Analysis of Maternal and Neonatal Complications in a Group of Patients with Gestational Diabetes Mellitus

The Impact of Mobile Health (mHealth) Apps on Gestational Diabetes: A Systematic Review

Gestational diabetes mellitus (GDM) poses a significant health risk for pregnant women, as it is associated with an increased likelihood of developing type II diabetes and cardiovascular complications. In addition, there is a high risk for pregnancy-related complications, emphasizing the need for effective management of GDM. This study aimed to investigate the potential impact of mHealth applications on gestational diabetes-related outcomes. A systematic review was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in Pubmed, Scopus, and Web of Science, using the following search terms: (smartphone* OR mobile OR mHealth OR "mobile health") AND ("gestational diabetes" OR "maternal diabetes" OR "pregnancy diabetes" OR "pregnancy-induced diabetes" OR "perinatal diabetes"). In order to be included in the systematic review, the studies had to be papers published in peer-reviewed journals, published from February 2, 2020 to February 2, 2025, in the English language, being randomized trials, evaluating the impact of mHealth apps on women with GDM, excluding studies that incorporated additional technological interventions (e.g., WeChat supportive groups). The extracted data were the following: authors, country, total and per group number of participants, participants' characteristics, interventional content, assessments, time of the assessments, results, and potential information about participant adherence. The Jadad Scale was used for quality evaluation. Six studies met the predefined criteria and were included in the systematic review. Three studies found no or minimal benefits from the use of such applications. One study demonstrated highly significant benefits, not only in the management of GDM but also in reducing pregnancy-related complications. Another study indicated greater adherence to treatment and fewer admissions to neonatal intensive care units, while a third study reported a shift toward better postpartum health behaviors, which was closely associated with the use of mHealth applications, suggesting that those apps could support women in adopting healthier habits after childbirth. All studies reporting positive outcomes were carried out in Eastern Asian Countries (Singapore and China), whereas studies conducted in Europe found minimal or no benefits. The score on the Jadad Scale ranged from 2 to 3, indicating moderate to low quality. Οverall, while some promising findings were observed, further research is essential to evaluate these apps more thoroughly and enhance their effectiveness. Greater culturally influenced adherence to healthcare instructions leads to more significant benefits for Asian women with GDM. Cultural factors should be carefully considered when designing and implementing mHealth applications for women with GDM.

How Do Maternal Gestational Diabetes and Other Concomitant Maternal Factors Determine the Perinatal Outcomes of Pregnancy?-A Retrospective Analysis

OBJECTIVES

Gestational diabetes mellitus (GDM) is associated with an increased risk of both neonatal and maternal morbidity. The aim of this retrospective study was to evaluate the frequency of perinatal complications due to GDM in the Department of Neonatology at the Medical University of Wroclaw, Poland, considering the treatment of GDM-diet and physical activity versus insulin therapy. The influence of maternal comorbidities and the COVID-19 pandemic on pregnancy outcomes was assessed.

METHODS

A retrospective analysis of medical records was conducted. Statistics were calculated using a range of methods, with p < 0.05 considered significant. A sample of n = 625 mothers with n = 646 newborns were included in this study.

RESULTS

The newborns of insulin-treated mothers had cardiovascular defects more often (p < 0.05). A higher prevalence of vaginal infections was found in the diet-treated mothers (p < 0.05), while insulin-treated mothers had a higher prevalence of pregnancy-induced hypertension, pregnancy-induced hypothyroidism and obesity (p < 0.05). The mode of delivery, maternal age and maternal pregnancy-induced hypertension, obesity and cholestasis were found to influence neonatal outcomes (p < 0.05).

CONCLUSIONS

The maternal management of GDM is not the main determinant of pregnancy outcomes, which might be affected by other maternal comorbidities. Effective initiatives are needed to control GDM, support breastfeeding and prevent adverse pregnancy outcomes.

Gestational diabetes mellitus and risk of neonatal respiratory distress syndrome: a systematic review and meta-analysis

AIM

Gestational Diabetes Mellitus (GDM), a common pregnancy complication characterized by glucose intolerance, is increasingly recognized as a risk factor for Neonatal Respiratory Distress Syndrome (NRDS). This study aimed to systematically review and quantify the association between GDM and NRDS.

