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Liu J, Liu L, Pang X, Liu W. Incidence of glucose intolerance and risk factors in patients with gestational diabetes mellitus one year postpartum: a systematic review and meta-analysis. Endocrine 2025:10.1007/s12020-025-04271-2. [PMID: 40380032 DOI: 10.1007/s12020-025-04271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 05/01/2025] [Indexed: 05/19/2025]
Abstract
PURPOSE The purpose of this study is to explore the incidence and risk factors of glucose intolerance within one year postpartum in women with gestational diabetes mellitus (GDM), with the goal of informing the creation of effective preventive measures. METHOD A systematic literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, Ovid, Scopus, CINAHL, Wiley, China National Knowledge Infrastructure Database (CNKI), WANFANG Database, China Science and Technology Journal Database (CSTJ), and China Biology Medicine Database (CBM) for records published from January 1990 to August 2024. The index terms included 'gestational diabetes mellitus', 'glucose intolerance', 'postpartum', and 'risk factor'. Investigators assessed eligibility, extracted data, and evaluated the methodological quality. The meta-analysis was conducted using Stata 17.0 and Review Manager 5.4. RESULT Eighteen studies were included in the analysis, with 14 categorized as low risk of bias and 4 classified as medium risk of bias. The pooled incidence of glucose intolerance in women with GDM within 1 year postpartum was 34.5% (95% CI: 1.34-1.58). The following risk factors for glucose intolerance one year postpartum in women with GDM were identified: age (MD = 1.71; 95% CI: 0.50-2.91), pre-pregnancy BMI (MD = 1.75; 95% CI: 0.73-2.78), weight gain during pregnancy (MD = 1.25; 95% CI: 0.74-1.76), family history of diabetes (OR = 1.96; 95% CI: 1.58-2.42), fasting blood glucose at diagnosis (MD = 0.64; 95% CI: 0.39-0.88), 1-h postprandial blood glucose at diagnosis (MD = 1.24; 95% CI: 0.92-1.57), 2-h postprandial blood glucose at diagnosis (MD = 1.30; 95% CI: 0.72-1.87), history of GDM (OR = 2.62; 95% CI: 1.79-3.84), insulin use (OR = 2.41; 95% CI: 1.43-4.08), postpartum BMI (MD = 0.90; 95% CI: 0.24-1.55), diagnosed gestational weeks (MD = -1.82; 95% CI: -2.94--0.71), glycated hemoglobin (HbA1c) level at diagnosis (MD = 0.36; 95% CI: 0.14-0.58), HbA1c levels at 6-12 weeks postpartum (MD = 0.85; 95% CI: 0.42-1.29), fasting blood glucose levels 6 to 12 weeks postpartum (MD = 0.31; 95% CI: 0.05-0.57), 2-h postprandial blood glucose level 6 to 12 weeks postpartum(MD = 2.47; 95% CI: 0.68-4.26), Low-density lipoprotein (LDL) levels at diagnosis (MD = 0.20; 95% CI: 0.01-0.40), and triglyceride (TG) level at diagnosis(MD = 0.55; 95% CI: 0.34-0.75). CONCLUSION The incidence of glucose intolerance one year postpartum in women with GDM is relatively high. The subgroup analysis of this study revealed that the incidence is highest among Asian women and lowest among Caucasian women. 17 risk factors have been identified; these findings may help to better understand which GDM patients are more likely to experience glucose intolerance one year postpartum, and provide higher-level evidence for assessing the incidence and risk factors of glucose intolerance in GDM patients one year after delivery.
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Affiliation(s)
- Jie Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Leyang Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiaoqin Pang
- School of Nursing, Capital Medical University, Beijing, China
| | - Weiwei Liu
- School of Nursing, Capital Medical University, Beijing, China.
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Morita A, Tanaka A, Higeta D, Sato T, Yamada E, Iwase A. Association of early onset gestational diabetes mellitus with postpartum glucose intolerance. Diabetol Int 2025; 16:414-420. [PMID: 40166453 PMCID: PMC11954781 DOI: 10.1007/s13340-025-00807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 02/06/2025] [Indexed: 04/02/2025]
Abstract
Background This study aimed to investigate the association between postpartum glucose intolerance and the timing of gestational diabetes mellitus (GDM) diagnosis according to criteria from the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Methods A single-center retrospective case-control study involving patients diagnosed with GDM according to IADPSG criteria was conducted. Patients underwent a postpartum 75 g oral glucose tolerance test (OGTT) and were divided into 2 groups: normal (control) and abnormal glucose tolerance (AGT). Gestational age at GDM diagnosis and the maternal and neonatal outcomes were compared between the groups. Results Data from 177 controls and 102 patients diagnosed with AGT were analyzed. The AGT group exhibited a higher pre-pregnancy body mass index, family history of diabetes, glycated hemoglobin level at the initial visit, and total daily insulin dose, but a lower rate of GDM diagnosis at 24-32 weeks' gestation. GDM diagnosed before 24 weeks' gestation was independently associated with AGT (adjusted odds ratio 2.18 [95% confidence interval 1.28-3.73]; p < 0.01]). Additionally, a higher proportion of patients diagnosed with GDM before 24 weeks' gestation had a lower disposition index (27.1% versus 14.8%; p = 0.01). Conclusions Patients diagnosed with GDM at < 24 weeks' gestation were at higher risk for postpartum glucose intolerance than those diagnosed at 24-32 weeks. The lower disposition index in patients early diagnosed highlights the need for tailored postpartum follow-up to address their specific risks.
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Affiliation(s)
- Akihito Morita
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Ayuko Tanaka
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Daisuke Higeta
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Tatsuya Sato
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Eijiro Yamada
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8511 Japan
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Chung HS, Middleton L, Garg M, Hristova VA, Vega RB, Baker D, Challis BG, Vitsios D, Hess S, Wallenius K, Holmäng A, Andersson-Hall U. Longitudinal clinical and proteomic diabetes signatures in women with a history of gestational diabetes. JCI Insight 2024; 10:e183213. [PMID: 39589852 PMCID: PMC11790031 DOI: 10.1172/jci.insight.183213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 11/21/2024] [Indexed: 11/28/2024] Open
Abstract
We characterized the longitudinal serum protein signatures of women 6 and 10 years after having gestational diabetes mellitus (GDM) to identify factors associated with the development of type 2 diabetes mellitus (T2D) and prediabetes in this at-risk post-GDM population, aiming to discover potential biomarkers for early diagnosis and prevention of T2D. Our study identified 75 T2D-associated serum proteins and 23 prediabetes-associated proteins, some of which were validated in an independent T2D cohort. Machine learning (ML) performed on the longitudinal proteomics highlighted protein signatures associated with progression to post-GDM diabetes. We also proposed prognostic biomarker candidates that were differentially regulated in healthy participants at 6 years postpartum who later progressed to having T2D. Our longitudinal study revealed T2D risk factors for post-GDM populations who are relatively young and healthy, providing insights for clinical decisions and early lifestyle interventions.
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Affiliation(s)
- Heaseung Sophia Chung
- Dynamic Omics, Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Lawrence Middleton
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Manik Garg
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Ventzislava A. Hristova
- Dynamic Omics, Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Rick B. Vega
- Early Clinical Development, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | | | - Benjamin G. Challis
- Translational Science and Experimental Medicine, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Dimitrios Vitsios
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Sonja Hess
- Dynamic Omics, Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Kristina Wallenius
- Bioscience Metabolism, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Agneta Holmäng
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Andersson-Hall
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sundarapperuma TD, Katulanda P, Wijesinghe CJ, Hettiarachchi P, Wasalathanthri S. The impact of a culturally adapted lifestyle intervention on the glycaemic profile of mothers with GDM one year after delivery - a community-based, cluster randomized trial in Sri Lanka. BMC Endocr Disord 2024; 24:104. [PMID: 38977979 PMCID: PMC11229281 DOI: 10.1186/s12902-024-01643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND A woman with a history of GDM has a high risk of developing type two diabetes (T2DM) in her future life. Lifestyle modifications are known to attenuate the progression of GDM to T2DM. Therefore, the aim of this study was to assess the impact of a simple, cost effective, culturally acceptable lifestyle intervention programme on the trajectory towards T2DM in women with a history of GDM. METHODS This cluster randomized trial was conducted in 100 postpartum women in three selected districts of Sri Lanka. The subjects were divided into intervention (n = 50) and control groups (n = 50) by cluster randomization method. A culturally adapted protocol (comprised of dietary and physical activity modifications) was administered to the intervention group. The glycemic profile was assessed using fasting and 2-hour post-OGTT plasma glucose and HbA1c, and insulin resistance by HOMA-IR at baseline and after one year of intervention. RESULTS The mean age (SD) of the subjects in the intervention and control groups were 33.0 (5.1) and 34.3 (6.5) years respectively. All glycemic and insulin resistance parameters (i.e. Fasting plasma glucose- FPG, 2-hour post-OGTT plasma glucose, HbA1c and HOMA-ir) were comparable (p > 0.05) between the two groups at baseline. FPG, 2 h post OGTT, HbA1c and HOMA-ir values between intervention vs. control (p) at 12 months were 87.3 vs. 123.2 (< 0.01); 106.5 vs. 156.1 (0.01); 5.3 vs. 6.8 (< 0.01) and 0.9 vs. 2.3 (< 0.01) respectively. All glycemic parameters showed a significant reduction in the intervention group at 12 months compared to baseline. In contrast, the control group showed a significant increase in FPG, 2-hour post-OGTT plasma glucose and HbA1c at 12 months compared to baseline. In multiple linear regression model adjusted for age, parity and family history, the control group showed an approximately 33 times risk of developing insulin resistance compared to the intervention group. CONCLUSION The culturally acceptable and individualized lifestyle intervention was able to produce remarkable reductions in glycaemic and insulin resistance parameters among postpartum women with a history of GDM. TRIAL REGISTRATION Ethical clearance was obtained from the Ethics Review Committee of the University of Sri Jayewardenepura, Sri Lanka (ERC 52/14), Sri Lanka Clinical trial registration number Sri Lanka Clinical Trials Registry (SLCTR/2015/021 date 25.09.2015).
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Affiliation(s)
- Thamudi D Sundarapperuma
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, 80000, Sri Lanka.
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| | - Champa J Wijesinghe
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, 80000, Sri Lanka
| | - Priyadarshika Hettiarachchi
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, 11222, Sri Lanka
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Tieu S, Koivusalo S, Lahti J, Engberg E, Laivuori H, Huvinen E. Genetic risk of type 2 diabetes modifies the association between lifestyle and glycemic health at 5 years postpartum among high-risk women. BMJ Open Diabetes Res Care 2024; 12:e003942. [PMID: 38631819 PMCID: PMC11029483 DOI: 10.1136/bmjdrc-2023-003942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Lifestyle interventions are effective in preventing type 2 diabetes, but genetic background may influence the individual response. In the Finnish gestational diabetes prevention study, RADIEL, lifestyle intervention during pregnancy and first postpartum year was effective in preventing gestational diabetes (GDM) and postpartum glycemic abnormalities only among women at highest genetic risk of type 2 diabetes. This study aimed to assess whether still 5 years postpartum the genetic risk modifies the association between lifestyle and glycemic health. RESEARCH DESIGN AND METHODS The RADIEL study (randomized controlled trial) aimed to prevent GDM with a lifestyle intervention among high-risk women (body mass index ≥30 kg/m2 and/or prior GDM). The follow-up study 5 years postpartum included anthropometric measurements, laboratory assessments, device-measured physical activity (PA), and questionnaires. A Healthy Lifestyle Score (HLS) indicated adherence to lifestyle goals (PA, diet, smoking) and a polygenic risk score (PRS) based on 50 type 2 diabetes risk alleles depicted the genetic risk. RESULTS Altogether 314 women provided genetic and glycemic data 5 years postpartum. The PRS for type 2 diabetes was not associated with glycemic abnormalities, nor was HLS in the total study sample. There was, however, an interaction between HLS and type 2 diabetes PRS on glycemic abnormalities (p=0.03). When assessing the association between HLS and glycemic abnormalities in PRS tertiles, HLS was associated with reduced risk of glycemic abnormalities only among women at the highest genetic risk (p=0.008). CONCLUSIONS These results extend our previous findings from pregnancy and first postpartum year demonstrating that still at 5 years postpartum, healthy lifestyle is associated with a lower risk of prediabetes/diabetes only among women at the highest genetic risk of type 2 diabetes.
