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Scavenius C, Petersen ERB, Jensen DM, Ringholm L, Danielsen JS, Mathiesen ER, McIntyre D, Damm P, Overgaard M, Clausen TD. Pre-analytical diagnostic differences despite high adherence to guidelines for gestational diabetes mellitus. Scand J Clin Lab Invest 2024; 84:30-37. [PMID: 38319177 DOI: 10.1080/00365513.2024.2312152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Abstract
Regional variations in the prevalence of gestational diabetes mellitus (GDM) have been found across Denmark. The objectives of this exploratory survey were to evaluate adherence to the national guideline for screening and diagnosing GDM and to identify variations in pre-analytical or analytical factors, which could potentially contribute to variations in GDM prevalence across regions. In a national interview-based survey, obstetric departments and laboratories throughout Denmark handling GDM screening or diagnostic testing were invited to participate. Survey questionnaires were completed through personal interviews. In total, 21 of 22 identified obstetric departments and 44 of 45 identified laboratories participated. Adherence to guideline among obstetric departments ranged 67-100% and uniformity in laboratory procedures was high. However, the gestational age at the time of late diagnostic testing with oral glucose tolerance test (OGTT) varied considerably, with 48% (10/21) of departments testing outside the recommended 24-28 weeks' gestation. Procedural heterogeneity was most pronounced for the parts not described in current guidelines, with choice of laboratory equipment being the most diverse factor ranging 3-39% nationally. In conclusion, the overall adherence to the national guidelines was high across regions, and obstetric departments and laboratories had high uniformity in the procedures for screening and diagnosing GDM. Uniformity was generally high for procedures included in the guideline and low if not included. However, a high proportion of GDM testing was performed outside the recommended gestational window in late pregnancy, which may be a pre-analytical contributor to regional differences in GDM prevalence.
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Affiliation(s)
- Cathrine Scavenius
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | | | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Rigshospitalet, København, Denmark
| | - Jakoba Sevdal Danielsen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Rigshospitalet, København, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David McIntyre
- Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, København, Denmark
| | - Martin Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Tine Dalsgaard Clausen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, København, Denmark
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Scheuer CM, Jensen DM, McIntyre HD, Ringholm L, Mathiesen ER, Nielsen CPK, Nolsöe RLM, Milbak J, Hillig T, Damm P, Overgaard M, Clausen TD. Applying WHO2013 diagnostic criteria for gestational diabetes mellitus reveals currently untreated women at increased risk. Acta Diabetol 2023; 60:1663-1673. [PMID: 37462764 PMCID: PMC10587026 DOI: 10.1007/s00592-023-02148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 10/21/2023]
Abstract
AIMS To estimate the prevalence of gestational diabetes mellitus (GDM) in a Danish cohort comparing the current Danish versus the WHO2013 diagnostic criteria, and to evaluate adverse pregnancy outcomes among currently untreated women in the gap between the diagnostic thresholds. METHODS Diagnostic testing was performed by a 75 g oral glucose tolerance test (OGTT) at 24-28 weeks' gestation in a cohort of pregnant women. GDM diagnosis was based on the current Danish criterion (2-h glucose ≥ 9.0 mmol/L, GDMDK) and on the WHO2013 criteria (fasting ≥ 5.1, 1 h ≥ 10.0 or 2 h glucose ≥ 8.5 mmol/L, GDMWHO2013). Currently untreated women fulfilling the WHO2013 but not the Danish diagnostic criteria were defined as New-GDM-women (GDMWHO2013-positive and GDMDK-negative). Adverse outcomes risks were calculated using logistic regression. RESULTS OGTT was completed by 465 women at a median of 25.7 weeks' gestation. GDMDK prevalence was 2.2% (N = 10) and GDMWHO2013 21.5% (N = 100). New-GDM was present in 19.4% (N = 90), of whom 90.0% had elevated fasting glucose. Pregnancies complicated by New-GDM had higher frequencies of pregnancy-induced hypertension (13.3% vs 4.1%, p = 0.002), large-for-gestational-age infants (22.2% vs 9.9%, p = 0.004), neonatal hypoglycaemia (8.9% vs 1.9%, p = 0.004) and neonatal intensive care unit admission (16.7% vs 5.8%, p = 0.002) compared to pregnancies without GDM. CONCLUSIONS GDM prevalence increased tenfold when applying WHO2013 criteria in a Danish population, mainly driven by higher fasting glucose levels. Untreated GDM in the gap between the current Danish and the WHO2013 diagnostic criteria resulted in higher risks of adverse pregnancy outcomes.
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Affiliation(s)
- Cathrine Munk Scheuer
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H David McIntyre
- Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Julie Milbak
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Martin Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Tine Dalsgaard Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
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Jensen NH, Kragelund Nielsen K, Dahl-Petersen IK, Kampmann U, Damm P, Ovesen P, Mathiesen ER, Vinter CA, Davidsen E, Thøgersen M, Timm A, Andersen LLT, Knorr S, Jensen DM, Maindal HT. Health promotion intervention among women with recent gestational diabetes mellitus: penetration, participation, and baseline findings from the Face-it randomized controlled trial. BMJ Open Diabetes Res Care 2023; 11:e003529. [PMID: 37793679 PMCID: PMC10551966 DOI: 10.1136/bmjdrc-2023-003529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/24/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Face-it is a randomized controlled trial for women with recent gestational diabetes mellitus (GDM) and their families designed to evaluate the effect of a health promotion intervention on type 2 diabetes mellitus (T2DM) risk and quality of life. This study examined (1) the penetration and participation rates for the Face-it trial, (2) the characteristics of the participating women and the potential differences in characteristics according to partner participation status, and (3) representativity of the women at baseline. RESEARCH DESIGN AND METHODS We identified women with GDM during pregnancy and invited them and their partners to a baseline examination 10-14 weeks after delivery. Representativity was assessed by comparing the baseline participants with non-participating women, the general population of women with GDM delivering in Denmark, and populations from other intervention trials. RESULTS The penetration rate was 38.0% (867/2279) and the participation rate was 32.9% (285/867). The 285 women who attended baseline had a mean age of 32.7 (±4.8) years and body mass index (BMI) of 28.1 (±5.4) kg/m2, and 69.8% had a partner who participated. The women participating with a partner were more often primiparous, born in Denmark (82.8% vs 68.2%), were younger, and more often had a BMI ≤24.9 kg/m2 (35.7% vs 21.2%) compared with women without a partner. Compared with the general population of women with GDM in Denmark, these women broadly had similar degree of heterogeneity, but had higher rates of primiparity and singleton deliveries, and lower rates of preterm delivery and prepregnancy obesity. CONCLUSIONS The penetration and participation rates were acceptable. We found a high rate of partner participation. Overall, women participating with a partner were comparable with those participating without a partner. Participating women were broadly similar to the general national GDM population, however with prepregnancy obesity, multiparity, preterm delivery, and multiple pregnancy being less represented. TRIAL REGISTRATION NUMBER NCT03997773.
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Affiliation(s)
| | - Karoline Kragelund Nielsen
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Inger Katrine Dahl-Petersen
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Ovesen
- Steno Diabetes Center Aarhus, Aarhus, Denmark
- Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Anne Vinter
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Emma Davidsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Maja Thøgersen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anne Timm
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Dorte Møller Jensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Timm A, Kragelund Nielsen K, Alvesson HM, Jensen DM, Maindal HT. Motivation for Behavior Change among Women with Recent Gestational Diabetes and Their Partners-A Qualitative Investigation among Participants in the Face-It Intervention. Nutrients 2023; 15:3906. [PMID: 37764690 PMCID: PMC10535498 DOI: 10.3390/nu15183906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Promoting diet and physical activity is important for women with recent gestational diabetes mellitus (GDM) and their partners to reduce the risk of future type 2 diabetes (T2D). The study aimed to understand how motivation for changing diet and physical activity behaviors among women with recent GDM and their partners was experienced after participation in the Danish Face-it intervention. Fourteen couples' interviews were conducted. Data analysis followed a reflexive thematic analysis. Guided by self-determination theory and interdependence theory, we identified four themes affecting couples' motivation for health behavior change: (1) The need to feel understood after delivery; (2) adjusting health expectations; (3) individual and mutual preferences for health behaviors; and (4) the health threat of future T2D as a cue to action. We found that couples in general perceived the Face-it intervention as useful and motivating. Using couple interviews increased our understanding of how the women and partners influenced each other's perspectives after a GDM-affected pregnancy and thus how targeting couples as opposed to women alone may motivate health behavior change.
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Affiliation(s)
- Anne Timm
- Health Promotion Research, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark; (K.K.N.); (H.T.M.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Karoline Kragelund Nielsen
- Health Promotion Research, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark; (K.K.N.); (H.T.M.)
| | | | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense, Denmark;
- Department of Gynaecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark; (K.K.N.); (H.T.M.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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Munk Scheuer C, Duevang Tvarnø C, Gils C, Dahl Ravn J, David McIntyre H, Møller Jensen D, Damm P, Kepp Bruun Lauenborg J, Dalsgaard Clausen T, Overgaard M. The impact of inter-laboratory glucose bias on the diagnosis of gestational diabetes mellitus: Comparison of common automated central laboratory methods. Clin Chim Acta 2023:117414. [PMID: 37263535 DOI: 10.1016/j.cca.2023.117414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/07/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS The diagnosis of gestational diabetes mellitus (GDM) is based exclusively on glucose measurements, which are highly influenced by pre-analytical and analytical factors. Therefore, poor agreement across laboratories may affect the prevalence of GDM. We aimed to determine the inter-laboratory bias of glucose measurements and the impact on GDM prevalence. MATERIAL AND METHODS A prospective cohort study of women (n=110) referred for second-trimester GDM diagnostics using a 75 g oral glucose tolerance test. Maternal glucose was assessed from venous plasma at fasting, 1 h and 2 h. Venous blood were collected in Fluoride Citrate tubes and frozen. Samples were analyzed at five central laboratories using four different automated glucose Hexokinase methods and GDM prevalence was evaluated according to WHO2013 diagnostic criteria. RESULTS Maximum inter-laboratory bias was 0.19, 0.30 and 0.27 mmol/L in fasting, 1 h and 2 h samples, respectively. GDM prevalence ranged 30.0-41.1% across laboratories. CONCLUSION Inter-laboratory bias for mean venous glucose was low and within desirable limits. Nonetheless, the impact on GDM prevalence was considerable, which may inappropriately affect clinical practice.
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Affiliation(s)
- Cathrine Munk Scheuer
- Shared first authorship; Department of Gynaecology and Obstetrics, University of Copenhagen, Nordsjællands Hospital. Dyrehavevej 29, DK-3400 Hillerød.
| | - Casper Duevang Tvarnø
- Shared first authorship; Department of Gynaecology, Obstetrics and Paediatrics, Nykøbing Falster Sygehus, Denmark. Fjordvej 15, DK-4800 Nykøbing Falster.
| | - Charlotte Gils
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C.
| | - Julie Dahl Ravn
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C.
| | - H David McIntyre
- Mater Research, Faculty of Medicine, The University of Queensland, Australia. Raymond Terrace, Level 3 Aubigny Place, South Brisbane QLD 4101, Australia.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Denmark Kløvervænget 10, DK-5000 Odense C; Department of Gynecology and Obstetrics, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C; Department of Clinical Research, University of Southern Denmark, Denmark. J.B. Winsløws Vej 19.3, DK-5000 Odense C.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Denmark. Blegdamsvej 9, DK-2100 Copenhagen East; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 3b 33.5. DK-2200 Copenhagen.
| | - Jeannet Kepp Bruun Lauenborg
- Department of Gynaecology, Obstetrics and Paediatrics, Nykøbing Falster Sygehus, Denmark. Fjordvej 15, DK-4800 Nykøbing Falster; Department of Gynaecology and Obstetrics, Copenhagen University Hospital Herlev, Denmark. Borgmester Ib Juuls Vej 11, DK-2730 Herlev.
| | - Tine Dalsgaard Clausen
- Department of Gynaecology and Obstetrics, University of Copenhagen, Nordsjællands Hospital. Dyrehavevej 29, DK-3400 Hillerød; Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Denmark. Blegdamsvej 9, DK-2100 Copenhagen East.
| | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C; Department of Clinical Research, University of Southern Denmark, Denmark. J.B. Winsløws Vej 19.3, DK-5000 Odense C.
