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das Chagas LA, Torloni MR, Silva-Neto LGR, Dualib PM, de Sousa RML, Bittencourt JAS, Araujo Júnior E, Granese R, Mattar R. Dietary Intake and Oral Glucose Tolerance Test Results in Women with Gestational Diabetes. J Clin Med 2024; 13:2948. [PMID: 38792489 PMCID: PMC11122252 DOI: 10.3390/jcm13102948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/02/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objective: Diet is a risk factor for gestational diabetes mellitus (GDM). There are few studies on women's diet and glucose tolerance test (GTT) results during pregnancy. The objective of this study was to evaluate the relationship between one's previous diet and the number of abnormal values on the diagnostic GTT in women with GDM. We hypothesized that there would be an inverse relation between antioxidant micronutrient consumption and the number of abnormal GTT values. Methods: This cross-sectional study included 60 women diagnosed with GDM (2-h, 75 g-GTT), divided in two groups as follows: 1 abnormal glucose value and 2-3 abnormal values. Shortly after the diagnosis, participants answered a validated food frequency questionnaire to assess their food consumption in the last 6 months. The Mann-Whitney test was used to compare the dietary intake of the participants in the two groups. Results: The participant characteristics were similar. The median intake of total calories, carbohydrates, lipids, and proteins did not differ significantly between groups. Participants with 1 abnormal GTT value had significantly higher intakes of fiber (11.9 vs. 11.0 g/day p = 0.049), vitamin D (40.6 vs. 40.4 mcg/day p = 0.049), and vitamin C (180.0 vs. 151.0 mg/day p = 0.008) than those with 2-3 abnormal values. Conclusions: Our results suggest a possible association between the consumption of fiber and antioxidant micronutrients and the number of abnormal GTT values.
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Affiliation(s)
- Lucas Almeida das Chagas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil; (L.A.d.C.); (M.R.T.); (E.A.J.); (R.M.)
| | - Maria Regina Torloni
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil; (L.A.d.C.); (M.R.T.); (E.A.J.); (R.M.)
- Evidence Based Health Care, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-900, SP, Brazil
| | - Luiz Gonzaga Ribeiro Silva-Neto
- Department of Nutrition, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil;
| | - Patricia Medici Dualib
- Discipline of Endocrinology, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04038-001, SP, Brazil;
| | | | - Jalila Andréa Sampaio Bittencourt
- Laboratory of Biological Information Processing, Department of Electrical Engineering, Federal University of Maranhão (UFMA), São Luiz 65080-805, MA, Brazil;
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil; (L.A.d.C.); (M.R.T.); (E.A.J.); (R.M.)
| | - Roberta Granese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, “G. Martino” University Hospital, 98100 Messina, Italy
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil; (L.A.d.C.); (M.R.T.); (E.A.J.); (R.M.)
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Sartorão Filho CI, Barbosa AMP, Calderon IDMP, Rudge MVC. Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1134-1140. [PMID: 36580942 PMCID: PMC9800152 DOI: 10.1055/s-0042-1759742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gestational diabetes mellitus (GDM)is an entity with evolving conceptual nuances that deserve full consideration. Gestational diabetes leads to complications and adverse effects on the mother's and infants' health during and after pregnancy. Women also have a higher prevalence of urinary incontinence (UI) related to the hyperglycemic status during pregnancy. However, the exact pathophysiological mechanism is still uncertain. We conducted a narrative review discussing the impact of GDM on the women's pelvic floor and performed image assessment using three-dimensional ultrasonography to evaluate and predict future UI.
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Affiliation(s)
- Carlos Izaias Sartorão Filho
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil,Department of Medical School, Fundação Educacional do Município de Assis (FEMA), Assis, SP, Brazil
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil
| | - Iracema de Mattos Paranhos Calderon
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil
| | - Marilza Vieira Cunha Rudge
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil,Address for correspondence Marilza Vieira Cunha Rudge Distrito de Rubião Jr s/n 18.618-000, Botucatu, SPBrazil
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Jiang L, Tang K, Magee LA, von Dadelszen P, Ekeroma A, Li X, Zhang E, Bhutta ZA. A global view of hypertensive disorders and diabetes mellitus during pregnancy. Nat Rev Endocrinol 2022; 18:760-775. [PMID: 36109676 PMCID: PMC9483536 DOI: 10.1038/s41574-022-00734-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.
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Affiliation(s)
- Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Alec Ekeroma
- Department of Obstetrics and Gynecology, Wellington School of Medicine, University of Otago, Wellington, New Zealand
- National University of Samoa, Apia, Samoa
| | - Xuan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Enyao Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan.
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Dualib PM, Taddei CR, Fernandes G, Carvalho CRS, Sparvoli LG, Silva IT, Mattar R, Ferreira SRG, Dib SA, de Almeida-Pititto B. Gut Microbiota across Normal Gestation and Gestational Diabetes Mellitus: A Cohort Analysis. Metabolites 2022; 12:metabo12090796. [PMID: 36144203 PMCID: PMC9504460 DOI: 10.3390/metabo12090796] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 12/16/2022] Open
Abstract
The prevalence of gestational diabetes mellitus (GDM) is a global public health concern. The mechanism that leads to glucose tolerance beyond normal physiological levels to pathogenic conditions remains incompletely understood, and it is speculated that the maternal microbiome may play an important role. This study analyzes the gut microbiota composition in each trimester of weight-matched women with and without GDM and examines possible bacterial genera associations with GDM. This study followed 56 pregnant women with GDM and 59 without admitted to the outpatient clinic during their first/second or third trimester of gestation. They were submitted to a standardized questionnaire, dietary recalls, clinical examination, biological sample collection, and molecular profiling of fecal microbiota. Women with GDM were older and had a higher number of pregnancies than normal-tolerant ones. There was no difference in alpha diversity, and the groups did not differ regarding the overall microbiota structure. A higher abundance of Bacteroides in the GDM group was found. A positive correlation between Christensenellaceae and Intestinobacter abundances with one-hour post-challenge plasma glucose and a negative correlation between Enterococcus and two-hour plasma glucose levels were observed. Bifidobacterium and Peptococcus abundances were increased in the third gestational trimester for both groups. The gut microbiota composition was not dependent on the presence of GDM weight-matched women throughout gestation. However, some genera abundances showed associations with glucose metabolism. Our findings may therefore encourage a deeper understanding of physiological and pathophysiological changes in the microbiota throughout pregnancy, which could have further implications for diseases prevention.
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Affiliation(s)
- Patricia M. Dualib
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sena Madureira, 1500, Vila Clementino, São Paulo CEP 04021-001, Brazil
- Correspondence: ; Tel.: +55-11-983-220-909
| | - Carla R. Taddei
- Department of Clinical and Toxicological Analysis and Obstetrics, School of Arts, Sciences and Humanities, Universidade de São Paulo (USP), Av. Prof. Lineu Prestes 580—Bloco 17, São Paulo CEP 05508-000, Brazil
| | - Gabriel Fernandes
- DepaBiosystems Informatics and Genomics Group, Instituto René Rachou—Fiocruz Minas, Av. Augusto de Lima, 1714, Belo Horizonte CEP 30190-002, Brazil
| | - Camila R. S. Carvalho
- Graduate Program in Endocrinology and Metabology, Universidade Federal de São Paulo, Rua Estado de Israel, nº 639, Vila Clementino, São Paulo CEP 04022-001, Brazil
| | - Luiz Gustavo Sparvoli
- Department of Clinical and Toxicological Analysis and Obstetrics, School of Arts, Sciences and Humanities, Universidade de São Paulo (USP), Av. Prof. Lineu Prestes 580—Bloco 17, São Paulo CEP 05508-000, Brazil
| | - Isis T. Silva
- Nutrition Course, Centro Universitário Estácio de Sá, Rua Erê, 207, Belo Horizonte CEP 30411-052, Brazil
| | - Rosiane Mattar
- Departament of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, R. Napoleão de Barros, 875—Vila Clementino, São Paulo CEP 04024-002, Brazil
| | - Sandra R. G. Ferreira
- Department of Epidemiology, Escola de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715—Cerqueira César, São Paulo CEP 01246-904, Brazil
| | - Sergio A. Dib
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sena Madureira, 1500, Vila Clementino, São Paulo CEP 04021-001, Brazil
| | - Bianca de Almeida-Pititto
- Department of Preventive Medicine, Escola Paulista de Medicina, Campus São Paulo, Universidade Federal de São Paulo, Rua Botucatu, n° 740, Vila Clementino, São Paulo CEP 04023-062, Brazil
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Souza CM, Iser BPM. Gestational diabetes mellitus according to different diagnostic criteria: Prevalence and related factors. Midwifery 2022; 113:103428. [PMID: 35870228 DOI: 10.1016/j.midw.2022.103428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/26/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) has an impact on maternal health; however, there is no consensus about the diagnostic criterion and frequency of disease. The objective of this study was to estimate the prevalence of GDM and to evaluate the clinical characteristics of normoglycemic pregnant women and of those diagnosed with gestational diabetes mellitus, based on each criterion. METHODS Prospective cohort study. Third-trimester pregnant women participated, with the occurrence of GDM being verified, according to two different diagnostic criteria. Prevalence was estimated in each category, and the prevalence ratios (PR) and 95% confidence intervals were adjusted using Poisson Regression. RESULTS A total of 8.7% of women were diagnosed with GDM (glycemia ≥95) and 8% had glycemic levels ≥92mg/dL according to IADPSG diagnosis. Factors related to the disease were the same, although the magnitude of the associations differed according to the diagnosis criteria. Pre-gestational obesity (PR 3.59 CI 1.28-10,07), previous diseases (PR 3.03 CI 1.15-7.94), and excessive weight gain (PR 4.71 CI 1.80-12.33) were factors related to total GDM, plus low nutritional knowledge (PR 3.17 CI 1.10-9.11). Regardless of the diagnostic criterion, women with GDM were at higher risk of intercurrences during pregnancy. CONCLUSION Nutritional knowledge and status were associated with GDM occurrence, independently of the diagnosis criteria. The adoption of the glycemic cutoff point of ≥ 92mg/dL indicated an important portion of the population without a diagnosis, suggesting that this cutoff point, more sensitive, should be used in order to guide women and minimize untoward outcomes.
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Affiliation(s)
- Cláudia Meurer Souza
- Nutritionist, Master of Health Sciences, Postgraduate Program in Health Sciences. University of Southern Santa Catarina at Tubarão, Santa Catarina, Av. José Acácio Moreira, 787, Dehon, Tubarão SC, 88704900, Brazil
| | - Betine Pinto Moehlecke Iser
- PhD Epidemiology, Researcher at Postgraduate Program in Health Sciences. University of Southern Santa Catarina at Tubarão, Santa Catarina, Av. José Acácio Moreira, 787, Dehon, Tubarão SC, 88704900, Brazil.