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Affiliation(s)
- Sim Tieu
- Helsinki University Central Hospital, Helsinki, Finland
| | | | - Jari Lahti
- Department of Psychology, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Elina Engberg
- Folkhälsan Research Center, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, Helsinki University Hospital, Helsinki, Finland
- Tampere University, Tampere, Finland
| | - Emilia Huvinen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
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Tsur N, Frankel M, Cahn A, Tsur A. Gestational diabetes and risk of future diabetes in a multi-ethnic population. J Diabetes Complications 2024; 38:108720. [PMID: 38452402 DOI: 10.1016/j.jdiacomp.2024.108720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/09/2024]
Abstract
AIM To investigate ethnic disparities in risk of gestational diabetes-mellitus (GDM) and future diabetes. METHODS A population-based retrospective cohort study of women who underwent a 100-g oral glucose-tolerance-test (oGTT) during pregnancy between 2007 and 2017 in Clalit-Health-Services of the Jerusalem district. Univariate and multivariate logistic regression analyses were used to compare the risk of GDM in Arab versus Jewish women. Further, Cox-regression analysis was used to establish the risk of future diabetes. RESULTS A total of 9875 women, 71 % of Jewish ethnicity and 29 % of Arab ethnicity were included. Arab women had a higher incidence of GDM compared to Jewish women (17.3 % vs. 10.6 %, p < 0.001), which persisted after adjusting for age, BMI, and metabolic profile (aOR 1.7; CI 1.48-2.0, P < 0.001). Additionally, Arab ethnicity was associated with an increased risk of future diabetes, even after adjusting for GDM status (aHR 5.9; 95 % CI 3.7-9.4, P < 0.001). CONCLUSIONS Women of Arab ethnicity have a higher risk for both GDM and future diabetes, a risk that is beyond the initial increased risk associated with GDM. These findings highlight the need for increased focus on preventing diabetes in women of Arab ethnicity, especially those with a history of GDM.
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Affiliation(s)
- Noa Tsur
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Meir Frankel
- Endocrinology Unit, Shaare Zedek Medical Center, Jerusalem, Israel; Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel
| | - Avivit Cahn
- The Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel; The Faculty of Medicine, Hadassah Hebrew University, Jerusalem, Israel
| | - Anat Tsur
- Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel; The Faculty of Medicine, Hadassah Hebrew University, Jerusalem, Israel.
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Tsur N, Pollack R, Frankel M, Tsur A. Future diabetes risk can be predicted by the number of abnormal oral glucose tolerance test values during pregnancy. Diabetes Obes Metab 2024; 26:1050-1056. [PMID: 38112029 DOI: 10.1111/dom.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023]
Abstract
AIM To quantify the future risk of type 2 diabetes (T2D) in women with gestational diabetes (GD) based on baseline metabolic characteristics and the number of abnormal values during a 3-hour 100-g oral glucose tolerance test (OGTT). MATERIALS AND METHODS We conducted a population-based retrospective cohort study of 10 023 pregnant women who underwent testing for GD in a large health maintenance organization in Israel using a 100-g OGTT. Glucose values were obtained at four time points, 0, 60, 120 and 180 minutes. RESULTS We identified 9939 women who met the study criteria. Median follow-up was 3.25 (interquartile range 1.5-5.1; maximum 10.1) years. Using women without GD as reference, women with GD were at an increased risk of future T2D (hazard ratio [HR] 5.33 [95% confidence interval {CI} 3.86-7.34]). This risk increased with a greater number of abnormal OGTT values, with the highest risk seen in women with four abnormal values (HR 16.67 [95% CI 7.94-35.01]). In a multivariate model, a higher number of abnormal values, Arab ethnicity, higher body mass index, triglycerides and prepregnancy glucose were significantly associated with increased risk. Future T2D risk was also affected by the type of OGTT abnormality; an abnormal fasting value had the greatest risk, whereas an abnormal 3-hour value had the lowest risk (HR 3.61 [95% CI 2.42-5.38] vs. 1.50 [95% CI 0.93-2.43], respectively). CONCLUSIONS GD is a heterogenous disease, with varying degrees of glucose intolerance and subsequent T2D risk. Targeting interventions to women at the highest risk may help to improve postpartum adherence and effective long-term follow-up strategies.
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Affiliation(s)
- Noa Tsur
- Department of Internal Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Rena Pollack
- Department of Endocrinology and Metabolism, Hadassah Medical Centre, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meir Frankel
- Endocrinology Unit, Shaare Zedek Medical Centre, Jerusalem, Israel
- Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel
| | - Anat Tsur
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel
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Hummelen R, Sodhi S, Poirier J, Gordon J, Asokan S, Matsumoto CL, Kelly L. Progression From Gestational Diabetes Mellitus to Type 2 Diabetes Mellitus Among First Nations Women in Northwest Ontario: A Retrospective Cohort Study. Can J Diabetes 2023; 47:566-570. [PMID: 37196981 DOI: 10.1016/j.jcjd.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Our aim in this study was to identify the incidence of type 2 diabetes mellitus among First Nations women in northwest Ontario with a history of gestational diabetes mellitus (GDM). METHODS This work was a retrospective cohort study of women diagnosed with GDM using a 50-gram oral glucose challenge test or a 75-gram oral glucose tolerance test from January 1, 2010, to December 31, 2017, at the Sioux Lookout Meno Ya Win Health Centre. Outcomes were assessed based on glycated hemoglobin (A1C) measurements performed between January 1, 2010, and December 31, 2019. RESULTS The cumulative incidence of T2DM among women with a history of GDM was 18% (42 of 237) at 2 years and 39% (76 of 194) at 6 years. Women with GDM who developed T2DM were of similar age and parity and had equivalent C-section rates (26%) compared to those who did not develop T2DM. They had higher birth weights (3,866 grams vs 3,600 grams, p=0.006) and rates of treatment with insulin (24% vs 5%, p<0.001) and metformin (16% vs 5%, p=0.005). CONCLUSIONS GDM confers a significant risk for the development of T2DM in First Nations women. Broad community-based resources, food security, and social programming are required.
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Affiliation(s)
- Ruben Hummelen
- Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, Ontario, Canada
| | - Sumeet Sodhi
- Department of Family and Community Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Poirier
- Sioux Lookout Northern Ontario School of Medicine Local Education Group, Sioux Lookout, Ontario, Canada
| | - Janet Gordon
- Sioux Lookout First Nations Health Authority, Sioux Lookout, Ontario, Canada
| | - Shanthive Asokan
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada
| | - Cai-Lei Matsumoto
- Sioux Lookout Northern Ontario School of Medicine Local Education Group, Sioux Lookout, Ontario, Canada
| | - Len Kelly
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada.
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Utilizing fog computing and explainable deep learning techniques for gestational diabetes prediction. Neural Comput Appl 2022. [DOI: 10.1007/s00521-022-08007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractGestational diabetes mellitus (GDM) is one of the pregnancy complications that poses a significant risk on mothers and babies as well. GDM usually diagnosed at 22–26 of gestation. However, the early prediction is desirable as it may contribute to decrease the risk. The continuous monitoring for mother’s vital signs helps in predicting any deterioration during pregnancy. The originality of this paper is to provide comprehensive framework for pregnancy women monitoring. The proposed Data Replacement and Prediction Framework consists of three layers which are: (i) IoT Layer, (ii) Fog Layer, and (iii) Cloud Layer. The first layer used IOT sensors to aggregate vital sings from pregnancies using invasive and noninvasive sensors. Then the vital signs transmitted to fog nodes to processed and finally stored in the cloud layer. The main contribution in this paper is located in the fog layer producing GDM module to implement two influential tasks which are: (i) Data Finding Methodology (DFM), and (ii) Explainable Prediction Algorithm (EPM) using DNN. First, the DFM is used to replace the unused data to free the cache space for the new incoming data items. The cache replacement is very important in the case of healthcare system as the incoming vital signs are frequent and must be replaced continuously. Second, the EPM is used to predict the incidence of GDM that may occur in the second trimester of the pregnancy. To evaluate our model, we extract data of 16,354 pregnancy women from medical information mart for intensive care (MIMIC III) benchmark dataset. For each woman, vital signs, demographic data and laboratory tests was aggregated. The results of the prediction model superior the state of the art (ACC = 0.957, AUC = 0.942). Regarding to explainability, we utilized Shapley additive explanation framework to provide local and global explanation for the developed models. Overall, the proposed framework is medically intuitive, allow the early prediction of GDM with cost effective solution.
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García-Moreno RM, Benítez-Valderrama P, Barquiel B, Hillman N, Herranz L, Pérez-de-Villar NG. Predictors of postpartum glucose metabolism disorders in women with gestational diabetes mellitus. Diabetes Metab Syndr 2022; 16:102629. [PMID: 36191536 DOI: 10.1016/j.dsx.2022.102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Postpartum glucose metabolism disorders are a common problem in women with gestational diabetes mellitus (GDM). They are often underdiagnosed since many patients do not attend the postpartum screening. This study aims to assess predictors of postpartum glucose metabolism disorders and type 2 diabetes mellitus (T2DM) after GDM. MATERIAL AND METHODS Retrospective study in women with GMD who underwent postpartum screening for glucose metabolism disorders (n = 2688). Logistic regression was used in the statistical analysis. RESULTS 24.6% of women had postpartum glucose metabolism disorder. In multivariate analysis, pre-pregnancy body mass index (BMI) 25-30 kg/m2 (OR 1.46, 95%CI 1.05 to 2.02) or BMI ≥30 kg/m2 (OR 2.62, 95%CI 1.72 to 3.96), diagnosis of GDM before 20 weeks of pregnancy (OR 2.33, 95%CI 1.57 to 3.46), fasting plasma glucose after diagnosis of GDM ≥90 mg/dl (OR 2.12, 95%CI 1.50 to 2.98), postprandial glucose ≥100 mg/dl (OR 1.47, 95%CI 1.09 to 2.99), and HbA1c in the third trimester of pregnancy ≥5.3% (2.04, 95%CI, 1.52 to 2.75) were independent predictors for any postpartum glucose metabolism disorder. CONCLUSION postpartum screening for T2DM should be performed in all women with GDM, and it is especially important not to lose follow-up in those with one or more predictive factors.
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Affiliation(s)
- Rosa M García-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain.
| | | | - Beatriz Barquiel
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Natalia Hillman
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Lucrecia Herranz
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
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11
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Prediction of gestational diabetes based on explainable deep learning and fog computing. Soft comput 2022. [DOI: 10.1007/s00500-022-07420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractGestational diabetes mellitus (GDM) is one of the pregnancy complications that endangers both mothers and babies. GDM is usually diagnosed at 22–26 weeks of gestation. However, early prediction is preferable because it may decrease the risk. The continuous monitoring of the mother’s vital signs helps in predicting any deterioration during pregnancy. The originality of this research is to provide a comprehensive framework for pregnancy women monitoring. The proposed Data Replacement and Prediction Framework consists of three layers, which are: (i) Internet of things (IoT) Layer, (ii) Fog Layer, and (iii) Cloud Layer. The first layer used IoT sensors to aggregate vital signs from pregnancies using invasive and non-invasive sensors. The vital signs are then transmitted to fog nodes to be processed and finally stored in the cloud layer. The main contribution in this research is located in the fog layer producing the GDM module to implement two influential tasks which are as follows: (i) Data Finding Methodology (DFM), and (ii) Explainable Prediction Algorithm (EPM) using DNN. First, the DFM is used to replace the unused data to free up the cache space for new incoming data items. The cache replacement is very important in the case of the healthcare system as the incoming vital signs are frequent and must be replaced continuously. Second, the EPM is used to predict the occurrence of GDM in the second trimester of the pregnancy. To evaluate our model, we extracted data from 16,354 pregnant women from the medical information mart for intensive care (MIMIC III) benchmark dataset. For each woman, vital signs, demographic data, and laboratory tests were aggregated. The results of the prediction model are superior to the state-of-the-art (ACC = 0.957, AUC = 0.942). Regarding explainability, we used Shapley additive explanation (SHAP) framework to provide local and global explanations for the developed models. Overall, the proposed framework is medically intuitive and allows the early prediction of GDM with a cost-effective solution.
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Dai F, Mani H, Nurul SR, Tan KH. Risk stratification of women with gestational diabetes mellitus using mutually exclusive categories based on the International Association of Diabetes and Pregnancy Study Groups criteria for the development of postpartum dysglycaemia: a retrospective cohort study. BMJ Open 2022; 12:e055458. [PMID: 35177456 PMCID: PMC8860034 DOI: 10.1136/bmjopen-2021-055458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Women with gestational diabetes mellitus (GDM) are more predisposed to develop postpartum diabetes mellitus (DM). This study aimed to estimate the relative risk (RR) of postpartum dysglycaemia (prediabetes and DM) using mutually exclusive categories according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria cut-off points in patients with GDM, so as to establish a risk-stratification method for developing GDM management strategies. DESIGN, SETTING AND PARTICIPANTS In this retrospective cohort study, 942 women who had been diagnosed with GDM (IADPSG criteria) at 24-28 weeks of gestation from November 2016 to April 2018 underwent a 75 g oral glucose tolerance test (OGTT) at 6-12 weeks postpartum in a tertiary hospital of Singapore. Seven mutually exclusive categories (three one timepoint positive categories (fasting, 1 hour and 2 hours), three two timepoint positive categories (fasting+1 hour, fasting+2 hours and 1 hour+2 hours) and one three timepoint positive category (fasting+1 hour+2 hours)) were derived from the three timepoint antenatal OGTT according to the IADPSG criteria. To calculate the RRs of postpartum dysglyceamia of each mutually exclusive group, logistic regression was applied. RESULTS 924 mothers with GDM, whose mean age was 32.7±4.7 years, were mainly composed of Chinese (45.4%), Malay (21.7%) and Indian (14.3%) ethnicity. The total prevalence of postnatal dysglycaemia was 16.7% at 6-12 weeks postpartum. Stratifying subjects into seven mutually exclusive categories, the RRs of the one-time, two-time and three-time positive groups of the antenatal OGTT test were 1.0 (Ref.), 2.0 (95% CI=1.3 to 3.1; p=0.001) and 6.7 (95% CI=4.1 to 10.9; p<0.001), respectively, which could be used to categorise patients with GDM into low-risk, intermediate-risk and high-risk group. CONCLUSIONS Mutually exclusive categories could be useful for risk stratification and early management of patients with prenatal GDM. It is plausible and can be easily translated into clinical practice.
