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Bashir M, Fagier Y, Ahmed B, C Konje J. An overview of diabetes mellitus in pregnant women with obesity. Best Pract Res Clin Obstet Gynaecol 2024; 93:102469. [PMID: 38359580 DOI: 10.1016/j.bpobgyn.2024.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Rates of obesity are increasing world-wide with an estimated 1billion people projected to be obese by 2030 if current trends remain unchanged. Obesity currently considered one of the most significant associated factors of non-communicable diseases poses the greatest threat to health. Diabetes mellitus is an important metabolic disorder closely associated with obesity. It is therefore expected that with the increasing rates of obesity, the rates of diabetes in pregnancy will also be rising. This disorder may pre-date pregnancy (diagnosed or undiagnosed and diagnosed for the first time in pregnancy) or may be of onset in pregnancy. Irrespective of the timing of onset, diabetes in pregnancy is associated with both fetal and maternal complications. Outcomes are much better if control is maximised. Early diagnosis, multidisciplinary care and tailored management with optimum glycaemic control is associated with a significant reduction in not only pregnancy complications but long-term consequences on both the mother and offspring. This review brings together the current understanding of the pathogenesis of the endocrine derangements that are associated with diabetes in pregnancy how screening should be offered and management including pre-pregnancy care and the role of newer agents in management.
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Affiliation(s)
- Mohammed Bashir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar; Endocrinology, Weill Cornell Medicine, Doha, Qatar.
| | - Yassin Fagier
- Women's Clinical Management Group, Sidra Medicine, Doha, Qatar
| | - Badreldeen Ahmed
- Feto Maternal Centre, Al Markhiya Street, Doha, Qatar; Obstetrics and Gynaecology, Weill Cornell Medicine, Doha, Qatar; Obstetrics and Gynaecology, Qatar University, Doha, Qatar
| | - Justin C Konje
- Feto Maternal Centre, Al Markhiya Street, Doha, Qatar; Obstetrics and Gynaecology, Weill Cornell Medicine, Doha, Qatar; Obstetrics and Gynaecology, University of Leicester, UK
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Lajili O, Htira Y, Temessek A, Hedfi I, Ben Amara S, Ben Mami F. Incidence of maternal and fetal outcomes in women with gestational diabetes. LA TUNISIE MEDICALE 2022; 100:241-246. [PMID: 36005916 PMCID: PMC9387649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is associated with both maternal and fetal complications related to maternal hyperglycemia. AIM The aim of the study was to describe the incidence of maternal and fetal complications associated with GDM in a reference maternity hospital in the Tunis (2019-2020). METHODS We conducted a prospective longitudinal descriptive and analytical study including 220 patients followed for GDM at the research unit «Diabetes and pregnancy» of the C department of the National Institute of Nutrition of Tunis. The patients were followed during pregnancy and until post partum, for a period of 18 months (July 2019-December 2020). The patients were divided into two groups Group1(G1) including women treated with insulin therapy (n=68) and Group 2(G2) including women treated with diet only (n=152). RESULTS In the current study, 63,6% of patients delivered by cesarean section and 5% developed gestational induced hypertension. Neonatal outcomes were dominated by macrosomia (13.5%) and transient respiratory distress (11.4%). Insulin-treated women had a higher incidence of gestational induced hypertension (G1:11,9% versus G2: 2,1%;p=0,03). There was no significant difference between the two groups in the incidence of fetal outcomes including macrosomia (G1:17.6% versus G2:11.2%; p=0.203),transient respiratory distress (G1:11.8% versus G2: 10.5%; p=0.781) and prematurity (G1:7.4% versus G2:4.6%; p=0.452). CONCLUSION Our study showed that Insulin-treated women had a higher incidence of gestational induced hypertension. However, there was no significant difference between the two groups in the incidence of fetal complications.
