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Calderón Vicente DMª, Marco Martínez A, Gómez García I, Quílez Toboso R, Quiroga López I, Delgado Rey M, Gargallo Vaamonde J, Olmos Alemán M, Miralles Moragrega R, Gonzalvo Díaz C, González López J. Effects of the COVID-19 pandemic on gestational diabetes in Castilla-La Mancha (Spain). ENDOCRINOL DIAB NUTR 2024; 71:53-60. [PMID: 38493008 DOI: 10.1016/j.endien.2024.03.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/02/2023] [Indexed: 03/18/2024]
Abstract
SUBJECT-MATTER To assess the effect of the 2019 coronavirus (COVID-19) pandemic on gestational diabetes (GDM). MATERIAL AND METHODS In this retrospective, multicentre, non-interventional study carried out in Castilla-La Mancha, Spain, we compared 663 women with GDM exposed to the pandemic (pandemic group), with 622 women with GDM seen one year earlier (pre-pandemic group). The primary endpoint was a Large for Gestational Age (LGA) newborn as an indicator of poor GDM control. Secondary endpoints included obstetric and neonatal complications. RESULTS During the pandemic, the gestational week at diagnosis (24.2 ± 7.4 vs 22.9 ± 7.7, p = 0.0016) and first visit to Endocrinology (26.6 ± 7.2 vs 25.3 ± 7.6, p = 0.0014) were earlier. Face-to-face consultations were maintained in most cases (80.3%). The new diagnostic criteria for GDM were used in only 3% of cases. However, in the pandemic group, the final HbA1c was higher (5.2 ± 0.48 vs 5.29 ± 0.44%, p = 0.047) and there were more LGA newborns (8.5% vs 12.8%, p = 0.015). There were no differences in perinatal complications. CONCLUSIONS Care for GDM in our Public Health System did not significantly deteriorate during the COVID-19 pandemic. However, this did not prevent a higher number of LGA newborns.
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Affiliation(s)
| | | | - Inés Gómez García
- Servicio de Endocrinología y Nutritición, Hospital La Mancha Centro, Ciudad Real, Spain; Hospital General de Tomelloso, Ciudad Real, Spain
| | - Rosa Quílez Toboso
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Albacete, Albacete, Spain
| | - Iván Quiroga López
- Servicio de Endocrinología y Nutrición, Hospital Nuestra Señora del Prado, Toledo, Spain
| | - Manolo Delgado Rey
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - María Olmos Alemán
- Servicio de Endocrinología y Nutrición, Hospital General de Villarrobledo, Albacete, Spain
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Hao H, Liu Q, Chen J, Zhou H. Overexpression of circRNAs LRP6 in gestational diabetes mellitus predicts foetal malformation and intrauterine death. ENDOCRINOL DIAB NUTR 2023; 70:124-129. [PMID: 36925229 DOI: 10.1016/j.endien.2023.02.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 03/15/2023]
Abstract
INTRODUCTION circRNA LRP6 participates in high-glucose-regulated cellular behaviours, while its role in gestational diabetes mellitus (GDM) is unclear. Our preliminary sequencing analysis revealed the altered expression of LRP6, suggesting its potential involvement in GDM and possible clinical value. This study explored the involvement of LRP6 in GDM. METHODS In this study, a total of 300 pregnant women were enrolled and followed up until delivery. The occurrence of GDM and adverse outcomes was recorded. These 300 participants were grouped into high and low LRP6 level groups (n=150; cutoff=median). Occurrence of GDM and adverse outcomes were compared between the two groups. ROC curve analysis was conducted to explore the role of LRP6 expression on the day of admission in predicting GDM. Associations between LRP6 expression and adverse outcomes were analysed with the Chi-squared test. RESULTS We observed that participants in the high LRP6 level group experienced a higher incidence of GDM during follow-up (33/150) compared to those in the low LRP6 level group (10/150). Compared to participants who developed GDM during follow-up, participants who did not develop GDM showed lower expression levels of LRP6 in plasma. ROC curve analysis showed that high expression levels of LRP6 on the day of admission effectively distinguished potential GDM patients from other participants. Interestingly, LRP6 was only closely associated with foetal malformation and intrauterine death, but not premature delivery, hypertension, macrosomia, intrauterine distress, miscarriage and intrauterine infection in all participants. CONCLUSION Therefore, increased expression levels of LRP6 in GDM predicts foetal malformation and intrauterine death.
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Affiliation(s)
- Hairong Hao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, Jiangsu 223002, PR China
| | - Qun Liu
- Lianshui County People's Hospital, Huai'an, Jiangsu 223400, PR China
| | - Jianhui Chen
- Jiangsu Food and Pharmaceutical Science College, Huai'an, Jiangsu 223003, PR China
| | - Huan Zhou
- Department of Obstetrics and Gynaecology, Huai'an Maternity and Child Health Hospital, Huai'an, Jiangsu 223002, PR China.