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6
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Do NC, Vestgaard M, Ásbjörnsdóttir B, Andersen LLT, Jensen DM, Ringholm L, Damm P, Mathiesen ER. Home Blood Pressure for the Prediction of Preeclampsia in Women With Preexisting Diabetes. J Clin Endocrinol Metab 2022; 107:e3670-e3678. [PMID: 35766641 DOI: 10.1210/clinem/dgac392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Outside of pregnancy, home blood pressure (BP) has been shown to be superior to office BP for predicting cardiovascular outcomes. OBJECTIVE This work aimed to evaluate home BP as a predictor of preeclampsia in comparison with office BP in pregnant women with preexisting diabetes. METHODS A prospective cohort study was conducted of 404 pregnant women with preexisting diabetes; home BP and office BP were measured in early (9 weeks) and late pregnancy (35 weeks). Discriminative performance of home BP and office BP for prediction of preeclampsia was assessed by area under the receiver operating characteristic curves (AUC). RESULTS In total 12% (n = 49/404) developed preeclampsia. Both home BP and office BP in early pregnancy were positively associated with the development of preeclampsia (adjusted odds ratio (95% CI) per 5 mm Hg, systolic/diastolic): home BP 1.43 (1.21-1.70)/1.74 (1.34-2.25) and office BP 1.22 (1.06-1.40)/1.52 (1.23-1.87). The discriminative performance for prediction of preeclampsia was similar for early-pregnancy home BP and office BP (systolic, AUC 69.3 [61.3-77.2] vs 64.1 [55.5-72.8]; P = .21 and diastolic, AUC 68.6 [60.2-77.0] vs 66.6 [58.2-75.1]; P = .64). Similar results were seen when comparing AUCs in late pregnancy (n = 304). In early and late pregnancy home BP was lower than office BP (early pregnancy P < .0001 and late pregnancy P < .01 for both systolic and diastolic BP), and the difference was greater with increasing office BP. CONCLUSION In women with preexisting diabetes, home BP and office BP were positively associated with the development of preeclampsia, and for the prediction of preeclampsia home BP and office BP were comparable.
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Affiliation(s)
- Nicoline Callesen Do
- Center for Pregnant Women with Diabetes, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Marianne Vestgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | | | - Dorte Møller Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, DK-5000 Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, DK-5000 Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
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7
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Acosta-Manzano P, Leopold-Posch B, Simmons D, Devlieger R, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen LL, Tanvig M, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill DJ, Snoek FJ, Jelsma J, Desoye G, van Poppel M. The unexplored role of sedentary time and physical activity in glucose and lipid metabolism-related placental mRNAs in pregnant women who are obese: the DALI lifestyle randomised controlled trial. BJOG 2022; 129:708-721. [PMID: 34559946 DOI: 10.1111/1471-0528.16945] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We aimed to explore: (i) the association of sedentary time (ST) and physical activity (PA) during pregnancy with the placental expression of genes related to glucose and lipid metabolism in pregnant women who are obese; (ii) maternal metabolic factors mediating changes in these placental transcripts; and (iii) cord blood markers related to the mRNAs mediating neonatal adiposity. DESIGN Multicentre randomised controlled trial. SETTING Hospitals in nine European countries. POPULATION A cohort of 112 pregnant women with placental tissue. METHODS Both ST and moderate-to-vigorous PA (MVPA) levels were measured objectively using accelerometry at three time periods during pregnancy. MAIN OUTCOME MEASURES Placental mRNAs (FATP2, FATP3, FABP4, GLUT1 and PPAR-γ) were measured with NanoString technology. Maternal and fetal metabolic markers and neonatal adiposity were assessed. RESULTS Longer periods of ST, especially in early to middle pregnancy, was associated with lower placental FATP2 and FATP3 expression (P < 0.05), whereas MVPA at baseline was inversely associated with GLUT1 mRNA (P = 0.02). Although placental FATP2 and FATP3 expression were regulated by the insulin-glucose axis (P < 0.05), no maternal metabolic marker mediated the association of ST/MVPA with placental mRNAs (P > 0.05). Additionally, placental FATP2 expression was inversely associated with cord blood triglycerides and free fatty acids (FFAs; P < 0.01). No cord blood marker mediated neonatal adiposity except for cord blood leptin, which mediated the effects of PPAR-γ on neonatal sum of skinfolds (P < 0.05). CONCLUSIONS In early to middle pregnancy, ST is associated with the expression of placental genes linked to lipid transport. PA is hardly related to transporter mRNAs. Strategies aimed at reducing sedentary behaviour during pregnancy could modulate placental gene expression, which may help to prevent unfavourable fetal and maternal pregnancy outcomes. TWEETABLE ABSTRACT Reducing sedentary behaviour in pregnancy might modulate placental expression of genes related to lipid metabolism in women who are obese.
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Affiliation(s)
- P Acosta-Manzano
- PA-HELP 'Physical Activity for Health Promotion, CTS-1018' Research Group, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - B Leopold-Posch
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
| | - D Simmons
- Western Sydney University, Campbelltown, New South Wales, Australia
| | - R Devlieger
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - S Galjaard
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - R Corcoy
- CIBER Bioengineering, Biomaterials and Nanomedicine, Instituto de Salud Carlos III, Zaragoza, Spain
| | - J M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - F Dunne
- Galway Diabetes Research Centre (GDRC) and National University of Ireland, Galway, Ireland
| | - J Harreiter
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - A Kautzky-Willer
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - P Damm
- Departments of Endocrinology and Obstetrics, Rigshospitalet and Department of Clinical Medicine, Centre for Pregnant Women with Diabetes, University of Copenhagen, Copenhagen, Denmark
| | - E R Mathiesen
- Departments of Endocrinology and Obstetrics, Rigshospitalet and Department of Clinical Medicine, Centre for Pregnant Women with Diabetes, University of Copenhagen, Copenhagen, Denmark
| | - D M Jensen
- Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - L L Andersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - M Tanvig
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - A Lapolla
- Department of Medical and Surgical Sciences, Università degli Studi di Padova, Padua, Italy
| | - M G Dalfra
- Department of Medical and Surgical Sciences, Università degli Studi di Padova, Padua, Italy
| | - A Bertolotto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poznan, Poland
| | - A Zawiejska
- Chair of Medical Education, Department of Medical Simulation, Poznan University of Medical Sciences, Poznan, Poland
| | - D J Hill
- Lawson Health Research Institute, London, Ontario, Canada
| | - F J Snoek
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, VU University, Amsterdam, the Netherlands
| | - Jgm Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - G Desoye
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
| | - Mnm van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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8
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Sørensen AE, van Poppel MNM, Desoye G, Simmons D, Damm P, Jensen DM, Dalgaard LT. The Temporal Profile of Circulating miRNAs during Gestation in Overweight and Obese Women with or without Gestational Diabetes Mellitus. Biomedicines 2022; 10:biomedicines10020482. [PMID: 35203692 PMCID: PMC8962411 DOI: 10.3390/biomedicines10020482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/12/2022] Open
Abstract
Circulating non-coding microRNAs (miRNAs) are important for placentation, but their expression profiles across gestation in pregnancies, which are complicated by gestational diabetes mellitus (GDM), have not been fully established. Investigating a single time point is insufficient, as pregnancy is dynamic, involving several processes, including placenta development, trophoblast proliferation and differentiation and oxygen sensing. Thus, the aim of this study was to compare the temporal expression of serum miRNAs in pregnant women with and without GDM. This is a nested case-control study of longitudinal data obtained from a multicentric European study (the ‘DALI’ study). All women (n = 82) were overweight/obese (BMI ≥ 29 kg/m2) and were normal glucose tolerant (NGT) at baseline (before 20 weeks of gestation). We selected women (n = 41) who were diagnosed with GDM at 24–28 weeks, according to the IADPSG/WHO2013 criteria. They were matched with 41 women who remained NGT in their pregnancy. miRNA (miR-16-5p, -29a-3p, -103-3p, -134-5p, -122-5p, -223-3p, -330-3p and miR-433-3p) were selected based on their suggested importance for placentation, and measurements were performed at baseline and at 24–28 and 35–37 weeks of gestation. Women with GDM presented with overall miRNA levels above those observed for women remaining NGT. In both groups, levels of miR-29a-3p and miR-134-5p increased consistently with progressing gestation. The change over time only differed for miR-29a-3p when comparing women with GDM with those remaining NGT (p = 0.044). Our findings indicate that among overweight/obese women who later develop GDM, miRNA levels are already elevated early in pregnancy and remain above those of women who remain NGT during their pregnancy. Maternal circulating miRNAs may provide further insight into placentation and the cross talk between the maternal and fetal compartments.
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Affiliation(s)
- Anja Elaine Sørensen
- Department of Science and Environment, Roskilde University, 4000 Roskilde, Denmark;
- Correspondence: ; Tel.: +45-4674-3994
| | - Mireille N. M. van Poppel
- Faculty of Environmental and Regional Sciences and Education, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria;
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria;
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - David Simmons
- Macarthur Clinical School, School of Medicine, Western Sydney University, Campbelltown, NSE 2560, Australia;
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Dorte Møller Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark;
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
- Steno Diabetes Center Odense, Department of Gynecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark
| | - Louise Torp Dalgaard
- Department of Science and Environment, Roskilde University, 4000 Roskilde, Denmark;
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9
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Jacobsen KH, Aalders J, Sølling K, Andersen MS, Snogdal LS, Christensen MH, Vinter CA, Højlund K, Jensen DM. Long-Term Metabolic Outcomes after Gestational Diabetes Mellitus (GDM): Results from the Odense GDM Follow-Up Study (OGFUS). J Diabetes Res 2022; 2022:4900209. [PMID: 35789592 PMCID: PMC9250439 DOI: 10.1155/2022/4900209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/28/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS To compare metabolic profiles and the long-term risk of metabolic dysfunction between women with previous gestational diabetes mellitus (pGDM) and women without pGDM (non-GDM) matched on age, prepregnancy body mass index (BMI), and parity. METHODS In total, 128 women with pGDM (median follow-up: 7.8 years) and 70 non-GDM controls (median follow-up: 10.0 years) completed a 2 h oral glucose tolerance test (OGTT) with assessment of glucose, C-peptide, insulin, and other metabolic measures. Additionally, anthropometrics, fat mass, and blood pressure were assessed and indices of insulin sensitivity and beta cell function were calculated. RESULTS The prevalence of type 2 diabetes mellitus (T2DM) was significantly higher in the pGDM group compared to the non-GDM group (26% vs. 0%). For women with pGDM, the prevalence of prediabetes (38%) and the metabolic syndrome (MetS) (59%) were approximately 3-fold higher than in non-GDM women (p's < 0.001). Both insulin sensitivity and beta cell function were significantly reduced in pGDM women compared to non-GDM women. CONCLUSION Despite similar BMI, women with pGDM had a substantially higher risk of developing T2DM, prediabetes, and the MetS compared to controls. Both beta cell dysfunction and reduced insulin sensitivity seem to contribute to this increased risk.
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Affiliation(s)
| | - Jori Aalders
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Katrine Sølling
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Marianne Skovsager Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | | | - Maria Hornstrup Christensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Christina Anne Vinter
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Kurt Højlund
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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10
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Nulsen B, Jensen DM, Kovacs TOG, Ghassemi KA, Kaneshiro M, Dulai GS, Jutabha R, Gornbein JA. Outcomes in Severe Upper GI Hemorrhage from Dieulafoy's Lesion with Monitoring of Arterial Blood Flow. Dig Dis Sci 2021; 66:3495-3504. [PMID: 33128681 DOI: 10.1007/s10620-020-06679-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dieulafoy's lesion (DL) is a rare but increasingly recognized cause of severe upper GI hemorrhage (SUGIH). There is little consensus regarding the endoscopic approach to management of bleeding from DL. AIMS Our purposes were to compare 30-day outcomes of patients with SUGIH from DL with Doppler endoscopic probe (DEP) monitoring of blood flow and guided treatment versus standard visually guided hemostasis (VG). METHODS Eighty-two consecutive DL patients with SUGIH were identified in a large CURE Hemostasis database from previous prospective cohort studies and two recent RCTs at two university-based medical centers. 30-day outcomes including rebleeding, surgery, angiography, death, and severe medical complications were compared between the two treatment groups. RESULTS 40.2% of DL bleeds occurred in inpatients. 43.9% of patients had cardiovascular disease, and 48.7% were taking medications associated with bleeding. For the entire cohort, 41.3% (26/63) of patients treated with VG had a composite 30-day outcome as compared to 10.5% (2/19) of patients treated with DEP (p = 0.017). Rebleeding occurred within 30 days in 33.3% and 10.5% of those treated with VG and DEP, respectively (p = 0.051). After propensity score matching, the adjusted 30-day composite outcome occurred in 39.0% in the VG group compared to 2.6% in the DEP group (p < 0.001). Adjusted 30-day rebleeding occurred in 25.3% in the VG group versus 2.6% in the DEP group (p < 0.001). DISCUSSION DL patients with SUGIH were frequently inpatients and had severe cardiovascular comorbidities and recurrent bleeding. Lesion arterial blood flow monitoring and obliteration are an effective way to treat bleeding from DL which reduces negative 30-day clinical outcomes.
