1
|
Jamal WZ, Khan FR, Zuberi N, Kazmi SMR, Rozi S. Association of periodontal disease with gestational diabetes mellitus among postpartum women at a private tertiary care hospital of Karachi, Pakistan: a cross-sectional study. Sci Rep 2024; 14:9951. [PMID: 38688972 PMCID: PMC11061300 DOI: 10.1038/s41598-024-60659-6] [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: 08/15/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
Due to the overlapping aetiology of Gestational Diabetes Mellitus (GDM) and Periodontal disease (PD), which are prevalent metabolic disorder and chronic inflammatory disorder in pregnant women respectively, they are often at risk of developing both diseases simultaneously. This study aims to evaluate the association of periodontal disease and gestational diabetes mellitus among post-partum women who delivered within 24 h at private tertiary care hospital, Karachi, Pakistan. Analytical cross sectional study with sample size of 178 by non- probability purposive sampling, a total of 101 postpartum women (57%) were diagnosed with periodontal disease and 50 (28%) were GDM positive. Of those who had PD, 35% (n = 35/101) were GDM positive. An insignificant association of the prevalence ratio of GDM in women with periodontal disease was found. [PR = 1.7; 95% CI: 0.2-3.2; p-value 0.07] A statistically significant association was found between the prevalence ratio of GDM in women with obesity. It was 2.6 times compared to women who were not obese (p value < 0.01, 95% CI: 1.3-5.1). There is insignificant association found between the prevalence ratio of GDM in women with periodontal disease in our setting. Women who are overweight or tend to gain weight should be closely monitored and guided to take dietary measures.
Collapse
Affiliation(s)
- Wafa Zehra Jamal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | | | - Nadeem Zuberi
- Department of Obstetrics & Gynecology, Aga Khan University, Karachi, Pakistan
| | | | - Shafquat Rozi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
2
|
Scrivani C, Urban AR, Dudley DJ, Rieck RE, Ennen CS. Predicting the need for medication in gestational diabetes using the 100-gram glucose tolerance test. Am J Obstet Gynecol MFM 2024; 6:101315. [PMID: 38373498 DOI: 10.1016/j.ajogmf.2024.101315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/28/2024] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Claire Scrivani
- Division of Academic Specialists in General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, 1221 Lee St., 3rd Floor, Charlottesville, VA 22903.
| | - Amanda R Urban
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA
| | - Donald J Dudley
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA
| | - Rebecca E Rieck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA
| | - Christopher S Ennen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA
| |
Collapse
|
3
|
Gosain R, Motwani R, Anupama H. CD68 expression in the placenta of gestational diabetic mothers: A case-control study. INDIAN J PATHOL MICR 2023; 66:727-731. [PMID: 38084523 DOI: 10.4103/ijpm.ijpm_99_22] [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] [Indexed: 11/05/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy and is the most common metabolic complication of pregnancy. Significant maternal and fetal complications can result from undiagnosed or inadequately treated GDM. Aim To investigate the difference in the expression of the CD-68 marker in the Hofbauer cells (HCs) and their distribution within the villi in the placentas of diabetic and non-diabetic mothers. Materials and Methods Sixty placentas were included in the study, 30 as controls and 30 from mothers with diagnosed GDM as cases. Full-thickness cross sections of placentas were obtained. Tissue processing was done, followed by haematoxylin and eosin (H&E). A study of CD68 markers (placental macrophages) was done using standard protocols of immunohistochemistry. Statistical Analysis Frequencies and percentages of Hofbauer cells (HCs) found in case and control placental tissue were calculated. Student's t-test was used to compare two groups using SPSS 13.0 software. When P is 0.0001, differences were considered statistically significant. Results and Conclusion We studied the distribution and number of fetal macrophages (CD68+) in diabetic and non-diabetic placentas. The immunostained CD68+ cell count was identified to be significantly higher in the GDM placenta. In relation to fetal blood vessels in the villus stroma of the GDM placenta in comparison to control, CD68+ cells were found more frequently. This study shows a significant increase in the number of Hofbauer cells in the placenta of mothers with GDM in comparison to control (P < 0.0001). An increase in macrophages in these placentae might be related to the protective mechanism against inflammation. Further studies are required to investigate the mechanism in detail.
Collapse
Affiliation(s)
- Ratna Gosain
- Department of Pathology, ESIC Medical College and Superspeciality Hospital, Sanathnagar, Hyderabad, Telangana, India
| | - Rohini Motwani
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - Hari Anupama
- Department of Obstetrics and Gynecology, Mallareddy Medical College for Women, Jeedimetla, Hyderabad, Telangana, India
| |
Collapse
|
4
|
Manuello J, Verdejo-Román J, Torres Espínola F, Escudero-Marín M, Catena A, Cauda F, Campoy C. Influence of Gestational Diabetes and Pregestational Maternal BMI on the Brain of Six-Year-Old Offspring. Pediatr Neurol 2022; 133:55-62. [PMID: 35759804 DOI: 10.1016/j.pediatrneurol.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/02/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gestational diabetes (GD) and maternal excess weight are common pregnancy conditions that increase the risk of future complications for both the mother and her offspring. Their consequences on neurodevelopment are widely described in the literature, but less is known concerning the potential transgenerational influence on the brain structure. METHODS We used a combination of support vectors machine and hierarchical clustering to investigate the potential presence of anatomical brain differences in a sample of 109 children aged six years, born to mothers with overweight or obesity, or to mothers diagnosed with GD during pregnancy. RESULTS Significant effects are visible in the brain of children born to mothers with GD associated with pregestational excess weight, especially overweight instead of obesity. No differences in children's brain were observed when considering those born to normal-weight mothers. CONCLUSIONS Our study highlights the need for clinical attention of pregnant women at risk to develop GD, and especially those with pregestational excess weight, since this status was found to be associated with detectable transgenerational brain changes. These effects may be due to the absence of specific and individualized intervention in these mothers during pregnancy.
Collapse
Affiliation(s)
- Jordi Manuello
- Gcs-Fmri, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy; Focus Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Juan Verdejo-Román
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
| | - Francisco Torres Espínola
- Euristikos Excellence Centre For Pediatric Research, University of Granada, Granada, Spain; Department of Pediatrics, School of Medicine, University of Granada, Granada, Spain; DR. Federico Oloriz Neurosciences Institute, University of Granada, Granada, Spain
| | - Mireia Escudero-Marín
- Euristikos Excellence Centre For Pediatric Research, University of Granada, Granada, Spain; Department of Pediatrics, School of Medicine, University of Granada, Granada, Spain; DR. Federico Oloriz Neurosciences Institute, University of Granada, Granada, Spain
| | - Andrés Catena
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
| | - Franco Cauda
- Gcs-Fmri, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy; Focus Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Cristina Campoy
- Euristikos Excellence Centre For Pediatric Research, University of Granada, Granada, Spain; Department of Pediatrics, School of Medicine, University of Granada, Granada, Spain; DR. Federico Oloriz Neurosciences Institute, University of Granada, Granada, Spain; Spanish Network of Biomedical Research In Epidemiology and Public Health (Ciberesp), Granada's Node, Institute of Health Carlos III, Madrid, Spain; Biohealth Research Institute (IBS), Granada, Health Sciences Technological Park, Granada, Spain.
