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Nazarpour S, Simbar M, Kiani Z, Khalaji N, Khorrami Khargh M, Naeiji Z. The relationship between quality of life and some mental problems in women with gestational diabetes mellitus (GDM): a cross-sectional study. BMC Psychiatry 2024; 24:511. [PMID: 39026253 PMCID: PMC11256570 DOI: 10.1186/s12888-024-05960-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Women with medical problems during pregnancy, including women with Gestational Diabetes Mellitus (GDM), experience an increased prevalence of mental health disorders which can affect their quality of life. This study aimed to assess the relationship between GDM-related quality of life and depression, anxiety, and stress. METHODS This analytical cross-sectional study was performed on 150 women with GDM. The participants were selected using a multi-stage sampling including quota and then randomized method from maternal care centers affiliated with Shahid Beheshti University of Medical Sciences, Tehran-Iran. The data were collected using a personal information questionnaire, the GDM-related quality of life questionnaire (GDMQoL-36), and the depression, anxiety, and stress scale (DASS). The data were analyzed using SPSS-23 software and statistical tests of coefficient Spearman's correlation, t-test, analysis of variance, and multiple linear regression. RESULTS The mean ± SD score for the GDM-related quality of life and the DASS scale were 55.51 ± 8.87 and 27.12 ± 19.43%, respectively. Different degrees of depression, anxiety, and stress were present in 40, 61.3, and 42% of women, respectively. The total score of GDM-related quality of life had a significant negative correlation with the total score of DASS and the scores of the subscales including depression, anxiety, and stress (P < 0.001). There were significant correlations between the total score of GDM-related quality of life with age, BMI, length of marriage, educational level of the woman and her spouse, the occupation of the woman and her spouse, income, and economic class of the family. Multiple linear regression revealed that depression, education, and job are predictive factors for GDM-related quality of life. CONCLUSION GDM-related quality of life is related to some mental disorders. Therefore, it is important to consider the mental health promotion of pregnant women with GDM in future prenatal health programs to improve their quality of life. This also shows the importance of integrating mental health promotion strategies to enhance the quality of life of pregnant women with GDM.
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Affiliation(s)
- Soheila Nazarpour
- Department of Midwifery, Chalous Branch, Islamic Azad University, Chalous, Iran
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Khalaji
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Khorrami Khargh
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Naeiji
- Department of Obstetrics and Gynecology, School of Medicine, Mahdieh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Semnani-Azad Z, Gaillard R, Hughes AE, Boyle KE, Tobias DK, Perng W. Predictors and risk factors of short-term and long-term outcomes among women with gestational diabetes mellitus (GDM) and their offspring: Moving toward precision prognosis? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.14.23288199. [PMID: 37131686 PMCID: PMC10153333 DOI: 10.1101/2023.04.14.23288199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
As part of the American Diabetes Association Precision Medicine in Diabetes Initiative (PMDI) - a partnership with the European Association for the Study of Diabetes (EASD) - this systematic review is part of a comprehensive evidence evaluation in support of the 2 nd International Consensus Report on Precision Diabetes Medicine. Here, we sought to synthesize evidence from empirical research papers published through September 1 st , 2021 to evaluate and identify prognostic conditions, risk factors, and biomarkers among women and children affected by gestational diabetes mellitus (GDM), focusing on clinical endpoints of cardiovascular disease (CVD) and type 2 diabetes (T2D) among women with a history of GDM; and adiposity and cardiometabolic profile among offspring exposed to GDM in utero. We identified a total of 107 observational studies and 12 randomized controlled trials testing the effect of pharmaceutical and/or lifestyle interventions. Broadly, current literature indicates that greater GDM severity, higher maternal body mass index, belonging to racial/ethnic minority group; and unhealthy lifestyle behaviors would predict a woman's risk of incident T2D and CVD, and an unfavorable cardiometabolic profile among offspring. However, the level of evidence is low (Level 4 according to the Diabetes Canada 2018 Clinical Practice Guidelines for diabetes prognosis) largely because most studies leveraged retrospective data from large registries that are vulnerable to residual confounding and reverse causation bias; and prospective cohort studies that may suffer selection and attrition bias. Moreover, for the offspring outcomes, we identified a relatively small body of literature on prognostic factors indicative of future adiposity and cardiometabolic risk. Future high-quality prospective cohort studies in diverse populations with granular data collection on prognostic factors, clinical and subclinical outcomes, high fidelity of follow-up, and appropriate analytical approaches to deal with structural biases are warranted.
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Barforoush TS, Ghadimi R, Pahlevan Z, Ahmadi N, Delavar MA. The relationship between neck circumference and gestational diabetes mellitus in Iranian women. Clin Diabetes Endocrinol 2021; 7:22. [PMID: 34906254 PMCID: PMC8672644 DOI: 10.1186/s40842-021-00136-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/29/2021] [Indexed: 12/31/2022] Open
Abstract
Background The aim of the present study was to assess the relationship between neck circumference and gestational diabetes. Methods This prospective study was conducted on 372 Iranian pregnant women. The criteria set by the American Diabetes Association through 2 h was used to classify subjects with regard to their gestational diabetes. At the 14–16th weeks of pregnancy, the neck circumference was measured. The maternal and fetal outcomes were measured as well. Results The adjusted logistic regression revealed that neck circumference was a predictor for gestational diabetes mellitus (OR = 1.20; 95% CI = 1.06, 1.34; P = 0.002). The ROC analysis depicted that the cut-off for neck circumference in indicating gestational diabetes was 34.3 cm, with the sensitivity of 53% and the specificity of 66%. Conclusion The findings of the present study revealed that the neck circumference of ≥34.3 cm can be deemed as a predictor of gestational diabetes in the case of Iranian pregnant women.
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Affiliation(s)
| | - Reza Ghadimi
- Department of Community Medicine, School of Medicine, Social Determinants of Health, Research Center, Research Institute for Health, Babol University of Medical Sciences, Babol, Iran
| | - Zaynab Pahlevan
- Department of Obstetrics & Gynecology, Infertility and Reproductive Health Research Center, Research Institute for Health, Babol University of Medical Sciences, Babol, Iran
| | - Niloufar Ahmadi
- Student Committee Research, Babol University of Medical Sciences, Babol, Iran
| | - Mouloud Agajani Delavar
- Infertility and Reproductive Health Research Center, Research Institute for Health, Babol University of Medical Sciences, Babol-Amol oldhighway, after Mohammadhasan Khan Bridge, Po. Box: 47135-547, Babol, Mazandaran, Iran.
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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: 27] [Impact Index Per Article: 9.0] [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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You H, Hu J, Liu Y, Luo B, Lei A. Risk of type 2 diabetes mellitus after gestational diabetes mellitus: A systematic review & meta-analysis. Indian J Med Res 2021; 154:62-77. [PMID: 34782531 PMCID: PMC8715678 DOI: 10.4103/ijmr.ijmr_852_18] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background &objectives: Women with gestational diabetes are at an increased risk of being diagnosed as type 2 diabetes, but the postpartum screening rate is low. To provide evidence-based data for health providers and promote postpartum screening, this systematic review and meta-analysis was conducted to access the risks of type 2 diabetes mellitus (T2DM) diagnosis after gestational diabetes mellitus (GDM) in different demographic and maternal subgroups. Methods: MEDLINE, Embase and Cochrane Library were searched systematically. Unadjusted relative risks (RRs) and 95 per cent confidence intervals (CIs) were calculated and pooled using a random-effects model. Heterogeneity was assessed with Cochrane’s Q text and by calculating I2 values. Subgroup analyses were conducted to address the disparities of type 2 diabetes conversion after gestational diabetes in different demographic and maternal subgroups. Results: 1809 publications were screened and 39 cohort studies including 2,847,596 women were selected. In these studies, 78,893 women were diagnosed as T2DM at six weeks or later after delivery. The unadjusted RRs of women diagnosed T2DM at six weeks or later after delivery ranged from 1.32 (95% CI, 0.46-3.37) to 47.25 (95% CI, 2.95-758.01) with a pooled unadjusted RR of 8.92 (95% CI, 7.84-10.14). Older women, women with a family history of diabetes, Black and non-Hispanic White women and women living in Europe and South-East Asia had a higher risk of developing T2DM after GDM. Interpretation & conclusionsxs: It is suggested that healthcare providers may focus on older women with GDM and women with GDM and a family history of diabetes. Black and non-Hispanic White women with GDM may receive more attention, and healthcare providers, especially those in Europe and South-East Asia, may pay more attention to preventive measures for postpartum T2DM.
