on the relationship between GDM and circulating irisin levels up to September 2019, using the CNKI, WANFANG-DATA, PubMed and the Web of Science databases. RESULTS Twenty two articles including 3563 participants were selected in the meta-analysis. Meta-analysis found the blood irisin levels for GDM group were significantly lower than that for control group during pregnancy(SMD = -0.88, 95%CI: -1.34, -0.42, P < 0.001). However, there was no significant difference of irisin levels in the postpartum blood and cord blood between the two groups (SMD = -1.44, 95 %CI: -3.79, 0.92, P = 0.23; SMD = -0.17, 95 %CI: -0.59, 0.25, P = 0.42, respectively). CONCLUSIONS Compared with the control group, irisin levels in the GDM group during pregnancy are lower. However, it is no significant difference of irisin levels in the postpartum blood and cord blood. Irisin may play an important role in the occurrence and development of GDM, which needs further research to demonstrate.
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Affiliation(s)
- Lingling Cui
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Tianyi Qiao
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Fan Xu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhonglei Li
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Tingting Chen
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hongli Su
- Department of Health, The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Guixia Chen
- Department of Health, The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Li Zhang
- Department of Health, The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Dongmei Xu
- Department of Health, The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaofeng Zhang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
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36
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McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers 2019; 5:47. [PMID: 31296866 DOI: 10.1038/s41572-019-0098-8] [Citation(s) in RCA: 787] [Impact Index Per Article: 157.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
Hyperglycaemia that develops during pregnancy and resolves after birth has been recognized for over 50 years, but uniform worldwide consensus is lacking about threshold hyperglycaemic levels that merit a diagnosis of 'gestational diabetes mellitus' (GDM) and thus treatment during pregnancy. GDM is currently the most common medical complication of pregnancy, and prevalence of undiagnosed hyperglycaemia and even overt diabetes in young women is increasing. Maternal overweight and obesity, later age at childbearing, previous history of GDM, family history of type 2 diabetes mellitus and ethnicity are major GDM risk factors. Diagnosis is usually performed using an oral glucose tolerance test (OGTT), although a non-fasting, glucose challenge test (GCT) is used in some parts of the world to screen women for those requiring a full OGTT. Dietary modification and increased physical activity are the primary treatments for GDM, but pharmacotherapy, usually insulin, is used when normoglycaemia is not achieved. Oral hypoglycaemic agents, principally metformin and glibenclamide (glyburide), are also used in some countries. Treatment improves immediate pregnancy outcomes, reducing excess fetal growth and adiposity and pregnancy-related hypertensive disorders. GDM increases the risk of long-term complications, including obesity, impaired glucose metabolism and cardiovascular disease, in both the mother and infant. Optimal management of mother and infant during long-term follow-up remains challenging, with very limited implementation of preventive strategies in most parts of the world.
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Affiliation(s)
- H David McIntyre
- Mater Research and University of Queensland, Brisbane, Queensland, Australia.
| | - Patrick Catalano
- Mother Infant Research Institute, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Elisabeth R Mathiesen
- Department of Endocrinology, Center for Pregnant Women with Diabetes, Rigshospitalet and The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet and The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Schmidt CB, Voorhorst I, van de Gaar VHW, Keukens A, Potter van Loon BJ, Snoek FJ, Honig A. Diabetes distress is associated with adverse pregnancy outcomes in women with gestational diabetes: a prospective cohort study. BMC Pregnancy Childbirth 2019; 19:223. [PMID: 31269913 PMCID: PMC6610799 DOI: 10.1186/s12884-019-2376-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Around 12% of pregnant women develop gestational diabetes mellitus (GDM), which is associated with increased health risks for both mother and child and pre- and postpartum depression. Little is known about the relationship of GDM with diabetes-specific emotional distress (diabetes distress). The aims of this study are to assess the prevalence of diabetes distress in GDM and its association with adverse pregnancy outcomes. METHODS A prospective cohort study was carried out in an Amsterdam based teaching hospital with an ethnic diverse population. Women diagnosed with GDM completed a set of questionnaires at three time points. Questionnaires consisted of Problem Areas in Diabetes Scale 5 (PAID-5) for diabetes distress (T0-T1), Patient Health Questionnaire 9 (PHQ-9) for depressive symptoms (T0-T2), and questions to assess adverse pregnancy outcomes (T2). Adverse pregnancy outcomes (collected via self-report and if feasible from the medical records) were defined as hypertension, pre-eclampsia, caesarean section, severe perineal tearing, postpartum hemorrhage, postpartum depression, shoulder dystocia, neonatal hospitalization, macrosomia, jaundice, hypoglycemia and other (among which low heart rate, fever, hypoxia). Adverse pregnancy outcomes were dichotomized into none and 1 or more. Additional information was collected from the medical charts. Missing data were imputed via predictive mean matching and a multivariable logistic regression analysis was performed with diabetes distress, depressive symptoms, socioeconomic status, parity and ethnicity as predictors and age, HbA1c, and BMI as covariates. RESULTS A total of 100 women were included, mean age 32.5 (4.1), mean BMI 26.7 (4.8), 71% were of non-Dutch ethnic background. Elevated diabetes distress (PAID score ≥ 8) was reported by 36% of the women. Multivariable logistic regression analyses revealed that both high diabetes distress (OR 4.70, p = .02) and parity (OR 0.21, p = .02) but not antepartum depressive symptoms were related to adverse pregnancy outcomes. CONCLUSIONS Diabetes distress is likely in women with GDM and our findings suggest an association between both diabetes distress, parity and adverse pregnancy outcomes in women with GDM. This warrants replication and further research into the underlying mechanisms explaining the impact of diabetes distress in GDM and potential interventions to reduce distress.
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Affiliation(s)
- Charlotte B. Schmidt
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ilse Voorhorst
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | | | - Anne Keukens
- Department of Gynaecology, OLVG, Amsterdam, the Netherlands
| | | | - Frank J. Snoek
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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38
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Cheung NW, Blumenthal C, Smith BJ, Hogan R, Thiagalingam A, Redfern J, Barry T, Cinnadaio N, Chow CK. A Pilot Randomised Controlled Trial of a Text Messaging Intervention with Customisation Using Linked Data from Wireless Wearable Activity Monitors to Improve Risk Factors Following Gestational Diabetes. Nutrients 2019; 11:E590. [PMID: 30862052 PMCID: PMC6470941 DOI: 10.3390/nu11030590] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 01/21/2023] Open
Abstract
Gestational diabetes (GDM) is a highly prevalent disorder of pregnancy which portends a high risk for future type 2 diabetes. Limited evidence indicates lifestyle intervention prevents the development of diabetes, but most previously studied interventions are resource-intensive. Intervention programs that utilise newer technologies may be scalable at lower cost. This 6-month pilot randomized controlled trial tested the delivery of text messages linked to an activity monitor, adaptive physical activity goal setting, and limited face-to-face counseling, as an intervention to improve rates of post-partum glucose tolerance testing and lifestyle behaviours amongst women following a GDM pregnancy. Sixty subjects were randomised 2:1 intervention vs. control. Compared to control subjects, there were trends for intervention subjects to improve diet, increase physical activity, and lose weight. There was no difference between the groups in the rate of glucose tolerance testing. Only 46 (77%) subjects completed some, and 19 subjects completed all the elements of the final evaluation. Feedback regarding the text messages and activity monitor was highly positive. Overall, results suggest that a text message and activity monitor intervention is feasible for a larger study or even as a potentially scalable population health intervention. However, low completion rates necessitate carefully considered modification of the protocol.
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Affiliation(s)
- N Wah Cheung
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead NSW 2145, Australia.
- Westmead Clinical School & Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead NSW 2145, Australia.
| | - Caron Blumenthal
- Division of Women and Newborn Health, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Ben J Smith
- School of Public Health, University of Sydney, Sydney NSW 2006, Australia.
| | - Roslyn Hogan
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Aravinda Thiagalingam
- Westmead Clinical School & Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead NSW 2145, Australia.
- Department of Cardiology, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Julie Redfern
- Westmead Clinical School & Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead NSW 2145, Australia.
| | - Tony Barry
- Department of Cardiology, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Nancy Cinnadaio
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead NSW 2145, Australia.
| | - Clara K Chow
- Westmead Clinical School & Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead NSW 2145, Australia.
- Department of Cardiology, Westmead Hospital, Westmead NSW 2145, Australia.
