Adverse effects of gestational diabetes-related risk factors on pregnancy outcomes and intervention measures

The Effect of Oxidative Stress and Antioxidants Treatment on Gestational Diabetes Mellitus Outcome: A Scoping Review

Diagnosing a pregnant woman's glucose intolerance is referred to as gestational diabetes mellitus (GDM). Diabetes has been linked to enhanced oxidative stress. In this condition, oxidative stress may damage nucleic acids, fats, and proteins, which in turn affects cell and tissue functions. The present study highlights the relationship between oxidative stress and GDM, with a particular focus on the role of hyperglycemia-induced processes during reactive oxygen species (ROS) oversupply, followed by it discusses the oxidative stress biomarkers and assesses the effects of antioxidant supplements on glycemic control, inflammatory processes, and oxidative stress among individuals with GDM. Two reviewers conducted a comprehensive literature search utilizing the PubMed®, Web of Science™, and Scopus® databases. Only items published in the English language up until June 2024 were taken into account. We conducted a thorough search of research databases to identify articles that had the terms "oxidative stress" or "antioxidant" and "GDM". From this search, we selected 55 relevant papers to be included in this narrative review. Pregnancy-induced hypertension, postpartum bleeding, lower birth weight, a higher risk of hyperbilirubinemia in their neonates, fetal growth retardation, and birth asphyxia were revealed to be outcomes of women enduring major oxidative stress during pregnancy. Furthermore, tight glycemic control both before and throughout pregnancy as well as oxidative stress treatment may help women highly prone to GDM.

Diabetes mellitus in pregnancy across Canada

BACKGROUND

Contemporary estimates of diabetes mellitus (DM) rates in pregnancy are lacking in Canada. Accordingly, this study examined trends in the rates of type 1 (T1DM), type 2 (T2DM) and gestational (GDM) DM in Canada over a 15-year period, and selected adverse pregnancy outcomes.

METHODS

This study used repeated cross-sectional data from the Canadian Institute of Health Information (CIHI) hospitalization discharge abstract database (DAD). Maternal delivery records were linked to their respective birth records from 2006 to 2019. The prevalence of T1DM, T2DM and GDM were calculated, including relative changes over time, assessed by a Cochrane-Armitage test. Also assessed were differences between provinces and territories in the prevalence of DM.

RESULTS

Over the 15-year study period, comprising 4,320,778 hospital deliveries in Canada, there was a statistically significant increase in the prevalence of GDM and T1DM and T2DM. Compared to pregnancies without DM, all pregnancies with any form of DM had higher rates of hypertension and Caesarian delivery, and also adverse infant outcomes, including major congenital anomalies, preterm birth and large-for-gestational age birthweight.

CONCLUSION

Among 4.3 million pregnancies in Canada, there has been a rise in the prevalence of DM. T2DM and GDM are expected to increase further as more overweight women conceive in Canada.

Epidemiology of hyperglycemia during pregnancy in Ethiopia: prevalence, associated factors, and feto-maternal outcomes: systematic review and meta-analysis

BACKGROUND

Hyperglycemia in pregnancy (HIP) is a significant medical complication affecting pregnant women globally and is considered a public health burden due to the negative outcomes it can cause for both mother and infant. The aim of this systematic review and meta-analysis was to examine the prevalence, risk factors, and feto-maternal outcomes of HIP in Ethiopia.

METHODS

To gather relevant information for this study, both published and unpublished studies were searched for in several major databases, including PubMed, Embase, HINARI, Web of Science direct, and Google Scholar, as well as other sources. The Joanna Briggs Institute (JBI) tool was used to evaluate the methodological quality of the findings from these studies. Data was then extracted and summarized using a template in Microsoft Excel software, and the extracted data was analyzed using Stata software version 16.0. If significant heterogeneity was found between studies, subgroup analyses were conducted to further examine the data.

RESULT

Eighteen studies were included in this systematic review and meta-analysis, involving a total sample size of 50,816 pregnant women in Ethiopia. The prevalence of HIP among pregnant women varied considerably across the primary studies, ranging from 0.4 to 26.2%. The pooled prevalence of HIP among pregnant women in Ethiopia was found to be 6.9% (95% C 2.2-11.6). Pregnant women with a family history of diabetes had 2.5 times higher odds of developing HIP compared to those without a family history of diabetes (OR = 2.49; 95% CI = 2.02, 2.96). However, there was no significant association found between HIP and maternal obesity (OR 2.31, 95% CI = 0.85, 3.78) or previous history of abortion (OR 3.89; 95% CI 0.85, 6.94). The common fetal outcomes associated with HIP were admission to the intensive care unit (46.2; 95% CI 27.4, 65.1), macrosomia (27.3%; 95% CI 9.4%, 45.1%), and preterm birth (16.9; 95% CI 12.5, 21.3). Additionally, hypertensive disorders of pregnancy (28.0%; 95% CI 15.2, 40.8) and operative delivery (51.4%; 95% CI 35.9, 66.8) were more common among women with HIP in Ethiopia.