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Gestational weight gain and adverse maternal and perinatal outcomes among women with gestational diabetes mellitus according to International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria: A cross sectional study. Clin Nutr ESPEN 2022; 50:207-211. [DOI: 10.1016/j.clnesp.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
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Carvalho MR, Crivellenti LC, Sartorelli DS. Estimate of Dietary Total Antioxidant Capacity of Pregnant Women and Associated Factors. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:91-99. [PMID: 35213906 PMCID: PMC9948131 DOI: 10.1055/s-0041-1741454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the dietary total antioxidant capacity (DTAC) of pregnant women, and associated factors. METHODS Cross-sectional study conducted with 785 pregnant adult women attended in primary health care centers of Ribeirão Preto, state of São Paulo, Brazil. Two 24-hour dietary recalls were obtained, and the usual intake was estimated through the Multiple Source Method. The DTAC was estimated using the ferric reducing antioxidant power assay. The relationship between the higher DTAC estimate (≥ median of 4.3 mmol/day) and associated factors was investigated using adjusted logistic models with backward selection. RESULTS In total, 25% of the pregnant women were classified as overweight, and 32% as obese. The median (P25, P75) DTAC was 4.3 (3.3-5.6) mmol/day. Through adjusted logistic regression models with backward selection, a higher chance of DTAC estimates above the median among pregnant women aged ≥ 35 years old (2.01 [1.24-3.27]) was verified when compared with younger pregnant women. Women with prepregnancy overweight (0.63 [0.45-0.89]) and obesity (0.59 [0.40-0.88]) presented a lower chance of DTAC estimates above the median when compared with eutrophic pregnant women. A higher DTAC estimate was positively associated with the use of dietary supplements (1.39 [1.03-1.88]), and negatively associated with total dietary energy (0.59 [0.42-0.85]). CONCLUSION The DTAC estimate over the median was associated with greater age, adequate body weight, use of dietary supplements, and lower energy intake.
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Affiliation(s)
- Mariana Rinaldi Carvalho
- Department of Social Medicine, Public Health Program, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Lívia Castro Crivellenti
- Department of Social Medicine, Public Health Program, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela Saes Sartorelli
- Department of Social Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Nigatu B, Workneh T, Mekuria T, Yifter H, Mamuye Y, Gize A. Prevalence of Gestational Diabetes Mellitus among pregnant women attending antenatal care clinic of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Clin Diabetes Endocrinol 2022; 8:2. [PMID: 35197130 PMCID: PMC8867668 DOI: 10.1186/s40842-022-00139-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background The prevalence of Gestational Diabetes Mellitus (GDM) varies worldwide among racial and ethnic groups, population characteristics (eg, average age and body mass index (BMI) of pregnant women), testing method, and diagnostic criteria. This study was aimed at determining the prevalence of GDM using the one-step 75-g Oral glucose tolerance test (OGTT) protocol, with plasma glucose measurement taken when patient is fasting and at 1 and 2 h and identify associated risk factors among pregnant women attending antenatal care clinic at St. Paul Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. Methods Institution based cross sectional study was conducted from April, 2017 to October, 2017 at antenatal care clinic of SPHMMC among a randomly selected sample of 390 eligible pregnant women. Data were collected using a pretested questioner using 5% of the total sample size and later was modified accordingly to capture all the necessary data. Descriptive statistics, independent t-test and Binary Logistic Regression were used for analysis using SPSS version 23.0. Results The prevalence of GDM among the study population was 16.9%. Factors that affect prevalence of GDM were age group (AOR = 2.75, 95% CI: 1.03, 7.35 for 30–34 years old and AOR = 4.98, 95% CI: 1.703, 14.578 for ≥ 35 years old)and BMI (AOR = 2.23, 95% CI: 1.21, 4.11). Conclusions The prevalence of GDM among the study population is higher than previous reports in Ethiopia and even in other countries. This implies that these women and their newborns might be exposed to increased risk of immediate and long term complications from GDM including future risk of GDM and Type II Diabetes Mellitus. Supplementary Information The online version contains supplementary material available at 10.1186/s40842-022-00139-w.
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Affiliation(s)
- Balkachew Nigatu
- Department of Obstetrics and Gynecology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Tigist Workneh
- Department of Internal Medicine, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Thomas Mekuria
- Department of Obstetrics and Gynecology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Helen Yifter
- Endocrinology Unit, Department of Internal Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yeshiwondim Mamuye
- Department of Microbiology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Addisu Gize
- Department of Microbiology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Miranda DEGDA, Santos IDS, Silva CA, Carvalho MR, Shivappa N, Hébert JR, Crivellenti LC, Sartorelli DS. Pro-inflammatory diet during pregnancy is associated with large for gestational age infants. Nutr Res 2022; 100:47-57. [DOI: 10.1016/j.nutres.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
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Wu Q, Chen Y, Zhou M, Liu M, Zhang L, Liang Z, Chen D. An early prediction model for gestational diabetes mellitus based on genetic variants and clinical characteristics in China. Diabetol Metab Syndr 2022; 14:15. [PMID: 35073990 PMCID: PMC8785509 DOI: 10.1186/s13098-022-00788-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/06/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To evaluate the influence of genetic variants and clinical characteristics on the risk of gestational diabetes mellitus (GDM) and to construct and verify a prediction model of GDM in early pregnancy. METHODS Four hundred seventy five women with GDM and 487 women without, as a control, were included to construct the prediction model of GDM in early pregnancy. Both groups had complete genotyping results and clinical data. They were randomly divided into a trial cohort (70%) and a test cohort (30%). Then, the model validation cohort, including 985 pregnant women, was used for the external validation of the GDM early pregnancy prediction model. RESULTS We found maternal age, gravidity, parity, BMI and family history of diabetes were significantly associated with GDM (OR > 1; P < 0.001), and assisted reproduction was a critical risk factor for GDM (OR = 1.553, P = 0.055). MTNR1B rs10830963, C2CD4A/B rs1436953 and rs7172432, CMIP rs16955379 were significantly correlated with the incidence of GDM (AOR > 1, P < 0.05). Therefore, these four genetic susceptible single nucleotide polymorphisms (SNPs) and six clinical characteristics were included in the construction of the GDM early pregnancy prediction model. In the trial cohort, a predictive model of GDM in early pregnancy was constructed, in which genetic risk score was independently associated with GDM (AOR = 2.061, P < 0.001) and was the most effective predictor with the exception of family history of diabetes. The ROC-AUC of the prediction model was 0.727 (95% CI 0.690-0.765), and the sensitivity and specificity were 69.9% and 64.0%, respectively. The predictive power was also verified in the test cohort and the validation cohort. CONCLUSIONS Based on the genetic variants and clinical characteristics, this study developed and verified the early pregnancy prediction model of GDM. This model can help screen out the population at high-risk for GDM in early pregnancy, and lifestyle interventions can be performed for them in a timely manner in early pregnancy.
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Affiliation(s)
- Qi Wu
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, China
| | - Yanmin Chen
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, China
| | - Menglin Zhou
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, China
| | - Mengting Liu
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, China
| | - Lixia Zhang
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, China
| | - Zhaoxia Liang
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Los Angeles, United States of America
| | - Danqing Chen
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, China.
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Xintong L, Dongmei X, Li Z, Ruimin C, Yide H, Lingling C, Tingting C, Yingying G, Jiaxin L. Correlation of body composition in early pregnancy on gestational diabetes mellitus under different body weights before pregnancy. Front Endocrinol (Lausanne) 2022; 13:916883. [PMID: 36387861 PMCID: PMC9649916 DOI: 10.3389/fendo.2022.916883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The prediction of gestational diabetes mellitus (GDM) by body composition-related indicators in the first trimester was analyzed under different body mass index (BMI) values before pregnancy. METHODS This was a retrospective analysis of pregnant women who were treated, had documented data, and received regular perinatal care at the Third Affiliated Hospital of Zhengzhou University from January 1, 2021, to December 31, 2021. Women with singleton pregnancies who did not have diabetes before pregnancy were included. In the first trimester (before the 14th week of pregnancy), bioelectric impedance assessment (BIA) was used to analyze body composition-related indicators such as protein levels, mineral levels, fat volume, and the waist-hip fat ratio. The Pearman's correlation coefficient was used to evaluate the linear relationship between the continuous variables and pre-pregnancy body mass index (BMI). In the univariate body composition analysis, the association with the risk of developing GDM was included in a multivariate analysis using the relative risk and 95% confidence interval obtained from logarithmic binomial regression, and generalized linear regression was used for multivariate regression analysis. Furthermore, the area under the curve (AUC) was calculated by receiver operating characteristic (ROC) curves. The optimal cutoff value of each risk factor was calculated according to the Youden Index. RESULTS In a retrospective study consisting of 6698 pregnant women, we collected 1109 cases of gestational diabetes. Total body water (TBW), protein levels, mineral levels, bone mineral content (BMC), body fat mass (BFM), soft lean mass (SLM), fat-free mass (FMM), skeletal muscle mass (SMM), percent body fat (PBF), the waist-hip ratio (WHR), the visceral fat level (VFL), and the basal metabolic rate (BMR) were significantly higher in the GDM group than in the normal group (P<0.05). Under the pre-pregnancy BMI groupings, out of 4157 pregnant women with a BMI <24 kg/m2, 456 (10.97%) were diagnosed with GDM, and out of 2541 pregnant women with a BMI ≥24 kg/m2, 653 (25.70%) were diagnosed with GDM. In the generalized linear regression model, it was found that in all groups of pregnant women, pre-pregnancy BMI, age, gestational weight gain (GWG) in the first trimester, and weight at the time of the BIA had a certain risk for the onset of GDM. In Model 1, without adjusting for confounders, the body composition indicators were all positively correlated with the risk of GDM. In Model 3, total body water, protein levels, mineral levels, bone mineral content, soft lean mass, fat-free mass, skeletal muscle mass, and the basal metabolic rate were protective factors for GDM. After Model 4 was adjusted for confounders, only the waist-hip ratio was positively associated with GDM onset. Among pregnant women with a pre-pregnancy BMI <24 kg/m2, the body composition-related indicators in Model 2 were all related to the onset of GDM. In Model 3, total body water, soft lean mass, fat-free mass, and the basal metabolic rate were negatively correlated with GDM onset. In the body composition analysis of among women with a pre-pregnancy BMI ≥ 24 kg/m2, only Model 1 and Model 2 were found to show positive associations with GDM onset. In the prediction model, in the basic data of pregnant women, the area under the receiver operating characteristic curve predicted by gestational weight gain for GDM was the largest (0.795), and its cutoff value was 1.415 kg. In the body composition results, the area under the receiver operating characteristic curve of body fat mass for predicting GDM risk was larger (0.663) in all pregnant women. CONCLUSIONS Through this retrospective study, it was found that the body composition-related indicators were independently associated with the onset of GDM in both the pre-pregnancy BMI <24 kg/m2 and pre-pregnancy BMI ≥24 kg/m2 groups. Body fat mass, the visceral fat level, and the waist-hip ratio had a higher correlation with pre-pregnancy BMI. Total body water, protein levels, mineral levels, bone mineral content, soft lean mass, fat-free mass, skeletal muscle mass, and the basal metabolic rate were protective factors for GDM after adjusting for some confounders. In all pregnant women, the waist-hip ratio was found to be up to 4.562 times the risk of GDM development, and gestational weight gain had the best predictive power for GDM. Gestational weight gain in early pregnancy, body fat mass, and the waist-hip ratio can assess the risk of GDM in pregnant women, which can allow clinicians to predict the occurrence of GDM in pregnant women as early as possible and implement interventions to reduce adverse perinatal outcomes.