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Affiliation(s)
- Huaxuan You
- Key Laboratory of Birth Defects & Related Diseases of Women & Children, Ministry of Education; Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Juan Hu
- Key Laboratory of Birth Defects & Related Diseases of Women & Children, Ministry of Education; Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ying Liu
- West China Nursing School, Sichuan University, Chengdu, China
| | - Biru Luo
- Key Laboratory of Birth Defects & Related Diseases of Women & Children, Ministry of Education; Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Anjiang Lei
- Key Laboratory of Birth Defects & Related Diseases of Women & Children, Ministry of Education; Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Kosinski C, Rossel JB, Gross J, Helbling C, Quansah DY, Collet TH, Puder JJ. Adverse metabolic outcomes in the early and late postpartum after gestational diabetes are broader than glucose control. BMJ Open Diabetes Res Care 2021; 9:9/2/e002382. [PMID: 34750153 PMCID: PMC8576469 DOI: 10.1136/bmjdrc-2021-002382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/03/2021] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus is associated with an increased cardiovascular risk. To better target preventive measures, we performed an in-depth characterization of cardiometabolic risk factors in a cohort of women with gestational diabetes in the early (6-8 weeks) and late (1 year) postpartum. RESEARCH DESIGN AND METHODS Prospective cohort of 622 women followed in a university gestational diabetes clinic between 2011 and 2017. 162 patients who attended the late postpartum visit were analyzed in a nested long-term cohort starting in 2015. Metabolic syndrome (MetS) was based on the International Diabetes Federation definition, and then having at least two additional criteria of the MetS (blood pressure, triglycerides, high-density lipoprotein (HDL) cholesterol, plasma glucose above or below the International Diabetes Federation cut-offs). RESULTS Compared with prepregnancy, weight retention was 4.8±6.0 kg in the early postpartum, and the prevalence of obesity, pre-diabetes, MetS-body mass index (BMI) and MetS-waist circumference (WC) were 28.8%, 28.9%, 10.3% and 23.8%, respectively. Compared with the early postpartum, weight did not change and waist circumference decreased by 2.6±0.6 cm in the late postpartum. However, the prevalence of obesity, pre-diabetes, MetS-WC and MetS-BMI increased (relative increase: 11% for obesity, 82% for pre-diabetes, 50% for MetS-WC, 100% for MetS-BMI; all p≤0.001).Predictors for obesity were the use of glucose-lowering treatment during pregnancy and the prepregnancy BMI. Predictors for pre-diabetes were the early postpartum fasting glucose value and family history of diabetes. Finally, systolic blood pressure in pregnancy and in the early postpartum, the 2-hour post oral glucose tolerance test glycemia and the HDL-cholesterol predicted the development of MetS (all p<0.05). CONCLUSIONS The prevalence of metabolic complications increased in the late postpartum, mainly due to an increase in fasting glucose and obesity, although weight did not change. We identified predictors of late postpartum obesity, pre-diabetes and MetS that could lead to high-risk identification and targeted preventions.
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Affiliation(s)
- Christophe Kosinski
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Benoît Rossel
- Department Woman-Mother-Child, Service of Obstetrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Justine Gross
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department Woman-Mother-Child, Service of Obstetrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline Helbling
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Department Woman-Mother-Child, Service of Obstetrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Geneve, Switzerland
| | - Jardena J Puder
- Department Woman-Mother-Child, Service of Obstetrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Ouyang H, Wu N. Effects of Different Glucose-Lowering Measures on Maternal and Infant Outcomes in Pregnant Women with Gestational Diabetes: A Network Meta-analysis. Diabetes Ther 2021; 12:2715-2753. [PMID: 34482529 PMCID: PMC8479018 DOI: 10.1007/s13300-021-01142-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION A network meta-analysis was conducted to compare and rank the effects of different glucose-lowering measures on maternal and infant outcomes in pregnant women with gestational diabetes mellitus (GDM). METHODS We searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases for relevant studies published between database establishment and June 2021. Study retrieval involved subject-heading and keyword searches. Randomized controlled trials (RCTs) with different glucose-lowering treatments for GDM patients were included. The Cochrane tool was used to assess bias risk. Pairwise and network meta-analyses were used to compare and rank the effects of different hypoglycemic measures on maternal and infant outcomes in pregnant women with GDM. RESULTS We included 41 RCTs involving 6245 pregnant women with GDM. Patients treated with insulin had a higher incidence of neonatal intensive care unit (NICU) occupancy (1.3, 95% CI 1.0-1.7) than those treated with metformin. The insulin (1.5, 95% CI 1.1-2.1 and 1.8, 95% CI 1.0-3.3) and glyburide (2.0, 95% CI 1.2-3.2 and 2.5, 95% CI 1.1-8.4) groups exhibited higher incidences of neonatal hypoglycemia and large for gestational age (LGA) newborns than the metformin group. The glyburide group exhibited a lower probability of cesarean section than the metformin (0.76, 95% CI 0.55-1.0) and insulin (0.71, 95% CI 0.52-0.96) groups. Preeclampsia incidence in the diet and exercise groups was significantly lower than in the metformin (0.19, 95% CI 0.043-0.72) and insulin (0.15, 95% CI 0.032-0.52) groups. No intervention significantly reduced the incidences of macrosomia, preterm birth, gestational hypertension, or respiratory distress syndrome (RDS). The ranking results showed that the metformin group had the lowest rates of neonatal hypoglycemia, macrosomia, LGA, and NICU occupancy. The glyburide group had the lowest NICU occupancy and cesarean section rates and the highest neonatal hypoglycemia, LGA, preeclampsia, and gestational hypertension rates. The diet and exercise group had the lowest preterm delivery and preeclampsia rates and the highest NICU occupancy rate. CONCLUSION Metformin is a potentially superior choice for GDM treatment because it is associated with minimal incidences of multiple adverse pregnancy outcome indicators and does not lead to high values of certain adverse outcome indices. Other hypoglycemic agent or diet groups exhibit high incidences of certain adverse outcomes. Therefore, when selecting a GDM treatment strategy, the efficacies and risks of different treatment programs should be evaluated according to the scenario in hand.
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Affiliation(s)
- Hong Ouyang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China.
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, China.
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Burlina S, Dalfrà MG, Lapolla A. Long-term cardio-metabolic effects after gestational diabetes: a review. J Matern Fetal Neonatal Med 2021; 35:6021-6028. [PMID: 33779467 DOI: 10.1080/14767058.2021.1903863] [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: 12/17/2022]
Abstract
Women with GDM are at high risk of metabolic syndrome and type 2 diabetes (T2DM). A relationship with GDM and future development of cardiovascular disease (CVD) has been also recognized. Pregnancy and postpartum period in women with GDM give us the opportunity to identify the underlying, often unrecognized, CVD risk factors. Ideally, the postpartum follow-up of this women should be done by a multidisciplinary team to evaluate their cardio-metabolic risk and to counseling regarding lifestyle modification (healthy diet and regular physical activity) and breastfeeding that can reduce their risk. Longer follow-up of these women should be individualized, focusing attention on women at medium-high cardio-metabolic risk. The link between GDM and T2DM-CVD offers us a great opportunity for the diseases prevention.
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Affiliation(s)
- S Burlina
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - M G Dalfrà
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - A Lapolla
- Department of Medicine - DIMED, University of Padova, Padova, Italy
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Pathirana MM, Lassi ZS, Ali A, Arstall MA, Roberts CT, Andraweera PH. Association between metabolic syndrome and gestational diabetes mellitus in women and their children: a systematic review and meta-analysis. Endocrine 2021; 71:310-320. [PMID: 32930949 DOI: 10.1007/s12020-020-02492-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The primary aim of this systematic review and meta-analysis was to determine the association between gestational diabetes mellitus (GDM) and metabolic syndrome (MetS) in women and children. Our secondary aim was to assess the development of MetS with respect to the elapsed time postpartum at which MetS was diagnosed. METHODS This review is registered with PROSPERO (CRD42020173319). PubMed, CINHAL, SCOPUS, and EMBASE databases were searched. Studies reporting on the rate of MetS in pregnant women with GDM, the rate of MetS in women with a history of GDM, and the rate of MetS in offspring exposed to GDM in utero compared to healthy controls were selected. RESULTS We identified 588 articles from the literature search. Fifty-one studies were included in the review and of those 35 were included in the meta-analysis. Quantitative summary measures showed that women with a history of GDM had an increased risk of developing MetS compared to those without a history of GDM (RR 2.36, 95% CI 1.77-3.14, 29 studies, 13,390 participants; heterogeneity: χ2 p < 0.00001; I2 = 93%). Offspring exposed to GDM in utero have an increased risk of developing MetS compared to those not exposed to GDM in utero. (RR 2.07, 95% CI 1.26-3.42, three studies, 4,421 participants; heterogeneity: χ2 p = 0.33; I2 = 12%). Women diagnosed with GDM have an increased risk of developing MetS during pregnancy (RR 20.51, 95% CI 5.04-83.55; three studies, 406 participants; heterogeneity: χ2 p = 0.96; I2 = 0%). Subgroup analysis revealed that MetS is diagnosed as early as <1 year postpartum in women with a history of GDM. CONCLUSIONS/INTERPRETATION Women with GDM have an increased risk of developing MetS during pregnancy. Women with a history of GDM and offspring exposed to GDM in utero have higher risks of developing MetS compared to those with no history of GDM. Metabolic syndrome in women with a history of GDM is seen as early as <1 year postpartum.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Zohra S Lassi
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Health Performance and Policy Research Unit, Basil Hetzel Institute, The University of Adelaide, Adelaide, SA, Australia
- Adelaide G-TRAC Centre and CRE Frailty and Healthy Ageing Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Margaret A Arstall
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Prabha H Andraweera
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, 5005, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
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OuYang H, Chen B, Abdulrahman AM, Li L, Wu N. Associations between Gestational Diabetes and Anxiety or Depression: A Systematic Review. J Diabetes Res 2021; 2021:9959779. [PMID: 34368368 PMCID: PMC8337159 DOI: 10.1155/2021/9959779] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022] Open
Abstract
Gestational diabetes mellitus (GDM) pregnant women are under more psychological stress than normal pregnant women. With the deepening of the study of gestational diabetes mellitus, research has shown that anxiety and depression are also an important cause of gestational diabetes mellitus. Anxiety and depression can cause imbalances in the hormone levels in the body, which has a serious impact on the pregnancy outcome and blood glucose control of pregnant women with GDM. Therefore, the main purpose of this paper is to provide a systematic review of the association between anxiety, depression, and GDM, as well as the adverse effects on pregnant women with GDM. To this end, we searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases. Studies on the incidence of anxiety, depression, and GDM, blood glucose in pregnant women with GDM, delivery mode, and maternal and infant outcomes were included to be analyzed, and the source of anxiety and depression in pregnant women with GDM and related treatment measures were discussed.