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Affiliation(s)
- B Nulsen
- CURE Hemostasis Research Unit, Los Angeles, CA, USA. .,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA. .,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA.
| | - D M Jensen
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA.,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA
| | - T O G Kovacs
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA
| | - K A Ghassemi
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA
| | - M Kaneshiro
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA.,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA
| | - G S Dulai
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA
| | - R Jutabha
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA.,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA
| | - J A Gornbein
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,Department of Medicine - GIM - DOMSTATS, UCLA, Los Angeles, CA, USA
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11
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Maindal HT, Timm A, Dahl-Petersen IK, Davidsen E, Hillersdal L, Jensen NH, Thøgersen M, Jensen DM, Ovesen P, Damm P, Kampmann U, Vinter CA, Mathiesen ER, Nielsen KK. Systematically developing a family-based health promotion intervention for women with prior gestational diabetes based on evidence, theory and co-production: the Face-it study. BMC Public Health 2021; 21:1616. [PMID: 34479526 PMCID: PMC8418002 DOI: 10.1186/s12889-021-11655-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with prior gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes; however, this risk can be reduced by engaging in positive health behaviours e.g. healthy diet and regular physical activity. As such behaviours are difficult to obtain and maintain there is a need to develop sustainable behavioural interventions following GDM. We aimed to report the process of systematically developing a health promotion intervention to increase quality of life and reduce diabetes risk among women with prior GDM and their families. We distil general lessons about developing complex interventions through co-production and discuss our extensions to intervention development frameworks. METHODS The development process draws on the Medical Research Council UK Development of complex interventions in primary care framework and an adaptation of a three-stage framework proposed by Hawkins et al. From May 2017 to May 2019, we iteratively developed the Face-it intervention in four stages: 1) Evidence review, qualitative research and stakeholder consultations; 2) Co-production of the intervention content; 3) Prototyping, feasibility- and pilot-testing and 4) Core outcome development. In all stages, we involved stakeholders from three study sites. RESULTS During stage 1, we identified the target areas for health promotion in families where the mother had prior GDM, including applying a broad understanding of health and a multilevel and multi-determinant approach. We pinpointed municipal health visitors as deliverers and the potential of using digital technology. In stage 2, we tested intervention content and delivery methods. A health pedagogic dialogue tool and a digital health app were co-adapted as the main intervention components. In stage 3, the intervention content and delivery were further adapted in the local context of the three study sites. Suggestions for intervention manuals were refined to optimise flexibility, delivery, sequencing of activities and from this, specific training manuals were developed. Finally, at stage 4, all stakeholders were involved in developing realistic and relevant evaluation outcomes. CONCLUSIONS This comprehensive description of the development of the Face-it intervention provides an example of how to co-produce and prototype a complex intervention balancing evidence and local conditions. The thorough, four-stage development is expected to create ownership and feasibility among intervention participants, deliverers and local stakeholders. TRIAL REGISTRATION ClinicalTrials.gov NCT03997773 , registered retrospectively on 25 June 2019.
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Affiliation(s)
- Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark. .,Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.
| | - Anne Timm
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Emma Davidsen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Line Hillersdal
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | | | - Maja Thøgersen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Ovesen
- Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christina Anne Vinter
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
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12
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Jensen RC, Jensen DM, Gibbons KS, Glintborg D, Jensen TK, McIntyre HD, Andersen M. Adapting fasting plasma glucose threshold for GDM diagnosis according to the population distribution - An approach to the Danish paradox. Diabetes Res Clin Pract 2021; 175:108832. [PMID: 33895195 DOI: 10.1016/j.diabres.2021.108832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/31/2021] [Accepted: 04/17/2021] [Indexed: 01/15/2023]
Abstract
AIMS To examine third trimester fasting venous plasma glucose (FVPG) according to the distribution of a Danish population of pregnant women and identify potential local FVPG thresholds for GDM diagnosis related to risks of adverse pregnancy outcomes. METHODS In the observational Odense Child Cohort (OCC) study, 1516 women had FVPG measured at 27-28 weeks' gestation and were considered normal by Danish criteria and remained untreated. Maternal FVPG from OCC were standardized according to the local FVPG mean and standard deviation calibrated to data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. Associations between maternal FVPG and clinical and anthropometric outcomes were analysed. Potential FVPG cut points were identified. RESULTS Unadjusted areas under the ROC curve for FVPG to discriminate for large for gestational age (LGA) and hypertensive disorders of pregnancy were 0.61 (95% CI 0.56, 0.67) and 0.57 (95% CI 0.52, 0.63), respectively. The Youden FVPG cut point for LGA was 5.5 mmol/L and 5.0 mmol/L for hypertensive disorders of pregnancy. CONCLUSIONS This study identified a potential locally appropriate third trimester FVPG cut point between 5.5 and 5.7 mmol/L based on LGA risk in pregnancy. This cut point should be validated prospectively in other Danish cohorts.
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Affiliation(s)
- Richard Christian Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Denmark; Department of Endocrinology, Odense University Hospital, Odense C, Denmark.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense C, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Kristen S Gibbons
- Faculty of Medicine, The University of Queensland, South Brisbane, QLD 4102, Australia
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Tina Kold Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark; Odense Patient Data Exploratory Network (OPEN), University of Southern Denmark, Odense C, Denmark
| | - H David McIntyre
- Faculty of Medicine, The University of Queensland, South Brisbane, QLD 4102, Australia; Mater Research, The University of Queensland, South Brisbane, QLD 4102, Australia
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
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13
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Byberg S, Bundesen C, Rudolf F, Haraldsdottir TL, Indjai L, Barai R, Beck-Nielsen H, Sodemann M, Jensen DM, Bjerregaard-Andersen M. Diabetes in urban Guinea-Bissau; patient characteristics, mortality and prevalence of undiagnosed dysglycemia. Glob Health Action 2021; 13:1802136. [PMID: 32814520 PMCID: PMC7480585 DOI: 10.1080/16549716.2020.1802136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The burden of diabetes mellitus in Sub-Saharan Africa is growing rapidly, and yet the prevalence and patient characteristics are still largely unknown. Objectives We analyzed clinical and demographic characteristics of Type 2 diabetes (T2DM) patients attending a diabetes clinic in Guinea-Bissau from February 2008 to April 2014, and estimated the prevalence and risk factors of unknown-impaired fasting plasma glucose (FPG) and diabetes, as well as excess mortality associated with T2DM. Methods We characterized T2DM patients attending the national diabetes clinic in Bissau. Diabetes was diagnosed based on FPG. We matched T2DM patients 1:1 with non-diabetes community controls on age and sex to determine relevant risk factors for T2DM using logistic regression. Furthermore, we matched patients 1:6 with community controls to assess long-term survival (until February 2019) in a Cox regression using calendar time as the underlying timescale. Verbal autopsies determined the cause of death among T2DM patients and controls. Results The mean age among T2DM was 50.6 (SD 11.1), and the mean FPG at first consultation was high (13.2 mmol/L (SD 5.1)). Ethnicity, family history of diabetes, hypertension, and anthropometrics differed among T2DM patients, community controls with impaired FPG, and healthy controls. Family history of diabetes (OR = 5.65, 95% CI: 3.10–10.3) and elevated waist circumference (2.33, 1.26–4.29) were significant risk factors for T2DM. 20.4% (59/289) of community controls had abnormal FPG. T2DM patients had an excess mortality hazard ratio of 3.53 (95%CI: 1.92–6.52). Deaths caused by bacterial infections, including foot ulcers, were more common among T2DM patients, compared with community controls (54% (7/13) vs. 19% (5/27) (P = 0.02)). Conclusion Several risk factors including were associated with T2DM in Guinea-Bissau. We found a high prevalence of elevated FPG among randomly selected community controls. In combination with higher mortality among T2DM patients, an urgent need for better treatment options and increased awareness.
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Affiliation(s)
- Stine Byberg
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute , Copenhagen, Denmark.,Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen , Gentofte, Denmark
| | - Camilla Bundesen
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Department of Infectious Diseases, Odense University Hospital , Odense, Denmark
| | - Frauke Rudolf
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital Skejby , Aarhus, Denmark
| | - Thorny Linda Haraldsdottir
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital Skejby , Aarhus, Denmark
| | - Lamine Indjai
- The Diabetes Clinic, The National Diabetes Association (ANDD) , Bissau, Guinea-Bissau
| | - Rui Barai
- The Diabetes Clinic, The National Diabetes Association (ANDD) , Bissau, Guinea-Bissau
| | | | - Morten Sodemann
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Department of Infectious Diseases, Odense University Hospital , Odense, Denmark
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital , Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital , Odense, Denmark
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network , Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute , Copenhagen, Denmark.,Steno Diabetes Center Odense, Odense University Hospital , Odense, Denmark.,Department of Endocrinology, Hospital of Southwest Denmark , Esbjerg, Denmark
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14
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Immanuel J, Simmons D, Harreiter J, Desoye G, Corcoy R, Adelantado JM, Devlieger R, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Dunne FP, Damm P, Mathiesen ER, Jensen DM, Andersen LLT, Hill DJ, Jelsma JGM, Kautzky-Willer A, Galjaard S, Snoek FJ, van Poppel MNM. Metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes. Diabet Med 2021; 38:e14413. [PMID: 32991758 DOI: 10.1111/dme.14413] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/10/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
AIMS To describe the metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes. METHODS We performed a post hoc analysis using data from the Vitamin D And Lifestyle Intervention for gestational diabetes prevention (DALI) trial conducted across nine European countries (2012-2014). In women with a BMI ≥29 kg/m2 , insulin resistance and secretion were estimated from the oral glucose tolerance test values performed before 20 weeks, using homeostatic model assessment of insulin resistance and Stumvoll first-phase indices, respectively. Women with early gestational diabetes, defined by the International Association of Diabetes and Pregnancy Study Groups criteria, were classified into three groups: GDM-R (above-median insulin resistance alone), GDM-S (below-median insulin secretion alone), and GDM-B (combination of both) and the few remaining women were excluded. RESULTS Compared with women in the normal glucose tolerance group (n = 651), women in the GDM-R group (n = 143) had higher fasting and post-load glucose values and insulin levels, with a greater risk of having large-for-gestational age babies [adjusted odds ratio 3.30 (95% CI 1.50-7.50)] and caesarean section [adjusted odds ratio 2.30 (95% CI 1.20-4.40)]. Women in the GDM-S (n = 37) and GDM-B (n = 56) groups had comparable pregnancy outcomes with those in the normal glucose tolerance group. CONCLUSIONS In overweight and obese women with early gestational diabetes, higher degree of insulin resistance alone was more likely to be associated with adverse pregnancy outcomes than lower insulin secretion alone or a combination of both.
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Affiliation(s)
- J Immanuel
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
| | - D Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
| | - J Harreiter
- Department of Medicine III, Division of Endocrinology, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - G Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - R Corcoy
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - J M Adelantado
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Belgium
| | - A Lapolla
- Universita Degli Studi di Padova, Padua, Italy
| | - M G Dalfra
- Universita Degli Studi di Padova, Padua, Italy
| | - A Bertolotto
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - E Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poland
| | - A Zawiejska
- Department of Reproduction, Poznan University of Medical Sciences, Poland
| | - F P Dunne
- National University of Ireland, Galway, Ireland
| | - P Damm
- Centre for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - E R Mathiesen
- Centre for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - L L T Andersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - D J Hill
- Recherche en Santé Lawson SA, St. Gallen, Switzerland
- Lawson Health Research Institute, London, Ontario, Canada
| | - J G M Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - A Kautzky-Willer
- Department of Medicine III, Division of Endocrinology, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
- Gender Institute Gars am Kamp, Vienna, Austria
| | - S Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - F J Snoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - M N M van Poppel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
- Institute of Sport Science, University of Graz, Graz, Austria
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15
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Abdelhadi Z, Bladbjerg EM, Jensen DM, Schousboe A, Støving RK. Venous thromboembolism in anorexia nervosa: four cases from a specialized unit. Indication for thromboprophylaxis? Eat Weight Disord 2020; 25:1833-1837. [PMID: 31849001 DOI: 10.1007/s40519-019-00830-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of mortality and morbidity. VTE may occur asymptomatic or subclinical. Fluid retention during intensive re-nutrition or rapid weight changes are well-known phenomena in anorexia nervosa (AN) and may represent a significant risk factor for VTE. OBJECTIVE The incidence of VTE in patients with AN is unknown, and the conditions may be overlooked in a complex clinical picture. METHOD This study report four cases of VTE in women with severe AN (age range 19-41 years, BMI range 10.6-13.1) admitted to a specialized unit for medical stabilization. RESULTS DVT or PE was diagnosed in all four patients. The patients were admitted for intensive re-nutrition according to conventional conservative guidelines with slow increase in energy supply (start low and advance slow). Due to suspected VTE, thromboprophylaxis was given during hospitalization, three of whom were undergoing re-nutrition. CONCLUSION The four presented cases suggest that VTE during re-nutrition in AN may be an overlooked risk which may not be sufficiently addressed in the literature. General recommendations should not be issued on the basis of case reports; however, we want to raise awareness and call for studies to identify the VTE risk and appropriate thromboprophylaxis in AN patients.