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Affiliation(s)
- Li Xintong
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xu Dongmei
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Perinatal Health, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xu Dongmei,
| | - Zhang Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cao Ruimin
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Yide
- Anesthesiology, Xinxiang Medical University, Xinxiang, China
| | - Cui Lingling
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chen Tingting
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guo Yingying
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Li Jiaxin
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
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Higa R, Leonardi ML, Jawerbaum A. Intrauterine Programming of Cardiovascular Diseases in Maternal Diabetes. Front Physiol 2021; 12:760251. [PMID: 34803741 PMCID: PMC8595320 DOI: 10.3389/fphys.2021.760251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Maternal diabetes is a prevalent pathology that increases the risk of cardiovascular diseases in the offspring, the heart being one of the main target organs affected from the fetal stage until the adult life. Metabolic, pro-oxidant, and proinflammatory alterations in the fetal heart constitute the first steps in the adverse fetal programming of cardiovascular disease in the context of maternal diabetes. This review discusses both human and experimental studies addressing putative mechanisms involved in this fetal programming of heart damage in maternal diabetes. These include cardiac epigenetic changes, alterations in cardiac carbohydrate and lipid metabolism, damaging effects caused by a pro-oxidant and proinflammatory environment, alterations in the cardiac extracellular matrix remodeling, and specific signaling pathways. Putative actions to prevent cardiovascular impairments in the offspring of mothers with diabetes are also discussed.
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Affiliation(s)
- Romina Higa
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.,Laboratory of Reproduction and Metabolism, CONICET-Universidad de Buenos Aires, CEFYBO, Buenos Aires, Argentina
| | - María Laura Leonardi
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.,Laboratory of Reproduction and Metabolism, CONICET-Universidad de Buenos Aires, CEFYBO, Buenos Aires, Argentina
| | - Alicia Jawerbaum
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.,Laboratory of Reproduction and Metabolism, CONICET-Universidad de Buenos Aires, CEFYBO, Buenos Aires, Argentina
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de Wit L, Zijlmans AB, Rademaker D, Naaktgeboren CA, DeVries JH, Franx A, Painter RC, van Rijn BB. Estimated impact of introduction of new diagnostic criteria for gestational diabetes mellitus. World J Diabetes 2021; 12:868-882. [PMID: 34168734 PMCID: PMC8192254 DOI: 10.4239/wjd.v12.i6.868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Implementation of new diagnostic criteria for gestational diabetes mellitus (GDM) are still a subject of debate, mostly due to concerns regarding the effects on the number of women diagnosed with GDM and the risk profile of the women newly diagnosed. AIM To estimate the impact of the World Health Organization (WHO) 2013 criteria compared with the WHO 1999 criteria on the incidence of gestational diabetes mellitus as well as to determine the diagnostic accuracy for detecting adverse pregnancy outcomes. METHODS We retrospectively analyzed a single center Dutch cohort of 3338 women undergoing a 75 g oral glucose tolerance test where the WHO 1999 criteria to diagnose GDM were clinically applied. Women were categorized into four groups: non-GDM by both criteria, GDM by WHO 1999 only (excluded from GDM), GDM by WHO 2013 only (newly diagnosed) and GDM by both criteria. We compared maternal characteristics, pregnancy outcomes and likelihood ratios for adverse pregnancy outcomes. RESULTS Retrospectively applying the WHO 2013 criteria increased the cohort incidence by 13.1%, from 19.3% to 32.4%. Discordant diagnoses occurred in 21.3%; 4.1% would no longer be labelled as GDM, and 17.2% were newly diagnosed. Compared to the non-GDM group, women newly diagnosed were older, had higher rates of obesity, higher diastolic blood pressure and higher rates of caesarean deliveries. Their infants were more often delivered preterm, large-for-gestational-age and were at higher risk of a 5 min Apgar score < 7. Women excluded from GDM were older and had similar pregnancy outcomes compared to the non-GDM group, except for higher rates of shoulder dystocia (4.3% vs 1.3%, P = 0.015). Positive likelihood ratios for adverse outcomes in all groups were generally low, ranging from 0.54 to 2.95. CONCLUSION Applying the WHO 2013 criteria would result in a substantial increase in GDM diagnoses. Newly diagnosed women are at increased risk for pregnancy adverse outcomes. This risk, however, seems to be lower than those identified by the WHO 1999 criteria. This could potentially influence the treatment effect that can be achieved in this group. Evidence on treatment effects in newly diagnosed women is urgently needed.
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Affiliation(s)
- Leon de Wit
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht 3584 EA, Netherlands
| | - Anna B Zijlmans
- Department of Obstetrics and Gynaecology, Gelderse Vallei Hospital, Ede 6716 RP, Netherlands
| | - Doortje Rademaker
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers- Location AMC, Amsterdam 1105 AZ, Netherlands
| | - Christiana A Naaktgeboren
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers–Location AMC, Amsterdam 1105 AZ, Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam University Medical Centers–Location AMC, Amsterdam 1105 AZ, Netherlands
| | - Arie Franx
- Department of Obstetrics and Fetal Medicine, Erasmus MC Sophia Children Hospital, Rotterdam 3015 GD, Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers–Location AMC, Amsterdam 1105 AZ, Netherlands
| | - Bas B van Rijn
- Department of Obstetrics and Fetal Medicine, Erasmus MC Sophia Children Hospital, Rotterdam 3015 GD, Netherlands
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A better quality of maternal dietary fat reduces the chance of large-for-gestational-age infants: A prospective cohort study. Nutrition 2021; 91-92:111367. [PMID: 34265579 DOI: 10.1016/j.nut.2021.111367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We sought to investigate the relationship between the usual intake of fatty acids and indices of dietary fat quality in pregnant women and the birth-weight categories of their newborns. METHODS This prospective cohort study was conducted with 734 mother-infant pairs in Brazil. Dietary intake was estimated through 24-h dietary recalls. Secondary data on birth weight, sex of the newborn, and pregnancy duration were obtained. The relationship of fatty acids and indices with birth-weight categories were investigated using logistic regression models adjusted for confounding factors. We considered P values < 0.05 significant. RESULTS The median (interquartile range) maternal age was 27 (23-31) y; 46.2% of the pregnant women had pregestational body mass index ≥ 25 kg/m2, 18.1% had gestational diabetes mellitus, and 11.2% had hypertension. Regarding the newborns, 68 (9.3%) were classified as small for gestational age, 545 (74.2%) as appropriate size for gestational age, and 121 (16.5%) as large for gestational age. In adjusted logistic regression models, a lower chance of being large for gestational age was observed among the children of women classified in the third tertile (versus the first tertile) for intake of polyunsaturated fatty acids (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.31-0.89; P = 0.02), ω-3 fatty acids (OR, 0.48; 95% CI, 0.28-0.80; P = 0.005), and ω-6 fatty acids (OR, 0.56; 95% CI, 0.33-0.96; P = 0.04) and for ratios of polyunsaturated to saturated fatty acids (OR, 0.54; 95% CI, 0.32-0.92; P = 0.03) and hypocholesterolemic to hypercholesterolemic fatty acids (OR, 0.51; 95% CI, 0.30-0.87; P = 0.01). CONCLUSIONS The data suggest that better-quality fat in the maternal diet can reduce the chance of a large-for-gestational-age newborn.
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Silveira LRPD, Schmidt MI, Reichelt ADAJ, Drehmer M. Obesity, gestational weight gain, and birth weight in women with gestational diabetes: the LINDA-Brasil (2014-2017) and the EBDG (1991-1995) studies. J Pediatr (Rio J) 2021; 97:167-176. [PMID: 32283049 PMCID: PMC9432266 DOI: 10.1016/j.jped.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/22/2020] [Accepted: 03/12/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate gestational weight gain and birth weight in women with gestational diabetes mellitus of two Brazilian cohorts enrolled three decades apart. METHODS The authors compared data of 2362 women from the Lifestyle INtervention for Diabetes Prevention After Pregnancy study (LINDA-Brasil, 2014-2017) to those of 359 women from the Estudo Brasileiro de Diabetes Gestacional study (EBDG, 1991-1995). Gestational weight gain was classified by the 2009 Institute of Medicine criteria; large and small for gestational age newborns, by the Intergrowth-21st chart. Differences in birth weight means between pregestational BMI and gestational weight gain categories were evaluated by ANOVA; the associations of gestational weight gain and birth weight, through multivariable Poisson regression. RESULTS In LINDA-Brasil, women presented higher pregestational body mass index (30.3±6.5 vs. 24.6±4.4kg/m2) and were frequently obese (46.4 vs. 11.1%) compared to those of the EBDG. In the EBDG, gestational weight gain was larger (11.3±6.1 vs. 9.2±7.6kg) and rates of small for gestational age higher (7.5 vs. 4.5%) compared to LINDA-Brasil. In LINDA-Brasil, excessive gestational weight gain was associated to macrosomia (adjusted relative risk [aRR]: 1.59, 95% CI 1.08-2.35) and large for gestational age (aRR: 1.40; 95% CI 1.05-1.86); less gain increased the risk of low birth weight (aRR: 1.66; 95% CI 1.05-2.62) and small for gestational age (aRR: 1.79; 95% CI 1.03-3.11). These associations were similar in the EBDG, although not statistically significant. CONCLUSIONS Improvements in gestational weight gain and rates of small for gestational age occurred over time in gestational diabetes mellitus pregnancies, accompanied by a worsening in maternal weight profile. This highlights the nutritional transition during this period and the importance of avoiding excessive gestational weight gain as well as promoting adequate weight before conception.
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Affiliation(s)
- Letícia Ribeiro Pavão da Silveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - Maria Inês Schmidt
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Medicina Social, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | | | - Michele Drehmer
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Medicina Social, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Nutrição, Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Porto Alegre, RS, Brazil.