| |
Collapse
|
5
|
Exercise-Diet Therapy Combined with Insulin Aspart Injection for the Treatment of Gestational Diabetes Mellitus: A Study on Clinical Effect and Its Impact. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4882061. [PMID: 35936373 PMCID: PMC9352494 DOI: 10.1155/2022/4882061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the clinical effect and impact of exercise-diet therapy combined with Insulin Aspart Injection on gestational diabetes mellitus (GDM). Methods The objects of study were patients with pregestational diabetes mellitus (PGDM) and 62 patients with GDM who were diagnosed by oral glucose tolerance test (OGTT) and insulin release test from February 2017 to February 2019. According to the severity of the disease, enrolled patients were informed to have appropriate exercise and diet control or Insulin Aspart Injection on this basis until the completion of delivery. By using 50 pregnant women with normal glucose as the control, the fasting plasma glucose (FPG), 1-hour postprandial glucose (1hPG), 2-hour postprandial glucose (2hPG), nocturnal glucose, and glycosylated hemoglobin (HbA1c) levels were compared between the PGDM group and the GDM group before and after treatment; besides, further comparison was made in terms of glucose compliance rate, islet B-cell secretory function, and insulin resistance after treatment. The pregnant women were examined by B-ultrasound at 24 and 26 weeks of gestation to check if the fetus had abnormalities in the central nervous system and the heart. Further B-ultrasound examination was performed at 32 and 37 weeks of gestation to check the problems such as polyhydramnios and stillbirth. In addition, a comparative analysis was carried out in terms of the adverse pregnancy outcomes and complications, associated with the comparison of the results after treatment with control group. Results After treatment, the levels of FPG, 1hPG, 2hPG, nocturnal glucose, and HbA1c were decreased in the PGDM group and GDM group than those before treatment, especially in the GDM group, with significant difference still when compared with the control group (P < 0.05). Statistical analysis revealed that the blood glucose compliance rate in the GDM group was higher than that in the PGDM group, showing a better therapeutic effect. Fasting insulin (FINS) and homeostasis model assessment index for insulin resistance (HOMA-IR) in the GDM group were significantly higher than those in control group, but lower than those in the PGDM group (P < 0.01), while the level of HOMA-β was lower in the GDM group than that in the control group and higher than that in PGDM (P < 0.01). Further ultrasound examination revealed the presence of fetal cardiac abnormality, polyhydramnios, stillbirth, and problems, showing a higher incidence in the PGDM group but almost nonexistence in the control group. In addition, the incidence of hypertension, macrosomia, premature rupture of membranes, postpartum hemorrhage, and infection were obviously higher in the PGDM group than those in the GDM group and control group (P < 0.05). Conclusion Exercise-diet therapy combined with Insulin Aspart Injection can effectively control the blood glucose level of pregnant patients with GDM, improve the pregnancy outcome to a certain extent, and ensure the health of pregnant women and fetus, which is worthy of clinical application.
Collapse
|
6
|
Cibickova L, Langova K, Schovanek J, Macakova D, Krystynik O, Karasek D. Pregnancy lipid profile and different lipid patterns of gestational diabetes treated by diet itself. Physiol Res 2022; 71:241-248. [PMID: 35275701 PMCID: PMC9150557 DOI: 10.33549/physiolres.934835] [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] [Indexed: 11/25/2022] Open
Abstract
The development of gestational diabetes mellitus (GDM) affects lipid metabolism during pregnancy. However, the magnitude of changes in lipid parameters is unclear. In addition, the patterns of these changes may vary based on the criteria selected for making the diagnosis of GDM. Thus, our aim was to compare the anthropometric and laboratory profiles of GDM-associated vs. GDM-free gestation with those of healthy non-pregnant women. We designed a cross-sectional study involving a group of females affected by GDM, a group of healthy pregnant controls and a group of healthy non-pregnant counterparts. GDM patients were divided into 3 subgroups according to the fulfilled diagnostic criteria, that is, those presenting with high fasting plasma glucose in the first trimester (subgroup 1), high fasting plasma glucose in the second trimester (subgroup 2) and high plasma glucose following oral glucose load in the second trimester (subgroup 3). The anthropometric and metabolic profiles of GDM subjects resembled the facets of metabolic syndrome (highest body mass index, waist circumference, C-peptide level, triglycerides) significantly more than the respective profiles of healthy non-pregnant women (p<0.0001). While total cholesterol (TC) (together with LDL-C and non-HDL-C) in pregnant women with GDM and without GDM did not differ, both groups had significantly higher levels of triglycerides (TG) than non-pregnant women (p<0.0001). Subgroup 1 had the highest fasting glucose level in the second trimester whereas subgroup 3 had the lowest fasting glucose level (p=0.019). Concentration of TG increased, being the lowest in subgroup 1 and the highest in subgroup 3 (p=0.006). Women with GDM had more pronounced features of metabolic syndrome than pregnant women without GDM. Both groups reached higher levels of TC (LDL-C, non-HDL-C) than non-pregnant controls and did not differ from each other. We found differences in TG and fasting glucose levels among different types of GDM.
Collapse
Affiliation(s)
- L Cibickova
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University, Czech Republic.
| | | | | | | | | | | |
Collapse
|
7
|
Hu M, Gu X, Niu Y, Lu W, Huang C, Tang Q, Wu J. Elevated serum triglyceride levels at first prenatal visit is associated with the development of gestational diabetes mellitus. Diabetes Metab Res Rev 2022; 38:e3491. [PMID: 34407277 DOI: 10.1002/dmrr.3491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
AIMS While several studies have indicated that maternal serum lipid profiles are associated with the development of gestational diabetes mellitus (GDM), the results have been inconsistent. This study aimed to explore the relationship between maternal lipids profiles at first prenatal visit and GDM and determine the optimal cut-off values of possible trimester-specific variables in predicting GDM. MATERIALS AND METHODS Clinical data of women with singleton pregnancies who delivered in Xinhua Hospital between January 2016 and January 2017 were collected from electronic databases. Multivariate logistic regression was used to determine the potential risk factors of GDM (specific to the trimester at first prenatal visit), including age, body mass index (BMI), and serum lipid profile and fasting plasma glucose (FPG) levels. The receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off values of significant variables. RESULTS Among the 2191 pregnant women included, 315 (14.38%) were diagnosed with GDM. Of these, 880 (40.16%) had their first prenatal visit before 14 gestational weeks. Univariate and multivariate analyses showed that both FPG and triglyceride (TG) levels in the first and second trimesters were associated with a high risk of GDM (p < 0.05). The ROC curve showed that serum TG levels >1.235 mmol/L and >1.525 mmol/L in the first and second trimesters, respectively, were significantly associated with the development of GDM (p < 0.05). CONCLUSIONS TG levels at first prenatal visit is associated with GDM risk. Different TG cut-off values should be applied in the different trimesters of pregnancy for GDM screening.
Collapse
Affiliation(s)
- Ming Hu
- Department of Clinical Nutrition, Huadong Hospital, Fudan University, Shanghai, China
- Department of Nutrition, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohan Gu
- Department of Clinical Nutrition, Huadong Hospital, Fudan University, Shanghai, China
- Department of Nutrition, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Niu
- Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenyi Lu
- Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuihua Huang
- Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingya Tang
- Department of Nutrition, Shanghai Jiao Tong University, Shanghai, China
- Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Wu
- Department of Clinical Nutrition, Huadong Hospital, Fudan University, Shanghai, China
| |
Collapse
|
8
|
Wang Y, Zhao S, Peng W, Chen Y, Chi J, Che K, Wang Y. The Role of Slit-2 in Gestational Diabetes Mellitus and Its Effect on Pregnancy Outcome. Front Endocrinol (Lausanne) 2022; 13:889505. [PMID: 35813663 PMCID: PMC9261261 DOI: 10.3389/fendo.2022.889505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Slit guidance ligand 2 (Slit-2), as a member of the Slit family, can regulate the inflammatory response and glucose metabolism. The purpose of this study was to explore the expression of Slit-2 in maternal peripheral blood and neonatal cord blood of gestational diabetes mellitus (GDM) patients and its potential importance in disease progression. METHODS This study included 57 healthy pregnant women and 61 GDM patients. The levels of Slit-2, C-reactive protein (CRP), monocyte chemoattractant protein-1 (MCP-1), C-peptide (C-P), galectin-3(Gal-3), HbA1c, fasting blood glucose (FBG) and fasting insulin (FINS) in maternal peripheral blood and neonatal cord blood were detected by ELISA. Spearman's rank correlation test was used to assess the association between peripheral Slit-2 and inflammatory indicators, insulin resistance, and pregnancy outcomes. Logistic regression analysis was used to analyze the risk factors of GDM. RESULTS Slit-2 levels in maternal peripheral blood and neonatal cord blood of the GDM patients were higher than those of the HC. Slit-2 levels in maternal peripheral blood and neonatal cord blood of the GDM patients were positively correlated with inflammatory factors CRP and MCP-1 levels. The level of Slit-2 in the maternal peripheral blood of the GDM patients was positively correlated with the level of homeostasis model assessment insulin resistance (HOMA-IR) and HbA1c in maternal peripheral blood, but was negatively correlated with the level of homeostasis model assessment -β (HOMA-β). We also found that the Slit-2 level in the maternal peripheral blood of the GDM patients was negatively correlated with neonatal blood glucose, positively correlated with neonatal weight and independent of neonatal total bilirubin. CONCLUSION Our study suggests that the abnormal increase in Slit-2 in GDM may be related to its pathogenesis, and it was correlated with neonatal blood glucose and weight in patients with GDM, suggesting that Slit-2 may be a potential biomarker of GDM.
