Trends in maternal characteristics, and maternal and neonatal outcomes of women with gestational diabetes: A study from Jordan

Effects of gestational diabetes mellitus on offspring: A literature review

Gestational diabetes mellitus (GDM) is a health problem that is becoming increasingly serious worldwide. It has a high incidence and strongly affects both mothers and children. In recent years, more extensive and in-depth studies have been conducted. In the present study, we systematically reviewed the effects of GDM on offspring, including the short- and long-term outcomes. Related articles were indexed in PubMed, Web of Science, Science Direct, and the Cochran Library up to June 2024. Recommendations were extracted from the identified articles and collated as themes. Many studies, which are mostly observational, have shown that GDM increases the risk of macrosomia, premature delivery or metabolic diseases, and so on, seriously affecting the outcome of pregnancy, growth and development of the child, and even the duration of the child's life. Cohort studies are the main force providing research data. The short-term effects are mainly childbirth complications. Maternal-offspring complications include a high risk of cesarean section, shoulder dystocia, and birth injury, which are often due to a large fetus. The long-term effects, including metabolic, cardiovascular, and nervous system disease are serious. Specifically, obesity, adiposity, glucose metabolism, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, neurodevelopmental and mental disease, lung and allergic disease and even risk of chromosomol abnormalities (CAs), and so on, are included. Therefore, it is important to note the negative effects of GDM on offspring. Managing pregnant women with GDM well is a top priority, especially lifestyle interventions (diet and exercise) and glucose-lowering measures in necessity.

Healthcare professionals' perceptions of barriers and facilitators to postpartum diabetes screening participation in women with gestational diabetes mellitus in China: A qualitative study

BACKGROUND

Women with a history of gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes (T2DM). Postpartum diabetes screening is usually recommended to identify glucose intolerance and introduce timely diabetes prevention strategies. However, the uptake of postpartum diabetes screening is suboptimal, especially in China, where GDM is prevalent. Healthcare professionals (HCPs) may offer unique insights into the challenges women face when attending screening, helping to develop interventions that improve uptake and fit in with routine clinical practice.

AIM

To explore HCPs' perceptions of barriers and facilitators to postpartum diabetes screening uptake.

METHODS

Online semi-structured interviews were conducted with HCPs recruited via online networks. The data were analysed using framework analysis and the socio-ecological model.

RESULTS

Eighteen HCPs, including obstetricians, midwives, nurses, nurse managers, and a dietician participated. Thirteen themes were generated across four levels (individual, interpersonal, organisational and policy). Individual level themes included: women's limited understanding, adherence and motivation; low diabetes risk awareness; and competing priorities. Interpersonal challenges involved communication and relationships between HCPs and women. Organizational barriers included workforce shortages, a lack of systemic GDM follow-up and care integration, and limited screening accessibility. At the policy level, GDM follow-up was not promoted nor prioritised.

CONCLUSION

HCPs have a vital role in improving patient education, postpartum follow-up and support after GDM to reduce long-term health risks. Strengthening HCP training in communication with women and improving continuity and integration of care could enhance GDM follow-up and prevent diabetes in women following GDM.

Lymphocyte Subsets and Cytokine Changes in Women With Gestational Diabetes Mellitus: A Systematic Review

Introduction: Gestational diabetes mellitus (GDM) is a major health concern during pregnancy, affecting both the mother and the baby. Immune system alterations, particularly changes in lymphocyte subsets and cytokine profiles, have been associated with the pathophysiology of various metabolic disorders, including diabetes. This study is aimed at systematically reviewing the literature on the changes in lymphocyte subsets and cytokines in GDM. Methods: In this systematic review, we applied specific criteria to select observational studies (such as case-controls, cross-sectionals, or cohorts) that focused on pregnant women. We performed an extensive search across electronic databases, including Web of Science, Scopus, PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar, from January 1, 2010, to March 20, 2024. Results: A total of 19 articles, with 2517 participants (1128 with GDM and 1389 without GDM), were included in the qualitative synthesis. Due to high heterogeneity among the articles, a meta-analysis was not conducted. The studies assessed 35 different lymphocyte subsets or proportions. The most commonly assessed subsets were CD3+ T cell (five articles, mostly no difference between GDM and non-GDM), CD4+ T cell (five articles with contradictory results), CD8+ T cell (four articles with contradictory results), B cell and NK cell (three articles, mostly no difference between GDM and non-GDM), and Tregs (three articles with contradictory results). Additionally, 32 cytokines or proportions were assessed in the studies. The most commonly assessed cytokines were IL-6 (eight articles, higher or similar levels in GDM compared to non-GDM), TNF-α (seven articles, mostly higher or similar levels in GDM compared to non-GDM), IL-10 (six articles, mostly no difference between GDM and non-GDM), IL-2 (three articles, mostly no difference between GDM and non-GDM), and IFN-γ (three articles with contradictory results). Conclusion: According to the results, there were no significant changes in CD3+ T cells, B cells, NK cells, IL-10, and IL-2 in GDM. However, the levels of IL-6 and TNF-α were higher or similar in GDM compared to non-GDM. The changes of other lymphocyte subsets and cytokines in GDM remained unclear.

