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Keikkala E, Mustaniemi S, Koivunen S, Kinnunen J, Viljakainen M, Männisto T, Ijäs H, Pouta A, Kaaja R, Eriksson JG, Laivuori H, Gissler M, Erkinheimo TL, Keravuo R, Huttunen M, Metsälä J, Stach-Lempinen B, Klemetti MM, Tikkanen M, Kajantie E, Vääräsmäki M. Cohort Profile: The Finnish Gestational Diabetes (FinnGeDi) Study. Int J Epidemiol 2021; 49:762-763g. [PMID: 32374401 PMCID: PMC7394962 DOI: 10.1093/ije/dyaa039] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/29/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Elina Keikkala
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Sanna Mustaniemi
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Sanna Koivunen
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Jenni Kinnunen
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Matti Viljakainen
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Tuija Männisto
- Northern Finland Laboratory Centre NordLab, Department of Clinical Chemistry and MRC Oulu, Oulu University Hospital and the University of Oulu, Oulu, Finland
| | - Hilkka Ijäs
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Anneli Pouta
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Government Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Risto Kaaja
- University of Turku and Turku University Hospital, Institute of Clinical Medicine, Internal Medicine, Turku, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hannele Laivuori
- Department of Obstetrics and Gynaecology, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Information Services Department, Helsinki, Finland.,Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Tiina-Liisa Erkinheimo
- Department of Obstetrics and Gynaecology, Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Ritva Keravuo
- Department of Obstetrics and Gynaecology, Kainuu Central Hospital, Kajaani, Finland
| | - Merja Huttunen
- Department of Obstetrics and Gynaecology, Satakunta Health Care District, Pori, Finland
| | - Jenni Metsälä
- Department of Obstetrics and Gynaecology, Central Finland Health Care District, Jyväskylä, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynaecology, South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Miira M Klemetti
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynaecology, South Karelia Social and Health Care District, Lappeenranta, Finland.,Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Minna Tikkanen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Kajantie
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marja Vääräsmäki
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland
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Kivelä M, Rissanen I, Kajantie E, Ijäs H, Rusanen H, Miettunen J, Paananen M. Pregnancy Risk Factors as Predictors of Offspring Cerebrovascular Disease: The Northern Finland Birth Cohort Study 1966. Stroke 2021; 52:1347-1354. [PMID: 33626905 DOI: 10.1161/strokeaha.120.031618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Milja Kivelä
- Center for Life Course Health Research (M.K., J.M., M.P.), University of Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital (M.K., I.R., J.M., M.P.), University of Oulu, Finland
| | - Ina Rissanen
- Medical Research Center Oulu, Oulu University Hospital (M.K., I.R., J.M., M.P.), University of Oulu, Finland.,Research Unit of Clinical Neuroscience, Oulu University Hospital (I.R., H.R.), University of Oulu, Finland.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (I.R.)
| | - Eero Kajantie
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital (E.K., H.I.), University of Oulu, Finland.,Finnish Institute for Health and Welfare, Public Health Promotion Unit, Helsinki and Oulu, Finland (E.K.).,Norwegian University of Science and Technology, Department of Clinical and Molecular Medicine, Trondheim, Norway (E.K.)
| | - Hilkka Ijäs
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital (E.K., H.I.), University of Oulu, Finland
| | - Harri Rusanen
- Research Unit of Clinical Neuroscience, Oulu University Hospital (I.R., H.R.), University of Oulu, Finland.,Department of Neurology, Oulu University Hospital (H.R.)
| | - Jouko Miettunen
- Center for Life Course Health Research (M.K., J.M., M.P.), University of Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital (M.K., I.R., J.M., M.P.), University of Oulu, Finland
| | - Markus Paananen
- Center for Life Course Health Research (M.K., J.M., M.P.), University of Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital (M.K., I.R., J.M., M.P.), University of Oulu, Finland.,Kerava Health Care Center, Finland (M.P.)
