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Pisek A, McKinney CM, Muktabhant B, Pitiphat W. Maternal Metabolic Status and Orofacial Cleft Risk: A Case-Control Study in Thailand. Int Dent J 2024:S0020-6539(24)00061-3. [PMID: 38614877 DOI: 10.1016/j.identj.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES Metabolic syndrome (MetS) has been suggested to play a role in congenital defects. This study investigated the association of MetS and its components with orofacial clefts (OFCs). METHODS We conducted a case-control study in Northeast Thailand. Ninety-four cases with cleft lip, with or without cleft palate, were frequency matched with 94 controls on the infant's age and mother's education. We administered a mother's health questionnaire and collected anthropometric measurements and blood samples. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses were performed among infants without a family history of OFCs, mothers who were not currently breastfeeding, and mothers who were >6 months postpartum. RESULTS When compared to mothers of normal weight, the OR associated with OFCs were 2.44 (95% CI, 1.04-5.76, P = .04) in overweight mothers, and 3.30 (95% CI, 1.14-9.57, P = .03) in obese mothers. Low HDL-C raised the risk of OFCs 2.95 times (95% CI, 1.41-6.14, P = .004) compared to normal HDL-C levels. Mothers with 4 or 5 features of MetS were 2.77 times as likely to have the affected child than those who did not (95% CI, 0.43-17.76), but this difference was not statistically significant (P = .28). Subgroup analyses showed similar results, uncovering an additional significant association between underweight mothers and OFCs. CONCLUSIONS The results indicate a robust association between underweight and overweight/obese maternal body mass index and increased OFC risk. Additionally, low HDL-C in mothers is linked to an elevated risk of OFCs. Further research is needed to evaluate if promoting strategies to maintain optimal body weight and enhance HDL-C levels in reproductive-age and pregnant women icould contribute to a reduction of the risk of OFCs in their progeny.
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Affiliation(s)
- Araya Pisek
- Division of Dental Public Health, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Christy M McKinney
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, Seattle, Washington, USA
| | - Benja Muktabhant
- Department of Public Health Administration, Health Promotion and Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Waranuch Pitiphat
- Division of Dental Public Health, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand.
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Uppuluri E, Idrees N, Shapiro N. Warfarin dosage in a postpartum woman while breastfeeding: A case report. Pharmacotherapy 2024; 44:343-347. [PMID: 38634189 DOI: 10.1002/phar.2917] [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: 01/02/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
Warfarin is the only oral anticoagulant recommended in women who are breastfeeding. Although warfarin is a compatible and recommended agent in the postpartum period and during lactation, little is known regarding changes to warfarin dose requirements in this patient population. Here, we report the case of a 40-year-old woman who transitioned from enoxaparin monotherapy back to warfarin at 2 months postpartum, while she was breastfeeding. Despite resuming warfarin at her previously therapeutic dose, her international normalized ratio (INR) remained subtherapeutic and required multiple dose increases. She ultimately required a 100% increase in her warfarin dose postpartum, compared to pre-pregnancy, to achieve a therapeutic INR. This case suggests patients may require higher warfarin doses postpartum, compared to pre-pregnancy, especially if breastfeeding. Clinicians should closely monitor these patients and adjust warfarin doses as necessary.
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Affiliation(s)
- Ellen Uppuluri
- University of Illinois Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Niha Idrees
- University of Illinois Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Nancy Shapiro
- University of Illinois Chicago College of Pharmacy, Chicago, Illinois, USA
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3
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Che X, Hong X, Gross S, Pearson C, Bartell T, Wang X, Wang G. Maternal Mediterranean-Style Diet Adherence during Pregnancy and Metabolomic Signature in Postpartum Plasma: Findings from the Boston Birth Cohort. J Nutr 2024; 154:846-855. [PMID: 38278216 PMCID: PMC10942856 DOI: 10.1016/j.tjnut.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND The health benefits of a Mediterranean-style diet (MSD) are well observed, but the underlying mechanisms are unclear. Metabolomic profiling offers a systematic approach for identifying which metabolic biomarkers and pathways might be affected by an MSD. OBJECTIVES This study aimed to identify postpartum plasma metabolites that are associated with MSD adherence during pregnancy and to further test whether these identified metabolites may vary by maternal characteristics. METHODS We analyzed data from 1410 mothers enrolled in the Boston Birth Cohort (BBC). A maternal food frequency questionnaire (FFQ) was administered and epidemiologic information was obtained via an in-person standard questionnaire interview within 24-72 h postpartum. Maternal clinical information was extracted from electronic medical records. A Mediterranean-style diet score (MSDS) was calculated using responses to the FFQ. Metabolomic profiling in postpartum plasma was conducted by liquid chromatography-MS. Linear regression models were used to assess the associations of each metabolite with an MSDS, adjusting for covariates. RESULTS Among the 380 postpartum plasma metabolites analyzed, 24 were associated with MSDS during pregnancy (false discovery rate < 0.05). Of 24 MSDS-associated metabolites, 19 were lipids [for example, triacylglycerols, phosphatidylcholines (PCs), PC plasmalogen, phosphatidylserine, and phosphatidylethanolamine]; others were amino acids (methionine sulfoxide and threonine), tropane (nor-psi-tropine), vitamin (vitamin A), and nucleotide (adenosine). The association of adenosine and methionine sulfoxide with MSDS differed by race (P-interaction = 0.033) and maternal overweight or obesity status (P-interaction = 0.021), respectively. CONCLUSIONS In the BBC, we identified 24 postpartum plasma metabolites associated with MSDS during pregnancy. The associations of the 2 metabolites varied by maternal race and BMI. This study provides a new insight into dietary effects on health under the skin. More studies are needed to better understand the metabolic pathways underlying the short- and long-term health benefits of an MSD during pregnancy.
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Affiliation(s)
- Xiaoyu Che
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Susan Gross
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Colleen Pearson
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Tami Bartell
- Patrick M. Magoon Institute for Healthy Communities, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Nichols AR, Chavarro JE, Oken E. Reproductive risk factors across the female lifecourse and later metabolic health. Cell Metab 2024; 36:240-262. [PMID: 38280383 PMCID: PMC10871592 DOI: 10.1016/j.cmet.2024.01.002] [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: 10/06/2023] [Revised: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
Metabolic health is characterized by optimal blood glucose, lipids, cholesterol, blood pressure, and adiposity. Alterations in these characteristics may lead to the development of type 2 diabetes mellitus or dyslipidemia. Recent evidence suggests that female reproductive characteristics may be overlooked as risk factors that contribute to later metabolic dysfunction. These reproductive traits include the age at menarche, menstrual irregularity, the development of polycystic ovary syndrome, gestational weight change, gestational dysglycemia and dyslipidemia, and the severity and timing of menopausal symptoms. These risk factors may themselves be markers of future dysfunction or may be explained by shared underlying etiologies that promote long-term disease development. Disentangling underlying relationships and identifying potentially modifiable characteristics have an important bearing on therapeutic lifestyle modifications that could ease long-term metabolic burden. Further research that better characterizes associations between reproductive characteristics and metabolic health, clarifies underlying etiologies, and identifies indicators for clinical application is warranted in the prevention and management of metabolic dysfunction.
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Affiliation(s)
- Amy R Nichols
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Ćwiek D, Malinowski W, Ogonowski J, Zimny M, Szymoniak K, Czechowska K, Dawid W, Sipak-Szmigiel O, Iwanowicz-Palus G. The Effects of Breastfeeding and Gestational Diabetes Mellitus on Body Mass Composition and the Levels of Selected Hormones after Childbirth. Nutrients 2023; 15:4828. [PMID: 38004222 PMCID: PMC10675250 DOI: 10.3390/nu15224828] [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: 09/25/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Breastfeeding may have a positive effect on glucose metabolism and insulin sensitivity, which may reduce the risk of developing diabetes following gestational diabetes mellitus (GDM). This study aimed to evaluate the effect of breastfeeding and GDM on the body mass composition of the studied women, the levels of leptin, ghrelin, adiponectin, resistin, and insulin, and weight loss during the 6-8-week postpartum period and 1 year after childbirth. MATERIALS AND METHODS The study group included 42 women with a singleton pregnancy, diagnosed with GDM between the 24th and 28th week of gestation. The control group consisted of 28 non-diabetic women with a singleton pregnancy. This study was carried out at 6-8 weeks as well as at 1 year postpartum. The women were subjected to body weight measurements and body composition analysis performed using a professional body composition analyzer TANITA DC-430 S MA. Waist circumference and subcutaneous fat was measured. Blood for laboratory tests was taken in the morning, on an empty stomach. RESULTS It was shown that, regardless of diabetes, exclusive breastfeeding had a significant impact on weight loss at 6-8 weeks postpartum (p = 0.014785) and lower insulin levels (p = 0.047). However, there was no effect of breastfeeding on the women's anthropometric measurements or hormone levels one year after delivery, except for the thickness of subcutaneous adipose tissue, which was significantly lower in breastfeeding women (p = 0.03). One year after delivery, breastfeeding women had a lower BMI (p = 0.0014), less-thick subcutaneous adipose tissue (p < 0.001), and a lower risk of obesity (p = 0.016). There were also higher insulin and ghrelin levels in both breastfeeding and non-breastfeeding women (p < 0.001), and lower resistin levels in non-breastfeeding women (p = 0.004). Women who had diabetes during pregnancy had a significantly reduced waist circumference and subcutaneous fat thickness after one year (p < 0.001 and p = 0.05, respectively). CONCLUSIONS Having diabetes during pregnancy did not significantly affect the results of anthropometric measurements and hormone levels noted at 6-8 weeks after delivery (the only exception was the thickness of subcutaneous fat tissue, which was greater in women without GDM). This may indicate normalization of carbohydrate metabolism after childbirth; however, the observation period is too short to elucidate long-term metabolic effects. This suggests the need for further research related to GDM and breastfeeding.