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Sesmilo G, Prats P, Álvarez M, Romero I, Guerrero M, Rodríguez I, Rodríguez-Melcón A, Garcia S, Serra Also B. Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART). ENDOCRINOL DIAB NUTR 2022; 69:837-843. [PMID: 36526354 DOI: 10.1016/j.endien.2022.11.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/14/2021] [Indexed: 06/17/2023]
Abstract
UNLABELLED Infertility affects millions worldwide and use of assisted reproductive techniques (ART) is in high demand. AIMS To investigate whether women that underwent ART at our hospital had a higher incidence of GDM than women who conceived spontaneously, if the ART subtype affects the GDM rate and to study obstetrical outcomes in women with GDM in both groups. METHODS This was a retrospective analysis of prospectively collected data of singleton pregnancies attended at Hospital Universitari Dexeus between 2008 and 2019. Age<18 years, pregestational diabetes, metformin prior to pregnancy and multiple pregnancies were excluded. RESULTS A total of 29,529 patients were included. Pregnancy was achieved by ART in 2596 (8.8%): in vitro fertilisation (IVF/ICSI) 32.8%, frozen embryo transfer (FET) 37.7%, oocyte donor receptors (ODR) 17.2% and insemination 12.2%. The GDM rate was 8.9% (12.7% in ART vs 8.5% in non-ART, p<0.001). The GDM was 11.2% in IVF/ICSI, 17.7% in ODR, 13% in FET and 9.1% in the insemination group (p=0.001). In a multivariable analysis adjusting for age, parity and BMI, ART was not associated with GDM [OR 1.03 (0.90-1.19)], nor was type of ART. Pregnancy outcomes in GDM patients were similar in both groups except for C-section rates (30.0% in ART vs 15.9% in non-ART (p<0.001). CONCLUSIONS Despite a higher prevalence of GDM in ART pregnancies, ART was not associated with an increased risk of GDM when adjusting for age, parity and BMI. The prognosis of GDM in ART and non-ART was similar except for C-section rates.
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Affiliation(s)
- Gemma Sesmilo
- Endocrine Unit, Dexeus University Hospital, Barcelona, Spain
| | - Pilar Prats
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain.
| | - Manuel Álvarez
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Irene Romero
- Endocrine Unit, Dexeus University Hospital, Barcelona, Spain
| | - Mireia Guerrero
- Endocrine Unit, Dexeus University Hospital, Barcelona, Spain
| | - Ignacio Rodríguez
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Alberto Rodríguez-Melcón
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Sandra Garcia
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Bernat Serra Also
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
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Al Hashmi I, Al Yazidi B, Al Omari O. Translation and psychometric validation of the Arabic Gestational Diabetes Management Self-Efficacy Scale (GDMSES). J Healthc Qual Res 2022; 37:231-238. [PMID: 35042678 DOI: 10.1016/j.jhqr.2021.12.004] [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: 01/10/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The assessment of self-efficacy for adherence to healthy behaviours among women with gestational diabetes (GDM) is undermined by the unavailability of validated tools. Therefore, this study aimed at translating, culturally adapting and assessing the psychometric properties of the Arabic version of Gestational Diabetes Management Self-Efficacy Scale (GDMSES). MATERIALS AND METHODS This methodological study was conducted in the Antenatal Clinic at Sultan Qaboos University Hospital in Oman between October 2016 and January 2017. A total of 90 forms of the Arabic GDMSES tool were completed by Omani pregnant women with gestational diabetes. The study has a multiphase design: (1) cultural and linguistic validation; (2) content and face validity; (3) construct validity; (4) internal validity. RESULTS The Arabic GDMSES showed satisfactory content validity (CVI between .8 and 1), acceptable overall scale internal consistency reliability (Cronbach's alpha=0.85) and stability overtime (Pearson correlation coefficient>.6). Four factors emerged for construct validity using exploratory factor analysis: nutrition and body weight, adaptation to healthy eating, physical activity and treatment and blood sugar. Our sample size of 90 was considered adequate in determining these factors (Kaiser-Meyer-Olkin=.78). CONCLUSIONS GDMSES is a valid and reliable tool, thus providing a quick and easy self-efficacy assessment tool for antenatal nurses dealing with pregnant women with GDM.
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Affiliation(s)
- I Al Hashmi
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman.
| | - B Al Yazidi
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman
| | - O Al Omari
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman
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Martínez-Cruz CF, Guido-Campuzano MA, Ramírez-Maya AM, Themann PGA, Poblano-Alcalá A, López-Navarrete GE, Poblano A. Body mass index in offspring of mothers with diabetes mellitus: follow-up at 2, 4, 6, and 8 years of age. Bol Med Hosp Infant Mex 2021; 78:395-403. [PMID: 34570748 DOI: 10.24875/bmhim.20000311] [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] [Indexed: 11/17/2022] Open
Abstract
Background Offspring of mothers with diabetes mellitus (DM) during pregnancy may be at high risk for developmental alterations. This study aimed to identify the effects of maternal pre- and gestational diabetes on the body mass index of infants and children at two, four, six, and eight years of age. Methods We studied children of mothers with type 1, type 2, and gestational diabetes and a control group. Maternal and neonatal variables were analyzed for associations with children overweight/obesity. Results Mothers with DM were older than controls (32 ± 6 vs. 22 ± 6 years, p < 0.001). The frequency of preeclampsia in mothers with DM was 28%. Gestational age and weight at birth were lower in infants from the groups of mothers with DM in comparison with controls (32.8 ± 3.1 vs. 36.4 ± 2.2 weeks, p < 0.001, and 1,637 ± 600 vs. 2,208 ± 518 g, p < 0.001, respectively). At 8 years of age, 47% of the offspring of mothers with DM type 2 had overweight/obesity (odds ratio (OR 8.25) 95% confidence interval (CI) 1.3-51, p = 0.01), while 27% of offspring of mothers with type 1 DM had overweight/obesity, and 10% of offspring of mothers with gestational diabetes presented overweight/obesity. Conclusions Offspring of pre-gestational DM mothers have a higher risk to develop overweight/obesity, as was observed with follow-up until school age, for which they require continuous vigilance.
