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Bashir M, Ibrahim I, Beer S, Shahbic H, Eltaher F, Al-Mutawaa K, Zirie M, Abou-Samra AB. Integrated care of diabetes during pregnancy: a Qatari nationwide cohort. EClinicalMedicine 2024; 72:102605. [PMID: 38680518 PMCID: PMC11053263 DOI: 10.1016/j.eclinm.2024.102605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
Background Diabetes in pregnancy (DIP) is associated with adverse fetal and maternal outcomes. DIP is classified as either pre-existing or new-onset diabetes mellitus (DM), which is classified into gestational DM (GDM) and newly detected type 2 (N-T2D). All pregnant women in Qatar who are not known to have pre-existing DM are offered screening for DIP during the first antenatal care visit and after 24 weeks gestation. The study aims to report the DIP screening rates, the prevalence of DIP, and the impact of the universal screening program on adverse pregnancy outcomes. Methods This retrospective study included all women who gave birth in Hamad Medical Corporation (HMC) hospitals between 2019 and 2022. New-onset DIP was defined using the WHO-2013 criteria. The primary outcomes were the screening rates and the prevalence of DIP in Qatar. The secondary outcomes were the difference in preterm delivery, C-section, macrosomia, large for gestational age (LGA), small for gestational age (SGA), and intra-uterine fetal death (IUFD) between women with or without GDM. Findings We included 94,422 women who gave birth to 96,017 neonates (85.7%) out of 112,080 neonates born nationwide. The number of women with pre-existing diabetes was 2496 women. Of 91,926 eligible women, 77,372 (84.2%) were screened for DIP. The prevalence of GDM is 31.6% (95% CI: 31.3-32.0%); N-T2D is 2.2% (95% CI: 2.1-2.3%), and pre-existing Type 2 DM and Type 1 DM was 2.6% (95% CI: 0.8-3.0%) and 0.2% (0.19-0.25), respectively. Compared to the non-GDM group, women with GDM were older (30.8 ± 5.3 versus 29.7 ± 5.2 years, p < 0.001). After adjusting for age, women with GDM had lower risk of IUFD and SGA (0.63 [95% CI 0.50-0.80, p < 0.001], 0.88 [95% CI 0.84-0.92, p < 0.001] respectively) but higher risk of C-section and LFD (1.07 [95% CI 1.04-1.10, p < 0.001], 1.09 [95% CI 1.01-1.15, p = 0.01], respectively, compared to women with no-GDM. Interpretation Of the women eligible for screening, 84.2% were screened by the DIP program in Qatar. The prevalence of DIP in Qatar is 36.9%. Integrated care is critical for the screening and management of diabetes during pregnancy. Fundings The authors did not receive any funding for this project.
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Affiliation(s)
- Mohammed Bashir
- Endocrine Section, Internal Medicine Department, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
- Qatar Metabolic Institute, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ibrahim Ibrahim
- Sidra Medicine, Qatar Foundation, P.O Box 26999, Doha, Qatar
| | - Stephen Beer
- Endocrine Section, Internal Medicine Department, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
- Qatar Metabolic Institute, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Hessa Shahbic
- Women's Health Program, Primary Health Care Corporation, Box: 26555, Doha, Qatar
| | - Faten Eltaher
- Department of Obstetrics and Gynaecology, Women's Wellness and Research Centre, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
| | - Kholoud Al-Mutawaa
- Non-communicable Diseases, Public Health Department, Ministry of Public Health, P.O Box. 7744, Doha, Qatar
- Qatar National Diabetes Committee, Ministry of Public Health, P.O Box. 7744, Doha, Qatar
| | - Mahmoud Zirie
- Endocrine Section, Internal Medicine Department, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
- Qatar National Diabetes Committee, Ministry of Public Health, P.O Box. 7744, Doha, Qatar
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Qatar National Diabetes Committee, Ministry of Public Health, P.O Box. 7744, Doha, Qatar
