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Kariniemi K, Vääräsmäki M, Männistö T, Mustaniemi S, Kajantie E, Eteläinen S, Keikkala E. Neonatal outcomes according to different glucose threshold values in gestational diabetes: a register-based study. BMC Pregnancy Childbirth 2024; 24:271. [PMID: 38609891 PMCID: PMC11010296 DOI: 10.1186/s12884-024-06473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Mild hyperglycaemia is associated with increased birth weight but association with other neonatal outcomes is controversial. We aimed to study neonatal outcomes in untreated mild hyperglycaemia using different oral glucose tolerance test (OGTT) thresholds. METHODS This register-based study included all (n = 4,939) singleton pregnant women participating a 75 g 2-h OGTT in six delivery hospitals in Finland in 2009. Finnish diagnostic cut-offs for GDM were fasting ≥ 5.3, 1 h ≥ 10.0 or 2-h glucose ≥ 8.6 mmol/L. Women who did not meet these criteria but met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria (fasting 5.1-5.2 mmol/L and/or 2-h glucose 8.5 mmol/L, n = 509) or the National Institute for Health and Clinical Excellence (NICE) criteria (2-h glucose 7.8-8.5 mmol/L, n = 166) were considered as mild untreated hyperglycaemia. Women who met both the Finnish criteria and the IADPSG or the NICE criteria were considered as treated GDM groups (n = 1292 and n = 612, respectively). Controls were normoglycaemic according to all criteria (fasting glucose < 5.1 mmol/L, 1-h glucose < 10.0 mmol/L and 2-h glucose < 8.5 mmol/L, n = 3031). Untreated mild hyperglycemia groups were compared to controls and treated GDM groups. The primary outcome - a composite of adverse neonatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, birth trauma or perinatal mortality - was analysed using multivariate logistic regression. RESULTS The risk for the adverse neonatal outcome in untreated mild hyperglycemia was not increased compared to controls (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 0.71-1.44, using the IADPSG criteria; aOR: 1.05, 95% CI: 0.60-1.85, using the NICE criteria). The risk was lower compared to the treated IADPSG (aOR 0.38, 95% CI 0.27-0.53) or the treated NICE group (aOR 0.32, 95% CI 0.18-0.57). DISCUSSION The risk of adverse neonatal outcomes was not increased in mild untreated hyperglycaemia compared to normoglycaemic controls and was lower than in the treated GDM groups. The OGTT cut-offs of 5.3 mmol/L at fasting and 8.6 mmol/L at 2 h seem to sufficiently identify clinically relevant GDM, without excluding neonates with a risk of adverse outcomes.
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Affiliation(s)
- Kaisa Kariniemi
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marja Vääräsmäki
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuija Männistö
- NordLab, Oulu, Finland
- Faculty of Medicine, Research Unit of Translational Medicine, University of Oulu, Oulu, Finland
| | - Sanna Mustaniemi
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Eero Kajantie
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sanna Eteläinen
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Elina Keikkala
- Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220, Oulu, Finland.
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
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Ciaunica A, Levin M, Rosas FE, Friston K. Nested Selves: Self-Organization and Shared Markov Blankets in Prenatal Development in Humans. Top Cogn Sci 2023. [PMID: 38158882 DOI: 10.1111/tops.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
The immune system is a central component of organismic function in humans. This paper addresses self-organization of biological systems in relation to-and nested within-other biological systems in pregnancy. Pregnancy constitutes a fundamental state for human embodiment and a key step in the evolution and conservation of our species. While not all humans can be pregnant, our initial state of emerging and growing within another person's body is universal. Hence, the pregnant state does not concern some individuals but all individuals. Indeed, the hierarchical relationship in pregnancy reflects an even earlier autopoietic process in the embryo by which the number of individuals in a single blastoderm is dynamically determined by cell- interactions. The relationship and the interactions between the two self-organizing systems during pregnancy may play a pivotal role in understanding the nature of biological self-organization per se in humans. Specifically, we consider the role of the immune system in biological self-organization in addition to neural/brain systems that furnish us with a sense of self. We examine the complex case of pregnancy, whereby two immune systems need to negotiate the exchange of resources and information in order to maintain viable self-regulation of nested systems. We conclude with a proposal for the mechanisms-that scaffold the complex relationship between two self-organising systems in pregnancy-through the lens of the Active Inference, with a focus on shared Markov blankets.