METHODS

A comprehensive search was conducted in PubMed, Scopus, Embase, and Web of Science from their inception through July 30, 2024, to identify relevant studies. A total of 44 studies, including 50 datasets and over 6.2 million participants, were included in the analysis. Meta-analyses were performed using random-effects models to estimate pooled odds ratios (ORs) and assess heterogeneity among studies. Subgroup analyses were conducted based on study design, gestational age, diagnostic methods, and geographical regions.

RESULTS

Our meta-analysis demonstrated a statistically significant association between GDM and an increased risk of NRDS in newborns (OR 1.9; 95%CI 1.5-2.3). A sub-group analysis based on studies participants showed significant association in both GDM-based (OR, 2.0; 95%CI, 1.5-2.7) and NRSD-based studies (OR, 1.7; 95%CI, 1.3-2.3). This association was consistent across other various subgroups, including both term and preterm pregnancies and across different continents. Sensitivity analysis confirmed the robustness of these findings, and cumulative meta-analysis showed a steady increase in the strength of the association over time.

CONCLUSION

Our findings highlight GDM as a significant risk factor for NRDS, underscoring the need for early detection and effective management of GDM to reduce adverse neonatal outcomes. However, limitations such as residual confounding, high heterogeneity among studies, and evidence of publication bias should be considered when interpreting these results. Future research should address these issues by including diverse populations and accounting for key confounders to better understand the GDM-NRDS relationship and explore targeted interventions to mitigate the risk in infants born to mothers with GDM.

Infants of Diabetic Mothers and Associated Complications in the Neonatal Intensive Care Unit

Background The incidence of pregnancy-associated diabetes has increased in recent decades, leading to neonatal adverse outcomes like metabolic and hematologic disorders, respiratory distress, cardiac disorders, and neurologic impairment. Macrosomia, a common consequence of diabetes, is influenced by maternal blood glucose levels, impacting adverse neonatal outcomes. Aim The current study aimed to assess the neonatal and maternal outcomes of the infants of diabetic mothers. Methods An observational retrospective study was conducted among infants of diabetic mothers at Maternity and Children Hospital, Saudi Arabia, from 2022 to 2023. The data included socio-demographic details, diabetes-related information, and maternal and neonatal outcomes.  Results A study of 400 mothers aged 18-40 years found that 54.3% had 1-4 previous pregnancies, while 35.5% had more than four. The majority had gestational diabetes mellitus (GDM), with 25.5% having diabetes for more than five years. The most common complications were preeclampsia (7.5%), polyhydramnios (6%), UTI (5.3%), PROM (4.3%), and pregnancy-induced hypertension (4.3%). The majority had no complications, while 12.5% of neonates had respiratory and metabolic complications. Conclusion The study found that most women with gestational diabetes had previously been diagnosed with diabetes mellitus (DM) and are multiparous, with Caesarean delivery being the dominant mode. While maternal complications were seen in only less than one-third of mothers, neonatal complications were noted in 12.5%.

The Interactions Between Diet and Gut Microbiota in Preventing Gestational Diabetes Mellitus: A Narrative Review

Recent studies have revealed that dysbiosis, defined as alterations in gut microbiota, plays an important role in the development and the progression of many non-communicable diseases, including metabolic disorders, such as type 2 diabetes mellitus and gestational diabetes mellitus (GDM). The high frequency of GDM makes this disorder an important public health issue, which needs to be addressed in order to reduce both the maternal and fetal complications that are frequently associated with this disease. The studies regarding the connections between gut dysbiosis and GDM are still in their early days, with new research continuously emerging. This narrative review seeks to outline the mechanisms through which a healthy diet that protects the gut microbiota is able to prevent the occurrence of GDM, thus providing medical nutritional therapeutic perspectives for the management of GDM.

Back to Roots: Dysbiosis, Obesity, Metabolic Syndrome, Type 2 Diabetes Mellitus, and Obstructive Sleep Apnea-Is There an Objective Connection? A Narrative Review

In recent decades, it has become clear that the gut is more than just a digestive organ; it also functions as an immune organ with regulatory capabilities and acts as a "second brain" that influences brain function due to the presence and regulatory roles of the gut microbiota (GM). The GM is a crucial component of its host and significantly impacts human health. Dysbiosis, or microbial imbalance, has been closely linked to various diseases, including gastrointestinal, neurological, psychiatric, and metabolic disorders. The aim of this narrative review is to highlight the roles of the GM in maintaining metabolic health. Sleep is a vital biological necessity, with living organisms having evolved an internal sleep-wake rhythm that aligns with a roughly 24 h light/dark cycle, and this is known as the circadian rhythm. This cycle is essential for tissue repair, restoration, and overall optimal body functioning. Sleep irregularities have become more prevalent in modern society, with fast-paced lifestyles often disrupting normal sleep patterns. Urban living factors, such as fast food consumption, shift work, exposure to artificial light and nighttime noise, medications, and social activities, can adversely affect circadian rhythms, with dysbiosis being one of the many factors incriminated in the etiology of sleep disorders.