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Bawah AT, Ngala RA, Alidu H, Seini MM, Wumbee JDK, Yeboah FA. Gestational diabetes mellitus and obstetric outcomes in a Ghanaian community. Pan Afr Med J 2019; 32:94. [PMID: 31223385 PMCID: PMC6560956 DOI: 10.11604/pamj.2019.32.94.17334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION This study was aimed at evaluating effect of Gestational diabetes mellitus (GDM) and maternal characteristics on pregnancy outcome. GDM has several risk factors including; advanced maternal age, ethnic background, obesity and family history of diabetes mellitus. These pregnancy complications are associated with fetal morbidity and mortality and may lead to macrosomia and shoulder dystocia. Others are stillbirth, miscarriages, preterm and small for gestational age babies. METHODS This was a retrospective case-case control study which compared maternal characteristics and pregnancy outcome among pregnant women with and without GDM. Diagnosis of GDM was done in accordance with the American Diabetes Association (ADA) criteria. Weight and height were determined and Body mass index (BMI) calculated. Pregnancy outcome was determined at the end of pregnancy and information on maternal characteristics obtained using questionnaire and patient folders. RESULTS Those who developed GDM were significantly older (OR= 1.772; 95% CI =1.432-2.192; P<0.0001) and had higher BMI (OR=1.637; 95% CI=1.004-1.289; P=0.044) than those who did not. A significant number of those who developed GDM also had stillbirths OR= 5.188; 95% CI=1.093-24.613; p=0.038) and cesarean deliveries (OR=14.362; 95% CI=3.661-56.335; p= 0.001). CONCLUSION Women who develop GDM are more likely to deliver stillborn or macrosmic babies and may require surgical intervention in order to have normal deliveries.
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Affiliation(s)
- Ahmed Tijani Bawah
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Health and Allied Health Sciences, Ho, Ghana
| | - Robert Amadu Ngala
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Huseini Alidu
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Health and Allied Health Sciences, Ho, Ghana
| | | | | | - Francis Agyemang Yeboah
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Sukumar N, Dallosso H, Saravanan P, Yates T, Telling C, Shorthose K, Northern A, Schreder S, Brough C, Gray LJ, Davies MJ, Khunti K. Baby Steps - a structured group education programme with accompanying mobile web application designed to promote physical activity in women with a history of gestational diabetes: study protocol for a randomised controlled trial. Trials 2018; 19:682. [PMID: 30541621 PMCID: PMC6292087 DOI: 10.1186/s13063-018-3067-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/21/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A diagnosis of gestational diabetes (GDM) is associated with an over sevenfold increase in the risk of developing type 2 diabetes (T2D), while among parous women with T2D, up to 30% have a history of GDM. Lifestyle interventions have been shown to reduce the risk of incident T2D in adults with impaired glucose tolerance, including in women with a history of GDM. The aim of this study is to establish whether a group self-management education programme, supported by a mobile web application, can improve levels of physical activity at 12 months in women who have had GDM. METHODS The study is a randomised controlled trial with follow-up at 6 and 12 months. Primary outcome is change in objectively measured average daily physical activity at 12 months. Secondary outcomes include lipid profile, blood pressure, glycated haemoglobin, obesity, smoking and alcohol status, self-reported physical activity, anxiety, depression and quality of life. Participants are recruited from maternity and diabetes departments in hospital trusts in two sites in the UK. Women aged > 18 years, with a diagnosis of GDM during any pregnancy in the previous 60 months are eligible. Participants need to have a good understanding of written and verbal English, be able to give informed consent and have access to a smart-phone. Women who are pregnant or have type 1 or type 2 diabetes are not eligible. In total, 290 participants will be recruited and randomly assigned, with stratification for age and ethnicity, to either the control group, receiving usual care, or the intervention group who are invited to participate in the Baby Steps programme. This comprises a group education programme and access to a mobile web application which provides an education component and interacts with a wrist-worn activity monitor providing automated messages, setting challenges and encouraging motivation. DISCUSSION If effective, the Baby Steps programme could be translated into a primary care-based intervention that women with GDM are referred to in the postnatal period. This could help them make lifestyle changes that could reduce their future risk of T2D. TRIAL REGISTRATION ISRCTN, ISRCTN17299860 . Registered on 5 April 2017.