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Affiliation(s)
- Anna Ciaunica
- Centre for Philosophy of Science (CFCUL), University of Lisbon
- Institute of Cognitive Neuroscience, University College London
| | - Michael Levin
- Department of Biology and Allen Discovery Center, Tufts University
| | - Fernando E Rosas
- Department of Informatics, University of Sussex
- Centre for Complexity Science, Imperial College London
- Department of Brain Sciences, Imperial College London
- Centre for Eudaimonia and Human Flourishing, University of Oxford
| | - Karl Friston
- Welcome Centre for Human Neuroimaging, University College London
- VERSES AI Research Lab
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Zeng X, Zhan Y, Zhou W, Qiu Z, Wang T, Chen Q, Qu D, Huang Q, Cao J, Zhou N. The Influence of Airborne Particulate Matter on the Risk of Gestational Diabetes Mellitus: A Large Retrospective Study in Chongqing, China. TOXICS 2023; 12:19. [PMID: 38250975 PMCID: PMC10818620 DOI: 10.3390/toxics12010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Emerging research findings suggest that airborne particulate matter might be a risk factor for gestational diabetes mellitus (GDM). However, the concentration-response relationships and the susceptible time windows for different types of particulate matter may vary. In this retrospective analysis, we employ a novel robust approach to assess the crucial time windows regarding the prevalence of GDM and to distinguish the susceptibility of three GDM subtypes to air pollution exposure. This study included 16,303 pregnant women who received routine antenatal care in 2018-2021 at the Maternal and Child Health Hospital in Chongqing, China. In total, 2482 women (15.2%) were diagnosed with GDM. We assessed the individual daily average exposure to air pollution, including PM2.5, PM10, O3, NO2, SO2, and CO based on the volunteers' addresses. We used high-accuracy gridded air pollution data generated by machine learning models to assess particulate matter per maternal exposure levels. We further analyzed the association of pre-pregnancy, early, and mid-pregnancy exposure to environmental pollutants using a generalized additive model (GAM) and distributed lag nonlinear models (DLNMs) to analyze the association between exposure at specific gestational weeks and the risk of GDM. We observed that, during the first trimester, per IQR increases for PM10 and PM2.5 exposure were associated with increased GDM risk (PM10: OR = 1.19, 95%CI: 1.07~1.33; PM2.5: OR = 1.32, 95%CI: 1.15~1.50) and isolated post-load hyperglycemia (GDM-IPH) risk (PM10: OR = 1.23, 95%CI: 1.09~1.39; PM2.5: OR = 1.38, 95%CI: 1.18~1.61). Second-trimester O3 exposure was positively correlated with the associated risk of GDM, while pre-pregnancy and first-trimester exposure was negatively associated with the risk of GDM-IPH. Exposure to SO2 in the second trimester was negatively associated with the risk of GDM-IPH. However, there were no observed associations between NO2 and CO exposure and the risk of GDM and its subgroups. Our results suggest that maternal exposure to particulate matter during early pregnancy and exposure to O3 in the second trimester might increase the risk of GDM, and GDM-IPH is the susceptible GDM subtype to airborne particulate matter exposure.
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Affiliation(s)
- Xiaoling Zeng
- Institute of Toxicology, Facutly of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; (X.Z.); (T.W.); (Q.C.)
- School of Public Health, China Medical University, Shenyang 110122, China
| | - Yu Zhan
- Department of Environmental Science and Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (Z.Q.)
| | - Wei Zhou
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing 401147, China; (W.Z.); (Q.H.)
| | - Zhimei Qiu
- Department of Environmental Science and Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (Z.Q.)
| | - Tong Wang
- Institute of Toxicology, Facutly of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; (X.Z.); (T.W.); (Q.C.)
| | - Qing Chen
- Institute of Toxicology, Facutly of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; (X.Z.); (T.W.); (Q.C.)
| | - Dandan Qu
- Clinical Research Centre, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, China;
- Chongqing Research Centre for Prevention & Control of Maternal and Child Diseases and Public Health, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Qiao Huang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing 401147, China; (W.Z.); (Q.H.)
| | - Jia Cao
- Institute of Toxicology, Facutly of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; (X.Z.); (T.W.); (Q.C.)
