1
|
Lemaitre M, Bourdon G, Bruandet A, Lenne X, Subtil D, Rakza T, Vambergue A. Pre-gestational diabetes and the risk of congenital heart defects in the offspring: A French nationwide study. Diabetes Metab 2023; 49:101446. [PMID: 37031733 DOI: 10.1016/j.diabet.2023.101446] [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] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
AIM To compare the frequencies and types of congenital heart defects for infants of women without and with pre-gestational diabetes, type 1 and type 2 diabetes (T1DM, T2DM) and to identify risk factors. METHODS All live births between 2012 and 2020 were screened for maternal diabetes and infant congenital heart defects using the French Medical Information System Program in Medicine, Surgery and Obstetrics database (PMSI-MCO). Incidences of these defects were estimated, and a logistic model evaluated maternal and fetal prognostic risk factors. RESULTS Overall, 6,038,703 mothers did not have pre-gestational diabetes (no-diabetes), 23,147 had T1DM, and 14,401 had T2DM. The incidence of infant congenital disease was 6.2% for the no-diabetes group, 8.0%, for women with T1DM, and 8.4% for women with T2DM (P < 0.001); for congenital heart defects, incidences were respectively 0.8%, 3.0% and 2.7% (P < 0.001). In comparison with the no-diabetes group, the odds ratios (95%CI) of coronary heart defects were 2.07 (1.91;2.24) (P < 0.001) for women with T1DM and 2.20 (1.99;2.44) (P < 0.001) for women with T2DM, with no difference between T1DM and T2DM (P = 0.336). cesarian section, small and large for gestational age, and prematurity were also associated with an increased risk of congenital heart defects. CONCLUSION In this study we observed higher incidences of congenital heart defects in infants of women with pre-gestational diabetes compared to women without pre-gestational diabetes, with no difference between women with T1DM or T2DM. These data call for intensifying preconception care and justify systematic cardiac echography in selected fetuses.
Collapse
Affiliation(s)
- Madleen Lemaitre
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, F-59000 Lille, France; University of Lille, F-59000 France; ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Gurvan Bourdon
- University of Lille, F-59000 France; CHU Lille, Department of Pediatrics, Lille University Hospital, F-59000 Lille, France
| | - Amélie Bruandet
- CHU Lille, Department of Medical Information, Lille University Hospital, F-59000 Lille, France
| | - Xavier Lenne
- CHU Lille, Department of Medical Information, Lille University Hospital, F-59000 Lille, France
| | - Damien Subtil
- University of Lille, F-59000 France; ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, F-59000 Lille, France
| | - Thameur Rakza
- CHU Lille, Department of Pediatrics, Lille University Hospital, F-59000 Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, F-59000 Lille, France; University of Lille, F-59000 France; European Genomic Institute for Diabetes, University School of Medicine, F-59000 Lille, France.
| |
Collapse
|
2
|
Kautzky-Willer A, Winhofer Y, Weitgasser R, Lechleitner M, Harreiter J. [Clinical practice recommendations for diabetes in pregnancy (Update 2023)]. Wien Klin Wochenschr 2023; 135:129-136. [PMID: 37101033 PMCID: PMC10133056 DOI: 10.1007/s00508-023-02188-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/28/2023]
Abstract
In 1989 the St. Vincent Declaration aimed to achieve comparable pregnancy outcomes in women with diabetes and those with normal glucose tolerance. However, currently women with pre-gestational diabetes still feature a higher risk of perinatal morbidity and even increased mortality. This fact is mostly ascribed to a persistently low rate of pregnancy planning and pre-pregnancy care with optimization of metabolic control prior to conception. All women should be experienced in the management of their therapy and on stable glycemic control prior to conception. In addition, thyroid dysfunction, hypertension as well as the presence of diabetic complications should be excluded or treated adequately before pregnancy in order to decrease the risk for a progression of complications during pregnancy as well as maternal and fetal morbidity. Near normoglycaemia and HbA1c in the normal range are targets for treatment, preferably without the induction of frequent resp. severe hypoglycaemic reactions. Especially in women with type 1 diabetes mellitus the risk of hypoglycemia is high in early pregnancy, but it decreases with the progression of pregnancy due to hormonal changes causing an increase of insulin resistance. In addition, obesity increases worldwide and contributes to higher numbers of women at childbearing age with type 2 diabetes mellitus and adverse pregnancy outcomes. Intensified insulin therapy with multiple daily insulin injections and pump treatment are equally effective in reaching good metabolic control during pregnancy. Insulin is the primary treatment option. Continuous glucose monitoring often adds to achieve targets. Oral glucose lowering drugs (Metformin) may be considered in obese women with type 2 diabetes mellitus to increase insulin sensitivity but need to be prescribed cautiously due to crossing the placenta and lack of long-time follow up data of the offspring (shared decision making). Due to increased risk for preeclampsia in women with diabetes screening needs to be performed. Regular obstetric care as well as an interdisciplinary treatment approach are necessary to improve metabolic control and ensure the healthy development of the offspring.