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Affiliation(s)
- Nithya Sukumar
- Population, Evidence & Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Academic Centre for Diabetes and Endocrinology, George Eliot Hospital, Nuneaton, CV10 7DJ, UK
| | - Helen Dallosso
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PR, UK
| | - Ponnusamy Saravanan
- Population, Evidence & Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Academic Centre for Diabetes and Endocrinology, George Eliot Hospital, Nuneaton, CV10 7DJ, UK
| | - Tom Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Carol Telling
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PR, UK
| | - Karen Shorthose
- Research & Development Department, George Eliot Hospital, Nuneaton, CV10 7DJ, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PR, UK
| | - Sally Schreder
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PR, UK
| | - Christopher Brough
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PR, UK
| | - Laura J Gray
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, LE5 4PW, UK. .,NIHR Collaboration for Leadership in Applied Health Research and Care - East Midlands, University of Leicester, Leicester, UK.
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Di Cianni G, Lacaria E, Lencioni C, Resi V. Preventing type 2 diabetes and cardiovascular disease in women with gestational diabetes - The evidence and potential strategies. Diabetes Res Clin Pract 2018; 145:184-192. [PMID: 29684619 DOI: 10.1016/j.diabres.2018.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 02/01/2023]
Abstract
Gestational Diabetes Mellitus is a condition strongly related to the development of type 2 diabetes later in life, although the risk and the onset have not been fully identified yet. Although glucose tolerance returns to normal levels after delivery in the majority of women with GDM, this condition represents an early stage in the natural history of T2DM. In addition, women with previous GDM exhibit an increased cardiovascular risk profile and a raised incidence of cardiovascular diseases. Lifestyle changes and pharmacological interventions might be able to reduce the incidence of type 2 diabetes in pGDM women, although results are still not conclusive. Long term continuous programs specifically addressed to women with pGDM should be implemented, with the ambitious target to encourage them to regularly check glucose tolerance, lipid profile and other parameters related to cardiovascular diseases, aimed at improving women's health. In this paper, we review the relationship between type 2 diabetes, cardiovascular diseases and a history of GDM.
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Affiliation(s)
- Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Livorno, Italy.
| | - Emilia Lacaria
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Livorno, Italy
| | - Cristina Lencioni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Lucca Hospital, Lucca, Italy
| | - Veronica Resi
- Diabetes Service, Unit of Endocrinology, IRCCS Cà Granda-Ospedale Maggiore Policlinico Foundation and Department of Medical Sciences, University of Milan, Milan, Italy
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Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational Diabetes Mellitus: Mechanisms, Treatment, and Complications. Trends Endocrinol Metab 2018; 29:743-754. [PMID: 30297319 DOI: 10.1016/j.tem.2018.09.004] [Citation(s) in RCA: 424] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy. The prevalence is rising and correlates with the increase in maternal obesity over recent decades. The etiology of GDM is complex, with genetic and environmental factors implicated in mechanistic and epidemiological studies. GDM begets important short- and long-term health risks for the mother, developing fetus, and offspring. This includes the high likelihood of subsequent maternal type 2 diabetes (T2DM), and possible adverse cardiometabolic phenotypes in the offspring. The most clinically and cost-effective methods of screening for GDM remain uncertain. Whilst treatments with lifestyle and pharmacological interventions have demonstrated short-term benefits, the long-term impact for the offspring of intrauterine exposure to antidiabetic medication remains unclear.
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MESH Headings
- Diabetes Complications/etiology
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/drug therapy
- Diabetes, Gestational/etiology
- Female
- Humans
- Hypertension, Pregnancy-Induced/etiology
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Infant, Newborn
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/pathology
- Infant, Newborn, Diseases/physiopathology
- Obstetric Labor Complications/etiology
- Pregnancy
- Prenatal Exposure Delayed Effects/chemically induced
- Prenatal Exposure Delayed Effects/metabolism
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Affiliation(s)
- Emma C Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK; BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.