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Affiliation(s)
- Hong OuYang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bo Chen
- Department of Endocrinology, The First People's Hospital of Kerqin District, Tongliao City, Inner Mongolia, China
| | - Al-Mureish Abdulrahman
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, China
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Contreras-Duarte S, Carvajal L, Garchitorena MJ, Subiabre M, Fuenzalida B, Cantin C, Farías M, Leiva A. Gestational Diabetes Mellitus Treatment Schemes Modify Maternal Plasma Cholesterol Levels Dependent to Women´s Weight: Possible Impact on Feto-Placental Vascular Function. Nutrients 2020; 12:E506. [PMID: 32079298 PMCID: PMC7071311 DOI: 10.3390/nu12020506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/11/2020] [Indexed: 12/19/2022] Open
Abstract
: Gestational diabetes mellitus (GDM) associates with fetal endothelial dysfunction (ED), which occurs independently of adequate glycemic control. Scarce information exists about the impact of different GDM therapeutic schemes on maternal dyslipidemia and obesity and their contribution to the development of fetal-ED. The aim of this study was to evaluate the effect of GDM-treatments on lipid levels in nonobese (N) and obese (O) pregnant women and the effect of maternal cholesterol levels in GDM-associated ED in the umbilical vein (UV). O-GDM women treated with diet showed decreased total cholesterol (TC) and low-density lipoproteins (LDL) levels with respect to N-GDM ones. Moreover, O-GDM women treated with diet in addition to insulin showed higher TC and LDL levels than N-GDM women. The maximum relaxation to calcitonin gene-related peptide of the UV rings was lower in the N-GDM group compared to the N one, and increased maternal levels of TC were associated with even lower dilation in the N-GDM group. We conclude that GDM-treatments modulate the TC and LDL levels depending on maternal weight. Additionally, increased TC levels worsen the GDM-associated ED of UV rings. This study suggests that it could be relevant to consider a specific GDM-treatment according to weight in order to prevent fetal-ED, as well as to consider the possible effects of maternal lipids during pregnancy.
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Affiliation(s)
- Susana Contreras-Duarte
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; (L.C.); (M.J.G.); (M.S.); (B.F.); (C.C.); (M.F.)
| | - Lorena Carvajal
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; (L.C.); (M.J.G.); (M.S.); (B.F.); (C.C.); (M.F.)
| | - María Jesús Garchitorena
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; (L.C.); (M.J.G.); (M.S.); (B.F.); (C.C.); (M.F.)
| | - Mario Subiabre
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; (L.C.); (M.J.G.); (M.S.); (B.F.); (C.C.); (M.F.)
| | - Bárbara Fuenzalida
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; (L.C.); (M.J.G.); (M.S.); (B.F.); (C.C.); (M.F.)
| | - Claudette Cantin
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; (L.C.); (M.J.G.); (M.S.); (B.F.); (C.C.); (M.F.)
| | - Marcelo Farías
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; (L.C.); (M.J.G.); (M.S.); (B.F.); (C.C.); (M.F.)
| | - Andrea Leiva
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; (L.C.); (M.J.G.); (M.S.); (B.F.); (C.C.); (M.F.)
- School of Medical Technology, Health Sciences Faculty, Universidad San Sebastian, Santiago 8330024, Chile
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12
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Dincgez Cakmak B, Dundar B, Ketenci Gencer F, Yildiz DE, Bayram F, Ozgen G, Aydin Boyama B. Assessment of relationship between serum vascular adhesion protein-1 (VAP-1) and gestational diabetes mellitus. Biomarkers 2019; 24:750-756. [DOI: 10.1080/1354750x.2019.1684562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Burcu Dincgez Cakmak
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, University of Health Sciences, Bursa, Turkey
| | - Betul Dundar
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, University of Health Sciences, Bursa, Turkey
| | - Fatma Ketenci Gencer
- Department of Obstetrics and Gynecology, Gaziosmanpasa Taksim Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Durkadin Elif Yildiz
- Department of Obstetrics and Gynecology, Gaziosmanpasa Taksim Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Feyza Bayram
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, University of Health Sciences, Bursa, Turkey
| | - Gulten Ozgen
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, University of Health Sciences, Bursa, Turkey
| | - Burcu Aydin Boyama
- Department of Obstetrics and Gynecology, Medipol University Esenler Hospital, Istanbul, Turkey
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13
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Lorenzo-Almorós A, Hang T, Peiró C, Soriano-Guillén L, Egido J, Tuñón J, Lorenzo Ó. Predictive and diagnostic biomarkers for gestational diabetes and its associated metabolic and cardiovascular diseases. Cardiovasc Diabetol 2019; 18:140. [PMID: 31666083 PMCID: PMC6820966 DOI: 10.1186/s12933-019-0935-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as the presence of high blood glucose levels with the onset, or detected for the first time during pregnancy, as a result of increased insulin resistance. GDM may be induced by dysregulation of pancreatic β-cell function and/or by alteration of secreted gestational hormones and peptides related with glucose homeostasis. It may affect one out of five pregnancies, leading to perinatal morbidity and adverse neonatal outcomes, and high risk of chronic metabolic and cardiovascular injuries in both mother and offspring. Currently, GDM diagnosis is based on evaluation of glucose homeostasis at late stages of pregnancy, but increased age and body-weight, and familiar or previous occurrence of GDM, may conditionate this criteria. In addition, an earlier and more specific detection of GDM with associated metabolic and cardiovascular risk could improve GDM development and outcomes. In this sense, 1st-2nd trimester-released biomarkers found in maternal plasma including adipose tissue-derived factors such as adiponectin, visfatin, omentin-1, fatty acid-binding protein-4 and retinol binding-protein-4 have shown correlations with GDM development. Moreover, placenta-related factors such as sex hormone-binding globulin, afamin, fetuin-A, fibroblast growth factors-21/23, ficolin-3 and follistatin, or specific micro-RNAs may participate in GDM progression and be useful for its recognition. Finally, urine-excreted metabolites such as those related with serotonin system, non-polar amino-acids and ketone bodies, may complete a predictive or early-diagnostic panel of biomarkers for GDM.
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Affiliation(s)
- A Lorenzo-Almorós
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - T Hang
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - C Peiró
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - L Soriano-Guillén
- Department of Paediatrics, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - J Egido
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain
| | - J Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Ó Lorenzo
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain.
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain.
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14
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Benhalima K, Lens K, Bosteels J, Chantal M. The Risk for Glucose Intolerance after Gestational Diabetes Mellitus since the Introduction of the IADPSG Criteria: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8091431. [PMID: 31510081 PMCID: PMC6780861 DOI: 10.3390/jcm8091431] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of the study was to assess the postpartum risk for glucose intolerance since the introduction of the ‘International Association of Diabetes and Pregnancy Study Groups’ (IADPSG) criteria for gestational diabetes mellitus (GDM). Studies published since 2010 were included, which evaluated the risk for type 2 diabetes mellitus (T2DM), impaired glucose tolerance (IGT), and cardiovascular (CV) events in women with previous GDM compared to normal glucose tolerant women. We included forty-three studies, evaluating 4,923,571 pregnant women of which 5.8% (284,312) had a history of GDM. Five studies used IADPSG criteria (n = 6174 women, 1314 with GDM). The overall pooled relative risk (RR) for postpartum T2DM was 7.42 (95% CI: 5.99–9.19) and the RR for postpartum T2DM with IADPSG criteria was 6.45 (95% CI: 4.74–8.77) compared to the RR of 9.08 (95% CI: 6.96–11.85; p = 0.17) for postpartum T2DM based on other diagnostic criteria. The RR for postpartum IGT was 2.45 (95% CI: 1.92–3.13), independent of the criteria used. None of the available studies with IADPSG criteria evaluated the risk for CV events. Women with a history of GDM based on the IADPSG criteria have a similarly increased risk for postpartum glucose intolerance compared to GDM based on other diagnostic criteria. More studies with GDM based on the IADPSG criteria are needed to increase the quality of evidence concerning the long-term metabolic risk.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Karen Lens
- Medical school, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Bosteels
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium
| | - Mathieu Chantal
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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15
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Nouhjah S, Shahbazian H, Shahbazian N, Jahanfar S, Jahanshahi A, Cheraghian B, Mohammadi ZD, Ghodrati N, Houshmandi S. Early postpartum metabolic syndrome in women with or without gestational diabetes: Results from Life after Gestational Diabetes Ahvaz cohort study. Diabetes Metab Syndr 2018; 12:317-323. [PMID: 29289537 DOI: 10.1016/j.dsx.2017.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/21/2017] [Indexed: 01/01/2023]
Abstract
AIMS This study aimed to determine the prevalence rate of metabolic syndrome and its potential risk factors, 6-12 weeks postpartum in women with GDM compared to women with normal glucose tolerance. METHODS LAGAs is an ongoing population-based prospective cohort study that started in March 2015 in Ahvaz, Iran. During 11 months of study progression, 176 women with GDM pregnancy and 86 healthy women underwent a fasting glucose test, 75-g OGTT and fasting lipid tests at 6-12 weeks postpartum. GDM was defined based on IADPSG criteria. Postpartum glucose intolerance was defined according to ADA criteria and metabolic syndrome using 2 sets of criteria. RESULTS The overall rate of metabolic syndrome at 6-12 weeks postpartum was 16% by NCEP-ATP III criteria (18.2% in women with GDM and 11.6% in controls) and 19.1% by IDF criteria (21% in women with gestational diabetes and 15.1% in controls). Pre-pregnancy overweight or obesity, (OR 1.89, 95% CI: 1.05-3.38, P = .03), pregnancy systolic blood pressure (OR 1.03, 95% CI: 1.008-1.52, P = .006) and requiring insulin or metformin (OR 3.08, 95% CI: 1.25-7.60, P = 0.01), were associated risk factors for the presence of MetS in GDM-exposed women. In women with normal glucose during pregnancy, pre-pregnancy BMI ≥25 kg/m2 was a risk factor of metabolic syndrome (OR 2.82, 95% CI: 1.11-7.15, P = .02). CONCLUSION The rate of metabolic syndrome in women with or without GDM at 6-12 weeks postpartum is high particularly in women with high BMI. An early postpartum prevention and screening program for cardiovascular risk factors is important for women with GDM.