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Affiliation(s)
- Olfa Lajili
- Unité de recherche 17 SPO2 « Diabète et grossesse », Service C de diabétologie nutrition et maladies nutritionnelles, Institut National de Nutrition et des technologies alimentaires / Faculté de médecine de Tunis
| | - Yosra Htira
- Unité de recherche 17 SPO2 « Diabète et grossesse », Service C de diabétologie nutrition et maladies nutritionnelles, Institut National de Nutrition et des technologies alimentaires / Faculté de médecine de Tunis
| | - Aroua Temessek
- Unité de recherche 17 SPO2 « Diabète et grossesse », Service C de diabétologie nutrition et maladies nutritionnelles, Institut National de Nutrition et des technologies alimentaires / Faculté de médecine de Tunis
| | - Imen Hedfi
- Unité de recherche 17 SPO2 « Diabète et grossesse », Service C de diabétologie nutrition et maladies nutritionnelles, Institut National de Nutrition et des technologies alimentaires / Faculté de médecine de Tunis
| | - Sarra Ben Amara
- Unité de recherche 17 SPO2 « Diabète et grossesse », Service C de diabétologie nutrition et maladies nutritionnelles, Institut National de Nutrition et des technologies alimentaires / Faculté de médecine de Tunis
| | - Feika Ben Mami
- Unité de recherche 17 SPO2 « Diabète et grossesse », Service C de diabétologie nutrition et maladies nutritionnelles, Institut National de Nutrition et des technologies alimentaires / Faculté de médecine de Tunis
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Cai M, Shao X, Xing F, Zhang Y, Gao X, Zeng Q, Dilimulati D, Qu S, Zhang M. Efficacy of canagliflozin versus metformin in women with polycystic ovary syndrome: A randomized, open-label, noninferiority trial. Diabetes Obes Metab 2022; 24:312-320. [PMID: 34726324 DOI: 10.1111/dom.14583] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine the safety and efficacy of canagliflozin in comparison to metformin in polycystic ovary syndrome (PCOS) patients with insulin resistance (IR). METHODS A single-centre, prospective, randomized open-label (ratio 1:1) noninferiority trial was conducted at the Department of Endocrinology, Shanghai Tenth People's Hospital, between July 2019 and April 2021. Women aged 18 to 45 years with PCOS and IR were enrolled and randomly assigned to either 100 mg (n = 33) canagliflozin daily or 1500 to 2000 mg metformin daily (n = 35) for 12 weeks. The primary outcome was changes in homeostatic model assessment (HOMA)-IR after 12 weeks of treatment. The secondary outcomes included changes in anthropometric measurements, menstrual frequency, sex hormone levels, metabolic variables and body fat distribution. RESULTS For lowering of HOMA-IR after 12 weeks of treatment, canagliflozin was found to be noninferior to metformin (least-squares mean difference -0.81% [95% confidence interval -2.13 to 0.51]). Both canagliflozin and metformin significantly improved menstrual pattern, reduced body weight and total fat mass, and decreased triglyceride levels. Compared with metformin, canagliflozin had significant advantages in reducing uric acid and dehydroepiandrosterone sulphate levels. Pruritus vulvae (9.09%) and gastrointestinal reaction (55.55%) were the main adverse events in the metformin group and canagliflozin group, respectively. CONCLUSION This study demonstrates that canagliflozin was not inferior to metformin in PCOS patients with IR, which suggests that sodium-glucose cotransporter-2 inhibitors should be considered as effective drugs in the treatment of PCOS patients with IR.
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Affiliation(s)
- Meili Cai
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaowen Shao
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Xing
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuqin Zhang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinyu Gao
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiongjing Zeng
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Diliqingna Dilimulati
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China
| | - Manna Zhang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China
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Selen DJ, Edelson PK, James K, Corelli K, Hivert MF, Meigs JB, Thadhani R, Ecker J, Powe CE. Physiological subtypes of gestational glucose intolerance and risk of adverse pregnancy outcomes. Am J Obstet Gynecol 2022; 226:241.e1-241.e14. [PMID: 34419453 PMCID: PMC8810751 DOI: 10.1016/j.ajog.2021.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Women with gestational glucose intolerance, defined as an abnormal initial gestational diabetes mellitus screening test, are at risk of adverse pregnancy outcomes even if they do not have gestational diabetes mellitus. Previously, we defined the physiological subtypes of gestational diabetes mellitus based on the primary underlying physiology leading to hyperglycemia and found that women with different subtypes had differential risks of adverse outcomes. Physiological subclassification has not yet been applied to women with gestational glucose intolerance. OBJECTIVE We defined the physiological subtypes of gestational glucose intolerance based on the presence of insulin resistance, insulin deficiency, or mixed pathophysiology and aimed to determine whether these subtypes are at differential risks