Collapse
Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit, Abt. für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Yvonne Winhofer
- Gender Medicine Unit, Abt. für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Raimund Weitgasser
- Abteilung für Innere Medizin/Diabetologie, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
- Universitätsklinik für Innere Medizin I, LKH Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Monika Lechleitner
- Avomed-Arbeitskreis für Vorsorgemedizin und Gesundheitsförderung in Tirol, Innsbruck, Österreich
| | - Jürgen Harreiter
- Gender Medicine Unit, Abt. für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| |
Collapse
|
3
|
Ahmed MA, Bailey HD, Pereira G, White SW, Wong K, Shepherd CCJ. Trends and burden of diabetes in pregnancy among Aboriginal and non-Aboriginal mothers in Western Australia, 1998-2015. BMC Public Health 2022; 22:263. [PMID: 35139837 PMCID: PMC8827280 DOI: 10.1186/s12889-022-12663-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 01/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Diabetes in pregnancy (DIP), which includes pre-gestational and gestational diabetes, is more prevalent among Aboriginal women. DIP and its adverse neonatal outcomes are associated with diabetes and cardiovascular disease in the offspring. This study investigated the impact of DIP on trends of large for gestational age (LGA) in Aboriginal and non-Aboriginal populations, and added to the limited evidence on temporal trends of DIP burden in these populations. Methods We conducted a retrospective cohort study that included all births in Western Australia between 1998 and 2015 using linked population health datasets. Time trends of age-standardised and crude rates of pre-gestational and gestational diabetes were estimated in Aboriginal and non-Aboriginal mothers. Mixed-effects multivariable logistic regression was used to estimate the association between DIP and population LGA trends over time. Results Over the study period, there were 526,319 births in Western Australia, of which 6.4% were to Aboriginal mothers. The age-standardised annual rates of pre-gestational diabetes among Aboriginal mothers rose from 4.3% in 1998 to 5.4% in 2015 and remained below 1% in non-Aboriginal women. The comparable rates for gestational diabetes increased from 6.7 to 11.5% over the study period in Aboriginal women, and from 3.5 to 10.2% among non-Aboriginal mothers. LGA rates in Aboriginal babies remained high with inconsistent and no improvement in pregnancies complicated by gestational diabetes and pre-gestational diabetes, respectively. Regression analyses showed that DIP explained a large part of the increasing LGA rates over time in Aboriginal babies. Conclusions There has been a substantial increase in the burden of pre-gestational diabetes (Aboriginal women) and gestational diabetes (Aboriginal and non-Aboriginal) in recent decades. DIP appears to substantially contribute to increasing trends in LGA among Aboriginal babies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12663-6.
Collapse
Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia. .,School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - Helen D Bailey
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia
| | - Gavin Pereira
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia.,Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
| |
Collapse
|
4
|
Jaffar F, Laycock K, Huda MSB. Type 1 Diabetes in Pregnancy: A Review of Complications and Management. Curr Diabetes Rev 2022; 18:e051121197761. [PMID: 34749617 DOI: 10.2174/1573399818666211105124829] [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: 05/30/2021] [Revised: 07/15/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pre-gestational diabetes can pose significant risk to the mother and infant, thus requiring careful counselling and management. Since Saint Vincent's declaration in 1989, adverse maternal and fetal outcomes, such as preeclampsia, perinatal mortality, congenital anomalies, and macrosomia, continue to be associated with type 1 diabetes. Although pregnancy is not considered an independent risk factor for the development of new onset microvascular complications, it is known to exacerbate pre-existing microvascular disease. Strict glycaemic control is the optimal management for pre-existing type 1 diabetes in pregnancy, as raised HbA1C is associated with increased risk of maternal and fetal complications. More recently, time in range on Continuous Glucose Monitoring glucose profiles has emerged as another useful evidence-based marker of fetal outcomes. OBJECTIVES This review summarises the complications associated with pre-gestational type 1 diabetes, appropriate evidence-based management, including preparing for pregnancy, intrapartum and postpartum care. METHODS A structured search of the PubMed and Cochrane databases was conducted. Peer-reviewed articles about complications and management guidelines on pre-gestational type 1 diabetes were selected and critically appraised. RESULTS One hundred and twenty-three manuscripts were referenced and appraised in this review, and international guidelines were summarised. CONCLUSION This review provides a comprehensive overview of the recurring themes in the literature pertaining to type 1 diabetes in pregnancy: maternal and fetal complications, microvascular disease progression, and an overview of current guideline-specific management.