Effects of Gestational Diabetes Mellitus on Fetal Liver Length: A Systematic Review and Meta-Analysis

Background

Gestational diabetes mellitus (GDM) is a serious pregnancy complication that can affect various organs and organ systems of the mother and fetus. In diabetic mothers, increased blood glucose delivery to the fetus leads to fetal hyperglycemia and hyperinsulinemia, which promotes the growth of insulin-dependent organs such as the liver. Therefore, this systematic review and meta-analysis was conducted to more precisely estimate the association between GDM and fetal liver length (FLL).

Methods

Six electronic databases (PubMed, Scopus, Web of Science, ProQuest, Cochrane, and Wiley) were searched up to Aug 2023. Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. The pooled weighted and standardized mean differences in FLL were calculated using random-effects models. Heterogeneity, subgroup analysis, and publication bias were also assessed using funnel plots. All statistical analyses were performed using Stata Version 16.0.

Results

Twelve articles were included in the final meta-analysis. GDM was associated with increased FLL, as assessed by ultrasound, in both the second (SMD=1.56; 95% CI: 1.04, 2.08; P<0.001) and third (SMD=0.84; 95% CI: 0.07, 1.61; P<0.001) trimesters of pregnancy. The pooled mean difference in FLL between the GDM and non-GDM groups was 4.85 mm (WMD=4.85; 95% CI: 3.26, 6.45), indicating larger liver size in fetuses from mothers with GDM.

Conclusion

GDM is a significant risk factor for increased FLL, as assessed by ultrasound, which may reflect fetal overgrowth and metabolic dysfunction.

Gestational Diabetes and Analysis of Maternal and Fetal Outcomes Among Pregnant Women: A Cross-Sectional Study

Purpose of the Study

To determine the occurrence of gestational diabetes mellitus and analyze the maternal and fetal outcomes among pregnant women.

Methods

A prospective cross-sectional study was conducted for a duration of 7 months in the Department of Gynecology and Obstetrics at tertiary care hospital where 518 pregnant women participants of age above 18 years who had come for labor and undergone DIPSI (diabetes in pregnancy study of India) test were included in the study after the ethical clearance and obtaining written informed consent, whereas pregnant women with pre-existing diabetes mellitus and on other medication that alter glucose metabolism were excluded from the study.

Results

The occurrence of GDM was found to be 15.44%. The majority of GDM patients (53.75%) were able to manage their condition through dietary modifications alone. Metformin was required for 36.25% of the subjects, while 10% needed insulin. The rates of cesarean delivery (72.1%) and postpartum hemorrhage (17.5%) were also higher in the GDM group compared to the non-GDM group (p < 0.001). Maternal complications, including gestational hypertension (11.3%), polyhydramnios (35%), and vaginal candidiasis (18.8%), were significantly more prevalent among GDM subjects (p < 0.001).

Conclusions

GDM is a frequently observed complication among pregnant women which can lead to adverse maternal and fetal outcomes as well as several complications such as cesarean delivery, postpartum hemorrhage, pre-eclampsia, polyhydramnios, UTI and vaginal candidiasis as compared to those without GDM.

Predictors of Neonatal Intensive Care Unit Admission and Adverse Outcomes Related to Gestational Diabetes

BACKGROUND

Gestational diabetes mellitus (GDM) is a type of diabetes that manifests itself in pregnant women. It poses a significant risk to the mother's health as well as the health of the infant, including more babies being brought to the neonatal intensive care unit (NICU). It puts both the mother's and the child's health at serious risk, increasing the likelihood that newborns may need to be treated in a neonatal critical care unit. This study aimed to determine the factors that predict GDM-related NICU admission and other adverse newborn outcomes.

METHODS

The study was a cross-sectional analysis of 175 pregnant women who presented with gestational diabetes at the Maternity and Children's Hospital in Bisha (MCH-Bisha), Saudi Arabia, between January 1 and December 31, 2022. A logistic regression model was used to analyze the data to predict adverse outcomes for newborns and NICU admissions and identify associations between maternal variables and outcomes.

RESULTS

Maternal characteristics highly associated with adverse neonatal outcomes included advanced maternal age (greater than 30 years), a family history of DM, and a history of greater than or equal to four previous pregnancies. Logistic regression models revealed that newborns delivered to mothers older than 30 years were 7.17 times more likely to be admitted to the NICU than newborns born to mothers younger than 30 years. Saudi nationality, urban residence, and cesarean section delivery factors account for nearly all adverse neonatal outcomes (91%, 75%, and 91%, respectively). Newborns delivered by cesarean section were 3.38 times more likely to be admitted to NICU, and the association was significant.