Gestational Outcomes Related to the Occurrence of Gestational Diabetes Mellitus: A Cohort Study

BACKGROUND

Gestational diabetes mellitus (GDM) is the main cause of hyperglycemia in pregnancy and is related to complications throughout the gestational and post-partum period.

OBJECTIVES

To analyze the pregnancy outcomes related to the occurrence of GDM in women and their offspring.

METHODS

Third-trimester pregnant women were interviewed and monitored until childbirth. The diagnosis of GDM, blood glucose ≥ 92 mg/dL, was defined by the criteria of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG).

RESULTS

A total of 138 women participated, and there were 136 births (due to 2 fetal losses); 23 (16.7%) were diagnosed with GDM. The risk of complications during childbirth was higher among pregnant women with GDM (RR 3.40; 95%CI 1.65-7.00), as was the occurrence of cesarean birth (RR 1.9; 95%CI 1.46-2.59). The occurrence of preterm birth did not show a significant difference between GDM/non-GDM groups. There was a non-significant association in adjusted analyses of macrosomia (birth weight ≥ 4000 g) among newborns born to mothers with GDM (RR 1.27; 95%CI 0.67-2.38). For newborns born to pregnant women with GDM, there was a higher risk for the following outcomes: large for gestational age (LGA) (3.29 95%CI 1.62-6.64), low Apgar (4.98 95%CI 2.32-10.69), and birth asphyxia (9.51 95%CI 3.42-26.48).

CONCLUSIONS

The findings reinforce that GDM is an important risk factor for adverse pregnancy outcomes for women and their offspring.

Maternal and foetal complications of pregestational and gestational diabetes: a descriptive, retrospective cohort study

Gestational diabetes is characterized by hyperglycaemia diagnosed during pregnancy. Gestational and pregestational diabetes can have deleterious effects during pregnancy and perinatally. The baby's weight is frequently above average and might reach macrosomia (≥ 4 kg), which can reduce pregnancy time causing preterm births, and increase foetal-pelvic disproportion which often requires delivery by caesarean section. Foetal-pelvic disproportion due to the baby's weight can also cause foetal distress resulting in lower Apgar scores. To analyse the association between pregestational and gestational diabetes with maternal and foetal risk. We conducted a retrospective cohort study in women pregnant between 2012 and 2018 in the region of Lleida. Regression coefficients and 95% confidence intervals (CI) were used. The multivariate analysis showed statistically significant associations between pregestational diabetes and: prematurity (OR 2.4); caesarean section (OR 1.4); moderate (OR 1.3), high (OR 3.3) and very high (OR 1.7) risk pregnancies; and birth weight ≥ 4000 g (macrosomia) (OR 1.7). In getational diabetes the multivariate analysis show significant association with: caesarean section (OR 1.5); moderate (OR 1.7), high (OR 1.7) and very high (OR 1.8) risk pregnancies and lower 1-minuto Apgar score (OR 1.5). Pregestational and gestational diabetes increase: pregnancy risk, caesarean sections, prematurity, low Apgar scores, and macrosomia.

Hyperglycemia in pregnancy did not worsen the short-term outcomes of very preterm infants: a propensity score matching study

Background

Hyperglycemia in pregnancy (HGP) has generally been considered a risk factor associated with adverse outcomes in offspring, but its impact on the short-term outcomes of very preterm infants remains unclear.

Methods

A secondary analysis was performed based on clinical data collected prospectively from 28 hospitals in seven regions of China from September 2019 to December 2020. According to maternal HGP, all infants were divided into the HGP group or the non-HGP group. A propensity score matching analysis was used to adjust for confounding factors, including gestational age, twin or multiple births, sex, antenatal steroid administration, delivery mode and hypertensive disorders of pregnancy. The main complications and the short-term growth status during hospitalization were evaluated in the HGP and non-HGP groups.