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Affiliation(s)
- Carlos F Martínez-Cruz
- Departamento de Seguimiento Pediátrico, Instituto Nacional de Perinatología Dr. Isidro Espinosa de los Reyes. Mexico City, Mexico
| | - Martina A Guido-Campuzano
- Departamento de Seguimiento Pediátrico, Instituto Nacional de Perinatología Dr. Isidro Espinosa de los Reyes. Mexico City, Mexico
| | - Alma M Ramírez-Maya
- Departamento de Seguimiento Pediátrico, Instituto Nacional de Perinatología Dr. Isidro Espinosa de los Reyes. Mexico City, Mexico
| | - Patricia García-Alonso Themann
- Departamento de Seguimiento Pediátrico, Instituto Nacional de Perinatología Dr. Isidro Espinosa de los Reyes. Mexico City, Mexico
| | - Adriana Poblano-Alcalá
- Laboratorio de Neurofisiología Cognitiva, Instituto Nacional de Rehabilitación. Mexico City, Mexico
| | - Gloria E López-Navarrete
- Departamento de Seguimiento Pediátrico, Instituto Nacional de Perinatología Dr. Isidro Espinosa de los Reyes. Mexico City, Mexico
| | - Adrián Poblano
- Laboratorio de Neurofisiología Cognitiva, Instituto Nacional de Rehabilitación. Mexico City, Mexico
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Cabrera Fernández S, Martín Martínez MD, De Francisco Montero C, Gabaldón Rodríguez I, Vilches Arenas Á, Ortega Calvo M. [Predictive models of gestational diabetes, a new prediction mode]. Semergen 2021; 47:515-20. [PMID: 34509372 DOI: 10.1016/j.semerg.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/18/2021] [Accepted: 07/31/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Recognized the value of gestational diabetes (GD) as a health problem, our aim in this work has been to analyze the diagnostic performance of the different today's existing criteria (GEDE, O'Sullivan and Carpenter) after the overload of 100 g of glucose and revise how to increase its efficiency. MATERIALS AND METHODS We carried out a description of all the variables. In the analytical phase of the work, we used Pearson's Chi square to see if there were differences in the percentage of cases collected in each health center and the proportions contrast test to study the differences between the experimental prevalence. We completed binary logistic regression models using as result variable having or not having gestational diabetes (yes/no) and as predictors the four measurements of the curve with 100 g of glucose overload. To decide which model was better, the stepwise backward-forward analysis and the surface of the ROC curve generated by each of them were considered. RESULTS We obtained a sample of 170 pregnant women from six different Primary Care Area of Seville health centers who had shown a positive O'Sullivan test with a median age of 35 years. There were significant differences in the prevalence proportions according to the criteria used: GEDE/O'Sullivan p < 0.001; GEDE/Carpenter p < 0.001. Logistic models with three and four predictor variables were equal in discriminatory diagnostic capacity when the GEDE criteria were used (area under the ROC curve = 0.96, 95% CI: 0.93-0.98). The back-forward stepwise analysis stayed with the three-variable model as the most parsimonious. The same did not occur when applying the other two criteria. CONCLUSIONS Regarding an observational design, we state that there are significant differences in the prevalence proportions observed according to the criteria applied (p < 0.001) and we can also support that using the GEDE criteria, the taking of the third hour could be dispensed with, based on Bayesian criteria and the application of the ROC curve analysis.
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Reyes-Muñoz E, Sosa SEY, Flores-Robles CM, Arce-Sánchez L, Martínez-Cruz N, Gutiérrez-Castrellón P. Suplementos nutricionales para prevención de diabetes mellitus gestacional: lecciones aprendidas basadas en la evidencia. GAC MED MEX 2020; 156:S43-S50. [PMID: 33373343 DOI: 10.24875/gmm.m20000437] [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] [Indexed: 11/17/2022] Open
Abstract
Introduction Gestational diabetes mellitus (GDM) affects between 5 and 40% of pregnant women. Recently different interventions with nutritional supplements have been evaluated for prevention of GDM. Aim To perform a synthesis of the evidence on the efficacy of nutritional supplements (myo-inositol, probiotics, and vitamin D) in the prevention of GDM. Methods A systematic search in PubMed and Cochrane library was performed, including systematic reviews of randomized clinical trials (RCTs), published in English or Spanish until May 2020, using the keywords: "prevention", "gestational diabetes", "hyperglycemia and pregnancy", "supplementation", "probiotics", "myo-inositol" and "vitamin D". Results 10 systematic reviews that met the inclusion criteria were analyzed. Myo-inositol supplementation compared to placebo decreased the incidence of GDM (RR: 0.44 [0.27-0.87]; five RCTs), low quality of evidence. Although the supplementation with vitamin D or probiotics during pregnancy could reduce the incidence of GDM the evidence is limited. Conclusions Myo-inositol supplementation is effective for prevention of GDM in high-risk women. Supplementation with vitamin D or probiotics probably decreases the incidence of GDM.