CONCLUSION

Although there was some variation between studies, the meta-analysis revealed that approximately seven out of 100 pregnant women in Ethiopia had HIP. A family history of diabetes was found to be a significant predictor of HIP in Ethiopia. Additionally, HIP was associated with various serious adverse outcomes for both mothers and infants in Ethiopia. These findings highlight the need for national guidelines to ensure that pregnant women are uniformly screened for HIP.

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.

Prevalence of gestational diabetes mellitus in Pakistan: a systematic review and meta-analysis

BACKGROUND

A variety of screening tools and criteria are used for the diagnosis of gestational diabetes mellitus (GDM). As a result, the prevalence rate of GDM varied from 4.41% to 57.90% among studies from Pakistan. Beside this disagreement, similar multi-centric studies, community surveys and pooled evidence were lacking from the country. Therefore, this first systematic review and meta-analysis aimed to measure the overall and subgroup pooled estimates of GDM and explore the methodological variations among studies for any inconsistency.

METHODS

Using the PRISMA guidelines, seventy studies were identified from PubMed, ScienceDirect, Google Scholar and PakMediNet database. Of them, twenty-four relevant studies were considered for systematic review and nine eligible studies selected for meta-analysis. AXIS was used for measuring quality of reporting, I^2 statistics for heterogeneity among studies and subgroups, funnel plot for reporting potential publication bias and forest plot for presenting pooled estimates.

RESULTS

The pooled sample of nine studies was 27,034 (126 - 12,450) pregnant women, of any gestational age, from all four provinces of Pakistan. Overall pooled estimate of GDM was 16.7% (95% CI 13.1 - 21.1). The highest subgroup pooled estimate of GDM observed in studies from Balochistan (35.8%), followed by Islamabad (23.9%), Khyber Pakhtunkhwa (17.2%), Sindh (13.2%), and Punjab (11.4%). The studies that adopted 75g 2-h OGTT had a little lower pooled estimate (16.3% vs. 17.3%); and that adopted diagnostic cut-off values [≥ 92 (F), ≥ 180 (1-h) and ≥ 153 (2-h)] had a greater pooled estimate (25.4% vs. 15.8%). The studies that adopted Carpenter criteria demonstrated the highest subgroup pooled estimate of GDM (26.3%), after that IADPSG criteria (25.4%), and ADA criteria (23.9%).

CONCLUSIONS

Along with poor quality of reporting, publishing in non-indexed journals and significant disagreement between studies, the prevalence rate of GDM is high in Pakistan. Consensus building among stakeholders for recommended screening methods; and continuous medical education of the physicians are much needed for a timely detection and treatment of GDM.

Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative review

BACKGROUND

Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy.

METHODS

A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework.

RESULTS

From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis - the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group.

CONCLUSION

Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence.

Previous traumatic brain injury is associated with an increased odds for gestational diabetes: a nationwide register-based cohort study in finland

AIMS

Despite recent findings that traumatic brain injury (TBI) is a possible risk factor for type 2 diabetes (DM2) and that a strong association exists between gestational diabetes (GDM) and the risk for the development of DM2, no previous studies have investigated the effects of TBI on the risk for the development of GDM. Therefore, this study aims to determine the possible association between a previous traumatic brain injury and later gestational diabetes.

METHODS

In this retrospective register-based cohort study, data from the National Medical Birth Register were combined with data from the Care Register for Health Care. Women who had sustained a TBI before pregnancy were included in the patient group. Women who had sustained previous fractures of the upper extremity, pelvis, or lower extremity were included in the control group. A logistic regression model was used to assess the risk for the development of GDM during pregnancy. Adjusted odds ratios (aOR) with 95% confidence intervals between the groups were compared. The model was adjusted by prepregnancy body mass index (BMI) and maternal age during pregnancy, the use of in vitro fertilization (IVF), maternal smoking status, and multiple pregnancies. The risk for the development of GDM during different periods following the injury (0-3 years, 3-6 years, 6-9 years, and 9+ years) was calculated.

RESULTS

In total, a 75 g 2-h oral glucose tolerance test (OGTT) was performed on 6802 pregnancies of women who had sustained a TBI and on 11 717 pregnancies of women who sustained fractures of the upper extremity, pelvis, or lower extremity. Of these, 1889 (27.8%) pregnancies were diagnosed with GDM in the patient group and 3117 (26.6%) in the control group. The total odds for GDM were higher after TBI compared to the other traumas (aOR 1.14, CI 1.06-1.22). The odds were highest at 9 + years after the injury (aOR 1.22, CI 1.07-1.39).