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Crowther CA, Alsweiler JM, Hughes R, Brown J. Tight or less tight glycaemic targets for women with gestational diabetes mellitus for reducing maternal and perinatal morbidity? (TARGET): study protocol for a stepped wedge randomised trial. BMC Pregnancy Childbirth 2018; 18:425. [PMID: 30373539 PMCID: PMC6206938 DOI: 10.1186/s12884-018-2060-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/16/2018] [Indexed: 01/04/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is strongly associated with significant adverse maternal and perinatal health outcomes that have lifelong consequences. Treatment for women with GDM aims to normalise maternal blood glucose concentrations to reduce these adverse health risks. Target recommendations for glycaemic control in women with GDM vary amongst international organisations. All their recommendations rely on consensus, as there have been no published randomised trials that compare different intensities of glucose control in women with GDM. The TARGET Trial aims to determine whether tighter targets for glycaemic control in women with GDM compared with less tight targets, reduce maternal and perinatal morbidity without adverse health consequences. Methods/design Using a stepped wedge, cluster randomised trial the 10 participating hospitals will be randomised to the timing of the change from the less tight to the tighter glycaemic target period. During the less tight target period, all health professionals at the hospital will aim to use the less tight glycaemic targets for treatment of women with GDM (fasting plasma glucose < 5.5 mmol/L; 1 h postprandial < 8.0 mmol/L; 2 h postprandial < 7.0 mmol/L). During the tighter target period all health professionals at the hospital will aim to use the tighter glycaemic targets for treatment of women with GDM (fasting plasma glucose ≤5.0 mmol/L, 1 h postprandial ≤7.4 mmol/L; 2 h postprandial ≤6.7 mmol/L). The primary study outcome is large for gestational age infant (birth weight > 90th centile). A sample size of 1080 participants will detect a treatment difference of 6% in the proportion of large for gestational age babies from 13% with less tight glycaemic targets to 7% with tighter targets, assuming an intra-cluster correlation coefficient of 0.05. Discussion The TARGET Trial will provide high-level evidence of direct relevance for clinical practice. If tighter treatment targets for women with GDM clearly result in significantly fewer large for gestational age infants and less adverse maternal and perinatal outcomes then they should be recommended for women with GDM. This would be of great importance to these women, their children, health services and communities. Trial registration Australian New Zealand Clinical Trials Registry - ACTRN 12615000282583.
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Affiliation(s)
- Caroline A Crowther
- Liggins Institute, The University of Auckland, Building 503, Level 2, 85 Park Road, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Jane M Alsweiler
- Newborn Services, Auckland City Hospital, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Ruth Hughes
- Department of Obstetrics and Gynaecology, Christchurch Women's Hospital, University of Otago, Christchurch, New Zealand
| | - Julie Brown
- Liggins Institute, The University of Auckland, Building 503, Level 2, 85 Park Road, Private Bag 92019, Auckland, 1142, New Zealand
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Gürkan E, Dirican E, Bülbül N. The Effect of Common and Possible Risk Factors’ Co-occurrence to the Development of Gestational Diabetes Mellitus. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.461421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J. Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2018; 8:CD012327. [PMID: 30103263 PMCID: PMC6513179 DOI: 10.1002/14651858.cd012327.