Collapse
Affiliation(s)
- Farah Jaffar
- Department of Diabetes & Metabolism, Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, UK
| | - Kate Laycock
- Department of Diabetes & Metabolism, Barts Health NHS Trust, St Bartholomew's and Royal London Hospital, London, UK
| | - Mohammed S B Huda
- Department of Diabetes & Metabolism, Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, UK
| |
Collapse
|
5
|
Jethwani P, Saboo B, Jethwani L, Chawla R, Maheshwari A, Agarwal S, Jaggi S. Use of insulin glargine during pregnancy: A review. Diabetes Metab Syndr 2021; 15:379-384. [PMID: 33540243 DOI: 10.1016/j.dsx.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/07/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGOUND AND AIMS Hyperglycemia during pregnancy is increasing globally. Insulin therapy is considered the standard of care for its optimum management. Insulin glargine, in spite of widespread use in non-pregnant adults, lacks randomized controlled trial evidence as safe basal insulin during pregnancy. Aim of this review is to discuss major available evidences and recommendations on the use of insulin glargine during pregnancy. METHODS Evidences related to use of insulin glargine during pregnancy, including animal studies, placental transfer studies, case reports as well as observational studies were retrieved using PUBMED & Google scholar. Recommendations regarding use of insulin glargine during pregnancy by international and Indian organizations were reviewed. RESULTS Trans-placental transfer studies show that insulin glargine does not cross placenta when used at therapeutic concentrations. Although there are no randomized controlled trials on insulin glargine in pregnancy, it's use during pregnancy is not associated with any adverse maternal or neonatal outcomes as shown in many case reports and observational studies (both prospective and retrospective). It's use during pregnancy is hence considered safe by many organizations across the globe. CONCLUSIONS Insulin glargine can be continued safely during pregnancy in women who are already taking it prior to pregnancy and have achieved good glycemic control with it. However we require preferably randomized controlled trials or large prospective observational studies to establish it as first line or preferred basal insulin for management of hyperglycemia during pregnancy.
Collapse
Affiliation(s)
| | - B Saboo
- Diacare- Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | - R Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - A Maheshwari
- Sri Harikamal Diabetes Clinic & Research Centre, Vikas Nagar, Lucknow, India
| | - S Agarwal
- Dept. of Medicine, Ruby Hall Clinic, Pune, India
| | - S Jaggi
- Lifecare Diabetes Centre, New Delhi, India
| |
Collapse
|
6
|
Dodesini AR, Galliani S, Ciriello E, Bellante R, Trevisan R. Pre-gestational diabetes during the COVID-19 pandemic in Bergamo, Italy. Int J Gynaecol Obstet 2020; 151:295-296. [PMID: 32657430 PMCID: PMC9087511 DOI: 10.1002/ijgo.13306] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 01/28/2023]
Abstract
Effective enforcement of lockdown measures, use of technology, and implementation of telemedicine may have significantly reduced the number of diabetic pregnant women who tested positive for COVID‐19 in Bergamo, Italy.
