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Zhang T, Tian M, Zhang P, Du L, Ma X, Zhang Y, Tang Z. Risk of adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus by age: a multicentric cohort study in Hebei, China. Sci Rep 2024; 14:807. [PMID: 38191624 PMCID: PMC10774329 DOI: 10.1038/s41598-023-49916-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is an unique metabolic disorder that occurs during pregnancy. Both GDM and advanced age increase the risk of adverse pregnancy outcomes. This study used a GDM cohort study to investigate the role of age in the adverse pregnancy outcomes for pregnant women with GDM. From 2015 to 2021, 308,175 pregnant women were selected, and the data received from 22 hospitals by the Hebei Province Maternal Near Miss Surveillance System. There were 24,551 pregnant women with GDM that were divided into five groups by age (20-24, 25-29, 30-34, 35-39, 40-44 years old). Because the prevalence of adverse pregnancy outcomes was lower in pregnant women with GDM aged 25-29, they were used as a reference group (P < 0.05). Compared with GDM women aged 25-29 years, GDM women aged 35-44 years had a significant higher risk of cesarean delivery (aOR: 2.86, 95% CI 2.52-3.25) (P < 0.001), abnormal fetal position (aOR: 1.78, 95% CI 1.31-2.37) (P < 0.001), pre-eclampsia (aOR: 1.28, 95% CI 1.01-1.61) (P < 0.05), macrosomia (aOR: 1.25, 95% CI 1.08-1.45) (P < 0.05), and large for gestational age (LGA) (aOR: 1.16, 95% CI 1.02-1.31) (P < 0.05), GDM women aged 40-44 years had a higher risk of placenta previa (aOR: 2.53, 95% CI 1.01-6.35) (P < 0.05), anemia (aOR: 3.45, 95% CI 1.23-9.68) (P < 0.05) and small for gestational age (aOR: 1.32, 95% CI 1.01-1.60) (P < 0.05). Advanced maternal age was an independent risk factor for abnormal fetal position, pre-eclampsia, anemia, macrosomia, and LGA in pregnant women with GDM.
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Affiliation(s)
- Ting Zhang
- Department of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, China
| | - Meiling Tian
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Ping Zhang
- Department of Obstetrics and Gynecology, Hebei Maternity Hospital, Intersection of Hongqi Street and Xinshi North Road, Shijiazhuang, 050000, Hebei, China
| | - Liyan Du
- Department of Information Management, Hebei Center for Women and Children's Health, Shijiazhuang, China
| | - Xuyuan Ma
- Department of Graduate School, Hebei Medical University, Shijiazhuang, China
| | - Yingkui Zhang
- Department of Information Management, Hebei Center for Women and Children's Health, Shijiazhuang, China
| | - Zengjun Tang
- Department of Obstetrics and Gynecology, Hebei Maternity Hospital, Intersection of Hongqi Street and Xinshi North Road, Shijiazhuang, 050000, Hebei, China.
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The Impact of Ethnicity on Fetal and Maternal Outcomes of Gestational Diabetes. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091161. [PMID: 36143838 PMCID: PMC9503395 DOI: 10.3390/medicina58091161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/20/2022]
Abstract
Background and Objectives: The prevalence of gestational diabetes mellitus (GDM) significantly varies across different ethnic groups. In particular, Africans, Latinos, Asians and Pacific Islanders are the ethnic groups with the highest risk of GDM. The aim of this study was to evaluate the impact of ethnicity on pregnancy outcomes in GDM. Patients and Methods: n = 399 patients with GDM were enrolled, n = 76 patients of high-risk ethnicity (HR-GDM), and n = 323 of low-risk ethnicity (LR-GDM). Clinical and biochemical parameters were collected during pregnancy until delivery. Fetal and maternal short-term outcomes were evaluated. Results: HR-GDM had significantly higher values of glycosylated hemoglobin checked at 26−29 weeks of gestation (p < 0.001). Gestational age at delivery was significantly lower in HR-GDM (p = 0.03). The prevalence of impaired fetal growth was significantly higher in HR-GDM than LR-GDM (p = 0.009). In logistic regression analysis, the likelihood of impaired fetal growth was seven times higher in HR-GDM than in LR-GDM, after adjustment for pre-pregnancy BMI and gestational weight gain (OR = 7.1 [2.0−25.7] 95% CI, p = 0.003). Conclusions: HR-GDM had worse pregnancy outcomes compared with LR-GDM. An ethnicity-tailored clinical approach might be effective in reducing adverse outcomes in GDM.