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Affiliation(s)
- Sedigheh Nouhjah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nahid Shahbazian
- Department of Obstetrics and Gynecology, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shayesteh Jahanfar
- School of Health Sciences Building 2212, Room 2239 Central Michigan University, Mount Pleasant, MI 48859, USA.
| | - Alireza Jahanshahi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Internal Medicine Ward, Golestan Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Zeinab Dehghan Mohammadi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Niloofar Ghodrati
- Student Research Committee, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Sousan Houshmandi
- Department of Midwifery, Ardabil University of medical sciences, Ardabil, Iran.
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16
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Song C, Lyu Y, Li C, Liu P, Li J, Ma RC, Yang X. Long-term risk of diabetes in women at varying durations after gestational diabetes: a systematic review and meta-analysis with more than 2 million women. Obes Rev 2018; 19:421-429. [PMID: 29266655 DOI: 10.1111/obr.12645] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/23/2017] [Accepted: 10/18/2017] [Indexed: 01/02/2023]
Abstract
This study aims to investigate the impact of gestational diabetes mellitus (GDM) on the long-term risks of diabetes in women with prior GDM, including the effect at different time periods after GDM. We searched PubMed and other databases to retrieve articles which were published prior to February 28, 2017. Cohort studies which evaluated the risk and time of onset of diabetes postpartum in women with and without GDM were included. Meta-analysis with random effects models was used to obtain pooled relative risks and 95% confidence intervals for the risk of diabetes. Subgroup analyses were performed to check for different effect sizes as well as consistency across groups. Multivariable logistic regression was used to adjust for confounders. Thirty cohort studies with 2,626,905 pregnant women were included. Women with prior GDM had 7.76-fold (95% confidence intervals: 5.10-11.81) unadjusted pooled risk of diabetes as compared with women without GDM, whilst the adjusted risk was 17.92-fold (16.96-18.94). The adjusted ORs of GDM for diabetes among women at <3, ≥3 - <6 and ≥6 - <10 years after GDM were 5.37 (3.51-9.34), 16.55 (16.08-17.04) and 8.20 (4.53-14.86), respectively. Women with prior GDM had substantially increased risk of diabetes, with the risk highest during the 3-6 years after GDM.
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Affiliation(s)
- C Song
- Department of Epidemiology and Biostatistics, School of Public Health and National Demonstration Center for Experimental Preventive Medicine Education, Tianjin Medical University, Tianjin, China.,Center for Disease Control and Prevention of Tianjin Economic-Technological Development Area (TEDA), TEDA, Tianjin, China
| | - Y Lyu
- Division of General Internal Medicine, Tianjin Hospital, Tianjin, China
| | - C Li
- Department of Epidemiology and Biostatistics, School of Public Health and National Demonstration Center for Experimental Preventive Medicine Education, Tianjin Medical University, Tianjin, China
| | - P Liu
- Department of Nursing, Tianjin Medical College, Tianjin, China
| | - J Li
- Department of Epidemiology and Biostatistics, School of Public Health and National Demonstration Center for Experimental Preventive Medicine Education, Tianjin Medical University, Tianjin, China
| | - R C Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - X Yang
- Department of Epidemiology and Biostatistics, School of Public Health and National Demonstration Center for Experimental Preventive Medicine Education, Tianjin Medical University, Tianjin, China
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17
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Wu P, Farrell WE, Haworth KE, Emes RD, Kitchen MO, Glossop JR, Hanna FW, Fryer AA. Maternal genome-wide DNA methylation profiling in gestational diabetes shows distinctive disease-associated changes relative to matched healthy pregnancies. Epigenetics 2018; 13:122-128. [PMID: 27019060 DOI: 10.1080/15592294.2016.1166321] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Several recent reports have described associations between gestational diabetes (GDM) and changes to the epigenomic landscape where the DNA samples were derived from either cord or placental sources. We employed genome-wide 450K array analysis to determine changes to the epigenome in a unique cohort of maternal blood DNA from 11 pregnant women prior to GDM development relative to matched controls. Hierarchical clustering segregated the samples into 2 distinct clusters comprising GDM and healthy pregnancies. Screening identified 100 CpGs with a mean β-value difference of ≥0.2 between cases and controls. Using stringent criteria, 5 CpGs (within COPS8, PIK3R5, HAAO, CCDC124, and C5orf34 genes) demonstrated potentials to be clinical biomarkers as revealed by differential methylation in 8 of 11 women who developed GDM relative to matched controls. We identified, for the first time, maternal methylation changes prior to the onset of GDM that may prove useful as biomarkers for early therapeutic intervention.
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Affiliation(s)
- Pensee Wu
- a Institute for Science and Technology in Medicine , Keele University, Guy Hilton Research Center , Staffordshire , UK.,b Academic Unit of Obstetrics and Gynecology, University Hospital of North Midlands NHS Trust , Stoke-on-Trent, Staffordshire , UK
| | - William E Farrell
- a Institute for Science and Technology in Medicine , Keele University, Guy Hilton Research Center , Staffordshire , UK
| | - Kim E Haworth
- a Institute for Science and Technology in Medicine , Keele University, Guy Hilton Research Center , Staffordshire , UK
| | - Richard D Emes
- c School of Veterinary Medicine and Science, University of Nottingham , Leicestershire , UK.,d Advanced Data Analysis Center , University of Nottingham , Leicestershire , UK
| | - Mark O Kitchen
- a Institute for Science and Technology in Medicine , Keele University, Guy Hilton Research Center , Staffordshire , UK
| | - John R Glossop
- a Institute for Science and Technology in Medicine , Keele University, Guy Hilton Research Center , Staffordshire , UK.,e Haywood Rheumatology Center, Haywood Hospital , Staffordshire , UK
| | - Fahmy W Hanna
- f Department of Diabetes and Endocrinology , University Hospital of North Midlands NHS Trust , Stoke-on-Trent, Staffordshire , UK
| | - Anthony A Fryer
- a Institute for Science and Technology in Medicine , Keele University, Guy Hilton Research Center , Staffordshire , UK
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18
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Saklamaz A, Akyıldız M, Kasap E, Cengiz H. Gestasyonel diabetes mellitusta osteopontin seviyeleri artmaz. EGE TIP DERGISI 2017. [DOI: 10.19161/etd.395216] [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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19
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Vilmi-Kerälä T, Koivistoinen T, Palomäki O, Uotila J, Palomäki A. Arterial stiffness in fertile women with metabolic syndrome. Ann Med 2017; 49:636-643. [PMID: 28590772 DOI: 10.1080/07853890.2017.1339907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Although metabolic syndrome (MetS) is evidently associated with the risk of cardiovascular disease (CVD), recently its use has been questioned. We studied the utility of MetS diagnosis when estimating individual CVD risk. METHODS We compared 27 fertile women with MetS and 27 counterparts without the syndrome, matched pairwise according to well-known risk factors of CVD. Pulse wave velocity (PWV) and central blood pressure (cBP) were determined noninvasively via a SphygmoCor device. Arterial compliance was measured noninvasively with an HDI/PulseWaveTMCR-2000 arterial tonometer. RESULTS PWV (7.1 ± 2.5 versus 6.5 ± 1.1 m/s, p = .037), and both systolic (120.9 ± 12.2 versus 111.5 ± 16.0 mmHg, p = .031) and diastolic cBP (81.3 ± 8.5 versus 74.1 ± 11.2 mmHg, p = .035) were higher in the MetS group. Systemic arterial compliance values were lower in both large (15.1 ± 8.0 versus 16.1 ± 4.4 mL/mmHg × 10, p = .034) and small arteries (7.1 ± 2.5 versus 9.3 ± 3.2 mL/mmHg ×100, p = .010) in women with MetS. CONCLUSIONS Fertile women with MetS had increased arterial stiffness, as measured by three different methods. Our results highlight the utility of MetS when revealing increased individual CVD risks in fertile-aged women. Key messages Women with MetS have increased arterial stiffness when measured by different methods. MetS is a useful clinical tool to assess increased cardiovascular risk, particularly among fertile-aged women.