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Ijäs H, Koivunen S, Raudaskoski T, Kajantie E, Gissler M, Vääräsmäki M. Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: A register-based study. PLoS One 2019; 14:e0221549. [PMID: 31465425 PMCID: PMC6715199 DOI: 10.1371/journal.pone.0221549] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/09/2019] [Indexed: 12/03/2022] Open
Abstract
AIMS Gestational diabetes (GDM) is often accompanied by maternal overweight. Our aim was to evaluate the separate and concomitant effects of GDM and maternal overweight/obesity on perinatal outcomes. METHODS We used the Finnish Medical Birth Register to identify all 24,577 women with a singleton pregnancy who delivered in 2009 in Finland and underwent an oral glucose tolerance test (OGTT). Women were divided into groups according to the result of OGTT (GDM/no GDM) and pre-pregnancy body mass index (BMI): normal weight (≤24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). Primary outcomes included macrosomia, caesarean delivery, and treatment at neonatal ward. Normal weight women without GDM constituted the reference group. RESULTS Compared to reference group, overweight or obese women without GDM had an increased risk of macrosomia [odds ratio adjusted for age, parity, smoking and socio-economic status (aOR)1.18 (95% CI 1.09-1.28) and 1.50 (95% CI 1.19-1.88)], and caesarean delivery [aORs 1.17 (95% CI 1.07-1.28) and 1.52 (95% CI 1.37-1.69)], respectively. In normal weight GDM women the risk of macrosomia [aOR 1.17 (95% CI 0.85-1.62)] and caesarean delivery [aOR 1.10 (95% CI 0.96-1.27)] was not significantly increased as compared to normal weight women without GDM. GDM increased the risk of treatment at neonatal ward in all BMI categories and maternal obesity without GDM was also a risk factor for treatment at neonatal ward. Interaction p values between BMI and GDM on these outcomes were <0.001. CONCLUSIONS Maternal overweight and obesity without GDM increased the risk of macrosomia and caesarean delivery when compared to the reference group. These risks were amplified when overweight/obesity was accompanied by GDM. Obesity without GDM was a risk factor for treatment at neonatal ward; GDM increased this risk in all BMI categories. Our results suggest that especially maternal obesity should be considered as a risk factor for adverse pregnancy outcomes and GDM further amplifies this risk.
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Affiliation(s)
- Hilkka Ijäs
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
| | - Sanna Koivunen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
| | - Tytti Raudaskoski
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mika Gissler
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
- Karolinska Institute, Stockholm, Sweden
| | - Marja Vääräsmäki
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
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van Weelden W, Wekker V, de Wit L, Limpens J, Ijäs H, van Wassenaer-Leemhuis AG, Roseboom TJ, van Rijn BB, DeVries JH, Painter RC. Long-Term Effects of Oral Antidiabetic Drugs During Pregnancy on Offspring: A Systematic Review and Meta-analysis of Follow-up Studies of RCTs. Diabetes Ther 2018; 9:1811-1829. [PMID: 30168045 PMCID: PMC6167305 DOI: 10.1007/s13300-018-0479-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Antidiabetic drugs (OADs) are increasingly prescribed to treat hyperglycaemia during pregnancy in women with gestational diabetes mellitus (GDM) or polycystic ovary syndrome (PCOS), even though long-term effects on offspring are unknown. This systematic review summarises the evidence of follow-up studies of randomised controlled trials (RCTs) reporting on long-term effects of prenatal exposure to OADs on offspring. METHODS The MEDLINE, EMBASE and CENTRAL databases were searched from inception to April 2018 for the concepts antidiabetic agents and prenatal exposure (or pregnancy and offspring/child) in combination with an RCT search filter. RCTs evaluating post-neonatal health effects in offspring and comparing maternal treatment with an OAD with no treatment, placebo, an alternative OAD or insulin during pregnancy were eligible for inclusion. Two independent researchers selected, extracted and assessed the data. Meta-analyses were performed using a random effects model and the Cochrane Collaboration's risk of bias tool was used for quality assessment. RESULTS Ten studies were included, with a maximal follow-up duration of 9 years, comprising 778 children of mothers with GDM or PCOS who were randomised to either metformin or insulin/placebo during pregnancy. Meta-analysis showed that children prenatally exposed to metformin were heavier compared to controls (standardised mean difference (SMD) 0.26 [95% CI 0.11-0.41]), but not taller (SMD 0.10 [95% CI -0.14-0.33]). Additionally, offspring body mass index (BMI) z scores did not differ according to metformin exposure (mean difference 0.30 [95% CI -0.01-0.61]). Individual small studies reported that prenatal exposure to metformin was associated with greater mid-upper arm, head and waist circumferences, biceps skinfolds, waist-to-height ratio, more arm fat, higher fasting glucose, ferritin and lower LDL cholesterol in offspring. CONCLUSION Prenatal exposure to metformin is associated with increased offspring weight, but not with height or BMI. Larger follow-up studies are needed to confirm and look into the implications of these findings. Plain language summary available for this article.