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Affiliation(s)
- Fei Dai
- Divsion of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Hemaavathi Mani
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Syaza Razali Nurul
- Divsion of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
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Li N, Li J, Zhang C, Liu G, Leng J, Liu J, Wang L, Li W, Yu Z, Hu G, Chan JCN, Yang X. Usefulness of cut-off points of International criteria for prediction of post-partum diabetes and prediabetes among Chinese women with gestational diabetes. Diabetes Metab Res Rev 2021; 37:e3456. [PMID: 33855793 DOI: 10.1002/dmrr.3456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
AIMS This study tests whether cut-off points of the International Association of Diabetes and Pregnancy Study Group's (IADPSG) criteria had threshold effects on post-partum prediabetes and diabetes among Chinese pregnant women with gestational diabetes mellitus (GDM). MATERIALS AND METHODS A total of 507 out of 1000 women with GDM (948 of them enrolled in a lifestyle trial during pregnancy) turned up for the follow-up study and underwent a 75-g 2-h oral glucose tolerance test. GDM was diagnosed based on the IADPSG's criteria while post-partum diabetes and prediabetes were defined by the World Health Organization's. Generalized logit model was used to obtain odds ratios (OR) and 95% confidence interval (CI) of fasting, 1-h and 2-h plasma glucoses (PGs) for post-partum diabetes and prediabetes. Restricted cubic spline was used to identify any threshold effects. RESULTS At a median of 9.1 weeks post-partum, 3.7% (n = 19) women developed post-partum diabetes and 35.1% (n = 178) developed post-partum prediabetes. Fasting PG ≥ 5.1 mmol/L was associated with markedly increased risk of post-partum diabetes without a discernible threshold (adjusted OR: 3.87, 95% CI: 1.03-14.52) while 2-h PG ≥ 8.5 and ≥ 9.0 mmol/L had threshold effects on post-partum prediabetes (2.10, 1.33-3.30) and diabetes (4.02, 1.04-15.56). The 1-h PG also had a threshold at ≥10.0 mmol/L for prediabetes (1.67, 1.06-2.64), but it was not significant for post-partum diabetes. CONCLUSIONS Among Chinese women with GDM, fasting PG ≥ 5.1 mmol/L was associated with post-partum diabetes without any discernible threshold effects while 2-h PG ≥ 8.5 and ≥ 9.0 mmol/L respectively identified women at high risk of post-partum prediabetes and diabetes.
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Affiliation(s)
- Ninghua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Cuiping Zhang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Gongshu Liu
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Junhong Leng
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Jinnan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Leishen Wang
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Weiqin Li
- Tianjin Women and Children's Health Centre, Tianjin, China
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
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Varejão AM, Ferreira JL, Dória M, Laranjo M, Araújo MC, Peixinho C, Couto AS, Príncipe RM. HbA1c as a predictor of postpartum diabetes mellitus after gestational diabetes mellitus. Diabetes Metab Syndr 2021; 15:102269. [PMID: 34517197 DOI: 10.1016/j.dsx.2021.102269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/22/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
AIMS Women diagnosed with Gestational Diabetes Mellitus (GDM) should be evaluated postpartum with an Oral Glucose Tolerance Test (OGTT). Nevertheless, women frequently fail to it. We intend to evaluate the performance of third trimester HbA1c in the prediction of postpartum diabetes mellitus (PDM). METHODS We conducted a retrospective study of 10245 women with GDM based on the National Registry of GDM. A receiver-operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of third trimester HbA1c in PDM prediction. RESULTS The mean third trimester HbA1c level was 5.81% (SD 0.69%) in women who developed PDM, 5.40% (SD 0.52%) in women with pre-diabetes and 5.21% (SD 0.43%) in women with normal glucose tolerance in postpartum OGTT, with statistically significant differences (p < 0.0001). As to the ROC curve ability to predict PDM was fair, with an optimal cut-off point of HbA1c of 5.4%. Women presenting HbA1c values ≥ 5.4% were 6.1 times more likely to develop PDM. CONCLUSIONS A third trimester HbA1c level ≥5.4% is associated with a significant higher risk of PDM (p < 0.0001). It could be used as a reliable tool for screening women with GDM and detect who will benefit the most from a close follow-up after pregnancy.
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Affiliation(s)
- Ana Mesquita Varejão
- Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr Eduardo Torres, 4461-513, Senhora da Hora, Matosinhos, Portugal.
| | - Joana Lima Ferreira
- Department of Endocrinology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr Eduardo Torres, 4461-513, Senhora da Hora, Matosinhos, Portugal.
| | - Mariana Dória
- Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr Eduardo Torres, 4461-513, Senhora da Hora, Matosinhos, Portugal.
| | - Mafalda Laranjo
- Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr Eduardo Torres, 4461-513, Senhora da Hora, Matosinhos, Portugal.
| | - Mónica Calado Araújo
- Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr Eduardo Torres, 4461-513, Senhora da Hora, Matosinhos, Portugal.
| | - Catarina Peixinho
- Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr Eduardo Torres, 4461-513, Senhora da Hora, Matosinhos, Portugal.
| | - Adelina Sá Couto
- Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr Eduardo Torres, 4461-513, Senhora da Hora, Matosinhos, Portugal.
| | - Rosa Maria Príncipe
- Department of Endocrinology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr Eduardo Torres, 4461-513, Senhora da Hora, Matosinhos, Portugal.
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Hiersch L, Shah BR, Berger H, Geary M, McDonald SD, Murray-Davis B, Halperin I, Retnakaran R, Barrett J, Melamed N. Oral Glucose Tolerance Test Results in Pregnancy Can Be Used to Individualize the Risk of Future Maternal Type 2 Diabetes Mellitus in Women With Gestational Diabetes Mellitus. Diabetes Care 2021; 44:1860-1867. [PMID: 34131049 DOI: 10.2337/dc21-0659] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to quantify the risk of future maternal type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) based on the type and number of abnormal 75-g oral glucose tolerance test (OGTT) values and the diagnostic criteria used for the diagnosis of GDM. RESEARCH DESIGN AND METHODS We conducted a population-based retrospective cohort study of all nulliparous women with a live singleton birth who underwent testing for GDM using a 75-g OGTT in Ontario, Canada (2007-2017). We estimated the incidence rate (per 1,000 person-years), overall risk (expressed as adjusted hazard ratio [aHR]), and risk at 5 years after the index pregnancy of future maternal T2DM. Estimates were stratified by the type and number of abnormal OGTT values, as well as by the diagnostic criteria for GDM (Diabetes Canada [DC] vs. International Association of the Diabetes and Pregnancy Study Groups [IADPSG] criteria). RESULTS A total of 55,361 women met the study criteria. The median duration of follow-up was 4.4 (interquartile range 2.8-6.3; maximum 10.3) years. Using women without GDM as reference (incidence rate 2.18 per 1,000 person-years), women with GDM were at an increased risk of future T2DM; this risk was greater when using the DC compared with the IADPSG criteria (incidence rate 18.74 [95% CI 17.58-19.90] vs. 14.07 [95% CI 13.24-14.91] per 1,000 person-years, respectively). The risk of future maternal T2DM increased with the number of abnormal OGTT values and was highest for women with three abnormal values (incidence rate 49.93 per 1,000 person-years; aHR 24.57 [95% CI 21.26-28.39]). The risk of future T2DM was also affected by the type of OGTT abnormality: women with an abnormal fasting value had the greatest risk, whereas women with an abnormal 2-h value had the lowest risk (aHR 14.09 [95% CI 12.46-15.93] vs. 9.22 [95% CI 8.19-10.37], respectively). Similar findings to those described above were observed when the risk of T2DM at a fixed time point of 5 years after the index pregnancy was considered as the outcome of interest. CONCLUSIONS In women with GDM, individualized information regarding the future risk of T2DM can be provided based on the type and number of abnormal OGTT values, as well as the diagnostic criteria used for the diagnosis of GDM.
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Affiliation(s)
- Liran Hiersch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada .,Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baiju R Shah
- Institutes for Clinical Evaluative Sciences and Health Policy, Management and Evaluation, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Geary
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Beth Murray-Davis
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Ilana Halperin
- Division of Endocrinology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jon Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Olmos-Ortiz A, Flores-Espinosa P, Díaz L, Velázquez P, Ramírez-Isarraraz C, Zaga-Clavellina V. Immunoendocrine Dysregulation during Gestational Diabetes Mellitus: The Central Role of the Placenta. Int J Mol Sci 2021; 22:8087. [PMID: 34360849 PMCID: PMC8348825 DOI: 10.3390/ijms22158087] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) is a transitory metabolic condition caused by dysregulation triggered by intolerance to carbohydrates, dysfunction of beta-pancreatic and endothelial cells, and insulin resistance during pregnancy. However, this disease includes not only changes related to metabolic distress but also placental immunoendocrine adaptations, resulting in harmful effects to the mother and fetus. In this review, we focus on the placenta as an immuno-endocrine organ that can recognize and respond to the hyperglycemic environment. It synthesizes diverse chemicals that play a role in inflammation, innate defense, endocrine response, oxidative stress, and angiogenesis, all associated with different perinatal outcomes.
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Affiliation(s)
- Andrea Olmos-Ortiz
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPer), Ciudad de México 11000, Mexico; (A.O.-O.); (P.F.-E.)
| | - Pilar Flores-Espinosa
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPer), Ciudad de México 11000, Mexico; (A.O.-O.); (P.F.-E.)
| | - Lorenza Díaz
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico;
| | - Pilar Velázquez
- Departamento de Ginecología y Obstetricia, Hospital Ángeles México, Ciudad de México 11800, Mexico;
| | - Carlos Ramírez-Isarraraz
- Clínica de Urología Ginecológica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPer), Ciudad de México 11000, Mexico;
| | - Verónica Zaga-Clavellina
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPer), Ciudad de México 11000, Mexico
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Andersson-Hall U, Joelsson L, Svedin P, Mallard C, Holmäng A. Growth-differentiation-factor 15 levels in obese and healthy pregnancies: Relation to insulin resistance and insulin secretory function. Clin Endocrinol (Oxf) 2021; 95:92-100. [PMID: 33547817 DOI: 10.1111/cen.14433] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE/AIM Growth-differentiation-factor 15 (GDF15) has been suggested to improve or protect beta cell function. During pregnancy, beta cell numbers and function increase to overcome the natural rise in insulin resistance during gestation. In this study, we longitudinally measured serum GDF15 levels during and after pregnancy in women of normal weight (NW) and in women with obesity (OB) and explored associations between GDF15 and changes in beta cell function by homeostatic model assessment (HOMA). METHODS The cohort participants were 38 NW (BMI 22.3 ± 1.7) and 35 OB (BMI 35.8 ± 4.2). Blood was sampled and body composition measured at each trimester (T1, T2, and T3) and at 6, 12 and 18 months postpartum. Fasting glucose, insulin and GDF15 were measured, and HOMA for insulin resistance (HOMA-IR) and beta cell function (HOMA-B) determined. RESULTS GDF15 levels increased significantly each trimester and were ~200-fold higher at T3 than in the nonpregnant postpartum state. GDF15 was higher in NW than OB during pregnancy, but was reversed after pregnancy with a significant interaction effect. GDF15 correlated inversely with BMI and fat-free mass at T3. Low GDF15 was associated with lower incidence of nausea and with carrying a male foetus. The pregnancy induced increase in GDF15 associated with increased HOMA-B in OB and with reduced fasting glucose in all women. CONCLUSION Large gestational upregulation of GDF15 levels may help increase insulin secretory function to overcome pregnancy-induced insulin resistance.
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Affiliation(s)
- Ulrika Andersson-Hall
- Department of Physiology, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Louise Joelsson
- Department of Physiology, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Chemistry, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pernilla Svedin
- Department of Physiology, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Carina Mallard
- Department of Physiology, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Holmäng
- Department of Physiology, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Abstract
BACKGROUND In perinatal epidemiology, the development of risk prediction models is complicated by parity; how repeat pregnancies influence the predictive accuracy of models that include obstetrical history is unclear. METHODS To assess the influence of repeat pregnancies on the association between predictors and the outcomes, as well as the influence of ignoring the nonindependence between pregnancies, we created four analytical cohorts using the Clinical Practice Research Datalink. The cohorts included (1) first deliveries, (2) a random sample of one delivery per woman, (3) all eligible deliveries per woman, and (4) all eligible deliveries and censoring of follow-up at subsequent pregnancies. Using Plasmode simulations, we varied the predictor-outcome association across cohorts. RESULTS We found minimal differences in the relative contribution of predictors to the overall predictions and the discriminative accuracy of models in the cohort of randomly sampled deliveries versus the all deliveries cohort (C-statistic: 0.62 vs. 0.63; Nagelkerke's R2: 0.03 for both). Accounting for clustering and censoring upon subsequent pregnancies also had negligible influence on model performance. We found important differences in model performance between the models developed in the cohort of first deliveries and the random sample of deliveries. CONCLUSIONS In our study, a model including first deliveries had the best predictive accuracy but was not generalizable to women of varying parities. Moreover, including repeat pregnancies did not improve the predictive accuracy of the models. Multiple models may be needed to improve the transportability and accuracy of prediction models when the outcome of interest is influenced by parity.