Collapse
Affiliation(s)
| | - Silvia Galliani
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Elena Ciriello
- Gynecology and Obstetric Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Rosalia Bellante
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberto Trevisan
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
7
|
Wali AS, Rafique R, Iftikhar S, Ambreen R, Yakoob MY. High proportion of overt diabetes mellitus in pregnancy and missed opportunity for early detection of diabetes at a tertiary care centre in Pakistan. Pak J Med Sci 2020; 36:S38-S43. [PMID: 31933605 PMCID: PMC6943103 DOI: 10.12669/pjms.36.icon-suppl.1723] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives To determine the frequency of diabetes in pregnancy (DIP), namely pre-gestational, gestational (GDM) and overt diabetes mellitus (DM) in women registered for delivery. Methods A retrospective chart review of antenatal women registered between January 01 to August 31, 2017 was performed. Gestational age, diagnosis of DIP, glucose levels at diagnosis and other relevant data was extracted. The effect of various fasting blood glucose (FBG) thresholds for diagnosis of DIP was assessed. Results DIP was diagnosed in 21.8% women (pre-gestational: 2%, GDM: 81.2%, overt: DM: 16.8%). In early registrants, 30.2% were detected through screening. However, 55.3% of women registered late. Women with pre-gestational DM were older, had more miscarriages, and greater personal and family history of diabetes versus GDM and overt DM. Raising the diagnostic threshold of FBG from 92 mg/dl to 95 mg/dl missed three women (0.1%) and to 105 mg/dl, missed six women (0.2%). Conclusion We observed a high proportion of overt DM. In early registrants, almost one third of DIP was diagnosed in the first half of pregnancy, an opportunity missed in late registrants. Altering diagnostic thresholds of DIP affected only a small proportion of women.
Collapse
Affiliation(s)
- Aisha Syed Wali
- Aisha Syed Wali, FCPS. Sheikh Saeed Memorial Hospital, Indus Health Network, Karachi, Pakistan
| | - Raheela Rafique
- Raheela Rafique, MBBS. Sheikh Saeed Memorial Hospital, Indus Health Network, Karachi, Pakistan
| | - Sundus Iftikhar
- Sundus Iftikhar, MS. Indus Hospital Research Center, Indus Health Network, Karachi, Pakistan
| | - Rakhshinda Ambreen
- Rakhshinda Ambreen, BDS. Indus Hospital Research Center, Indus Health Network, Karachi, Pakistan
| | - Mohammad Yawar Yakoob
- Mohammad Yawar Yakoob, DS. Indus Hospital Research Center, Indus Health Network, Karachi, Pakistan
| |
Collapse
|
8
|
Kapustin RV, Drobintseva AO, Alekseenkova EN, Onopriychuk AR, Arzhanova ON, Polyakova VO, Kvetnoy IM. Placental protein expression of kisspeptin-1 (KISS1) and the kisspeptin-1 receptor (KISS1R) in pregnancy complicated by diabetes mellitus or preeclampsia. Arch Gynecol Obstet 2019; 301:437-445. [PMID: 31811415 DOI: 10.1007/s00404-019-05408-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/22/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Kisspeptins regulate the trophoblast invasion. The disturbance of this process might lead to the development of preeclampsia (PE). Diabetes mellitus (DM) is associated with the high rate of this complication. The main hypothesis was to investigate the placental protein expression of kisspeptin-1 (KISS1) and its receptor (KISS1R) in diabetic, preeclamptic, and healthy pregnancies. METHODS Placentae (n = 65) were divided into the following groups: the control group (n = 20), either PE or non-PE type-1 diabetes mellitus (T1DM) (n = 10), either PE or non-PE type-2 diabetes mellitus (T2DM) (n = 10), either PE or non-PE gestational diabetes mellitus (GDM) (n = 10) and preeclampsia without diabetes (PE) (n = 15). Immunohistochemistry analysis was used for demonstrating the presence and location of KISS1/KISS1R in placental tissue and to measure the area of immunopositive expression. Correlation analyses were performed to detect the links between protein expression of these biomarkers and the main obstetric outcomes. RESULTS The highest placental protein expressions of KISS1 were detected in the PE (35.4%) and GDM (33.2%) groups. In case of DM, levels of KISS1 expression depended on the presence of PE and were higher compared with DM no PE and control groups: (30.6%) in T1DM + PE and (30.1%) in T2DM + PE group. The lowest expression was detected in the control group (14.1%). The expression of KISS1R was higher in DM and PE compared to the control group. We detected the strong direct link between PE and placental expression of KISS1 (r = 0.81) and KISS1R (r = 0.56), and inverse correlation link between KISS1 and preterm birth weight (r = - 0.73). The low correlation links were found between KISS1 and IUGR (r = 0.29), and preterm birth (r = 0.24). The same trend was detected for KISS1R. We did not find any significant correlations between placental expressions of KISS/KISS1R and placental weight or HbA1c levels. CONCLUSION Increased expression levels of KISS1 and KISS1R in case of diabetes mellitus may play a role in the altered placentation process and lead to the development of preeclampsia.