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Affiliation(s)
- Wenneke van Weelden
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent Wekker
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Leon de Wit
- Department of Gynaecology and Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hilkka Ijäs
- Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland
| | - Aleid G van Wassenaer-Leemhuis
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bas B van Rijn
- Department of Gynaecology and Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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Mustaniemi S, Vääräsmäki M, Eriksson JG, Gissler M, Laivuori H, Ijäs H, Bloigu A, Kajantie E, Morin-Papunen L. Polycystic ovary syndrome and risk factors for gestational diabetes. Endocr Connect 2018; 7:859-869. [PMID: 29858213 PMCID: PMC6026881 DOI: 10.1530/ec-18-0076] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the roles of self-reported symptoms and/or prior diagnosis of polycystic ovary syndrome (PCOS) and other potential risk factors for gestational diabetes mellitus (GDM) and to clarify whether the screening of GDM in early pregnancy is beneficial for all women with PCOS. DESIGN The FinnGeDi multicentre case-control study including 1146 women with singleton pregnancies diagnosed with GDM and 1066 non-diabetic pregnant women. There were 174 women with PCOS (symptoms and/or diagnosis self-reported by a questionnaire) and 1767 women without PCOS (data missing for 271). METHODS The study population (N = 1941) was divided into four subgroups: GDM + PCOS (N = 105), GDM + non-PCOS (N = 909), non-GDM + PCOS (N = 69), and controls (N = 858). The participants' characteristics and their parents' medical histories were compared. RESULTS The prevalence of PCOS was 10.4% among GDM women and 7.4% among non-diabetics (odds ratios (OR) 1.44, 95% CI: 1.05-1.97), but PCOS was not an independent risk for GDM after adjustments for participants' age and pre-pregnancy BMI (OR 1.07, 95% CI: 0.74-1.54). In a multivariate logistic regression analysis, the most significant parameters associated with GDM were overweight, obesity, age ≥35 years, participant's mother's history of GDM, either parent's history of type 2 diabetes (T2D) and participant's own preterm birth. CONCLUSIONS The increased risk of GDM in women with PCOS was related to obesity and increased maternal age rather than to PCOS itself, suggesting that routine early screening of GDM in PCOS women without other risk factors should be reconsidered. Instead, family history of GDM/T2D and own preterm birth were independent risk factors for GDM.
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Affiliation(s)
- Sanna Mustaniemi
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marja Vääräsmäki
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health CareUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research CentreHelsinki, Finland
| | - Mika Gissler
- Information Services DepartmentNational Institute for Health and Welfare, Helsinki, Finland
- Division of Family MedicineDepartment of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hannele Laivuori
- Medical and Clinical GeneticsUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and GynaecologyTampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life SciencesUniversity of Tampere, Tampere, Finland
- Institute for Molecular Medicine FinlandHelsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Hilkka Ijäs
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aini Bloigu
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Children's HospitalUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laure Morin-Papunen
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Ijäs H, Vääräsmäki M, Saarela T, Keravuo R, Raudaskoski T. A follow-up of a randomised study of metformin and insulin in gestational diabetes mellitus: growth and development of the children at the age of 18 months. BJOG 2014; 122:994-1000. [DOI: 10.1111/1471-0528.12964] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 12/27/2022]
Affiliation(s)
- H Ijäs
- Department of Obstetrics and Gynaecology; Oulu University Hospital; Oulu Finland
| | - M Vääräsmäki
- Department of Obstetrics and Gynaecology; Oulu University Hospital; Oulu Finland
| | - T Saarela
- Department of Paediatrics; Oulu University Hospital; Oulu Finland
| | - R Keravuo
- Department of Obstetrics and Gynaecology; Kainuu Central Hospital; Kajaani Finland
| | - T Raudaskoski
- Department of Obstetrics and Gynaecology; Oulu University Hospital; Oulu Finland