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Francis EC, Powe CE, Lowe WL, White SL, Scholtens DM, Yang J, Zhu Y, Zhang C, Hivert MF, Kwak SH, Sweeting A. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2023; 3:185. [PMID: 38110524 PMCID: PMC10728189 DOI: 10.1038/s43856-023-00393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. METHODS Systematic literature searches were performed in PubMed and EMBASE from inception to March 2022 for studies comparing perinatal outcomes among women with GDM. We searched for precision markers in the following categories: maternal anthropometrics, clinical/sociocultural factors, non-glycemic biochemical markers, genetics/genomics or other -omics, and fetal biometry. We conducted post-hoc meta-analyses of a subset of studies with data on the association of maternal body mass index (BMI, kg/m2) with offspring macrosomia or large-for-gestational age (LGA). RESULTS A total of 5905 titles/abstracts were screened, 775 full-texts reviewed, and 137 studies synthesized. Maternal anthropometrics were the most frequent risk marker. Meta-analysis demonstrated that women with GDM and overweight/obesity vs. GDM with normal range BMI are at higher risk of offspring macrosomia (13 studies [n = 28,763]; odds ratio [OR] 2.65; 95% Confidence Interval [CI] 1.91, 3.68), and LGA (10 studies [n = 20,070]; OR 2.23; 95% CI 2.00, 2.49). Lipids and insulin resistance/secretion indices were the most studied non-glycemic biochemical markers, with increased triglycerides and insulin resistance generally associated with greater risk of offspring macrosomia or LGA. Studies evaluating other markers had inconsistent findings as to whether they could be used as precision markers. CONCLUSIONS Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. Future studies examining non-glycemic biochemical, genetic, other -omic, or sociocultural precision markers among women with GDM are warranted.
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Affiliation(s)
- Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiaxi Yang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Coelho S, Canha M, Leite AR, Neves JS, Oliveira AI, Carvalho D. Relation between weight gain during pregnancy and postpartum reclassification in gestational diabetes. Endocrine 2023; 82:296-302. [PMID: 37668927 DOI: 10.1007/s12020-023-03441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is the most common metabolic disease in pregnancy. It is known that GDM is a precursor to type 2 diabetes (T2D). There is evidence that excessive gestational weight variation (GWV) increases the risk of GDM. So, in this study, we aimed to evaluate the association between GWV and the persistence of diabetes in postpartum reclassification. METHODS A retrospective observational study including pregnant women based on data from the Portuguese National Registry of Gestational Diabetes. Six-to-eight weeks after delivery, all women included underwent a reclassification test. We performed unadjusted and adjusted logistic regression models to evaluate the associations between GWV and diabetes diagnosis at the reclassification test. A subgroup analysis according to the pre-gestational BMI was also performed. RESULTS We included 10,389 pregnant women, of which 19.6% had GDM in a previous pregnancy. The median of GWV was 10.0 [6.4, 14.0] kg and was found to be higher for those with a normal BMI. At the DM reclassification test, 1% of the women were diagnosed with T2D. We found a negative association between GWV and postpartum diabetes mellitus (DM). We also present a subgroup analysis, and these associations were only significant for the group with a normal pre-gestational BMI. CONCLUSION Our results showed that women with normal pre-gestational BMI and lower GWV were more likely to have a diagnosis of DM in the postpartum reclassification test. This study helps to fill the gap in the effect of GWG on the persistence of diabetes in postpartum reclassification.