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Saeedi M, Cao Y, Fadl H, Gustafson H, Simmons D. Increasing prevalence of gestational diabetes mellitus when implementing the IADPSG criteria: A systematic review and meta-analysis. Diabetes Res Clin Pract 2021; 172:108642. [PMID: 33359574 DOI: 10.1016/j.diabres.2020.108642] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022]
Abstract
AIMS Quantify the proportional increase in gestational diabetes (GDM) prevalence when implementing the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria compared to prior GDM criteria, and to assess risk factors that might affect the change in prevalence. METHODS A systematic review and meta-analysis was performed of cohort and cross-sectional studies between January 1, 2010 to December 31, 2018 among pregnant women with GDM using IADPSG criteria compared to, and stratified by, old GDM criteria. Web of science, PubMed, EMBASE, Cochrane, Open Grey and Grey literature reports were included. The relative risk for each study was calculated. Subgroup analyses were performed by maternal age, body mass index, study design, country of publication, screening method, sampling method and data stratified according to diagnostic criteria. RESULTS Thirty-one cohort and cross-sectional studies with 136 705 women were included. Implementing the IADPSG criteria was associated with a 75% (RR 1.75, 95% CI 1.53-2.01) increase in number of women with GDM with evidence of heterogeneity. CONCLUSIONS The IADPSG criteria increase the prevalence of GDM, but allow movement towards more homogeneity. More studies are needed of the benefits, harms, psychological effects and health costs of implementing the IADPSG criteria.
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Affiliation(s)
- Maryam Saeedi
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden.
| | - Yang Cao
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 70 182 Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
| | - Hanne Gustafson
- Department of Geriatrics, Örebro University Hospital, Region Örebro County, PO Box 1613, SE-701 16, Sweden
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, Australia; Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
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Gorban de Lapertosa S, Sucani S, Salzberg S, Alvariñas J, Faingold C, Jawerbaum A, Rovira G. Prevalence of gestational diabetes mellitus in Argentina according to the Latin American Diabetes Association (ALAD) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria and the associated maternal-neonatal complications. Health Care Women Int 2020; 42:636-656. [PMID: 32886577 DOI: 10.1080/07399332.2020.1800012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In Argentina, gestational diabetes mellitus (GDM) is diagnosed by the Latin American Diabetes Association (ALAD) diagnostic criterion. In this work, we investigated GDM prevalence according to the ALAD and IADPSG diagnostic criteria, evaluated maternal and fetal outcomes and assessed whether fasting glycemia between 92-99 mg/dL was associated with increased risk of macrosomia and maternal obesity/overweight in an Argentine cohort of pregnant women. GDM prevalence was 9.8% with the ALAD diagnostic criterion and 25% considering the IADPSG criterion. Increased prevalence of maternal obesity/overweight was observed in patients with fasting glycemia over 99 mg/dL. A population of high metabolic risk is identified by the ALAD criterion.
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Affiliation(s)
| | - Stella Sucani
- Hospital Materno Provincial Dr R F Lucini, Córdoba, Argentina
| | - Susana Salzberg
- Department of Clinical Investigations, Instituto Centenario, Buenos Aires, Argentina
| | - Jorge Alvariñas
- Nutrition Department, Enrique Tornu Hospital, Buenos Aires, Argentina
| | - Cristina Faingold
- Endocrinology Service, Dr. Milstein Hospital, Buenos Aires, Argentina
| | - Alicia Jawerbaum
- Laboratory of Reproduction and Metabolism, Universidad de Buenos Aires, Facultad de Medicina and CEFYBO-CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gabriela Rovira
- Department of Endocrinology, Diabetes, Metabolism and Nutrition, British Hospital, Buenos Aires, Argentina
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- Diabetes and Pregnancy Study Group of the Argentine Society of Diabetes (DPSG-SAD)
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Nicolosi BF, Souza RT, Mayrink J, Feitosa FE, Rocha Filho EA, Leite DF, Vettorazzi J, Sousa MH, Costa ML, Baker PN, Kenny LC, Cecatti JG, Calderon IM. Incidence and risk factors for hyperglycemia in pregnancy among nulliparous women: A Brazilian multicenter cohort study. PLoS One 2020; 15:e0232664. [PMID: 32401767 PMCID: PMC7219776 DOI: 10.1371/journal.pone.0232664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/02/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To assess the incidence and risk factors for hyperglycemia in pregnancy in a cohort of Brazilian nulliparous pregnant women. MATERIALS AND METHODS This is a secondary analysis of a multicenter cohort study that enrolled 1,008 nulliparous pregnant women at 19-21 weeks. Exclusion criteria included chronic exposure to corticosteroids and previous diabetes. Bivariate and multivariate analyses by Poisson regression were used to identify associated factors. RESULTS The incidence of hyperglycemia in pregnancy was 14.9% (150/1,008), and 94.7% of these cases were gestational diabetes mellitus (142/150). Significant associated factors included a family history of diabetes mellitus, maternal overweight or obesity at enrollment, and previous maternal conditions (polycystic ovarian syndrome, thyroid dysfunctions and hypertensive disorders). A BMI ≥ 26.3Kg/m2 (RRadj 1.87 [1.66-2.10]) and a family history of diabetes mellitus (RRadj 1.71 [1.37-2.15]) at enrollment were independent risk factors for HIP. CONCLUSIONS A family history of diabetes mellitus and overweight or obesity (until 19-21 weeks of gestation) may be used as selective markers for HIP in Brazilian nulliparous women. Given the scarcity of results in nulliparous women, our findings may contribute to determine the optimal diagnostic approach in populations of similar socioeconomic characteristics.
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Affiliation(s)
- Bianca F. Nicolosi
- Department of Obstetrics and Gynecology, Botucatu Medical School, Unesp, Botucatu, SP, Brazil
| | - Renato T. Souza
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Jussara Mayrink
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Francisco E. Feitosa
- MEAC–Maternity School of the Federal University of Ceará, in Fortaleza, CE, Brazil
| | - Edilberto A. Rocha Filho
- Department of Maternal and Child Health, Maternity of Clinic Hospital, Federal University of Pernambuco, Recife, PE, Brazil
| | - Débora F. Leite
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
- Department of Maternal and Child Health, Maternity of Clinic Hospital, Federal University of Pernambuco, Recife, PE, Brazil
| | - Janete Vettorazzi
- Department of Obstetrics and Gynecology, Maternity of the Clinic Hospital, Federal University of RS, Porto Alegre, RS, Brazil
| | - Maria H. Sousa
- Statistics Unit, Jundiai School of Medicine, Jundiaí, SP, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Philip N. Baker
- College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Louise C. Kenny
- Faculty of Health and Life Sciences, Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
- * E-mail:
| | - Iracema M. Calderon
- Department of Obstetrics and Gynecology, Botucatu Medical School, Unesp, Botucatu, SP, Brazil
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Sartorelli DS, Carvalho MR, da Silva Santos I, Crivellenti LC, Souza JP, Franco LJ. Dietary total antioxidant capacity during pregnancy and birth outcomes. Eur J Nutr 2020; 60:357-367. [PMID: 32347332 DOI: 10.1007/s00394-020-02251-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/14/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE To investigate the effect of maternal dietary total antioxidant capacity (DTAC) and main food sources on the risk of preterm birth (PB) and offspring birth size. METHODS Cohort study that included 733 Brazilian mother-child pairs. Two 24 h dietary recalls were obtained during pregnancy and the usual intake was estimated through the Multiple Source Method. Data of the offspring were extracted from the national live births information system. Adjusted multivariable logistic regression models were used to investigate the relationship that energy-adjusted DTAC and food sources have with the outcomes. RESULTS In total, 9.7% of the children were PBs, 6.0% were born with low birth weight (LBW), 6.7% with macrosomia, 9.3% were small for gestational age (SGA) and 16.4% large for gestational age (LGA). The mean energy-adjusted DTAC ± SD was 4.7 ± 2.1 mmol. The adjusted OR (95%CI) of PB for each increasing tertile of maternal DTAC were 0.71 (0.41, 1.30) and 0.54 (0.29, 0.98), when compared with the lowest intake. For LBW, these were 0.25 (0.09, 0.65) and 0.63 (0.28, 1.41). A likelihood of lower odds for PB was found for a higher intake of fruits [0.66 (0.39, 1.09)]. Women with a higher consumption of milk were less likely to have a child with LBW [0.48 (0.23, 1.01)], and children whose mothers reported a higher intake of beans had lower odds of being born LGA [0.61 (0.39, 0.93)]. CONCLUSION The data suggest that a higher intake of foods with antioxidant activity during pregnancy might reduce the chance of adverse birth outcomes.
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Affiliation(s)
- Daniela Saes Sartorelli
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | - Mariana Rinaldi Carvalho
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Izabela da Silva Santos
- Graduate Program of Nutrition and Metabolism, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Lívia Castro Crivellenti
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Laércio Joel Franco
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
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Sartorelli DS, Crivellenti LC, Zuccolotto DCC, Franco LJ. Relationship between minimally and ultra-processed food intake during pregnancy with obesity and gestational diabetes mellitus. CAD SAUDE PUBLICA 2020; 35:e00049318. [PMID: 31066773 DOI: 10.1590/0102-311x00049318] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/22/2018] [Indexed: 01/11/2023] Open
Abstract
This study aimed to investigate the relationship between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight, obesity, and gestational diabetes mellitus conditions. This is a cross-sectional study conducted among 785 adult women in singleton pregnancies (between 24th and 39th weeks of gestation) in Brazil. Usual food intake was estimated by the Multiple Source Method, using two 24-hour dietary recalls. The food groups of interest in this study were the unprocessed or minimally processed foods and ultra-processed foods. The World Health Organization criteria for the diagnosis of gestational diabetes mellitus and the Atalah criteria for excess weight were used. Adjusted multinomial logistic regression models were used to assess the relationship between energy contribution (%E) from foods with overweight and obesity conditions and, adjusted logistic regression models for gestational diabetes mellitus. In total, 32.1% participants were overweight, 24.6% were obese, and 17.7% of women were diagnosed with gestational diabetes mellitus . After adjustments, an inverse association between the highest tertile of %E from the intake of unprocessed or minimally processed foods and obesity was found [0.49 (0.30-0.79)]. Moreover, a positive association between the highest tertile of %E from ultra-processed food intake [3.06 (1.27-3.37)] and obesity was observed. No association between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight or gestational diabetes mellitus was found. The findings suggest a role of food processing in obesity but not in gestational diabetes mellitus. Further research is warranted to provide robust evidence on the relationship between the role of processed foods in obesity and gestational diabetes mellitus.
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Affiliation(s)
| | | | | | - Laércio Joel Franco
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
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Abstract
PURPOSE OF REVIEW Currently, the diagnosis of gestational diabetes mellitus (GDM) lacks uniformity. Several controversies are still under debate, especially on the method of screening and diagnosis. This review focuses on recent literature and provides current evidence for the screening and diagnosis of GDM. RECENT FINDINGS Selective screening would miss a significant number of women with GDM. In contrast, universal screening has been shown to be cost-effective, compared with selective screening, and is recommended by many medical societies. For the diagnostic methods for GDM, most observational cohort studies reported that the one-step method is associated with improved pregnancy outcomes and is cost-saving or cost-effective, compared with the two-step method, although these findings should be confirmed in the upcoming randomized controlled trials which compare the performance of one-step and two-step methods. On the other hand, the methods of early screening or diagnosis of GDM are varied, and current evidence does not justify their use during early pregnancy. In conclusion, current evidence favors universal screening for GDM using the one-step method. Early screening for GDM is not favorably supported by the literature.