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Affiliation(s)
- Dorota Ćwiek
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Witold Malinowski
- Faculty of Health Sciences in Płock, Masovian Public University, 09-402 Płock, Poland;
| | - Jarosław Ogonowski
- Diabetes Clinic—Independent Public Provincial Integrated Hospital in Szczecin, 71-455 Szczecin, Poland;
| | - Małgorzata Zimny
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Katarzyna Szymoniak
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Krystyna Czechowska
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Weronika Dawid
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Olimpia Sipak-Szmigiel
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Grażyna Iwanowicz-Palus
- Department of Specialist Care in Obstetric, Chair of Obstetrics Development of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
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de Oliveira JM, Dualib PM, Ferraro AA, Carvalho CRDS, Mattar R, Dib SA, de Almeida-Pititto B. Prolactin does not seem to mediate the improvement on insulin resistance markers and blood glucose levels related to breastfeeding. Front Endocrinol (Lausanne) 2023; 14:1219119. [PMID: 37711904 PMCID: PMC10499379 DOI: 10.3389/fendo.2023.1219119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Strategies to decrease this risk should be strongly encouraged. Lactation has been associated, for the mother, with reduction in future T2DM risk in several studies. The mechanisms behind this phenomenon, however, are poorly understood. The aims of this study were, first, to compare blood glucose levels and markers of insulin resistance (MIR) in early postpartum women with overweight/obesity according to their breastfeeding status and, second, to evaluate whether prolactin (PRL) levels could mediate improvements in these parameters. Methods The prospective study followed 95 women older than 18 years from early pregnancy for up to 60 to 180 days postpartum. All participants had a BMI > 25 kg/m2 and a singleton pregnancy. At each visit, questionnaires and clinical and biochemical evaluations were performed. Participants were divided into two groups according to the breastfeeding status as "yes" for exclusive or predominant breastfeeding, and "no" for not breastfeeding. Results Breastfeeding women (n = 44) had significantly higher PRL levels [47.8 (29.6-88.2) vs. 20.0 (12.0-33.8), p< 0.001]. They also had significantly lower fasting blood glucose levels [89.0 (8.0) vs. 93.9 (12.6) mg/dl, p = 0.04], triglycerides (TG) [92.2 (37.9) vs. 122.4 (64.4) mg/dl, p = 0.01], TG/HDL ratio [1.8 (0.8) vs. 2.4 (1.6) mg/dl, p = 0.02], TyG index [8.24 (0.4) vs. 8.52 (0.53), p = 0.005], fasting serum insulin [8.9 (6.3-11.6) vs. 11.4 (7.7-17.0), p = 0.048], and HOMA-IR [2.0 (1.3-2.7) vs. 2.6 (1.6-3.9), p = 0.025] in the postpartum period compared to the non-breastfeeding group. Groups were homogeneous in relation to prevalence of GDM, pre-gestational BMI, as well as daily caloric intake, physical activity, and weight loss at postpartum. Linear regression analysis with adjustments for confounders showed a statistically significant association of breastfeeding with fasting blood glucose [-6.37 (-10.91 to -1.83), p = 0.006], HOMA-IR [-0.27 (-0.51 to -0.04), p = 0.024], TyG index [-0.04 (-0.06 to -0.02), p = 0.001], and TG/HDL ratio [-0.25 (-0.48 to -0.01), p = 0.038]. Mediation analysis showed that PRL did not mediate these effects. Sensitivity analyses considering different cutoffs for PRL levels also did not show modification effect in the mediation analyses. Conclusion Breastfeeding was associated with improvement in glucose metabolism and MIR 60 to 180 days after birth in overweight and obese women, even when adjusted for confounders. PRL levels were not found to mediate the association between breastfeeding and improvement in MIR.
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Affiliation(s)
- Julia Martins de Oliveira
- Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Patricia Medici Dualib
- Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de Sao Paulo, São Paulo, Brazil
- Department of Medicine, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | | | | | - Rosiane Mattar
- Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Sérgio Atala Dib
- Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de Sao Paulo, São Paulo, Brazil
- Department of Medicine, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Bianca de Almeida-Pititto
- Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de Sao Paulo, São Paulo, Brazil
- Department of Preventive Medicine, Universidade Federal de Sao Paulo, São Paulo, Brazil
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7
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Elbeltagi R, Al-Beltagi M, Saeed NK, Bediwy AS. Cardiometabolic effects of breastfeeding on infants of diabetic mothers. World J Diabetes 2023; 14:617-631. [PMID: 37273257 PMCID: PMC10236993 DOI: 10.4239/wjd.v14.i5.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/01/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants. It may protect infants against many metabolic diseases, predominantly obesity and type 2 diabetes. Diabetes mellitus (DM) is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood. Breastfeeding protects against infant mortality and diseases, such as necrotizing enterocolitis, diarrhoea, respiratory infections, viral and bacterial infection, eczema, allergic rhinitis, asthma, food allergies, malocclusion, dental caries, Crohn's disease, and ulcerative colitis. It also protects against obesity and insulin resistance and increases intelligence and mental development. Gestational diabetes has short and long-term impacts on infants of diabetic mothers (IDM). Breast milk composition changes in mothers with gestational diabetes.
AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.
METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15, 2022, in this review.
RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms. Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM. Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term, the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.
CONCLUSION We need more comprehensive research to prove these effects. Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding, every effort should be made to encourage them to breastfeed.
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Affiliation(s)
- Reem Elbeltagi
- Department of Medicine, Irish Royal College of Surgeon, Busaiteen 15503, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Bahrain
- Department of Microbiology, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
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van Zyl CDW, van Reenen M, Osthoff G, du Preez I. Evaluation of BAYESIL for automated annotation of 1H NMR data using limited sample volumes: application to African elephant serum. Metabolomics 2023; 19:31. [PMID: 36995481 PMCID: PMC10063514 DOI: 10.1007/s11306-023-02001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Technological advancements enabled the analyses of limited sample volumes on 1H NMR. Manual spectral profiling of the data is, however, complex, and timely. OBJECTIVE To evaluate the performance of BAYESIL for automated identification and quantification of 1H NMR spectra of limited volume samples. METHOD Aliquots of a pooled African elephant serum sample were analyzed using standard and reduced volumes. Performance was evaluated on confidence scores, non-detects and laboratory CV. RESULTS Of the 47 compounds detected, 28 had favorable performances. The approach could differentiate samples based on biological variation. CONCLUSIONS BAYESIL is valuable for limited sample 1H NMR data analyses.
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Affiliation(s)
| | - Mari van Reenen
- Centre for Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Gernot Osthoff
- Department of Microbiology and Biochemistry, University of the Free State, Bloemfontein, South Africa
| | - Ilse du Preez
- Centre for Human Metabolomics, North-West University, Potchefstroom, South Africa.
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Magnus MC, Wallace MK, Demirci JR, Catov JM, Schmella MJ, Fraser A. Breastfeeding and Later-Life Cardiometabolic Health in Women With and Without Hypertensive Disorders of Pregnancy. J Am Heart Assoc 2023; 12:e026696. [PMID: 36847057 PMCID: PMC10111449 DOI: 10.1161/jaha.122.026696] [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] [Indexed: 03/01/2023]
Abstract
Background Breastfeeding is associated with improved cardiometabolic profiles decades after pregnancy. Whether this association exists for women who experience hypertensive disorders of pregnancy (HDP) is unknown. The authors examined whether breastfeeding duration or exclusivity are associated with long-term cardiometabolic health, and whether this relationship differs by HDP status. Methods and Results Participants (N=3598) were from the UK ALSPAC (Avon Longitudinal Study of Parents and Children) cohort. HDP status was assessed by medical record review. Breastfeeding behaviors were assessed by contemporaneous questionnaires. Breastfeeding duration was categorized as never, <1, 1 to <3, 3 to <6, 6 to <9, and 9+ months. Breastfeeding exclusivity was categorized as never, <1, 1 to <3, and 3 to 6 months. Measures of cardiometabolic health (body mass index, waist circumference, C-reactive protein, insulin, proinsulin, glucose, lipids, blood pressure, mean arterial pressure, carotid intima-media thickness, and arterial distensibility) were measured 18 years after pregnancy. Analyses were conducted using linear regression adjusting for relevant covariates. Breastfeeding was associated with improved cardiometabolic health (lower body mass index, waist circumference, C-reactive protein, triglycerides, insulin, and proinsulin) in all women, but not for every breastfeeding duration. Interaction tests revealed additional benefits in women with a history of HDP, with the strongest benefit observed in the 6- to 9-month breastfeeding category (diastolic blood pressure, -4.87 mm Hg [95% CI, -7.86 to -1.88], mean arterial pressure -4.61 [95% CI, -7.45 to -1.77], and low-density lipoprotein cholesterol, -0.40 mmol/L [95% CI, -0.62 to -0.17 mmol/L]). Differences in C-reactive protein and low-density lipoprotein "survived" Bonferroni correction (P<0.001). Similar results were observed in the exclusive breastfeeding analyses. Conclusions Breastfeeding may be a mechanism to reduce the cardiovascular disease sequela associated with HDP; however, there is a need to establish whether associations reflect a causal effect.