Collapse
Affiliation(s)
- Yan Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shihua Zhao
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Peng
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying Chen
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingwei Chi
- Qingdao Key Laboratory of Thyroid Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kui Che
- Qingdao Key Laboratory of Thyroid Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yangang Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Yangang Wang,
| |
Collapse
|
9
|
Nwali SA, Onoh RC, Dimejesi IB, Obi VO, Jombo SE, Edenya OO. Universal versus selective screening for gestational diabetes mellitus among antenatal clinic attendees in Abakaliki: using the one-step 75 gram oral glucose tolerance test. BMC Pregnancy Childbirth 2021; 21:735. [PMID: 34715805 PMCID: PMC8555289 DOI: 10.1186/s12884-021-04168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
AIM To compare universal screening with selective risk factor based screening for GDM, using the one-step 75 g oral glucose tolerance test (OGTT). MATERIALS AND METHOD A cross-sectional, comparison between universal and selective risk factor based screening for GDM, among 400 antenatal care clients at Alex-Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). All the participants had 75 g OGTT at 24-28 weeks of gestation and risk factor screening for GDM. All 400 participants formed the universal group while participants with one or more of the considered risk factors formed the selective risk factor group. Data were analyzed using IBM SPSS version 20. Statistical comparison was done using t- test for continuous variables. Logistics regression was used to determine the level of associations of the independent predictors for hyperglycemia. Level of significance was set at P < 0.05. RESULTS The point prevalence of GDM using universal and selective screening were 11.51 and 7.93% respectively, giving a selective screening miss rate of 31.11%. The sensitivity, specificity, positive predictive value and negative predictive value were 73.58, 48.82, 19.12 and 92.51% respectively for the selective risk factor based screening compared to universal screening. On multivariate analysis; age ≥ 35 years, weight ≥ 90 kg, history of previous GDM and hypertension were significantly related to the development of hyperglycemia. CONCLUSION Selective risk factor based screening missed 31.11% of patients with GDM when compare to Universal screening with one step 75 g OGTT. Universal screening for GDM using the one step 75 g OGTT is recommended for pregnant women and more studies are needed to compare pregnancy outcomes for pregnant women diagnosed with GDM with and without risk factors.
Collapse
Affiliation(s)
- Silas Alegu Nwali
- Department Of Obstetrics And Gynecoloy (Obgyn), Alex-Ekwueme Federal University Teaching Hosital (Ae-Futh), Abakaliki, Nigeria.
| | - Robinson Chukwudi Onoh
- Department Of Obstetrics And Gynecoloy (Obgyn), Alex-Ekwueme Federal University Teaching Hosital (Ae-Futh), Abakaliki, Nigeria
| | - Ikechukwu Bo Dimejesi
- Department Of Obstetrics And Gynecoloy (Obgyn), Alex-Ekwueme Federal University Teaching Hosital (Ae-Futh), Abakaliki, Nigeria
| | - Vitus Okwuchukwu Obi
- Department Of Obstetrics And Gynecoloy (Obgyn), Alex-Ekwueme Federal University Teaching Hosital (Ae-Futh), Abakaliki, Nigeria
| | | | | |
Collapse
|
10
|
Park JY, Kim WJ, Chung YH, Kim B, Park Y, Park IY, Ko HS. Association between pregravid liver enzyme levels and gestational diabetes in twin pregnancies: a secondary analysis of national cohort study. Sci Rep 2021; 11:18695. [PMID: 34548558 PMCID: PMC8455664 DOI: 10.1038/s41598-021-98180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022] Open
Abstract
Multiple pregnancies are prone to gestational diabetes mellitus (GDM). This study investigated the association between pregravid liver enzyme levels and the development of GDM in a twin pregnancy. Women who had the National Health Screening Examination and delivered their twin babies within one year were enrolled. Pregravid liver enzyme levels were divided into high and low level. Risks for developing GDM by high levels of liver enzymes were analyzed, in subgroups by pregravid obesity or metabolic syndrome. Among the 4348 twin pregnancies, 369 women (8.5%) developed GDM not requiring insulin treatment (GDM - IT), and 119 women (2.7%) developed GDM requiring insulin treatment(GDM + IT). High levels of pregravid GGT and ALT were related to risks of GDM + IT not only in women with obesity or metabolic syndrome (odds ratio[OR] 6.348, 95% confidence interval [CI] 2.579-15.624 and OR 6.879, 95% CI 2.232-21.204, respectively), but also in women without obesity (OR 3.05, 95% CI 1.565-5.946) or without metabolic syndrome (OR 3.338, 95% CI 1.86-5.992), compared to in women with low levels of those. However, there were no significant associations in the pregravid ALT and GGT levels and risks for development of GDM - IT, unrelated to pregravid obesity or metabolic syndrome. Therefore, this study suggests that women with high levels of pregravid GGT and ALT need to recognize their increased risk of GDM + IT, regardless of pregravid obesity or MetS, when they get pregnant twin.
Collapse
Affiliation(s)
- Jae-Young Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woo Jeng Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yoo Hyun Chung
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bongseong Kim
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yonggyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| |
Collapse
|
11
|
Shpakov AO. Improvement Effect of Metformin on Female and Male Reproduction in Endocrine Pathologies and Its Mechanisms. Pharmaceuticals (Basel) 2021; 14:ph14010042. [PMID: 33429918 PMCID: PMC7826885 DOI: 10.3390/ph14010042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
Metformin (MF), a first-line drug to treat type 2 diabetes mellitus (T2DM), alone and in combination with other drugs, restores the ovarian function in women with polycystic ovary syndrome (PCOS) and improves fetal development, pregnancy outcomes and offspring health in gestational diabetes mellitus (GDM) and T2DM. MF treatment is demonstrated to improve the efficiency of in vitro fertilization and is considered a supplementary drug in assisted reproductive technologies. MF administration shows positive effect on steroidogenesis and spermatogenesis in men with metabolic disorders, thus MF treatment indicates prospective use for improvement of male reproductive functions and fertility. MF lacks teratogenic effects and has positive health effect in newborns. The review is focused on use of MF therapy for restoration of female and male reproductive functions and improvement of pregnancy outcomes in metabolic and endocrine disorders. The mechanisms of MF action are discussed, including normalization of metabolic and hormonal status in PCOS, GDM, T2DM and metabolic syndrome and restoration of functional activity and hormonal regulation of the gonadal axis.