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Successful treatments for gestational diabetes mellitus (GDM) have the potential to improve health outcomes for women with GDM and their babies. OBJECTIVES To provide a comprehensive synthesis of evidence from Cochrane systematic reviews of the benefits and harms associated with interventions for treating GDM on women and their babies. METHODS We searched the Cochrane Database of Systematic Reviews (5 January 2018) for reviews of treatment/management for women with GDM. Reviews of pregnant women with pre-existing diabetes were excluded.Two overview authors independently assessed reviews for inclusion, quality (AMSTAR; ROBIS), quality of evidence (GRADE), and extracted data. MAIN RESULTS We included 14 reviews. Of these, 10 provided relevant high-quality and low-risk of bias data (AMSTAR and ROBIS) from 128 randomised controlled trials (RCTs), 27 comparisons, 17,984 women, 16,305 babies, and 1441 children. Evidence ranged from high- to very low-quality (GRADE). Only one effective intervention was found for treating women with GDM.EffectiveLifestyle versus usual careLifestyle intervention versus usual care probably reduces large-for-gestational age (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.50 to 0.71; 6 RCTs, N = 2994; GRADE moderate-quality).PromisingNo evidence for any outcome for any comparison could be classified to this category.Ineffective or possibly harmful Lifestyle versus usual careLifestyle intervention versus usual care probably increases the risk of induction of labour (IOL) suggesting possible harm (average RR 1.20, 95% CI 0.99 to 1.46; 4 RCTs, N = 2699; GRADE moderate-quality).Exercise versus controlExercise intervention versus control for return to pre-pregnancy weight suggested ineffectiveness (body mass index, BMI) MD 0.11 kg/m², 95% CI -1.04 to 1.26; 3 RCTs, N = 254; GRADE moderate-quality).Insulin versus oral therapyInsulin intervention versus oral therapy probably increases the risk of IOL suggesting possible harm (RR 1.3, 95% CI 0.96 to 1.75; 3 RCTs, N = 348; GRADE moderate-quality).Probably ineffective or harmful interventionsInsulin versus oral therapyFor insulin compared to oral therapy there is probably an increased risk of the hypertensive disorders of pregnancy (RR 1.89, 95% CI 1.14 to 3.12; 4 RCTs, N = 1214; GRADE moderate-quality).InconclusiveLifestyle versus usual careThe evidence for childhood adiposity kg/m² (RR 0.91, 95% CI 0.75 to 1.11; 3 RCTs, N = 767; GRADE moderate-quality) and hypoglycaemia was inconclusive (average RR 0.99, 95% CI 0.65 to 1.52; 6 RCTs, N = 3000; GRADE moderate-quality).Exercise versus controlThe evidence for caesarean section (RR 0.86, 95% CI 0.63 to 1.16; 5 RCTs, N = 316; GRADE moderate quality) and perinatal death or serious morbidity composite was inconclusive (RR 0.56, 95% CI 0.12 to 2.61; 2 RCTs, N = 169; GRADE moderate-quality).Insulin versus oral therapyThe evidence for the following outcomes was inconclusive: pre-eclampsia (RR 1.14, 95% CI 0.86 to 1.52; 10 RCTs, N = 2060), caesarean section (RR 1.03, 95% CI 0.93 to 1.14; 17 RCTs, N = 1988), large-for-gestational age (average RR 1.01, 95% CI 0.76 to 1.35; 13 RCTs, N = 2352), and perinatal death or serious morbidity composite (RR 1.03; 95% CI 0.84 to 1.26; 2 RCTs, N = 760). GRADE assessment was moderate-quality for these outcomes.Insulin versus dietThe evidence for perinatal mortality was inconclusive (RR 0.74, 95% CI 0.41 to 1.33; 4 RCTs, N = 1137; GRADE moderate-quality).Insulin versus insulinThe evidence for insulin aspart versus lispro for risk of caesarean section was inconclusive (RR 1.00, 95% CI 0.91 to 1.09; 3 RCTs, N = 410; GRADE moderate quality).No conclusions possibleNo conclusions were possible for: lifestyle versus usual care (perineal trauma, postnatal depression, neonatal adiposity, number of antenatal visits/admissions); diet versus control (pre-eclampsia, caesarean section); myo-inositol versus placebo (hypoglycaemia); metformin versus glibenclamide (hypertensive disorders of pregnancy, pregnancy-induced hypertension, death or serious morbidity composite, insulin versus oral therapy (development of type 2 diabetes); intensive management versus routine care (IOL, large-for-gestational age); post- versus pre-prandial glucose monitoring (large-for-gestational age). The evidence ranged from moderate-, low- and very low-quality. AUTHORS' CONCLUSIONS Currently there is insufficient high-quality evidence about the effects on health outcomes of relevance for women with GDM and their babies for many of the comparisons in this overview comparing treatment interventions for women with GDM. Lifestyle changes (including as a minimum healthy eating, physical activity and self-monitoring of blood sugar levels) was the only intervention that showed possible health improvements for women and their babies. Lifestyle interventions may result in fewer babies being large. Conversely, in terms of harms, lifestyle interventions may also increase the number of inductions. Taking insulin was also associated with an increase in hypertensive disorders, when compared to oral therapy. There was very limited information on long-term health and health services costs. Further high-quality research is needed.