of adverse outcomes. We hypothesized that women with the insulin-resistant subtype of gestational glucose intolerance would have the greatest risk of adverse pregnancy outcomes. STUDY DESIGN In a hospital-based cohort study, we studied women with gestational glucose intolerance (glucose loading test 1-hour glucose, ≥140 mg/dL; n=236) and normal glucose tolerance (glucose loading test 1-hour glucose, <140 mg/dL; n=1472). We applied homeostasis model assessment to fasting glucose and insulin levels at 16 to 20 weeks' gestation to assess insulin resistance and deficiency and used these measures to classify women with gestational glucose intolerance into subtypes. We compared odds of adverse outcomes (large for gestational age birthweight, neonatal intensive care unit admission, pregnancy-related hypertension, and cesarean delivery) in each subtype to odds in women with normal glucose tolerance using logistic regression with adjustment for age, race and ethnicity, marital status, and body mass index. RESULTS Of women with gestational glucose intolerance (12% with gestational diabetes mellitus), 115 (49%) had the insulin-resistant subtype, 70 (27%) had the insulin-deficient subtype, 40 (17%) had the mixed pathophysiology subtype, and 11 (5%) were uncategorized. We found increased odds of large for gestational age birthweight (primary outcome) in women with the insulin-resistant subtype compared with women with normal glucose tolerance (odds ratio, 2.35; 95% confidence interval, 1.43-3.88; P=.001; adjusted odds ratio, 1.74; 95% confidence interval, 1.02-3.48; P=.04). The odds of large for gestational age birthweight in women with the insulin-deficient subtype were increased only after adjustment for covariates (odds ratio, 1.69; 95% confidence interval, 0.84-3.38; P=.14; adjusted odds ratio, 2.05; 95% confidence interval, 1.01-4.19; P=.048). Among secondary outcomes, there was a trend toward increased odds of neonatal intensive care unit admission in the insulin-resistant subtype in an unadjusted model (odds ratio, 2.09; 95% confidence interval, 0.99-4.40; P=.05); this finding was driven by an increased risk of neonatal intensive care unit admission in women with the insulin-resistant subtype and a body mass index of <25 kg/m2. Infants of women with other subtypes did not have increased odds of neonatal intensive care unit admission. The odds of pregnancy-related hypertension in women with the insulin-resistant subtype were increased (odds ratio, 2.09; 95% confidence interval, 1.31-3.33; P=.002; adjusted odds ratio, 1.77; 95% confidence interval, 1.07-2.92; P=.03) compared with women with normal glucose tolerance; other subtypes did not have increased odds of pregnancy-related hypertension. There was no difference in cesarean delivery rates in nulliparous women across subtypes. CONCLUSION Insulin-resistant gestational glucose intolerance is a high-risk subtype for adverse pregnancy outcomes. Delineating physiological subtypes may provide opportunities for a more personalized approach to gestational glucose intolerance.
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Affiliation(s)
- Daryl J Selen
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - P Kaitlyn Edelson
- Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics and Gynecology, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kaitlyn James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Kathryn Corelli
- Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Marie-France Hivert
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - James B Meigs
- Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA
| | - Ravi Thadhani
- Harvard Medical School, Boston, MA; Mass General Brigham, Boston, MA
| | - Jeffrey Ecker
- Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Camille E Powe
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA.
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Zhou Z, Deng C, Xiang X. Blood glucose related to pregnancy induced hypertension syndrome. Am J Transl Res 2021; 13:5301-5307. [PMID: 34150122 PMCID: PMC8205659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND To investigate the incidence of hyperglycemia caused by abnormal glucose metabolism during pregnancy and the relationship between abnormal glucose metabolism and pregnancy induced hypertension (PIH). METHODS 734 pregnant females were assigned into the PIH group (n=284) and the normal group (n=304). We examined fasting blood glucose (FBG), 1 hour postprandial blood glucose, 2-hour postprandial blood glucose, fasting insulin (FINS), 1 hour postprandial insulin, 2 hour postprandial insulin, triglyceride (TG), total cholesterol (TC), Hemoglobin A1c (HbA1c) and Insulin sensitivity index (ISI), at the same time, we recorded the SBP, DBP, BMI of each pregnant women. RESULTS The fasting blood glucose, 1 hour postprandial blood glucose and 2 hours postprandial blood glucose in the PIH group were higher than those in the normal group (P<0.05). And insulin sensitivity index and hemoglobin Alc (HbA1c) in the PIH group was statistically significant compared with the normal group during 24-28 weeks of gestation. CONCLUSIONS Our results demonstrated that abnormal glucose metabolism in second trimester may be related to higher risk of PIH, and hyperglycemia may be one of the important factors of pregnancy induced hypertension.