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Affiliation(s)
- Maria C Magnus
- Center for Fertility and Health Norwegian Institute of Public Health Oslo Norway.,MRC Integrative Epidemiology Unit at the University of Bristol Bristol United Kingdom.,Population Health Sciences Bristol Medical School Bristol United Kingdom
| | - McKenzie K Wallace
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing The Ohio State University Columbus OH
| | - Jill R Demirci
- School of Nursing University of Pittsburgh Pittsburgh PA
| | - Janet M Catov
- Department of Epidemiology University of Pittsburgh Pittsburgh PA.,Department of Obstetrics, Gynecology & Reproductive Science University of Pittsburgh Pittsburgh PA
| | | | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol Bristol United Kingdom.,Population Health Sciences Bristol Medical School Bristol United Kingdom
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Ottka C, Vapalahti K, Arlt SP, Bartel A, Lohi H. The metabolic differences of anestrus, heat, pregnancy, pseudopregnancy, and lactation in 800 female dogs. Front Vet Sci 2023; 10:1105113. [PMID: 36816179 PMCID: PMC9932911 DOI: 10.3389/fvets.2023.1105113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Reproduction causes major hormonal and physiological changes to the female body. However, the metabolic changes occurring during canine reproduction are scarcely studied. Methods In this cross-sectional study, we assessed the metabolic effects of canine reproductive status using a 1H NMR metabolomics platform optimized and validated for canine use. The study population consisted of a total of 837 healthy, intact female dogs in breeding age, of which 663 dogs were in anestrus, 78 in heat, 43 were pseudopregnant, 15 were pregnant, and 38 were lactating. The differences in metabolite profiles between these states were studied by the Kruskal-Wallis test with post-hoc tests performed using the Dunn's test, and visualized by box plots and a heatmap. The ability of the metabolite profile to differentiate pregnant dogs from non-pregnant ones was assessed by creating a multivariate Firth logistic regression model using forward stepwise selection. Results Lactation, pregnancy and heat all were associated with distinct metabolic changes; pregnancy caused major changes in the concentrations of glycoprotein acetyls, albumin and creatinine, and smaller changes in several lipids, citrate, glutamine, and alanine. Pseudopregnancy, on the other hand, metabolically largely resembled anestrus. Lactation caused major changes in amino acid concentrations and smaller changes in several lipids, albumin, citrate, creatinine, and glycoprotein acetyls. Heat, referring to proestrus and estrus, affected cholesterol and LDL metabolism, and increased HDL particle size. Albumin and glycoprotein acetyls were the metabolites included in the final multivariate model for pregnancy detection, and could differentiate pregnant dogs from non-pregnant ones with excellent sensitivity and specificity. Discussion These results increase our understanding of the metabolic consequences of canine reproduction, with the possibility of improving maternal health and ensuring reproductive success. The identified metabolites could be used for confirming canine pregnancy.
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Affiliation(s)
- Claudia Ottka
- PetBiomics Ltd., Helsinki, Finland,Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland,Folkhälsan Research Center, Helsinki, Finland,*Correspondence: Claudia Ottka ✉
| | - Katariina Vapalahti
- PetBiomics Ltd., Helsinki, Finland,Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Sebastian P. Arlt
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Alexander Bartel
- Institute for Veterinary Epidemiology and Biostatistics, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Hannes Lohi
- PetBiomics Ltd., Helsinki, Finland,Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland,Folkhälsan Research Center, Helsinki, Finland
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11
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Riddle AY, Li W, Bhutta ZA, Vlassoff C, Taljaard M, Kristjansson E, Welch V, Wells GA. Associations between dimensions of empowerment and nutritional status among married adolescent girls in East Africa: a structural equation modelling study. BMC Public Health 2023; 23:225. [PMID: 36732719 PMCID: PMC9893589 DOI: 10.1186/s12889-022-14949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Empowering adolescent girls is an important component of combating malnutrition in this age group. Because empowerment is multidimensional and context specific, it can be difficult for policymakers and practitioners to target the dimensions of empowerment associated with adolescent girls' nutrition in a particular setting. This study sought to identify the empowerment dimensions significantly associated with married adolescent girls' nutritional status in East Africa; a region where malnutrition and gender inequality stubbornly persist. METHODS We used cross-sectional Demographic and Health Survey (DHS) data from Ethiopia (2016), Kenya (2014), Tanzania (2015-16) and Uganda (2016) to construct and test theoretically informed structural equation models of the relationship between six dimensions of empowerment and BMI-for-age and haemoglobin levels for married adolescent girls aged 15-19 years. RESULTS Our models were found to be a good fit for the data. Married adolescent girls' access to information, measured by their education level and mass media use, was directly and positively associated with their BMI-for-age (p < 0.05). Asset ownership, measured by owning a house or land alone or jointly, was directly and positively associated with haemoglobin (p < 0.05) and reduced odds of being moderately to severely anemic. Rejecting justifications for intimate partner violence, a measure of respondents' intrinsic agency, was directly and positively associated with the odds of being overweight or obese. Adolescent girls' level of empowerment across all dimensions had a direct relationship with their country of residence and household wealth. CONCLUSIONS Our findings suggest that investment in girls' access to information through education and mass/social media and their economic empowerment may be important contributors to their overall empowerment and nutritional status. However, caution is needed as greater autonomy may contribute to increased consumption of unhealthy foods that can contribute to overweight and obesity. Strategies to empower married adolescent girls should be tailored to their specific circumstances. There is an urgent need for better data on adolescent empowerment and health, including increased research into age-, sex- and gender-appropriate empowerment measures and longitudinal data to assess causality. The use of statistical models should be complemented by robust qualitative research to further results interpretation.
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Affiliation(s)
- Alison Y. Riddle
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON K1G 5Z3 Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5 Canada
| | - Wenshan Li
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON K1G 5Z3 Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5 Canada
| | - Zulfiqar A. Bhutta
- grid.42327.300000 0004 0473 9646Centre for Global Child Health, Hospital for Sick Children (SickKids), 525 University Avenue, Suite 702, Toronto, ON M5G 2L3 Canada ,grid.7147.50000 0001 0633 6224Institute for Global Health and Development, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800 Pakistan
| | - Carol Vlassoff
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON K1G 5Z3 Canada
| | - Monica Taljaard
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON K1G 5Z3 Canada ,grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road Box 511, Ottawa, ON K1H 8L6 Canada
| | - Elizabeth Kristjansson
- grid.28046.380000 0001 2182 2255School of Psychology, Social Sciences Building, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
| | - Vivian Welch
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON K1G 5Z3 Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5 Canada
| | - George A. Wells
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON K1G 5Z3 Canada ,grid.28046.380000 0001 2182 2255University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
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12
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Walker RE, Harvatine KJ, Ross AC, Wagner EA, Riddle SW, Gernand AD, Nommsen-Rivers LA. Fatty Acid Transfer from Blood to Milk Is Disrupted in Mothers with Low Milk Production, Obesity, and Inflammation. J Nutr 2023; 152:2716-2726. [PMID: 36208911 PMCID: PMC9840005 DOI: 10.1093/jn/nxac220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/26/2022] [Accepted: 09/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Obesity is associated with chronic inflammation and is a risk factor for insufficient milk production. Inflammation-mediated suppression of LPL could inhibit mammary uptake of long-chain fatty acids (LCFAs; >16 carbons). OBJECTIVES In an ancillary case-control analysis, we investigated whether women with low milk production despite regular breast emptying have elevated inflammation and disrupted transfer of LCFAs from plasma into milk. METHODS Data and specimens from a low milk supply study and an exclusively breastfeeding control group were analyzed, with milk production measured by 24-h test-weighing at 2-10 wk postpartum. Low milk supply groups were defined as very low (VL; <300 mL/d; n = 23) or moderate (MOD; ≥300 mL/d; n = 20) milk production, and compared with controls (≥699 mL/d; n = 18). Serum and milk fatty acids (weight% of total) were measured by GC, serum and milk TNF-α by ELISA, and serum high-sensitivity C-reactive protein (hsCRP) by clinical analyzer. Group differences were assessed by linear regression models, chi-square exact tests, and Kruskal-Wallis nonparametric tests. RESULTS VL cases, as compared with MOD cases and controls, had higher prevalence of elevated serum hsCRP (>5 mg/L; 57%, 15%, and 22%, respectively; P = 0.004), detectable milk TNF-α (67%, 32%, and 33%, respectively; P = 0.04), and obesity (78%, 40%, and 22%, respectively; P = 0.003). VL cases had lower mean ± SD LCFAs in milk (60% ± 3%) than MOD cases (65% ± 4%) and controls (66% ± 5%) (P < 0.001). Milk and serum LCFAs were strongly correlated in controls (r = 0.82, P < 0.001), but not in the MOD (r = 0.25, P = 0.30) or VL (r = 0.20, P = 0.41) groups (Pint < 0.001). CONCLUSIONS Mothers with very low milk production have significantly higher obesity and inflammatory biomarkers, lower LCFAs in milk, and disrupted association between plasma and milk LCFAs. These data support the hypothesis that inflammation disrupts normal mammary gland fatty acid uptake. Further research should address impacts of inflammation and obesity on mammary fatty acid uptake for milk production.
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Affiliation(s)
- Rachel E Walker
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Kevin J Harvatine
- Department of Animal Science, The Pennsylvania State University, University Park, PA, USA
| | - A Catharine Ross
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Erin A Wagner
- College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah W Riddle
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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13
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Fatty acid transfer from blood to milk is disrupted in mothers with low milk production, obesity, and inflammation. J Nutr 2022. [DOI: 10.1016/j.tjnut.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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14
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Oxylipins as Potential Regulators of Inflammatory Conditions of Human Lactation. Metabolites 2022; 12:metabo12100994. [PMID: 36295896 PMCID: PMC9610648 DOI: 10.3390/metabo12100994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic low-grade inflammation can be associated with obesity or subclinical mastitis (SCM), which is associated with poor infant growth in low- to middle-income country settings. It is unknown what physiological mechanisms are involved in low milk supply, but our research group has shown that mothers with low milk supply have higher inflammatory markers. Studies investigating oxylipin signaling have the potential to help explain mechanisms that mediate the impacts of inflammation on milk production. Animal studies have reported various elevated oxylipins during postpartum inflammation, mastitis, and mammary involution in ruminant models. Several investigations have quantified oxylipins in human milk, but very few studies have reported circulating oxylipin concentrations during lactation. In addition, there are technical considerations that must be addressed when reporting oxylipin concentrations in human milk. First, the majority of milk oxylipins are esterified in the triglyceride pool, which is not routinely measured. Second, total milk fat should be considered as a covariate when using milk oxylipins to predict outcomes. Finally, storage and handling conditions of milk samples must be carefully controlled to ensure accurate milk oxylipin quantitation, which may be affected by highly active lipases in human milk.