Collapse
Affiliation(s)
- R V Kapustin
- D.O. Ott Institute of Obstetrics Gynaecology, and Reproductive Medicine, 3 Mendeleyevskaya Line, Saint Petersburg, 199034, Russian Federation.
| | - A O Drobintseva
- D.O. Ott Institute of Obstetrics Gynaecology, and Reproductive Medicine, 3 Mendeleyevskaya Line, Saint Petersburg, 199034, Russian Federation
| | - E N Alekseenkova
- D.O. Ott Institute of Obstetrics Gynaecology, and Reproductive Medicine, 3 Mendeleyevskaya Line, Saint Petersburg, 199034, Russian Federation
| | - A R Onopriychuk
- D.O. Ott Institute of Obstetrics Gynaecology, and Reproductive Medicine, 3 Mendeleyevskaya Line, Saint Petersburg, 199034, Russian Federation
| | - O N Arzhanova
- D.O. Ott Institute of Obstetrics Gynaecology, and Reproductive Medicine, 3 Mendeleyevskaya Line, Saint Petersburg, 199034, Russian Federation
| | - V O Polyakova
- D.O. Ott Institute of Obstetrics Gynaecology, and Reproductive Medicine, 3 Mendeleyevskaya Line, Saint Petersburg, 199034, Russian Federation
| | - I M Kvetnoy
- D.O. Ott Institute of Obstetrics Gynaecology, and Reproductive Medicine, 3 Mendeleyevskaya Line, Saint Petersburg, 199034, Russian Federation
| |
Collapse
|
9
|
Morris JR, Tepper NK. Description and comparison of postpartum use of effective contraception among women with and without diabetes. Contraception 2019; 100:474-479. [PMID: 31484057 PMCID: PMC10983026 DOI: 10.1016/j.contraception.2019.08.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE As diabetes is increasing among women of reproductive age in the United States, access to effective contraception is important to allow time for optimal glycemic control which may mitigate complications in future pregnancies. This study sought to describe contraceptive use and compare the effectiveness of contraceptive methods among postpartum women with and without diabetes. STUDY DESIGN This study used data from the Pregnancy Risk Assessment Monitoring System and included women with recent live births during 2012-2015 (N = 93,574). Women were asked about pre-gestational or recent gestational diabetes and their postpartum contraceptive method. Chi-square and multivariate logistic regression analyses were used to compare contraceptive methods between women with and without diabetes. RESULTS Contraceptive prevalence was similar between women with (82%) and without (83%) diabetes; women with diabetes were more likely to use the most effective methods. This was driven by higher use of female sterilization among women with diabetes (15%) compared to women without diabetes (9%) (p < 0.001). In multivariate analysis, odds of use of female sterilization versus reversible prescription methods was higher among women with diabetes than women without diabetes (adjusted odds ratio 1.29, 95% confidence interval 1.19-1.39). CONCLUSIONS Although overall postpartum contraceptive use was high, only 1/3 of women with or without diabetes were using the most effective methods. Furthermore, women with diabetes were more likely to use female sterilization than women without diabetes. It is important all postpartum women, particularly those with high risk pregnancies such as women with diabetes, receive counseling about and access to all contraceptive methods. IMPLICATIONS It is important for clinicians to counsel women with pregnancies affected by diabetes that reversible contraceptives such as implants and IUDs are as effective as female permanent contraception.