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Affiliation(s)
- Enrique Reyes-Muñoz
- Coordinación de Endocrinología Ginecológica y Perinatal, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Ciudad de México, México
| | - Salvador Espino Y Sosa
- Subdirección de Investigación clínica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Ciudad de México, México
| | - Claudia M Flores-Robles
- Coordinación de Endocrinología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Ciudad de México, México
| | - Lidia Arce-Sánchez
- Coordinación de Endocrinología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Ciudad de México, México
| | - Nayeli Martínez-Cruz
- Coordinación de Endocrinología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Ciudad de México, México
| | - Pedro Gutiérrez-Castrellón
- Centro de Investigación Translacional en Ciencias de la Salud, Hospital General Dr. Manuel Gea González. Ciudad de México, México.,Sociedad Latinoamericana de Gastroenterologia, Hepatología y Nutrición Pediátrica. Ciudad de México, México
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Assaf-Balut C, García de la Torre N, Calle-Pascual AL, Calle-Pascual AL, Torre NGDL, Durán A, Jiménez I, Rubio MÁ, Herraíz MÁ, Izquierdo N, Pérez N, Garcia AS, Dominguez GC, Torrejón MJ, Cuadrado MÁ, Assaf-Balut C, Del Valle L, Bordiú E, Valerio J, Barabash A, Orta MS, Parayuelo MVSD, Muñoz LF, Calzada F. Detection, treatment and prevention programs for gestational diabetes mellitus: The St Carlos experience. ACTA ACUST UNITED AC 2019; 67:342-350. [PMID: 31519528 DOI: 10.1016/j.endinu.2019.06.007] [Citation(s) in RCA: 3] [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] [Received: 04/22/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 01/15/2023]
Abstract
Gestational diabetes mellitus (GDM) increases the risk of adverse events in pregnancy and jeopardizes long-term health of the mother and offspring. There is currently no consensus as to what screening strategies improve the efficiency of GDM diagnosis. Which criteria should be used? Is the one-step or two-step procedure better? There is no agreement as to what the best dietary approach in the treatment of GDM is. In addition, different nutritional interventions have been studied in the prevention of GDM. The Mediterranean diet seems to be effective in preventing GDM and other maternofoetal outcomes. We review herein our experience using the one-step criteria for GDM screening; the treatment and prevention strategies used; and the overall impact of nutrition on maternofoetal health.
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Affiliation(s)
- Carla Assaf-Balut
- Endocrinology and Nutrition Department. Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Nuria García de la Torre
- Endocrinology and Nutrition Department. Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Alfonso L Calle-Pascual
- Endocrinology and Nutrition Department. Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain; Departamento de Medicina II, Facultad de Medicina, Universidad Complutense de Madrid, Spain.
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Guerrero Cervera B, Morales-Suarez-Varela M, Perales Marin A, Peraita-Costa I, Marcos Puig B, Llopis-Morales A, Llopis-Gonzalez A. Alterations of carbohydrate metabolism during pregnancy. Effects on the mother and new born infant. Med Clin (Barc) 2019; 154:119-124. [PMID: 31239079 DOI: 10.1016/j.medcli.2019.04.021] [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: 12/20/2018] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gestational diabetes is the pathology that most frequently causes medical alterations in pregnancy. The objective of this study was to assess the relationship between the presence of alterations in the metabolism of carbohydrates during pregnancy and the risk of adverse obstetric outcomes in mother and foetus. PATIENTS AND METHOD An observational study was conducted on 799 women who had just given birth. The clinical and obstetric characteristics of the patients, as well as the data related to pregnancy and delivery, including the state of the new born infant were analysed. The information was evaluated in relation to the alterations in carbohydrate metabolism. RESULTS AND DISCUSSION For women with gestational diabetes a 2.64 times greater risk of loss of foetal well-being and 3.14 times greater risk of requiring hospitalization during pregnancy were found. For pregnant women with carbohydrate intolerance, a 2.61 times higher risk of requiring episiotomy in vaginal delivery, a 7.54 times greater risk of finding loss of foetal well-being, and a 2.06 times greater risk of requiring hospitalization were found. The group with carbohydrate intolerance behaved similarly to that with diabetes. CONCLUSIONS The group with intolerance to carbohydrates is a little studied group and significant obstetric alterations were found compared to the control group and similar to those of the gestational diabetes group.
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Affiliation(s)
- Borja Guerrero Cervera
- Área de Medicina Preventiva y Salud Pública, Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal, Universidad de Valencia, Burjassot, Valencia, España
| | - María Morales-Suarez-Varela
- Área de Medicina Preventiva y Salud Pública, Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal, Universidad de Valencia, Burjassot, Valencia, España; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | | | - Isabel Peraita-Costa
- Área de Medicina Preventiva y Salud Pública, Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal, Universidad de Valencia, Burjassot, Valencia, España; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | | | - Agustin Llopis-Morales
- Área de Medicina Preventiva y Salud Pública, Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal, Universidad de Valencia, Burjassot, Valencia, España
| | - Agustin Llopis-Gonzalez
- Área de Medicina Preventiva y Salud Pública, Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal, Universidad de Valencia, Burjassot, Valencia, España; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, España
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López Del Val T, Alcázar Lázaro V, García Lacalle C, Torres Moreno B, Castillo Carbajal G, Alameda Fernandez B. Fasting glucose in the first trimester: An initial approach to diagnosis of gestational diabetes. ACTA ACUST UNITED AC 2018; 66:11-18. [PMID: 30190244 DOI: 10.1016/j.endinu.2018.06.012] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To establish whether fasting glucose levels in the first trimester (FGFT)of pregnancy ≥ 92 mg/dL (5.1 mmol/L) (FGFT) anticipate the occurrence of maternal-fetal complications of gestational diabetes mellitus. To assess whether FGFT can replace diagnosis of GDM using the classical two-step oral glucose tolerance test (OGTT). METHODS A retrospective study of 1425 pregnancies with FGFT and O'Sullivan Test (OST) and/or OGTT according to OST results in the second trimester. FGFT sensitivity and specificity were assessed as compared to the conventional diagnosis of GDM. The relationship between maternal-fetal complications and FGFT was assessed in the total group and after excluding mothers who received specific medical treatment for GDM. RESULTS Sensitivity and specificity of FGFT levels ≥ 92mg/dL were 46.4% and 88.8% as compared to diagnosis of GDM using Carpenter and Coustan criteria. In the total group, a statistically significant relationship was found between FGFT levels ≥ 92 mg/dL and newborn weight (3228±86 versus 3123±31g; P<.05), as well as a higher rate of macrosomia (6.9% versus 3.5%; P<.05). This association persisted after excluding patients diagnosed with and treated for GDM (weight: 3235±98 versus 3128±31 g; P<.05; percentage of macrosomia: 7.2% versus 3.4%; P<.05). CONCLUSIONS FGFT is not a good substitute for conventional diagnosis of GDM in the second trimester. Pregnant women with FGFT levels ≥ 92 mg/dL, even with no subsequent diagnosis of GDM, are a risk group for fetal macrosomia and could benefit from dietary measures and physical exercise.