| | - Niya Zhou
- Clinical Research Centre, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, China;
- Chongqing Research Centre for Prevention & Control of Maternal and Child Diseases and Public Health, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, China
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Ramezani Tehrani F, Sheidaei A, Rahmati M, Farzadfar F, Noroozzadeh M, Hosseinpanah F, Abedini M, Hadaegh F, Valizadeh M, Torkestani F, Khalili D, Firouzi F, Solaymani-Dodaran M, Ostovar A, Azizi F, Behboudi-Gandevani S. Various screening and diagnosis approaches for gestational diabetes mellitus and adverse pregnancy outcomes: a secondary analysis of a randomized non-inferiority field trial. BMJ Open Diabetes Res Care 2023; 11:e003510. [PMID: 38164706 PMCID: PMC10729207 DOI: 10.1136/bmjdrc-2023-003510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION We evaluate which screening and diagnostic approach resulted in the greatest reduction in adverse pregnancy outcomes due to increased treatment. RESEARCH DESIGN AND METHODS This study presents a secondary analysis of a randomized community non-inferiority trial conducted among pregnant women participating in the GULF Study in Iran. A total of 35 430 pregnant women were randomly assigned to one of the five prespecified gestational diabetes mellitus (GDM) screening protocols. The screening methods included fasting plasma glucose (FPG) in the first trimester and either a one-step or a two-step screening method in the second trimester of pregnancy. According to the results, participants were classified into 6 groups (1) First-trimester FPG: 100-126 mg/dL, GDM diagnosed at first trimester; (2) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at first trimester; (3) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at second trimester; (4) First trimester FPG: 92-99.9 mg/dL, healthy at second trimester; (5) First trimester FPG<92 mg/dL, GDM diagnosed at second trimester; (6) First trimester FPG<92 mg/dL, healthy at second trimester. For our analysis, we initially used group 6, as the reference and repeated the analysis using group 2, as the reference group. The main outcome of the study was major adverse maternal and neonatal outcomes. RESULTS Macrosomia and primary caesarean section occurred in 9.8% and 21.0% in group 1, 7.8% and 19.8% in group 2, 5.4% and 18.6% in group 3, 6.6% and 21.5% in group 4, 8.3% and 24.0% in group 5, and 5.4% and 20.0% in group 6, respectively. Compared with group 6 as the reference, there was a significant increase in the adjusted risk of neonatal intensive care unit (NICU) admission in groups 1, 3, and 5 and an increased risk of macrosomia in groups 1, 2, and 5. Compared with group 2 as the reference, there was a significant decrease in the adjusted risk of macrosomia in group 3, a decreased risk of NICU admission in group 6, and an increased risk of hyperglycemia in group 3. CONCLUSIONS We conclude that screening approaches for GDM reduced the risk of adverse pregnancy outcomes to the same or near the same risk level of healthy pregnant women, except for the risk of NICU admission that increased significantly in groups diagnosed with GDM compared with healthy pregnant women. Individuals with slight increase in FPG (92-100 mg/dL) at first trimester, who were diagnosed as GDM, had an even increased risk of macrosomia in comparison to those group of women with FPG 92-100 mg/dL in the first trimester, who were not diagnosed with GDM, and developed GDM in second trimester TRIAL REGISTRATION: IRCT138707081281N1 (registered: February 15, 2017).
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- School of Public Health, Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Noroozzadeh
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & DiseaseTreatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faegheh Firouzi
- Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | | | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hsu MC, Lin CH, Lin MC. Maternal gestational diabetes mellitus and risk of allergic diseases in offspring. Pediatr Neonatol 2023:S1875-9572(23)00216-4. [PMID: 38052685 DOI: 10.1016/j.pedneo.2023.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/21/2023] [Accepted: 06/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus has been linked to inflammation, immune dysregulation in offspring, and changes in the microbiota. It may have long-term implications for the health of children. The aim of this study was to determine if gestational diabetes mellitus increases the risk of allergic diseases in offspring. METHODS The data source was the National Health Insurance Research Database (NHIRD) of Taiwan. The pairing of mothers and children was established by connecting the NHIRD with the Taiwan Maternal and Child Health Database. First-time pregnant mothers between 2004 and 2019 were enrolled. The GDM group consisted of 22,741 cases. The control group was selected from individuals without GDM matched by maternal age, neonatal gender, and neonatal birthdate at a ratio of 1-4. The primary endpoint was the incidence of childhood allergic diseases, such as asthma, allergic rhinitis, atopic dermatitis, and urticaria. The secondary endpoint was the risk associated with the development of allergic diseases in offspring, considering the presence or absence of insulin therapy. RESULTS The development of allergic rhinitis, atopic dermatitis, and urticaria were found to be significantly associated with GDM. However, no significant association was observed between GDM and asthma. GDM control without insulin was associated with an increased risk of developing allergic rhinitis, urticaria, and atopic dermatitis. However, in the group receiving insulin treatment, there was no significant elevation in the risk of any allergic diseases. CONCLUSION GDM may elevate the risk of certain atopic diseases in offspring, such as allergic rhinitis, atopic dermatitis, and urticaria.