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15
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Jensen NH, Nielsen KK, Dahl-Petersen IK, Maindal HT. The experience of women with recent gestational diabetes during the COVID-19 lockdown: a qualitative study from Denmark. BMC Pregnancy Childbirth 2022; 22:84. [PMID: 35093021 PMCID: PMC8800544 DOI: 10.1186/s12884-022-04424-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/20/2022] [Indexed: 12/17/2022] Open
Abstract
Background Following COVID-19 and the lockdowns, maternity care and support for women after delivery have been temporary restructured. Studies show that COVID-19 adversely impacts pregnant and peripartum women in the general population, but experiences among women in the first year after delivery/in the wider postpartum period remain unexplored. Moreover, experiences among women with recent gestational diabetes mellitus (GDM) are lacking; though it is a group with a potential high need for support after delivery. The aim of our study was to investigate (i) how women with recent GDM experienced COVID-19 and the first lockdown in Denmark, and (ii) the women’s risk perception and health literacy in terms of interaction with the healthcare system in relation to COVID-19. Methods We performed a qualitative study among 11 women with recent GDM (infants aged 2-11 months old). Semi-structured interviews were conducted in April-May 2020 by telephone or Skype for Business, when Denmark was under lockdown. We analysed data using a thematic qualitative content analysis. Results Three themes emerged: i) Everyday life and family well-being, ii) Worries about COVID-19 and iii) Health literacy: Health information and access to healthcare. The women were generally not worried about their own or their infant’s risk of COVID-19. The lockdown had a negative impact on everyday life e.g. routines, loneliness, breastfeeding uncertainties and worries for the infant’s social well-being; but better family dynamics were also described. It was challenging to maintain healthy behaviours and thus the women described worries for the risk of type 2 diabetes and GDM in subsequent pregnancies. The women missed peer support and face-to-face visits from health visitors and found it difficult to navigate the restructured care with online/telephone set-ups. Conclusions COVID-19 and the lockdown affected everyday life among women with recent GDM both positively and negatively. Our findings suggest a need for care that are responsive to psychological and social aspects of health throughout the COVID-19 pandemic and support to limit worries about adaptation to motherhood and the infant’s social well-being. Communication focusing on the importance and relevance of contacting healthcare providers should also be strengthened.
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16
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Hsiao BSJ, Sibeko L. Breastfeeding Is Inversely Associated with Allostatic Load in Postpartum Women: Cross-Sectional Data from Nationally Representative US Women. J Nutr 2021; 151:3801-3810. [PMID: 34515317 DOI: 10.1093/jn/nxab302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/30/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The postpartum period is a critical transition period when exposures to protective factors such as breastfeeding can have long-lasting health impact. Studies have suggested downregulating effects of breastfeeding on stress biomarkers such as cortisol but have not explored the way breastfeeding interacts with allostatic load, a multisystem indicator of chronic stress. OBJECTIVE We aimed to examine the association between breastfeeding and maternal allostatic load among women within 2 y postpartum using nationally representative data. METHODS A cross-sectional analysis of 10 waves of data from the NHANES (1999-2018) was conducted in a sample of 1302 women aged ≥18 y who provided information on breastfeeding through the reproductive health questionnaire. Clinical and empirical allostatic load scores (range: 0-10; higher numbers associated with increased risk) were derived for each participant based on 10 biomarkers reflecting metabolic, cardiovascular, and immune health. Multiple linear regression tested associations between breastfeeding and allostatic load, adjusting for maternal age, race and ethnicity, education, poverty level, and survey wave. RESULTS Breastfeeding had a significant inverse association with allostatic load in unadjusted and adjusted models. Controlling for age, race and ethnicity, education, poverty level, and survey wave, breastfeeding women had a 0.36-point lower clinical allostatic load score than nonbreastfeeding women (β = -0.36, SE = 0.11; 95% CI: -0.59, -0.14; P = 0.002) and a 0.44-point lower empirical allostatic load score (β = -0.44, SE = 0.15; 95% CI: -0.74, -0.14; P = 0.005). CONCLUSIONS Our study suggests that breastfeeding is protective of maternal stress and provides a more comprehensive picture of breastfeeding's influence on multiple body systems, exemplifying physiological benefits beyond effects on single biomarkers. However, limitations of cross-sectional data and non-classification of breastfeeding duration, mode, and intensity should be considered when interpreting these findings, and further research to address the role of breastfeeding and allostatic load is needed.
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Affiliation(s)
- Bi-Sek J Hsiao
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Lindiwe Sibeko
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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17
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Lis-Kuberka J, Orczyk-Pawiłowicz M. Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910409. [PMID: 34639709 PMCID: PMC8508017 DOI: 10.3390/ijerph181910409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022]
Abstract
Gestational diabetes mellitus (GDM) is a multifaceted disease and is associated with complications for newborns and mothers. The aim of the study was to assess Polish women’s knowledge concerning GDM and their attitude to breastfeeding. As a research tool, an anonymous online survey that included 33 questions, grouped into three main sections—sociodemographic and obstetric variables, risk factors for GDM and neonatal adverse outcomes, and knowledge about breastfeeding—was used and administered online. A total of 410 women aged from 18 to 45 participated in this study. Based on the survey, it was demonstrated that the women had moderate knowledge concerning the maternal risk factors and adverse neonatal outcomes associated with GDM and, additionally, the short- and long-term effects of breastfeeding. Significantly deeper knowledge about GDM, including breastfeeding by GDM mothers, was observed among hyperglycemic mothers in comparison to normoglycemic mothers. However, knowledge concerning the health benefits of breastfeeding was not related to the mothers’ glycemic status. In conclusion, educational programs must include pre-pregnancy education of women and place emphasis on explaining the mechanism of development of GDM and the transformation of GDM to type 2 diabetes. This is crucial for changing the public’s perception of GDM as a temporary, reversible clinical entity.
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18
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Marschner S, Chow C, Thiagalingam A, Simmons D, McClean M, Pasupathy D, Smith BJ, Flood V, Padmanabhan S, Melov S, Ching C, Cheung NW. Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2). BMJ Open 2021; 11:e054756. [PMID: 34535488 PMCID: PMC8451310 DOI: 10.1136/bmjopen-2021-054756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes (GDM) contributes substantially to the population burden of type 2 diabetes (T2DM), with a high long-term risk of developing T2DM. This study will assess whether a structured lifestyle modification programme for women immediately after a GDM pregnancy, delivered via customised text messages and further individualised using data from activity monitors, improves T2DM risk factors, namely weight, physical activity (PA) and diet. METHODS AND ANALYSIS This multicentre randomised controlled trial will recruit 180 women with GDM attending Westmead, Campbelltown or Blacktown hospital services in Western Sydney. They will be randomised (1:1) on delivery to usual care with activity monitor (active control) or usual care plus activity monitor and customised education, motivation and support delivered via text messaging (intervention). The intervention will be customised based on breastfeeding status, and messages including their step count achievements to encourage PA. Messages on PA and healthy eating will encourage good lifestyle habits. The primary outcome of the study is healthy lifestyle composed of weight, dietary and PA outcomes, to be evaluated at 6 months. The secondary objectives include the primary objective components, body mass index, breastfeeding duration and frequency, postnatal depression, utilisation of the activity monitor, adherence to obtaining an oral glucose tolerance test post partum and the incidence of dysglycaemia at 12 months. Relative risks and their 95% CIs will be presented for the primary objective and the appropriate regression analysis, adjusting for the baseline outcome results, will be done for each outcome. ETHICS AND DISSEMINATION Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee (2019/ETH13240). All patients will provide written informed consent. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12620000615987; Pre-results.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Penrith South, New South Wales, Australia
- Macarthur Diabetes School, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Mark McClean
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Dharmintra Pasupathy
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben J Smith
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Flood
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Suja Padmanabhan
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Melov
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Cellina Ching
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| | - N Wah Cheung
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
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19
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Pinho-Gomes AC, Morelli G, Jones A, Woodward M. Association of lactation with maternal risk of type 2 diabetes: A systematic review and meta-analysis of observational studies. Diabetes Obes Metab 2021; 23:1902-1916. [PMID: 33908692 DOI: 10.1111/dom.14417] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
AIM To investigate the association between lactation and maternal risk of type 2 diabetes, including a potential graded association according to lactation duration. METHODS A systematic review and meta-analysis of observational studies that investigated the reported association between lactation (irrespective of duration, intensity or mode) and maternal risk of type 2 diabetes was conducted. RESULTS A total of 22 studies (17 cohort studies and five cross-sectional studies) were included in this systematic review, and 16 contributed to the meta-analysis. Studies that investigated the association of lactation with risk of type 2 diabetes in the first months after birth in women with gestational diabetes reported conflicting results. Studies with a longer follow-up showed a graded protective association for lactation and the risk of type 2 diabetes, with a potentially larger risk reduction in women with gestational diabetes than in those without gestational diabetes. Overall, ever versus never lactation was associated with a 27% lower risk of type 2 diabetes (RR 0.73, 95% CI [0.65, 0.83]). Each additional month of lactation was associated with a 1% lower risk of type 2 diabetes (RR 0.99, 95% CI [0.98, 0.99]). However, the overall quality of the studies was modest. CONCLUSIONS Lactation is associated with a significantly reduced risk of maternal type 2 diabetes over the life course, particularly in women with gestational diabetes. The protective effect seems to increase with longer duration of lactation. Further research is warranted to understand whether this association is modified by exposure to other risk factors.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- King's College London, London, UK
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgia Morelli
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Welch Center for Epidemiology, Prevention and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
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20
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Groth SW, Fernandez ID, Block RC, Thurston SW, Wong E, Brunner J, Mayo N, Kapula N, Yu Y, Meng Y, Yeh KL, Kinkade CW, Thornburg LL, O’Connor TG, Barrett ES. Biological changes in the pregnancy-postpartum period and subsequent cardiometabolic risk-UPSIDE MOMS: A research protocol. Res Nurs Health 2021; 44:608-619. [PMID: 33993510 PMCID: PMC8378197 DOI: 10.1002/nur.22141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 01/21/2023]
Abstract
Multiple physiological changes occur in pregnancy as a woman's body adapts to support the growing fetus. These pregnancy-induced changes are essential for fetal growth, but the extent to which they reverse after pregnancy remains in question. For some women, physiological changes persist after pregnancy and may increase long-term cardiometabolic disease risk. The National Institutes of Health-funded study described in this protocol addresses a scientific gap by characterizing weight and biological changes during pregnancy and an extended postpartum period in relation to cardiometabolic risk. We use a longitudinal repeated measures design to prospectively examine maternal health from early pregnancy until 3 years postpartum. The aims are: (1) identify maternal weight profiles in the pregnancy-postpartum period that predict adverse cardiometabolic risk profiles three years postpartum; (2) describe immune, endocrine, and metabolic biomarker profiles in the pregnancy-postpartum period, and determine their associations with cardiometabolic risk; and (3) determine how modifiable postpartum health behaviors (diet, physical activity, breastfeeding, sleep, stress) (a) predict weight and cardiometabolic risk in the postpartum period; and (b) moderate associations between postpartum weight retention and downstream cardiometabolic risk. The proposed sample is 250 women. This study of mothers is conducted in conjunction with the Understanding Pregnancy Signals and Infant Development study, which examines child health outcomes. Biological and behavioral data are collected in each trimester and at 6, 12, 24, and 36 months postpartum. Findings will inform targeted health strategies that promote health and reduce cardiometabolic risk in childbearing women.