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Affiliation(s)
- Tiina Vilmi-Kerälä
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Obstetrics and Gynecology , Tampere University Hospital , Tampere , Finland
| | - Teemu Koivistoinen
- c Department of Emergency Medicine , Kanta-Häme Central Hospital , Hämeenlinna , Finland
| | - Outi Palomäki
- b Department of Obstetrics and Gynecology , Tampere University Hospital , Tampere , Finland
| | - Jukka Uotila
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Obstetrics and Gynecology , Tampere University Hospital , Tampere , Finland
| | - Ari Palomäki
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,c Department of Emergency Medicine , Kanta-Häme Central Hospital , Hämeenlinna , Finland.,d Cardiometabolic Unit , Linnan Klinikka , Hämeenlinna , Finland
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20
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Jensen LA, Chik CL, Ryan EA. Review of gestational diabetes mellitus effects on vascular structure and function. Diab Vasc Dis Res 2016; 13:170-82. [PMID: 26940821 DOI: 10.1177/1479164115624681] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Vascular dysfunction has been described in women with a history of gestational diabetes mellitus. Furthermore, previous gestational diabetes mellitus increases the risk of developing Type 2 diabetes mellitus, a risk factor for cardiovascular disease. Factors contributing to vascular changes remain uncertain. The aim of this review was to summarize vascular structure and function changes found to occur in women with previous gestational diabetes mellitus and to identify factors that contribute to vascular dysfunction. A systematic search of electronic databases yielded 15 publications from 1998 to March 2014 that met the inclusion criteria. Our review confirmed that previous gestational diabetes mellitus contributes to vascular dysfunction, and the most consistent risk factor associated with previous gestational diabetes mellitus and vascular dysfunction was elevated body mass index. Heterogeneity existed across studies in determining the relationship of glycaemic levels and insulin resistance to vascular dysfunction.
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Affiliation(s)
- Louise A Jensen
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Constance L Chik
- Division of Endocrinology & Metabolism, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Edmond A Ryan
- Division of Endocrinology & Metabolism, Alberta Diabetes Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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21
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Liu H, Zhang S, Wang L, Leng J, Li W, Li N, Li M, Qiao Y, Tian H, Tuomilehto J, Yang X, Yu Z, Hu G. Fasting and 2-hour plasma glucose, and HbA1c in pregnancy and the postpartum risk of diabetes among Chinese women with gestational diabetes. Diabetes Res Clin Pract 2016; 112:30-36. [PMID: 26686048 PMCID: PMC4753114 DOI: 10.1016/j.diabres.2015.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/26/2015] [Accepted: 11/18/2015] [Indexed: 01/11/2023]
Abstract
AIMS Very few studies have assessed the association of fasting and 2h glucose, and HbA1c during pregnancy with postpartum diabetes risk among women with prior gestational diabetes mellitus (GDM). We assessed the association of fasting glucose, 2h glucose and HbA1c at 26-30 gestational weeks with postpartum diabetes risk among women with prior GDM. METHODS A cohort study in 1263 GDM women at 1-5 years after delivery was performed. Cox proportional hazards regression models were used to evaluate the association of fasting and 2h plasma glucose, and HbA1c at 26-30 gestational weeks with the risk of diabetes at postpartum. RESULTS The multivariable-adjusted (age, pre-pregnancy body mass index, weight gain during pregnancy, current body mass index, family history of diabetes, marital status, education, family income, smoking status, passive smoking, leisure-time physical activity, alcohol drinking, and intake of energy, saturated fat, and dietary fiber) hazard ratios of postpartum diabetes were 1.61 (95% confidence interval [CI]: 1.36-1.91) for each 1 mmol/l increase in fasting glucose during pregnancy, 1.63 (95% CI: 1.45-1.84) for each 1 mmol/l increase in 2h glucose during pregnancy, 2.11 (95% CI: 1.50-2.97) for each 1 unit (%) increase in HbA1c during pregnancy. When fasting glucose, 2h glucose and HbA1c during pregnancy were entered multivariable-adjusted model simultaneously, 2h glucose and HbA1c but not fasting glucose remained to be significant and positive predictors for postpartum diabetes. CONCLUSIONS For women with prior GDM, 2h plasma glucose and HbA1c during pregnancy are independent predictors of postpartum diabetes, but fasting plasma glucose during pregnancy is not.
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Affiliation(s)
- Huikun Liu
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Nan Li
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Min Li
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Yijuan Qiao
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Huiguang Tian
- Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland; Centre for Vascular Prevention, Danube-University Krems, 3500 Krems, Austria; Department of Chronic Disease Prevention, National Institute for Health and Welfare, 00271 Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, 21589 Jeddah, Saudi Arabia
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, Tianjin Medical University, 22 Qixiangtai Road, Heping district, Tianjin 300070, China
| | - Zhijie Yu
- Population Cancer Research program, Dalhousie University, 6299 South Street, Halifax, NS, Canada B3H 4R2
| | - Gang Hu
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Kern Pessôa VN, Rodacki M, Negrato CA, Zajdenverg L. Changes in lipid profile after treatment of women with gestational diabetes mellitus. J Clin Lipidol 2015; 10:350-5. [PMID: 27055966 DOI: 10.1016/j.jacl.2015.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/29/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insulin resistance, a key factor in the pathophysiology of gestational diabetes mellitus (GDM), is associated with an atherogenic lipid profile. Lipid metabolism is altered during normal pregnancy, but it is still unknown how the treatment of GDM affects lipoprotein concentrations. OBJECTIVE To evaluate maternal lipids at GDM diagnosis, after treatment, and in the puerperium and analyze the influence of BMI, insulin requirement, and glycemic control on lipoproteins. METHODS In this observational prospective study, total cholesterol (TC), HDL, and triglycerides (TG) were measured, and LDL was calculated at diagnosis (Dx), at 3-6 weeks after GDM treatment initiation (PI, post initiation) and 6-week postpartum (PP). Subgroups analyses were performed according to categories of maternal BMI, insulin requirement, and quality of glucose control. RESULTS TC and TG increased from Dx to PI and decreased in PP (TC: 213.6 mg/dL, 223.9 mg/dL, and 195.5 mg/dL; TG: 181.5 mg/dL, 203.5 mg/dL, and 100.5 mg/dL, at Dx, PI, and PP, respectively; P < .0001). HDL declined in the puerperium (Dx = 60 mg/dL, PI = 60.8 mg/dL, PP = 51.8 mg/dL; P < .0001 for Dx-PP and PI-PP, respectively). Insulin-treated patients showed an increase in LDL from Dx to PP, whereas LDL declined in the diet-only group (12 vs -11.1 mg/dL, P = .010). TC and TG increased from Dx to PI in patients with adequate glycemic control and decreased in the uncontrolled subgroup (TC: 15.5 vs -1.2 mg/dL, P = .041; TG: 29.7 vs -12.5 mg/dL, P = .07). No significant differences in lipids variation were observed according to BMI. CONCLUSIONS Insulin requirement and glycemic control status directly affected the variation of lipid profile in women with GDM.
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Affiliation(s)
| | - Melanie Rodacki
- Internal Medicine Department, Diabetes Section-Federal University of Rio de Janeiro, Brazil
| | | | - Lenita Zajdenverg
- Internal Medicine Department, Diabetes Section-Federal University of Rio de Janeiro, Brazil
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Ajala O, Jensen LA, Ryan E, Chik C. Women with a history of gestational diabetes on long-term follow up have normal vascular function despite more dysglycemia, dyslipidemia and adiposity. Diabetes Res Clin Pract 2015; 110:309-14. [PMID: 26489823 DOI: 10.1016/j.diabres.2015.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/17/2015] [Accepted: 10/01/2015] [Indexed: 12/26/2022]
Abstract
AIMS Previous gestational diabetes (GDM) is a risk factor for type 2 diabetes and increased metabolic risk, but the link with vascular dysfunction is not clear. This study examined vascular function in women 4-10 years after a diagnosis of GDM who had a normal oral glucose tolerance test (OGTT) in the first postpartum year. METHODS We studied 90 women with a history of GDM and 59 age-matched controls, examining differences in insulin resistance as measured by the Homeostatic Model Assessment (HOMA-IR) and glucose responses during an OGTT, adiposity, lipid profile and C-reactive protein (CRP). Using pulse wave analysis, we also measured cardiac function, vascular compliance, and systemic vascular resistance. RESULTS Women with a history of GDM had higher measures of adiposity (body mass index 28.9 ± 6.5 vs. 26.6 ± 6.9 kg/m(2), P=0.04, waist-hip ratio 0.85 ± 0.06 vs. 0.79 ± 0.07, P<0.001), dyslipidemia (LDL cholesterol 2.78 ± 0.64 vs. 2.41 ± 0.56 mmol/L, P<0.001, total cholesterol: HDL cholesterol 3.93 ± 1.2 vs. 3.21 ± 0.82 mmol/L, P<0.001) and abnormal glucose metabolism (50% vs. 12%, P<0.001). However, there was no difference in CRP, HOMA-IR, or measures of cardiovascular function including pulse rate, pulse pressure, mean arterial pressure, cardiac output, systemic vascular resistance, small and large artery elasticity index. After controlling for adiposity, blood pressure, lipids and CRP, glycemic status did not contribute to vascular function. CONCLUSION Despite a higher incidence of adiposity, dyslipidemia, and impaired glycemia, women with a history of GDM who had a normal postpartum OGTT did not have impaired vascular function 4-10 years postpartum, when compared to healthy controls.