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Affiliation(s)
- Zhao Zhou
- Department of Obstetrics, Jiaozhou Central Hospital Qingdao 266300, Shangdong Province, China
| | - Cuiyan Deng
- Department of Obstetrics, Jiaozhou Central Hospital Qingdao 266300, Shangdong Province, China
| | - Xuewen Xiang
- Department of Obstetrics, Jiaozhou Central Hospital Qingdao 266300, Shangdong Province, China
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Xu XH, Kou LC, Wang HM, Bo CM, Song XC. Genetic polymorphisms of melatonin receptors 1A and 1B may result in disordered lipid metabolism in obese patients with polycystic ovary syndrome. Mol Med Rep 2019; 19:2220-2230. [PMID: 30664204 PMCID: PMC6390034 DOI: 10.3892/mmr.2019.9872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a condition in which a woman's levels of the sex hormones (estrogen and progesterone) are out of balance, leading to the growth of ovarian cysts. PCOS can affect the menstrual cycle, fertility, cardiac function and even appearance of women. Therefore, we aimed to explore the genetic polymorphism of the melatonin receptors 1A and 1B in obese patients with PCOS to identify a new theoretical basis for its treatment. Patients presenting with PCOS (n=359) were enrolled and classified into an obese OB-PCOS group [body mass index (BMI) of PCOS patients ≥25 kg/m2] or a nonobese NOB-PCOS group, and 215 oviduct infertile patients who experienced normal ovulation were used as the control group. All baseline characteristics, endocrine hormone levels, lipid and glucose metabolism, and insulin indices were measured. The genotypes of rs2119882 within the MTNR1A gene and of rs10830963 within the MTNR1B gene were determined by PCR-RFLP; the genotype frequency and the difference in the distribution of allele frequency were compared. For rs2119882, C allele carriers who were not diagnosed with PCOS had an increased risk of developing PCOS, and C allele carriers with PCOS had an increased risk of developing OB-PCOS. For rs10830963, G allele carriers who were not diagnosed with PCOS had an increased risk of developing PCOS. The TT genotype in rs2119882 and the CC genotype in rs10830963 were protective factors for OB-PCOS, and increased levels of LH, testosterone, and estradiol and abnormal menstruation were key risk factors for PCOS. Furthermore, the TT genotype at the rs2119882 site was the key protective factor for OB-PCOS patients. Our study found that MTNR1A rs2119882 and MTNR1B rs10830963 could increase the risk for PCOS and cause glycolipid metabolism disorder in PCOS patients.
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Affiliation(s)
- Xiu-Hua Xu
- Obstetrics and Gynecology Clinic, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Lian-Cui Kou
- Department of Blood Rheumatism, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Hai-Mei Wang
- Marketing and Customer Service, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Chun-Mei Bo
- Obstetrics and Gynecology Clinic, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Xiao-Cui Song
- Department of Reproductive Medicine, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
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Wang H, Yang J, Du H, Xu L, Liu S, Yi J, Qian X, Chen Y, Jiang Q, He G. Perfluoroalkyl substances, glucose homeostasis, and gestational diabetes mellitus in Chinese pregnant women: A repeat measurement-based prospective study. ENVIRONMENT INTERNATIONAL 2018; 114:12-20. [PMID: 29459131 DOI: 10.1016/j.envint.2018.01.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/07/2018] [Accepted: 01/26/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Exposure to perfluoroalkyl substances (PFASs) can affect glucose homeostasis and has been suggested as a potential risk of diabetes mellitus, but data are limited for pregnant women. OBJECTIVES We aimed to explore the associations of exposure to PFASs with glucose homeostasis and gestational diabetes mellitus (GDM) in Chinese pregnant women. METHODS The current study was conducted in Hebei Province of Northern China between 2013 and 2014 and 560 pregnant women were recruited in their early term of pregnancy and two representative serum PFASs, perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS), were measured. In 385 pregnant women who completed oral glucose tolerance test (OGTT), the associations of serum PFOA and PFOS concentrations with fasting blood glucose (FBG), fasting insulin (FIns), and homeostasis model assessment of insulin resistance (HOMA-IR) in the early, middle, and late terms of pregnancy and occurrence of GDM were examined using linear and Cox proportional hazard regression models. The reproducibility of serum PFASs during pregnancy was assessed in 230 pregnant women. RESULTS The intraclass correlation coefficients of serum PFASs, covariates, and outcomes based on averaged repeat measurement (0.35-0.96) were higher than those based on single measurement (0.16-0.92). Serum PFOA was positively associated with averaged FIns and HOMA-IR in the early, middle, and late terms of pregnancy and averaged blood glucose level at 1 h and 2 h of OGTT, but serum PFOS tended to be negatively associated with averaged FBG and OGTT blood glucose. The adjusted hazard ratios of GDM associated with serum PFOA and PFOS were 1.98 (95% confidence interval: 0.70-5.57; p-value: 0.197) and 0.71 (0.29-1.75; 0.453), respectively. CONCLUSIONS Our data raised a possibility that exposure to PFASs might have different influences on glucose homeostasis and GDM in Chinese pregnant women. More lab and human studies are needed to further test the hypothesis and investigate potential mechanisms.