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Affiliation(s)
- Min-Che Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Food and Nutrition, Providence University, Taichung, Taiwan; Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chien-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chih Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Food and Nutrition, Providence University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Lei SK, Wong CL, Leung KP, Shum TC. Gestational glucose intolerance and pregnancy outcomes: a retrospective study in the primary care setting of Macau. Medicine (Baltimore) 2023; 102:e35175. [PMID: 37713817 PMCID: PMC10508387 DOI: 10.1097/md.0000000000035175] [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: 10/04/2022] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
Although glucose intolerance is prevalent in Macau, it is rarely assessed during pregnancy. This study examined short-term maternal and neonatal outcomes at different maternal glucose levels in Macau. A total of 2388 pregnant women who received antenatal care at Health Centers and delivered at the Centro Hospitalar Conde de São Januário between June 2018 and December 2019 were included in this study. Gestational diabetes mellitus (GDM) was diagnosed using Carpenter and Coustan criteria, involving a 50 g glucose challenge test (GCT) followed by a 100g oral glucose tolerance test (OGTT). Participants were categorized into 4 groups: normal glucose tolerance if GCT was negative; mild gestational hyperglycemia in this study if positive GCT without GDM; GDM patients with normal fasting blood glucose (FBG) or high FBG in OGTT. Logistic regression analysis was employed to compare pregnancy outcomes among these 4 groups. Due to the limited number of cases, we combined several adverse maternal outcomes, including pregnancy-induced hypertension, assisted delivery, primary Caesarean section, moderate to severe perineal trauma, and postpartum hemorrhage, into a composite measure. The results showed higher rates of the aforementioned outcomes for mild gestational hyperglycemia and GDM with high FBG in OGTT groups [adjusted odds ratio (aOR) 1.32, 95% confidence interval (CI) 1.06-1.64; aOR 2.04, 95% CI 1.24-3.37], as well as macrosomia risk (aOR 2.02, 95% CI 1.11-3.66; aOR 5.04, 95% CI 2.03-12.52) and large-for-gestational age infants (aOR 1.48, 95% CI 1.02-2.16; aOR 4.34, 95% CI 2.31-8.15). Pregnancy outcomes were similar for normal glucose tolerance and GDM with normal FBG in OGTT. Mild gestational hyperglycemia raised the likelihood of adverse maternal outcomes and excessive infant birth weights. Even after achieving target glucose levels, GDM patients with elevated fasting glucose readings in OGTT remained at significant risk for these events. Instead, fasting normoglycemic GDM was treated effectively at Macau Health Centers.
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Affiliation(s)
- Sao Kuan Lei
- Seac Pai Van Health Center, Health Bureau, Macao SAR, China
| | - Chi Leong Wong
- Center for Disease Control and Prevention, Health Bureau, Macao SAR, China
| | - Ka Pou Leung
- Seac Pai Van Health Center, Health Bureau, Macao SAR, China
| | - Tai Chun Shum
- Seac Pai Van Health Center, Health Bureau, Macao SAR, China
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Goyette F, Wo BL, Iglesias MH, Rey E, Godbout A. Treatment of women with mild gestational diabetes mellitus decreases the risk of adverse perinatal outcomes. DIABETES & METABOLISM 2023; 49:101458. [PMID: 37336281 DOI: 10.1016/j.diabet.2023.101458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
AIMS Glycemic thresholds used to diagnose gestational diabetes mellitus (GDM) are a continued subject of debate. Lower glycemic thresholds identify women with milder GDM for whom treatment benefit is unclear. We compared adverse maternal and neonatal outcomes in treated and untreated women with mild hyperglycemia. METHODS We reviewed 11 553 patient charts from two tertiary care centers and included singleton pregnancies >32-week gestation. GDM was diagnosed using the one- or two-step 75 g oral glucose tolerance test (OGTT) depending on the center. All OGTT results were reviewed. Women with glycemic values falling between the thresholds of the two tests, referred to as intermediate hyperglycemic (IH), defined as FPG 5.1-5.2 mmol/L, 1 h PG 10.0-10.5 mmol/L, or 2 h PG 8.5-8.9 mmol/L at 75 g OGTT, were untreated at center A and treated at center B. RESULTS There were 630 women with IH, 334 were untreated (center A) and 296 who were treated (center B). After adjusting for covariates, untreated IH women had significantly higher rates of gestational hypertension (aOR 6.02, P = 0.002), large for gestational age (LGA) (aOR 3.73, P < 0.001) and birthweights > 4000 g (aOR 3.35, P = 0.001). Our results indicate that treating 11 women with IH would prevent one LGA birth and treating 13 would prevent 1 birthweight > 4000 g. CONCLUSION The diagnosis of GDM using the two-step OGTT fails to identify subgroups of women with mild hyperglycemia that would benefit from treatment to lower the risk for adverse maternal and neonatal outcomes. Treatment of women with mild hyperglycemia decreased the risk of LGA and birthweight >4000 g by 3-fold.