Collapse
Affiliation(s)
- Jerrine R Morris
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| |
Collapse
|
10
|
Rousseau-Ralliard D, Couturier-Tarrade A, Thieme R, Brat R, Rolland A, Boileau P, Aubrière MC, Daniel N, Dahirel M, Derisoud E, Fournier N, Schindler M, Duranthon V, Fischer B, Santos AN, Chavatte-Palmer P. A short periconceptional exposure to maternal type-1 diabetes is sufficient to disrupt the feto-placental phenotype in a rabbit model. Mol Cell Endocrinol 2019; 480:42-53. [PMID: 30308265 DOI: 10.1016/j.mce.2018.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/13/2018] [Revised: 08/03/2018] [Accepted: 10/07/2018] [Indexed: 01/10/2023]
Abstract
Tight metabolic control of type-1 diabetes is essential during gestation, but it could be crucial during the periconception period. Feto-placental consequences of maternal type-1 diabetes around the time of conception need to be explored. Using a rabbit model, type-1 diabetes was induced by alloxan 7 days before mating. Glycemia was maintained at 15-20 mmol/L with exogenous insulin injections to prevent ketoacidosis. At 4 days post-conception (dpc), embryos were collected from diabetic (D) or normoglycemic control (C) dams, respectively, and transferred into non-diabetic recipients. At 28dpc, D- and C-feto-placental units were collected for biometry, placental analyses and lipid profiles. D-fetuses were growth-retarded, hyperglycemic and dyslipidemic compared to C-fetuses. The efficiency of D-placentas was associated with an increased gene expression related to nutrient supply and lipid metabolism whereas volume density of fetal vessels decreased. Fetal plasma, placental and fetal liver membranes had specific fatty acid signatures depending on embryonic origin. Tissues from D-fetuses contained more omega-6 polyunsaturated fatty acids. The concentrations of docosahexaenoic acid decreased while linoleic acid increased in the heart of D-fetuses. This study demonstrates that a short exposure to maternal type-1 diabetes in the periconception window, until the blastocyst stage, is able to irreversibly malprogram the feto-placental phenotype, through precocious and persistent structural and molecular adaptations of placenta.
Collapse
Affiliation(s)
| | | | - René Thieme
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, D-06097, Halle, Germany; Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Roselyne Brat
- UMR BDR, INRA, ENVA, Université Paris Saclay, 78350, Jouy en Josas, France
| | - Audrey Rolland
- UMR BDR, INRA, ENVA, Université Paris Saclay, 78350, Jouy en Josas, France
| | - Pascal Boileau
- UVSQ (University of Versailles-Saint Quentin), Neonatal Medicine-CHIPS, 78303, Poissy, France
| | | | - Nathalie Daniel
- UMR BDR, INRA, ENVA, Université Paris Saclay, 78350, Jouy en Josas, France
| | - Michèle Dahirel
- UMR BDR, INRA, ENVA, Université Paris Saclay, 78350, Jouy en Josas, France
| | - Emilie Derisoud
- UMR BDR, INRA, ENVA, Université Paris Saclay, 78350, Jouy en Josas, France
| | - Natalie Fournier
- European Georges Pompidou Hospital, Biochemistry Unit, 75015, Paris, France
| | - Maria Schindler
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, D-06097, Halle, Germany
| | | | - Bernd Fischer
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, D-06097, Halle, Germany
| | - Anne Navarrete Santos
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, D-06097, Halle, Germany
| | | |
Collapse
|
11
|
Alessi J, Wiegand DM, Hirakata VN, Oppermann MLR, Reichelt AJ. Temporal changes in characteristics and outcomes among pregnant women with pre-gestational diabetes. Int J Gynaecol Obstet 2018; 143:59-65. [PMID: 29978470 DOI: 10.1002/ijgo.12590] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/08/2018] [Accepted: 07/04/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate pregnancy outcomes among women with pre-gestational diabetes. METHODS Retrospective analysis of pregnant women with type 1 or type 2 diabetes attending a university hospital in Brazil. Maternal characteristics and pregnancy outcomes were compared among deliveries between May 1, 2005, and December 31, 2010, and between January 1, 2011, and December 31, 2015. Risks were calculated by Poisson regression. RESULTS In total 220 women were included. Type 1 diabetes was more frequent in 2005-2010 than in 2011-2015, and type 2 diabetes was more frequent in 2011-2015 (P=0.005). History of macrosomia (P=0.011), hypertensive disorders of pregnancy (P=0.015), and pre-gestational excess weight (body mass index >25 kg/m2 ; P=0.003) was more frequent in 2011-2015. For women with type 1 diabetes, pre-gestational weight (P=0.007) and glycated hemoglobin (P=0.026) were higher in 2011-2015. For women with type 2 diabetes, previous hypertensive disorders of pregnancy (P=0.032) were more prevalent and family history of diabetes (P<0.001) less prevalent in 2011-2015. Adverse pregnancy outcomes were similar for type 1 and type 2, and across both periods. CONCLUSION Type 2 diabetes became more common over the two time periods and women with type 1 diabetes had higher pre-gestational weight. Perinatal outcomes were similar.