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Affiliation(s)
- Hexing Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Jiaqi Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Hongyi Du
- Department of Maternal, Child and Adolescent Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Linji Xu
- Maternal and Child Health Care Hospital, Tangshan Municipality, Tangshan 063000, Hebei province, China
| | - Shuping Liu
- Maternal and Child Health Care Hospital, Tangshan Municipality, Tangshan 063000, Hebei province, China
| | - Jianping Yi
- Maternal and Child Health Care Hospital, Tangshan Municipality, Tangshan 063000, Hebei province, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1G5Z3, Canada
| | - Qingwu Jiang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
| | - Gengsheng He
- Department of Nutrition and Food Hygiene, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China.
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Guo J, Liu G, Guo G. Association of insulin resistance and autonomic tone in patients with pregnancy-induced hypertension. Clin Exp Hypertens 2017; 40:476-480. [PMID: 29172729 DOI: 10.1080/10641963.2017.1403619] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pregnancy-induced hypertension (PIH) remains the main cause of maternal and fatal mortality. Insulin resistance (IR) and autonomic nervous system (ANS) imbalance are two principal drivers of PIH development. Few previous researches investigated the association between IR and ANS imbalance in Chinese PIH patients. 120 pregnant women were enrolled in our study, sixty healthy pregnant women (control group), fourty one gestational hypertension (GH group) and nineteen preeclampsia patients (PE group). The homeostasis model assessment of IR (HOMA-IR) and markers of ANS (plasma biomarkers and heart rate variability (HRV) components) were collected. Body mass index (BMI), Ln(HOMA-IR), noradrenaline level, LnTP (total power), Ln SDNN (standard deviation of the normal-to-normal interval), LnLF (low frequency), LnLF/LnHF (low frequency/high frequency) were different in the GH and PE groups compared with the controls. Significant correlations were observed between Ln (HOMA-IR) and gestational duration (r = 0.237, P = 0.031), BMI(r = 0.314, P = 0.002), systolic blood pressure (r = 0.108, P = 0.016), noradrenaline (r = 0.451, P = 0.009), LnTP (r = -0.269, P = 0.015) and LnLF/HF (r = 0.183, P = 0.026) in those PIH patients. Furthermore, BMI, noradrenaline and LnTP were independent determinants of Ln(HOMA-IR) in PIH patients by multiple regression analysis. Our finding verified both IR and ANS imbalance were more severe in PIH patients than healthy pregnant women. Moreover, IR had a close association with ANS parameters in PIH patients, suggesting that they probably had contributory effects on the occurrence and development of PIH. We propose that these parameters could be added to the traditional indexes for individualized treatment of PIH patients in the future.
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Affiliation(s)
- Jing Guo
- a Gynaecology and obstetrics Department , Shanghai Tenth People's Hospital affiliated to Tongji University School of Medicine , Shanghai , China
| | - Guanghui Liu
- b Endocrinology Department , Tongji Hospital affiliated to Tongji University , Shanghai , China
| | - Gang Guo
- c Emergency Department , Tongji Hospital affiliated to Tongji University , Shanghai , China
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