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Affiliation(s)
- Fanny Goyette
- Endocrinology Division, Department of Medicine, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Bi Lan Wo
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Marie-Hélène Iglesias
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, CHU Sainte-Justine Research Center, Université de Montréal, Montreal, Quebec, Canada
| | - Evelyne Rey
- Obstetric Medicine Division, Departments of Medicine and Obstetrics and Gynecology, CHU Sainte-Justine Research Center, Université de Montréal, Montreal, Quebec, Canada
| | - Ariane Godbout
- Endocrinology Division, Department of Medicine, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
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Ramezani Tehrani F, Farzadfar F, Hosseinpanah F, Rahmati M, Firouzi F, Abedini M, Hadaegh F, Valizadeh M, Torkestani F, Khalili D, Solaymani-Dodaran M, Bidhendi-Yarandi R, Bakhshandeh M, Ostovar A, Dovom MR, Amiri M, Azizi F, Behboudi-Gandevani S. Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter? Front Endocrinol (Lausanne) 2023; 14:1155007. [PMID: 37334302 PMCID: PMC10273274 DOI: 10.3389/fendo.2023.1155007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives The aim of the study was to investigate the effect of treatment on pregnancy outcomes among women who had fasting plasma glucose (FPG) 5.1-5.6 mmol/l in the first trimester of pregnancy. Methods We performed a secondary-analysis of a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. All pregnant women with FPG values range 5.1-5.6 mmol/l in the first trimester of gestation were included in the present study (n=3297) and classified to either the (i) intervention group who received treatment for GDM along with usual prenatal care (n=1,198), (ii) control group who received usual-prenatal-care (n=2,099). Macrosomia/large for gestational age (LGA) and primary cesarean-section (C-S) were considered as primary-outcomes. A modified-Poisson-regression for binary outcome data with a log link function and robust error variance was used to RR (95%CI) for the associations between GDM status and incidence of pregnancy outcomes. Results The mean maternal age and BMI of pregnant women in both study groups were similar. There were no statistically significant differences in the adjusted risks of adverse pregnancy outcomes, including macrosomia, primary C-S, preterm birth, hyperbilirubinemia, preeclampsia, NICU-admission, birth trauma, and LBW both groups. Conclusions It is found that treating women with first-trimester FPG values of 5.1-5.6 mmol/l could not improve adverse pregnancy outcomes including macrosomia, Primary C-S, Preterm birth, hypoglycemia, hypocalcemia, preeclampsia, NICU admission, Birth trauma and LBW. Therefore, extrapolating the FPG cut-off point of the second trimester to the first -which has been proposed by the IADPSG, might therefore not be appropriate. Clinical Trial Registration https://www.irct.ir/trial/518, identifier IRCT138707081281N1.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faegheh Firouzi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and Cell Therapy Office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marzieh Bakhshandeh
- Family Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Bogdanet D, Castillo MT, Doheny H, Dervan L, Luque-Fernandez MA, Halperin JA, O’Shea PM, Dunne FP. The ability of pGCD59 to predict adverse pregnancy outcomes: a prospective study of non-diabetic pregnant women in Ireland. Acta Diabetol 2023; 60:211-223. [PMID: 36309618 PMCID: PMC9617525 DOI: 10.1007/s00592-022-01983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023]
Abstract
AIM Even though most pregnancies are uneventful, occasionally complications do occur. Gestational diabetes is linked to an increased risk of adverse pregnancy outcomes. Early identification of women at risk of experiencing adverse outcomes, ideally through a single blood test, would facilitate early intervention. Plasma glycated CD59 (pGCD59) is an emerging biomarker which has shown promise in identifying hyperglycaemia during pregnancy and has been associated with the risk of delivering an LGA infant. The aim of this study was to explore the ability of the first- and second-trimester pGCD59 to predict adverse pregnancy outcomes. METHODS This was a prospective study of 378 pregnant women. Samples for pGCD59 were taken at the first antenatal visit and at the time of the 2 h 75 g OGTT (24-28 weeks