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Affiliation(s)
- Susan W Groth
- University of Rochester, School of Nursing, Rochester NY
| | - I Diana Fernandez
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences
| | - Robert C Block
- University of Rochester, Departments of Public Health Sciences, Cardiology, and Medicine
| | - Sally W Thurston
- University of Rochester, Department of Biostatistics and Computational Biology
| | - Eunyoung Wong
- University of Rochester, School of Nursing, Rochester NY
| | - Jessica Brunner
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Nicole Mayo
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences
| | - Ntemena Kapula
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Yang Yu
- University of Rochester, School of Nursing, Rochester NY
| | - Ying Meng
- University of Rochester, School of Nursing, Rochester NY
| | - Kuan-Lin Yeh
- University of Rochester, School of Nursing, Rochester NY
| | - Carolyn W Kinkade
- Rutgers University, Exposure Science and Epidemiology, Environmental and Occupational Health Sciences Institute
| | - Loralei L Thornburg
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Thomas G O’Connor
- University of Rochester, Departments of Psychiatry, Psychology, Neuroscience, Obstetrics and Gynecology, and Wynne Center for Family Research
| | - Emily S Barrett
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
- Rutgers University, Exposure Science and Epidemiology, Environmental and Occupational Health Sciences Institute
- Rutgers School of Public Health, Biostatistics and Epidemiology
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21
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Kole-White MB, Griffin L, Ding JJ, Ayala NK, Has P, Werner EF. Breastfeeding Success Among Women with Gestational Diabetes Managed by Diet Only Compared with Those Requiring Medications. Breastfeed Med 2021; 16:419-423. [PMID: 33999695 DOI: 10.1089/bfm.2020.0321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Breastfeeding is known to have a positive impact on maternal and neonatal health. Some have suggested that gestational diabetes mellitus (GDM) is associated with lower breastfeeding rates, but it is not known whether rates are further impacted by glucose control in pregnancy. Thus, we examined whether patients with GDM requiring medication (A2 GDM) were more likely to not initiate or discontinue breastfeeding compared with patients with GDM well controlled by diet (A1 GDM). Research Design and Methods: This is a secondary analysis of a prospective cohort study of 600 patients with GDM. Eligible patients were enrolled during their delivery hospitalization and followed prospectively postpartum. The primary outcome was exclusive breastfeeding at hospital discharge and secondary outcomes included breastfeeding rates at 3 months postpartum. Patients classified as A2 GDM were compared with those classified as A1 GDM. Results: Of the 600 patients enrolled, 301 had A2 GDM and 299 had A1 GDM. Patients who needed medication were observed to be older and more likely to be parous and obese. There were no significant differences in labor outcomes or neonatal complications. After adjusting for baseline differences between the two groups, adjusted odds ratios (aORs) for exclusive breastfeeding rates were similar in mothers with A2 GDM compared with those with A1 GDM at hospital discharge (aOR 0.83 [0.54-1.28]) and 3 months postpartum (aOR 0.58 [0.34-1.01]). Additionally, any breastfeeding rates were similar in mothers with A2 GDM compared with those with A1 GDM, both at hospital discharge (aOR 0.72 [0.44-1.16]) and 3 months postpartum (aOR 0.63 [0.34-1.17]). Conclusions: After adjusting for baseline differences, there was no difference in any or exclusive breastfeeding rates at hospital discharge or 3 months postpartum among patients with A2 GDM compared with those with A1 GDM.
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Affiliation(s)
- Martha B Kole-White
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laurie Griffin
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jia Jennifer Ding
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Phinnara Has
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Erika F Werner
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Cummins L, Meedya S, Wilson V. Factors that positively influence in-hospital exclusive breastfeeding among women with gestational diabetes: An integrative review. Women Birth 2021; 35:3-10. [PMID: 33745821 DOI: 10.1016/j.wombi.2021.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 01/03/2023]
Abstract
PROBLEM Women with gestational diabetes have higher rates of introducing infant formula before leaving hospital. BACKGROUND Despite health professional support, less women with gestational diabetes exclusively breastfeed in hospital. AIM To find factors that positively influence in-hospital exclusive breastfeeding practices among women with gestational diabetes. METHODS An online search was performed in Medline, Scopus, Pubmed, CINAHL and Cochrane databases. Studies containing the keywords gestational diabetes and breastfeeding were retrieved. FINDINGS Authors identified 1935 papers from search criteria. Twenty-six papers with no restrictions on research design met inclusion criteria and were included in the review. Factors were divided into personal, antenatal, intrapartum and postnatal factors. The main modifiable factors that were associated with improved in-hospital exclusive breastfeeding rates were having a strong intention to breastfeed, being confident, feeling supported and having continuity of education and support. Women's main reasons to introduce formula were related to baby's hypoglycaemia, delayed lactogenesis II and perceived low milk supply. Skin-to-skin contact after birth combined with frequent breastfeeds were effective ways to improve in-hospital exclusive breastfeeding rates. CONCLUSION Influencing factors such as women's breastfeeding intention, confidence and ongoing support are no different to the general population of women. However, promoting skin-to-skin contact after birth combined with frequent feeds are crucial for women with gestational diabetes who are more likely to introduce formula due to delayed lactogenesis II and fear of neonatal hypoglycaemia. There is a need for developing educational and supportive interventions that are tailored specifically for women who have gestational diabetes.
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Affiliation(s)
- Leanne Cummins
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus St, Wollongong, NSW, 2500, Australia.
| | - Shahla Meedya
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Valerie Wilson
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus St, Wollongong, NSW, 2500, Australia
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Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study. Nutrients 2021; 13:nu13020408. [PMID: 33525398 PMCID: PMC7912373 DOI: 10.3390/nu13020408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022] Open
Abstract
(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; p = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; p = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.
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Tarrant M, Chooniedass R, Fan HSL, Del Buono K, Masina S. Breastfeeding and Postpartum Glucose Regulation Among Women With Prior Gestational Diabetes: A Systematic Review. J Hum Lact 2020; 36:723-738. [PMID: 32877291 DOI: 10.1177/0890334420950259] [Citation(s) in RCA: 4] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gestational diabetes mellitus is associated with adverse maternal and fetal outcomes and increases subsequent risk of Type 2 diabetes. Researchers have shown that breastfeeding may reduce diabetes risk in women with recent gestational diabetes. RESEARCH AIM To assess association between infant feeding and postpartum glucose tolerance in mothers with recent gestational diabetes within 1 year postpartum. METHODS A literature search was performed up to December 31, 2019, retrieving articles related to infant feeding, gestational diabetes, and postpartum glucose regulation in four major databases (PubMed, Cochrane, CINAHL, and Embase). Methodological quality was assessed using tools from the United States National Institutes of Health and the National Heart, Lung, and Blood Institute. RESULTS The search yielded 15 cohort studies meeting the selection criteria. Of the 15 studies, 13 (86.7%) examined the influence of breastfeeding on postpartum glycemic status, and eight (53.4%) compared the mean blood glucose values between breastfeeding and non-breastfeeding participants. Of the 13 studies that compared postpartum glycemic status, nine (60%) of the research teams found that breastfeeding lowered rates of impaired glucose tolerance, and four (26.7%) showed no significant change. In eight of the studies reporting mean blood glucose values, six (75%) reported significantly lower fasting plasma glucose in breastfeeding participants, with reductions ranging from 3.7 to 7.4 mg/dL (0.2-0.4 mmol/L). CONCLUSION Breastfeeding has been associated with improved postpartum glucose regulation in mothers with gestational diabetes. In pregnant women with gestational diabetes, breastfeeding may reduce the risk of Type 2 diabetes, and women with gestational diabetes should be strongly encouraged and supported to breastfeed.