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Affiliation(s)
- Olubukola Ajala
- Division of Endocrinology and Metabolism, Department of Medicine, 9th Floor, Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada.
| | - Louise A Jensen
- Faculty of Nursing Level 3 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
| | - Edmond Ryan
- Division of Endocrinology and Metabolism, Department of Medicine, 9th Floor, Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
| | - Constance Chik
- Division of Endocrinology and Metabolism, Department of Medicine, 9th Floor, Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
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24
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Bartáková V, Malúšková D, Mužík J, Bělobrádková J, Kaňková K. Possibility to predict early postpartum glucose abnormality following gestational diabetes mellitus based on the results of routine mid-gestational screening. Biochem Med (Zagreb) 2015; 25:460-8. [PMID: 26526166 PMCID: PMC4622188 DOI: 10.11613/bm.2015.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/02/2015] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Women with previous gestational diabetes mellitus (GDM) have increased risk of developing glucose abnormality, but current diagnostic criteria are evidence-based for adverse pregnancy outcome. THE AIMS OF OUR STUDY WERE (i) to ascertain a frequency of early conversion of GDM into permanent glucose abnormality, (ii) to determine predictive potential of current GDM diagnostic criteria for prediction of postpartum glucose abnormality and (iii) to find optimal cut-off values of oral glucose tolerance test (oGTT) to stratify GDM population according to postpartum risk. MATERIALS AND METHODS Electronic medical records of an ethnically homogenous cohort of women diagnosed and treated for GDM in a single medical centre during the period 2005-2011 who completed postpartum oGTT up to 1 year after the index delivery were retrospectively analysed (N=305). RESULTS Postpartum glucose abnormality was detected in 16.7% subjects. Mid-trimester oGTT values, respective area under the curve and HbA1c were significantly associated with early postpartum glucose abnormality (P<0.05, Mann-Whitney) and exhibited significant predictive potential for postpartum glucose abnormality risk assessment. Optimal cut-off values for discrimination of at-risk sub-population were identified using ROC analysis and their comparison with WHO and IADPSG criteria exhibited superiority of IADPSG for risk-stratification of GDM population. CONCLUSION Risk-based stratification at the time of GDM diagnosis could improve efficiency of the post-gestational screening for diabetes. IADPSG criteria seem to optimally capture both perinatal and maternal metabolic risks and are therefore medically and economically justified.
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Affiliation(s)
- Vendula Bartáková
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Denisa Malúšková
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Jan Mužík
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Jana Bělobrádková
- Diabetes Centre, Department of Internal Medicine - Gastroenterology, University Hospital Brno, Czech Republic
| | - Kateřina Kaňková
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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25
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Carter EB, Stuart JJ, Farland LV, Rich-Edwards JW, Zera CA, McElrath TF, Seely EW. Pregnancy Complications as Markers for Subsequent Maternal Cardiovascular Disease: Validation of a Maternal Recall Questionnaire. J Womens Health (Larchmt) 2015; 24:702-12. [PMID: 26061196 DOI: 10.1089/jwh.2014.4953] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We designed and tested the validity of a questionnaire to characterize maternal recall of pregnancy complications associated with increased future cardiovascular disease risk, based on the 2011 American Heart Association (AHA) guidelines. METHODS A maternal recall questionnaire of pregnancy history was administered to 971 patients who had participated in a previous cohort study of 1,608 pregnant women. Medical records from the study pregnancy served as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV), and/or Spearman's correlation coefficients (r) were calculated for each question. RESULTS A total of 526 (54%) individuals recontacted responded. Respondents were more likely to be older, white, educated, and nulliparous and were less likely to deliver low-birthweight infants in the study pregnancy than were individuals who did not respond. Mean length of recall was 4.35 years (standard deviation [SD] 0.46) postpartum. Maternal recall was most accurate for gestational diabetes (sens: 92%, spec: 98%, PPV: 79%, NPV: 99%), infant birthweight (r=0.95), and gestation length (r=0.85). Maternal recall was modest for preeclampsia (sens: 79%, spec: 97%, PPV: 68%, NPV: 98%) and pregnancy-associated hypertension, including preeclampsia or gestational hypertension (sens: 60%, spec: 95%, PPV: 64%, NPV: 94%). CONCLUSIONS This validation study demonstrated that the majority of women could accurately recall a history of gestational diabetes, infant birthweight, and gestational age at delivery, 4 years postpartum on average. Recall of preeclampsia and pregnancy-associated hypertension overall was modest. Maternal report of these pregnancy conditions may help clinicians identify women at increased risk for cardiovascular disease.
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Affiliation(s)
- Ebony Boyce Carter
- 1 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Barnes-Jewish Hospital, Washington University School of Medicine , St. Louis, Missouri
| | - Jennifer J Stuart
- 2 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- 3 Connors Center for Women's Health and Gender Biology, Division of Women's Health, Brigham and Women's Hospital , Boston, Massachusetts
| | - Leslie V Farland
- 2 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Janet W Rich-Edwards
- 2 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- 3 Connors Center for Women's Health and Gender Biology, Division of Women's Health, Brigham and Women's Hospital , Boston, Massachusetts
| | - Chloe A Zera
- 4 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - Thomas F McElrath
- 4 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - Ellen W Seely
- 5 Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital , Boston, Massachusetts
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26
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Noctor E, Dunne FP. Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria. World J Diabetes 2015; 6:234-244. [PMID: 25789105 PMCID: PMC4360417 DOI: 10.4239/wjd.v6.i2.234] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/17/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
A previous diagnosis of gestational diabetes (GDM) carries a lifetime risk of progression to type 2 diabetes of up to 60%. Identification of those women at higher risk of progression to diabetes allows the timely introduction of measures to delay or prevent diabetes onset. However, there is a large degree of variability in the literature with regard to the proportion of women with a history of GDM who go on to develop diabetes. Heterogeneity between cohorts with regard to diagnostic criteria used, duration of follow-up, and the characteristics of the study population limit the ability to make meaningful comparisons across studies. As the new International Association for Diabetes in Pregnancy Study Group criteria are increasingly adopted worldwide, the prevalence of GDM is set to increase by two-to three-fold. Here, we review the literature to examine the evolution of diagnostic criteria for GDM, the implications of changing criteria on the proportion of women with previous GDM progressing to diabetes, and how the use of different diagnostic criteria may influence the development of appropriate follow-up strategies.
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Vilmi-Kerälä T, Palomäki O, Vainio M, Uotila J, Palomäki A. The risk of metabolic syndrome after gestational diabetes mellitus - a hospital-based cohort study. Diabetol Metab Syndr 2015; 7:43. [PMID: 26893617 PMCID: PMC4758091 DOI: 10.1186/s13098-015-0038-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/27/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) are at an increased risk of developing metabolic syndrome (MetS) after delivery. Recently, the prevalence of both GDM and MetS has increased worldwide, in parallel with obesity. We investigated whether the presentation of MetS and its clinical features among women with previous GDM differs from that among those with normal glucose tolerance during pregnancy, and whether excess body weight affects the results. METHODS This hospital-based study of two cohorts was performed in Kanta-Häme Central Hospital, Finland. 120 women with a history of GDM and 120 women with a history of normal glucose metabolism during pregnancy, all aged between 25 and 46 were enrolled. They all underwent physical examination and had baseline blood samples taken. All 240 women were also included in subgroup analyses to study the effect of excess body weight on the results. RESULTS Although the groups did not differ in body mass index (BMI; p = 0.069), the risk of developing MetS after pregnancy complicated by GDM was significantly higher than after normal pregnancy, 19 vs. 8 cases (p = 0.039). Fasting glucose (p < 0.001) and triglyceride levels (p < 0.001) were significantly higher in women affected. In subgroup analysis, cardiovascular risk factors were more common in participants with high BMI than in those with previous gestational diabetes. CONCLUSIONS The risk of MetS was 2.4-fold higher after GDM than after normal pregnancy. Cardiovascular risk factors were more common in participants with high BMI than in those with previous GDM. Multivariate analysis supported the main findings. Weight control is important in preventing MetS after delivery.
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Affiliation(s)
- Tiina Vilmi-Kerälä
- />School of Medicine, University of Tampere, Tampere, Finland
- />Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
- />Department of Obstetrics and Gynaecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Outi Palomäki
- />Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
| | - Merja Vainio
- />Department of Obstetrics and Gynaecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Jukka Uotila
- />School of Medicine, University of Tampere, Tampere, Finland
- />Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
| | - Ari Palomäki
- />School of Medicine, University of Tampere, Tampere, Finland
- />Department of Emergency Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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Simón-Muela I, Llauradó G, Chacón MR, Olona M, Näf S, Maymó-Masip E, Gil P, de la Flor M, Gonzalez Clemente JM, Vendrell J, Megía A. Reduced circulating levels of TWEAK are associated with gestational diabetes mellitus. Eur J Clin Invest 2015; 45:27-35. [PMID: 25443800 DOI: 10.1111/eci.12375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/10/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND To evaluate the inflammatory axis mediated by tumour necrosis factor-like weak inducer of apoptosis (TWEAK) and its scavenger receptor CD163 during pregnancy and their influence on insulin sensitivity in normal pregnancy and in gestational diabetes mellitus (GDM). MATERIALS AND METHODS One hundred and thirty seven women with one singleton pregnancy, 71 with normal glucose tolerance (NGT) and 66 with GDM were studied. Glucose metabolism was assessed by oral glucose tolerance test. Serum concentrations of soluble TWEAK (sTWEAK) and CD163 (sCD163) and insulin resistance (HOMA-IR index) were determined in maternal blood drawn at recruitment, in the early third trimester. Offspring weight and height were assessed at birth. RESULTS Women with GDM had lower circulating sTWEAK concentrations than control NGT group (237·8 (192·1-301·0) pg/mL vs. 277·2 (206·4-355·7) pg/mL; P = 0·013). sTWEAK was negatively associated with the presence of GDM (r = -0·212; P = 0·013), HOMA-IR index (r = -0·197; P = 0·021) and ponderal index of the newborn (r = -0·196; P = 0·025), but positively with HDL cholesterol (r = 0·283; P = 0·001). In multiple regression analysis, sTWEAK concentration emerged as one of the main predictors of insulin resistance, along with BMI, triglycerides and low concentrations of HDL cholesterol (R(2) = 0·486; P < 0·001). No relationship was found between HOMA-IR index and sCD163 or sCD163/sTWEAK ratio. CONCLUSIONS sTWEAK concentrations are lower in patients with GDM compared with healthy pregnant women, and low concentrations of sTWEAK are associated with insulin resistance. These findings suggest that insulin resistance during pregnancy is closely linked to inflammatory imbalance and sTWEAK may represent a new candidate associated with GDM.