Results

A total of 2,514 infants were eligible for analysis. After matching, there were 437 infants in the HGP group and 874 infants in the non-HGP group. There was no significant difference between the two groups in main complications including respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, culture positive sepsis, intraventricular hemorrhage, periventricular leukomalacia, anemia, feeding intolerance, metabolic bone disease of prematurity, or parenteral nutrition-associated cholestasis. The incidences of extrauterine growth retardation and increased growth retardation for weight and head circumference in the non-HGP group were all higher than those in the HGP group after matching (P < 0.05).

Conclusions

HGP did not worsen the short-term outcomes of the surviving very preterm infants, as it did not lead to a higher risk of the main neonatal complications, and the infants' growth improved during hospitalization.

Risk of adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus by age: a multicentric cohort study in Hebei, China

Gestational diabetes mellitus (GDM) is an unique metabolic disorder that occurs during pregnancy. Both GDM and advanced age increase the risk of adverse pregnancy outcomes. This study used a GDM cohort study to investigate the role of age in the adverse pregnancy outcomes for pregnant women with GDM. From 2015 to 2021, 308,175 pregnant women were selected, and the data received from 22 hospitals by the Hebei Province Maternal Near Miss Surveillance System. There were 24,551 pregnant women with GDM that were divided into five groups by age (20-24, 25-29, 30-34, 35-39, 40-44 years old). Because the prevalence of adverse pregnancy outcomes was lower in pregnant women with GDM aged 25-29, they were used as a reference group (P < 0.05). Compared with GDM women aged 25-29 years, GDM women aged 35-44 years had a significant higher risk of cesarean delivery (aOR: 2.86, 95% CI 2.52-3.25) (P < 0.001), abnormal fetal position (aOR: 1.78, 95% CI 1.31-2.37) (P < 0.001), pre-eclampsia (aOR: 1.28, 95% CI 1.01-1.61) (P < 0.05), macrosomia (aOR: 1.25, 95% CI 1.08-1.45) (P < 0.05), and large for gestational age (LGA) (aOR: 1.16, 95% CI 1.02-1.31) (P < 0.05), GDM women aged 40-44 years had a higher risk of placenta previa (aOR: 2.53, 95% CI 1.01-6.35) (P < 0.05), anemia (aOR: 3.45, 95% CI 1.23-9.68) (P < 0.05) and small for gestational age (aOR: 1.32, 95% CI 1.01-1.60) (P < 0.05). Advanced maternal age was an independent risk factor for abnormal fetal position, pre-eclampsia, anemia, macrosomia, and LGA in pregnant women with GDM.

Abnormal neonatal brain microstructure in gestational diabetes mellitus revealed by MRI texture analysis

To investigate the value of MRI texture analysis in evaluating the effect of gestational diabetes mellitus (GDM) on neonatal brain microstructure development, we retrospectively collected images of neonates undergoing head MRI scans, including a GDM group (N1 = 37) and a healthy control group (N2 = 34). MaZda texture analysis software was used to extract the texture features from different sequence images and perform dimensionality reduction, and then the texture features selected by the lowest misjudgement rate method were imported into SPSS software for statistical analysis. In our study, we found that GDM affects the development of the microstructure of the neonatal brain, and different combinations of texture features have different recognition performances, such as different sequences and different brain regions. As a consequence, texture analysis combining multiple conventional MRI sequences has a high recognition performance in revealing the abnormal development of the brain microstructure of neonates born of mothers with GDM.

Blood-Biomarkers for Glucose Metabolism in Preterm Infants

This was an exploratory, prospective, longitudinal, cohort study that aimed to establish "healthy" reference levels related to growth parameters and glucose metabolites in preterm infants. This was conducted to further investigate growth and metabolic disturbances potentially related to neonatal illness. The study sample consisted of 108 preterm infants born before 32 weeks in 2018-2019 in the Capital Region of Denmark. Repetitive blood samples were acquired at the neonatal wards, while clinical data were obtained from the regional hospital medical record system. Thirty-four "healthy" preterm infants (31%) were identified. The "ill" infants were divided into four subgroups dependent on gestational age and small for gestational age. Reference levels for the growth parameters and metabolic biomarkers glucose, albumin, and adiponectin, and two glucose control indicators, glycated albumin and fructosamine, were determined for the "healthy" and "ill" subgroups. The "ill" extremely preterm infants had increased glucose levels (mean difference 0.71 mmol/L, 95% CI 0.23; 1.18 mmol/L) and glycated albumin (corrected; %) (mean difference 0.92 mmol/L, 95% CI 0.38 mmol/L;1.47 mmol/L) compared to the "healthy" infants. In "ill" extremely preterm infants and "ill" very preterm infants born small for gestational age, levels of biomarkers containing proteins were decreased. In the "Ill" extremely preterm infants and infants born small for gestational age, postnatal growth was continuously decreased throughout the postconceptional period. The short-term glucose-control indicator, glycated albumin (corrected; %), reflected well the high glucose levels due to its correction for the depleted plasma-protein pool.

Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol

INTRODUCTION

Gestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy, which is closely associated with many short-term and long-term maternal and neonatal complications and can incur heavy financial burden on both families and society. Web-based interventions have been used to manage GDM because of the advantages of high accessibility and flexibility, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to comprehensively investigate the multidimensional effectiveness of web-based interventions for pregnant women with GDM, thereby aiding implementation decisions in clinical settings.

METHODS AND ANALYSIS

This systematic review protocol strictly adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Six electronic databases (PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, CINAHL and PsycINFO) will be comprehensively searched from their inception to 26 January 2022 to identify randomised controlled trials and controlled clinical trials regarding the efficacy of web-based interventions for pregnant women with GDM on glycaemic control, behavioural outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service utilisation and costs. Two reviewers will independently conduct the study selection, data extraction and quality assessment. The methodological quality of included studies will be assessed using the Effective Public Health Practice Project assessment tool. The overall meta-analyses for each of the interested outcomes will be performed if the outcome data are sufficient and provides similar effect measures, as well as subgroup analyses for glycaemic control indicators based on the different types of intervention format, interactivity and technology. We will conduct a qualitative synthesis for studies that cannot be quantitatively synthesised.

ETHICS AND DISSEMINATION

Ethics approval is not required for this review as no human participants will be involved. The results will be disseminated via a peer-reviewed journal or an academic conference.

PROSPERO REGISTRATION NUMBER

CRD42022296625.

Maternal and Fetal Metabolites in Gestational Diabetes Mellitus: A Narrative Review

Gestational diabetes mellitus (GDM) is a major public health issue of our century due to its increasing prevalence, affecting 5% to 20% of all pregnancies. The pathogenesis of GDM has not been completely elucidated to date. Increasing evidence suggests the association of environmental factors with genetic and epigenetic factors in the development of GDM. So far, several metabolomics studies have investigated metabolic disruptions associated with GDM. The aim of this review is to highlight the usefulness of maternal metabolites as diagnosis markers of GDM as well as the importance of both maternal and fetal metabolites as prognosis biomarkers for GDM and GDM’s transition to type 2 diabetes mellitus T2DM.

Analysis of Risk Factors for the Development of Gestational Diabetes Mellitus in a Group of Romanian Patients

INTRODUCTION

Gestational diabetes mellitus (GDM) is caused by numerous risk factors, the most common being old age, obesity, family history of diabetes mellitus, GDM, history of fetal macrosomia, history of polycystic ovary syndrome or treatment with particular drugs, multiple births, and certain races. The study proposed to analyze the risk factors causing GDM.

METHOD

In the study, we included 97 pregnant women to whom there was an OGTT performed between weeks 24th and 28th of pregnancy, divided into two groups, with GDM and without GDM. The statistical analysis was performed with SPSS 26.0, the tests being statistically significant if p value < 0.05.

RESULTS

The favoring risk factors for the onset of GDM were analyzed, with statistically significant differences between the GDM group and the group without GDM related to the delivery age (32.39 ± 4.66 years old vs. 28.61 ± 4.71 years old), history of fetal macrosomia (13.7% vs. 0%), presence of GDM during previous pregnancies (7.8% vs. 0%), HBP before pregnancy (9.8% vs. 0%), gestational HBP (17.6% vs. 0%), glycemia value at first medical visit (79.37 ± 9.34 mg/dl vs. 71.39 ± 9.16 mg/dl), and weight gain during pregnancy (14.61 ± 4.47 kg vs. 12.48 ± 5.87 kg).

CONCLUSIONS

Identifying the risk factors for the GDM onset has a special importance, implying an early implementation of interventional measures in order to avoid the onset of GDM and associated maternal and fetal complications.