CONCLUSIONS

Maternal age greater than 30 years and a history of more than or equal to four pregnancies were the strongest indicators of infant adverse outcomes and NICU admittance among women with gestational diabetes. These findings highlight the need for approaches to GDM management that are efficient, thorough, and multidisciplinary.

Maternal Mortality in a Rural District of Pakistan and Contributing Factors

INTRODUCTION

Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality.

MATERIAL AND METHODS

A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence.

RESULTS

The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants.

CONCLUSION

The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services.

Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score

BACKGROUND

Gestational diabetes mellitus (GDM) refers to abnormal glucose tolerance during pregnancy, and it is often accompanied by obvious changes in glucose and lipid metabolism, and associated with adverse pregnancy outcomes. The incidence of fetal distress, polyhydramnios, puerperal infection, premature delivery, and macrosomia in pregnant women with GDM are higher than in those without GDM.

AIM

To analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score.

METHODS

A total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected. Among them, 377 aged < 35 years were selected as the right age group and 206 aged > 35 years were selected as the older group. The clinical data of the two groups were collected, and the relationship between age of the pregnant women with GDM and mode of delivery, maternal and neonatal outcomes, and neonatal Apgar score were compared. In the older group, 159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes. The related factors of adverse maternal and infant outcomes were analyzed through logistic regression.

RESULTS

The number of women with assisted pregnancy, ≤ 37 wk gestation, ≥ 2 pregnancies, one or more deliveries, and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group (P < 0.05). The natural delivery rate in the right age group was 40.85%, which was higher than 22.33% in the older group (P < 0.05). The cesarean section rate in the older group was 77.67%, which was higher than 59.15% in the right age group (P < 0.05). The older group had a higher incidence of polyhydramnios and postpartum hemorrhage, and lower incidence of fetal distress than the right age group had (P < 0.05). There was no significant difference in neonatal weight between the two groups (P > 0.05). The right age group had higher Apgar scores at 1 and 5 min than the older group had (P < 0.05). Significant differences existed between the poor and good outcome groups in age, education level, pregnancy mode, ≤ 37 wk gestation, number of pregnancies, and premature rupture of membranes (P < 0.05). Logistic regression showed that age, education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants (P < 0.05).

CONCLUSION

Delivery mode and Apgar score of pregnant women with GDM are related to age. Older age increases the adverse outcome of mothers and infants.

Alterations of gut microbiota-derived metabolites in gestational diabetes mellitus and clinical significance

BACKGROUND

The change in the characteristics of the gut microbiota is linked to gestational diabetes mellitus (GDM). However, whether and how the gut microbiota-derived metabolites change in GDM is uncertain. Here, we aimed to determine associations between the gut microbiota-derived metabolites and GDM.

METHODS

Using targeted metabolomics approaches, 7 types of short-chain fatty acids (SCFAs), 38 types of bile acids (BAs), and 5 types of trimethylamine N-oxide (TMAO), and its derivatives of serum samples were obtained from pregnant women with GDM (n = 24), and healthy pregnant controls (HC, n = 28) were detected to identify the metabolic signature of GDM to investigate the potential biomarkers. Moreover, we assessed the associations between gut microbiota-derived metabolites and clinical parameters.

RESULTS

In our study, the gut microbiota-derived metabolites signatures were significantly different between GDM and HC. Quantitative results showed the levels of isobutyric acid, isovaleric acid, valeric acid, caproic acid, GUDCA, THDCA + TUDCA, and LCA-3S were significantly higher in GDM, but the level of TMAO and its derivatives did not change significantly. Some altered gut microbiota-derived metabolites were significantly correlated with glucose and lipid levels. Receiver-operating characteristic (ROC) analysis of generalized linear models showed that gut microbiota-derived metabolites may be potential biomarkers of GDM.

CONCLUSION

This study highlights gut microbiota-derived metabolites alterations in GDM and correlation of the clinical indicators, which provides a new direction for future studies aiming to novel serum biomarker for early detection or target of drug therapy of GDM.

Addressing the gaps in nutritional care before and during pregnancy

The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the 'patient voice'. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.

Immunoendocrine Dysregulation during Gestational Diabetes Mellitus: The Central Role of the Placenta

Gestational Diabetes Mellitus (GDM) is a transitory metabolic condition caused by dysregulation triggered by intolerance to carbohydrates, dysfunction of beta-pancreatic and endothelial cells, and insulin resistance during pregnancy. However, this disease includes not only changes related to metabolic distress but also placental immunoendocrine adaptations, resulting in harmful effects to the mother and fetus. In this review, we focus on the placenta as an immuno-endocrine organ that can recognize and respond to the hyperglycemic environment. It synthesizes diverse chemicals that play a role in inflammation, innate defense, endocrine response, oxidative stress, and angiogenesis, all associated with different perinatal outcomes.