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Affiliation(s)
- Sofia Coelho
- Department of Biomedicins, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Marta Canha
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Ana Rita Leite
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | | | - Davide Carvalho
- Instituto de Investigação e Inovação em Saúde (i3s), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
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Msollo SS, Martin HD, Mwanri AW, Petrucka P. Simple method for identification of women at risk of gestational diabetes mellitus in Arusha urban, Tanzania. BMC Pregnancy Childbirth 2022; 22:545. [PMID: 35794524 PMCID: PMC9258134 DOI: 10.1186/s12884-022-04838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Screening for gestational diabetes mellitus in Tanzania is challenged by limited resources. Therefore, this study aimed to develop a simple method for identification of women at risk of gestational diabetes mellitus in Arusha urban, Tanzania. METHODS This study used data from a cross sectional study, that was conducted between March and December 2018 in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Urine glucose was tested using urine multistics and blood glucose levels by Gluco-Plus™ and diagnosed in accordance with the World Health Organization's criteria. Anthropometrics were measured using standard procedures and maternal characteristics were collected through face-to-face interviews using a questionnaire with structured questions. Univariate analysis assessed individual variables association with gestational diabetes mellitus where variables with p-value of < 0.05 were included in multivariable analysis and predictors with p-value < 0.1 remained in the final model. Each variable was scored based on its estimated coefficients and risk scores were calculated by multiplying the corresponding coefficients by ten to get integers. The model's performance was assessed using c-statistic. Data were analyzed using Statistical Package for Social Science™. RESULTS The risk score included body fat ≥ 38%, delivery to macrosomic babies, mid-upper arm circumference ≥ 28 cm, and family history of type 2 diabetes mellitus. The score correctly identified 98% of women with gestational diabetes with an area under the receiver operating characteristic curve of 0.97 (95% CI 0.96-0.99, p < 0.001), sensitivity of 0.98, and specificity of 0.46. CONCLUSION The developed screening tool is highly sensitive and correctly differentiates women with and without gestational diabetes mellitus in a Tanzanian sub-population.
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Affiliation(s)
- Safiness Simon Msollo
- Depertment of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Haikael David Martin
- School of Life Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Akwilina Wendelin Mwanri
- Depertment of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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Grønvall L, Skjeldestad FE. Changed definition of disease and broader screening criteria had little impact on prevalence of gestational diabetes mellitus. Acta Obstet Gynecol Scand 2022; 101:581-588. [PMID: 34699074 PMCID: PMC9564809 DOI: 10.1111/aogs.14276] [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: 06/28/2021] [Revised: 08/31/2021] [Accepted: 09/27/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are major controversies in screening for gestational diabetes mellitus (GDM). The present study evaluates the impact of the 2017 revised guidelines for GDM screening and a changed definition of GDM in Norway. MATERIAL AND METHODS We used a case-series design and included women with no pre-pregnancy diabetes mellitus, who gave birth after gestational week 29 to a singleton fetus at the University Hospital of North Norway, Tromsø, or at a local maternity ward in Troms county, during the first 6 months of 2013 (before group, n = 676) and 2018 (after group, n = 673). Data were collected from antenatal records, maternal health information sheets, and electronic medical records (Partus). We assessed the screening criteria age, parity, pre-pregnancy BMI, and ethnicity. Primary outcomes were change in size of the population eligible for GDM screening, screening adherence, and prevalence of GDM, and follow up of GDM (treatment and obstetric risk assessment at gestational week 36). Statistical analyses were done using IBM SPSS with chi-squared test. A p value less than 0.05 was considered statistically significant. RESULTS The proportion of women eligible for GDM screening increased from 46.4% in the before group to 67.6% in the after group (+45%) (p < 0.01). However, screening adherence among eligible women was only 28.3% and 49.2% in the before and after groups, respectively (p < 0.01). Among screened women, 16.9% (15/89) and 10.7% (24/224), respectively, were diagnosed with GDM, resulting in an overall estimated prevalence of 2.2% (15/676) and 3.6% (24/673). Among women diagnosed with GDM, 13.3% received no follow up in 2013 and this proportion was 20.8% in 2018. The remaining women underwent obstetric risk assessment at gestational week 36 as advised in the guidelines. CONCLUSIONS The introduction of broader screening criteria and a more liberal case definition increased the population eligible for GDM screening by 45%. The higher proportion of women screened resulted in an insignificant higher prevalence of GDM. Screening adherence was poor in both study groups. Stakeholders for obstetric care need to consolidate quality measures and revisit the screening algorithm.