of gestation). Adjusted receiver operating characteristic curves were used to evaluate the ability of pGCD59 to predict maternal and neonatal outcomes. RESULTS First-trimester pGCD59 levels were higher in women with gestational diabetes who delivered a macrosomic infant (4.2 ± 0.7 vs. 3.5 ± 1.0 SPU, p < 0.01) or an LGA infant (4.3 ± 0.3 vs. 3.6 ± 1.0 SPU, p = 0.01) compared to women with GDM that did not experience these outcomes. Second-trimester pGCD59 levels were higher in women that developed polyhydramnios (2.9 ± 0.4 vs. 2.5 ± 1.1 SPU, p = 0.03). First- and second-trimester pGCD59 predicted pregnancy-induced hypertension with good accuracy (AUC:0.85, 95%CI:0.78-0.91; AUC: 0.80, 95%CI: 0.73-0.88, respectively) and neonatal hypoglycaemia with fair to good accuracy (AUC:0.77, 95%CI: 0.54-0.99, AUC:0.81, 95%CI:0.62-0.99). CONCLUSIONS This study has shown that pGCD59 has the potential to predict adverse pregnancy outcomes. Prospective studies with a larger number of cases are necessary to fully explore and validate the potential of this emerging biomarker in predicting adverse pregnancy outcomes.
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Affiliation(s)
- Delia Bogdanet
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
| | - Michelle Toth Castillo
- Divisions of Haematology, Brigham & Women’s Hospital, Harvard Medical School, Boston, USA
| | - Helen Doheny
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Louise Dervan
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
| | - Miguel Angel Luque-Fernandez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jose A. Halperin
- Divisions of Haematology, Brigham & Women’s Hospital, Harvard Medical School, Boston, USA
| | - Paula M. O’Shea
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Fidelma P. Dunne
- College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway, Ireland
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10
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Zhang M, Li Q, Wang KL, Dong Y, Mu YT, Cao YM, Liu J, Li ZH, Cui HL, Liu HY, Hu AQ, Zheng YJ. Lipolysis and gestational diabetes mellitus onset: a case-cohort genome-wide association study in Chinese. J Transl Med 2023; 21:47. [PMID: 36698149 PMCID: PMC9875546 DOI: 10.1186/s12967-023-03902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Genetic knowledge of gestational diabetes mellitus (GDM) in Chinese women is quite limited. This study aimed to identify the risk factors and mechanism of GDM at the genetic level in a Chinese population. METHODS We conducted a genome-wide association study (GWAS) based on single nucleotide polymorphism (SNP) array genotyping (ASA-CHIA Bead chip, Illumina) and a case-cohort study design. Variants including SNPs, copy number variants (CNVs), and insertions-deletions (InDels) were called from genotyping data. A total of 2232 pregnant women were enrolled in their first/second trimester between February 2018 and December 2020 from Anqing Municipal Hospital in Anhui Province, China. The GWAS included 193 GDM patients and 819 subjects without a diabetes diagnosis, and risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated by a regression-based method conditional on the population structure. The calling and quality control of genotyping data were performed following published guidelines. CNVs were merged into CNV regions (CNVR) to simplify analyses. To interpret the GWAS results, gene mapping and overexpression analyses (ORAs) were further performed to prioritize the candidate genes and related biological mechanisms. RESULTS We identified 14 CNVRs (false discovery rate corrected P values < 0.05) and two suggestively significant SNPs (P value < 0.00001) associated with GDM, and a total of 19 candidate genes were mapped. Ten genes were significantly enriched in gene sets related to lipase (triglyceride lipase and lipoprotein lipase) activity (LIPF, LIPK, LIPN, and LIPJ genes), oxidoreductase activity (TPH1 and TPH2 genes), and cellular components beta-catenin destruction complex (APC and GSK3B genes), Wnt signalosome (APC and GSK3B genes), and lateral element in the Gene Ontology resource (BRCA1 and SYCP2 genes) by two ORA methods (adjusted P values < 0.05). CONCLUSIONS Genes related to lipolysis, redox reaction, and proliferation of islet β-cells are associated with GDM in Chinese women. Energy metabolism, particularly lipolysis, may play an important role in GDM aetiology and pathology, which needs further molecular studies to verify.