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A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes. PLoS One 2021; 16:e0252501. [PMID: 34170930 PMCID: PMC8232404 DOI: 10.1371/journal.pone.0252501] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict risk and treatment response, we developed a risk prediction model specifically for women with prior GDM. Methods The Diabetes Prevention Program was a randomized controlled trial to evaluate the effectiveness of intensive lifestyle intervention, metformin (850mg twice daily), and placebo in preventing diabetes. Data from the Diabetes Prevention Program (DPP) was used to conduct a secondary analysis to evaluate 11 baseline clinical variables of 317 women with prediabetes and a self-reported history of GDM to develop a 3-year diabetes risk prediction model using Cox proportional hazards regression. Reduced models were explored and compared with the main model. Results Within three years, 82 (25.9%) women developed diabetes. In our parsimonious model using 4 of 11 clinical variables, higher fasting glucose and hemoglobin A1C were each associated with greater risk for diabetes (each hazard ratio approximately 1.4), and there was an interaction between treatment arm and BMI suggesting that metformin was more effective relative to no treatment for BMI ≥ 35kg/m2 than BMI < 30kg/m2. The model had fair discrimination (bias corrected C index = 0.68) and was not significantly different from our main model using 11 clinical variables. The estimated incidence of diabetes without treatment was 37.4%, compared to 20.0% with intensive lifestyle intervention or metformin treatment for women with a prior GDM. Conclusions A clinical prediction model was developed for individualized decision making for prediabetes treatment in women with prior GDM.
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Migrant Middle Eastern women with gestational diabetes seven years after delivery - positive long-term development of beliefs about health and illness shown in follow-up interviews. Prim Health Care Res Dev 2021; 22:e21. [PMID: 34034848 PMCID: PMC8165453 DOI: 10.1017/s1463423621000232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM No previous studies have been found focusing on the long-term development of beliefs about health, illness and healthcare in migrant women with gestational diabetes mellitus (GDM). The aim of this study was to explore this and the influence on health-related behaviour (i.e. self-care and care seeking) in migrant women from the Middle East living in Sweden seven years after delivery. BACKGROUND GDM is increasing, particularly in migrant women. The risk of adverse outcomes of GDM for health can be improved by interventions reducing blood glucose and lifestyle modifications which medicalise the woman's pregnancy due to intensive follow-up and demanding self-care. The reactions might have an enduring impact on the women's long-term psychological and physical health and adoption of preventive health behaviours. METHOD Qualitative exploratory study. Semi-structured follow-up interviews 7 years after delivery with women previously interviewed in gestational weeks 34-38 and 3 and 14 months after delivery. Data analysed with qualitative content analysis. FINDINGS Health meant freedom from illness, feeling well and living long to be able to care for the children. The present situation was described either positively, changing to a healthier lifestyle, or negatively, with worries about being affected by type 2 diabetes. Beliefs changed among the majority of women, leading to a healthier lifestyle, and they looked positively back at the time when diagnosed and their reactions to it. With few exceptions, they were confident of being aware of future health risks and felt responsible for their own and their children's health/lifestyle. None except those diagnosed with type 2 diabetes had been in contact with healthcare since the last follow-up a year after delivery. Yet, they still would like and need a healthcare model delivering more information, particularly on developing a healthy lifestyle for children, and with regular check-ups also after the first year after delivery.
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Bartáková V, Barátová B, Pácal L, Ťápalová V, Šebestová S, Janků P, Kaňková K. Development of a New Risk Score for Stratification of Women with Gestational Diabetes Mellitus at High Risk of Persisting Postpartum Glucose Intolerance Using Routinely Assessed Parameters. Life (Basel) 2021; 11:life11060464. [PMID: 34070991 PMCID: PMC8224770 DOI: 10.3390/life11060464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 01/21/2023] Open
Abstract
The aims of the study were (i) to find predictive factors for early postpartum conversion of gestational diabetes mellitus (GDM) into persisting glucose intolerance (PGI), (ii) to evaluate potential differences in adverse perinatal outcomes in GDM women with and without early postpartum PGI and, finally, (iii) to establish a risk score to predict postpartum PGI. A cross-sectional study comprised 244 GDM patients with known age, parity, positive family history of diabetes, pre-gestational BMI, comorbidities, smoking history, results of mid-trimester oral glucose tolerance test, HbA1c, obstetric complications, neonatal outcomes and mode of delivery. A risk score was calculated using parameters with highest odds ratios in a statistic scoring model. Significant differences between women with and without PGI postpartum were ascertained for mid-trimester fasting plasma glucose (p < 0.001), HbA1c above 42 mmol/mol (p = 0.035), prevalence of obesity (p = 0.007), hypothyroidism, family history of diabetes and smoking. We also observed higher incidence of prolonged and complicated delivery in PGI group (p = 0.04 and 0.007, respectively). In conclusion, this study identified several parameters with predictive potential for early PGI and also adverse peripartal outcomes. We established a simple risk-stratification score for PGI prediction applicable for GDM affected women prior their leaving maternity ward. Yet, given a relatively small sample size as a main limitation of this study, the proposed score should be validated in the larger cohort.
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Affiliation(s)
- Vendula Bartáková
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.B.); (L.P.); (K.K.)
- Correspondence: ; Tel.: +420-549-495-807
| | - Beáta Barátová
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.B.); (L.P.); (K.K.)
- Department of Pediatrics, University Children Hospital, Černopolní 9, 613 00 Brno, Czech Republic
| | - Lukáš Pácal
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.B.); (L.P.); (K.K.)
| | - Veronika Ťápalová
- Department of Obstetrics and Gynaecology, University Hospital Brno, 625 00 Brno, Czech Republic; (V.Ť.); (P.J.)
| | - Silvie Šebestová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
| | - Petr Janků
- Department of Obstetrics and Gynaecology, University Hospital Brno, 625 00 Brno, Czech Republic; (V.Ť.); (P.J.)
- Department of Nursing and Midwifery, Masaryk University, 625 00 Brno, Czech Republic
| | - Kateřina Kaňková
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.B.); (L.P.); (K.K.)
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CAN B, ÇİFTÇİ S, YENİDÜNYA YALIN G, DİNÇÇAĞ N. Risk factors predicting the development of diabetes mellitus and metabolic syndrome following gestational diabetes mellitus. Turk J Med Sci 2021; 51:595-603. [PMID: 33021758 PMCID: PMC8203179 DOI: 10.3906/sag-2002-65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 10/06/2020] [Indexed: 01/21/2023] Open
Abstract
Background/aim To determine risk factors associated with the development of insulin resistance, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) in gestational diabetes mellitus (GDM) patients 10 years after giving birth. Materials and methods Medical records of patients with former GDM were screened. Eligible patients were invited to the hospital to obtain information about their present health status. Patients with pregestational diabetes and patients with multiple pregnancies were excluded. A total of 67 women formed the study group. American Diabetes Association (ADA) and International Diabetes Federation (IDF) criteria were used to define T2DM and MetS, respectively. Results A total of 27 patients developed diabetes (40.3%) and 35 patients (52%) developed MetS. T2DM developed, on average, 4.8 years after delivery. There was a significant difference between diabetic and nondiabetic patients in terms of insulin use during pregnancy (P < 0.001). Women who developed diabetes within 10 years after giving birth were observed to have significantly higher fasting plasma glucose on oral glucose tolerance test during their pregnancy (P = 0.007). Current and pregestational body mass indices had a significant effect on the development of MetS (P = 0.003 and P = 0.027, respectively). Conclusion In this long-term study, we found that patients with high fasting plasma glucose (FPG) and insulin requirement during pregnancy are at an increased risk of developing T2DM, while pregestational obesity is predictive of progression to MetS. Identifying and targeting high-risk individuals may delay and possibly prevent T2DM and MetS.
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Affiliation(s)
- Bülent CAN
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, İstanbul Medeniyet University, İstanbulTurkey
| | - Sema ÇİFTÇİ
- Department of Endocrinology and Metabolism, Bakırköy Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Gülşah YENİDÜNYA YALIN
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, İstanbul University, İstanbulTurkey
| | - Nevin DİNÇÇAĞ
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, İstanbul University, İstanbulTurkey
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Karakoc Kumsar A, Taskin Yilmaz F, Demirel G. Preferences of participating in diabetes screening programs for postpartum women with gestational diabetes mellitus in a university hospital in Turkey. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-08-2020-0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The aim of this study is to determine the preferences to participate in diabetes screening program of women with gestational diabetes mellitus (GDM) in postpartum period.
Design/methodology/approach
The data of retrospective and descriptive study were collected using “Individual Identification Form” and “Information Form for the Screening of Diabetes in the Postpartum Period” from 151 women in referred to obstetrics and gynecology clinic of a university hospital in Turkey.
Findings
Only 21.9% of women had diabetes screening in postpartum period and 21.2% of the participants were diagnosed with type 2 diabetes. It was determined that the participants mostly participated in screening because of the diabetes history in their family (30.3%). Women who had diabetes screening in postpartum period had lower level of education than those who did not and their level of knowledge about the screening in postpartum and the history of abortion were higher (p < 0.01).
Originality/value
The rate of participation in the screening for diabetes in the postpartum period is very low in pregnant women diagnosed with GDM. It was determined that the educational status, history of previous abortion and knowledge level of the women were factors that prevented participation in diabetes screening. This research is original because there are inadequacy of studies examining determining the participation status of pregnant women with GDM to diabetes screening in the literature. This study will contribute to health professionals in order to improve preventive factors and increase the participation of pregnant women with GDM in diabetes screening in the postpartum period.
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Moore LE, Voaklander B, Savu A, Yeung RO, Ryan E, Chojecki D, Kaul P, Ospina MB. Association between the antepartum oral glucose tolerance test and the risk of future diabetes mellitus among women with gestational diabetes: A systematic review and meta-analysis. J Diabetes Complications 2021; 35:107804. [PMID: 33349557 DOI: 10.1016/j.jdiacomp.2020.107804] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/21/2020] [Accepted: 11/14/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The antepartum oral glucose tolerance test (OGTT) has re-emerged as associated with risk of diabetes among women with gestational diabetes (GDM). This systematic review summarized evidence on associations between antepartum OGTT and risk of diabetes in GDM (PROSPERO CRD42018100316). METHODS MEDLINE, EMBASE, Web of Science, and CENTRAL were searched from January 1, 1982 to February 2020. Studies assessing associations between antepartum OGTT and risk of diabetes among women with GDM were included. Data on study characteristics, participants, OGTT values, and diabetes outcomes were extracted. Estimates on the association between antepartum OGTT and diabetes at follow-up were recorded. Pooled odds ratios for developing diabetes were calculated by study design. FINDINGS AND CONCLUSIONS Of 6423 citations, 17 studies were included. Both elevated fasting blood glucose (FBG; OR: 3.62 ([95% CI 1.30, 10.12], I2 = 36%, p < 0.05)) and 2 h OGTT (OR: 3.96 [1.17, 13.40], I2 = 87%, p < 0.05) were associated with diabetes. These associations were attenuated (FBG: OR: 1.91 ([95% CI 0.80, 24.54], I2 = 83%, p = NS) and 1.58 ([95% CI 0.92, 2.74] I2 = 83%, p = NS) for prospective and retrospective data, respectively; 2 h OGTT: ORa: 1.95 ([95% CI 0.43, 8.93], I2 = 94%, p = NS)) after adjustments for common confounders. Further research is needed before clinical recommendations can be made.
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Affiliation(s)
- Linn E Moore
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
| | - Britt Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Anamaria Savu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Edmond Ryan
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dagmara Chojecki
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Wang T, Yin W, Huang Y, Zhang Q. Identification of Significant Predictors for the Need of Insulin Therapy and Onset of Postpartum Impaired Glucose Tolerance in Gestational Diabetes Mellitus Patients. Diabetes Metab Syndr Obes 2021; 14:2609-2617. [PMID: 34140790 PMCID: PMC8203192 DOI: 10.2147/dmso.s309618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) during pregnancy can greatly increase the risk for a number of adverse prenatal and postpartum consequences, including postpartum impaired glucose tolerance (IGT). Determining the need for insulin therapy is critical for controlling the glycemic level in GDM patients. The study contains two major purposes: 1) to identify the potential predictors for the need of insulin therapy in GDM patients; 2) to identify the factors that are related to the onset of postpartum IGT. MATERIALS AND METHODS Here, we performed a retrospective study on 112 GDM patients in China to identify the significant predictors for the need of insulin therapy and onset of postpartum IGT in patients with GDM. RESULTS Age and gestational weeks at GDM diagnosis, pregestational BMI, family history of diabetes mellitus (DM), plasma glucose levels assessed by 75-g OGTT at both the 1-hour and 2-hour time points (PG-1h and PG-2h) and HbA1c level were all significantly different between the patients that received insulin therapy and those did not. During postpartum, family history of DM, PG-1h PG-2h and HbA1c level were found to be significantly different between the patients with normal glucose tolerance and those with IGT. CONCLUSION Our results reveal a number of factors that are closely associated with the need of insulin therapy and onset of postpartum IGT, especially the PG-1h and PG-2h levels. These findings will provide valuable indications on selection of treatment strategy for GDM and GDM-induced postpartum IGT.