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Affiliation(s)
- Zainab Abdelhadi
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
| | - Else Marie Bladbjerg
- Unit for Thrombosis Research, Department of Regional Health Research, The University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Science, University of Southern Denmark, Odense, Denmark
| | - Amalie Schousboe
- Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark
| | - René Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark. .,Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark. .,Mental Health Services in the Region of Southern Denmark, Odense, Denmark. .,Clinical Institute, University of Southern Denmark, Odense, Denmark.
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16
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Larsen MD, Jensen DM, Fedder J, Jølving LR, Nørgård BM. Live-born children after assisted reproduction in women with type 1 diabetes and type 2 diabetes: a nationwide cohort study. Diabetologia 2020; 63:1736-1744. [PMID: 32548699 PMCID: PMC7406522 DOI: 10.1007/s00125-020-05193-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/23/2020] [Indexed: 01/10/2023]
Abstract
AIMS/HYPOTHESIS Type 1 and type 2 diabetes are among the most prevalent chronic diseases in women in the fertile years and women with diabetes may experience several reproductive issues. We aimed to examine the chance of biochemical pregnancy, clinical pregnancy and live birth after assisted reproductive technology (ART) treatment in women with type 1 and type 2 diabetes and whether obesity per se influenced the results. METHODS This nationwide register-based cohort study is based on the Danish ART Registry comprising 594 women with either type 1 diabetes or type 2 diabetes from 2006 to 2017. RESULTS Relative to women without diabetes, the adjusted OR (95% CI) of a live birth per embryo transfer was 0.50 (0.36, 0.71) in women with type 2 diabetes and 1.10 (0.86, 1.41) in women with type 1 diabetes. CONCLUSIONS/INTERPRETATION Our data on the efficacy of ART treatment in women with type 1 and type 2 diabetes is the first in this field. When compared with women without diabetes, women with type 1 diabetes had an equivalent chance of a live birth per embryo transfer whereas women with type 2 diabetes had a reduced chance. The findings in women with type 2 diabetes did not seem to be driven by obesity per se as the same pattern was seen in both normal-weight and obese women. Graphical abstract.
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Affiliation(s)
- Michael Due Larsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Erling Skjalgssons gt. 1, Laboratoriesenteret, 5. etasje, 7491, Trondheim, Norway.
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jens Fedder
- Department D, Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Dieberger AM, Desoye G, Stolz E, Hill DJ, Corcoy R, Simmons D, Harreiter J, Kautzky-Willer A, Dunne F, Devlieger R, Wender-Ozegowska E, Zawiejska A, Lapolla A, Dalfra MG, Bertolotto A, Galjaard S, Adelantado JM, Jensen DM, Andersen LL, Tanvig M, Damm P, Mathiesen ER, Snoek FJ, Jelsma JGM, van Poppel MNM. Less sedentary time is associated with a more favourable glucose-insulin axis in obese pregnant women-a secondary analysis of the DALI study. Int J Obes (Lond) 2020; 45:296-307. [PMID: 32661292 PMCID: PMC7840500 DOI: 10.1038/s41366-020-0639-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/03/2020] [Indexed: 12/29/2022]
Abstract
Background/objectives Obese pregnant women are at high risk of developing gestational diabetes mellitus (GDM), which might be reduced by sufficient physical activity (PA) and reduced sedentary time (ST). We assessed whether PA and ST are longitudinally associated with the glucose-insulin axis in obese pregnant women. Subjects/methods In this secondary analysis of the DALI (vitamin D And Lifestyle Intervention for gestational diabetes mellitus prevention) study, pregnant women, <20 weeks gestation, with a pre-pregnancy body mass index (BMI) ≥ 29 kg/m2, without GDM on entry were included. Time spent in moderate-to-vigorous PA (MVPA) and ST were measured objectively with accelerometers at <20 weeks, 24–28 weeks and 35–37 weeks of gestation. Fasting glucose (mmol/l) and insulin (mU/l), insulin resistance (HOMA-IR) and first-phase and second-phase insulin release (Stumvoll first and second phase) were assessed at the same time. Linear mixed regression models were used to calculate between-participant differences and within-participant changes over time. Analyses were adjusted for gestational age, randomisation, pre-pregnancy BMI, education and age. MVPA, Insulin, HOMA-IR and Stumvoll first and second phase were log-transformed for analyses due to skewness. Results 232 women were included in the analysis. Concerning differences between participants, more ST was associated with higher fasting glucose (Estimate: 0.008; 95% CI: 0.002, 0.014), fasting insulin (0.011; 0.002, 0.019), HOMA-IR (0.012; 0.004, 0.021) and Stumvoll first and second phase (0.008; 0.001, 0.014 and 0.007; 0.001, 0.014). Participants with more MVPA had lower Stumvoll first and second phase (−0.137; −0.210, −0.064 and −0.133; −0.202, −0.063). Concerning changes over time, an increase in ST during gestation was associated with elevated Stumvoll first and second phase (0.006; 0.000, 0.011). Conclusions As the glucose-insulin axis is more strongly associated with ST than MVPA in our obese population, pregnant women could be advised to reduce ST in addition to increasing MVPA. Moreover, our findings suggest that behaviour change interventions aiming at GDM risk reduction should start in early or pre-pregnancy.
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Affiliation(s)
- Anna M Dieberger
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - David J Hill
- Recherche en Santé Lawson SA, Bronschhofen, Switzerland.,Lawson Health Research Institute, London, ON, N6C 2R5, Canada
| | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.,CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Fidelma Dunne
- Galway Diabetes Research Centre and College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Agnieszka Zawiejska
- Division of Reproduction, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | | | - Sander Galjaard
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Juan M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lise-Lotte Andersen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mette Tanvig
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank J Snoek
- Department of Medical Psychology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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18
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Do NC, Vestgaard M, Ásbjörnsdóttir B, Nichum VL, Ringholm L, Andersen LLT, Jensen DM, Damm P, Mathiesen ER. Physical activity, sedentary behavior and development of preeclampsia in women with preexisting diabetes. Acta Diabetol 2020; 57:559-567. [PMID: 31781957 DOI: 10.1007/s00592-019-01459-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIMS To explore the association between physical activity in early pregnancy and development of preeclampsia in women with preexisting diabetes. METHODS In a prospective cohort study of 189 women with preexisting diabetes (110 type 1 and 79 type 2 diabetes), physical activity during pregnancy including sedentary behavior was evaluated with the Pregnancy Physical Activity Questionnaire. Primary outcome was preeclampsia. Secondary outcomes were preterm delivery, large and small for gestational age infants. RESULTS Women developing preeclampsia (n = 23) had higher diastolic blood pressure in early pregnancy (mean 82 ± 9 SD vs. 77 ± 8, p = 0.004) and were more often nulliparous (91 vs. 52%, p < 0.001) compared with the remaining women (n = 166). Total physical activity in early pregnancy was similar between the groups (median 148 metabolic equivalent of task hours per week (MET-h/week) (interquartile range 118-227) versus 153 (121-205), p = 0.97). In early pregnancy, women developing preeclampsia reported a higher level of sedentary behavior (15 MET-h/week (7-18) versus 7 (4-15); p = 0.04); however, when adjusting for parity, diastolic blood pressure and smoking, the association attenuated (p = 0.13). Total physical activity and sedentary behavior in early pregnancy were not associated with preterm delivery, large or small for gestational age infants. CONCLUSIONS Among women with diabetes, sedentary behavior was reported higher in early pregnancy in women developing preeclampsia compared with the remaining women, while total physical activity was similar. Sedentary behavior was a predictor of preeclampsia in the univariate analysis, but not in the multiple regression analysis, and larger studies are needed to evaluate this possible modifiable risk factor. Trial registration The study was registered at ClinicalTrials.gov (ID: NCT02890836).
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Affiliation(s)
- Nicoline Callesen Do
- Center for Pregnant Women with Diabetes 4002, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Marianne Vestgaard
- Center for Pregnant Women with Diabetes 4002, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes 4002, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Ladefoged Nichum
- Center for Pregnant Women with Diabetes 4002, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes 4002, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Dorte Møller Jensen
- Department of Obstetrics, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes 4002, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with Diabetes 4002, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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19
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Nielsen KK, Dahl-Petersen IK, Jensen DM, Ovesen P, Damm P, Jensen NH, Thøgersen M, Timm A, Hillersdal L, Kampmann U, Vinter CA, Mathiesen ER, Maindal HT. Protocol for a randomised controlled trial of a co-produced, complex, health promotion intervention for women with prior gestational diabetes and their families: the Face-it study. Trials 2020; 21:146. [PMID: 32033613 PMCID: PMC7006376 DOI: 10.1186/s13063-020-4062-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/09/2020] [Indexed: 12/17/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is associated with an increased risk of future diabetes in both mother, father and offspring. More knowledge is needed about how to effectively reduce the risk of diabetes through sustained behavioural interventions in these families. The Face-it intervention is a complex health promotion intervention embedded in multi-level supportive environments. The aim of the intervention is to reduce type 2 diabetes risk and increase quality of life among families in the first year following a GDM-affected pregnancy by promoting physical activity, healthy dietary behaviours and breastfeeding through a focus on social support, motivation, self-efficacy, risk perception and health literacy. Methods This national multicentre study is a two-arm randomised controlled trial including 460 women with GDM in a ratio of 2 (intervention):1 (usual care). The Face-it intervention consists of three main components: 1) additional visits from municipal health visitors, 2) digital health coaching tailored to family needs and 3) a structured cross-sectoral communication system in the health care system. The intervention runs from 3 to 12 months after delivery. The primary outcome is maternal body mass index at 12 months after delivery as a proxy for diabetes risk. The women will be examined at baseline and at follow-up, and this examination will include blood tests, oral glucose tolerance test (OGTT), anthropometrics, blood pressure, self-reported diet and physical activity, breastfeeding, quality of life, health literacy, physical and mental health status, risk perception and social support. Aside from those data collected for OGTT and breastfeeding and offspring parameters, the same data will be collected for partners. Data on offspring anthropometry will also be collected. Information on pregnancy- and birth-related outcomes will be derived from the medical records of the woman and child. Discussion This randomised controlled trial seeks to demonstrate whether the Face-it intervention, addressing the individual, family and health care system levels, is superior to usual care in reducing diabetes risk for mothers and their families. Coupled with a process evaluation and an economic analysis, the study will provide evidence for policymakers and health services about health promotion among families affected by GDM and the potential for reducing risk of type 2 diabetes and associated conditions. Trial registration ClinicalTrials.gov NCT03997773. Registered June 25, 2019 – Retrospectively registered.
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Affiliation(s)
| | | | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Per Ovesen
- Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Damm
- Centre for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Maja Thøgersen
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark
| | - Anne Timm
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Line Hillersdal
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark.,Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | | | - Christina Anne Vinter
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Centre for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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20
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Ásbjörnsdóttir B, Vestgaard M, Ringholm L, Andersen LLT, Jensen DM, Damm P, Mathiesen ER. Effect of motivational interviewing on gestational weight gain and fetal growth in pregnant women with type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000733. [PMID: 31798895 PMCID: PMC6861008 DOI: 10.1136/bmjdrc-2019-000733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
Objective To study how lifestyle coaching with motivational interviewing to improve adherence to healthy eating affects gestational weight gain and fetal growth in pregnant women with type 2 diabetes in a real-world setting. Research design and methods A cohort study including a prospective intervention cohort of consecutive, singleton pregnant, Danish-speaking women with type 2 diabetes included between August 2015 and February 2018 and a historical reference cohort included between February 2013 and August 2015. The intervention consisted of a motivational interviewing to improve adherence to healthy eating in addition to routine care. The reference cohort received routine care only. The main outcomes were gestational weight gain and large for gestational age (LGA) infants. Results Ninety-seven women were included in the intervention cohort and 92 in the reference cohort. Pre-pregnancy body mass index (32.8±6.9 kg/m2 vs 32.4±7.4 kg/m2, p=0.70), gestational weight gain (9.2±5.8 kg vs 10.2±5.8 kg, p=0.25), HbA1c in early pregnancy (6.7%±1.1% vs 6.5%±1.3% (50±12 mmol/mol vs 48±14 mmol/mol), p=0.32) and late pregnancy (5.9%±0.5% vs 6.0%±0.6% (41±6 mmol/mol vs 42±7 mmol/mol), p=0.34) were comparable in the two cohorts. LGA infants occurred in 20% vs 31%, p=0.07, respectively, and after adjustment for maternal characteristics 14% vs 27% delivered LGA infants (p=0.04). Birth weight z-score was 0.24±1.36 vs 0.61±1.38, p=0.06. Conclusions Motivational interviewing to improve adherence to healthy eating in addition to routine care in pregnant women with type 2 diabetes tended to reduce fetal overgrowth without major effect on gestational weight gain. Further studies investigating the cost-benefit of enhancing motivation are needed. Trial registration number NCT02883127.