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Affiliation(s)
- Lina Grønvall
- Research Group Epidemiology of Chronic DiseasesInstitute of Community MedicineUiT the Arctic University of NorwayTromsøNorway
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic DiseasesInstitute of Community MedicineUiT the Arctic University of NorwayTromsøNorway
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Haschka SJ, Gar C, Sacco V, Banning F, Ferrari U, Freibothe I, Kern-Matschilles S, Potzel AL, Rauch B, Fueessl LU, Meisel M, Benz I, Then C, Seissler J, Lechner A. Pre-diabetes, diabetes and fluctuations of glucose tolerance after gestational diabetes mellitus: 5-year follow-up of a contemporary, prospective study in Germany. BMJ Open Diabetes Res Care 2022; 10:10/2/e002621. [PMID: 35241429 PMCID: PMC8895937 DOI: 10.1136/bmjdrc-2021-002621] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/29/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Ten years ago, Germany started offering screening for gestational diabetes mellitus (GDM) to all pregnant women. This approach revealed more but also, on average, less severe cases of GDM than the risk-based screening practiced previously. We now examined the incidence of pre-diabetes and diabetes following a GDM diagnosis in the era of universal screening in Germany and compared our results with studies in the previous period. Additionally, we examined the year-to-year fluctuations of glucose tolerance after a pregnancy complicated by GDM. RESEARCH DESIGN AND METHODS We report 5-year follow-up data from 202 women in the prospective, monocenter, postpartum study PPSDiab. Consecutive recruitment took place in Munich, Germany between 2011 and 2016. In the study, we conducted yearly examinations that included anthropometrics, laboratory chemistry and oral glucose tolerance testing. RESULTS During the first 5 years post partum, 111 (55%) and 12 (6%) of the women developed pre-diabetes and type 2 diabetes, respectively, while 2 (1%) developed type 1 diabetes. Impaired fasting glucose (IFG) was the most common first manifestation of disturbed glucose tolerance, followed by impaired glucose tolerance (IGT), the combination of IFG and IGT, and diabetes. Glucose tolerance did not deteriorate steadily in most women but fluctuated from year to year. CONCLUSIONS In our analysis, the incidence of diabetes, both type 1 and type 2, after GDM diagnosed in universal screening was substantially lower than in studies from the previous period of risk-based screening. Nevertheless, the high incidence of pre-diabetes we observed after GDM still confirms the importance of this diagnosis as a risk marker. Additionally, we documented frequent fluctuations of glucose tolerance from 1 year to the next. Therefore, a single postpartum glucose tolerance test, as currently practiced in routine care, may be insufficient for reliable risk stratification after GDM.
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Affiliation(s)
- Stefanie J Haschka
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Christina Gar
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Vanessa Sacco
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Friederike Banning
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Uta Ferrari
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Ines Freibothe
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Stefanie Kern-Matschilles
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Anne L Potzel
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Barbara Rauch
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Louise U Fueessl
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Mandy Meisel
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Irina Benz
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Cornelia Then
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Jochen Seissler
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Andreas Lechner
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
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Minschart C, Beunen K, Benhalima K. An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review. Diabetes Metab Syndr Obes 2021; 14:3047-3076. [PMID: 34262311 PMCID: PMC8273744 DOI: 10.2147/dmso.s287121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. Screening and diagnostic practices for GDM are inconsistent across the world. This narrative review includes data from 87 observational studies and randomized controlled trials (RCTs), and aims to give an overview of the current evidence on screening strategies and diagnostic criteria for GDM. Screening in early pregnancy remains controversial and studies show conflicting results on the benefit of screening and treatment of GDM in early pregnancy. Implementing the one-step "International Association of Diabetes and Pregnancy Study Groups" (IADPSG) screening strategy at 24-28 weeks often leads to a substantial increase in the prevalence of GDM, without conclusive evidence regarding the benefits on pregnancy outcomes compared to a two-step screening strategy with a glucose challenge test (GCT). In addition, RCTs are needed to investigate the impact of treatment of GDM diagnosed with IADPSG criteria on long-term maternal and childhood outcomes. Selective screening using a risk-factor-based approach could be helpful in simplifying the screening algorithm but carries the risk of missing significant proportions of GDM cases. A two-step screening method with a 50g GCT and subsequently a 75g oral glucose tolerance test (OGTT) with IADPSG could be an alternative to reduce the need for an OGTT. However, to have an acceptable sensitivity to screen for GDM with the IADPSG criteria, the threshold of the GCT should be lowered from 7.8 to 7.2 mmol/L. A pragmatic approach to screen for GDM can be implemented during the COVID-19 pandemic, using fasting plasma glucose (FPG), HbA1c or even random plasma glucose (RPG) to reduce the number of OGTTs needed. However, usual guidelines and care should be resumed as soon as the COVID pandemic is controlled.