Collapse
Affiliation(s)
- Alexander O Shpakov
- I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences, 194223 Saint Petersburg, Russia
| |
Collapse
|
12
|
Benhalima K, Minschart C, Van Crombrugge P, Calewaert P, Verhaeghe J, Vandamme S, Theetaert K, Devlieger R, Pierssens L, Ryckeghem H, Dufraimont E, Vercammen C, Debie A, De Block C, Vandenberghe G, Van Imschoot S, Verstraete S, Buyse L, Wens J, Muyldermans J, Meskal A, De Spiegeleer S, Mathieu C. The 2019 Flemish consensus on screening for overt diabetes in early pregnancy and screening for gestational diabetes mellitus. Acta Clin Belg 2020; 75:340-347. [PMID: 31259665 DOI: 10.1080/17843286.2019.1637389] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Screening for gestational diabetes mellitus (GDM) is important to improve pregnancy outcomes and to prevent type 2 diabetes after pregnancy. The 'International Association of Diabetes and Pregnancy Study Groups' (IADPSG) recommends a universal one-step approach with the 75 g oral glucose tolerance test (OGTT) for screening of GDM. The IADPSG recommendation remains controversial due to the important increase in GDM prevalence and increased workload. After review of the latest evidence and based on data from the 'Belgian Diabetes in Pregnancy' study, members of the Diabetes Liga, the Flemish associations of general physicians (Domus Medica), obstetricians (VVOG), midwives (VVOB), diabetes nurse educators (BVVDV) and clinical chemists (RBSLM) have reached a new consensus on screening for GDM in Flanders. This new consensus recommends universal screening for overt diabetes when planning pregnancy or at the latest at first prenatal contact, preferably by measuring the fasting plasma glucose by using the same diagnostic criteria as in the non-pregnant state. In women with impaired fasting glycaemia, but also in normoglycemic obese women and women with a previous history of GDM, lifestyle counselling is advised with screening for GDM with a 75 g OGTT at 24 weeks. In all other women, we recommend a two-step screening strategy with a 50 g glucose challenge test (GCT) at 24 weeks followed by a 75 g OGTT when the glucose level 1 hour after the GCT ≥130 mg/dl. Diagnosis of GDM is made using the IADPSG criteria for GDM. Postpartum screening for subsequent glucose abnormalities should be advocated and organized for every woman with GDM.
Collapse
Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Caro Minschart
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Paul Van Crombrugge
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Peggy Calewaert
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Siska Vandamme
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Katrien Theetaert
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Leen Pierssens
- Department of clinical Biology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Hannah Ryckeghem
- Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda ziekenhuis, Bonheiden, Belgium
| | - Chris Vercammen
- Department of Endocrinology Imelda ziekenhuis, Bonheiden, Belgium
| | - Ann Debie
- Department of Endocrinology Imelda ziekenhuis, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Belgium
| | - Griet Vandenberghe
- Department of Obstetrics & Gynecology, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Johan Wens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Wilrijk, Belgium
| | | | - Anissa Meskal
- Department of Clinical Biology, GZA, Wilrijk, Belgium
| | - Sandy De Spiegeleer
- Department of Clinical Biology, Laboratoire Luc Olivier SA, Fernelmont, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| |
Collapse
|
13
|
Lai Y, Chen H, Du Z, Zhou S, Xu W, Li T. The diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus among Chinese pregnant individuals. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1014. [PMID: 32953814 PMCID: PMC7475463 DOI: 10.21037/atm-20-5464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background This study aims to investigate the diagnostic value of the glycated hemoglobin (HbA1c) test for detecting gestational diabetes mellitus (GDM) in pregnant Chinese patients. Methods We enrolled a large cohort of 19,261 pregnant individuals who had both oral glucose tolerance test (OGTT) and HbA1c test between 24 and 28 weeks of gestation in a large Chinese tertiary hospital consecutively from 2013 to 2018. We used Pearson's correlation test to evaluate the correlation between OGTT and HbA1c. The diagnostic accuracy of HbA1c for GDM was examined with the receiver operating characteristic curve, using OGTT as the reference standard. Results A total of 3,547 (18.42%) women were diagnosed with GDM. HbA1c was positively, but only weakly correlated with the fasting, 1-hour glucose, and 2-hour glucose (r=0.31, 0.24, and 0.25, respectively, all P<0.001). The area under the curve of the HbA1c level for detecting GDM was 0.664 (95% CI: 0.653-0.674, P<0.01). The optimal cut-off point of HbA1c for GDM diagnosis was determined at 5.0% (31 mmol/mol), which yielded a sensitivity of 60.1%, a specificity of 65.3%, a positive predictive value of 28.1%, and a negative predictive value of 87.9%. Conclusions HbA1c test is weakly correlated with OGTT during pregnancy, and it offers only limited value in diagnosing GDM among Chinese pregnant individuals.
Collapse
Affiliation(s)
- Yi Lai
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
| | - Hanxiao Chen
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Ze Du
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Shu Zhou
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
| | - Wenming Xu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China.,Joint Laboratory of Reproductive Medicine, Sichuan University-The Chinese University of Hong Kong (SCU-CUHK), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
| |
Collapse
|
14
|
miR-657 Promotes Macrophage Polarization toward M1 by Targeting FAM46C in Gestational Diabetes Mellitus. Mediators Inflamm 2019; 2019:4851214. [PMID: 31915414 PMCID: PMC6930733 DOI: 10.1155/2019/4851214] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 02/08/2023] Open
Abstract
MicroRNA (miRNA) has been widely suggested to play a vital role of in the pathogenesis of gestational diabetes mellitus (GDM). We have previously demonstrated that miR-657 can regulate macrophage inflammatory response in GDM. However, the role of miR-657 on M1/M2 macrophage polarization in GDM pathogenesis is not clear yet. This study is aimed at elucidating this issue and identifying novel potential GDM therapeutic targets based on miRNA network. miR-657 is found to be upregulated in placental macrophages demonstrated by real-time PCR, which can enhance macrophage proliferation and migration in vitro. Luciferase reporter assay shows the evidence that FAM46C is a target of miR-657. In addition, miR-657 can promote macrophage polarization toward the M1 phenotype by downregulating FAM46C in macrophages. The present study strongly suggests miR-657 is involved in GDM pathogenesis by regulating macrophage proliferation, migration, and polarization via targeting FAM46C. miR-657/FAM46C may serve as promising targets for GDM diagnosis and treatment.
Collapse
|
15
|
Iwama N, Sugiyama T, Metoki H, Kusaka H, Yaegashi N, Sagawa N, Hiramatsu Y, Toyoda N. Difference in the prevalence of gestational diabetes mellitus according to gestational age at 75-g oral glucose tolerance test in Japan: The Japan Assessment of Gestational Diabetes Mellitus Screening trial. J Diabetes Investig 2019; 10:1576-1585. [PMID: 30897272 PMCID: PMC6825953 DOI: 10.1111/jdi.13044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/06/2019] [Accepted: 03/15/2019] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION To evaluate the differences in the results of 75-g oral glucose tolerance tests (OGTTs) according to gestational age in Japan. MATERIALS AND METHODS In this prospective cohort study, 2,578 pregnant women were divided into three categories based on their gestational age during the 75-g OGTT: <14 weeks' gestation, 14-23 weeks' gestation and 24-32 weeks' gestation. The association between gestational age and the results of the 75-g OGTT were evaluated using multivariable analysis. RESULTS Early gestational age was associated with high fasting plasma glucose levels at the time of the 75-g OGTT, and low corresponding 1-h and 2-h plasma glucose levels. Compared with women with a gestational age of 24-32 weeks, women who had undergone the 75-g OGTT at <14 weeks' gestation had significantly higher odds of gestational diabetes mellitus diagnosis based on the currently used criteria in Japan (adjusted odds ratio 1.42, 95% confidence interval 1.07-1.90). CONCLUSIONS The results of the 75-g OGTT varied by gestational age. The use of the same 75-g OGTT cut-off values for the diagnosis of gestational diabetes mellitus, regardless of gestational age, might lead to increases in the prevalence of gestational diabetes mellitus diagnosis in Japan.