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Affiliation(s)
- Inmaculada Simón-Muela
- Endocrinology, Diabetes and Nutrition Section, Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
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Li JW, He SY, Liu P, Luo L, Zhao L, Xiao YB. Association of gestational diabetes mellitus (GDM) with subclinical atherosclerosis: a systemic review and meta-analysis. BMC Cardiovasc Disord 2014; 14:132. [PMID: 25266849 PMCID: PMC4192280 DOI: 10.1186/1471-2261-14-132] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/24/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with an elevated risk of adverse health outcomes such as type 2 diabetes and cardiovascular diseases. Carotid intima-media thickness (cIMT) is increasingly used as a noninvasive marker for subclinical atherosclerosis. Whether there is a direct correlation between GDM and elevated cIMT is still controversial. METHODS PubMed, Embase and reference lists of relevant papers were reviewed. Studies assessing the relationship between GDM and cIMT were included. Weighted Mean Difference (WMD) of cIMT was calculated using random-effect models. RESULTS Fifteen studies with a total of 2247 subjects were included in our analysis, giving a pooled WMD of 0.05 (95% confidence interval [CI] 0.03 -0.07). Furthermore, meta regression and subgroup analysis found that the association between GDM and larger cIMT already existed during pregnancy, and this relation was stronger in obese GDM patients. CONCLUSIONS GDM in and after pregnancy is associated with subclinical atherosclerosis. Weight control may be helpful to prevent cardiovascular diseases for GDM patients.
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Affiliation(s)
- Jing-Wei Li
- Institute of Cardiovascular Surgery, PLA, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiao Street, Chongqing, 400037 PR China
| | - Si-Yi He
- Institute of Cardiovascular Surgery, PLA, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiao Street, Chongqing, 400037 PR China
| | - Peng Liu
- Institute of Cardiovascular Surgery, PLA, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiao Street, Chongqing, 400037 PR China
| | - Lin Luo
- Institute of Cardiovascular Surgery, PLA, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiao Street, Chongqing, 400037 PR China
| | - Liang Zhao
- Institute of Cardiovascular Surgery, PLA, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiao Street, Chongqing, 400037 PR China
| | - Ying-Bin Xiao
- Institute of Cardiovascular Surgery, PLA, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiao Street, Chongqing, 400037 PR China
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Harreiter J, Dovjak G, Kautzky-Willer A. Gestational diabetes mellitus and cardiovascular risk after pregnancy. ACTA ACUST UNITED AC 2014; 10:91-108. [PMID: 24328601 DOI: 10.2217/whe.13.69] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Gestational diabetes mellitus (GDM) affects many women in pregnancy and is enhanced by epidemic conditions of obesity, increasing age at the time of the first pregnancy, stressful life conditions, a sedentary lifestyle with less physical activity and unhealthy nutrition with highly processed, high-calorie food intake. GDM does not affect the mother and offspring in pregnancy alone, as there is compelling evidence of the long-term effects of the hyperglycemic state in pregnancy postpartum. Type 2 diabetes mellitus, cardiovascular disease and metabolic syndrome are more common in GDM women, and even the offspring of GDM women are reported to have higher obesity rates and a higher risk for noncommunicable diseases. Early prevention of risk factors seems to be key to overcoming the vicious cycle of cardiometabolic disease onset.
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Affiliation(s)
- Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology & Metabolism, Department of Medicine III, Medical University Vienna, Währingergürtel 18-20, 1090 Vienna, Austria
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31
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Gunderson EP, Chiang V, Pletcher MJ, Jacobs DR, Quesenberry CP, Sidney S, Lewis CE. History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the Coronary Artery Risk Development in Young Adults study. J Am Heart Assoc 2014; 3:e000490. [PMID: 24622610 PMCID: PMC4187501 DOI: 10.1161/jaha.113.000490] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/21/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND History of gestational diabetes mellitus (GDM) increases lifetime risk of type 2 diabetes (DM) and the metabolic syndrome (MetS), which increase risk of cardiovascular disease. It is unclear, however, whether GDM increases risk of early atherosclerosis independent of pre-pregnancy obesity and subsequent metabolic disease. METHODS AND RESULTS Of 2787 women (18 to 30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we studied 898 (47% black) who were free of DM and heart disease at baseline (1985-1986), delivered ≥1 post-baseline births, reported GDM history, and had common carotid intima media thickness (ccIMT, mm) measured in 2005-2006. We used multivariable linear regression to assess associations between GDM and ccIMT adjusted for race, age, parity, and pre-pregnancy cardiometabolic risk factors. We assessed mediators (weight gain, insulin resistance, blood pressure), and effect modification by incident DM or MetS during the 20-year period. Of the 898 women, 119 (13%) reported GDM (7.6 per 100 deliveries). Average age was 31 at last birth and 44 at ccIMT measurement for GDM and non-GDM groups. Unadjusted mean ccIMT was 0.023 mm higher for GDM than non-GDM groups (P=0.029), but pre-pregnancy BMI attenuated the difference to 0.016 mm (P=0.109). In 777 women without subsequent DM or the MetS, mean ccIMT was 0.023 mm higher for GDM versus non-GDM groups controlling for race, age, parity, and pre-pregnancy BMI (0.784 versus 0.761, P=0.039). Addition of pre-pregnancy insulin resistance index had minimal impact on adjusted mean net ccIMT difference (0.22 mm). Mean ccIMT did not differ by GDM status among 121 women who developed DM or the MetS (P=0.58). CONCLUSIONS History of GDM may be a marker for early atherosclerosis independent of pre-pregnancy obesity among women who have not developed type 2 diabetes or the metabolic syndrome.
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Affiliation(s)
- Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (E.P.G., V.C., C.P.Q., S.S.)
| | - Vicky Chiang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (E.P.G., V.C., C.P.Q., S.S.)
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (M.J.P.)
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (D.R.J.)
- Department of Nutrition, University of Oslo, Oslo, Norway (D.R.J.)
| | - Charles P. Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (E.P.G., V.C., C.P.Q., S.S.)
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (E.P.G., V.C., C.P.Q., S.S.)
| | - Cora E. Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL (C.E.L.)
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Metabolic syndrome risk after gestational diabetes: a systematic review and meta-analysis. PLoS One 2014. [PMID: 24498216 DOI: 10.1371/journal.pone.0087863.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A number of studies have been conducted to investigate the risk of metabolic syndrome (MS) after gestational diabetes mellitus (GDM), but the results are contradictory. Accordingly, we performed a systematic review and meta-analysis to assess the association between these two conditions. The aim was to better understand the risks of MS with prior gestational diabetes. METHODS Pubmed, ISI Web of Science, and Cochrane databases from September 1, 1979 to July 11, 2013 were searched to identify relevant studies. 17 studies containing 5832 women and 1149 MS events were included. We calculated the odds ratio (OR) with 95% confidence interval (CI) in analysis for each study using a random-effect or fixed-effect model. We also determined heterogeneity among these 17 articles and their publication bias. RESULTS Women with a history of gestational diabetes had a significantly higher risk of MS than those who had a normal pregnancy (OR, 3.96; 95% CI, 2.99 to 5.26), but had significant heterogeneity (I (2) = 52.6%). The effect remained robust (OR, 4.54; 95% CI, 3.78-5.46) in the subgroup of Caucasians, but no association (OR, 1.28; 95% CI, 0.64-2.56) was found in Asians. Heterogeneity was reduced (body mass index (BMI) matched group I (2) = 14.2%, BMI higher in the GDM group I (2) = 13.2%) in the subgroup of BMI. In addition, mothers with higher BMI in the GDM group had higher risk of MS than those in the BMI matched group (BMI higher in GDM group OR, 5.39; 95% CI, 4.47-6.50, BMI matched group OR, 2.53; 95% CI, 1.88-3.41). CONCLUSIONS This meta-analysis demonstrated increased risk of MS after gestational diabetes. Therefore, attention should be given to preventing or delaying the onset of MS in GDM mothers, particularly in Caucasian and obese mothers.
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Xu Y, Shen S, Sun L, Yang H, Jin B, Cao X. Metabolic syndrome risk after gestational diabetes: a systematic review and meta-analysis. PLoS One 2014; 9:e87863. [PMID: 24498216 PMCID: PMC3909287 DOI: 10.1371/journal.pone.0087863] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/31/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A number of studies have been conducted to investigate the risk of metabolic syndrome (MS) after gestational diabetes mellitus (GDM), but the results are contradictory. Accordingly, we performed a systematic review and meta-analysis to assess the association between these two conditions. The aim was to better understand the risks of MS with prior gestational diabetes. METHODS Pubmed, ISI Web of Science, and Cochrane databases from September 1, 1979 to July 11, 2013 were searched to identify relevant studies. 17 studies containing 5832 women and 1149 MS events were included. We calculated the odds ratio (OR) with 95% confidence interval (CI) in analysis for each study using a random-effect or fixed-effect model. We also determined heterogeneity among these 17 articles and their publication bias. RESULTS Women with a history of gestational diabetes had a significantly higher risk of MS than those who had a normal pregnancy (OR, 3.96; 95% CI, 2.99 to 5.26), but had significant heterogeneity (I (2) = 52.6%). The effect remained robust (OR, 4.54; 95% CI, 3.78-5.46) in the subgroup of Caucasians, but no association (OR, 1.28; 95% CI, 0.64-2.56) was found in Asians. Heterogeneity was reduced (body mass index (BMI) matched group I (2) = 14.2%, BMI higher in the GDM group I (2) = 13.2%) in the subgroup of BMI. In addition, mothers with higher BMI in the GDM group had higher risk of MS than those in the BMI matched group (BMI higher in GDM group OR, 5.39; 95% CI, 4.47-6.50, BMI matched group OR, 2.53; 95% CI, 1.88-3.41). CONCLUSIONS This meta-analysis demonstrated increased risk of MS after gestational diabetes. Therefore, attention should be given to preventing or delaying the onset of MS in GDM mothers, particularly in Caucasian and obese mothers.