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Affiliation(s)
- Chun-Heng Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
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Yuen L, Saeedi P, Riaz M, Karuranga S, Divakar H, Levitt N, Yang X, Simmons D. Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019; 157:107841. [PMID: 31518656 DOI: 10.1016/j.diabres.2019.107841] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/06/2019] [Indexed: 01/13/2023]
Abstract
AIM Hyperglycaemia in pregnancy (HIP) is one of the most common complications of pregnancy. This study aims to examine the projected HIP prevalence in 2030 and 2045 using multiple methods. METHODS The International Diabetes Federation Diabetes Atlas 2019 prevalence was projected to 2030 and 2045 by: (1) carrying forward the 2019 age-adjusted prevalence rates; (2) applying a linear regression of the past four editions of the IDF Diabetes Atlas; (3) applying a regression of the previous editions with the most consistent trend, followed by extrapolation from the 9th edition HIP estimate. RESULTS Respectively, for 2030 and 2045, Method 1 projected a declining HIP rate with prevalences of 14.0% and 13.3%, Method 2 projected an increasing HIP prevalence at 16.5% and 18.3%, Method 3 predicted stabilisation of the rate from 16.0% to 15.8%. CONCLUSION Assuming other factors remain unchanged, our best estimation of age-adjusted HIP will show stabilisation between 2019 and 2045 of 15.8% to 16.0%. However, this estimate is confounded by the heterogeneity of studies and the influence of different gestational diabetes mellitus diagnostic criteria. To provide accurate future comparisons we recommend standardising the diagnostic criteria to the International Association of Diabetes in Pregnancy Study Groups.
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Affiliation(s)
- Lili Yuen
- International Diabetes Federation Atlas 9th Edition Hyperglycaemia in Pregnancy Special Interest Group (HIP-SIG), Belgium; School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Pouya Saeedi
- International Diabetes Federation Atlas 9th Edition Hyperglycaemia in Pregnancy Special Interest Group (HIP-SIG), Belgium; International Diabetes Federation, Brussels, Belgium
| | - Musarrat Riaz
- International Diabetes Federation Atlas 9th Edition Hyperglycaemia in Pregnancy Special Interest Group (HIP-SIG), Belgium; Baqai Medical University, Karachi, Pakistan
| | - Suvi Karuranga
- International Diabetes Federation Atlas 9th Edition Hyperglycaemia in Pregnancy Special Interest Group (HIP-SIG), Belgium; International Diabetes Federation, Brussels, Belgium
| | - Hema Divakar
- International Diabetes Federation Atlas 9th Edition Hyperglycaemia in Pregnancy Special Interest Group (HIP-SIG), Belgium; Divakar's Specialty Hospital, Bengaluru, India; Federation of Obstetric and Gynaecological Societies of India (FOGSI), India
| | - Naomi Levitt
- International Diabetes Federation Atlas 9th Edition Hyperglycaemia in Pregnancy Special Interest Group (HIP-SIG), Belgium; University of Cape Town, South Africa
| | - Xilin Yang
- International Diabetes Federation Atlas 9th Edition Hyperglycaemia in Pregnancy Special Interest Group (HIP-SIG), Belgium; Tianjin Medical University, Tianjin, China
| | - David Simmons
- International Diabetes Federation Atlas 9th Edition Hyperglycaemia in Pregnancy Special Interest Group (HIP-SIG), Belgium; School of Medicine, Western Sydney University, Campbelltown, Australia.
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Niroomand M, Afsar J, Hosseinpanah F, Afrakhteh M, Farzaneh F, Serahati S. Comparison of the International Association of Diabetes in Pregnancy Study Group Criteria with the Old American Diabetes Association Criteria for Diagnosis of Gestational Diabetes Mellitus. Int J Endocrinol Metab 2019; 17:e88343. [PMID: 31903093 PMCID: PMC6935709 DOI: 10.5812/ijem.88343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study aimed to assess the prevalence of gestational diabetes mellitus (GDM) based on two sets of criteria, namely the old criteria suggested in 2009 by the American Diabetes Association and new criteria of the International Association of Diabetes in Pregnancy Study Group. We also evaluated the predictive power of the risk factors of GDM. METHODS Pregnant women from three outpatient clinics in Tehran, Iran, participated in this cross-sectional observational study. During the first perinatal visit, demographic data, medical histories, weight, and height of mothers were recorded. The mother's fasting glucose and glycosylated hemoglobin were measured. An oral glucose tolerance test was also performed. The prevalence of GDM, based on the two criteria, was estimated and its predictive factors were investigated. RESULTS Of 1,117 pregnant women, 156 (15.6%) and 71 (7.1%) patients had GDM based on the new and old criteria, respectively. Multivariate analysis showed that older age at pregnancy (OR = 1.05; 95% CI: 1.006 - 1.107; P = 0.03), higher body mass index (OR = 1.2; 95% CI: 1.15 - 1.3; P < 0.001), family history of diabetes (OR = 1.97; 95% CI: 1.11 - 3.5; P = 0.02), and history of macrosomia (OR = 7.8; 95% CI: 1.96 - 30.9; P = 0.004) were independent predictive factors for GDM. CONCLUSIONS Using the new criteria, the prevalence of GDM increases by 2.2 folds compared to the old criteria. Several factors can independently predict the occurrence of GDM.
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Affiliation(s)
- Mahtab Niroomand
- Endocrinology Division, Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Endocrinology Division, Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Jamileh Afsar
- Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Afrakhteh
- Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Farzaneh
- Department of Obstetrics and Gynecology, Gynecology Cancer Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Serahati
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Volanski W, do Prado AL, Al-Lahham Y, Teleginski A, Pereira FS, Alberton D, Rego FGDM, Valdameri G, Picheth G. d-GDM: A mobile diagnostic decision support system for gestational diabetes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:524-530. [PMID: 31482958 PMCID: PMC10522262 DOI: 10.20945/2359-3997000000171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/09/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the study is to describe a portable and convenient software to facilitate the diagnostics of gestational (GDM) and pre-gestational diabetes (PGDM). MATERIALS AND METHODS An open source software, d-GDM, was developed in Java. The integrated development environment Android Studio was used as the Android operational system. The software for GDM diagnosis uses the criteria endorsed by the International Association of Diabetes and Pregnancy Study Group, modified by the World Health Organization. RESULTS GDM diagnosis criteria is not simple to follow, therefore, errors or inconsistencies in diagnosis are expected and could delay the appropriate treatment. The d-GDM, was developed to assist GDM diagnosis with precision and consistency diagnostic reports. The open source software can be manipulated conveniently. The operator requires information regarding the gestational period and selects the appropriate glycaemic marker options from the menu. During operation, pressing the button "diagnosticar" on the screen will present the diagnosis and information for the follow up. d-GDM is available in Portuguese or English and can be downloaded from the Google PlayStore. A responsive web version of d-GDM is also available. The usefulness and accuracy of d-GDM was verify by field tests involving 22 subjects and 5 mobile phone brands. The approval regards user-friendliness and efficiency were 95% or higher. The GDM diagnosis were 100% correct, in this pilot test. d-GDM is a user-friendly, free software for diagnosis that was developed for mobile devices. It has the potential to contribute and facilitate the diagnosis of gestational diabetes for healthcare professionals.
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Affiliation(s)
- Waldemar Volanski
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
- Prefeitura Municipal de CuritibaPrefeitura Municipal de CuritibaCuritibaPRBrasilPrefeitura Municipal de Curitiba, Curitiba, PR, Brasil
| | - Ademir Luiz do Prado
- Instituto Federal de Educação, Ciência e Tecnologia do ParanáInstituto Federal de Educação, Ciência e Tecnologia do ParanáPRBrasilInstituto Federal de Educação, Ciência e Tecnologia do Paraná, PR, Brasil
| | - Yusra Al-Lahham
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Adriana Teleginski
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Fabiana Santos Pereira
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Dayane Alberton
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Fabiane Gomes de Moraes Rego
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Glaucio Valdameri
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Geraldo Picheth
- Universidade Federal do ParanáPrograma de Pós-graduação em Ciências FarmacêuticasUniversidade Federal do ParanáCuritibaPRBrasilPrograma de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brasil
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Braga FO, Negrato CA, Matta MDFBD, Carneiro JRI, Gomes MB. Relationship between inflammatory markers, glycated hemoglobin and placental weight on fetal outcomes in women with gestational diabetes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:22-29. [PMID: 30864628 PMCID: PMC10118841 DOI: 10.20945/2359-3997000000099] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 11/14/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between inflammatory cytokines, placental weight, glycated hemoglobin and adverse perinatal outcomes (APOs) in women with gestational diabetes mellitus (GDM). SUBJECTS AND METHODS This was a prospective, longitudinal and observational study conducted from April 2004 to November 2005 in Bauru, Brazil. Included patients had singleton pregnancies and performed a 100 g OGTT and had the levels of C-reactive protein (CRP), interleukin (IL)-6, TNF alfa and glycated hemoglobin (HbA1c) determined at 24-28th gestation weeks. RESULTS A total of 176 patients were included, of whom 78 had the diagnosis of GDM (44.3%). Multivariate analysis demonstrated that HbA1c, age, body mass index (BMI) and previous history of GDM were independent predictors for GDM diagnosis. ROC curve indicated that HbA1C levels ≥ 5.1% at 24-28 weeks gestation were associated with GDM. No difference was found in IL-6, tumor necrosis factor alpha (TNF-alpha) and CRP serum levels in women with and without GDM. Multivariate analysis showed that placental weight was significantly associated with APOs (p < 0.005), with a cut-off value of 610 grams as demonstrated by the ROC curve. CONCLUSION Placental weight ≥ 610 grams and HbA1C ≥ 5.1% were found to be associated with APOs and GDM, respectively, and their evaluation should be part of prenatal care routine.
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Affiliation(s)
- Fernanda Oliveira Braga
- Unidade de Diabetes, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
| | | | | | - João Régis Ivar Carneiro
- Departamento de Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Marília Brito Gomes
- Unidade de Diabetes, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
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Dickson LM, Buchmann EJ, Janse Van Rensburg C, Norris SA. The impact of differences in plasma glucose between glucose oxidase and hexokinase methods on estimated gestational diabetes mellitus prevalence. Sci Rep 2019; 9:7238. [PMID: 31076622 PMCID: PMC6510785 DOI: 10.1038/s41598-019-43665-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/23/2019] [Indexed: 12/20/2022] Open
Abstract
We evaluated the extent of measurement discordance between glucose oxidase and hexokinase laboratory methods and the effect of this on estimated gestational diabetes mellitus (GDM) prevalence in a routine clinical setting. 592 consecutive urban African women were screened for GDM. Paired venous specimens were submitted to two independent calibrated laboratories that used either method to measure plasma glucose concentrations. World Health Organisation diagnostic criteria were applied. GDM prevalence determined by the glucose oxidase and hexokinase methods was 6.9% and 5.1% respectively. The overall GDM prevalence was 9%. Only 34% of GDM positive diagnoses were common to both laboratory methods. Bland Altman plots identified a bias of 0.2 mmol/l between laboratory methods. Plasma glucose concentrations measured by the glucose oxidase method were more platykurtic in distribution. Low diagnostic agreement between laboratory methods was further indicated by a Cohen's kappa of 0.48 (p < 0.001). Reports of GDM prevalence using either the glucose oxidase or hexokinase laboratory methods may not be truly interchangeable or directly comparable.