Collapse
Affiliation(s)
- Noriyuki Iwama
- Center for Perinatal MedicineTohoku University HospitalSendaiMiyagiJapan
| | - Takashi Sugiyama
- Department of Obstetrics and GynecologyEhime University Graduate School of MedicineToonEhimeJapan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and EpidemiologyTohoku Medical Pharmaceutical UniversitySendaiMiyagiJapan
| | - Hideto Kusaka
- Department of Obstetrics and GynecologyNational Hospital Organization Mie Chuo Medical CenterTsuMieJapan
| | - Nobuo Yaegashi
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Norimasa Sagawa
- Department of Obstetrics and GynecologyRakuwakai Otowa HospitalKyotoJapan
| | - Yuji Hiramatsu
- Department of Obstetrics and GynecologyOkayama City General Medical CenterOkayamaJapan
| | | | | |
Collapse
|
16
|
de Wit L, Bos DM, van Rossum AP, van Rijn BB, Boers KE. Repeated oral glucose tolerance tests in women at risk for gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2019; 242:79-85. [PMID: 31569028 DOI: 10.1016/j.ejogrb.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pregnant women with a negative oral glucose tolerance test (OGTT) between 24-28 weeks as part of risk-based screening for gestational diabetes mellitus (GDM) may develop clinical signs or symptoms suggestive for GDM in the third trimester. We aimed to determine the additional yield of repeating an OGTT to detect missed GDM in this group and assess patient characteristics and indications associated with a positive second OGTT. STUDY DESIGN We conducted a retrospective cohort study of women with a negative OGTT between 24-28 weeks of pregnancy in two hospitals in the Netherlands. Patient characteristics, pregnancy outcomes, OGTT results and indications were compared between women with normal (non-GDM) and abnormal (GDM) results of the second OGTT, using the WHO 1999 criteria (fasting glucose ≥7.0 mmol/L or 2 -h post load ≥7.8 mmol/L). We used receiver operating characteristic (ROC) curve analysis to determine cut-offs for fasting and 2 -h glucose values of the index OGTT that were associated with a positive OGTT in the third trimester. RESULTS Of 3147 women at risk for GDM, 183 underwent a second OGTT in the third trimester following their regular OGTT at 24-28 weeks. In 43 women (23.5%) GDM was diagnosed based on the second OGTT. A history of GDM was associated with subsequent GDM diagnosis, with an odds ratio of 2.6 (95% CI 1.0-6.3). Both fasting and 2 -h post load glucose values of the index OGTT were significantly higher in women with abnormal OGTT results later in pregnancy. Index OGTT glucose value cut-offs of 4.8 mmol/L (fasting) and 6.5 mmol/L (2 -h) had positive predictive values of 0.32 and 0.47 for a positive OGTT in the third trimester, and negative predictive values of 0.83 and 0.90, respectively. Fetal growth as a clinical symptom for GDM was the most frequent indication for repeating the OGTT, resulting in the diagnosis of GDM in 22.7% of women tested for this indication. CONCLUSION Repeating an OGTT after initial negative screening results in additional GDM diagnoses. In case of clinical signs, especially in women with additional risk factors such as a history of GDM or higher index OGTT glucose values, repeating an OGTT could be considered.
Collapse
Affiliation(s)
- L de Wit
- Department of Obstetrics & Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - D M Bos
- Department of Obstetrics & Gynecology, University Medical Center Leiden, Leiden University, Leiden, the Netherlands.
| | - A P van Rossum
- Department of Clinical Chemistry and Hematology, Haaglanden Medical Center Bronovo, the Hague, the Netherlands.
| | - B B van Rijn
- Department of Obstetrics & Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - K E Boers
- Department of Obstetrics & Gynecology, Haaglanden Medical Center Bronovo, the Hague, the Netherlands.
| |
Collapse
|
17
|
Pascual-Morena C, Martínez-Vizcaíno V, Álvarez-Bueno C, Pozuelo-Carrascosa DP, Notario-Pacheco B, Saz-Lara A, Fernández-Rodriguez R, Cavero-Redondo I. Exercise vs metformin for gestational diabetes mellitus: Protocol for a network meta-analysis. Medicine (Baltimore) 2019; 98:e16038. [PMID: 31232936 PMCID: PMC6636956 DOI: 10.1097/md.0000000000016038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The purpose of this protocol is to provide a network meta-analysis methodology that compares the effects of metformin and physical exercise in the prevention and treatment of gestational diabetes mellitus (GDM) and its associated fetal and maternal morbidity. METHODS AND ANALYSIS This protocol conforms to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the recommendations of the Cochrane Collaboration Handbook. An electronic search will be conducted in MEDLINE, EMBASE, Web of Science and the Cochrane Library, from the inception until July 2019. There will be no language restrictions. The Cochrane Collaboration tool for assessing risk of bias (RoB2) and the quality assessment tool for quantitative studies will be used. The Grading of Recommendations, Assessment, Development and Evaluation scale will be used to evaluate the strength of the evidence. A Bayesian network meta-analysis will be carried out, which allows direct and indirect comparison of the interventions, for the risk of GDM, prematurity, caesarean section, macrosomia, hypertensive disorders, insulin requirement, and differences in basal glucose, maternal weight, and weight of the newborn. DISCUSSION With this protocol, a methodology is established that resolves the limitations of previous meta-analysis. It will be possible to determine the difference of effect between physical exercise and metformin in the main outcomes of the GDM, as well as the type and intensity of the exercise, and the dose of metformin, more effective. ETHICS AND DISSEMINATION The data included in the network meta-analysis will be obtained from trials that meet accepted ethical standards and the Declaration of Helsinki. The results will be published in a peer-reviewed journal. The evidence obtained could be included in the guidelines of clinical practice in pregnancy. STRENGTHS AND LIMITATIONS A comprehensive methodology is established for the analysis, through network meta-analysis, of the comparative efficacy of metformin and physical exercise in gestational diabetes mellitus. The results obtained could help medical professionals by establishing the best evidence-based interventions which may be recommended for these population groups. REGISTRATION NUMBER PROSPERO CRD42019121715.
Collapse
Affiliation(s)
- Carlos Pascual-Morena
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Celia Álvarez-Bueno
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | | | | | - Alicia Saz-Lara
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| | | | - Iván Cavero-Redondo
- Universidad de Castilla – La Mancha, Health and Social Research Center, Cuenca, Spain
| |
Collapse
|
18
|
Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Minschart C, Devlieger R, Mathieu C. Risk factor screening for gestational diabetes mellitus based on the 2013 WHO criteria. Eur J Endocrinol 2019; 180:353-363. [PMID: 31120231 DOI: 10.1530/eje-19-0117] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Since many European countries use risk factor screening for gestational diabetes mellitus (GDM), we aimed to determine the performance of selective screening for GDM based on the 2013 WHO criteria. DESIGN AND METHODS Overall, 1811 women received universal screening with a 75 g oral glucose tolerance test (OGTT) with GDM in 12.5% (n = 231) women based on the 2013 WHO criteria. We retrospectively applied different European selective screening guidelines to this cohort and evaluated the performance of different clinical risk factors to screen for GDM. RESULTS By retrospectively applying the English, Irish, French and Dutch guidelines for selective screening, respectively 28.5% (n = 526), 49.7% (n = 916), 48.5% (n = 894) and 50.7% (n = 935) had at least one risk factor, with GDM prevalence of respectively 6.5% (n = 120), 7.9% (n = 146), 8.0% (n = 147) and 8.4% (n = 154). Using maternal age ≥30 and/or BMI ≥25 for screening, positive rate was 69.9% (n = 1288), GDM prevalence 10.2% (n = 188), sensitivity 81.4% (CI: 75.8–86.2%) and specificity 31.8% (CI: 29.5–34.1%). Adding other clinical risk factors did not improve detection. GDM women without risk factors had more neonatal hypoglycemia (14.4 vs 4.0%, P = 0.001) and labor inductions (39.7 vs 25.9%, P = 0.020) than normal-glucose tolerant women, and less cesarean sections than GDM women with risk factors (13.8 vs 31.0%, P = 0.010). CONCLUSIONS By applying selective screening by European guidelines, about 50% of women would need an OGTT with the lowest number of missed cases (33%) by the Dutch guidelines. Screening with age ≥30 years and/or BMI ≥25, reduced the number of missed cases to 18.6% but 70% would need an OGTT.
