Intergenerational transmission of macrosomia in women with gestational diabetes and normal glucose tolerance

OBJECTIVES

It has been suggested that neonatal macrosomia may contribute to increased risk of obesity and type 2 diabetes in later life. Much less is known about the association between maternal birth weight (MBW) and offspring birth weight (OBW). This retrospective study evaluated the prevalence of macrosomia in women with treated gestational diabetes mellitus (GDM) and normal glucose tolerance during pregnancy. The study also investigated associations between MBW and OBW.

STUDY DESIGN

Medical records of 519 pregnant women with treated GDM and 766 women with normal glucose tolerance, referred to the Gestational Diabetes Outpatient Clinic in Szczecin, Poland, were analyzed. The following data were assessed: maternal age, pregravid body weight, height, gestational weight gain, prior GDM, prior macrosomia, MBW and OBW. Birth weight was classified as small for gestational age (SGA), appropriate for gestational age (AGA), large for gestational age (LGA) and macrosomia (≥4000g). OBW was obtained from birth certificates, and MBW was obtained from birth certificates or self-report.

RESULTS

The overall prevalence of macrosomia was 8.1%, and was comparable in subgroups of women with and without GDM (7.7% and 8.4%, respectively; p=0.905). The frequencies of SGA, AGA and LGA did not differ between study groups. A positive correlation was found between MBW and OBW in women with treated GDM (r=0.211, p<0.001) and in women with normal glucose tolerance (r=0.220, p<0.001). Regardless of glucose tolerance status during pregnancy, the greatest proportion of macrosomic babies were born to mothers who were themselves born macrosomic (26.5% in mothers with GDM and 20.0% in mothers with normal glucose tolerance; p=0.631). On logistic regression, MBW was found to be a robust predictor of macrosomia in offspring [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.15-2.36 in women with treated GDM; OR 1.35, 95% CI 1.07-1.76 in women with normal glucose tolerance). Other independent predictors of fetal macrosomia were gestational weight gain, prior macrosomia and pregravid body mass index (BMI).

CONCLUSIONS

MBW, prior macrosomia, pregravid BMI and gestational weight gain were predictors of macrosomia in offspring, but GDM was not. High MBW seems to contribute to intergenerational transmission of macrosomia.

Patient-reported outcomes in women with gestational diabetes: a longitudinal study

BACKGROUND

Gestational Diabetes Mellitus (GDM) is a common health problem among pregnant women and may be associated with distress.

PURPOSE

The purpose of the study was to describe changes in patient-reported outcomes in women with GDM and identify factors associated with increased distress in these patients.

RESEARCH DESIGN

The study was conducted in 205 women diagnosed with GDM. Study participants underwent a physical examination and completed a questionnaire two times during pregnancy. On average, the questionnaire was completed at 27 weeks of gestation at baseline and 36 weeks at follow-up. The questionnaire included socio-demographic and clinical variables, standardized patient-reported outcome measures, and questions about the impact of GDM on daily life, satisfaction with care, knowledge about GDM, and social and professional support. Our main outcome of interest was diabetes-related distress, measured by the Problem Areas in Diabetes (PAID) questionnaire. Data were analyzed using descriptive statistics and multivariable regression models.

RESULTS

At baseline, 80% of the women were satisfied with their diabetes care and 58% said they managed their diabetes well. The proportion reporting little or no knowledge of GDM dropped from almost 50% at baseline to 14% at follow-up. However, the proportion reporting that GDM affected their social life increased from 26 to 35%, and the proportion reporting interference with family life increased from 14 to 26%. Insulin treatment, frequency of blood glucose measurements, lack of knowledge about GDM, and lack of support from family and health care providers were strongly and significantly associated with distress.

CONCLUSION

In women with GDM, intensified treatment and lack of informational and social support are associated with distress. These aspects of GDM care appear to be appropriate targets for future research and interventions aimed at reducing the level of distress in these patients.

Supercritical CO2 extract from strawberry seeds as a valuable component of mild cleansing compositions

OBJECTIVE

The aim of this work was an elaboration of mild cleansing compositions, containing supercritical CO2 extract from strawberry seeds (SC-CO2 strawberry seed oil), as a moisturizing and skin-softening agent. The influence of concentration of the oil on user properties of shower/bath products was studied.