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Affiliation(s)
- Ting Wang
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Department of Reproductive Medicine Center, The First People’s Hospital of Foshan(Affiliated FoShan Hospital of Sun Yat-sen University), Foshan, People’s Republic of China
| | - Wei Yin
- Department of Obstetrics, Guangzhou Women and Children’s Center, Guangzhou, People’s Republic of China
| | - Yonghan Huang
- Department of Reproductive Medicine Center, The First People’s Hospital of Foshan(Affiliated FoShan Hospital of Sun Yat-sen University), Foshan, People’s Republic of China
| | - Qingxue Zhang
- Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Correspondence: Qingxue Zhang Email
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Muche AA, Olayemi OO, Gete YK. Predictors of postpartum glucose intolerance in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria. BMJ Open 2020; 10:e036882. [PMID: 32868358 PMCID: PMC7462231 DOI: 10.1136/bmjopen-2020-036882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To identify the incidence of postpartum glucose intolerance and develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance. DESIGN Prospective cohort study. SETTING Gondar town public health facilities in Northwest Ethiopia. PARTICIPANTS Women who had gestational diabetes mellitus were advised to undergo postpartum oral glucose tolerance test at 6-12 weeks of delivery. MAIN OUTCOME Postpartum glucose intolerance. DATA ANALYSIS Predictors of postpartum glucose intolerance were identified using multivariable logistic regression analysis. The discriminative power of the predictor variables for postpartum glucose intolerance and the model accuracy were computed by area under the receiver operating characteristic curve and estimated by area under the curve (AUC) with 95% CI. RESULTS A total of 112 (85.5%) women with gestational diabetes mellitus returned and completed the postpartum oral glucose tolerance test. The incidence of postpartum glucose intolerance was 21.4% (95% CI14.3 to 28.4), inclusive of 18.7% pre-diabetes and 2.7% diabetes. Multivariable logistic regression analysis revealed that advanced maternal age, high fasting plasma glucose level at diagnosis, overweight and/or obesity, and antenatal depression were predictors of postpartum glucose intolerance. The AUC of the final reduced model to predict postpartum glucose intolerance was 0.884 (95% CI 0.822 to 0.937). Fasting plasma glucose at diagnosis of gestational diabetes mellitus (AUC=0.736, 95% CI0.616 to 0.845) and overweight and/or obesity (AUC=0.718, 95% CI 0.614 to 0.814) were better predictors of postpartum glucose intolerance. Moreover, the AUC for the combined predictors of fasting plasma glucose at diagnosis and mid-upper arm circumference was 0.822 (95% CI 0.722 to 0.907), which was the best predictor. CONCLUSIONS The incidence of postpartum glucose intolerance was high among women with gestational diabetes mellitus. Antenatal predictors modestly predicted postpartum glucose intolerance. The findings suggest ongoing glucose screening is indicated for all women with gestational diabetes mellitus.
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Affiliation(s)
- Achenef Asmamaw Muche
- Pan African University Life and Earth Sciences Institute (including health and agriculture), Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Oladapo O Olayemi
- Obstetrics and Gynaecology, University College Hospital Ibadan, Ibadan, Nigeria
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
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27
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Li Z, Wang D, Cheng Y, Chen P, Ding W, Wang Z. Association between neonatal birthweight and risk of maternal glucose intolerance after gestational diabetes mellitus. J Diabetes Investig 2020; 12:425-433. [PMID: 32628808 PMCID: PMC7926240 DOI: 10.1111/jdi.13349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022] Open
Abstract
Aims/Introduction To evaluate whether the neonatal birthweight (NBW) is associated with early postpartum glucose intolerance in women with gestational diabetes mellitus. Materials and Methods A total of 1,113 women diagnosed with gestational diabetes mellitus who completed an oral glucose tolerance test at 6–9 weeks postpartum between 1 April 2014 and 8 January 2020 were included in this observational prospective cohort study. They were grouped by neonatal birthweight quartiles, and the odds ratios of postpartum glucose intolerance for different levels of neonatal birthweight were assessed. Results A lower NBW quartile was associated with an increased maternal risk of postpartum glucose intolerance after gestational diabetes mellitus. The adjusted odds ratios for maternal glucose intolerance were 1.69 (95% confidence interval 1.13–2.51) in the lowest NBW quartile (NBW 1,980–2,930 g) when compared with the highest NBW quartile (NBW 3,410–4,610 g). The association between lower NBW and maternal glucose intolerance was significantly stronger in women who delivered a girl. Additionally, NBW ≥3,100 g appears to be associated with a lower risk of maternal glucose intolerance postpartum. Conclusions Our findings suggest that low NBW is a previously unrecognized risk factor for maternal glucose intolerance after gestational diabetes in early postpartum in South China.
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Affiliation(s)
- Zhuyu Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dongyu Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunjiu Cheng
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peisong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenjing Ding
- Department of Obstetrics and Gynaecology, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Zilian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Zhuang W, Lv J, Liang Q, Chen W, Zhang S, Sun X. Adverse effects of gestational diabetes-related risk factors on pregnancy outcomes and intervention measures. Exp Ther Med 2020; 20:3361-3367. [PMID: 32855709 DOI: 10.3892/etm.2020.9050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/28/2020] [Indexed: 12/26/2022] Open
Abstract
This study was designed to investigate the risk factors of gestational diabetes mellitus (GDM), analyze its adverse effects on pregnancy outcomes and propose corresponding interventions. From January 2017 to December 2018, 378 GDM patients (GDM group) awaiting delivery in Weifang People's hospital were selected. At the same time, 200 pregnant women with normal blood glucose (NGT) were randomly selected as the control group. According to general and clinical data, the univariate and multivariate logistic regression analyses were used to screen the risk factors for GDM. The pregnancy outcomes of the two groups were calculated and corresponding intervention measures were proposed to provide a basis for the comprehensive prevention and treatment of gestational diabetes. Multivariate logistic regression analysis showed that age, pre-pregnancy body mass index (BMI), family history of diabetes, 2 h postprandial blood glucose (2hPBG), and glycated hemoglobin (HbA1c) were independent risk factors for GDM (P<0.05). The incidence of dystocia and cesarean section, abnormal amniotic fluid, premature rupture of membranes, and pathological pregnancy in the GDM group were significantly higher than those in the normal control group (P<0.01). The probability of fetal distress, macrosomia, small for date infants, and preterm infants in the GDM group was significantly higher than those in the normal control group (P<0.01). The 2hPBG and HbA1c in the GDM group after the intervention were significantly lower than those before intervention (P<0.05). The age of pregnant women and family history of diabetes play important roles in the presence and progression of GDM. Therefore, pregnant women should pay close attention to the relevant risk factors that trigger GDM, in the screening and prevention of GDM during pregnancy, reduce and prevent the presence of GDM to ensure the safety of mothers and infants.
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Affiliation(s)
- Wenzhen Zhuang
- Medical Record Management Section, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Jia Lv
- Department of Obstetrics and Gynecology, Qingdao Hospital of Traditional Chinese Medicine, Qingdao Hiser Hospital, Qingdao, Shandong 266033, P.R. China
| | - Qing Liang
- Department of Obstetrics and Gynecology, Jiyang People's Hospital, Jinan, Shandong 251400, P.R. China
| | - Wenping Chen
- Department of Cardiothoracic Surgery, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Shuangjun Zhang
- Department of Radiology, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Xicai Sun
- Department of Health Management, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
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Tura A, Göbl C, Morettini M, Burattini L, Kautzky-Willer A, Pacini G. Insulin clearance is altered in women with a history of gestational diabetes progressing to type 2 diabetes. Nutr Metab Cardiovasc Dis 2020; 30:1272-1280. [PMID: 32513580 DOI: 10.1016/j.numecd.2020.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Insulin clearance is a relevant process in glucose homeostasis. In this observational study, we aimed to assess insulin clearance (ClINS) in women with former gestational diabetes (fGDM) both early after delivery and after a follow-up. METHODS AND RESULTS We analysed 59 fGDM women, and 16 women not developing GDM (CNT). All women underwent an oral glucose tolerance test (OGTT) yearly, and an insulin-modified intravenous glucose tolerance test (IVGTT) at baseline and at follow-up end (until 7 years). Both IVGTT and OGTT ClINS was assessed as insulin secretion to plasma insulin ratio. We also defined IVGTT first (0-10 min) and second phase (10-180 min) ClINS. We found that 14 fGDM women progressed to type 2 diabetes (PROG), whereas 45 women remained diabetes-free (NONPROG). At baseline, IVGTT ClINS showed alterations in PROG, especially in second phase (0.88 ± 0.10 l·min-1 in PROG, 0.60 ± 0.06 in NONPROG, 0.54 ± 0.07 in CNT, p ≤ 0.03). Differences in ClINS were not found from OGTT. Cox regression analysis showed second phase ClINS as significant type 2 diabetes predictor (hazard ratio = 1.90, 95% confidence interval 1.09-3.30, p = 0.02). CONCLUSION This study showed that insulin clearance derived from an insulin-modified IVGTT is notably altered in women with history of GDM progressing towards type 2 diabetes.
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Affiliation(s)
- Andrea Tura
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy.
| | - Christian Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Micaela Morettini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Laura Burattini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Giovanni Pacini
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy
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Fakhrul-Alam M, Sharmin-Jahan, Mashfiqul-Hasan, Nusrat-Sultana, Mohona-Zaman, Rakibul-Hasan M, Farid-Uddin M, Hasanat MA. Insulin secretory defect may be the major determinant of GDM in lean mothers. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2020; 20:100226. [PMID: 32382513 PMCID: PMC7199011 DOI: 10.1016/j.jcte.2020.100226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/29/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
Aims To compare the insulin sensitivity and secretion indices of pregnant Bangladeshi women with GDM and normal glucose tolerance (NGT). Methods This cross sectional study was performed with 40 GDM and equal number of NGT pregnant women diagnosed on basis of WHO criterion-2013 during 24–40 weeks of gestation. Glucose was measured by glucose oxidase method and fasting insulin by chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate indices of insulin resistance (HOMA-IR), β-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Results The GDM group had significantly higher insulin resistance as indicated by higher fasting insulin value [GDM vs. NGT; 10.23 (7.94–14.50) vs. 7.07 (5.28–11.07) µIU/ml] and HOMA-IR [GDM vs. NGT; 2.47 (1.75–3.43) vs. 1.50 (0.99–2.22)] and poor β-cell secretion [GDM vs. NGT; HOMA-B: 113.37 (90.30–191.35) vs. 150.98 (109.85–271.72), median (IQR); p < 0.001 for all]. HOMA-B was significantly lower in GDM than NGT with BMI < 23 kg/m2 [GDM vs. NGT; 63.37 (49.19–83.83) vs. 134.89 (93.50–193.17) ng/ml; p = 0.010] despite having statistically comparable difference in IR. BMI was found to be a significant predictor of HOMA-IR in GDM. Conclusions Though impairments of both insulin secretion and sensitivity are hallmarks in the pathogenesis of GDM, β-cell dysfunction contributes more to development of GDM in those with relatively lower BMI in our population.
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Affiliation(s)
- M Fakhrul-Alam
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Sharmin-Jahan
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Mashfiqul-Hasan
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Nusrat-Sultana
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Mohona-Zaman
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - M Rakibul-Hasan
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - M Farid-Uddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - M A Hasanat
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
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31
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Miao Z, Wu H, Ren L, Bu N, Jiang L, Yang H, Zhang J, Guo X. Long-Term Postpartum Outcomes of Insulin Resistance and β-cell Function in Women with Previous Gestational Diabetes Mellitus. Int J Endocrinol 2020; 2020:7417356. [PMID: 32184821 PMCID: PMC7061142 DOI: 10.1155/2020/7417356] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS The objective of the present study was to explore the long-term postpartum glucose metabolism in women with previous GDM, and study the mechanism of hyperglycemia from gestation to postpartum by investigating the postpartum insulin resistance and insulin secretion. METHODS A total of 321 females with previous GDM were followed up once during 1- to 6-years postpartum. Characteristics during pregnancy, perinatal period, and postpartum were compared between postpartum NGT and hyperglycemic women. HOMA-IR and HOMA-β were used to assess insulin resistance and insulin secretion levels with different glucose statuses. RESULTS The prevalence of postpartum hyperglycemia had a fluctuant increase from 25.9% at 1 year, to 53.7% at 5 year. 75 g OGTT 2 hPG during pregnancy was an independent predictor of postpartum hyperglycemia with an OR of 2.15 (95% CI 1.245, 3.722) (P=0.006). After ROC analysis, the best equilibrium between sensitivity (70.3%) and specificity (60.4%) for 2 hPG was 9.03 mmol/L. HOMA-IR was increased in postpartum normal glucose tolerance (NGT), prediabetes, and T2DM (1.64 vs. 2.14 vs. 4.27, P=0.006). After ROC analysis, the best equilibrium between sensitivity (70.3%) and specificity (60.4%) for 2 hPG was 9.03 mmol/L. HOMA-IR was increased in postpartum normal glucose tolerance (NGT), prediabetes, and T2DM (1.64 vs. 2.14 vs. 4.27, β were used to assess insulin resistance and insulin secretion levels with different glucose statuses. P=0.006). After ROC analysis, the best equilibrium between sensitivity (70.3%) and specificity (60.4%) for 2 hPG was 9.03 mmol/L. HOMA-IR was increased in postpartum normal glucose tolerance (NGT), prediabetes, and T2DM (1.64 vs. 2.14 vs. 4.27, β were used to assess insulin resistance and insulin secretion levels with different glucose statuses. CONCLUSIONS 75 g OGTT 2h PG during pregnancy higher than 9.03 mmol/L is regarded as an independent risk factor of postpartum hyperglycemia. Insulin resistance with insufficient insulin secretion compensation is still common phenomenon during long-term postpartum. Women with heavier insulin resistance in the postpartum period are more likely develop prediabetes, while decreased β-cell function contributes more to T2DM development.β were used to assess insulin resistance and insulin secretion levels with different glucose statuses.