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Sánchez-Lechuga B, Lara-Barea A, Córdoba-Doña JA, Montero Galván A, Abal Cruz A, Aguilar-Diosdado M, López-Tinoco C. Usefulness of blood pressure monitoring in patients with gestational diabetes mellitus. ACTA ACUST UNITED AC 2018; 65:394-401. [PMID: 29680782 DOI: 10.1016/j.endinu.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/05/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Gestational diabetes mellitus (GDM) is associated to an increased risk of pregnancy-induced hypertension (PIH). Ambulatory blood pressure monitoring (ABPM) has been used to detect PIH and preeclampsia, but few data are currently available on its use in women with GDM. The aim of this study was to achieve early identification in women with GDM of BP profiles (detected by ABPM) that could define a population at greater risk of developing PIH and preeclampsia. MATERIAL AND METHODS A prospective study of 93 normotensive women with GDM in whom 24-h ABPM was performed (using a Spacelabs 90207 monitor) at 28-32 weeks of pregnancy. Clinical and laboratory variable and obstetric and perinatal outcomes were analyzed. RESULTS Mean age was 34.8±4.39years, and 5.4% of patients developed PIH. Higher levels of HbA1c (P=.005) and microalbumin (P=.001) were seen in patients with PIH. Patients with non-dipper patterns (50.5%) had higher values of night-time systolic BP (106.7 vs 98.4mmHg) and night-time diastolic BP (64.8 vs 57.2mmHg) (P<.001). Lower birth weights (3,084.57 vs 3,323.7) (P=.021) and shorter gestational age at delivery (38.67 vs 39.27 weeks) (P=.04) were found in women with non-dipper pattern. High night-time systolic BP significantly increased the chance of developing PIH (OR: 1.18; 95%CI: 1.00-1.39; P=.043). CONCLUSIONS Patients with GDM have BP changes, with predominance of the non-dipper pattern and higher night-time systolic and diastolic BP, changes that could be useful predictors of PIH. High night-time systolic BP values increase the risk of developing PIH. Further studies are needed to ascertain the relationships between BP changes and obstetric and perinatal complications.
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Affiliation(s)
- Begoña Sánchez-Lechuga
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Almudena Lara-Barea
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España
| | | | - Ana Montero Galván
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Alicia Abal Cruz
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Manuel Aguilar-Diosdado
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Cádiz, España
| | - Cristina López-Tinoco
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Cádiz, España.
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Álvarez-Silvares E, Domínguez-Vigo P, Domínguez-Sánchez J, González-González A. [Suitability of screening for diabetes mellitus in women with a history of gestational diabetes]. ACTA ACUST UNITED AC 2017; 32:135-140. [PMID: 28169102 DOI: 10.1016/j.cali.2016.10.002] [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: 07/01/2016] [Revised: 10/07/2016] [Accepted: 10/28/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess long-term suitability of screening for type 2 diabetes mellitus in women with a previous diagnosis of gestational diabetes in Primary Care. The secondary objectives were to determine if there were clinical factors that modified the usefulness of the screening. MATERIAL AND METHODS An observational cohort type study was performed, which included all patients with the diagnosis of gestational diabetes during the years 2000 to 2009 (n=470) in the University Hospital Complex of Ourense. The electronic medical records were reviewed to assess the existence of gestational diabetes and the year of the last fasting blood glucose. The mean follow-up time was 12.9 years. The screening for evidence of a fasting blood glucose in the last 3 years was considered adequate. The following variables were analysed: adequacy of screening for type 2 diabetes mellitus, age, body mass index, gestational diabetes in more than one gestation, and rural/urban environment. A descriptive analysis of the data was performed, using Chi2 and Student's t-test to determine differences between subgroups. Statistical significance was considered as P<.05 RESULTS: The long-term monitoring of these patients was very irregular. Only 67.08% of the study group underwent diabetes mellitus type 2 screening. The level of follow-up was not associated with age, BMI, the place of residence, or the year of diagnosis. In patients with more than one episode of gestational diabetes, subsequent blood glucose control was achieved in 94.1%. CONCLUSION The adequacy of the screening in our area is very irregular and highly improvable.