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Affiliation(s)
- Björg Ásbjörnsdóttir
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Vestgaard
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Dorte Møller Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen Ø, Denmark
- The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Palm CVB, Glintborg D, Kyhl HB, McIntyre HD, Jensen RC, Jensen TK, Jensen DM, Andersen M. Polycystic ovary syndrome and hyperglycaemia in pregnancy. A narrative review and results from a prospective Danish cohort study. Diabetes Res Clin Pract 2018; 145:167-177. [PMID: 29689322 DOI: 10.1016/j.diabres.2018.04.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insulin resistance is common in polycystic ovary syndrome (PCOS). PCOS may be associated with increased risk of gestational diabetes mellitus (GDM). OBJECTIVES To (1) review literature regarding PCOS and hyperglycaemia in pregnancy and (2) present original data from Odense Child Cohort (OCC) regarding GDM in PCOS. METHODS Literature search including original studies from 2000-18. OCC included 2548 pregnant women, 9.5% (n = 241) had PCOS. Fasting plasma glucose was measured in 1519 and 659 oral glucose tolerance tests were performed (with risk factor for GDM, n = 384, without risk factors, n = 275), applying two different GDM criteria. RESULTS 30 studies were eligible using 12 different sets of diagnostic criteria for GDM. Ten studies included n > 50, control group, assessment of GDM and BMI. Results were not uniform, but supported that higher BMI, higher age, Asian ethnicity, and fertility treatment increased the risk of GDM in PCOS. In OCC, women with PCOS and controls had similar prevalences of GDM independent of different sets of criteria for GDM. CONCLUSION PCOS may not be an individual risk factor for GDM. Pregnancies in PCOS are characterized by factors known to increase risk of GDM, especially high BMI and fertility treatment.
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Affiliation(s)
- Camilla Viola Buskbjerg Palm
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Henriette Boye Kyhl
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Odense Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - H David McIntyre
- Mater Research, University of Queensland, Brisbane, Australia; Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | | | - Tina Kold Jensen
- Odense Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Dorte Møller Jensen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Marianne Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
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Knold J, Gohr T, Jensen DM, Vinter CA, Henriksen FL. [Hypertriglyceridaemia-induced pancreatitis during pregnancy caused by a genetic defect]. Ugeskr Laeger 2018; 180:V05180329. [PMID: 30327091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This is a case report of a 35-year-old secundigravida woman with recurrent episodes of hypertriglyceridaemia-induced acute pancreatitis during pregnancy, which is a rare but serious complication in pregnancy. The woman was normal weight, and she was not known with any metabolic disorders, but she had idiopathic splenomegaly, which might be explained by the high triglyceride levels. Later genetic analysis revealed a lipoprotein lipase gene mutation known to cause hypertriglyceridaemia. This shows, that it is important to consider genetic aetiology in normal weight pregnant women with hypertriglyceridaemia and pancreatitis.
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Nielsen LH, Jensen BL, Fuglsang J, Andersen LLT, Jensen DM, Jørgensen JS, Kitlen G, Ovesen P. Urine albumin is a superior predictor of preeclampsia compared to urine plasminogen in type I diabetes patients. ACTA ACUST UNITED AC 2017; 12:97-107. [PMID: 29305116 DOI: 10.1016/j.jash.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/07/2017] [Accepted: 12/06/2017] [Indexed: 11/29/2022]
Abstract
Pregnant women with type I diabetes mellitus (T1DM) are at increased risk of developing preeclampsia (PE). Plasminogen is aberrantly filtrated from plasma into tubular fluid in PE patients and activated to plasmin. Plasmin activates the epithelial sodium channel in the collecting ducts potentially causing impaired sodium excretion, suppression of the renin-angiotensin-aldosterone system, and hypertension in PE. The objective of the study was to test whether urinary total plasmin(ogen)/creatinine ratio and plasma concentration of aldosterone were better predictors of PE in pregnant women with T1DM compared with urine albumin and haemoglobin A1C. The design was a longitudinal observational study of 88 pregnant T1DM patients at 2 Danish centers. Spot urine- and blood samples were collected at gestational weeks 12, 20, 28, 32, and 36. U-plasmin(ogen)/creatinine ratio increased during pregnancy. In gestational week 36, the ratio was significantly increased in the T1DM patients developing PE (P < .05). P-aldosterone was significantly increased in gestational week 20 in the group developing PE (P < .05). U-albumin/creatinine ratio was significantly increased and predicted PE at all tested gestational ages. U-albumin/creatinine ratio had a stronger association with the development of PE compared to u-total plasmin(ogen)/creatinine ratio and p-aldosterone. The positive association between u-total plasmin(ogen) and development of PE late in pregnancy is compatible with involvement in PE pathophysiology. The significance of albumin in urine emphasizes the importance of preventing renal complications when planning pregnancy in patients with type I diabetes.
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Affiliation(s)
- Lise Hald Nielsen
- Department of Gynecology and Obstetrics, Institute of Clinical Medicine, Aarhus University Hospital Skejby, Denmark.
| | - Boye L Jensen
- Department of Cardiovascular- and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jens Fuglsang
- Department of Gynecology and Obstetrics, Institute of Clinical Medicine, Aarhus University Hospital Skejby, Denmark
| | - Lise Lotte Torvin Andersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Dorte Møller Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark; Department of Endocrinology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jan Stener Jørgensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Gitte Kitlen
- Department of Cardiovascular- and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Per Ovesen
- Department of Gynecology and Obstetrics, Institute of Clinical Medicine, Aarhus University Hospital Skejby, Denmark
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Kjær MM, Torvin-Andersen LL, Dam P, Jensen DM, Lauenborg J, Stentebjerg LL, Støving RK, Renault KM. [Pregnancy after bariatric surgery]. Ugeskr Laeger 2017; 179:V05170349. [PMID: 29212591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This is a review of the recommendations regarding pregnancy after bariatric surgery from the Danish Society of Obstetrics and Gynaecology. The risk of vitamin/mineral deficiencies should be emphasized and checked with blood samples. Measurements of fetal growth should be offered at gestational age 28 and 34 as a supplement to the standard prenatal procedures because of the increased risk of intrauterine growth retardation. Because of persistent obesity there is still an increased risk of hypertension and diabetes mellitus. In case of abdominal pain internal herniation should be suspected.
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Geilswijk M, Andersen LL, Frost M, Brusgaard K, Beck-Nielsen H, Frederiksen AL, Jensen DM. Octreotide therapy and restricted fetal growth: pregnancy in familial hyperinsulinemic hypoglycemia. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM160126. [PMID: 28458896 PMCID: PMC5404468 DOI: 10.1530/edm-16-0126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/13/2017] [Indexed: 12/30/2022] Open
Abstract
SUMMARY Hypoglycemia during pregnancy can have serious health implications for both mother and fetus. Although not generally recommended in pregnancy, synthetic somatostatin analogues are used for the management of blood glucose levels in expectant hyperinsulinemic mothers. Recent reports suggest that octreotide treatment in pregnancy, as well as hypoglycemia in itself, may pose a risk of fetal growth restriction. During pregnancy, management of blood glucose levels in familial hyperinsulinemic hypoglycemia thus forms a medical dilemma. We report on pregnancy outcomes in a woman with symptomatic familial hyperinsulinemic hypoglycemia, type 3. During the patient's first pregnancy with a viable fetus octreotide treatment was instituted in gestational age 23 weeks to prevent severe hypoglycemic incidences. Fetal growth velocity declined, and at 37 weeks of gestation, intrauterine growth retardation was evident. During the second pregnancy with a viable fetus, blood glucose levels were managed through dietary intervention alone. Thus, the patient was advised to take small but frequent meals high in fiber and low in carbohydrates. Throughout pregnancy, no incidences of severe hypoglycemia occurred and fetal growth velocity was normal. We conclude that octreotide treatment during pregnancy may pose a risk of fetal growth restriction and warrants careful consideration. In some cases of familial hyperinsulinemic hypoglycemia, blood glucose levels can be successfully managed through diet only, also during pregnancy. LEARNING POINTS Gain-of-function mutations in GCK cause familial hyperinsulinemic hypoglycemia.Hypoglycemia during pregnancy may have serious health implications for mother and fetus.Pregnancy with hyperinsulinism represents a medical dilemma as hypoglycemia as well as octreotide treatment may pose a risk of fetal growth restriction.In some cases of familial hyperinsulinemic hypoglycemia, blood glucose levels can be successfully managed through diet only.
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Affiliation(s)
| | - Lise Lotte Andersen
- Departments of Obstetrics.,Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Morten Frost
- Departments of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Klaus Brusgaard
- Departments of Clinical Genetics.,Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Henning Beck-Nielsen
- Departments of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Anja Lisbeth Frederiksen
- Departments of Clinical Genetics.,Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Møller Jensen
- Departments of Obstetrics.,Departments of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
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Hennild DE, Bjerregaard-Andersen M, Joaquím LC, Christensen K, Sodemann M, Beck-Nielsen H, Jensen DM. Prevalence of impaired glucose tolerance and other types of dysglycaemia among young twins and singletons in Guinea-Bissau. BMC Endocr Disord 2016; 16:46. [PMID: 27491662 PMCID: PMC4973540 DOI: 10.1186/s12902-016-0126-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Twins may be at increased risk of dysglycaemic disorders due to adverse fetal conditions. Data from Africa regarding this association is limited. We studied impaired glucose tolerance (IGT) and other types of dysglycemia among twins and singletons in Guinea-Bissau. METHODS The study was conducted from February 2011 until March 2012 at the Bandim Health Project, a health and demographic surveillance system site in the capital Bissau. Twins (n = 209) and singletons (n = 182) were recruited from a previously established cohort. Oral glucose tolerance tests (OGTT) were performed, along with anthropometrics and collection of clinical and dietary data. RESULTS Median age was 16.6 and 14.2 years between twins and singletons, respectively (P = 0.08). Mean birth weight was 2410 vs. 3090 g, respectively (P < 0.001). Twins had higher median fasting- and two hour capillary plasma glucose, 5.4(3.2-8.2) vs. 5.0(3.2-11.5) mmol/L (P < 0.001) and 6.8(3.4-11.3) vs. 6.2(3.2-12.1) mmol/L (P < 0.001), respectively, compared to singletons. The prevalence of IGT was 2.5 % (5/209) vs. 3.5 % (6/182) (RR = 0.73, 95 % CI: 0.20-2.64). 12 % (25/209) of twins had impaired fasting glucose (IFG), compared to 3.5 % (6/182) of singletons (3.63, 1.53-8.62). Dysglycemia (IGT and/or IFG or overt diabetes) was found in 17 % (35/209) vs. 9 % (16/182) (1.90, 1.08-3.37), respectively. CONCLUSIONS Twins had higher glucose levels in both the fasting and postprandial state. This may indicate a detrimental effect of the twin fetal environment on glucose metabolism later in life, a result contrary to Scandinavian register studies. The IGT burden was low in this young age group and the risk was similar in twins and singletons.