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Affiliation(s)
- Zhirong Miao
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing 100034, China
| | - Honghua Wu
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing 100034, China
| | - Liu Ren
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing 100034, China
| | - Nan Bu
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing 100034, China
| | - Lili Jiang
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing 100034, China
| | - Huixia Yang
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
| | - Junqing Zhang
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing 100034, China
| | - Xiaohui Guo
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing 100034, China
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Funakoshi S, Yoshimura K, Hirano S, Ohmi S, Amano E, Fukuda Y, Terada Y, Fujimoto S. Undercarboxylated osteocalcin correlates with insulin secretion in Japanese individuals with diabetes. Diabetol Metab Syndr 2020; 12:72. [PMID: 32821293 PMCID: PMC7433182 DOI: 10.1186/s13098-020-00579-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/12/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Undercarboxylated osteocalcin (ucOC) is a secreted protein produced by osteoblasts that regulates insulin secretion and insulin sensitivity in rodents. However, the significance of these effects on glucose metabolism in human remains unknown. Moreover, the pathophysiological roles of ucOC on varying degrees of glucose intolerance, including diabetes need to be elucidated. In the present study, correlations between ucOC and indices of insulin secretion and sensitivity were analyzed in normal glucose tolerance (NGT), impaired glucose metabolism (IGM), and diabetes mellitus (DM) groups. METHODS Based on 75 g OGTT data in Japanese individuals without diabetic medication, or medications which may affect ucOC levels, individuals were classified as having normal glucose tolerance (NGT), impaired glucose metabolism (IGM), or diabetes (DM). In each group, 25 individuals were consecutively recruited [total 75 individuals, age: 65 ± 11 (mean ± SD); BMI: 24.9 ± 3.8 kg/m2]. QUICKI and Matsuda index (MI) were calculated as insulin sensitivity indices. Homeostasis model assessment (HOMA)-β and insulinogenic index (IGI) were calculated as insulin secretion indices. UcOC was measured using ECLIA. Normally-distributed loge-transformed (ln-) values were used for ucOC, HOMA-β, IGI, and MI. RESULTS The ucOC was not significantly different among the three groups. The results of multiple regression analysis showed that ln-ucOC did not significantly correlate with age, sex, BMI, waist circumference, fasting plasma glucose, plasma glucose 120 min after glucose loading, fasting plasma immunoreactive insulin, ln-HOMA-β, QUICKI, or ln-MI in any of the three groups. Interestingly, ln-ucOC correlated with ln-IGI (r = 0.422, P = 0.0354) and HbA1c (r = - 0.574, P = 0.0027) only in the DM group. There was no significant correlation between ln-IGI and age, sex, BMI, or HbA1c in the DM group. Further, the results of multiple regression analysis showed that ln-IGI could be independently predicted by BMI (β = 0.598, P = 0.0014) and ln-ucOC (β = 0.641, P = 0.0007) in the DM group (R2 = 0.488, P = 0.0006). CONCLUSION In our study, ucOC positively correlated with insulin secretion independently of BMI in Japanese individuals with diabetes. These results suggest that ucOC plays more important roles in insulin secretion than in insulin sensitivity in individuals with diabetes.
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Affiliation(s)
- Shogo Funakoshi
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Kumiko Yoshimura
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
- Fukuda Clinic, Kochi, Kochi 780-0023 Japan
| | - Seiki Hirano
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Satoko Ohmi
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Eri Amano
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | | | - Yoshio Terada
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Shimpei Fujimoto
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
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Takahi Y, Miyashita K, Takahara M, Katakami N, Kuroda A, Matsuoka TA, Matsuhisa M, Ito T, Shimomura I. Predictive factors of posttransplant glucose intolerance in Japanese patients with type 1 diabetes after pancreas transplantation. Endocr J 2019; 66:1101-1112. [PMID: 31495809 DOI: 10.1507/endocrj.ej19-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pancreas transplantation (PTx) has been performed worldwide for patients with type 1 diabetes accompanied with end-stage renal disease or uncontrollable glycemic fluctuation. Nevertheless, risk factors of posttransplant glucose intolerance, which is responsible for progress of diabetic complications, remains unclear, especially in cases without pancreatic graft function loss. Therefore, this study was conducted to search for predictive factors of future glucose tolerance in PTx recipients without pancreatic graft function loss. Subjects were selected from among 41 Japanese patients with type 1 diabetes who received PTx between 2000 and 2016 in Osaka University Hospital, and 24 subjects free from rejections and thromboses were analyzed. Several examinations to evaluate insulin secretion and insulin sensitivity within 6 months after transplantation (initial examination) were performed. Glucose tolerance was evaluated by 120-minute post-load plasma glucose level during 75-g oral glucose tolerance tests (OGTT), referred to as PGOGTT120, at the initial examination and between 1 year and 2 years posttransplantation (maintenance period). The initial examination factors that were correlated with PGOGTT120 in the maintenance period were PGOGTT120 [r = 0.52 (p = 0.01)], insulinogenic index [r = -0.65 (p < 0.01)], and the ratio of incremental area under the curve of insulin to that of plasma glucose (iAUCR) calculated from data of OGTT [r = -0.65 (p < 0.01)]. Insulinogenic index [β = -0.28 (p = 0.02)] and iAUCR [β = -0.29 (p = 0.02)] were still significantly correlated with PGOGTT120 in the maintenance period after adjustment for PGOGTT120 at the initial examination. In conclusion, insulinogenic index and iAUCR from OGTT performed in the early posttransplantation period were predictive factors of future glucose intolerance.
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Affiliation(s)
- Yasumitsu Takahi
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Kazuyuki Miyashita
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advance Medical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Taka-Aki Matsuoka
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advance Medical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Toshinori Ito
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka 536-8588, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
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Risks of Dysglycemia Over the First 4 Years After a Hypertensive Disorder of Pregnancy. Can J Diabetes 2019; 43:587-593. [PMID: 31585793 DOI: 10.1016/j.jcjd.2019.07.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/07/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women with the hypertensive disorders of pregnancy (HDP) (preeclampsia [PE] and gestational hypertension [GHTN]) have increased risks of future diabetes. Postpartum glycemic testing offers early identification and treatment of dysglycemia, but evidence-based recommendations for this high-risk population are lacking. The objective of this study was to describe the risks of developing dysglycemia in women with normotensive and hypertensive pregnancies over the first 4 years postpartum. METHODS The Discharge Abstract Database was used to identify women who delivered singleton live-born infants in Calgary, Alberta, Canada, between January 2010 and December 2012 (N=27,300). This was linked with Calgary Laboratory Services (for glycemic tests) and the Pharmaceutical Information Network databases (for antidiabetes medication prescriptions) over the first 4 years postpartum. Logistic regression analyses compared glycemic testing and results were adjusted for maternal age, gestational age, parity and the Pampalon deprivation index. RESULTS Women with HDP had more glycemic testing (GHTN 67.8% and PE 69.9% vs normotensive 60.9%; p<0.001) and significantly higher results for fasting plasma glucose (GHTN 4.82±0.51 mmol/L and PE 4.84±0.54 mmol/L vs normotensive 4.73±0.49 mmol/L; p<0.001), random plasma glucose (GHTN 5.20±0.96 mmol/L and PE 5.39±1.71 mmol/L vs normotensive 5.00±0.87 mmol/L; p<0.001) and glycated hemoglobin levels (PE 5.62±0.53% vs normotensive 5.49±0.32%; p<0.001). Women with HDP had a higher adjusted odds (95% confidence interval) of developing type 2 diabetes compared with normotensive women (GHTN: 2.26, 1.50 to 13.4; PE: 2.02, 0.91 to 4.46). CONCLUSIONS The high prevalence of early dysglycemia highlights the importance of targeted postpartum glycemic testing in women after HDP. Further research on optimal glycemic testing (specific tests and timing) in these high-risk women is needed.
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Poulsen H, Meurman JH, Kautiainen H, Heikkinen AM, Huvinen E, Koivusalo S, Eriksson JG. Oral Health in Women with a History of High Gestational Diabetes Risk. Dent J (Basel) 2019; 7:E92. [PMID: 31484379 PMCID: PMC6784739 DOI: 10.3390/dj7030092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/21/2022] Open
Abstract
We studied oral health in 115 women with and without a history of gestational diabetes (GDM), expecting poorer oral health in the GDM group. Full-mouth examinations were performed 5 years postpartum and the number of teeth, total dental index (TDI) and decayed, missing, filled teeth (DMFT) index were calculated. Bleeding on probing (BOP), probing depth (PD), visible plaque index (VPI), and clinical attachment level (CAL) were recorded. The periodontal inflammatory burden index (PIBI) was calculated. Panoramic radiographs were taken and signs of infections recorded. Oral health habits, symptoms and participants' own opinion of oral health were recorded with questionnaires. At the time of examination, 45% of the women had a history of GDM in the index pregnancy. Mild periodontitis (62%) and bleeding on probing (46%) were common. VPI (13% and 17%, p = 0.009) and PIBI (13.1 and 17.5, p = 0.041) were lower among women with a history of GDM compared with those with no history of GDM. There was no difference between groups in DMFT scores. All women reported good subjective oral health. Thus, contrary to our hypothesis, women with a history of GDM showed better oral health parameters than women without a history of GDM.
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Affiliation(s)
- Hanna Poulsen
- Department of Oral and Maxillofacial Diseases and Helsinki University Hospital, University of Helsinki, PB 700, 00029 HUS, Finland.
| | - Jukka H Meurman
- Department of Oral and Maxillofacial Diseases and Helsinki University Hospital, University of Helsinki, PB 700, 00029 HUS, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014 Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Eastern Finland, PO Box 1627, 70211 Kuopio, Finland
| | - Anna Maria Heikkinen
- Department of Oral and Maxillofacial Diseases and Helsinki University Hospital, University of Helsinki, PB 700, 00029 HUS, Finland
| | - Emilia Huvinen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 HUS, Helsinki, Finland
| | - Saila Koivusalo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 HUS, Helsinki, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014 Helsinki, Finland
- Folkhälsan Research Center, University of Helsinki, PO Box 20, 00014 Helsinki, Finland
- Department of Obstetrics and Gynecology, National University Singapore, Yong Loo Lin School of Medicine, 1E Kent Ridge Road, Singapore 119228, Singapore
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Kasuga Y, Miyakoshi K, Tajima A, Saisho Y, Ikenoue S, Ochiai D, Matsumoto T, Arata N, Hata K, Tanaka M. Clinical and genetic characteristics of abnormal glucose tolerance in Japanese women in the first year after gestational diabetes mellitus. J Diabetes Investig 2019; 10:817-826. [PMID: 30239167 PMCID: PMC6497595 DOI: 10.1111/jdi.12935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/20/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022] Open
Abstract
AIMS/INTRODUCTION Risk factors of type 2 diabetes mellitus in Japanese women with recent gestational diabetes mellitus are unknown. The objective of the present study was to investigate the clinical and genetic characteristics associated with postpartum abnormal glucose tolerance in Japanese women with gestational diabetes mellitus. MATERIALS AND METHODS A total of 213 Japanese women with recent gestational diabetes mellitus who underwent a postpartum 2-h oral glucose tolerance test were investigated. The association between antepartum clinical characteristics and postpartum abnormal glucose tolerance (diabetes or prediabetes based on the Japan Diabetes Society criteria) was examined. Frequencies of 45 known type 2 diabetes mellitus-associated genetic variants were also compared between women with and without postpartum abnormal glucose tolerance. RESULTS A total of 59 women showed postpartum abnormal glucose tolerance (prediabetes, n = 51; diabetes, n = 8). Plasma glucose levels at 1 or 2 h, the insulinogenic index and the insulin secretion-sensitivity index-2 of the antepartum oral glucose tolerance test were independent of postpartum abnormal glucose tolerance risk factors (P = 0.006, P = 0.00002, P = 0.01 and P = 0.006, respectively). Four genetic variants (rs266729 [ADIPOQ], rs6017317 [HNF4A], rs5215 [KCNJ11] and rs7177055 [HMG20A]) showed a nominally significant association with postpartum abnormal glucose tolerance (P < 0.05, respectively). Among these, three were related to insulin secretion. Postpartum abnormal glucose tolerance risk significantly increased with increasing risk-allele number (P = 0.0005; odds ratio 1.91). CONCLUSIONS Clinical features and genetic variants related to impaired insulin secretion are risk factors of postpartum abnormal glucose tolerance in Japanese women with recent gestational diabetes mellitus.