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Affiliation(s)
- E Álvarez-Silvares
- Servicio de Obstetricia y Ginecología, Complexo Hospitalario Universitario de Ourense, Orense, España.
| | - P Domínguez-Vigo
- Servicio de Obstetricia y Ginecología, Complexo Hospitalario Universitario de Ourense, Orense, España
| | - J Domínguez-Sánchez
- Servicio de Medicina de Familia y Comunitaria, Complexo Hospitalario Universitario de Ourense, Orense, España
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Hernández-Higareda S, Pérez-Pérez OA, Balderas-Peña LMA, Martínez-Herrera BE, Salcedo-Rocha AL, Ramírez-Conchas RE. [Maternal metabolic diseases related to pre-pregnancy overweight and obesity in mexican women with high risk pregnancy]. CIR CIR 2016; 85:292-298. [PMID: 27955851 DOI: 10.1016/j.circir.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/07/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pre-pregnancy obesity has been proposed as a risk factor related to gestational diabetes and hypertensive disorders during pregnancy. OBJECTIVES Identify pregnancy related diseases associated with pre-pregnancy obesity as a risk factor ina high risk preganancy patient population. METHODS 600 patients whose pre-pregnancy obesity had been assessed as a high risk factor were included in the study. The means, standard deviation, median, interquartile intervals, Pearson and Spearman correlation and logistic regression to estimate risk with the odds ratio and 95% confidence intervals were calculated. RESULTS The mean pre-pregnancy body mass index was 29.59 ± 6.42 kg/m2. The mean for recommended pregnancy weight gain was 2.31 ± 1.03 kg, but the mean of real weight gain was 8.91 ± 6.84 kg. A significant correlation between pre-pregnancy obesity and family history of diabetes mellitus (p=0.000), systemic hypertension (p=0.003), cardiac diseases (p=0.000), dyslipidemia (p=0.000) and obesity (p=0.000) was identified. Pre-pregnancy obesity was identified as a risk factor for the development of gestational diabetes (OR: 1.95; IC95%: 1.39 to 2.76; p=0.000) in this kind of patient. DISCUSSION AND CONCLUSION 75% of high risk pregnancy women in a high specialty hospital in West Mexico are overweight or obese when they become pregnant. These are risk factors in the development of gestational diabetes.
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Affiliation(s)
- Salvador Hernández-Higareda
- División de Medicina Perinatal, Unidad Médica de Alta Especialidad (UMAE), Hospital de Gineco-Obstetricia, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México
| | - Omar-Alejandro Pérez-Pérez
- División de Medicina Perinatal, Unidad Médica de Alta Especialidad (UMAE), Hospital de Gineco-Obstetricia, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México
| | - Luz-Ma-Adriana Balderas-Peña
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE), Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.
| | - Brenda-Eugenia Martínez-Herrera
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE), Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Ana-Leticia Salcedo-Rocha
- Unidad de Investigación Social, Epidemiológica y en Servicios de Salud, Delegación Estatal Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Rosa-Emilia Ramírez-Conchas
- Unidad de Investigación Social, Epidemiológica y en Servicios de Salud, Delegación Estatal Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
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14
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Ferriols E, Rueda C, Gamero R, Vidal M, Payá A, Carreras R, Flores-le Roux JA, Pedro-Botet J. [Relationship between lipid alterations during pregnancy and adverse pregnancy outcomes]. Clin Investig Arterioscler 2016; 28:232-244. [PMID: 26088001 DOI: 10.1016/j.arteri.2015.04.003] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
Lipids play an important role during pregnancy, and in this period major changes occur in lipoprotein metabolism. During the third trimester plasma cholesterol and triglyceride levels are substantially increased, returning to normal after delivery. Described associations between increased morbidity during pregnancy and excessive increases in plasma cholesterol and triglycerides. For this reason we have reviewed the relationship between lipid alterations, preeclampsia, gestational diabetes and preterm birth. The overall metabolic control can improve pregnancy outcomes, and the assessment of supraphysiological changes in lipid profile will classify pregnancy risk at a higher level, which would entail a stricter control.
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Affiliation(s)
- Elena Ferriols
- Servicio de Ginecología y Obstetricia, Hospital del Mar, Barcelona, España.
| | - Carolina Rueda
- Servicio de Ginecología y Obstetricia, Hospital del Mar, Barcelona, España
| | - Rocío Gamero
- Servicio de Ginecología y Obstetricia, Hospital del Mar, Barcelona, España
| | - Mar Vidal
- Servicio de Ginecología y Obstetricia, Hospital del Mar, Barcelona, España
| | - Antonio Payá
- Servicio de Ginecología y Obstetricia, Hospital del Mar, Barcelona, España; Departament de Pediatria, d'Obstetrícia i Ginecologia, i de Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, España
| | - Ramón Carreras
- Servicio de Ginecología y Obstetricia, Hospital del Mar, Barcelona, España; Departament de Pediatria, d'Obstetrícia i Ginecologia, i de Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, España
| | - Juana A Flores-le Roux
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Juan Pedro-Botet
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
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Lloreda-García JM, Sevilla-Denia S, Rodríguez-Sánchez A, Muñoz-Martínez P, Díaz-Ruiz M. Perinatal outcome of macrosomic infants born to diabetic versus non-diabetic mothers. ACTA ACUST UNITED AC 2016; 63:409-13. [PMID: 27267696 DOI: 10.1016/j.endonu.2016.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 03/01/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the incidence and perinatal complications of macrosomic infants born to diabetic and non-diabetic mothers. PATIENTS AND METHODS A six-year retrospective study of newborns at our hospital. A total of 996 macrosomic newborns were found. Maternal characteristics, mode of delivery, and perinatal outcomes were studied. RESULTS Of 18005 newborns, 996 were macrosomic infants (5.53%). Of these, 103 (10.3%) were born to diabetic mothers. Diabetic mothers had higher parity (1.89 vs. 1.35; P<0.000), cesarean section rate (52.4 vs. 31.1%; P<0.05), and resuscitation rate (5.8 vs. 1.8%; P<0.006; RR: 2.9; 95% CI: 1.42-5.9), and greater need for hospitalization (19.4 vs. 9.6%; p<0.002; RR: 2; 95% CI: 1.3-3.2) and intensive care (5.8 vs. 0.7%; P<0.000; RR: 5.3; 95% CI: 2.8-10) mostly for hypoglycemia (7.8 vs. 1%; P<0.000; RR: 5; 95% CI: 2.8-8.3), jaundice (8.7 vs. 2.1%; P<0.000; RR: 3.1; 95% CI: 1.9-5.9), respiratory distress (4.9 vs. 1.3%; P<0.009; RR: 2.9; 95% CI: 1.4-6.7), and asphyxia (2.9 vs. 0.4%; P<0.005; RR: 4.3; 95% CI: 1.8-11.1). No differences were found in birth trauma. CONCLUSIONS Macrosomic infants born to diabetic mothers have an increased risk of hospital admission in the neonatal period for hypoglycemia, jaundice, respiratory distress, and asphyxia, and a greater need of intensive care. Obstetric trauma rates were similar in both groups.