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Affiliation(s)
- Miao Zhang
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Qing Li
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, Anqing, 246003 China
| | - Kai-Lin Wang
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Yao Dong
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Yu-Tong Mu
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Yan-Min Cao
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Jin Liu
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Zi-Heng Li
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Hui-Lu Cui
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Hai-Yan Liu
- Department of Clinical Laboratory, Anqing Municipal Hospital, Anqing, 246003 China
| | - An-Qun Hu
- Department of Clinical Laboratory, Anqing Municipal Hospital, Anqing, 246003 China
| | - Ying-Jie Zheng
- grid.8547.e0000 0001 0125 2443Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032 China
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Effects of a smartphone-based nursing counseling and feedback system for women with gestational diabetes on compliance, glycemic control, and satisfaction: a randomized controlled study. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Wu Y, Han L, Chen X, He J, Fan X, Dai J, Liu Y, Bai J. Effects of thalassemia on pregnancy outcomes of women with gestational diabetes mellitus. J Obstet Gynaecol Res 2022; 48:1132-1140. [PMID: 35212088 DOI: 10.1111/jog.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To explore the effect of thalassemia on pregnancy outcomes of women with gestational diabetes mellitus (GDM). METHODS This retrospective study reviewed the medical records of women with GDM delivered at the Chongqing Maternal and Child Health Hospital in China between July 2017 and December 2020. The live singleton pregnancies with α or β-thalassemia were identified as the thalassemia group, included α-thalassemia subgroup and β-thalassemia subgroup, whereas pregnant women without thalassemia were randomly selected as the non-thalassemia group according to a control-to-case ratio of 10:1 by computerized randomization. Logistic regression analyses were used to explore the potential association between thalassemia and pregnancy outcomes. RESULTS A total of 223 pregnant women with GDM and thalassemia were analyzed, including women with α-thalassemia (n = 143) and β-thalassemia (n = 80). There were no significant differences in the incidence of adverse neonatal outcomes such as preterm birth and low-birth weight among groups. However, among pregnancy complications, significant differences were detected in the incidence of placenta increta, polyhydramnios, and postpartum anemia between the thalassemia group and the non-thalassemia group. Logistic regression results indicated that β-thalassemia increased the risk of polyhydramnios (odds ratio [OR] = 3.95, 95% confidence interval [CI]: 1.14-13.65, p = 0.030) and chorioamnionitis (OR = 3.61, 95%CI: 1.04-12.49, p = 0.043) compared with the non-thalassemia group. CONCLUSION In our study, thalassemia did not increase adverse neonatal outcomes, but β-thalassemia increased the risk of pregnancy complications, including polyhydramnios and chorioamnionitis.
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Affiliation(s)
- Yinyin Wu
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Lu Han
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Xiangxu Chen
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Jing He
- School of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoxiao Fan
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Jiamiao Dai
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Yanqun Liu
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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13
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Li C, Cai Y, Li Y, Peng B, Liu Y, Wang Z, Yang T, Hu Y, Fu Y, Shi T, Peng H, Zhang Y, Chen J, Li T, Chen L. Well-controlled gestational diabetes mellitus without pharmacologic therapy decelerates weight gain in infancy. Front Endocrinol (Lausanne) 2022; 13:1063989. [PMID: 36601002 PMCID: PMC9807162 DOI: 10.3389/fendo.2022.1063989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
AIM There are no prospective longitudinal studies on the association between well-controlled gestational diabetes mellitus (GDM) without pharmacologic therapy and the physical growth of offspring in infancy. We aimed to identify the trajectories in physical growth (from 0-12 months of age) in the offspring of mothers with well-controlled GDM without pharmacologic therapy in a prospective cohort in China. METHODS This study included 236 offspring of mothers with GDM and 369 offspring of mothers without GDM. Mothers with GDM were not on pharmacologic therapy. The length and weight of infants were measured at 0, 1, 3, 6, and 12 months. Linear mixed-effect models and linear mixed-effect models were applied. RESULTS The fully adjusted model showed that the weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and BMI-for-age z-score (BMIZ) were similar at birth for the GDM and control groups. However, subsequent increases in WAZ and BMIZ for the GDM group lagged the increases for the control group at the subsequent periods of observation, 0-1, 0-6, and 0-12 months. CONCLUSIONS Well-controlled GDM without pharmacologic therapy may normalize physical growth of offspring at birth and decelerate their weight gain in infancy. Whether glycemic control can mitigate the long-term effects of GDM on the growth trajectory in offspring remains unclear.