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Affiliation(s)
- Yoshifumi Kasuga
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
- Department of Maternal‐Fetal BiologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Kei Miyakoshi
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Atsushi Tajima
- Department of Bioinformatics and GenomicsGraduate School of Advanced Preventive Medical SciencesKanazawa UniversityIshikawaJapan
| | - Yoshifumi Saisho
- Department of Internal MedicineKeio University School of MedicineTokyoJapan
| | - Satoru Ikenoue
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Daigo Ochiai
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Tadashi Matsumoto
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Naoko Arata
- Department of Women's HealthNational Center for Child Health and DevelopmentTokyoJapan
| | - Kenichiro Hata
- Department of Maternal‐Fetal BiologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Mamoru Tanaka
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
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Gilbert L, Gross J, Lanzi S, Quansah DY, Puder J, Horsch A. How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review. BMC Pregnancy Childbirth 2019; 19:60. [PMID: 30732571 PMCID: PMC6367798 DOI: 10.1186/s12884-019-2185-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Gestational Diabetes Mellitus (GDM) is associated with future cardio-metabolic risks for the mother and her child. In addition, one-third of women with recent GDM develop postpartum depression. Given these adverse impacts of GDM on the health of the mother and her offspring, it is important to intervene on modifiable factors, such as diet, physical activity, and psychosocial well-being. This integrative review therefore explored evidence on how these modifiable factors interact in women with GDM and their offspring, and how effective combined interventions are on reducing adverse impacts of GDM. Methods A comprehensive search strategy included carefully selected terms that corresponded to the domains of interest (diet, physical activity and psychosocial well-being). The databases searched for articles published between 1980 and February 2018 were: CINAHL, PsycINFO, Embase, Pubmed and Cochrane. Studies that were included in this review were either observational or intervention studies that included at least two domains of interest. Articles had to at least report data on maternal outcomes of women with GDM. Results The search strategies identified 14′419 citations after excluding duplicates. After screening titles and then abstracts, 114 articles were selected for detailed evaluation of their full text, and 16 were included in this review: two observational and 14 intervention studies. Results from observational studies showed that psychosocial well-being (social support and self-efficacy) were positively associated with physical activity and dietary choice. Intervention studies always included diet and physical activity interventions, although none integrated psychosocial well-being in the intervention. These lifestyle interventions mostly led to increased physical activity, improved diet and lower stress perception. Many of these lifestyle interventions also reduced BMI and postpartum diabetes status, improved metabolic outcomes and reduced the risk of preterm deliveries and low birth weight. Conclusion This integrative review showed that psychosocial well-being interacted with diet as well as with physical activity in women with GDM. We recommend that future studies consider integrating psychosocial well-being in their intervention, as observational studies demonstrated that social support and self-efficacy helped with adopting a healthy lifestyle following GDM diagnosis. Electronic supplementary material The online version of this article (10.1186/s12884-019-2185-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leah Gilbert
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.
| | - Justine Gross
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.,Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Stefano Lanzi
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.,Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Jardena Puder
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010, Lausanne, Switzerland.,Neonatology service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
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Civantos S, Durán M, Flández B, Merino M, Navea C, Guijarro G, Martell N, Monereo S. Factores predictores de diabetes mellitus posparto en pacientes con diabetes gestacional. ENDOCRINOL DIAB NUTR 2019; 66:83-89. [DOI: 10.1016/j.endinu.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 01/23/2023]
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Wahlberg J, Ekman B, Arnqvist HJ. Most Women with Previous Gestational Diabetes Mellitus Have Impaired Glucose Metabolism after a Decade. Int J Mol Sci 2018; 19:ijms19123724. [PMID: 30477103 PMCID: PMC6321586 DOI: 10.3390/ijms19123724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022] Open
Abstract
Of 1324 women diagnosed with gestational diabetes mellitus (GDM) in Sweden, 25% reported >10 years after the delivery that they had developed diabetes mellitus. We assessed the long-term risk of all glucose metabolic abnormalities in a subgroup of these women. Women (n = 51) previously diagnosed with GDM by capillary blood glucose ≥9.0 mmol/L (≈plasma glucose ≥10.0 mmol/L) after a 2 h 75 g oral glucose tolerance test (OGTT) were included. All underwent a clinical and biochemical evaluation, including a second 2 h 75 g OGTT. Individuals with known type 1 diabetes were excluded. At the follow-up, 12/51 (24%) reported previously diagnosed type 2 diabetes. Another four cases were diagnosed after the second OGTT, increasing the prevalence to 16/51 cases (31%). Impaired fasting plasma glucose (IFG) was diagnosed in 13/51 women and impaired glucose tolerance (IGT) in 10/51 women, leaving only 12 women (24%) with normal glucose tolerance. In addition, 2/51 women had high levels of glutamic acid decarboxylase (GAD) antibodies; of these, one woman classified as type 2 diabetes was reclassified as type 1 diabetes, and the second GAD-positive woman was diagnosed with IGT. Of the women diagnosed with GDM by a 2 h 75 g OGTT, a large proportion had impaired glucose metabolism a decade later, including type 1 and type 2 diabetes.
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Affiliation(s)
- Jeanette Wahlberg
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, S-581 85 Linköping, Sweden.
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden.
| | - Bertil Ekman
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, S-581 85 Linköping, Sweden.
| | - Hans J Arnqvist
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden.
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Andersson-Hall U, Carlsson NG, Sandberg AS, Holmäng A. Circulating Linoleic Acid is Associated with Improved Glucose Tolerance in Women after Gestational Diabetes. Nutrients 2018; 10:nu10111629. [PMID: 30400149 PMCID: PMC6266712 DOI: 10.3390/nu10111629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023] Open
Abstract
Women with previously diagnosed gestational diabetes mellitus (GDM) are at increased risk of type-2-diabetes mellitus (T2D). We aimed to establish links between glucose tolerance (GT) and serum fatty acid (FA) profile in the transition from GDM to T2D. Six years after GDM, 221 women were grouped as having normal GT (NGT), impaired GT (IGT), or T2D based on oral GT test results. Fasting serum FAs were profiled, anthropometric measures taken, and dietary intake determined. Linoleic acid (LA) was significantly higher in NGT women (p < 0.001) compared with IGT and T2D, and emerged as a strong predictor of low glucose and insulin levels, independently of BMI. Self-reported vegetable oil consumption correlated with LA serum levels and glucose levels. Delta-6-, delta-9-, and stearoyl-CoA-desaturase activities were associated with decreased GT, and delta-5-desaturase activities with increased GT. In a subgroup of women at high risk of diabetes, low LA and high palmitic acid levels were seen in those that developed T2D, with no differences in other FAs or metabolic measurements. Results suggest that proportions of LA and palmitic acid are of particular interest in the transition from GDM to T2D. Interconversions between individual FAs regulated by desaturases appear to be relevant to glucose metabolism.
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Affiliation(s)
- Ulrika Andersson-Hall
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.
| | - Nils-Gunnar Carlsson
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, 412 96 Gothenburg, Sweden.
| | - Ann-Sofie Sandberg
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, 412 96 Gothenburg, Sweden.
| | - Agneta Holmäng
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.
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Huvinen E, Eriksson JG, Koivusalo SB, Grotenfelt N, Tiitinen A, Stach-Lempinen B, Rönö K. Heterogeneity of gestational diabetes (GDM) and long-term risk of diabetes and metabolic syndrome: findings from the RADIEL study follow-up. Acta Diabetol 2018; 55:493-501. [PMID: 29460080 DOI: 10.1007/s00592-018-1118-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/09/2018] [Indexed: 12/14/2022]
Abstract
AIMS To assess the metabolic health of obese and non-obese women at high GDM risk 5 years postpartum. METHODS This is a secondary analysis of the 5-year follow-up of the RADIEL GDM prevention study including 333 women at high GDM risk (BMI ≥ 30 kg/m2 and/or previous GDM). Five years postpartum metabolic health was assessed including anthropometric measurements, oral glucose tolerance test, lipid metabolism, and body composition as well as medical history questionnaires. For the analysis, we divided the women into four groups based on parity, BMI, and previous history of GDM. RESULTS Five years postpartum impaired glucose regulation (IFG, IGT, or diabetes) was diagnosed in 15% of the women; 3.6% had type 2 diabetes. The highest prevalence was observed among obese women with a history of GDM (26%), and the lowest prevalence (8%) among primiparous obese women (p = 0.021). At follow-up 25-39% of the obese women fulfilled the diagnostic criteria for the metabolic syndrome, in the non-obese group 11% (p < 0.001). This was associated with body fat percentage. The non-obese group, however, faced metabolic disturbances (IFG, IGT, diabetes, or metabolic syndrome) at a significantly lower BMI (p < 0.001). Among women who were non-obese before pregnancy, 5 years postpartum, the obesity prevalence based on BMI was 14% and based on body fat percentage 58%. CONCLUSIONS The prevalence of impaired glucose regulation and metabolic syndrome is high 5 years postpartum among women at high risk of GDM. There are high-risk women also among the non-obese, who develop metabolic derangements already at a lower BMI. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.com , NCT01698385.
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Affiliation(s)
- Emilia Huvinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Department of General Practice and Primary Health Care, Biomedicum Helsinki, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland.
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, Biomedicum Helsinki, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nora Grotenfelt
- Department of General Practice and Primary Health Care, Biomedicum Helsinki, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
| | - Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Das Gupta R, Gupta S, Das A, Biswas T, Haider MR, Sarker M. Ethnic predisposition of diabetes mellitus in the patients with previous history of gestational diabetes mellitus: a review. Expert Rev Endocrinol Metab 2018; 13:149-158. [PMID: 30058900 DOI: 10.1080/17446651.2018.1471354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/27/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The worldwide prevalence of Gestational Diabetes Mellitus (GDM) is increasing day by day. However, there is a knowledge gap regarding the effect of ethnic and geographical distribution on the risk of developing Diabetes Mellitus (DM) in women with history of GDM. This review was conducted to find out the role of ethnic and geographical distribution on the risk of developing DM is women with GDM. AREAS COVERED In this review we conducted a comprehensive search of published studies through different electronic databases (PubMed, Google Scholar, CINAHL, CINAHL plus and EMBASE) published between 1990 and 2017. The studies which were published in English investigated the risk of development of DM in women with previous history of GDM, reported outcome according to ethnicity with specific criteria of reporting DM and GDM, reported development of diabetes after 6 month of delivery in women with GDM during pregnancy were included. Initially, 350 articles were identified, among which 16 articles were included in the final review. EXPERT COMMENTARY Studies showed the increased risk of developing subsequent DM is associated with precedent GDM. Around 7-84% women developed diabetes after GDM in five years follow up, where some studies reported the risk continues to increase with increasing age. Risk of DM was found higher for some specific ethnicities, irrespective of the location of the study conducted. East Indian women showed the highest risk of postpartum DM after GDM and the crude prevalence remained almost similar in all form of study worldwide. Public health programme should focus more on women belonging to high-risk ethnicity of GDM for the prevention of postpartum DM.
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Affiliation(s)
- Rajat Das Gupta
- a BRAC James P Grant School of Public Health , BRAC University , Dhaka , Bangladesh
| | - Sabyasachi Gupta
- b Department of Medicine , Chittagong Medical College and Hospital , Chittagong , Bangladesh
| | - Anupom Das
- c The JiVitA Project , Johns Hopkins University , Gaibandha , Bangladesh
| | - Tuhin Biswas
- d Health System and Population Studies Division , The International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Mohammad Rifat Haider
- e Department of Public Health and Informatics , Jahangirnagar University , Dhaka , Bangladesh
- f Department of Health, Promotion, Education & Behavior, Norman J Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , United States
| | - Malabika Sarker
- a BRAC James P Grant School of Public Health , BRAC University , Dhaka , Bangladesh
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Coetzee A, Mason D, Hall DR, Conradie M. Prevalence and predictive factors of early postpartum diabetes among women with gestational diabetes in a single-center cohort. Int J Gynaecol Obstet 2018; 142:54-60. [PMID: 29574853 DOI: 10.1002/ijgo.12494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/28/2018] [Accepted: 03/22/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the prevalence of diabetes at 6-12 weeks postpartum among women with gestational diabetes mellitus (GDM), and to identify prenatal postpartum diabetes predictors. METHODS In the present prospective cohort study, glucose statuses of consecutive women newly diagnosed with hyperglycemia during pregnancy were evaluated at 6-12 weeks postpartum between November 1, 2015, and November 1, 2016, at Tygerberg Hospital, Cape Town, South Africa. Women with known diabetes were excluded. RESULTS There were 78 patients included; 36 (46%) patients had abnormal postpartum glucose values (21 [27%] diabetes; 15 [19%] pre-diabetes) and 29 (37%) had overt diabetes in pregnancy. In univariate analyses, GDM diagnosis before 24 weeks of pregnancy (P<0.001), degree of hyperglycemia at diagnosis (P=0.001), need for insulin (P=0.001), glycosylated hemoglobin (HbA1c) in the month preceding delivery (P=0.006), older than 36 years (P=0.039), family history of diabetes (P=0.048), and preterm labor (P=0.039) were risk factors for postpartum diabetes. Multivariate analyses confirmed family history of diabetes (OR 7.45, 95% CI 1.05-52.76; P=0.044), HbA1c at diagnosis (OR 5.33, 95% CI 2.25-12.60; P<0.001), and age (OR 8.8, 95% CI 1.35-58.45; P=0.023), as robust predictors of diabetes after GDM. CONCLUSION The high prevalence of diabetes supports early postpartum oral glucose tolerance testing. Several women had undiagnosed diabetes. The risk factors identified could be useful for prenatal risk stratification.