Collapse
Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Paul Van Crombrugge
- Department of Endocrinology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics & Gynecology, Antwerp University Hospital, Edegem, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan Brussel, Brussel, Belgium
| | - Katrien De Clippel
- Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Brussel, Belgium
| | | | - Anne Loccufier
- Department of Obstetrics & Gynecology, AZ St Jan Brugge, Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
| | - Caro Minschart
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| |
Collapse
|
19
|
Arbib N, Shmueli A, Salman L, Krispin E, Toledano Y, Hadar E. First trimester glycosylated hemoglobin as a predictor of gestational diabetes mellitus. Int J Gynaecol Obstet 2019; 145:158-163. [DOI: 10.1002/ijgo.12794] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/27/2018] [Accepted: 02/19/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Nissim Arbib
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Department of Obstetrics & GynecologyMeir Medical Center Kfar‐Saba Israel
| | - Anat Shmueli
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| | - Lina Salman
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| | - Eyal Krispin
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| | - Yoel Toledano
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| | - Eran Hadar
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Helen Schneider Hospital for WomenRabin Medical Center Petah Tikva Israel
| |
Collapse
|
20
|
Kansu-Celik H, Ozgu-Erdinc AS, Kisa B, Findik RB, Yilmaz C, Tasci Y. Prediction of gestational diabetes mellitus in the first trimester: comparison of maternal fetuin-A, N-terminal proatrial natriuretic peptide, high-sensitivity C-reactive protein, and fasting glucose levels. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:121-127. [PMID: 31038593 PMCID: PMC10522132 DOI: 10.20945/2359-3997000000126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 02/20/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated the utility of maternal fetuin-A, N-terminal proatrial natriuretic peptide (pro-ANP), high-sensitivity C-reactive protein (hs-CRP), and fasting glucose levels at 11-14 gestation weeks for predicting pregnancies complicated by gestational diabetes mellitus (GDM). SUBJECTS AND METHODS This prospective cohort study included 327 low-risk pregnant women who completed antenatal follow-up at a tertiary research hospital between January and April 2014. Maternal blood samples were collected between 11-14 gestational weeks in the first trimester of pregnancy and then stored at -80 °C until further analyses. During follow-up, 29 (8.8%) women developed GDM. The study population was compared 1:2 with age- and body mass index-matched pregnant women who did not develop GDM (n = 59). Fasting plasma glucose (FPG) levels and serum fetuin-A, pro-ANP, and hs-CRP levels were measured using automated immunoassay systems. RESULTS There was a significant negative correlation between fetuin-A and hs-CRP (CC = -0.21, p = 0.047) and a positive correlation between FPG and hs-CRP (CC = 0.251, p = 0.018). The areas under the receiver operating characteristic curve for diagnosing GDM were 0.337 (p = 0.013), 0.702 (p = 0.002), and 0.738 (p < 0.001) for fetuin-A, hs-CRP, and FPG, respectively. The optimal cut-off values were > 4.65, < 166, and > 88.5 mg/dL for maternal hs-CRP, fetuin-A, and FPG, respectively. CONCLUSION Reduced fetuin-A, elevated hs-CRP, and FPG levels in women in the first trimester can be used for the early detection of GDM. Further research is needed before accepting these biomarkers as valid screening tests for GDM.
Collapse
Affiliation(s)
- Hatice Kansu-Celik
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - A. Seval Ozgu-Erdinc
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Burcu Kisa
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Rahime Bedir Findik
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Canan Yilmaz
- Gazi University Faculty of MedicineDepartment of Medical BiochemistryAnkaraTurkeyGazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Yasemin Tasci
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| |
Collapse
|
21
|
Benhalima K, Minschart C, Ceulemans D, Bogaerts A, Van Der Schueren B, Mathieu C, Devlieger R. Screening and Management of Gestational Diabetes Mellitus after Bariatric Surgery. Nutrients 2018; 10:nu10101479. [PMID: 30314289 PMCID: PMC6213456 DOI: 10.3390/nu10101479] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/18/2018] [Accepted: 10/09/2018] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. This is partly due to the increasing prevalence of obesity in women of childbearing age. Since bariatric surgery is currently the most successful way to achieve maintained weight loss, increasing numbers of obese women of childbearing age receive bariatric surgery. Bariatric surgery performed before pregnancy significantly reduces the risk to develop GDM but the risk is generally still higher compared to normal weight pregnant women. Women after bariatric surgery therefore still require screening for GDM. However, screening for GDM is challenging in pregnant women after bariatric surgery. The standard screening tests such as an oral glucose tolerance test are often not well tolerated and wide variations in glucose excursions make the diagnosis difficult. Capillary blood glucose measurements may currently be the most acceptable alternative for screening in pregnancy after bariatric surgery. In addition, pregnant women after bariatric surgery have an increased risk for small neonates and need careful nutritional and foetal monitoring. In this review, we address the risk to develop GDM after bariatric surgery, the challenges to screen for GDM and the management of women with GDM after bariatric surgery.
Collapse
Affiliation(s)
- Katrien Benhalima
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Caro Minschart
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Dries Ceulemans
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, 2000 Antwerp, Belgium.
- Faculty of Health and Social Work, research unit Healthy Living, University Colleges Leuven-Limburg, 3001 Leuven, Belgium.
| | - Bart Van Der Schueren
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat, 49, 3000 Leuven, Belgium.
| | - Chantal Mathieu
- Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, University hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| |
Collapse
|
22
|
Zhen XM, Li X, Chen C. Longer-term outcomes in offspring of GDM mothers treated with metformin versus insulin. Diabetes Res Clin Pract 2018; 144:82-92. [PMID: 30031048 DOI: 10.1016/j.diabres.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/30/2018] [Accepted: 07/02/2018] [Indexed: 01/12/2023]
Abstract
Insulin has traditionally been the gold standard pharmacological treatment for gestational diabetes mellitus (GDM). Insulin requires multiple injections a day, can cause frequent hypoglycaemia, requires careful handling, and is generally more expensive compared to oral agents. Metformin has been increasingly popular in recent years. Based on the short-term data available, metformin appears to be safe and effective for the treatment of GDM but existing studies have all stressed the lack of longer-term offspring data. This article will analyse the evidence available on the longer-term outcomes in the offspring of women with GDM treated with metformin versus insulin. Pubmed, EMBASE, CENTRAL, and CNKI were searched for follow-up studies of randomised controlled trials that compared metformin with insulin for the treatment of GDM. Existing follow-up studies did not find any significant increase in the risk of adverse effects in terms of growth and development in the offspring of GDM mothers managed with metformin versus insulin.
Collapse
Affiliation(s)
- Xi May Zhen
- School of Medicine, The University of Queensland, Brisbane 4072, Australia; Royal Prince Alfred Hospital, Sydney 2050, Australia.
| | - Xue Li
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Chen Chen
- School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia.
| |
Collapse
|
23
|
Urinary Bisphenol A Concentration and Gestational Diabetes Mellitus in Chinese Women. Epidemiology 2018; 28 Suppl 1:S41-S47. [PMID: 29028674 DOI: 10.1097/ede.0000000000000730] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bisphenol A (BPA) has been associated with variable metabolic effects in animal models. It is unknown whether BPA exposure affects glucose tolerance in pregnancy. We aimed to investigate whether maternal urinary BPA concentration is associated with gestational diabetes mellitus (GDM). METHODS This study included 620 pregnant women from Shanghai, China 2012-2013. Maternal urinary BPA concentration was measured by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). GDM (n = 79) was diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Multivariate regressions were used to explore the relationships of urinary BPA with GDM, plasma glucose levels in the 75-g 2-hour oral glucose tolerance test (OGTT), birth weight, and ponder index. RESULTS The geometric mean of BPA was 1.32 μg/L. After adjustment for maternal age, education, husband smoking status, prepregnancy body mass index (BMI), and urinary creatinine concentration, plasma glucose at 2 hours in the 75-g OGTT was 0.36 mmol/L lower (95% confidence index [CI] = -0.73, 0.01) for women with urine BPA in the high versus the low tertile. For each unit increase in natural log-transformed BPA, the odds of GDM was reduced by 27% (odds ratio (OR) = 0.73; 95% CI = 0.56, 0.97), the birth weight decreased by 25.70 g (95% CI = -54.48, 3.07), and ponder index was decreased by 0.02 (100 g/cm) (95% CI = -0.03, 0.00). CONCLUSIONS Higher maternal urinary BPA concentrations were associated with reduced risk of GDM and marginally lower birth weight and ponder index.