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Affiliation(s)
- Marie Tarrant
- 8166 School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Rishma Chooniedass
- 8166 School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Heidi Sze Lok Fan
- 25809 School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Katie Del Buono
- 8166 School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Stephanie Masina
- 8166 School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
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Lactation Ketoacidosis: A Systematic Review of Case Reports. ACTA ACUST UNITED AC 2020; 56:medicina56060299. [PMID: 32560535 PMCID: PMC7353886 DOI: 10.3390/medicina56060299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/29/2022]
Abstract
Background and Objective: Lactation ketoacidosis is a rare cause of high anion gap metabolic acidosis affecting breastfeeding mothers. We aim to review and analyze all cases of lactation ketoacidosis reported. Materials and Methods: A systematic search of PubMed/MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL), identifying relevant case reports published from 1 January 1970 to 31 December 2019. We extracted the following data: the first author, country, year of publication, age of the mother, age of the child, weight/body mass index (BMI) of the mother, precipitating factors, presenting symptoms, biochemical results, treatment, breastfeeding, and time from presentation to the resolution of ketoacidosis. Results: Sixteen case reports and 1 case series reporting 18 cases of lactation ketoacidosis were found. Presenting symptoms were nausea (72%, 13/18), vomiting (67%, 12/18), malaise (56%, 10/18), abdominal pain (44%, 8/18), dyspnea (33%, 6/18), headache (22%, 4/18), and palpitation (11%, 2/18). Dieting and physical exercise to lose weight were reported in 76% (14/18). The treatments included IV dextrose, sodium bicarbonate, insulin, rehydration, monitoring and replacement of electrolytes, and resumption of a balanced diet. The prognoses were good, with no mortalities. Conclusions: lactation ketoacidosis should be suspected in unwell breastfeeding women with high anion gap metabolic acidosis, after excluding other causes.
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Yu J, Pudwell J, Dayan N, Smith GN. Postpartum Breastfeeding and Cardiovascular Risk Assessment in Women Following Pregnancy Complications. J Womens Health (Larchmt) 2020; 29:627-635. [DOI: 10.1089/jwh.2019.7894] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julie Yu
- Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Natalie Dayan
- Department of Medicine, McGill University, Montreal, Canada
| | - Graeme N. Smith
- Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Queen's University, Kingston, Canada
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27
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Turner AM, Donelan EA, Kiley JW. Contraceptive Options Following Gestational Diabetes: Current Perspectives. Open Access J Contracept 2019; 10:41-53. [PMID: 31749639 PMCID: PMC6817836 DOI: 10.2147/oajc.s184821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/04/2019] [Indexed: 01/11/2023] Open
Abstract
Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the United States. Along with risk factors related to pregnancy, women with a history of GDM also have an increased risk of developing type 2 diabetes mellitus later in life. These women require special consideration when discussing contraception and other reproductive health issues. GDM carries a category 1 rating in the US Medical Eligibility Criteria for all contraceptive methods, which supports safety of the various methods but does not account for effectiveness. Contraceptive options differ in composition and mechanisms of action, and concerns have been raised about possible effects of contraception on metabolism. Clinical evidence is limited to suggest that hormonal contraception has significantly adverse effects on body weight, lipid, or glucose metabolism. In addition, the majority of evidence does not suggest a relationship between development of type 2 diabetes mellitus and use of hormonal contraception. Data are limited, so it is challenging to make a broad, general recommendation regarding contraception for women with a history of GDM. A woman’s history of GDM should be considered during contraceptive counseling. Discussion should focus on potential medical comorbidities and the implications of GDM on future health, with special consideration of issues including bone health, obesity, cardiovascular disease, and thrombosis risk. Providers must emphasize the importance of reliable, highly effective contraception for women with GDM, to optimize the timing of future pregnancies. This approach to comprehensive counseling will guide optimal decision-making on contraceptive use, lifestyle changes, and planning of subsequent pregnancies.
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Affiliation(s)
- Ashley M Turner
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily A Donelan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica W Kiley
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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28
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Postpartum Weight Retention and Cardiometabolic Risk among Saudi Women: A Follow-Up Study of RAHMA Subcohort. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2957429. [PMID: 31355253 PMCID: PMC6634075 DOI: 10.1155/2019/2957429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
Objectives This papers aims to investigate the association between different levels of postpartum weight retention (PPWR) and cardiometabolic risk among the Saudi women 12 months postpartum. Methods This study is a follow-up of subgroup of cohort from Riyadh mother and baby multicenter cohort study. Clinical data were collected from participants 12 months after delivery and included current Body Mass Index (BMI), waist circumference, hip circumference, and blood pressure. In addition the following blood tests done were fasting blood glucose (FBG), glycosylated haemoglobin (HbA1c) levels, and lipids profile to assess the participants' cardiometabolic risks. The participants were categorized into three groups based on the level of PPWR: weight retention < 3kg; weight retention 3 to < 7kg; and weight retention ≥ 7kg. Subsequently, the prevalence of cardiometabolic risk factors was compared in the three groups to assess the association between different levels of PPWR and cardiometabolic risk factors. Logistic regression was used to test the effect of PPWR in the development of metabolic syndrome and Adjusted Odds Ratio (AOR) was calculated. Results A total of 115 women participated in this study. Around 35% of the study population retained ≥ 7 kg of weight. The prevalence of cardiometabolic risk factors, including metabolic syndrome (MetS), increases with the increase of PPWR (p<0.01). The prevalence of MetS is 13% with highest frequency in the group with the highest weight retention. The determinants developing MetS were prepregnancy weight; AOR (95% CI); 1.08 (1.02-1.14), P< 0.01, current BMI, AOR (95% CI); 1.30 (1.12-1.51), P< 0.01, and FBG during pregnancy, AOR (95% CI); and 4.82 (1.72-13.48), P < 0.01. Conclusion Increased weight retention after delivery augments the rate of occurrence of cardiometabolic risk factors. Determinants of the development of MetS in postpartum Saudi women are increased prepregnancy weight, current BMI, and FBG during pregnancy.
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29
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Tahir MJ, Haapala JL, Foster LP, Duncan KM, Teague AM, Kharbanda EO, McGovern PM, Whitaker KM, Rasmussen KM, Fields DA, Harnack LJ, Jacobs DR, Demerath EW. Association of Full Breastfeeding Duration with Postpartum Weight Retention in a Cohort of Predominantly Breastfeeding Women. Nutrients 2019; 11:nu11040938. [PMID: 31027268 PMCID: PMC6520964 DOI: 10.3390/nu11040938] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/16/2022] Open
Abstract
Full breastfeeding (FBF) is promoted as effective for losing pregnancy weight during the postpartum period. This study evaluated whether longer FBF is associated with lower maternal postpartum weight retention (PPWR) as compared to a shorter FBF duration. The MILK (Mothers and Infants Linked for Healthy Growth) study is an ongoing prospective cohort of 370 mother-infant dyads, all of whom fully breastfed their infants for at least 1 month. Breastfeeding status was subsequently self-reported by mothers at 3 and 6 months postpartum. Maternal PPWR was calculated as maternal weight measured at 1, 3, and 6 months postpartum minus maternal prepregnancy weight. Using linear mixed effects models, by 6 months postpartum, adjusted means ± standard errors for weight retention among mothers who fully breastfed for 1-3 (3.40 ± 1.16 kg), 3-6 (1.41 ± 0.69 kg), and ≥6 months (0.97 ± 0.32 kg) were estimated. Compared to mothers who reported FBF for 1-3 months, those who reported FBF for 3-6 months and ≥6 months both had lower PPWR over the period from 1 to 6 months postpartum (p = 0.04 and p < 0.01, respectively). However, PPWR from 3 to 6 months was not significantly different among those who reported FBF for 3-6 versus ≥6 months (p > 0.05). Interventions to promote FBF past 3 months may increase the likelihood of postpartum return to prepregnancy weight.
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Affiliation(s)
- Muna J Tahir
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Jacob L Haapala
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Laurie P Foster
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Katy M Duncan
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - April M Teague
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | | | - Patricia M McGovern
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA.
- Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA.
| | | | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Ellen W Demerath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
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Nguyen PTH, Pham NM, Chu KT, Van Duong D, Van Do D. Gestational Diabetes and Breastfeeding Outcomes: A Systematic Review. Asia Pac J Public Health 2019; 31:183-198. [DOI: 10.1177/1010539519833497] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Studies of gestational diabetes mellitus in relation to breastfeeding are limited, while their findings are inconsistent. This systematic review was conducted to assess the associations between gestational diabetes and breastfeeding outcomes. An initial search of PubMed, Web of Science, and ProQuest identified 518 studies, and after applying the inclusion criteria, 16 studies were finally included in the review. Four studies reported that “exclusive/predominant/full breastfeeding” rates at discharge were lower in mothers with gestational diabetes than in those without gestational diabetes, and 2 studies showed a shorter duration of “exclusive/predominant breastfeeding” in the former than in the latter. However, most studies found no apparent difference in the rate of “breastfeeding initiation”, “any breastfeeding” duration, or “any breastfeeding” in hospital and at discharge between mothers with and without gestational diabetes. In summary, mothers with gestational diabetes were less likely to exclusively breastfeed their infants and may have a shorter breastfeeding duration than other mothers.
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Affiliation(s)
| | - Ngoc Minh Pham
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Khac Tan Chu
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Dung Van Do
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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31
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Ma S, Hu S, Liang H, Xiao Y, Tan H. Metabolic effects of breastfeed in women with prior gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Res Rev 2019; 35:e3108. [PMID: 30513131 PMCID: PMC6590118 DOI: 10.1002/dmrr.3108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
This study was undertaken to provide comprehensive analyses of current research developments in the field of breastfeed (BF) and metabolic-related outcomes among women with prior gestational diabetes mellitus (GDM). Database PubMed, Embase, BIOSIS Previews, Web of Science, and Cochrane Library were searched through December 3, 2017. Odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) were pooled by random-effects model using Stata version 12.0. Twenty-three observational studies were included in quantitative synthesis. Reduced possibility of progression to type 2 diabetes mellitus (T2DM; OR = 0.79; 95% CI, 0.68-0.92) and pre-DM (OR = 0.66; 95% CI, 0.51-0.86) were found among women with longer BF of any intensity after GDM pregnancy. The positive effect of longer BF on progression to T2DM gradually became prominent with the extension of follow-up period. Compared with women with shorter BF, those with longer BF manifested more favourable metabolic parameters, including significant lower body mass index, fasting glucose, triglyceride, and higher insulin sensitivity index. The findings support that BF may play an important role in protection against the development of T2DM-related outcomes in midlife of women with prior GDM. However, further studies are needed to reveal the etiological mechanism.