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Affiliation(s)
- Jose Maria Lloreda-García
- Unidad de Neonatología y Unidad de Cuidados Intensivos Neonatales, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España.
| | - Sandra Sevilla-Denia
- Unidad de Neonatología y Unidad de Cuidados Intensivos Neonatales, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Alba Rodríguez-Sánchez
- Unidad de Neonatología y Unidad de Cuidados Intensivos Neonatales, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Pablo Muñoz-Martínez
- Unidad de Neonatología y Unidad de Cuidados Intensivos Neonatales, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Marta Díaz-Ruiz
- Unidad de Neonatología y Unidad de Cuidados Intensivos Neonatales, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
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16
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López Morales CM, Brito Zurita OR, González Heredia R, Cruz López M, Méndez Padrón A, Matute Briseño JA. [Placental atherosclerosis and markers of endothelial dysfunction in infants born to mothers with gestational diabetes]. Med Clin (Barc) 2016; 147:95-100. [PMID: 27242015 DOI: 10.1016/j.medcli.2016.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/07/2016] [Revised: 03/18/2016] [Accepted: 03/31/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The pathophysiology of gestational diabetes itself causes hyperstimulation of adipose tissue and of the placenta cells increasing the production of inflammatory cytokines, which cause changes in the tissues exposed such as the placenta and foetus. Therefore, the objective of this study was to compare metabolic markers and endothelial dysfunction in umbilical cord blood, as well as to determine the presence of atherosclerosis in the placentas of newborn infants of patients with gestational diabetes and in patients with normally progressing pregnancies. PATIENTS AND METHOD An analytical cross-sectional study was carried out in 84 patients, obtaining data such as age, smoking and weight gain in pregnancy; the gestational age of the newborns was determined by Capurro, and their weight and destination subsequent to birth, the placentas were also collected in order to look for atherosclerosis through histological studies and glucose, insulin, VLDL-C, HDL-C, triglycerides, cholesterol, fibrinogen, PCR and markers of endothelial dysfunction (adiponectin, VCAM-1, ICAM-1 and IL-6) were determined in blood samples obtained from the umbilical cord. RESULTS Placental atherosclerosis presented in 28.94% of the group with gestational diabetes compared to 10.52% of the group with normally progressing pregnancies (P=.044); differences were found in glucose, cholesterol, triglycerides, fibrinogen, HOMA-IR, PCR-us, HDL-C, not in VLDL-C. Twenty-one point five percent of the newborns of the gestational diabetes patients required hospitalization, against 5.2% in the control group, CONCLUSIONS Pregnancies that involve diabetes have higher proportion of atherosclerosis, hospitalization of the newborn, insulin resistance, as well as elevation of markers associated with inflammation and endothelial dysfunction in umbilical cord blood.
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Affiliation(s)
- Cruz Mónica López Morales
- Coordinación Auxiliar de Investigación, Instituto Mexicano del Seguro Social, Delegación de Sonora, Obregón, Sonora, México.
| | - Olga Rosa Brito Zurita
- Dirección de Educación e Investigación, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
| | - Ricardo González Heredia
- Centro de Investigación Educativa y Formación Docente, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
| | - Miguel Cruz López
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
| | - Araceli Méndez Padrón
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
| | - Juan Antonio Matute Briseño
- Departamento de Patología, Hospital General Regional 1, Instituto Mexicano del Seguro Social, Obregón, Sonora, México
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17
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Rubio JA, Ontañón M, Perea V, Megia A. Health care of pregnant women with diabetes in Spain: Approach using a questionnaire. Endocrinol Nutr 2016; 63:113-120. [PMID: 26775016 DOI: 10.1016/j.endonu.2015.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To ascertain how health care for pregnant women with gestational diabetes (GD) and pregestational diabetes (PGD) is organized, and to estimate the number of Pregnancy and Diabetes Units (PDUs) in Spain in 2013. MATERIAL AND METHODS The Spanish Group of Diabetes and Pregnancy (GEDE) developed and agreed on a questionnaire based on the recommendations of the group. The questionnaire was sent to members of the Spanish Society of Diabetes and the Spanish Society of Endocrinology and Nutrition. RESULTS Eighty-seven questionnaires were received from 81 hospitals, 4 outpatient specialty centers, and 2 primary healthcare centers, which accounted for 51% of the Spanish population and for 39% of births in 2013. GD was mainly diagnosed based on GEDE recommendations (98%), and less than 50% of women were reevaluated after delivery in primary care. Fourteen (26%) of the 53 centers identified as PDUs corresponded to a minimal model. Continuous subcutaneous insulin infusion (CSII) therapy was not available in 30% of centers, and 13% of hospitals had no preconceptional clinics. No nurse support was available in 20% of centers. CONCLUSIONS Care of women with PGD has a fair coverage with PDU, but significant deficits still exist, for instance, in preconception clinic and CSII. However, organization of care for women with GD appears to be adequate. There are aspects in need of improvement such as integration of diabetes educators and coordination with primary care for postpartum reclassification.