Collapse
|
24
|
Iwama N, Sugiyama T, Metoki H, Kusaka H, Maki J, Nishigori H, Yaegashi N, Sagawa N, Hiramatsu Y, Toyoda N. Maternal body mass index is a better indicator of large-for-gestational-age infants compared with a 75-g oral glucose tolerance test in early pregnancy: The JAGS trial. Diabetes Res Clin Pract 2017; 132:10-18. [PMID: 28783528 DOI: 10.1016/j.diabres.2017.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 07/07/2017] [Indexed: 11/17/2022]
Abstract
AIMS There is no previous study comparing the predictive ability of maternal pre-pregnancy body mass index (BMI) versus a 75-g oral glucose tolerance test (OGTT) in early pregnancy for large-for-gestational-age (LGA) infants. METHODS This multi-institutional prospective cohort study included 966 pregnant Japanese women. A multiple logistic regression model was applied to compare the effect size of pre-pregnancy BMI, fasting plasma glucose (PG), and 1- and 2-h PG levels after a 75-g OGTT performed before 22weeks gestation for LGA. After these variables were included separately into the model as per continuous variables 1 standard deviation (SD) increase, they were included simultaneously. RESULTS When pre-pregnancy BMI, fasting PG, and 1- and 2-h PG after a 75-g OGTT were separately included in the model, the adjusted odds ratios (ORs) for LGA per 1 SD increase in pre-pregnancy BMI, fasting, and 1- and 2-h PG were 1.55 (95% confidence interval [CI]: 1.26-1.91), 1.26 (95% CI: 1.03-1.54), 0.99 (95% CI: 0.78-1.25), and 1.17 (95% CI: 0.93-1.49), respectively. When these variables were included simultaneously, the adjusted ORs per 1 SD increase in pre-pregnancy BMI, fasting, and 1- and 2-h PG were 1.52 (95% CI: 1.23-1.88), 1.19 (95% CI: 0.96-1.46), 0.77 (95% CI: 0.57-1.03), and 1.30 (95% CI: 0.96-1.76), respectively. CONCLUSIONS Maternal pre-pregnancy BMI was more strongly associated with LGA compared with a 75-g OGTT in early pregnancy. Health-care providers should recognize that women with a higher pre-pregnancy BMI carry a higher risk for having LGA infants regardless of the results of a 75-g OGTT.
Collapse
Affiliation(s)
- Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Obstetrics and Gynecology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical Pharmaceutical University, Sendai, Miyagi, Japan
| | - Hideto Kusaka
- Department of Obstetrics and Gynecology, National Hospital Organization Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hidekazu Nishigori
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Norimasa Sagawa
- Department of Obstetrics and Gynecology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Yuji Hiramatsu
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Okayama, Japan
| | | |
Collapse
|
25
|
Qi X, Gong B, Yu J, Shen L, Jin W, Wu Z, Wang J, Wang J, Li Z. Decreased cord blood estradiol levels in related to mothers with gestational diabetes. Medicine (Baltimore) 2017; 96:e6962. [PMID: 28538390 PMCID: PMC5457870 DOI: 10.1097/md.0000000000006962] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Recent studies have revealed a link between estradiol (E2) and glucose homeostasis. We aimed to assess the association between cord blood hormone levels and the risk of gestational diabetes mellitus (GDM).A total of 204 pregnant women with GDM and 204 pregnant women without GDM (control) were included in the study. Maternal GDM were diagnosed using a 75 g oral glucose tolerance test at 24 to 26 weeks of gestation. Cord blood samples from neonates were collected immediately post delivery. Controls, which were randomly selected from the study population, were matched (cases to controls ratio: 1:1) to cases by age, sex of fetus, and gestational week.Pregravid body mass index (BMI) (mean ± standard deviation) was (GDM vs. control): 24.5 ± 2.1 versus 22.8 ± 2.4 (P = .001). Cord blood estradiol in the GDM group was significantly lower than in the control group (P < .05). Pregravid BMI in the GDM group was significantly higher than in the control group (P < .05). Estradiol concentrations in cord blood were negatively correlated with birth weight (r = -0.121, P < .05). Conditional logistic regressions showed pregravid BMI, cord blood estradiol, and parity independently and positively predicted GDM. Multivariable regression splines characterize a nonlinear relationship between cord blood estradiol and GDM risk.These results demonstrate a relationship between cord blood estradiol levels and GDM. Estradiol might be involved in the pathophysiology of GDM. Further studies are needed to explore potential mechanism.
Collapse
Affiliation(s)
| | - Bo Gong
- Department of Clinical laboratory
| | - Jing Yu
- Department of Clinical laboratory
| | - Limin Shen
- Department of Obstetrics, Shanghai Changning District Maternity and Infant Health Hospital, Changning District, Shanghai, China
| | - Wanling Jin
- Department of Obstetrics, Shanghai Changning District Maternity and Infant Health Hospital, Changning District, Shanghai, China
| | | | | | | | | |
Collapse
|
26
|
Yoo HJ, Choi KM, Baik SH, Park JH, Shin SA, Hong SC, Oh MJ, Kim HJ, Cho GJ. Influences of body size phenotype on the incidence of gestational diabetes needing prescription; analysis by Korea National Health Insurance (KNHI) claims and the National Health Screening Examination (NHSE) database. Metabolism 2016; 65:1259-66. [PMID: 27506733 DOI: 10.1016/j.metabol.2016.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Although growing evidence has emphasized the pivotal role of metabolic status irrespective of body mass index (BMI), there has been no study to examine the association of body size phenotype with development of gestational diabetes that requires treatment with oral hypoglycemic agent or insulin (GDM+T) in primiparas. METHODS Data from a total of 216,961 women who participated in the National Health Screening Examination (NHSE) between January 2007 and December 2011 and delivered their first babies within two years of the NHSE were analyzed. Body size phenotypes were classified according to body mass index (BMI) and the presence/absence of metabolic syndrome according to the results of the NHSE. GDM+T was identified using the International Classification of Diseases-10th Revision (ICD-10) and prescription codes using Korea National Health Insurance (KNHI) claims. RESULTS Approximately 0.39% of primiparas developed GDM+T. Compared to metabolically healthy normal weight (MHNW) women, both metabolically unhealthy normal weight (MUNW) and metabolically healthy obese (MHO) women had a significantly increased risk for developing GDM+T (odds ratio, OR: 9.53, 95% confidence interval, CI: 5.64-16.09 and OR: 3.30, 95% CI: 2.56-4.25, respectively). Specifically, MUNW individuals had a significantly higher risk of GDM+T when directly compared to MHO women even after adjusting for other GDM risk factors (OR: 2.92, 95% CI: 1.67-5.10). Furthermore, underweight women with metabolic syndrome showed a significantly increased frequency of GDM+T compared to MHNW subjects (OR: 8.87, 95% CI: 1.19-66.32). CONCLUSIONS Pre-pregnant metabolic status is critical for development of GDM+T, regardless of their BMI. Therefore, intensive intervention for the components of metabolic syndrome may be helpful for the prevention of GDM+T even in low or normal weight women.
Collapse
Affiliation(s)
- Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Seoul, Republic of Korea
| | - Soon-Ae Shin
- Big Data Steering Department, National Health Insurance Service, Seoul, Republic of Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
27
|
Dulipsingh L, Cooney S, Whitaker M, Demarest C, Patel D, Roy M, Spurrier W. Haemoglobin A 1c
as a screening tool to identify pre-diabetes and diabetes in postpartum women with gestational diabetes. PRACTICAL DIABETES 2016. [DOI: 10.1002/pdi.2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Latha Dulipsingh
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Sally Cooney
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Margaret Whitaker
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Carole Demarest
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Dhruv Patel
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Michele Roy
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Wendy Spurrier
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| |
Collapse
|
28
|
How high is too high in cutoff levels from 50-g glucose challenge test. Obstet Gynecol Sci 2016; 59:178-83. [PMID: 27200307 PMCID: PMC4871933 DOI: 10.5468/ogs.2016.59.3.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 12/22/2015] [Accepted: 01/05/2016] [Indexed: 11/08/2022] Open
Abstract
Objective To determine the highest 50-g glucose challenge test (GCT) value that indicates no further diagnostic test is needed to confirm a diagnosis of gestational diabetes mellitus (GDM) under the criteria of National Diabetes Data Group (NDDG) or the Carpenter and Coustan (C&C) and fasting glucose thresholds from the International Association of Diabetes and Pregnancy Study Group (IADPSG). Methods We collected the 50-g GCT results from 16,560 pregnancies and identified 2,457 gravidas with positive 50-g GCT (≥130 mg/dL) values who underwent the 100-g glucose tolerance test. We investigated GDM prevalence in pregnancies with positive 50-g GCT according to the respective diagnostic thresholds and determined the 50-g GCT cutoff values with 100% positive predictive value for GDM under each diagnostic threshold. Results Twelve point five percent (306/2,457), 20.0% (492/2,457), and 9.6% (235/2,457) met the diagnostic criteria of GDM with the application of NDDG, C&C criteria, and fasting glucose thresholds from IADPSG (≥92 mg/dL), respectively. We also found that the prevalence of GDM increased with increasing 50-g GCT values using each diagnostic criterion. Importantly, we identified that all subjects with a 50-g GCT value ≥223, ≥217, or ≥228 mg/dL can be exclusively diagnosed as having gestational diabetes according to the criteria of NDDG, C&C, and fasting glucose thresholds from IADPSG, respectively. Conclusion We propose that women with a 50-g GCT screening value ≥228 mg/dL can be reliably omitted from further confirmative tests for GDM, such as 100- or 75-g glucose tolerance test.