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Ijäs H, Morin-Papunen L, Keränen AK, Bloigu R, Ruokonen A, Puukka K, Ebeling T, Raudaskoski T, Vääräsmäki M. Pre-pregnancy overweight overtakes gestational diabetes as a risk factor for subsequent metabolic syndrome. Eur J Endocrinol 2013; 169:605-11. [PMID: 23959786 DOI: 10.1530/eje-13-0412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is associated with an increased risk of subsequent diabetes and metabolic syndrome (MS). The independent significance of overweight, often associated with GDM, is controversial. This study was aimed to investigate the prevalence of MS and carotid intima-media thickness (CIMT) values in normal and overweight women with previous insulin-treated GDM and control without GDM 19 years after the index pregnancy. METHODS The study group consisted of 61 women with prior GDM and 55 controls who gave birth in Oulu University Hospital between 1988 and 1993. These women were further divided into subgroups according to pre-pregnancy BMI (<25 or ≥25 kg/m(2)). In 2008-2010, anthropometrics and blood pressure were measured, blood samples were taken, and an oral glucose tolerance test was performed to investigate the components of MS. CIMT was measured by Doppler ultrasound. RESULTS Total prevalence of MS was 62% in the GDM group and 31% in the control group (P=0.001); it was highest (86%) in GDM women with pre-pregnancy overweight. CIMT was significantly thicker (0.67 vs 0.56 mm, P=0.007) and more often abnormal (71.7 vs 45.3%, P=0.004) in the GDM group compared with the controls. In logistic regression analysis, the strongest factor predicting MS in the whole study population was pre-pregnancy overweight. CONCLUSIONS Pre-pregnancy overweight was the strongest predictive factor for later MS, whereas GDM indicated increased risk of subsequent diabetes and subclinical atherosclerosis. The risk of MS was highest when both of these factors were present.
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Affiliation(s)
- H Ijäs
- Departments of Obstetrics and Gynecology Radiology, Oulu University Hospital, PO Box 23, FIN-90029 OYS Oulu, Finland
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Ijäs H, Vääräsmäki M, Morin-Papunen L, Keravuo R, Ebeling T, Saarela T, Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes: a prospective randomised study. BJOG 2010; 118:880-5. [PMID: 21083860 DOI: 10.1111/j.1471-0528.2010.02763.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine if oral metformin is as effective as insulin in the prevention of fetal macrosomy in pregnancies complicated with gestational diabetes mellitus (GDM). DESIGN Open-label prospective randomised controlled study. SETTING Maternity outpatient clinics in a secondary and tertiary level hospital in Finland. SAMPLE One hundred women with GDM who did not attain euglycaemia with diet. METHODS Women were randomised to therapy with insulin (n = 50) or oral metformin (n = 50). MAIN OUTCOME MEASURES Incidence of large-for-gestational-age (LGA) infants and neonatal morbidity. RESULTS There were no statistically significant differences in the incidence of LGA (8.5 versus 10.0%, P = 0.97), mean birthweight, mean cord artery pH or neonatal morbidity between the insulin and metformin groups. Fifteen (31.9%) of the 47 women randomised to metformin needed supplemental insulin. They were more obese (with a body mass index of 36 versus 30 kg/m(2), P = 0.002), had higher fasting blood glucose levels in an oral glucose tolerance test (6.1 versus 5.0 mmol/l, P = 0.001) and needed medical treatment for GDM earlier (26 versus 31 gestational weeks, P = 0.002) than women who were normoglycemic with metformin. There was a tendency to a higher rate of caesarean sections in the metformin group than in the insulin group (RR 1.9; 95% CI 0.99-3.71). CONCLUSIONS Metformin seems to be suitable for the prevention of fetal macrosomy, especially in lean or moderately overweight women developing GDM in late gestation. Women with considerable obesity, high fasting blood glucose and an early need for pharmacological treatment may be more suitable for insulin therapy.
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Affiliation(s)
- H Ijäs
- Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland.
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Ojala K, Mäkikallio K, Haapsamo M, Ijäs H, Tekay A. Interobserver agreement in the assessment of intrapartum automated fetal electrocardiography in singleton pregnancies. Acta Obstet Gynecol Scand 2008; 87:536-40. [DOI: 10.1080/00016340802023053] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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