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Affiliation(s)
- Ankia Coetzee
- Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Deidre Mason
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - David R Hall
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Magda Conradie
- Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Chirakalwasan N, Amnakkittikul S, Wanitcharoenkul E, Charoensri S, Saetung S, Chanprasertyothin S, Chailurkit LO, Panburana P, Bumrungphuet S, Thakkinstian A, Reutrakul S. Continuous Positive Airway Pressure Therapy in Gestational Diabetes With Obstructive Sleep Apnea: A Randomized Controlled Trial. J Clin Sleep Med 2018; 14:327-336. [PMID: 29458699 DOI: 10.5664/jcsm.6972] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/02/2017] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with gestational diabetes mellitus (GDM). This study assessed the effects of continuous positive airway pressure (CPAP) in obese pregnant females with GDM and OSA. METHODS A randomized controlled trial was conducted (April 2014 - June 2016). Obese females at 24 to 34 weeks gestation and with diet-controlled GDM were screened for OSA. Those with OSA were randomly assigned to receive 2 weeks nightly CPAP or be part of a waitlist control group. After 2 weeks, all patients were offered CPAP. The primary outcome was glucose metabolism, obtained from an oral meal tolerance test (MTT) at baseline and 2 weeks. Pregnancy outcomes were collected. RESULTS Eighteen patients were randomized to CPAP and 18 to control groups. There were no significant changes between groups in fasting glucose, glucose response to MTT, and insulin sensitivity or secretion after 2 weeks. Those adherent to CPAP had significantly improved insulin secretion (P = .016) compared to the control group. When a counterfactual instrumental variable approach was applied to deal with nonadherence, the CPAP group had significantly improved insulin secretion (P = .002) and insulin sensitivity (P = .015). Lower rates of preterm delivery (P = .002), unplanned cesarean section (P = .005), and neonatal intensive care unit admissions (P < .001) were observed among those who used CPAP longer than 2 weeks. CONCLUSIONS Two weeks of CPAP in females with GDM and OSA did not result in improved glucose levels, but insulin secretion improved in those adherent to CPAP. Continued CPAP use was possibly associated with improved pregnancy outcomes. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Obstructive Sleep Apnea and Gestational Diabetes: Incidence and Effects of Continuous Positive Airway Pressure Treatment on Glucose Metabolism; Identifier: NCT02108197; URL: https://clinicaltrials.gov/ct2/show/NCT02108197.
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Affiliation(s)
- Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Somvang Amnakkittikul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ekasitt Wanitcharoenkul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sunee Saetung
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwannee Chanprasertyothin
- Research Center, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - La-Or Chailurkit
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panyu Panburana
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sommart Bumrungphuet
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, Illinois
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Pastore I, Chiefari E, Vero R, Brunetti A. Postpartum glucose intolerance: an updated overview. Endocrine 2018; 59:481-494. [PMID: 28808874 DOI: 10.1007/s12020-017-1388-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/28/2017] [Indexed: 12/19/2022]
Abstract
The prevalence of type 2 diabetes mellitus has increased worldwide over the past three decades, as a consequence of the more westernized lifestyle, which is responsible for the increasing obesity rate in the modern adult's life. Concomitant with this increase there has been a gradual rise in the overall prevalence of gestational diabetes mellitus, a condition that strongly predisposes to overt diabetes later in life. Many women with previous gestational diabetes mellitus show glucose intolerance in the early postpartum period. Although the best screening strategy for postpartum glucose intolerance is still debated, numerous evidences indicate that identification of these women at this time is of critical importance, as efforts to initiate early intensive lifestyle modification, including hypocaloric diet and physical activity, and to ameliorate the metabolic profile of these high-risk subjects can prevent or delay the onset of type 2 diabetes mellitus. Nevertheless, less than one fifth of women attend the scheduled postpartum screening following gestational diabetes mellitus and they are at increased risk to develop type 2 diabetes mellitus later in their lives. Unsatisfying results have also come from early intervention strategies and tools that have been developed during the last few years to help improving the rate of adherence to postpartum glycemic testing, thereby indicating that more effective strategies are needed to improve women's participation in postpartum screening.
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Affiliation(s)
- Ida Pastore
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa (Loc. Germaneto), Catanzaro, 88100, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa (Loc. Germaneto), Catanzaro, 88100, Italy
| | - Raffaella Vero
- Complex Operative Structure Endocrinology-Diabetology, Hospital Pugliese-Ciaccio, Catanzaro, 88100, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa (Loc. Germaneto), Catanzaro, 88100, Italy.
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Kugishima Y, Yasuhi I, Yamashita H, Sugimi S, Umezaki Y, Suga S, Fukuda M, Kusuda N. Risk factors associated with the development of postpartum diabetes in Japanese women with gestational diabetes. BMC Pregnancy Childbirth 2018; 18:19. [PMID: 29310607 PMCID: PMC5759797 DOI: 10.1186/s12884-017-1654-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/29/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although the onset of gestational diabetes (GDM) is known to be a significant risk factor for the future development of type 2 diabetes, this risk specifically in women with GDM diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria has not yet been thoroughly investigated. This study was performed to investigate the risk factors associated with the development of postpartum diabetes in Japanese women with a history of GDM, and the effects of the differences in the previous Japanese criteria and the IADPSG criteria. METHODS This retrospective cohort study included Japanese women with GDM who underwent at least one postpartum oral glucose tolerance test (OGTT) between 2003 and 2014. Cases with overt diabetes in pregnancy were excluded. We investigated the risk factors including maternal baseline and pregnancy characteristics associated with the development of postpartum diabetes. RESULTS Among 354 women diagnosed with GDM during the study period, 306 (86%) (116/136 [85.3%] and 190/218 [87.2%] under the previous criteria and the IADPSG criteria, respectively) who underwent at least 1 follow-up OGTT were included in the study. Thirty-two women (10.1%) developed diabetes within a median follow-up period of 57 weeks (range, 6-292 weeks). Eleven (9.5%) and 21 (11.1%) were diagnosed as GDM during pregnancy based on the previous Japanese criteria and the IADPSG criteria, respectively, which did not significantly differ between those criteria. A multivariate logistic regression analysis revealed that HbA1c and 2-h plasma glucose (PG) at the time of the diagnostic OGTT during pregnancy were independent predictors of the development of diabetes after adjusting for confounders. The adjusted relative risk of HbA1c ≥5.6% for the development of diabetes was 4.67 (95% confidence interval, 1.53-16.73), while that of 2-h PG ≥183 mg/dl was 7.02 (2.51-20.72). CONCLUSIONS A modest elevation of the HbA1c and 2-h PG values at the time of the diagnosis of GDM during pregnancy are independent predictors of the development of diabetes during the postpartum period in Japanese women with a history of GDM. The diagnostic criteria did not affect the incidence of postpartum diabetes.
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Affiliation(s)
- Yukari Kugishima
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan.
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Masashi Fukuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Nobuko Kusuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
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Andersson-Hall U, Gustavsson C, Pedersen A, Malmodin D, Joelsson L, Holmäng A. Higher Concentrations of BCAAs and 3-HIB Are Associated with Insulin Resistance in the Transition from Gestational Diabetes to Type 2 Diabetes. J Diabetes Res 2018; 2018:4207067. [PMID: 29967793 PMCID: PMC6008749 DOI: 10.1155/2018/4207067] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/07/2018] [Indexed: 01/22/2023] Open
Abstract
AIM Determine the metabolic profile and identify risk factors of women transitioning from gestational diabetes mellitus (GDM) to type 2 diabetes mellitus (T2DM). METHODS 237 women diagnosed with GDM underwent an oral glucose tolerance test (OGTT), anthropometrics assessment, and completed lifestyle questionnaires six years after pregnancy. Blood was analysed for clinical variables (e.g., insulin, glucose, HbA1c, adiponectin, leptin, and lipid levels) and NMR metabolomics. Based on the OGTT, women were divided into three groups: normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. RESULTS Six years after GDM, 19% of subjects had T2DM and 19% IGT. After BMI adjustment, the IGT group had lower HDL, higher leptin, and higher free fatty acid (FFA) levels, and the T2DM group higher triglyceride, FFA, and C-reactive protein levels than the NGT group. IGT and T2DM groups reported lower physical activity. NMR measurements revealed that levels of branched-chain amino acids (BCAAs) and the valine metabolite 3-hydroxyisobyturate were higher in T2DM and IGT groups and correlated with measures of insulin resistance and lipid metabolism. CONCLUSION In addition to well-known clinical risk factors, BCAAs and 3-hydroxyisobyturate are potential markers to be evaluated as predictors of metabolic risk after pregnancy complicated by GDM.
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Affiliation(s)
- Ulrika Andersson-Hall
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carolina Gustavsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Pedersen
- Swedish NMR Centre, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Malmodin
- Swedish NMR Centre, University of Gothenburg, Gothenburg, Sweden
| | - Louise Joelsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Holmäng
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wanitcharoenkul E, Chirakalwasan N, Amnakkittikul S, Charoensri S, Saetung S, Chanprasertyothin S, Chailurkit LO, Panburana P, Bumrungphuet S, Ongphiphadhanakul B, Reutrakul S. Obstructive sleep apnea and diet-controlled gestational diabetes. Sleep Med 2017; 39:101-107. [PMID: 29157580 DOI: 10.1016/j.sleep.2017.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/26/2017] [Accepted: 08/29/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) was shown to be associated with gestational diabetes mellitus (GDM). However, prevalence of OSA in GDM women, its relationship to metabolic control, and predictive factors have not been studied. MATERIAL AND METHODS Eighty-two obese pregnant women with diet-controlled GDM between 24 and 34 weeks of gestation participated. The Berlin questionnaire was used to assess OSA symptoms. OSA was diagnosed using an overnight monitor. Fasting glucose and hemoglobin A1c (HbA1c) were obtained. Those with OSA underwent meal tolerance test (MTT) to assess their metabolic parameters. Classification tree analysis was used to develop a screening tool for OSA. RESULTS At a median gestational age of 29 weeks, OSA was diagnosed in 52.4% of the women, with a median apnea hypopnea index of 9.4 (interquartile range 6.4, 12.4). More severe OSA was significantly correlated with higher fasting glucose but not HbA1c. For those with OSA, sleep parameters related to oxygen desaturation significantly correlated with higher fasting insulin resistance and more severe β-cell dysfunction, as evaluated by MTT. A screening tool involving two variables, neck circumference and Berlin Questionnaire score, was developed. The sensitivity and specificity were 86% and 51%, respectively. The overall accuracy was 70%. CONCLUSION OSA is prevalent in obese pregnant women with diet-controlled GDM in the late second to early third trimester. OSA severity, especially the degree of oxygen desaturation, correlated with fasting glucose, insulin resistance, and β-cell function. A simple screening tool involving the Berlin Questionnaire and neck circumference can aid in predicting OSA in this patient group.
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Affiliation(s)
- Ekasitt Wanitcharoenkul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok 10330, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Rd, Pathumwan, Bangkok 10330, Thailand
| | - Somvang Amnakkittikul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - Sunee Saetung
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - Suwannee Chanprasertyothin
- Research Center, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - La-Or Chailurkit
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - Panyu Panburana
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - Sommart Bumrungphuet
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - Boonsong Ongphiphadhanakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok 10400, Thailand.
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Benhalima K, Verstraete S, Muylle F, Decochez K, Devlieger R, Crombrugge PV, Verhaegen A, Wens J, Mathieu C. Implementing a Reminder System in the Northern Part of Belgium to Stimulate Postpartum Screening for Glucose Intolerance in Women with Gestational Diabetes: The "Sweet Pregnancy" Project. Int J Endocrinol 2017; 2017:3971914. [PMID: 28775742 PMCID: PMC5523233 DOI: 10.1155/2017/3971914] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/25/2017] [Indexed: 01/21/2023] Open
Abstract
AIMS To evaluate the feasibility and efficacy of a gestational diabetes (GDM) recall register on the long-term screening uptake postpartum and to evaluate the prevalence of prediabetes postpartum. METHODS Evaluation of a GDM recall register implemented in 66 obstetrical centers in the northern part of Belgium from 2009 to 2016. Registrants receive yearly reminders to have a fasting plasma glucose test in primary care to timely detect prediabetes. RESULTS After 6 years, 7269 women were registered. The yearly response rates varied from 74.4% after the first year to 61.8% after the fifth year. The number of women who reported a screening test varied from 67.4% after the first year to 71.9% after the fifth year. Compared to women who responded at least once to a reminder, women who never responded were more often <30 years (41.4% versus 33.9%, p < 0.001) and were more often obese (29.3% versus 20.8%, p ≤ 0.001). Over a period of 6 years, 7.3% (CI 6.0%-8.8%) developed diabetes and 27.4% (CI 23.9%-31.0%) developed impaired fasting glycaemia. CONCLUSION We show now the long-term feasibility and efficacy of a GDM recall register to stimulate screening postpartum. One-third of women developed prediabetes within 6 years.
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Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | | | | | | | - Roland Devlieger
- Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | | | - Ann Verhaegen
- Department of Endocrinology, AZ Jan Palfijn, Merksem, Belgium
| | - Johan Wens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Wilrijk, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
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