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Affiliation(s)
- Lynnsay M Dickson
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa.
| | - Eckhart J Buchmann
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa
| | - Charl Janse Van Rensburg
- Biostatistics Unit, South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
| | - Shane A Norris
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa
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Sartorelli DS, Zuccolotto DCC, Crivellenti LC, Franco LJ. Dietary patterns during pregnancy derived by reduced-rank regression and their association with gestational diabetes mellitus. Nutrition 2019; 60:191-196. [DOI: 10.1016/j.nut.2018.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/27/2018] [Accepted: 10/07/2018] [Indexed: 01/11/2023]
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Nguyen CL, Lee AH, Minh Pham N, Hoang Nguyen PT, Ha AVV, Khac Chu T, Van Duong D, Thi Duong H, Binns CW. Prevalence and pregnancy outcomes of gestational diabetes mellitus by different international diagnostic criteria: a prospective cohort study in Vietnam. J Matern Fetal Neonatal Med 2019; 33:3706-3712. [DOI: 10.1080/14767058.2019.1583733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Cong Luat Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- School of Public Health, Curtin University, Perth, Australia
| | - Andy H. Lee
- School of Public Health, Curtin University, Perth, Australia
| | - Ngoc Minh Pham
- School of Public Health, Curtin University, Perth, Australia
- Department of Epidemiology, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Phung Thi Hoang Nguyen
- School of Public Health, Curtin University, Perth, Australia
- Department of Nutrition and Food, Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Anh Vo Van Ha
- School of Public Health, Curtin University, Perth, Australia
- Department of Environmental and Occupational Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tan Khac Chu
- School of Public Health, Curtin University, Perth, Australia
- Department of Epidemiology, Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hong Thi Duong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Colin W. Binns
- School of Public Health, Curtin University, Perth, Australia
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Czarnobay SA, Kroll C, Schultz LF, Malinovski J, Mastroeni SSDBS, Mastroeni MF. Predictors of excess birth weight in Brazil: a systematic review. J Pediatr (Rio J) 2019; 95:128-154. [PMID: 29787700 DOI: 10.1016/j.jped.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To describe the main predictors for excess birth weight in Brazilian children. DATA SOURCES Systematic review carried out in the bibliographic databases: PubMed/MEDLINE, Cochrane, Scopus, Web of Science, and LILACS. The research in the gray literature was performed using the Google Scholar database. The bias risk analysis was adapted from the Downs and Black scale, used to evaluate the methodology of the included studies. DATA SYNTHESIS Using the classifications of fetal macrosomia (>4.000g or ≥4.000g) and large for gestational age (above the 90th percentile), 64 risk factors for excess birth weight were found in 33 scientific articles in the five regions of the country. Of the 64 risk factors, 31 were significantly associated with excess birth weight, with excess gestational weight gain, pre-gestational body mass index ≥25kg/m2, and gestational diabetes mellitus being the most prevalent. CONCLUSION The main predictors for excess birth weight in Brazil are modifiable risk factors. The implementation of adequate nutritional status in the gestational period and even after childbirth appears to be due to the quality and frequency of the follow-up of the mothers and their children by public health agencies.
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Affiliation(s)
- Sandra Ana Czarnobay
- Universidade da Região de Joinville (UNIVILLE), Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brazil
| | - Caroline Kroll
- Universidade da Região de Joinville (UNIVILLE), Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brazil
| | - Lidiane F Schultz
- Universidade da Região de Joinville (UNIVILLE), Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brazil
| | - Juliana Malinovski
- Universidade da Região de Joinville (UNIVILLE), Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brazil
| | | | - Marco Fabio Mastroeni
- Universidade da Região de Joinville (UNIVILLE), Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brazil.
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Predictors of excess birth weight in Brazil: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Ramezani Tehrani F. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr 2019; 11:11. [PMID: 30733833 PMCID: PMC6359830 DOI: 10.1186/s13098-019-0406-1] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/22/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The absence of universal gold standards for screening of gestational diabetes (GDM) has led to heterogeneity in the identification of GDM, thereby impacting the accurate estimation of the prevalence of GDM. We aimed to evaluate the effect of different diagnostic criteria for GDM on its prevalence among general populations of pregnant women worldwide, and also to investigate the prevalence of GDM based on various geographic regions. METHODS A comprehensive literature search was performed in PubMed, Scopus and Google-scholar databases for retrieving articles in English investigating the prevalence of GDM. All populations were classified to seven groups based-on their diagnostic criteria for GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed effect and random-effects inverse variance model for calculating the pooled effect. Publication bias was assessed by Begg's test. The Meta-prop method was used for the pooled estimation of the prevalence of GDM. Meta-regression was conducted to explore the association between prevalence of GDM and its diagnostic criteria. Modified Newcastle-Ottawa Quality Assessment Scale for nonrandomized studies was used for quality assessment of the studies included; the ROBINS and the Cochrane Collaboration's risk of bias assessment tools were used to evaluate the risk of bias. RESULTS We used data from 51 population-based studies, i.e. a study population of 5,349,476 pregnant women. Worldwide, the pooled overall-prevalence of GDM, regardless of type of screening threshold categories was 4.4%, (95% CI 4.3-4.4%). The pooled overall prevalence of GDM in the diagnostic threshold used in IADPSG criteria was 10.6% (95% CI 10.5-10.6%), which was the highest pooled prevalence of GDM among studies included. Meta-regression showed that the prevalence of GDM among studies that used the IADPSG criteria was significantly higher (6-11 fold) than other subgroups. The highest and lowest prevalence of GDM, regardless of screening criteria were reported in East-Asia and Australia (Pooled-P = 11.4%, 95% CI 11.1-11.7%) and (Pooled-P = 3.6%, 95% CI 3.6-3.7%), respectively. CONCLUSION Over the past quarter century, the diagnosis of gestational diabetes has been changed several times; along with worldwide increasing trend of obesity and diabetes, reducing the threshold of GDM is associated with a significant increase in the incidence of GDM. The harm and benefit of reducing the threshold of diagnostic criteria on pregnancy outcomes, women's psychological aspects, and health costs should be evaluated precisely.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, P.O.Box: 19395-4763, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, P.O.Box: 19395-4763, Iran
| | - Razieh Bidhendi Yarandi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poor sina street, Tehran, P.O.Box: 1417653761, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, P.O.Box: 19395-4763, Iran
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Muhwava LS, Murphy K, Zarowsky C, Levitt N. Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa - a qualitative study. BMC Health Serv Res 2018; 18:349. [PMID: 29747657 PMCID: PMC5946476 DOI: 10.1186/s12913-018-3175-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/01/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders' perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant's first year of life. METHODS Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa's two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures. RESULTS The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers. CONCLUSION Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.
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Affiliation(s)
- Lorrein Shamiso Muhwava
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
| | - Katherine Murphy
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
| | - Christina Zarowsky
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
- University of Montreal, Hospital Research Centre and University of Montreal School of Public Health, Montreal, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Naomi Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
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Silva SDOCD, Saunders C, Zajdenverg L, Moreira LN, Heidelmann SP, Pereira ACDS, Padilha PDC. Predictive factors for birth weight of newborns of mothers with gestational diabetes mellitus. Diabetes Res Clin Pract 2018; 138:262-270. [PMID: 29412146 DOI: 10.1016/j.diabres.2018.01.032] [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: 07/31/2017] [Revised: 01/17/2018] [Accepted: 01/26/2018] [Indexed: 12/17/2022]
Abstract
AIMS To evaluate the predictive factors of birth weight (BW) of newborns of women with gestational diabetes mellitus (GDM). METHODS A cross-sectional study was performed among pregnant women with GDM treated in a public maternity unit, Brazil. We selected 283 pregnant women, with nutritional follow-up initiated till the 28th gestational week, singleton pregnancy, without chronic diseases and with birth weight information of the newborns. The predictive factors of BW were identified by multivariate linear regression. RESULTS Mean maternal age was 31.2 ± 5.8 years; 64.4% were non-white; 70.1% were pre-gestational overweight or obese. Mean BW was 3234.3 ± 478.8 g. An increase of 1 kg of weight in the first and third trimesters increased BW by 21 g (p = 0.01) and 27 g (p = 0.03), respectively. Similarly, the other predictive factors of BW were pre-gestational body mass index (β = 17.16, p = 0.02) and postprandial plasma glucose in the third trimester (β = 4.14, p = 0.008), in the model adjusted by gestational age at delivery (β = 194.68, p < 0.001). CONCLUSIONS The best predictors of BW were gestational age at birth, and maternal pre-gestational and gestational anthropometric characteristics. Maternal glycaemic levels may also influence BW. The results may contribute to a review of prenatal routines for pregnant women with GDM.
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Affiliation(s)
- Sara de Oliveira Corrêa da Silva
- Mestrado Profissional em Nutrição Clínica do, Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, sala 26, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil.
| | - Cláudia Saunders
- Mestrado Profissional em Nutrição Clínica do, Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, sala 26, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil; Maternidade Escola da, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | - Lenita Zajdenverg
- Maternidade Escola da, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | | | - Sonaly Petronilho Heidelmann
- Maternidade Escola da, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | - Ariane Cristine Dos Santos Pereira
- Multiprofessional Residency Program in Perinatal Health, Maternity School, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | - Patricia de Carvalho Padilha
- Mestrado Profissional em Nutrição Clínica do, Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, sala 26, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil; Maternidade Escola da, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
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Ilias I, Linardi A, Milionis C, Tselebis A, Koukkou E. [Procrastination in the self-management of gestational diabetes]. Presse Med 2018; 47:180-181. [PMID: 29373275 DOI: 10.1016/j.lpm.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/11/2017] [Accepted: 11/27/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ioannis Ilias
- Hôpital El Venizelou, département d'endocrinologie, Athènes, Grèce.
| | | | | | | | - Eftychia Koukkou
- Hôpital El Venizelou, département d'endocrinologie, Athènes, Grèce
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Abstract
BACKGROUND The diabetes epidemic affects most countries across the world and is increasing at alarming rates in Latin America. Nearly 12 million individuals have diabetes in Brazil, and the current prevalence ranges from 6.3% to 13.5%, depending on the region and the diagnostic criteria adopted in each study. OBJECTIVE To provide an overview of diabetes care in Brazil, focusing on studies of diabetes epidemiology, prevalence of patients within the standard targets of care, and economic burden of diabetes and its complications. METHODS SciELO and PubMed searches were performed for the terms "diabetes," "Brazil," "Brazilian," and "health system"; relevant literature from 1990 to 2015 was selected. Additional articles identified from reference list searches were also included. All articles selected were published in Portuguese and/or English. FINDINGS Recent studies detected a prevalence of gestational diabetes mellitus of nearly 20%. Among patients with type 1 diabetes, almost 90% fail to reach target of glycemic control, with less than 30% receiving treatment for both hypertension and dyslipidemia. More than 75% of patients with type 2 diabetes are either overweight or obese. Most of these patients fail to reach glycemic targets (42.1%) and less than 30% reached the target for systolic and diastolic blood pressure, body mass index, or low-density lipoprotein cholesterol. Only 0.2% of patients reach all these anthropometric and metabolic targets. CONCLUSIONS Brazil is the fourth country in the world in number of patients with diabetes. Regardless of the diabetes type, the majority of patients do not meet other metabolic control goals. The economic burden of diabetes and its complications in Brazil is extremely high, and more effective approaches for preventions and management are urgently needed.