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Affiliation(s)
- Shujuan Ma
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Shimin Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Huiling Liang
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Yanni Xiao
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
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32
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Nguyen PTH, Binns CW, Nguyen CL, Ha AVV, Chu TK, Duong DV, Do DV, Lee AH. Gestational Diabetes Mellitus Reduces Breastfeeding Duration: A Prospective Cohort Study. Breastfeed Med 2019; 14:39-45. [PMID: 30383402 DOI: 10.1089/bfm.2018.0112] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) and its complications are major concerns because of the negative effects of GDM during antenatal period and on the future health of mothers and infants. Breastfeeding is beneficial for GDM mothers and their babies to reduce future health risks. Little is known about the link between GDM and the duration of "any" breastfeeding. Therefore, the aim of this study was to investigate the relationship between GDM and the duration for which Vietnamese women breastfeed their babies postpartum. MATERIALS AND METHODS A prospective cohort of 2,030 pregnant women between 24 and 28 weeks of gestation was recruited. GDM status was determined using a 75 g oral glucose tolerance test. Included mothers were then followed up from discharge after childbirth until 12 months postpartum to determine their breastfeeding duration. Kaplan-Meier estimates, log-rank tests, logistic and Cox regression models were used to examine the association between GDM and breastfeeding outcomes. RESULTS In our cohort, 94.4% of all women reported "any" breastfeeding at discharge and 72.9% of women were still breastfeeding at 12 months postpartum. The risk of early breastfeeding cessation was higher in GDM women than their non-GDM counterparts after adjustment for demographic factors (hazard ratios [HR] = 1.39, 95% confidence intervals [CI] = 1.13-1.71, p = 0.002), and all potential confounding factors (HR = 1.38, 95% CI = 1.12-1.70, p = 0.002). There were no significant differences in breastfeeding outcomes at discharge (early initiation, prelacteal feeding, and "any" breastfeeding rate) between GDM and non-GDM mothers. CONCLUSIONS GDM was associated with shorter breastfeeding duration. Women with GDM require ongoing support after hospital discharge to maintain long-term breastfeeding.
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Affiliation(s)
- Phung Thi Hoang Nguyen
- 1 Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,2 School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Colin W Binns
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Cong Luat Nguyen
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia.,3 National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Anh Vo Van Ha
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia.,4 Department of Environmental and Occupational Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tan Khac Chu
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia.,5 Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Dat Van Duong
- 6 Department of Sexual and Reproductive Health, United Nations Population Fund, Hanoi, Vietnam
| | - Dung Van Do
- 1 Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Andy H Lee
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia
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Cheng AA, Li W, Hernandez LL. Effect of high-fat diet feeding and associated transcriptome changes in the peak lactation mammary gland in C57BL/6 dams. Physiol Genomics 2018; 50:1059-1070. [DOI: 10.1152/physiolgenomics.00052.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Maternal consumption of a high-fat diet (HFD) during pregnancy has established adverse effects on the developing neonate. In this study, we aimed to investigate the effect of an HFD on the murine mammary gland during midlactation. Female C57BL/6J mice were placed on either a low-fat diet (LFD/10% fat) or HFD (60% fat) from 3 wk of age through peak lactation (lactation day 11/L11). After 4 wk of consuming either the LFD or HFD, female mice were bred. There were no significant differences in milk yield between treatment groups, which was measured from L1 to L9. On L10, mice were subjected to an overnight fast and then euthanized on the morning of L11. Total RNA was isolated from inguinal mammary glands for whole transcriptome sequencing. We found 628 genes that were differentially expressed between the treatment groups. Notably, HFD feeding resulted in expression alterations of genes involved in collagen and cytoplasmic components. Additionally, genes related to inflammatory and immune responses were also impacted. Differential expression in gene transcript isoforms between the treatment groups was detected in three genes related to mammary duct development. This study sheds light as to how an HFD may affect the mammary gland transcriptome during midlactation.
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Affiliation(s)
- A. A. Cheng
- Department of Dairy Sciences, University of Wisconsin, Madison, Wisconsin
| | - W. Li
- United States Department of Agriculture Dairy Forage, Madison, Wisconsin
| | - L. L. Hernandez
- Department of Dairy Sciences, University of Wisconsin, Madison, Wisconsin
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Liu F, Lv L, Jiang H, Yan R, Dong S, Chen L, Wang W, Chen YQ. Alterations in the Urinary Microbiota Are Associated With Cesarean Delivery. Front Microbiol 2018; 9:2193. [PMID: 30258432 PMCID: PMC6143726 DOI: 10.3389/fmicb.2018.02193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/27/2018] [Indexed: 12/20/2022] Open
Abstract
Similar to the gut, the bladder contains urinary microbiota, and its bacterial composition and structure are determined by the individual’s health status. Cesarean section is a traumatic event for women and it is correlated with postpartum complications. To better understand the urinary microbiota alterations caused by cesarean section, 16S rDNA sequencing was used to assess urine specimens collected by transurethral catheterization from 30 healthy women undergoing cesarean section pre-delivery (PreD) and post-delivery (PostD). A significant increase in bacterial diversity and more detectable bacteria at the phylum, family, and genus levels was observed in the PostD group compared to the PreD group, indicating that cesarean delivery (a process that includes surgery and delivery) altered the bacterial community. Specifically, the phylum Firmicutes and its affiliated family Lactobacillaceae and genus Lactobacillus dramatically decreased in the PostD group, suggesting that beneficial bacteria decreased after cesarean section, and clinicians should be aware that this might increase the risk of complications. Concurrently, the phylum Proteobacteria and its affiliated bacteria Pseudomonadaceae and Pseudomonas increased in the PostD group compared to the PreD group. This indicates that pathogen growth increases after cesarean section, making it important for clinicians to combat these changes to protect women from infectious diseases. Interestingly, several metabolic pathways, such as metabolism of energy, cofactors and vitamins were strengthened in the PostD group, whereas membrane transport was lessened in this group. This suggests that women’s metabolic disorders might be cured by balancing urinary microbiota. In conclusion, the altered urinary microbiota between the PreD and PostD periods appears to provide insight into how to prevent postpartum metabolic disorders.
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Affiliation(s)
- Fengping Liu
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Longxian Lv
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huiyong Jiang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ren Yan
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shurong Dong
- Key Laboratory of Advanced Micro/Nano Electronic Devices and Smart Systems of Zhejiang, College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, China
| | - Liping Chen
- Intensive Unit, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wei Wang
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yong Q Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
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Kajale NA, Khadilkar V, Chiplonkar SA, Padidela R, Khadilkar AV. Prevalence of Metabolic Syndrome Markers among Women at 1-year Postpartum as per Prepregnancy Body Mass Index Status: A Longitudinal Study. Indian J Endocrinol Metab 2017; 21:703-709. [PMID: 28989878 PMCID: PMC5628540 DOI: 10.4103/ijem.ijem_145_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Maternal body composition (BC) changes during lactation. Increased prepregnancy obesity is associated with poor obstetric outcomes. The aim was to study changes in maternal BC postpartum (PP) to 1-year PP with reference to their prepregnancy body mass index (BMI) status. METHODS The study design was a 1-year follow-up study. Sixty-five apparently healthy primiparous women (28.6 ± 3.4 years delivered full-term infants) were randomly selected from December 2010 to June 2013 and postclassified on the basis of their prepregnancy BMI status. Anthropometry, sociodemographic status, physical activity, diet, clinical examination, biochemical tests, and BC at total body (dual energy X-ray absorptiometry, GE, Lunar DPX) were collected using standardized protocols. RESULTS Forty-one women were classified in Group A with normal prepregnancy BMI (20.4 ± 2.0 kg/m2) and 24 women in Group B with overweight/obese (OW/OB) prepregnancy BMI (26.1 ± 1.9 kg/m2). At 1 year, 75% of women returned to normal BMI in Group A, whereas all 100% of women from Group B remained in OW category at 1-year PP. Nearly 43% of Group B women showed the presence of at least two metabolic syndrome risk factors as compared to 36% in Group A at 1 year. CONCLUSION Women with OW/OB prepregnancy BMI accumulated higher visceral fat with a higher prevalence of metabolic risk factors at 1-year PP. Our study underlines the importance of maintaining BMI status in reference range in reproductive years.