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Affiliation(s)
- Ditte Egegaard Hennild
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Luis Carlos Joaquím
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Guinean Diabetes Association (ANDD), Bissau, Guinea-Bissau
| | - Kaare Christensen
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9, 5000 Odense C, Denmark
- Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Morten Sodemann
- Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
- Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Henning Beck-Nielsen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
- Elite Research Centre for Medical Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Dorte Møller Jensen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
- Elite Research Centre for Medical Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- The Research Unit of Gynaecology and Obstetrics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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27
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Stentebjerg LL, Andersen LLT, Renault K, Støving RK, Jensen DM. Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass. J Matern Fetal Neonatal Med 2016; 30:1182-1188. [PMID: 27426696 DOI: 10.1080/14767058.2016.1208746] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To compare perinatal and pregnancy outcomes including adherence to the Institute of Medicine's (IOM) recommendations for gestational weight gain (GWG) in pregnant women with conception <18 months (early group) compared to ≥18 months following gastric bypass (late group). METHODS Retrospective cohort study comprising 71 women with gastric bypass and a singleton pregnancy presenting at Odense University Hospital, November 2007-October 2013. Data were extracted from medical records and laboratory systems. The primary outcomes were timing of pregnancy and adherence to the IOM's recommendations for GWG. Secondary outcomes were birthweight, preterm delivery, cesarean section (CS), iron deficiency and post partum hemorrhage (PPH). RESULTS Forty-three (61%) women conceived less than 18 months after gastric bypass surgery. Women in the late group had a significantly higher risk of requiring CS or receiving intravenous iron supplementation compared to the early group (57% versus 30%, p = 0.03 and 29% versus 7%, p = 0.02, respectively). Early conception was not significantly associated with insufficient GWG, preterm delivery or birthweight. Among 54 women with information on GWG, only 13 (24%) had an appropriate GWG. CONCLUSION The majority of pregnant women with gastric bypass did not fulfill guidelines for GWG; however, this study could not support the recommendation to postpone pregnancy.
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Affiliation(s)
| | | | - Kristina Renault
- a Research Unit of Gynecology and Obstetrics, Odense University Hospital , Odense , Denmark and
| | - René Klinkby Støving
- b Elite Research Centre for Medical Endocrinology, Odense University Hospital , Odense , Denmark
| | - Dorte Møller Jensen
- a Research Unit of Gynecology and Obstetrics, Odense University Hospital , Odense , Denmark and.,b Elite Research Centre for Medical Endocrinology, Odense University Hospital , Odense , Denmark
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28
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Boisen AB, Knorr S, Hansen TK, Vlachova Z, Bytoft B, Damm P, Beck-Nielsen H, Jensen DM, Møller HJ, Gravholt CH. Signs of low-grade systemic inflammation in female offspring of women with type 1 diabetes: The EPICOM study. Diabetes Metab 2016; 42:462-465. [PMID: 27378631 DOI: 10.1016/j.diabet.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- A B Boisen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S Knorr
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - T K Hansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Z Vlachova
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - B Bytoft
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Beck-Nielsen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - D M Jensen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - H J Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - C H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
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29
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Pho MT, Jensen DM, Meltzer DO, Kim AY, Linas BP. Clinical impact of treatment timing for chronic hepatitis C infection: a decision model. J Viral Hepat 2015; 22:630-8. [PMID: 26135026 PMCID: PMC4515086 DOI: 10.1111/jvh.12412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/01/2015] [Indexed: 01/03/2023]
Abstract
Recent advances in the treatment of hepatitis C virus (HCV) infection have led to the availability of both highly efficacious interferon-containing and interferon-sparing regimens. However, the use of such therapies faces restrictions due to high costs. For patients who are medically eligible to receive interferon, the choice between the two will likely be impacted by preferences surrounding interferon, severity of disease, coverage policies and out-of-pocket costs. We developed a decision model to quantify the trade-offs between immediate, interferon-containing therapy and delayed, interferon-free therapy for patients with chronic, genotype 1 HCV infection. We projected the quality-adjusted life expectancy stratified by the presence or absence of cirrhosis for four strategies: (i) no treatment; (ii) immediate, one-time treatment with an interferon-containing regimen; (iii) immediate treatment as above with the opportunity for retreatment in patients who fail to achieve sustained virologic response with interferon-free therapy in 1 year; and (iv) delayed therapy with interferon-free therapy in 1 year. When compared to one-time immediate treatment with the interferon-containing regimen, delayed treatment with the interferon-free regimen in 1 year resulted in longer life expectancy, with a 0.2 quality-adjusted life year (QALY) increase in noncirrhotic patients, and a 1.1 QALY increase in patients with cirrhosis. This superiority in health benefits was lost when wait time for interferon-free therapy was greater than 3-3.2 years. In this modelling analysis, interferon-free therapy resulted in superior health benefits compared to immediate therapy with interferon until wait time exceeded 3-3.2 years. Such data can inform decision-making regarding treatment initiation for HCV as healthcare financing evolves.
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Affiliation(s)
- M T Pho
- Department of Medicine, Sections of Hospital Medicine and of Infectious Diseases and Global Health, University of ChicagoChicago, IL, USA,Correspondence: Mai T. Pho, MD MPH, Section of Infectious Diseases and Global Health, University of Chicago Medicine, 5841 S Maryland Avenue, MC 5065, Chicago, IL 60637, USA., E-mail:
| | - D M Jensen
- Center for Liver Disease, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago MedicineChicago, IL, USA
| | - D O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of ChicagoChicago, IL, USA
| | - A Y Kim
- Department of Medicine, Massachusetts General HospitalBoston, MA, USA
| | - B P Linas
- Department of Medicine, Section of Infectious Diseases, Boston Medical CenterBoston, MA, USA,Department of Epidemiology, Boston University School of Public HealthBoston, MA, USA
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Tuyns AJ, Péquignot G, Jensen DM. Role of diet, alcohol and tobacco in oesophageal cancer, as illustrated by two contrasting high-incidence areas in the North of Iran and West of France. Front Gastrointest Res 2015; 4:101-10. [PMID: 428882 DOI: 10.1159/000402291] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lundberg TP, Højlund K, Snogdal LS, Jensen DM. Glutamic acid decarboxylase autoantibody-positivity post-partum is associated with impaired β-cell function in women with gestational diabetes mellitus. Diabet Med 2015; 32:198-205. [PMID: 25345799 DOI: 10.1111/dme.12615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/18/2014] [Accepted: 10/15/2014] [Indexed: 01/25/2023]
Abstract
AIMS To investigate whether the presence of glutamic acid decarboxylase (GAD) autoantibodies post-partum in women with prior gestational diabetes mellitus was associated with changes in metabolic characteristics, including β-cell function and insulin sensitivity. METHODS During 1997-2010, 407 women with gestational diabetes mellitus were offered a 3-month post-partum follow-up including anthropometrics, serum lipid profile, HbA1c and GAD autoantibodies, as well as a 2-h oral glucose tolerance test (OGTT) with blood glucose, serum insulin and C-peptide at 0, 30 and 120 min. Indices of insulin sensitivity and insulin secretion were estimated to assess insulin secretion adjusted for insulin sensitivity, disposition index (DI). RESULTS Twenty-two (5.4%) women were positive for GAD autoantibodies (GAD+ve) and the remainder (94.6%) were negative for GAD autoantibodies (GAD-ve). The two groups had similar age and prevalence of diabetes mellitus. Women who were GAD+ve had significantly higher 2-h OGTT glucose concentrations during their index-pregnancy (10.5 vs. 9.8 mmol/l, P = 0.001), higher fasting glucose (5.2 vs. 5.0 mmol/l, P = 0.02) and higher 2-h glucose (7.8 vs. 7.1 mmol/l, P = 0.05) post-partum. Fasting levels of C-peptide and insulin were lower in GAD+ve women compared with GAD-ve women (520 vs. 761 pmol/l, P = 0.02 and 33 vs. 53 pmol/l, P = 0.05) Indices of insulin sensitivity were similar in GAD+ve and GAD-ve women, whereas all estimates of DI were significantly reduced in GAD+ve women. CONCLUSION GAD+ve women had higher glucose levels and impaired insulin secretion adjusted for insulin sensitivity (DI) compared with GAD-ve women. The combination of OGTT and GAD autoantibodies post-partum identify women with impaired β-cell function. These women should be followed with special focus on development of Type 1 diabetes.
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MESH Headings
- Adult
- Autoantibodies/analysis
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/epidemiology
- Autoimmune Diseases/etiology
- Autoimmune Diseases/immunology
- Biomarkers/blood
- Cohort Studies
- Denmark/epidemiology
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/etiology
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/immunology
- Diabetes, Gestational/blood
- Diabetes, Gestational/immunology
- Diabetes, Gestational/physiopathology
- Diagnosis, Differential
- Early Diagnosis
- Female
- Follow-Up Studies
- Glutamate Decarboxylase/antagonists & inhibitors
- Glutamate Decarboxylase/immunology
- Humans
- Insulin/blood
- Insulin/metabolism
- Insulin Resistance
- Insulin Secretion
- Insulin-Secreting Cells/immunology
- Insulin-Secreting Cells/metabolism
- Postpartum Period
- Pregnancy
- Prevalence
- Prospective Studies
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Affiliation(s)
- T P Lundberg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; The Clinical Research Institute, University of Southern Denmark, Odense, Denmark
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Ovesen PG, Jensen DM, Damm P, Rasmussen S, Kesmodel US. Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. a nation-wide study. J Matern Fetal Neonatal Med 2015; 28:1720-4. [DOI: 10.3109/14767058.2014.966677] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mumm H, Jensen DM, Sørensen JA, Andersen LLT, Ravn P, Andersen M, Glintborg D. Hyperandrogenism and phenotypes of polycystic ovary syndrome are not associated with differences in obstetric outcomes. Acta Obstet Gynecol Scand 2014; 94:204-11. [DOI: 10.1111/aogs.12545] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/18/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Hanne Mumm
- Department of Endocrinology and Metabolism; Odense University Hospital; Odense Denmark
| | - Dorte Møller Jensen
- Department of Endocrinology and Metabolism; Odense University Hospital; Odense Denmark
| | - Jens Aage Sørensen
- Department ofGynecology and Obstetrics; Odense University Hospital; Odense Denmark
| | | | - Pernille Ravn
- Department ofGynecology and Obstetrics; Odense University Hospital; Odense Denmark
| | - Marianne Andersen
- Department of Endocrinology and Metabolism; Odense University Hospital; Odense Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism; Odense University Hospital; Odense Denmark
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34
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Vinter CA, Jørgensen JS, Ovesen P, Beck-Nielsen H, Skytthe A, Jensen DM. Metabolic effects of lifestyle intervention in obese pregnant women. Results from the randomized controlled trial 'Lifestyle in Pregnancy' (LiP). Diabet Med 2014; 31:1323-30. [PMID: 24989831 DOI: 10.1111/dme.12548] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/20/2014] [Accepted: 06/30/2014] [Indexed: 12/24/2022]
Abstract
AIMS The Lifestyle in Pregnancy intervention in obese pregnant women resulted in significantly lower gestational weight gain compared with the control group, but without improvement in rates of clinical pregnancy complications. The impact of the lifestyle intervention on metabolic measurements in the study participants is now reported. METHODS The Lifestyle in Pregnancy study was a randomized controlled trial among 360 obese women (BMI 30-45 kg/m²) who were allocated in early pregnancy to lifestyle interventions with diet counselling and physical activities or to the control group. Fasting blood samples, including plasma glucose, insulin, lipid profile and capillary blood glucose during a 2-h oral glucose tolerance test were carried out three times throughout pregnancy. Insulin resistance was estimated with the homeostasis model assessment of insulin resistance. RESULTS Three hundred and four women (84%) were followed until delivery. Women in the intervention group had a significantly lower change in insulin resistance (HOMA-IR) from randomization to 28-30 weeks' gestation compared with control subjects (mean ± SD: 0.7 ± 1.3 vs. 1.0 ± 1.3, P = 0.02). Despite a significantly lower gestational weight gain in the intervention group, there was no difference between the groups with respect to total cholesterol, HDL, LDL or triglycerides. CONCLUSIONS Lifestyle intervention in obese pregnant women resulted in attenuation of the physiologic pregnancy-induced insulin resistance. Despite restricted gestational weight gain, there were no changes in glucose or lipid metabolism between the groups.
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Affiliation(s)
- C A Vinter
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense
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Bjerregaard-Andersen M, Biering-Sørensen S, Gomes GM, Bidonga A, Jensen DM, Rodrigues A, Christensen K, Aaby P, Beck-Nielsen H, Benn CS, Sodemann M. Infant twin mortality and hospitalisations after the perinatal period - a prospective cohort study from Guinea-Bissau. Trop Med Int Health 2014; 19:1477-87. [PMID: 25244312 DOI: 10.1111/tmi.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine mortality and hospitalisations among infant twins and singletons after the perinatal period in Guinea-Bissau. METHODS The study was conducted from September 2009 to November 2012 by the Bandim Health Project (BHP). Newborn twins and unmatched singleton controls were included at the National Hospital Simão Mendes in the capital Bissau. Children were examined clinically at enrolment. Maternal, pregnancy and obstetric information was collected and HIV testing offered at birth. Follow-up occurred at home at 2, 6 and 12 months and through linkage with the paediatric admission register at the National Hospital. RESULTS About 495 twins and 333 singletons were alive on day 7 after birth. In total, 36 twins and 12 singletons died during follow-up, the post-perinatal infant mortality rate being 91/1000 person-years for twins and 42/1000 for singletons (HR = 2.11, 95% CI: 1.09-4.07). In a multivariable analysis among twins only, birth weight <2000 g [3.32, (1.36-8.07)], death of the cotwin perinatally [2.54, (1.16-5.57)] and severe maternal illness during pregnancy [2.35, (1.00-5.51)] were significant risk factors for twin death. In the subgroup with available HIV status, maternal HIV infection was strongly associated with twin mortality [3.16, (1.24-8.05)]. Death occurred at home for 60% of twins and 67% of singletons. During follow-up, 90 first-time hospital admissions were registered, with similar rates observed for twins (139/1000) and singletons (143/1000) [0.97, (0.61-1.52)]. CONCLUSION The post-perinatal infant mortality rate of twins was double that of singletons. No excess in twin hospitalisations was observed, possibly implying obstacles to hospital admission for twins in case of severe illness.