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Affiliation(s)
- Walmir F Coutinho
- State Institute of Diabetes and Endocrinology (IEDE), Catholic University of Rio de Janeiro, 22451-900, Rio de Janeiro, Brazil.
| | - Wellington Santana Silva Júnior
- Diabetes Department, State Institute of Diabetes and Endocrinology (IEDE), 21330-683, Rio de Janeiro, Brazil; and PhD student in the Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), State University of Rio de Janeiro, 20551-030, Rio de Janeiro, Brazil
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Cabizuca CA, Rocha PS, Marques JV, Costa TFLR, Santos ASN, Schröder AL, Mello CAG, Sousa HD, Silva ESG, Braga FO, Abi-Abib RC, Gomes MB. Postpartum follow up of gestational diabetes in a Tertiary Care Center. Diabetol Metab Syndr 2018; 10:2. [PMID: 29308091 PMCID: PMC5751834 DOI: 10.1186/s13098-017-0303-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/20/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gestational diabetes is a risk factor for future development of type 2 diabetes. The primary aim of this study was to estimate the prevalence of postpartum glucose tolerance status evaluation in pregnancies complicated by gestational diabetes 6-12 weeks after delivery. The secondary one was to identify the factors that are implicated with postpartum glucose retesting. METHODS This was a retrospective study performed with a cohort of women with gestational diabetes, with prenatal care and delivery at a tertiary care center, from January 2013 to April 2017. The diagnosis of gestational diabetes was based on IADPSG criteria (Fasting ≥ 92 mg/dl, 1 h ≥ 180 mg/dl and/or 2 h ≥ 153 mg/dl, respectively) and the diagnosis of type 2 diabetes and prediabetes were made using the 2016 ADA's criteria (fasting and 2 h after glucose load ≥ 126 mg/dl and/or ≥ 200 and 100-125 mg/dl and/or 140 and 199 mg/dl, respectively). All women had an appointment scheduled 6-12 weeks postpartum with the results of a 75-g oral glucose tolerance test (OGTT). RESULTS Of the 152 evaluated women, 21 (13.8%) returned with the postpartum OGTT results. Of these, 9 (45.0%) had a diagnosis of prediabetes. The use of insulin during gestation was the only factor implicated in a higher adherence rate to postpartum testing OR 6.33 (p 0.002). No significance was found for other demographic and clinical variables (age, family income, years of study, parity, gestational age at first visit, smoking, family history of type 2 diabetes, diagnosis of gestational diabetes before the third trimester, pregestational body mass index, previous history of gestational diabetes and ethnicity). CONCLUSION The majority of patients with gestational diabetes did not return postpartum to perform OGTT and in our study the only factor implicated in a higher postpartum return was the use of insulin during pregnancy. Considering that 45.0% were diagnosed with prediabetes, diabetes care teams should initially identify non-adherent patients.
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Affiliation(s)
- C. A. Cabizuca
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Rua Cinco de Julho 63/504 Copacabana, Rio de Janeiro, CEP 22051-030 Brazil
| | - P. S. Rocha
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J. V. Marques
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - T. F. L. R. Costa
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A. S. N. Santos
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A. L. Schröder
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C. A. G. Mello
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - H. D. Sousa
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - E. S. G. Silva
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - F. O. Braga
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R. C. Abi-Abib
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. B. Gomes
- Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of Gestational Diabetes Mellitus in Eastern and Southeastern Asia: A Systematic Review and Meta-Analysis. J Diabetes Res 2018; 2018:6536974. [PMID: 29675432 PMCID: PMC5838488 DOI: 10.1155/2018/6536974] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/16/2017] [Indexed: 12/27/2022] Open
Abstract
AIM To review the prevalence of gestational diabetes mellitus (GDM) in Eastern and Southeastern Asia. METHODS We systematically searched for observational studies on GDM prevalence from January 2000 to December 2016. Inclusion criteria were original English papers, with full texts published in peer-reviewed journals. The quality of included studies was evaluated using the guidelines of the National Health and Medical Research Council, Australia. Fixed effects and random effects models were used to estimate the summary prevalence of GDM and the corresponding 95% confidence intervals (CI). RESULTS A total of 4415 papers were screened, and 48 studies with 63 GDM prevalence observations were included in the final review. The pooled prevalence of GDM was 10.1% (95% CI: 6.5%-15.7%), despite substantial variations across nations. The prevalence of GDM in lower- or upper-middle income countries was about 64% higher than in their high-income counterparts. Moreover, the one-step screening method was twice more likely to be used in diagnosing GDM when compared to the two-step screening procedure. CONCLUSIONS The prevalence of GDM in Eastern and Southeastern Asia was high and varied among and within countries. There is a need for international uniformity in screening strategies and diagnostic criteria for GDM.
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Affiliation(s)
- Cong Luat Nguyen
- School of Public Health, Curtin University, Perth, WA, Australia
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ngoc Minh Pham
- School of Public Health, Curtin University, Perth, WA, Australia
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Colin W. Binns
- School of Public Health, Curtin University, Perth, WA, Australia
| | | | - Andy H. Lee
- School of Public Health, Curtin University, Perth, WA, Australia
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Chiefari E, Arcidiacono B, Foti D, Brunetti A. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest 2017; 40:899-909. [PMID: 28283913 DOI: 10.1007/s40618-016-0607-5] [Citation(s) in RCA: 300] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/28/2016] [Indexed: 12/14/2022]
Abstract
The clinical and public health relevance of gestational diabetes mellitus (GDM) is widely debated due to its increasing incidence, the resulting negative economic impact, and the potential for severe GDM-related pregnancy complications. Also, effective prevention strategies in this area are still lacking, and controversies exist regarding diagnosis and management of this form of diabetes. Different diagnostic criteria are currently adopted worldwide, while recommendations for diet, physical activity, healthy weight, and use of oral hypoglycemic drugs are not always uniform. In the present review, we provide an update of current insights on clinical aspects of GDM, by discussing the more controversial issues.
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Affiliation(s)
- E Chiefari
- Chair of Endocrinology, Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa (Località Germaneto), 88100, Catanzaro, Italy
| | - B Arcidiacono
- Chair of Endocrinology, Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa (Località Germaneto), 88100, Catanzaro, Italy
| | - D Foti
- Chair of Clinical Pathology, Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa (Località Germaneto), 88100, Catanzaro, Italy
| | - A Brunetti
- Chair of Endocrinology, Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa (Località Germaneto), 88100, Catanzaro, Italy.
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Brown FM, Wyckoff J. Application of One-Step IADPSG Versus Two-Step Diagnostic Criteria for Gestational Diabetes in the Real World: Impact on Health Services, Clinical Care, and Outcomes. Curr Diab Rep 2017; 17:85. [PMID: 28799123 PMCID: PMC5552830 DOI: 10.1007/s11892-017-0922-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to summarize the impact of the one-step International Association of Diabetes and Pregnancy Study Groups (IADPSG) versus the two-step gestational diabetes mellitus (GDM) criteria with regard to prevalence, outcomes, healthcare delivery, and long-term maternal metabolic risk. RECENT FINDINGS Studies demonstrate a 1.03-3.78-fold rise in the prevalence of GDM with IADPSG criteria versus baseline criteria. Women with GDM by IADPSG criteria have more adverse pregnancy outcomes than women with normal glucose tolerance (NGT). Treatment of GDM by IADPSG criteria may be cost effective. Use of the fasting glucose as a screen before the 75-g oral glucose tolerance test to rule out GDM with fasting plasma glucose (FPG) < 4.4 (80 mg/dl) and rule in GDM with FPG ≥ 5.1 mmol/l (92 mg/dl) reduces the need for OGTT by 50% and its cost and inconvenience. The prevalence of postpartum abnormal glucose metabolism is higher for women with GDM diagnosed by IADPSG criteria versus that for women with NGT. Data support the use of IADPSG criteria, if the cost of diagnosis and treatment can be controlled and if lifestyle can be optimized to reduce the risk of future diabetes.
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Affiliation(s)
- Florence M Brown
- Joslin Diabetes Center, 1 Joslin Pl, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, USA.
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Reichelt AJ, Weinert LS, Mastella LS, Gnielka V, Campos MA, Hirakata VN, Oppermann MLR, Silveiro SP, Schmidt MI. Clinical characteristics of women with gestational diabetes - comparison of two cohorts enrolled 20 years apart in southern Brazil. SAO PAULO MED J 2017; 135:376-382. [PMID: 28793129 PMCID: PMC10015997 DOI: 10.1590/1516-3180.2016.0332190317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/19/2017] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE: The prevalence and characteristics of gestational diabetes mellitus (GDM) have changed over time, reflecting the nutritional transition and changes in diagnostic criteria. We aimed to evaluate characteristics of women with GDM over a 20-year interval. DESIGN AND SETTING: Comparison of two pregnancy cohorts enrolled in different periods, in university hospitals in Porto Alegre, Brazil: 1991 to 1993 (n = 216); and 2009 to 2013 (n = 375). METHODS: We applied two diagnostic criteria to the cohorts: International Association of Diabetes and Pregnancy Study Groups (IADPSG)/World Health Organization (WHO); and National Institute for Health and Care Excellence (NICE). We compared maternal-fetal characteristics and outcomes between the cohorts and within each cohort. RESULTS: The women in the 2010s cohort were older (31 ± 7 versus 30 ± 6 years), more frequently obese (29.4% versus 15.2%), with more hypertensive disorders (14.1% versus 5.6%) and at increased risk of cesarean section (adjusted relative risk 1.8; 95% confidence interval: 1.4 - 2.3), compared with those in the 1990s cohort. Neonatal outcomes such as birth weight category and hypoglycemia were similar. In the 1990s cohort, women only fulfilling IADPSG/WHO or only fulfilling NICE criteria had similar characteristics and outcomes; in the 2010s cohort, women only diagnosed through IADPSG/WHO were more frequently obese than those diagnosed only through NICE (33 ± 8 kg/m2 versus 28 ± 6 kg/m2; P < 0.001). CONCLUSION: The epidemic of obesity seems to have modified the profile of women with GDM. Despite similar neonatal outcomes, there were differences in the intensity of treatment over time. The IADPSG/WHO criteria seemed to identify a profile more associated with obesity.