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Affiliation(s)
- Caro Minschart
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
| | - Kaat Beunen
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
| | - Katrien Benhalima
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, 3000, Belgium
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Adiponectin DNA methylation in South African women with gestational diabetes mellitus: Effects of HIV infection. PLoS One 2021; 16:e0248694. [PMID: 33750967 PMCID: PMC7984613 DOI: 10.1371/journal.pone.0248694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
DNA methylation is increasingly recognized as a potential biomarker of metabolic disease. However, there is limited information on the impact of human immunodeficiency virus (HIV) infection on the candidacy of DNA methylation to serve as molecular biomarkers. This study investigated the effect of HIV infection on DNA methylation patterns in the peripheral blood of South African women with (n = 95) or without (n = 191) gestational diabetes mellitus (GDM). DNA methylation levels at eight CpG sites in the adiponectin gene (ADIPOQ) promoter were measured using bisulfite conversion and pyrosequencing. Differences between HIV negative (-) and positive (+) women were observed. In HIV- women, methylation at CpG -3400 was lower in GDM+ women compared to those with normoglycemia (8.5-fold; p = 0.004), and was associated with higher fasting glucose (β-co-efficient = 0.973; p = 0.006) and lower adiponectin (β-co-efficient = -0.057; p = 0.014) concentrations. These associations were not observed in HIV+ women. In silico analysis showed that Transcription Factor AP2-alpha is able to bind to the altered CpG site, suggesting that CpG -3400 may play a functional role in the regulation of ADIPOQ expression. Our findings show that DNA methylation differs by HIV status, suggesting that HIV infection needs to be taken into consideration in studies exploring DNA methylation as a biomarker of GDM in high HIV prevalence settings.
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Pheiffer C, Dias S, Jack B, Malaza N, Adam S. Adiponectin as a Potential Biomarker for Pregnancy Disorders. Int J Mol Sci 2021; 22:1326. [PMID: 33572712 PMCID: PMC7866110 DOI: 10.3390/ijms22031326] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
Adiponectin is an adipocyte-derived hormone that plays a critical role in energy homeostasis, mainly attributed to its insulin-sensitizing properties. Accumulating studies have reported that adiponectin concentrations are decreased during metabolic diseases, such as obesity and type 2 diabetes, with an emerging body of evidence providing support for its use as a biomarker for pregnancy complications. The identification of maternal factors that could predict the outcome of compromised pregnancies could act as valuable tools that allow the early recognition of high-risk pregnancies, facilitating close follow-up and prevention of pregnancy complications in mother and child. In this review we consider the role of adiponectin as a potential biomarker of disorders associated with pregnancy. We discuss common disorders associated with pregnancy (gestational diabetes mellitus, preeclampsia, preterm birth and abnormal intrauterine growth) and highlight studies that have investigated the potential of adiponectin to serve as biomarkers for these disorders. We conclude the review by recommending strategies to consider for future research.
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Affiliation(s)
- Carmen Pheiffer
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa; (S.D.); (B.J.); (N.M.)
- Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa; (S.D.); (B.J.); (N.M.)
| | - Babalwa Jack
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa; (S.D.); (B.J.); (N.M.)
| | - Nompumelelo Malaza
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa; (S.D.); (B.J.); (N.M.)
- Department of Reproductive Biology, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa
| | - Sumaiya Adam
- Department of Obstetrics and Gynaecology, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa;
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Pheiffer C, Dias S, Adam S. Intimate Partner Violence: A Risk Factor for Gestational Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217843. [PMID: 33114711 PMCID: PMC7663316 DOI: 10.3390/ijerph17217843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022]
Abstract
The early detection and management of gestational diabetes mellitus (GDM) is an important public health goal. GDM, which is defined as a glucose intolerance that develops during pregnancy, affects about 14% of pregnancies globally, and without effective treatment, it is associated with adverse short- and long-term maternal and neonatal outcomes. Risk-factor screening is an acceptable and affordable strategy to enable risk stratification and intervention. However, common biological risk factors such as overweight or obesity, excessive gestational weight gain, and family history of diabetes often have poor predictive ability, failing to identify a large proportion of women at risk of developing GDM. Accumulating evidence implicate psychosocial factors in contributing to GDM risk. As such, intimate partner violence (IPV), through its contributing effects on maternal stress and depression, presents a plausible risk factor for GDM. Experiencing IPV during pregnancy may dysregulate the hypothalamus-pituitary-adrenal (HPA) axis, leading to increased cortisol secretion and insulin resistance. These effects may exacerbate the insulin-resistant environment characteristic of pregnancy, thus increasing GDM risk. This review explores the relationship between IPV and GDM. We highlight studies that have linked IPV with GDM and propose a biological mechanism that connects IPV and GDM. Recommendations for IPV screening strategies to prevent GDM are discussed.
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Affiliation(s)
- Carmen Pheiffer
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa;
- Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
- Correspondence: ; Tel.: +27-21-938-0292
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa;
| | - Sumaiya Adam
- Department of Obstetrics and Gynecology, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa;
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Rottenstreich M, Rotem R, Reichman O, Farkash R, Rottenstreich A, Samueloff A, Sela HY. Previous non-diabetic pregnancy with a macrosomic infant - Is it a risk factor for subsequent gestational diabetes mellitus? Diabetes Res Clin Pract 2020; 168:108364. [PMID: 32791161 DOI: 10.1016/j.diabres.2020.108364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/10/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022]
Abstract
AIM To examine the association between previous pregnancy neonatal birthweight (BW) among non-diabetic women and the rate of gestational diabetes mellitus (GDM) in the subsequent pregnancy. METHODS Case control study in a university affiliated medical center from 2005 to 2019. Women who had a singleton pregnancy and two consecutive deliveries in our medical center were included. GDM diagnosis was based on either National Diabetes Data Group or Carpenter and Coustan criteria. Univariate analysis was followed by multivariate logistic regression. RESULTS A total of 47,823 women were included. GDM incidence among the subsequent pregnancies was 2.7% (1,312 women). Parturients with GDM had higher mean birthweight in their previous pregnancy compared with parturients without GDM (3336.9 ± 587.4 vs 3229.9 ± 488.2 g, p < 0.001). Women with GDM in the subsequent pregnancy as compared to women without GDM showed higher rates of having previous big neonates: BW ≥ 90% for gestational age, BW ≥ 4000 gr and BW ≥ 4500 g (p < 0.01 for all), 20.2% vs. 10.7%, 9.6% vs 4.5% and 1% vs. 0.3% respectively. Multivariate analysis adjusted for known risk factors for GDM showed that these factors were still independently associated with occurrence of GDM in the subsequent pregnancy 1.7 (1.1-2.5), 1.9 (1.1-3.4), 6.0 (1.6-22.8), respectively. CONCLUSION Neonatal BWs in previous pregnancy is associated with increased GDM incidence in the subsequent pregnancy; Women with previous macrosomia should possibly undergo a diagnostic testing.
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Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Orna Reichman
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Rivka Farkash
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
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