CONCLUSION

The total odds for the development of GDM after TBI were higher when compared to the control group. Based on our findings, more research on this topic is warranted. Moreover, a history of TBI should be considered a possible risk factor for the development of GDM.

Risk Factors of Gestational Diabetes Mellitus Among Women Attending an Antenatal Care Clinic in Prince Sultan Military Medical City (PSMMC), Riyadh, Kingdom of Saudi Arabia: A Case-Control Study

BACKGROUND

Gestational diabetes mellitus (GDM) is a serious health issue for both mother and child. As GDM is common worldwide, healthcare providers pay attention while screening and managing pregnant women to ensure good outcomes for both mother and child.

OBJECTIVE

This study aims to identify the risk factors associated with developing GDM in pregnant women attending antenatal care clinics in Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia.

METHODS

This is a case-control study that utilized patients' medical records for data collection. The study included 317 pregnant Saudi women who attended antenatal care clinics and antenatal diabetic clinics in PSMMC from May 2022 to May 2023. Cases were defined as women who met the inclusion and exclusion criteria and had a positive oral glucose tolerance test (OGTT) result, while controls were defined as women in the same age group and gravidity who had negative OGTT. Analysis was conducted using SPSS Statistics version 29.0 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 29.0. Armonk, NY: IBM Corp.) Results: The total number of cases was 132 out of 313 total samples, representing 42.2% of the total sample. Three factors were associated with an increased risk of developing GDM, including a family history of diabetes (p-value <0.001), a history of GDM (p-value <0.001), and macrosomia (p-value = 0.020). The study also found higher BMI and advanced maternal age were risk factors for GDM (p-value = 0.004, 0.007), respectively. However, the study did not find a significant association between GDM and other factors, such as chronic disease prevalence, history of miscarriage, or history of fetal death.

CONCLUSION

The study identified several risk factors associated with an increased risk of GDM including family history of diabetes, history of GDM, macrosomia, overweight/obesity, and advanced maternal age. It is recommended that antenatal care providers screen for GDM risk factors and closely monitor overweight, obese, or older women. Education and counseling on healthy lifestyle habits, such as maintaining a healthy weight and engaging in physical activity, may also be beneficial for preventing GDM. Further research is needed to confirm and identify additional risk factors for GDM.

Effect of gestational diabetes mellitus on pregnancy outcomes among younger and older women and its additive interaction with advanced maternal age

Background

The prevalence of gestational diabetes mellitus (GDM) and advanced maternal age (AMA, ≥ 35 years) has shown an increasing trend worldwide. This study aimed to evaluate the risk of pregnancy outcomes among younger (20-34 years) and older (≥ 35 years) women with GDM and further analyze the epidemiologic interaction of GDM and AMA on these outcomes.

Methods

This historical cohort study included 105 683 singleton pregnant women aged 20 years or older between January 2012 and December 2015 in China. Stratified by maternal age, the associations between GDM and pregnancy outcomes were analyzed by performing logistic regression. Epidemiologic interactions were assessed by using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) with their 95% confidence intervals (95%CIs).

Results

Among younger women, individuals with GDM had a higher risk of all maternal outcomes, preterm birth (relative risk [RR] 1.67, 95%CI 1.50-1.85), low birthweight (RR 1.24, 95%CI 1.09-1.41), large for gestational age (RR 1.51, 95%CI 1.40-1.63), macrosomia (RR 1.54, 95%CI 1.31-1.79), and fetal distress (RR 1.56, 95%CI 1.37-1.77) than those without GDM. Among older women, GDM increased the risk of gestational hypertension (RR 2.17, 95%CI 1.65-2.83), preeclampsia (RR 2.30, 95%CI 1.81-2.93), polyhydramnios (RR 3.46, 95%CI 2.01-5.96), cesarean delivery (RR 1.18, 95%CI 1.10-1.25), preterm birth (RR 1.35, 95%CI 1.14-1.60), large for gestational age (RR 1.40, 95%CI 1.23-1.60), macrosomia (RR 1.65, 95%CI 1.28-2.14) and fetal distress (RR 1.46, 95%CI 1.12-1.90). Additive interactions of GDM and AMA on polyhydramnios and preeclampsia were found, with RERI of 3.11 (95%CI 0.05-6.16) and 1.43 (95%CI 0.09-2.77), AP of 0.51 (95%CI 0.22-0.80) and 0.27 (95%CI 0.07-0.46), and SI of 2.59 (95%CI 1.17-5.77) and 1.49 (95%CI 1.07-2.07), respectively.

Conclusion

GDM is an independent risk factor for multiple adverse pregnancy outcomes, and may exert additive interactions with AMA on the risk of polyhydramnios and preeclampsia.

Optimal delivery time for patients with diet-controlled gestational diabetes mellitus: a single-center real-world study

Background

To determine the optimal delivery time for women with diet-controlled gestational diabetes mellitus by comparing differences in adverse maternal–fetal outcome and cesarean section rates.