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Affiliation(s)
- M Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Statens Serum Institute, Copenhagen, Denmark
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Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Tanvig M, Lamont RF, Jørgensen JS. Postpartum weight retention and breastfeeding among obese women from the randomized controlled Lifestyle in Pregnancy (LiP) trial. Acta Obstet Gynecol Scand 2014; 93:794-801. [DOI: 10.1111/aogs.12429] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Christina Anne Vinter
- Department of Gynecology and Obstetrics; Odense University Hospital; Odense Denmark
- University of Southern Denmark; Odense Denmark
| | - Dorte Møller Jensen
- University of Southern Denmark; Odense Denmark
- Department of Endocrinology; Odense University Hospital; Odense Denmark
| | - Per Ovesen
- Department of Gynecology and Obstetrics; Aarhus University Hospital, Skejby; Aarhus Denmark
| | - Henning Beck-Nielsen
- University of Southern Denmark; Odense Denmark
- Department of Endocrinology; Odense University Hospital; Odense Denmark
| | - Mette Tanvig
- Department of Gynecology and Obstetrics; Odense University Hospital; Odense Denmark
- University of Southern Denmark; Odense Denmark
| | - Ronald F. Lamont
- Department of Gynecology and Obstetrics; Odense University Hospital; Odense Denmark
- University of Southern Denmark; Odense Denmark
- Division of Surgery; University College London; Northwick Park Institute for Medical Research Campus; London UK
| | - Jan Stener Jørgensen
- Department of Gynecology and Obstetrics; Odense University Hospital; Odense Denmark
- University of Southern Denmark; Odense Denmark
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Houshmand A, Jensen DM, Mathiesen ER, Damm P. Evolution of diagnostic criteria for gestational diabetes mellitus. Acta Obstet Gynecol Scand 2013; 92:739-45. [DOI: 10.1111/aogs.12152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/12/2013] [Indexed: 12/01/2022]
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Bjerregaard-Andersen M, Lund N, Jepsen FS, Camala L, Gomes MA, Christensen K, Christiansen L, Jensen DM, Aaby P, Beck-Nielsen H, Benn CS, Sodemann M. A prospective study of twinning and perinatal mortality in urban Guinea-Bissau. BMC Pregnancy Childbirth 2012; 12:140. [PMID: 23216795 PMCID: PMC3534574 DOI: 10.1186/1471-2393-12-140] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 12/03/2012] [Indexed: 02/05/2023] Open
Abstract
Background Despite twinning being common in Africa, few prospective twin studies have been conducted. We studied twinning rate, perinatal mortality and the clinical characteristics of newborn twins in urban Guinea-Bissau. Methods The study was conducted at the Bandim Health Project (BHP), a health and demographic surveillance site in Bissau, the capital of Guinea-Bissau. The cohort included all newborn twins delivered at the National Hospital Simão Mendes and in the BHP study area during the period September 2009 to August 2011 as well as singleton controls from the BHP study area. Data regarding obstetric history and pregnancy were collected at the hospital. Live children were examined clinically. For a subset of twin pairs zygosity was established by using genetic markers. Results Out of the 5262 births from mothers included in the BHP study area, 94 were twin births, i.e. a community twinning rate of 18/1000. The monozygotic rate was 3.4/1000. Perinatal mortality among twins vs. singletons was 218/1000 vs. 80/1000 (RR = 2.71, 95% CI: 1.93-3.80). Among the 13783 hospital births 388 were twin births (28/1000). The hospital perinatal twin mortality was 237/1000. Birth weight < 2000g (RR = 4.24, CI: 2.39-7.51) and caesarean section (RR = 1.78, CI: 1.06-2.99) were significant risk factors for perinatal twin mortality. Male sex (RR = 1.38, CI: 0.97-1.96), unawareness of twin pregnancy (RR = 1.64, CI: 0.97-2.78) and high blood pressure during pregnancy (RR = 1.77, CI: 0.88-3.57) were borderline non-significant. Sixty-five percent (245/375) of the mothers who delivered at the hospital were unaware of their twin pregnancy. Conclusions Twins had a very high perinatal mortality, three-fold higher than singletons. A birth weight < 2000g was the strongest risk factor for perinatal death, and unrecognized twin pregnancy was common. Urgent interventions are needed to lower perinatal twin mortality in Guinea-Bissau.
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Tanvig M, Wehberg S, Vinter CA, Joergensen JS, Ovesen PG, Beck-Nielsen H, Jensen DM, Christesen HT. Pregestational body mass index is related to neonatal abdominal circumference at birth--a Danish population-based study. BJOG 2012; 120:320-30. [PMID: 23146023 DOI: 10.1111/1471-0528.12062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the impact of maternal pregestational body mass index (BMI) and smoking on neonatal abdominal circumference (AC) and weight at birth. To define reference curves for birth AC and weight in offspring of healthy, nonsmoking, normal weight women. DESIGN Population-based study. SETTING Data from the Danish Medical Birth Registry. POPULATION All live singletons without congenital malformations in Denmark 2004-10. METHODS Data on 366,886 singletons at 35(+0) to 41(+6) weeks(+days) of gestation were extracted and analysed using multivariate linear regressions. MAIN OUTCOME MEASURES Birth AC and weight in relation to pregestational maternal BMI, maternal smoking and medical conditions (any). RESULTS Birth AC and weight increased with increasing pregestational BMI, and decreased with smoking (P < 0.0001). Reference curves were created for offspring of healthy, nonsmoking mothers with normal pregestational BMI. Mean AC ranged from 30.1 cm and 30.2 cm at 35 weeks of gestation to 33.9 cm and 34.1 cm at 41 weeks of gestation, for girls and boys, respectively. Mean birthweight ranged from 2581 and 2666 g at 35 weeks to 3705 and 3852 g at 41 weeks of gestation for girls and boys, respectively. Pregestational BMI correlated more to the Z score of birthweight than to the Z score of AC (P < 0.0001). CONCLUSION Birth AC and weight are affected by maternal smoking status and pregestational BMI. Pregestational BMI correlated more to birthweight than to AC. Using data from healthy, nonsmoking mothers with normal pregestational BMI we have provided new reference curves for birth AC and birthweight.
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Affiliation(s)
- M Tanvig
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
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Jacobson IM, Pawlotsky JM, Afdhal NH, Dusheiko GM, Forns X, Jensen DM, Poordad F, Schulz J. A practical guide for the use of boceprevir and telaprevir for the treatment of hepatitis C. J Viral Hepat 2012; 19 Suppl 2:1-26. [PMID: 22404758 DOI: 10.1111/j.1365-2893.2012.01590.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study is to review clinical trial data on the newly approved protease inhibitors boceprevir and telaprevir to develop consensus recommendations on the optimal use of these agents for the treatment of patients with chronic hepatitis C virus (HCV) infection. An expert panel of seven leading authorities in viral hepatitis was convened to establish and disseminate a practical guide on best practices for incorporating boceprevir and telaprevir into therapy for HCV infection in both treatment-naive and treatment-experienced patients. The topics covered include selecting candidates for boceprevir- or telaprevir-based treatments, predictors of response and early viral kinetics, response-guided therapy approaches, on-treatment management strategies to optimize the likelihood of response and minimize the risk of drug resistance, management of adverse effects during therapy and key considerations for special populations. The expert panel incorporated the best available clinical evidence into recommendations on how boceprevir and telaprevir should be used in the clinical setting. They indicated how treatment regimens may differ according to the baseline factors, such as presence of cirrhosis and when therapy may need to be modified or stopped altogether because of adverse events or poor virologic response. This practical guide will serve as a valuable resource for clinicians embarking on the new treatment paradigm of boceprevir or telaprevir in combination with peginterferon/ribavirin for chronic genotype 1 HCV infection.
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Affiliation(s)
- I M Jacobson
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Vinter CA, Tanvig MH, Damm P, Naver KV, Andreasen KR, Andersen LLT, Liest S, Lunde S, Jensen DM, Renault KM. [Obese pregnant women and complications in relation to pregnancy and birth]. Ugeskr Laeger 2012; 174:1079-1082. [PMID: 22510547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
One third of the pregnant Danish women are overweight or obese. Maternal obesity is an independent risk factor for adverse maternal and foetal outcomes including infertility, miscarriage, congenital malformations, preeclampsia, gestational diabetes, complicated deliveries, caesarean section, macrosomia and childhood obesity. This article reviews the effect of maternal obesity on obstetric and neonatal outcomes and provides recommendations for management of obesity in pregnancy.
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Affiliation(s)
- Christina Anne Vinter
- Gynækologisk Obstetrisk Afdeling, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
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Renault K, Andersen LL, Kjær MM, Lauenborg J, Gjerris AC, Berlac JF, Jensen DM, Damm P. [Pregnancy following bariatric surgery requires special attention]. Ugeskr Laeger 2012; 174:1076-1079. [PMID: 22510546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In the latest years the number of pregnant women having undergone bariatric surgery before pregnancy has increased rapidly. In pregnancy, they seem to have a reduced risk of obesity-related complications but an increased risk of mechanical complications causing small bowel obstruction and complications due to malabsorption. This article reviews the effect of bariatric surgery before pregnancy on obstetric and neonatal outcomes and provides, based on the limited available evidence, recommendations for the management of pregnancy in these women.
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Affiliation(s)
- Kristina Renault
- Gynækologisk/Obstetrisk Afdeling, Hvidovre Hospital, Kettegård Alle 30, 2650 Hvidovre, Denmark.
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Clausen TD, Mortensen EL, Schmidt L, Mathiesen ER, Hansen T, Jensen DM, Holm S, Poulsen L, From M, Damm P. Cognitive function in adult offspring of women with Type 1 diabetes. Diabet Med 2011; 28:838-44. [PMID: 21434994 DOI: 10.1111/j.1464-5491.2011.03300.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Maternal diabetes may affect offspring cognitive function. The objective of the study was to evaluate cognitive function and potential predictors hereof in adult offspring of women with Type 1 diabetes. METHODS We conducted a follow-up study of adult offspring of women with Type 1 diabetes (n = 158) and a reference group from the background population (n = 118). The main outcome measure was offspring cognitive function measured by global cognitive score, derived from Raven's Progressive Matrices and three verbal subtests from the Weschler Adult Intelligence Scale. RESULTS Offspring of women with Type 1 diabetes obtained lower global cognitive scores (94.8 vs. 100.0, P = 0.004) than offspring from the background population. When adjusted for confounders, the groups no longer differed significantly (difference 0.4, 95% CI -3.3 to 4.). Positive predictors of cognitive function in offspring of women with diabetes were family social class, parental educational level, maternal diabetes duration, male gender and offspring age, whereas parity ≥ 1 and gestational age < 34 weeks were negative predictors. We found no association with maternal glycaemia during pregnancy or with neonatal hypoglycaemia. CONCLUSIONS Impaired cognitive function in adult offspring of women with Type 1 diabetes compared with the background population apparently reflects differences with respect to well-known confounders. However, harmful effects of maternal hyperglycaemia may be mediated through delivery at < 34 weeks.
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Affiliation(s)
- T D Clausen
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, The Capital Region of Denmark, Faculty of Health Sciences, Copenhagen, Denmark.