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Affiliation(s)
- Angela Jacob Reichelt
- MD, PhD. Physician, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre (RS), Brazil.
| | - Letícia Schwerz Weinert
- MD, PhD. Postgraduate Medical Sciences Program on Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Livia Silveira Mastella
- MD, MSc. Postgraduate Student, Postgraduate Medical Sciences Program on Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Vanessa Gnielka
- Medical Student, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS) Brazil.
| | - Maria Amélia Campos
- MD, MSc, Physician, Division of Endocrinology, Hospital Nossa Senhora da Conceição, Porto Alegre (RS), Brazil.
| | - Vânia Naomi Hirakata
- MSc. Statistician, Biostatistics Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre (RS), Brazil.
| | - Maria Lúcia Rocha Oppermann
- MD, PhD. Professor, Postgraduate Program on Gynecology and Obstetrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Sandra Pinho Silveiro
- MD, PhD. Professor, Postgraduate Medical Sciences Program on Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Maria Inês Schmidt
- MD, PhD. Professor, Postgraduate Program on Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
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Changes in plasma concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D during pregnancy: a Brazilian cohort. Eur J Nutr 2017; 57:1059-1072. [PMID: 28353072 DOI: 10.1007/s00394-017-1389-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 01/28/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To characterize the physiological changes in 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] throughout pregnancy. METHODS Prospective cohort of 229 apparently healthy pregnant women followed at 5th-13th, 20th-26th, and 30th-36th gestational weeks. 25(OH)D and 1,25(OH)2D concentrations were measured by LC-MS/MS. Statistical analyses included longitudinal linear mixed-effects models adjusted for parity, season, education, self-reported skin color, and pre-pregnancy BMI. Vitamin D status was defined based on 25(OH)D concentrations according to the Endocrine Society Practice Guideline and Institute of Medicine (IOM) for adults. RESULTS The prevalence of 25(OH)D <75 nmol/L was 70.4, 41.0, and 33.9%; the prevalence of 25(OH)D <50 nmol/L was 16.1, 11.2, and 10.2%; and the prevalence of 25(OH)D <30 nmol/L was 2, 0, and 0.6%, at the first, second, and third trimesters, respectively. Unadjusted analysis showed an increase in 25(OH)D (β = 0.869; 95% CI 0.723-1.014; P < 0.001) and 1,25(OH)2D (β = 3.878; 95% CI 3.136-4.620; P < 0.001) throughout pregnancy. Multiple adjusted analyses showed that women who started the study in winter (P < 0.001), spring (P < 0.001), or autumn (P = 0.028) presented a longitudinal increase in 25(OH)D concentrations, while women that started during summer did not. Increase of 1,25(OH)2D concentrations over time in women with insufficient vitamin D (50-75 nmol/L) at baseline was higher compared to women with sufficient vitamin D (≥75 nmol/L) (P = 0.006). CONCLUSIONS The prevalence of vitamin D inadequacy varied significantly according to the adopted criteria. There was a seasonal variation of 25(OH)D during pregnancy. The women with insufficient vitamin D status present greater longitudinal increases in the concentrations of 1,25(OH)2D in comparison to women with sufficiency.
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Single Fasting Plasma Glucose Versus 75-g Oral Glucose-Tolerance Test in Prediction of Adverse Perinatal Outcomes: A Cohort Study. EBioMedicine 2017; 16:284-291. [PMID: 28122694 PMCID: PMC5474498 DOI: 10.1016/j.ebiom.2017.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 01/20/2023] Open
Abstract
Background There remains uncertainty regarding whether a single fasting glucose measurement is sufficient to predict risk of adverse perinatal outcomes. Methods We included 12,594 pregnant women who underwent a 75-g oral glucose-tolerance test (OGTT) at 22–28 weeks' gestation in the Born in Guangzhou Cohort Study, China. Outcomes were large for gestational age (LGA) baby, cesarean section, and spontaneous preterm birth. We calculated the area under the receiver operator characteristic curves (AUCs) to assess the capacity of OGTT glucose values to predict adverse outcomes, and compared the AUCs of different components of OGTT. Results 1325 women had a LGA baby (10.5%). Glucose measurements were linearly associated with LGA, with strongest associations for fasting glucose (odds ratio 1.37, 95% confidence interval 1.30–1.45). Weaker associations were observed for cesarean section and spontaneous preterm birth. Fasting glucose have a comparable discriminative power for prediction of LGA to the combination of fasting, 1 h, and 2 h glucose values during OGTT (AUCs, 0.611 vs. 0.614, P = 0.166). The LGA risk was consistently increased in women with abnormal fasting glucose (≥ 5.1 mmol/l), irrespective of 1 h or 2 h glucose levels. Conclusions A single fasting glucose measurement performs comparably to 75-g OGTT in predicting risk of having a LGA baby. Fasting glucose had a significantly stronger association with large for gestational age than post-load glucoses. Single fasting glucose has comparable predictive ability of large for gestational age to 75g OGTT. Single fasting glucose test can be an alternative for identifying high risk of large for gestational age in Chinese women.
The new criteria for gestational diabetes (GDM) screening and diagnosis suggests that single abnormal of a fasting, 1 h or 2 h glucose measured by an universal, single-stage screening of 2 h 75-g oral glucose-tolerance test (OGTT) is adequate to make a diagnosis. However, the utility of each glucose measurement in the prediction of poor perinatal outcomes was unclear. Here, we reported single fasting plasma glucose performs comparably to 75 g OGTT in identification of women at increased risk of delivering a large for gestational age baby. Single fasting glucose testing can be an alternative for GDM screening, which will substantially reduce the psychological impact, opportunity and direct health costs for women and their families.
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Capula C, Chiefari E, Borelli M, Oliverio R, Vero A, Foti D, Puccio L, Vero R, Brunetti A. A new predictive tool for the early risk assessment of gestational diabetes mellitus. Prim Care Diabetes 2016; 10:315-323. [PMID: 27268754 DOI: 10.1016/j.pcd.2016.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/06/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
AIMS The Italian National Institute of Health has recently introduced a selective screening based on the risk profile of pregnant women, which while recommending against screening of women at low risk (LR) for GDM, it recommends an early test for women at high risk (HR) for GDM. Herein, we assessed the accuracy and cost-effectiveness of this screening and developed a new index that improves these requirements. METHODS We retrospectively enrolled 3974 pregnant women. GDM was diagnosed with a 2h 75-g OGTT at 16-18 weeks (early test) or 24-28 weeks of gestation, according to the IADPSG guidelines. RESULTS 55.6% of HR women had GDM, although only 38.4% underwent early screening. Among 2654 women at medium risk, 20.9% had GDM; paradoxically, among 770 LR women, that would not have been screened, 26.6% received a GDM diagnosis. Based on these unsatisfactory results, we elaborated the Capula's index, that reduced both screening tests (p<0.001) and potentially undetected GDM cases (p<0.001), and corrected the paradoxical prevalence estimates of GDM obtained with the current Italian guidelines. Also, Capula's index improved correlation of GDM risk profile with obstetric and neonatal adverse events. CONCLUSIONS Capula's index improves accuracy of selective screening for GDM.
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Affiliation(s)
- Carmelo Capula
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Eusebio Chiefari
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Massimo Borelli
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy
| | - Rosa Oliverio
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Anna Vero
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Daniela Foti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Luigi Puccio
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Raffaella Vero
- Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark.
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
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Hari Kumar K, Ahmad F, Sood S, Mansingh S. Visual Evoked Potential to Assess Retinopathy in Gestational Diabetes Mellitus. Can J Diabetes 2016; 40:131-4. [DOI: 10.1016/j.jcjd.2015.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 01/11/2023]
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Pintaudi B, Fresa R, Dalfrà M, Marcone T, Dodesini AR, Napoli A, Bonomo M. Level of implementation of guidelines on screening and diagnosis of gestational diabetes: A national survey. Diabetes Res Clin Pract 2016; 113:48-52. [PMID: 26972962 DOI: 10.1016/j.diabres.2015.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/24/2015] [Accepted: 12/27/2015] [Indexed: 11/18/2022]
Abstract
AIMS To describe the degree of diffusion and acceptance of national guideline on screening and diagnosis of gestational diabetes (GDM) among Italian diabetes centers and to detect possible areas for benchmarking. METHODS In 2013 the Italian Diabetes in Pregnancy Study Group structured a national survey, focused on GDM screening and diagnostic procedures, that was administered to diabetologists. RESULTS Overall, 122 diabetologists of 122 different diabetes centers (21.7% territorial, 78.3% hospital/University) completed the questionnaire. All respondents declared to execute a 75 g-oral glucose tolerance test (OGTT) as diagnostic test. Almost one in five centers preferred a universal screening procedure, the others executing a selective risk factors-based screening. In patients at high risk for GDM the OGTT was performed at 16-18 weeks' gestation in 84.0% of the cases; only 6.5% of respondents preferred to execute it as soon as possible; and 9.5% used to wait until 24-28 weeks' gestation. In the case of fasting plasma glucose (FPG) ≥ 5.1 mmol/l (92 mg/dl), two third of respondents used to proceed with the execution of the complete diagnostic OGTT, the others considering sufficient the FPG value for the diagnosis. CONCLUSIONS Good level of reception of national recommendations was documented. The diagnostic procedure was generally accepted and applied. Some criticisms were specifically linked to the choice of universal or risk factor-based screening procedure, and to the right time for executing the OGTT in women at high risk.
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Affiliation(s)
| | - Raffaella Fresa
- Endocrinology and Diabetes Unit, ASL Salerno, Cava de Tirreni, Italy
| | | | - Teresa Marcone
- SSD Diabetology, University Hospital OORR Foggia, Foggia, Italy
| | | | - Angela Napoli
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Matteo Bonomo
- SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy
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Abstract
Despite the increasing epidemic of diabetes mellitus affecting populations at different life stages, the global burden of gestational diabetes mellitus (GDM) is not well assessed. Systematically synthesized data on global prevalence estimates of GDM are lacking, particularly among developing countries. The hyperglycemic intrauterine environment as exemplified in pregnancies complicated by GDM might not only reflect but also fuel the epidemic of type 2 diabetes mellitus (T2DM). We comprehensively reviewed available data in the past decade in an attempt to estimate the contemporary global prevalence of GDM by country and region. We reviewed the risk of progression from GDM to T2DM as well. Synthesized data demonstrate wide variations in both prevalence estimates of GDM and the risk of progression from GDM to T2DM. Direct comparisons of GDM burden across countries or regions are challenging given the great heterogeneity in screening approaches, diagnostic criteria, and underlying population characteristics. In this regard, collaborative efforts to estimate global GDM prevalence would be a large but important leap forward. Such efforts may have substantial public health implications in terms of informing health policy makers and healthcare providers for disease burden and for developing more targeted and effective diabetes prevention and management strategies globally.
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Affiliation(s)
- Yeyi Zhu
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, 6100 Executive Blvd, Room 7B03G, Rockville, MD, 20852, USA
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, 6100 Executive Blvd, Room 7B03G, Rockville, MD, 20852, USA.
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