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Affiliation(s)
- Ruth Martis
- The University of AucklandLiggins InstitutePark RoadGraftonAucklandNew Zealand1142
| | - Caroline A Crowther
- The University of AucklandLiggins InstitutePark RoadGraftonAucklandNew Zealand1142
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Jane Alsweiler
- Auckland HospitalNeonatal Intensive Care UnitPark Rd.AucklandNew Zealand
| | - Michelle R Downie
- Southland HospitalDepartment of MedicineKew RoadInvercargillSouthlandNew Zealand9840
| | - Julie Brown
- The University of AucklandDepartment of Obstetrics and GynaecologyPark RdGraftonAucklandNew Zealand1142
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Paschou SA, Anagnostis P, Wolffenbuttel BHR, Goulis DG. The need for precision medicine in gestational diabetes mellitus. Maturitas 2018; 118:74-75. [PMID: 30082094 DOI: 10.1016/j.maturitas.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Apostolakis M, Paschou SA, Zapanti E, Sarantopoulou V, Vasileiou V, Anastasiou E. HbA1c presents low sensitivity as a post-pregnancy screening test for both diabetes and prediabetes in Greek women with history of gestational diabetes mellitus. Hormones (Athens) 2018; 17:255-259. [PMID: 29949125 DOI: 10.1007/s42000-018-0035-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/07/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIM Women with a history of gestational diabetes mellitus (GDM) are at increased risk for type 2 diabetes (T2D). It is thus recommended that an oral glucose tolerance test (OGTT) be performed after delivery. Recently, the use of glycated haemoglobin A1c (HbA1c) has been proposed as a simpler and faster method to diagnose glucose disorders. The aim of this study was to investigate whether HbA1c measurement can replace OGTT in the detection of prediabetes and T2D in women with a history of GDM. PATIENTS AND METHODS We studied 1336 women (35.3 ± 5.8 years old) with a history of GDM 16.6 ± 28.2 months after delivery. All women were evaluated through an OGTT and a simultaneous HbA1c measurement. American Diabetes Association (ADA) criteria were used for the assessment of glucose disorders. Sensitivity and specificity of HbA1c were measured for the prediction of T2D and prediabetes, while Cohen's coefficient of agreement (k) was calculated. ROC analysis was performed to evaluate the sensitivity and specificity of HbA1c. RESULTS Based on OGTT, 725 women (54.3%) were normal, 406 (30.4%) presented impaired fasting glucose (IFG), 48 (3.6%) impaired glucose tolerance (IGT), 74 (5.5%) combined IFG+IGT, and 83 presented with T2D (6.2%). By contrast, using HbA1c as a screening test, 1150 women (94.1%) were normal, while 49 (4.0%) had prediabetes and 23 (1.9%) T2D. Sensitivity of HbA1c for the diagnosis of prediabetes was 5.3% in comparison to OGTT, specificity was 99.2%, while for the diagnosis of T2D, the percentages were 29.6 and 100%, respectively. The consistency in classifying impaired glucose tolerance between HbA1c and OGTT was 59.7%. Cohen's coefficient of agreement was k = 0.116, indicating slight agreement. Performing a ROC curve, the optimal value of distinctive ability of HbA1c was 4.6% in the case of prediabetes, while for diabetes, it was 5.5%. CONCLUSION This study provided evidence that HbA1c can identify fewer women with prediabetes and T2D than OGTT, indicating that HbA1c cannot be recommended as an alternative post-pregnancy screening method.
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Affiliation(s)
- Michael Apostolakis
- Department of Endocrinology and Diabetes, "Alexandra" Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Zapanti
- Department of Endocrinology and Diabetes, "Alexandra" Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece
| | - Vasiliki Sarantopoulou
- Department of Endocrinology and Diabetes, "Alexandra" Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece
| | - Vasiliki Vasileiou
- Department of Endocrinology and Diabetes, "Alexandra" Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece
| | - Eleni Anastasiou
- Department of Endocrinology and Diabetes, "Alexandra" Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece.