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Affiliation(s)
- Neha A. Kajale
- Pediatric Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Pediatric Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Shashi A. Chiplonkar
- Pediatric Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Anuradha V. Khadilkar
- Pediatric Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
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Holmsen ST, Bakkebø T, Seferowicz M, Retterstøl K. Statins and breastfeeding in familial hypercholesterolaemia. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:686-687. [PMID: 28551957 DOI: 10.4045/tidsskr.16.0838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Much D, Beyerlein A, Kindt A, Krumsiek J, Stückler F, Rossbauer M, Hofelich A, Wiesenäcker D, Hivner S, Herbst M, Römisch-Margl W, Prehn C, Adamski J, Kastenmüller G, Theis F, Ziegler AG, Hummel S. Lactation is associated with altered metabolomic signatures in women with gestational diabetes. Diabetologia 2016; 59:2193-202. [PMID: 27423999 DOI: 10.1007/s00125-016-4055-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/20/2016] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Lactation for >3 months in women with gestational diabetes is associated with a reduced risk of type 2 diabetes that persists for up to 15 years postpartum. However, the underlying mechanisms are unknown. We examined whether in women with gestational diabetes lactation for >3 months is associated with altered metabolomic signatures postpartum. METHODS We enrolled 197 women with gestational diabetes at a median of 3.6 years (interquartile range 0.7-6.5 years) after delivery. Targeted metabolomics profiles (including 156 metabolites) were obtained during a glucose challenge test. Comparisons of metabolite concentrations and ratios between women who lactated for >3 months and women who lactated for ≤3 months or not at all were performed using linear regression with adjustment for age and BMI at the postpartum visit, time since delivery, and maternal education level, and correction for multiple testing. Gaussian graphical modelling was used to generate metabolite networks. RESULTS Lactation for >3 months was associated with a higher total lysophosphatidylcholine/total phosphatidylcholine ratio; in women with short-term follow-up, it was also associated with lower leucine concentrations and a lower total branched-chain amino acid concentration. Gaussian graphical modelling identified subgroups of closely linked metabolites within phosphatidylcholines and branched-chain amino acids that were affected by lactation for >3 months and have been linked to the pathophysiology of type 2 diabetes in previous studies. CONCLUSIONS/INTERPRETATION Lactation for >3 months in women with gestational diabetes is associated with changes in the metabolomics profile that have been linked to the early pathogenesis of type 2 diabetes.
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Affiliation(s)
- Daniela Much
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Alida Kindt
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jan Krumsiek
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Ferdinand Stückler
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michaela Rossbauer
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Anna Hofelich
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - David Wiesenäcker
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Pediatrics, Kinderklinik München Schwabing, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Susanne Hivner
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Melanie Herbst
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Werner Römisch-Margl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Cornelia Prehn
- Genome Analysis Center, Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jerzy Adamski
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Genome Analysis Center, Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany
| | - Gabi Kastenmüller
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Fabian Theis
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Forschergruppe Diabetes e.V., Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
- Forschergruppe Diabetes e.V., Neuherberg, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
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Abstract
Researchers hypothesize that pregnancy and lactation are part of a continuum, with lactation meant to "reset" the adverse metabolic profile that develops as a part of normal pregnancy, and that when lactation does not occur, women maintain an elevated risk of cardio-metabolic diseases. Several large prospective and retrospective studies, mostly from the United States and other industrialized countries, have examined the associations between lactation and cardio-metabolic outcomes. Less evidence exists regarding an association of lactation with maternal postpartum weight status and dyslipidemia, whereas more evidence exists for an association with diabetes, hypertension, and subclinical and clinical cardiovascular disease.
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Affiliation(s)
- Cria G Perrine
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia 30341;
| | - Jennifer M Nelson
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia 30341;
| | - Jennifer Corbelli
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Kelley S Scanlon
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia 30341;
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Katayama H, Tachibana D, Hamuro A, Misugi T, Motoyama K, Morioka T, Fukumoto S, Emoto M, Inaba M, Koyama M. Sustained Decrease of Early-Phase Insulin Secretion in Japanese Women with Gestational Diabetes Mellitus Who Developed Impaired Glucose Tolerance and Impaired Fasting Glucose Postpartum. JAPANESE CLINICAL MEDICINE 2015; 6:35-9. [PMID: 26688669 PMCID: PMC4675641 DOI: 10.4137/jcm.s32743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/29/2015] [Accepted: 10/31/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare glucose intolerance in the antenatal and the postpartum periods using a 75-g oral glucose tolerance test (OGTT) in the Japanese women with gestational diabetes mellitus (GDM) using a retrospective design. PATIENTS AND METHODS Data were obtained from 85 Japanese women with GDM who delivered from April 2011 through April 2015 and who underwent an OGTT 6–14 weeks postpartum. The women were divided into two groups based on the results of the postpartum OGTT: one group with normal glucose tolerance (NGT) and the other with impaired glucose tolerance (IGT) as well as impaired fasting glucose (IFG). We analyzed the associations between postpartum IGT–IFG and various factors. RESULTS Antenatally, a significant difference was observed between the groups only in the 1-hour plasma glucose level of the 75-g OGTT. Postpartum results of plasma glucose level were significantly higher at 0.5, 1, and 2 hours in the IGT–IFG group than those in the NGT group. Moreover, a significant decrease in the levels of 0.5-hour immunoreactive insulin and insulinogenic index was observed in the IGT–IFG group compared to those in the NGT group. Homeostasis model assessment-insulin resistance and homeostasis model assessment β-cell function of both groups were found to significantly decrease in the postpartum period; however, there was no significant change in the insulinogenic index of either group. CONCLUSIONS Our study clearly showed that the postpartum IGT and IFG levels of Japanese women with GDM are affected by impaired early-phase insulin secretion; however, insulin resistance promptly improves.
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Affiliation(s)
- Hiroko Katayama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Daisuke Tachibana
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Akihiro Hamuro
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Takuya Misugi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Koka Motoyama
- Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Shinya Fukumoto
- Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka City University, Asahimachi, Abeno-ku, Osaka, Japan
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Rinnov AR, Rathcke CN, Bonde L, Vilsbøll T, Knop FK. Plasma YKL-40 during pregnancy and gestational diabetes mellitus. J Reprod Immunol 2015; 112:68-72. [PMID: 26301577 DOI: 10.1016/j.jri.2015.06.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/15/2015] [Accepted: 06/19/2015] [Indexed: 01/04/2023]
Abstract
Gestational diabetes mellitus (GDM) is characterised by hyperglycaemia during pregnancy. The clinical circumstances involved in the development of GDM leaves the patient at a high risk of the subsequent development of type 2 diabetes. Plasma levels of the inflammation marker YKL-40 are elevated in type 2 diabetes and correlate with fasting plasma glucose levels and insulin resistance in patients with type 2 diabetes. With the present study we aimed to determine if pregnancy (and associated insulin resistance) with or without GDM affects plasma YKL-40 levels. Plasma from women diagnosed with GDM and healthy normal glucose-tolerant pregnant women (non-GDM) was obtained at the third trimester of pregnancy and again 3-4 months following delivery, and levels of YKL-40 and interleukin 6 (IL-6; known to regulate YKL-40) were measured. Plasma YKL-40 levels were similarly low during pregnancy in both groups and increased significantly after delivery, but remained lower in the GDM group compared with the non-GDM group postpartum. In contrast, plasma IL-6 levels were not affected by pregnancy or diagnosis of GDM, Nevertheless, YKL-40 levels were associated with IL-6 levels in the non-GDM group (but not in the GDM group). Pregnancy seems to be associated with a temporary reduction in circulating YKL-40, which increases after delivery, but to a much lesser extent in women with GDM than in non-GDM women.
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Affiliation(s)
- Anders R Rinnov
- The Centre of Inflammation and Metabolism, The Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Camilla N Rathcke
- Department of Endocrinology and Metabolism, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Bonde
- Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip K Knop
- Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Sokup A, Ruszkowska-Ciastek B, Walentowicz-Sadłecka M, Grabiec M, Rość D. Gestational diabetes mellitus worsens the profile of cardiometabolic risk markers and decrease indexes of beta-cell function independently of insulin resistance in nondiabetic women with a parental history of type 2 diabetes. J Diabetes Res 2014; 2014:743495. [PMID: 25097861 PMCID: PMC4109116 DOI: 10.1155/2014/743495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/14/2014] [Accepted: 05/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Women with a history of both parental type 2 diabetes (pt2DM) and previous gestational diabetes (pGDM) represent a group at high risk of cardiovascular events. We hypothesized that pGDM changes cardiometabolic risk markers levels as well as theirs associations with glucose indices in nondiabetic pt2DM women. METHODS Anthropometric parameters, glucose regulation (OGTT), insulin resistance (HOMA-IR), beta-cell function, lipid levels, parameters of endothelial dysfunction, and inflammation were evaluated in 55 women with pt2DM, 40 with both pt2DM and pGDM 2-24 months postpartum, and 35 controls. RESULTS Prediabetes was diagnosed more frequently in women with both pt2DM and pGDM in comparison with women with only pt2DM (10 versus 8, P = 0.04). The pGDM group had higher LDL-cholesterol, sICAM-1, tPa Ag, fibrinogen, and lower beta-cell function after adjustment for HOMA-IR, in comparison with pt2DM group. In pt2DM group postchallenge glucose correlated independently with hsCRP and in pGDM group fasting glucose with HOMA-IR. CONCLUSIONS pGDM exerts a combined effect on cardiometabolic risk markers in women with pt2DM. In these women higher LDL-cholesterol, fibrinogen, sICAM-1, tPa Ag levels and decreased beta cell function are associated with pGDM independently of HOMA-IR index value. Fasting glucose is an important cardiometabolic risk marker and is independently associated with HOMA-IR.
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Affiliation(s)
- Alina Sokup
- Department of Gastroenterology, Angiology and Internal Diseases, Nicolaus Copernicus University, Dr. J. Biziel University Hospital, Ujejskiego 75, 85-168 Bydgoszcz, Poland
- Department of Endocrinology, Dr. J. Biziel University Hospital, Ujejskiego 75, 85-168 Bydgoszcz, Poland
- *Alina Sokup:
| | - Barbara Ruszkowska-Ciastek
- Department of Pathophysiology, Nicolaus Copernicus University, Dr. A. Jurasz University Hospital, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Małgorzata Walentowicz-Sadłecka
- Department of Obstetrics and Gynecology, Nicolaus Copernicus University, Dr. J. Biziel University Hospital, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Marek Grabiec
- Department of Obstetrics and Gynecology, Nicolaus Copernicus University, Dr. J. Biziel University Hospital, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Danuta Rość
- Department of Pathophysiology, Nicolaus Copernicus University, Dr. A. Jurasz University Hospital, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
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