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Affiliation(s)
- Chao Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yixi Cai
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yinying Li
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Bin Peng
- School of Public Health and Management, Department of Health Statistics, Chongqing Medical University, Chongqing, China
| | - Yongfang Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Zhenming Wang
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Ting Yang
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yirong Hu
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yajun Fu
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Tingmei Shi
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Hong Peng
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yue Zhang
- Department of Child Health Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Jie Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Tingyu Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Li Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Growth, Development, and Mental Health of Children and Adolescence Center, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- *Correspondence: Li Chen, ;;
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Bidhendi Yarandi R, Vaismoradi M, Panahi MH, Gåre Kymre I, Behboudi-Gandevani S. Mild Gestational Diabetes and Adverse Pregnancy Outcome: A Systemic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:699412. [PMID: 34291067 PMCID: PMC8286997 DOI: 10.3389/fmed.2021.699412] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/07/2021] [Indexed: 01/11/2023] Open
Abstract
Background and Objectives: Mild gestational diabetes (GDM) refers to the gestational hyperglycemia, which does not fulfill the diagnostic criteria for GDM. The results of studies on adverse pregnancy outcomes among women with mild GDM are controversial. Therefore, the aim of this systematic review and meta-analysis was to investigate the impact of mild GDM on the risk of adverse maternal and neonatal outcomes. Methods: A thorough literature search was performed to retrieve articles that investigated adverse maternal and neonatal outcomes in women with mild GDM in comparison with non-GDM counterparts. All populations were classified to three groups based on their diagnostic criteria for mild GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed/random effects models. Publication bias was assessed using the Harbord test. DerSimonian and Laird, and inverse variance methods were used to calculate the pooled relative risk of events. Subgroup analysis was performed based on mild GDM diagnostic criteria. Quality and risk of bias assessment were performed using standard questionnaires. Results: Seventeen studies involving 11,623 pregnant women with mild GDM and 53,057 non-GDM counterparts contributed to the meta-analysis. For adverse maternal outcomes, the results of meta-analysis showed that the women with mild GDM had a significantly higher risk of cesarean section (pooled RR: 1.3, 95% CI 1.2-1.5), pregnancy-induced hypertension (pooled RR: 1.4, 95% CI 1.1-1.7), preeclampsia (pooled RR: 1.3, 95% CI 1.1-1.5) and shoulder dystocia (pooled RR: 2.7, 95% CI 1.5-5.1) in comparison with the non-GDM population. For adverse neonatal outcomes, the pooled relative risk of macrosomia (pooled RR = 0.4, 95% CI: 1.1-1.7), large for gestational age (pooled RR = 1.7, 95% CI: 1.3-2.3), hypoglycemia (pooled RR = 1.6, 95% CI: 1.1-2.3), hyperbilirubinemia (pooled RR = 1.1, 95% CI: 1-1.3), 5 min Apgar <7 (pooled RR = 1.6, 95% CI: 1.1-2.4), admission to the neonatal intensive care unit (pooled RR = 1.5, 95% CI: 1.1-2.1), respiratory distress syndrome (pooled RR = 3.2, 95% CI: 1.8-5.5), and preterm birth (pooled RR = 1.4, 95% CI: 1.1-1.7) was significantly increased in the mild GDM women as compared with the non-GDM population. However, the adverse events of small for gestational age and neonatal death were not significantly different between the groups. Analysis of composite maternal and neonatal outcomes revealed that the risk of those adverse outcomes in the women with mild GDM in all classifications were significantly higher than the non-GDM population. Also, the meta-regression showed that the magnitude of those increased risks in both composite maternal and neonatal outcomes was similar. Conclusion: The risks of sever adverse neonatal outcomes including small for gestational age and neonatal mortality are not increased with mild GDM. However, the increased risks of most adverse maternal and neonatal outcomes are observed. The risks have similar magnitudes for all mild GDM diagnostic classifications.
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Affiliation(s)
- Razieh Bidhendi Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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