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Affiliation(s)
- José Antonio Rubio
- Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias , Alcalá de Henares, Madrid, España; Departamento de Ciencias Biomédicas, Universidad de Alcalá, Alcalá de Henares, España.
| | - Marta Ontañón
- Servicio de Obstetricia y Ginecología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Verónica Perea
- Servicio de Endocrinología y Nutrición, Hospital Mutua de Terrassa, Barcelona, España
| | - Ana Megia
- Servicio de Endocrinología y Nutrición, Hospital Universitario Joan XXIII, Tarragona, España
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Mwanri AW, Kinabo J, Ramaiya K, Feskens EJM. Gestational diabetes mellitus in sub-Saharan Africa: systematic review and metaregression on prevalence and risk factors. Trop Med Int Health 2015; 20:983-1002. [PMID: 25877657 DOI: 10.1111/tmi.12521] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 01/28/2023]
Abstract
OBJECTIVE We systematically reviewed publications on prevalence and risk factors for gestational diabetes mellitus (GDM) in the 47 countries of sub-Saharan Africa. METHODS We conducted a systematic search in PUBMED and reviewed articles published until June 2014 and searched the references of retrieved articles. We explored sources of heterogeneity among prevalence proportions with metaregression analysis. RESULTS Of 1069 articles retrieved 22 studies were included. Half were from West Africa, specifically Nigeria, five from South Africa and six from East and Central Africa. There were differences in screening methods and diagnosis criteria used, even between studies carried out in the same country and same time period. Metaregression analysis indicated high heterogeneity among the studies (I(2) = 100, P < 0.001), which could not be sufficiently explained by study setting, population, diagnostic criteria or time trend, although we observed a relatively higher prevalence in studies carried out after 2000 (5.1% vs. 3.2%), when women at risk were selected (6.5% vs. 3.8%) and when more current diagnostic criteria were used (5.1% vs. 4.2%). Associations with risk factors were reported in six studies. Significant risk factors reported in more than one study were overweight and/or obesity, family history for type 2 diabetes, previous stillbirth, previous macrosomic child and age >30 years. CONCLUSIONS There are few studies on prevalence and risk factors for GDM in Sub-Saharan Africa and heterogeneity is high. Prevalence was up to about 14% when high-risk women were studied. Preventive actions should be taken to reduce the short- and long-term complications related to GDM in Sub-Saharan Africa.
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Affiliation(s)
- Akwilina W Mwanri
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.,Department of Food Science and Nutrition, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Joyce Kinabo
- Department of Food Science and Nutrition, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Edith J M Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Pascual Corrales E, Andrada P, Aubá M, Ruiz Zambrana A, Guillén Grima F, Salvador J, Escalada J, Galofré JC. Is autoimmune thyroid dysfunction a risk factor for gestational diabetes? ACTA ACUST UNITED AC 2014; 61:377-81. [PMID: 24680382 DOI: 10.1016/j.endonu.2014.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/11/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Some recent studies have related autoimmune thyroid dysfunction and gestational diabetes (GD). The common factor for both conditions could be the existence of pro-inflammatory homeostasis. The study objective was therefore to assess whether the presence of antithyroid antibodies is related to the occurrence of GD. MATERIAL AND METHODS Fifty-six pregnant women with serum TSH levels ≥ 2.5 mU/mL during the first trimester were retrospectively studied. Antithyroid antibodies were measured, and an O'Sullivan test was performed. GD was diagnosed based on the criteria of the Spanish Group on Diabetes and Pregnancy. RESULTS Positive antithyroid antibodies were found in 21 (37.50%) women. GD was diagnosed in 15 patients, 6 of whom (10.71%) had positive antibodies, while 9 (16.07%) had negative antibodies. Data were analyzed using exact logistic regression by LogXact-8 Cytel; no statistically significant differences were found between GD patients with positive and negative autoimmunity (OR = 1.15 [95%CI = 0.28-4.51]; P=1.00). CONCLUSIONS The presence of thyroid autoimmunity in women with TSH above the recommended values at the beginning of pregnancy is not associated to development of GD. However, GD prevalence was higher in these patients as compared to the Spanish general population, suggesting the need for closer monitoring in pregnant women with TSH levels ≥ 2.5 mU/mL.
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Affiliation(s)
- Eider Pascual Corrales
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España
| | - Patricia Andrada
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España
| | - María Aubá
- Departamento de Ginecología y Obstetricia, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España
| | - Alvaro Ruiz Zambrana
- Departamento de Ginecología y Obstetricia, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España
| | - Francisco Guillén Grima
- Departamento de Medicina Preventiva, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España
| | - Javier Salvador
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España
| | - Javier Escalada
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España
| | - Juan C Galofré
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España.
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