Methods

This real-world retrospective study included 1,050 patients with diet-controlled gestational diabetes mellitus who delivered at 35–42 weeks’ gestation. Data on patient characteristics, maternal–fetal outcomes, and cesarean section rate based on fetal gestational age were collected and analyzed. Differences between deliveries with and without iatrogenic intervention were also analyzed.

Results

The cesarean section rate at ≥ 41 weeks’ gestation was significantly higher than that at 39–39 + 6 weeks (56% vs. 39%, p = 0.031). There were no significant differences in multiple adverse maternal or neonatal outcomes at delivery before and after 39 weeks. Vaginal delivery rates were increased significantly at 39–39 + 6 weeks due to iatrogenic intervention (p = 0.005) and 40–40 + 6 weeks (p = 0.003) in patients without and with spontaneous uterine contractions, respectively.

Conclusions

It’s recommended that optimal delivery time for patients with diet-controlled gestational diabetes mellitus should be between 39- and 40 + 6 weeks’ gestation. Patients who have Bishop scores higher than 4 can undergo iatrogenic intervention at 39–39 + 6 weeks. However iatrogenic interventions are not recommended for patients with low Bishop scores.

How breastfeeding behavior develops in women with gestational diabetes mellitus: A qualitative study based on health belief model in China

BACKGROUND

Gestational diabetes mellitus (GDM) is a condition in which women develop hyperglycemia during pregnancy, and is associated with long-term health burden on both mother and their offspring, such as future type 2 diabetes mellitus (T2DM). Although breastfeeding was expected to mitigate metabolic sequelae for both mothers and their newborns, the prevalence of breastfeeding in GDM mothers are sub-optimal worldwide.

OBJECTIVE

To explore the experience of disease among mothers with GDM and how they develop feeding behaviors.

METHODS

This study was conducted in three branches of an integrated tertiary hospital in the central area of China. Mothers who were diagnosed with GDM, had no other complications, and gave birth before no more than 6 months were approached based on a purposive sampling. GDM mothers' experience of the disease and breastfeeding were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM.

RESULTS

16 GDM mothers were included in the current study, with nine using breastfeeding, six mixed feeding and one artificial feeding, respectively. Nine themes were identified, including: 1) GDM diagnosis and severity; 2) information searching and GDM knowledge;3) GDM management; 4) perceived susceptibility of future diabetes;5) perceived severity of future diabetes;6) perceived benefits of breastfeeding;7) perceived barriers of breastfeeding;8) decision making process of feeding and social support. Generally, mothers with GDM lack reliable sources of information, considered the disease as a minor and transient illness during pregnancy, and failed to realize the long-term risk of GDM and the protective effect of breastfeeding to themselves and their babies. They rarely considered GDM in their feeding decision. Instead, the formation of feeding behaviors depends on the balance between the benefits and barriers of breastfeeding as well as the level of social support.

CONCLUSION

To promote breastfeeding, a multi-facet intervention targeted on healthcare providers (HCPs), GDM mothers and their networks was important to help GDM mothers better and correctly understand the disease and breastfeeding, and increase their capacity of breastfeeding.

[Comparative impact analysis of risk factors on the course and outcomes of pregnancy with gestational diabetes mellitus]

BACKGROUND

The increasing prevalence of gestational diabetes mellitus (GDM), the high probability of unfavorable pregnancy outcomes for the mother and the fetus, as well as a number of long-term consequences in GDM are a serious medical and social problem and require the need for its prevention by correcting risk factors, timely diagnosis and effective treatment.

AIM

Analysis of risk factors for the development of gestational diabetes mellitus (GDM), the relationship between GDM, the course and outcomes of pregnancy.

MATERIALS AND METHODS

Retrospective analysis of 79 case histories of patients with confirmed GDM in the period from 2015 to 2017.

RESULTS

In the structure of risk factors for mother and fetus, age over 30 years (73.1%), burdened heredity for type 2 diabetes mellitus (T2DM) (30.8%), mother's pre-pregnancy body mass index (BMI) (overweight / obesity (26.9%)) had the greatest impact. Among the complications of pregnancy, the most common was the caesarean section (47.4%). The incidence of other complications (macrosomia (9%), premature birth (7.7%), congenital malformations of the fetus (5.1%), preeclampsia (5.1%) was lower than the average frequency of these complications in GDM, described in the literature. Nevertheless, it is 1.5-2 times higher than the average population indicators. In the course of statistical analysis of the data it was revealed, that the higher the mother's pre-pregnancy BMI, the lower the Apgar score for the first minute in the newborn.

CONCLUSION

Women with GDM require intensive monitoring of the course of pregnancy and timely hospitalization for planned delivery, and the provision of competent obstetric benefits.