Collapse
|
29
|
|
30
|
Jamilian M, Asemi Z. The Effect of Soy Intake on Metabolic Profiles of Women With Gestational Diabetes Mellitus. J Clin Endocrinol Metab 2015; 100:4654-61. [PMID: 26505826 DOI: 10.1210/jc.2015-3454] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT To our knowledge, no study has examined the effects of soy intake on metabolic status of women with gestational diabetes mellitus (GDM). OBJECTIVE This study was designed to assess the effects of soy intake on metabolic status of GDM women. METHODS A randomized clinical trial was performed among 68 women with GDM. Women were randomly assigned to receive either a control diet containing 0.8-g/kg protein (70% animal and 30% plant proteins) (n = 34) or a soy diet containing the same amount of protein with 35% animal protein, 35% soy protein, and 30% other plant proteins (n = 34) for 6 weeks. RESULTS Compared with soy protein consumption, the control group significantly increased fasting plasma glucose (+1.4 ± 11.6 vs -12.7 ± 13.2 mg/dL, P < .001), serum insulin levels (+5.0 ± 11.6 vs -0.9 ± 10.0 μIU/mL, P = .02), homeostasis model of assessment-insulin resistance (+1.2 ± 2.7 vs -0.8 ± 2.2, P = .002), and decreased quantitative insulin sensitivity check index (-0.007 ± 0.02 vs +0.01 ± 0.03, P = .004). Administration of the control diet resulted in a significant difference in serum triglycerides changes (+31.3 ± 38.0 vs +8.9 ± 46.1 mg/dL, P = .03) compared with soy protein. There were a significant decrease in total antioxidant capacity (-35.0 ± 136.2 vs +81.8 ± 188.8 mmol/L, P = .005) and glutathione (-41.3 ± 145.7 vs +53.3 ± 117.3 μmol/L, P = .004) by the control diet intake compared with soy protein. The control diet group had a higher incidence of newborn hyperbilirubinemia (32.4% vs 8.8%, P = .01) and newborn hospitalization (20.6% vs 2.9%, P = .02) compared with soy protein. CONCLUSION Soy protein consumption in women with GDM significantly improved the glucose homeostasis parameters, triglycerides, and biomarkers of oxidative stress, as well as reductions in the incidence of newborn hyperbilirubinemia and hospitalizations.
Collapse
Affiliation(s)
- Mehri Jamilian
- Department of Gynecology and Obstetrics (M.J.), School of Medicine, Arak University of Medical Sciences, Arak, Iran 38196; and Research Center for Biochemistry and Nutrition in Metabolic Diseases (Z.A.), Kashan University of Medical Sciences, Kashan, Iran 87159
| | - Zatollah Asemi
- Department of Gynecology and Obstetrics (M.J.), School of Medicine, Arak University of Medical Sciences, Arak, Iran 38196; and Research Center for Biochemistry and Nutrition in Metabolic Diseases (Z.A.), Kashan University of Medical Sciences, Kashan, Iran 87159
| |
Collapse
|
31
|
Effect of hyperemesis gravidarum on gestational diabetes mellitus screening. Int J Gynaecol Obstet 2015; 132:156-8. [PMID: 26582348 DOI: 10.1016/j.ijgo.2015.06.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/20/2015] [Accepted: 10/22/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To clarify the effect of starvation due to hyperemesis gravidarum on the screening of gestational diabetes mellitus (GDM). METHODS A retrospective study was undertaken of pregnant women who delivered at Tsukuba University Hospital, Japan, between October 1, 2010, and September 30, 2013. GDM screening was performed in the first trimester using the random blood glucose test with a cutoff value of 5.2mmol/L and in the second trimester using a 50-g glucose challenge test with a cutoff value of 7.8mmol/L. If the screening was positive, a 75-g oral glucose tolerance test was performed for a definite diagnosis. RESULTS Among 2112 eligible women, 33 (1.6%) required hospitalization for hyperemesis; the remaining 2079 women formed the control group. In the first trimester, the positive GDM screening rate was significantly higher in the hyperemesis group than in the control group (13 [39.4%] vs 115 [5.5%]; P<0.001). Additionally, the positive predictive value was significantly lower in the hyperemesis group (23.1% vs 73.9%; P<0.001). In the second trimester, no significant differences were observed between groups. CONCLUSION Hyperemesis gravidarum affects the positive GDM screening rate in the first trimester.
Collapse
|
32
|
Karamali M, Heidarzadeh Z, Seifati SM, Samimi M, Tabassi Z, Hajijafari M, Asemi Z, Esmaillzadeh A. Zinc supplementation and the effects on metabolic status in gestational diabetes: A randomized, double-blind, placebo-controlled trial. J Diabetes Complications 2015; 29:1314-9. [PMID: 26233572 DOI: 10.1016/j.jdiacomp.2015.07.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/23/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To the best of our knowledge, no reports are available indicating the effects of zinc supplementation on metabolic status in women with gestational diabetes (GDM). This study was designed to determine the effects of zinc supplementation on glucose homeostasis parameters and lipid concentrations in GDM women. METHODS This randomized, double-blind, placebo-controlled trial was performed among 58 women diagnosed with GDM, primigravida and aged 18-40years old. Patients were randomly divided into two groups to receive 233mg zinc gluconate (containing 30mg zinc) supplements (n=29) or placebo (n=29) per day for 6weeks. Fasting blood samples were taken at the beginning and end of the trial to quantify glucose, insulin and lipid concentrations. RESULTS Patients who received zinc supplements had significantly higher serum zinc concentrations (+6.9±13.2 vs. -1.5±16.5mg/dL, P=0.03) than those received the placebo. In addition, zinc-supplemented patients had reduced fasting plasma glucose (FPG) (-6.6±11.2 vs. +0.6±6.7mg/dL, P=0.005), serum insulin levels (-1.3±6.6 vs. +6.6±12.2μIU/mL, P=0.003), homeostasis model of assessment-insulin resistance (HOMA-IR) (-0.5±1.6 vs. +1.5±2.7, P=0.001), homeostatic model assessment-Beta cell function (HOMA-B) (-0.7±25.0 vs. +26.5±49.5, P=0.01) and increased quantitative insulin sensitivity check index (QUICKI) (+0.01±0.01 vs. -0.01±0.02, P=0.004) compared with the placebo. Additionally, significant differences in serum triglycerides (+13.6±61.4 vs. +45.9±36.5mg/dL, P=0.01) and VLDL-cholesterol concentrations (+2.7±12.3 vs. +9.2±7.3mg/dL, P=0.01) were observed following the administration of zinc supplements compared with the placebo.We did not observe any significant effects of taking zinc supplements on other lipid profiles. CONCLUSIONS Taken together, 30mg zinc supplementation per day for 6weeks among GDM women had beneficial effects on metabolic profiles.
Collapse
Affiliation(s)
- Maryam Karamali
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, I.R. Iran; Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Iran, I.R. Iran
| | - Zahra Heidarzadeh
- Department of Biology, Islamic Azad University, Ashkezar branch, Ashkezar, Iran
| | | | - Mansooreh Samimi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Zohreh Tabassi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Mohammad Hajijafari
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran.
| | - Ahmad Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|