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Affiliation(s)
- Yuhong Xu
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Shutong Shen
- Nanjing Medical University, Nanjing, People's Republic of China
| | - Lizhou Sun
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Haiwei Yang
- Clinical Research Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Bai Jin
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaohui Cao
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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Circulating apelin levels are associated with cardiometabolic risk factors in women with previous gestational diabetes. Arch Gynecol Obstet 2013; 289:787-93. [DOI: 10.1007/s00404-013-3070-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/24/2013] [Indexed: 12/16/2022]
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Carson MP, Frank MI, Keely E. Original research: postpartum testing rates among women with a history of gestational diabetes--systematic review. Prim Care Diabetes 2013; 7:177-186. [PMID: 23684416 DOI: 10.1016/j.pcd.2013.04.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 04/13/2013] [Accepted: 04/16/2013] [Indexed: 01/08/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) is increasing and 30% have persistent postpartum dysglycemia. Reported compliance with recommended postpartum testing ranges 9-95% without a clear explanation for this wide variation. Small and conflicting differences in testing rates are associated with some demographics (race, use of insulin), but system factors likely play a larger role. A systematic literature review was performed to identify system based factors that could explain the broad variation in postpartum GDM testing rates. METHODS Original articles reporting postpartum testing rates among women with GDM were identified within PubMed, OVID, EMBASE, and the Cochrane Database of systematic reviews. Articles that did not report rates for the entire GDM cohort were excluded. RESULTS 54/307 citations met inclusion criteria. The use of proactive patient contact programs increased postpartum testing rates from an average of 33% (range 9-71%) up to 60% (range 14-95%). CONCLUSIONS Proactively contacting patients via phone calls, education programs, or postal reminders was associated with higher postpartum testing rates. Rather than working to identifying individual demographic factors, systems based approaches were associated with a larger potential impact, and appear easily generalizable. Clinicians should think beyond individual habits and consider systematic approaches to improving testing rates.
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Affiliation(s)
- Michael P Carson
- UMDNJ-Robert Wood Johnson Medical School, Jersey Shore University Medical Center, Department of Medicine, Ackerman 3, 1945 Route 33, Neptune, NJ 07753, United States.
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Prevalence of metabolic syndrome one year after delivery in Finnish women at increased risk for gestational diabetes mellitus during pregnancy. J Pregnancy 2013; 2013:139049. [PMID: 23577256 PMCID: PMC3616344 DOI: 10.1155/2013/139049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/25/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Women with a history of gestational diabetes mellitus (GDM) are at increased risk for metabolic syndrome (MeS) after delivery. We studied the prevalence of MeS at one year postpartum among Finnish women who in early pregnancy were at increased risk of developing GDM. METHODS This follow-up study is a part of a GDM prevention trial. At one year postpartum, 150 women (mean age 33.1 years, BMI 27.2 kg/m(2)) were evaluated for MeS. RESULTS The prevalence of MeS was 18% according tothe International Diabetes Federation (IDF) criteria and 16% according toNational Cholestrol Education Program (NCEP) criteria. Of MeS components, 74% of participants had an increased waist circumference (≥80 cm). Twenty-seven percent had elevated fasting plasma glucose (≥5.6 mmol/L), and 29% had reduced HDL cholesterol (≤1.3 mmol/L). The odds ratio for the occurrence of MeS at one year postpartum was 3.0 (95% CI 1.0-9.2) in those who were overweight before pregnancy compared to normal weight women. CONCLUSIONS Nearly one-fifth of the women with an increased risk of GDM in early pregnancy fulfilled the criteria of MeS at one year postpartum. The most important factor associated with MeS was prepregnancy overweight. Weight management before and during pregnancy is important for preventing MeS after delivery.
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Freire CMV, Barbosa FBL, de Almeida MCC, Miranda PAC, Barbosa MM, Nogueira AI, Guimarães MM, Nunes MDCP, Ribeiro-Oliveira A. Previous gestational diabetes is independently associated with increased carotid intima-media thickness, similarly to metabolic syndrome - a case control study. Cardiovasc Diabetol 2012; 11:59. [PMID: 22651701 PMCID: PMC3403942 DOI: 10.1186/1475-2840-11-59] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/31/2012] [Indexed: 11/10/2022] Open
Abstract
Background Women with previous gestational diabetes mellitus (pGDM) face a higher risk of developing type 2 diabetes and, consequently, a higher cardiovascular risk. This study aimed to compare the carotid intima-media thickness (cIMT) from young women with pGDM to those with metabolic syndrome (MS) and to healthy controls (CG) to verify whether a past history of pGDM could be independently associated with increased cIMT. Methods This is a cross-sectional study performed in two academic referral centers. Seventy-nine women with pGDM, 30 women with MS, and 60 CG aged between 18 and 47 years were enrolled. They all underwent physical examination and had blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDLc), and triglycerides determined. The cIMT was measured by ultrasound in several carotid segments. The primary endpoint was cIMT and clinically relevant parameters included as predictors were: age, systolic blood pressure, waist, BMI, total cholesterol, LDLc, triglycerides, fasting glucose, previous history of GDM as a whole group, previous history of GDM without MS, presence of DM, presence of MS, and parity. Results cIMT was significantly higher in pGDM when compared to CG in all sites of measurements (P < 0.05) except for the right common carotid. The pGDM women showed similar cIMT measurements to MS in all sites of measurements, except for the left carotid bifurcation, where it was significantly higher than MS (P < 0.001). In a multivariate analysis which included classical cardiovascular risk factors and was adjusted for confounders, pGDM was shown to be independently associated with increased composite cIMT (P < 0.01). The pGDM without risk factors further showed similar cIMT to MS (P > 0.05) and an increased cIMT when compared to controls (P < 0.05). Conclusions Previous GDM was independently associated with increased composite cIMT in this young population, similarly to those with MS and regardless the presence of established cardiovascular risk factors.
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Affiliation(s)
- Claudia Maria Vilas Freire
- Laboratory of Endocrinology, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil
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Malinowska-Polubiec A, Sienko J, Lewandowski Z, Czajkowski K, Smolarczyk R. Risk factors of abnormal carbohydrate metabolism after pregnancy complicated by gestational diabetes mellitus. Gynecol Endocrinol 2012; 28:360-4. [PMID: 22385344 DOI: 10.3109/09513590.2011.613963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE In gestational diabetes mellitus (GDM) abnormal glucose metabolism normalizes soon after delivery. However, the history of GDM predisposes to carbohydrate intolerance in the future. The aim of the study was to explore risk factors and to evaluate risk of glucose intolerance and diabetes mellitus in women with a history of GDM. METHODS 155 patients entered this case-control study. Participants fulfilled the inclusion criteria: a history of GDM, perinatal care in the study center. Medical and family history and laboratory findings were analyzed. Oral glucose tolerance test (OGTT) was performed. RESULTS 18.1% of patients presented impaired fasting glucose during the study, 20% presented impaired glucose tolerance and 23.2% presented diabetes mellitus. Gestational age at diagnosis of GDM, the results of OGTT during pregnancy, serum HbA1c concentration at 2nd and 3rd trimester, serum fructosamine concentration, symptoms of diabetic fetopathy in the neonate, the need for insulin therapy after delivery, maternal age at diagnosis of GDM and maternal body mass index before pregnancy were the significant risk factors of impaired glucose tolerance or diabetes in the future. CONCLUSION GDM increases the risk of diabetes mellitus. Several risk factors of impaired carbohydrate metabolism can be distinguished in patients with a history of GDM.
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Bayraktar F, Akinci B, Celtik A, Tunali S, Genc S, Ozcan MA, Secil M, Yesil S. Insulin need in gestational diabetes is associated with a worse cardiovascular risk profile after pregnancy. Intern Med 2012; 51:839-43. [PMID: 22504236 DOI: 10.2169/internalmedicine.51.5846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Women with gestational diabetes mellitus (GDM) treated with insulin are more likely to develop type 2 diabetes after pregnancy compared to mild GDM cases treated with medical nutrition treatment (MNT) alone. We aimed to compare levels of subclinical atherosclerosis markers in women with previous GDM treated with insulin and MNT alone. METHODS Eighty-one women with previous GDM (45 treated with insulin, 36 treated with MNT) and 35 age-matched lean controls were included. Fasting glucose, insulin and lipids, circulating fibrinogen, CRP, PAI-1 and IL-6 levels were assayed. Carotid intima media thickness (IMT) was measured. RESULTS Women with previous GDM treated with insulin in pregnancy had significantly higher fasting glucose, plasma PAI-1 levels and carotid IMT compared to women treated with MNT alone. In multiple regression analysis, insulin need in pregnancy was associated with increased carotid IMT and plasma PAI-1 levels (corrected for age, BMI, postpartum duration, fasting glucose and lipids; model r(2)=0.132; beta=0.297, p=0.014 for carotid IMT; model r(2)=0.198; beta=0.345, p=0.003 for PAI-1). CONCLUSION Women with previous GDM treated with insulin in pregnancy had a worse cardiovascular risk profile compared to mild GDM patients. An intensive preventive approach for cardiovascular disorders is particularly essential for this subgroup of women.
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Affiliation(s)
- Firat Bayraktar
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Turkey
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