Collapse
Affiliation(s)
- Janine Alessi
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela M Wiegand
- Service of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vânia N Hirakata
- Unit of Biostatics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria L R Oppermann
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Service of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Angela J Reichelt
- Service of Endocrinology and Metabology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
12
|
Abstract
OBJECTIVE Docosahexaenoic acid (DHA) is vital for fetal development especially during the third trimester of gestation when the speed of fetal brain growth is at its peak. Diabetes modifies the maternal fatty acid profile, which may in turn change the quantity and/or quality of lipids transferred to the fetus. Neonates born to diabetic mothers might be more vulnerable to DHA deficiency leading to lower cognitive scores together with lower overall intellectual quotients when compared to control. We reviewed the influence of type 1 or type 2 pre-gestational (PGD) and gestational diabetes mellitus (GDM) on maternal and fetal DHA levels. METHOD We searched MEDLINE articles about PGD and/or GDM and DHA published before October 2016. RESULTS Maternal blood DHA level seems higher in those with diabetes than those without diabetes. However, DHA in cord plasma of neonates born to PGD and/or GDM mothers seem lower compared to neonates born to nondiabetic mothers. CONCLUSIONS Altogether, these results suggest that the transfer of DHA from the mother to the fetus may be deficient or dysregulated in diabetic pregnancies. What remains to be understood is how placental lipid transport is regulated and whether there is a link with clinical neurodevelopmental phenotypes in the newborns.
Collapse
Affiliation(s)
- Pauline Léveillé
- a Faculté de médecine et des sciences de la santé, Université de Sherbrooke , Sherbrooke , Canada.,b Research Center on Aging, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke.,c Institute of Nutrition and Functional Foods, Laval University , Québec , Canada
| | - Clémence Rouxel
- b Research Center on Aging, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke
| | - Mélanie Plourde
- a Faculté de médecine et des sciences de la santé, Université de Sherbrooke , Sherbrooke , Canada.,b Research Center on Aging, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke.,c Institute of Nutrition and Functional Foods, Laval University , Québec , Canada
| |
Collapse
|
13
|
Moran M, Mulcahy C, Daly L, Zombori G, Downey P, McAuliffe FM. Novel placental ultrasound assessment: potential role in pre-gestational diabetic pregnancy. Placenta 2014; 35:639-44. [PMID: 24908175 DOI: 10.1016/j.placenta.2014.03.007] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Management of women with pre-gestational diabetes continues to be challenging for clinicians. This study aims to determine if 3D power Doppler (3DPD) analysis of placental volume and flow, and calculation of placental calcification using a novel software method, differ between pregnancies with type 1 or type 2 diabetes and normal controls, and if there is a relationship between these ultrasound placental parameters and clinical measures in diabetics. METHODS This was a prospective cohort study of 50 women with diabetes and 250 controls (12-40 weeks gestation). 3DPD ultrasound was used to evaluate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Placental calcification was calculated by computer analysis. Results in diabetics were compared with control values, and correlated with early pregnancy HbA1c, Doppler results and placental histology. RESULTS Placental calcification and volume increased with advancing gestation in pre-gestational diabetic placentae. Volume was also found to be significantly higher than in normal placentae. VI and VFI were significantly lower in diabetic pregnancies between 35 and 40 weeks gestation. A strong relationship was seen between a larger placental volume and both increasing umbilical artery pulsatility index and decreasing middle cerebral artery pulsatility index. FI was significantly lower in cases which had a booking HbA1c level ≥6.5%. Ultrasound assessed placental calcification was reduced with a histology finding of delayed villous maturation. No other correlation with placental histology was found. CONCLUSIONS This study shows a potential role for 3D placental evaluation, and computer analysis of calcification, in monitoring pre-gestational diabetic pregnancies.
Collapse
Affiliation(s)
- M Moran
- Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Ireland.
| | - C Mulcahy
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
| | - L Daly
- Centre for Support and Training in Analysis and Research, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Ireland.
| | - G Zombori
- Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Ireland.
| | - P Downey
- Department of Pathology, National Maternity Hospital, Dublin, Ireland.
| | - F M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
| |
Collapse
|