METHODS

A series of products (shower/bath cosmetics) composed mainly of mild surfactants (amphoacetates, sulfosuccinates, betaines) and containing different amounts of the oil (0.5 up to 5.0%) were prepared. For the stable products (formulations containing up to 2% of the oil), the influence of the SC-CO2 strawberry seed oil addition on the products' stability, foam ability, surface tension, pH and rheological properties was studied. Moreover, the skin compatibility and moisturizing efficiency of the cleansing products were recorded in a group of 15 volunteers (including 10 women and five men, aged 20-30 years), using skin diagnosis system AramoTS, Aram Huvis Co. Additionally, characterization of CO2 extract from strawberry seeds was performed. Measurements of the oil's analytical constants, that is acid value and saponification number, were conducted according to Polish Standard PN-EN ISO 660:2010 and PN-EN ISO 3657:2013, respectively.

RESULTS

The oil concentration influences stability of the products. Only the formulations containing 0.5-2% of the extract have shown high stability. Moreover, used in the amount up to 2% the SC-CO2, strawberry seed oil does not affect significantly the cleansing and foaming properties of the products. The obtained shower/bath cosmetics showed good user properties and additionally good skin-moisturizing effect.

CONCLUSION

The supercritical CO2 extract from strawberry seeds, rich source of unsaturated fatty acid, could be successfully used in the formulation of body washing compositions as a moisturizing and skin-softening agent.

Pregravid body mass index as a predictor of gestational diabetes mellitus

AIMS

It has been well documented that overweight or obesity before pregnancy is a strong predictor of gestational diabetes mellitus (GDM). The aim of this study was to assess the risk of GDM in women who were classified on the basis of pregravid body mass index (BMI) as normal weight and underweight.

SUBJECTS AND METHODS

We analysed medical records of 1121 women with GDM who were referred to the Outpatient Clinic for Diabetic Pregnant Women in Szczecin (north-west part of Poland) between January 2001 and December 2005. The control group consisted of 1011 healthy pregnant women. All the women were Caucasian, were aged > or = 18 years and had single pregnancies.

RESULTS

The cut point for BMI as a risk indicator for GDM was 22.85 kg/m(2) (odds ratio = 1.91; 95% confidence interval 1.5-2.1; sensitivity 47.8%, specificity 65.9%). In all of the analysed BMI ranges, except for the underweight group, significant relationships between pregravid BMI and GDM were found and BMI was the strongest predictor for GDM treated with insulin. Of all women with GDM, 25.7% were treated with insulin. The percentage of women requiring insulin therapy significantly increased with an increase of BMI across all studied categories.

CONCLUSIONS

Not only in overweight but also in normal-weight women, the risk for GDM increases with increases in pregravid BMI and adjustment for confounding variables (age, prior GDM and parity) did not influence this relationship. Pregravid BMI is a strong predictor for GDM requiring insulin treatment.

[Cord blood insulin level in relation to metabolic control of maternal diabetes, duration of pregnancy and neonatal birth weight]

The aim of the study was to examine whether an association between cord blood insulin level (Ic) and maternal glycemic control, duration of pregnancy as well as neonatal birthweight exists. The study was performed in diabetic group consisted of 149 diabetic mothers (91 with GDM and 58 with IDDM) and 149 their babies as well as in the control group consisted of 100 healthy mothers and 100 their babies. Maternal glycemic control was indirectly assessment by using HbA1c and fructosamine levels estimated on the day of delivery. That was found a significant positive correlation between Ic and maternal HbA1c and fructosamine levels as well as between Ic and neonatal birthweight in the diabetic group. That was also found the significant negative correlation between Ic and duration of pregnancy in the diabetic group. We conclude that fetal hyperinsulinemia is a result of poor glycemic control during the last weeks of diabetic pregnancy. Furthermore the significant association exists between cord blood hyperinsulinemia and preterm delivery as well as higher birthweight of newborns born to diabetic mothers.

[Prevalence and risk factors of osteoporosis in a population sample of Szczecin residents over 50 years of age]

The prevalence of osteoporosis and risk factors were evaluated in the random sample of Szczecin population aged over 50 years. Five hundred five individuals (273 women and 232 men) were examined. Risk factors for osteoporosis were evaluated with the aid of an questionnaire. Two X-ray pictures of both thoracic and lumbar spine were taken in the lateral position in all examined subjects and evaluated for osteoporosis. The most frequently encountered risk factors included: low physical activity (60% of women and 50% of men), tobacco smoking (43% of women and 79% of men), low consumption of the diary products in adolescence (53% of women and 49% of men), history of bone fractures, early menopause, and diabetes mellitus. The interpretation of X-ray findings showed that the incidence of osteoporosis was increasing with the age in both sexes, and was considerably higher in women. An analysis of the relationship between risk factors and radiological diagnosis of osteoporosis with chi 2 test showed that significantly higher incidence of the disease in women was associated with long-term immobilization, low milk consumption, tobacco smoking, and early menopause. Osteoporosis in men correlated with only tobacco smoking.