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Rodriguez-Torres M, Sulkowski MS, Chung RT, Hamzeh FM, Jensen DM. Factors associated with rapid and early virologic response to peginterferon alfa-2a/ribavirin treatment in HCV genotype 1 patients representative of the general chronic hepatitis C population. J Viral Hepat 2010; 17:139-47. [PMID: 19674282 PMCID: PMC2810441 DOI: 10.1111/j.1365-2893.2009.01157.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Rapid virologic response (RVR) and complete early virologic response (cEVR) are associated with sustained virologic response to hepatitis C virus (HCV) therapy. We retrospectively examined baseline and on-treatment factors associated with RVR (HCV RNA undetectable at week 4) and cEVR (HCV RNA undetectable at week 12, regardless of week 4 response). The analysis comprised 1550 HCV genotype-1 patients from five clinical trials, including three enriched with difficult-to-treat populations, randomized to peginterferon alfa-2a 180 microg/week plus ribavirin 1000-1200 mg/day. Overall, 15.6% achieved RVR and 54.0% achieved cEVR. Baseline factors predictive of RVR were serum HCV RNA <or= 400,000 IU/mL (OR: 7.34; P < 0.0001), alanine aminotransferase >3 x ULN (OR: 2.01; P < 0.0001), non-cirrhotic status (OR: 1.92; P = 0.0087), age <or= 40 years (OR: 1.56; P = 0.0085), white non-Latino ethnicity (OR: 1.41; P = 0.0666) and individual study (P < 0.0001). These factors plus body mass index <or= 27 kg/m(2) were predictive of cEVR. After adjusting for these factors, mean on-treatment ribavirin dose >13 mg/kg/day was predictive of RVR (OR: 1.69; P = 0.005) and cEVR (OR: 1.24; P = 0.09), whereas peginterferon alfa-2a dose reduction was not. Greater decreases in haematologic parameters were observed in patients who achieved cEVR compared with patients who did not. In conclusion, several baseline and on-treatment factors were associated with RVR and cEVR to peginterferon alfa-2a plus ribavirin in difficult-to-treat HCV genotype-1 patients, providing important prognostic information on the antiviral response in a patient cohort that is reflective of the general chronic hepatitis C population.
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Affiliation(s)
| | | | - R T Chung
- Gastrointestinal Unit, Massachusetts General HospitalBoston, MA, USA
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Rodriguez-Torres M, Sulkowski MS, Chung RT, Hamzeh FM, Jensen DM. Factors associated with rapid and early virologic response to peginterferon alfa-2a/ribavirin treatment in HCV genotype 1 patients representative of the general chronic hepatitis C population. J Viral Hepat 2009. [PMID: 19674282 DOI: 10.1111/j.1365-2893.2009.01157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Rapid virologic response (RVR) and complete early virologic response (cEVR) are associated with sustained virologic response to hepatitis C virus (HCV) therapy. We retrospectively examined baseline and on-treatment factors associated with RVR (HCV RNA undetectable at week 4) and cEVR (HCV RNA undetectable at week 12, regardless of week 4 response). The analysis comprised 1550 HCV genotype-1 patients from five clinical trials, including three enriched with difficult-to-treat populations, randomized to peginterferon alfa-2a 180 microg/week plus ribavirin 1000-1200 mg/day. Overall, 15.6% achieved RVR and 54.0% achieved cEVR. Baseline factors predictive of RVR were serum HCV RNA <or= 400,000 IU/mL (OR: 7.34; P < 0.0001), alanine aminotransferase >3 x ULN (OR: 2.01; P < 0.0001), non-cirrhotic status (OR: 1.92; P = 0.0087), age <or= 40 years (OR: 1.56; P = 0.0085), white non-Latino ethnicity (OR: 1.41; P = 0.0666) and individual study (P < 0.0001). These factors plus body mass index <or= 27 kg/m(2) were predictive of cEVR. After adjusting for these factors, mean on-treatment ribavirin dose >13 mg/kg/day was predictive of RVR (OR: 1.69; P = 0.005) and cEVR (OR: 1.24; P = 0.09), whereas peginterferon alfa-2a dose reduction was not. Greater decreases in haematologic parameters were observed in patients who achieved cEVR compared with patients who did not. In conclusion, several baseline and on-treatment factors were associated with RVR and cEVR to peginterferon alfa-2a plus ribavirin in difficult-to-treat HCV genotype-1 patients, providing important prognostic information on the antiviral response in a patient cohort that is reflective of the general chronic hepatitis C population.
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Berg C, Goncales FL, Bernstein DE, Sette H, Rasenack J, Diago M, Jensen DM, Graham P, Cooksley G. Re-treatment of chronic hepatitis C patients after relapse: efficacy of peginterferon-alpha-2a (40 kDa) and ribavirin. J Viral Hepat 2006; 13:435-40. [PMID: 16792536 DOI: 10.1111/j.1365-2893.2006.00727.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
We conducted a randomized multinational study to determine whether 48 weeks of re-treatment with peginterferon-alpha-2a (40 kDa) plus ribavirin would induce a sustained virological response (SVR) in relapsed chronic hepatitis C patients. Patients who had previously relapsed during 24 weeks of untreated follow-up, after having achieved an end-of-treatment virological response with 24 weeks of peginterferon-alpha-2a (40 kDa)/ribavirin combination therapy, within a phase III trial, were studied. Although the recommended dosage was the same as that used at the end of the initial trial, adjustments were permitted. Data on serious adverse events, or adverse events that resulted in dose reductions or discontinuations, were collected. Following re-treatment, the overall SVR rate in the 64 patients was 55%. The SVR rates in patients infected with hepatitis C virus (HCV) genotype 1 and non-1 genotypes were 51% and 63%, respectively. Early (week 12) virological responses were seen in 39 patients (61%) and were predictive of an SVR. Re-treatment was well tolerated. The most frequent adverse events recorded were fatigue (5%) and abdominal pain (3%). Dosages of peginterferon-alpha-2a (40 kDa) and/or ribavirin were modified because of adverse events in 3% and 13% of patients, and because of laboratory abnormalities in 23% and 5% of patients, respectively. Thus, a 48-week course of peginterferon-alpha-2a (40 kDa) plus ribavirin induces an SVR in 55% of patients who relapsed during follow-up after 24 weeks of combination therapy. Physicians should not hesitate to offer re-treatment to patients who relapse after an initial, 24-week course of combination therapy, or who have prematurely stopped treatment because, for example, of laboratory abnormalities.
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Affiliation(s)
- C Berg
- University of Virginia Health Science Center, Charlottesville, VA 22908, USA.
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Sullivan SD, Jensen DM, Bernstein DE, Hassanein TI, Foster GR, Lee SS, Cheinquer H, Craxi A, Cooksley G, Klaskala W, Pettit K, Patel KK, Green J. Cost-effectiveness of combination peginterferon alpha-2a and ribavirin compared with interferon alpha-2b and ribavirin in patients with chronic hepatitis C. Am J Gastroenterol 2004; 99:1490-6. [PMID: 15307866 DOI: 10.1111/j.1572-0241.2004.30286.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sustained virological response (SVR) is the primary objective in the treatment of chronic hepatitis C (CHC). Results from a recent clinical trial of patients with previously untreated CHC demonstrate that the combination of peginterferon alpha-2a and ribavirin produces a greater SVR than interferon alpha-2b and ribavirin combination therapy. However, the cost-effectiveness of peginterferon alpha-2a plus ribavirin in the U.S. setting has not been investigated. METHODS A Markov model was developed to investigate cost-effectiveness in patients with CHC using genotype to guide treatment duration. SVR and disease progression parameters were derived from the clinical trials and epidemiologic studies. The impact of treatment on life expectancy and costs were projected for a lifetime. Patients who had an SVR were assumed to remain virus-free for the rest of their lives. In genotype 1 patients, the SVRs were 46% for peginterferon alpha-2a plus ribavirin and 36% for interferon alpha-2b plus ribavirin. In genotype 2/3 patients, the SVRs were 76% for peginterferon alpha-2a plus ribavirin and 61% for interferon alpha-2b plus ribavirin. Quality of life and costs were based on estimates from the literature. All costs were based on published U.S. medical care costs and were adjusted to 2003 U.S. dollars. Costs and benefits beyond the first year were discounted at 3%. RESULTS In genotype 1, peginterferon alpha-2a plus ribavirin increases quality-adjusted life expectancy (QALY) by 0.70 yr compared to interferon alpha-2b plus ribavirin, producing a cost-effectiveness ratio of $2,600 per QALY gained. In genotype 2/3 patients, peginterferon alpha-2a plus ribavirin increases QALY by 1.05 yr in comparison to interferon alpha-2b plus ribavirin. Peginterferon alpha-2a combination therapy in patients with HCV genotype 2 or 3 is dominant (more effective and cost saving) compared to interferon alpha-2b plus ribavirin. Results weighted by genotype prevalence (75% genotype 1; 25% genotype 2 or 3) also show that peginterferon alpha-2a plus ribavirin is dominant. Peginterferon alpha-2a and ribavirin remained cost-effective (below $16,500 per QALY gained) under sensitivity analyses on key clinical and cost parameters. CONCLUSION Peginterferon alpha-2a in combination with ribavirin with duration of therapy based on genotype, is cost-effective compared with conventional interferon alpha-2b in combination with ribavirin when given to treatment-naïve adults with CHC.
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Affiliation(s)
- D M Jensen
- UCLA/CURE, Veterans' Administration Medical Center, 11301 Wilshire Boulevard, Building 115, Room 318, Los Angeles, CA 90073, USA.
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Lauenborg J, Hansen T, Jensen DM, Vestergaard H, Mølsted-Pedersen L, Hornnes P, Locht H, Pedersen O, Damm P. Increasing incidence of diabetes after gestational diabetes: a long-term follow-up in a Danish population. Diabetes Care 2004; 27:1194-9. [PMID: 15111544 DOI: 10.2337/diacare.27.5.1194] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To study the incidence of diabetes among women with previous diet-treated gestational diabetes mellitus (GDM) in the light of the general increasing incidence of overweight and diabetes and to identify risk factors for the development of diabetes. RESEARCH DESIGN AND METHODS Women with diet-treated GDM during 1978-1985 (old cohort, n = 241, also followed up around 1990) or 1987-1996 (new cohort, n = 512) were examined in 2000-2002. Women were classified by a 2-h, 75-g oral glucose tolerance test according to the World Health Organization criteria or an intravenous glucagon test supplemented by measurement of GAD antibodies. Historical data from index-pregnancy and anthropometrical measurements were collected. RESULTS A total of 481 (63.9%) women were examined (median 9.8 years [interquartile range 6.4-17.2]) after index pregnancy. Diabetes and impaired glucose tolerance (IGT)/impaired fasting glucose were present in 40.0 and 27.0% of women, respectively. In the new cohort, 40.9% had diabetes compared with 18.3% in the old cohort at the 1990 follow-up (P < 0.0005). Prepregnancy BMI was significantly higher in the new compared with the old cohort (26.0 [22.5-30.8] vs. 22.9 kg/m2 [20.2-28.0], P < 0.0005). Among others, new-cohort membership, prepregnancy overweight (BMI > or = 25 kg/m2), and IGT postpartum were identified as independent predictors of diabetes by multiple logistic regression analyses. CONCLUSIONS The incidence of diabetes among Danish women with previous diet-treated GDM was very high and had more than doubled over a 10-year period. This seems to be due to a substantial increase in BMI in women with GDM.
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Affiliation(s)
- Jeannet Lauenborg
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Jensen DM, Cotler SJ, Lam H, Harb G, Shillington A. A comparison of hepatitis C treatment and outcomes at academic, private and Veterans' Affairs treatment centres. Aliment Pharmacol Ther 2004; 19:69-77. [PMID: 14687168 DOI: 10.1046/j.1365-2036.2003.01817.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Currently, there is a lack of published data examining hepatitis C treatment practices in different care settings. AIM To provide data describing treatment practices for patients with hepatitis C virus infection in actual clinical practice, and to examine clinical outcomes in patients treated with interferon alpha-2b/ribavirin combination therapy in academically affiliated centres, private treatment centres and Veterans' Affairs treatment centres. METHODS This multi-centre, retrospective, cohort study of 231 patients examined hepatitis C virus treatment practices in patients receiving interferon alpha-2b from January 1997 to May 2001 and explored outcomes in academically affiliated, private and Veterans' Affairs centres. RESULTS Differences in treatment practice and use of diagnostic procedures were found. Genotype testing was under-utilized in non-academic sites (academic centres, 79.2%; private centres, 33.7%; Veterans' Affairs centres, 35.9%; P<0.001). Liver biopsies were performed less often in private sites (academic centres, 95.8%; private centres, 80.0%; Veterans' Affairs centres, 92.2%; P<0.01). End-of-treatment viral response (academic centres, 40.0%; private centres, 31.3%; Veterans' Affairs centres, 17.2%; P<0.05) was lower than that found in published trial data. Multivariate analysis revealed genotype 1 as the single significant predictor of treatment failure (P<0.01). CONCLUSIONS Outside of the academic setting, there is significantly less diagnostic work-up performed prior to the initiation of hepatitis C virus therapy. This suggests a need for a standardization of care across treatment settings.
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Affiliation(s)
- D M Jensen
- Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA
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