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Simmons D, Nema J, Parton C, Vizza L, Robertson A, Rajagopal R, Ussher J, Perz J. The treatment of booking gestational diabetes mellitus (TOBOGM) pilot randomised controlled trial. BMC Pregnancy Childbirth 2018; 18:151. [PMID: 29747594 PMCID: PMC5946423 DOI: 10.1186/s12884-018-1809-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/30/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We piloted a randomised controlled trial (RCT) comparing pregnancy outcomes among women with booking gestational diabetes (GDM) receiving immediate or deferred treatment. METHODS Consecutive, consenting women < 20 weeks gestation, with GDM risk factors attending the hospital book-in clinic, completed an oral glucose tolerance test (OGTT). Clinicians were blinded to OGTT results. Women fulfilling World Health Organisation GDM criteria were randomised to either clinic referral /ongoing treatment (Treated Group n = 11), or no treatment (No Treatment Group n = 10). Women without 'Booking GDM' ('Decoys' n = 58) and those in the No Treatment Group had a repeat OGTT at 24-28 weeks (with GDM treated if diagnosed). Midwives and mothers were asked to complete surveys and attend focus groups before and after the study respectively regarding their experiences and expectations of the study protocol. RESULTS Sufficient women completed each step of the RCT. Gestation at OGTT was late at 18 ± 2 weeks with Treated and No Treatment groups largely similar. At 24-28 weeks gestation, GDM was present in 8/9 (89%) in the No Treatment group and 11/56 (20%) Decoys. NICU admission was highest in the Treated group (36% vs 0% p = 0.043), largely due to small for gestational age, and Large for Gestational Age babies greatest in the No Treatment group (0% vs 33% p = 0.030). CONCLUSION An RCT deferring 'Booking GDM' treatment is feasible. Most women with untreated 'Booking GDM' in mid 2nd trimester had GDM at 24-28 weeks. Early treatment may have both benefits and harms. A full RCT is needed. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12615000974505. Registered 17th May 2015; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369100&isReview=true Retrospectively Registered.
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Affiliation(s)
- David Simmons
- School of Medicine, Western Sydney University, Penrith, NSW 2571 Australia
- Campbelltown Hospital, Therry Road, Campbelltown, NSW 2560 Australia
- School of Medicine, Western Sydney University, Locked Bag 1797, Campbelltown, NSW 2751 Australia
| | - Jodie Nema
- School of Medicine, Western Sydney University, Penrith, NSW 2571 Australia
| | - Chloe Parton
- Centre for Health Research, Western Sydney University, Penrith, NSW 2571 Australia
| | - Lisa Vizza
- School of Medicine, Western Sydney University, Penrith, NSW 2571 Australia
| | - Annette Robertson
- Campbelltown Hospital, Therry Road, Campbelltown, NSW 2560 Australia
| | - Rohit Rajagopal
- Campbelltown Hospital, Therry Road, Campbelltown, NSW 2560 Australia
| | - Jane Ussher
- School of Medicine, Western Sydney University, Penrith, NSW 2571 Australia
| | - Janette Perz
- School of Medicine, Western Sydney University, Penrith, NSW 2571 Australia
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Lara-Cinisomo S, Swinford C, Massey D, Hardt H. Diabetes, Prenatal Depression, and Self-Rated Health in Latina Mothers. Diabetes Spectr 2018; 31:159-165. [PMID: 29773936 PMCID: PMC5951227 DOI: 10.2337/ds17-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Latinas in the United States have elevated rates of diabetes and prenatal depression (PND). The presence of diabetes and PND can also have a negative effect on women's self-rated health (SRH), a commonly used indicator of health that is consistent with objective health status and is a predictor of mortality. However, the associations between PND, diabetes, and SRH have not been tested, particularly among Latinas, who have elevated risk of both medical conditions. To address this gap, this pilot study tested the association between PND and diabetes using data from Latinas enrolled during their third trimester of pregnancy and explored whether these health conditions were associated with SRH in these women. METHODS For this study, the Edinburgh Postnatal Depression Scale was used to determine PND status, self-reported medical history to determine diabetes status, and SRH before and during the current pregnancy in a sample of 34 prenatal Latinas. Participants were invited to take part in the study in their third trimester of pregnancy. Bivariate analyses and logistic regressions were used to test associations between demographic variables, PND, diabetes, and SRH. RESULTS There was no significant association between PND and diabetes status in this sample of Latinas. There was a significant difference in SRH from pre-pregnancy to pregnancy, with worse ratings reported during pregnancy. Furthermore, women with PND or diabetes reported worse SRH, even after controlling for pre-pregnancy SRH. CONCLUSION SRH is an important and robust variable associated with PND and diabetes in prenatal Latinas, making it an important factor to assess when treating this high-risk group.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Claire Swinford
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Danielle Massey
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Heidi Hardt
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
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50
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De Sousa RAL. Gestational diabetes is associated to the development of brain insulin resistance in the offspring. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0618-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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