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Mandò C, Abati S, Anelli GM, Favero C, Serati A, Dioni L, Zambon M, Albetti B, Bollati V, Cetin I. Epigenetic Profiling in the Saliva of Obese Pregnant Women. Nutrients 2022; 14:nu14102122. [PMID: 35631263 PMCID: PMC9146705 DOI: 10.3390/nu14102122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
Maternal obesity is associated with inflammation and oxidative stress, strongly impacting the intrauterine environment with detrimental consequences for both mother and offspring. The saliva is a non-invasive biofluid reflecting both local and systemic health status. This observational study aimed to profile the epigenetic signature in the saliva of Obese (OB) and Normal-Weight (NW) pregnant women. Sixteen NW and sixteen OB Caucasian women with singleton spontaneous pregnancies were enrolled. microRNAs were quantified by the OpenArray Platform. The promoter region methylation of Suppressor of Cytokine Signaling 3 (SOCS3) and Transforming Growth Factor Beta 1 (TGF-Beta1) was assessed by pyrosequencing. There were 754 microRNAs evaluated: 20 microRNAs resulted in being differentially expressed between OB and NW. microRNA pathway enrichment analysis showed a significant association with the TGF-Beta signaling pathway (miTALOS) and with fatty acids biosynthesis/metabolism, lysine degradation, and ECM–receptor interaction pathways (DIANA–miRPath). Both SOCS3 and TGF-Beta1 were significantly down-methylated in OB vs. NW. These results help to clarify impaired mechanisms involved in obesity and pave the way for the understanding of specific damaged pathways. The characterization of the epigenetic profile in saliva of pregnant women can represent a promising tool for the identification of obesity-related altered mechanisms and of possible biomarkers for early diagnosis and treatment of pregnancy-adverse conditions.
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Affiliation(s)
- Chiara Mandò
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (G.M.A.); (A.S.); (I.C.)
- Correspondence:
| | - Silvio Abati
- Department of Dentistry, University Vita-Salute San Raffaele, 20132 Milan, Italy;
| | - Gaia Maria Anelli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (G.M.A.); (A.S.); (I.C.)
| | - Chiara Favero
- EPIGET LAB, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (C.F.); (L.D.); (B.A.); (V.B.)
| | - Anaïs Serati
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (G.M.A.); (A.S.); (I.C.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20054 Segrate, Italy
| | - Laura Dioni
- EPIGET LAB, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (C.F.); (L.D.); (B.A.); (V.B.)
| | - Marta Zambon
- Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospital, ASST Fatebenefratelli-Sacco, 20154 Milan, Italy;
| | - Benedetta Albetti
- EPIGET LAB, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (C.F.); (L.D.); (B.A.); (V.B.)
| | - Valentina Bollati
- EPIGET LAB, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (C.F.); (L.D.); (B.A.); (V.B.)
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Irene Cetin
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (G.M.A.); (A.S.); (I.C.)
- Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospital, ASST Fatebenefratelli-Sacco, 20154 Milan, Italy;
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Diceglie C, Anelli GM, Martelli C, Serati A, Lo Dico A, Lisso F, Parisi F, Novielli C, Paleari R, Cetin I, Ottobrini L, Mandò C. Placental Antioxidant Defenses and Autophagy-Related Genes in Maternal Obesity and Gestational Diabetes Mellitus. Nutrients 2021; 13:nu13041303. [PMID: 33920886 PMCID: PMC8071310 DOI: 10.3390/nu13041303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 01/07/2023] Open
Abstract
Maternal obesity and gestational diabetes mellitus (GDM) are increasing worldwide, representing risk factors for both mother and child short/long-term outcomes. Oxidative stress, lipotoxicity and altered autophagy have already been reported in obesity, but few studies have focused on obese pregnant women with GDM. Antioxidant and macro/chaperone-mediated autophagy (CMA)-related gene expressions were evaluated herein in obese and GDM placentas. A total of 47 women with singleton pregnancies delivered by elective cesarean section were enrolled: 16 normal weight (NW), 18 obese with no comorbidities (OB GDM(–)), 13 obese with GDM (OB GDM(+)). Placental gene expression was assessed by real-time PCR. Antioxidant gene expression (CAT, GPX1, GSS) decreased, the pro-autophagic ULK1 gene increased and the chaperone-mediated autophagy regulator PHLPP1 decreased in OB GDM(–) vs. NW. On the other hand, PHLPP1 expression increased in OB GDM(+) vs. OB GDM(–). When analyzing results in relation to fetal sex, we found sexual dimorphism for both antioxidant and CMA-related gene expressions. These preliminary results can pave the way for further analyses aimed at elucidating the placental autophagy role in metabolic pregnancy disorders and its potential targetability for the treatment of diabetes outcomes.
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Affiliation(s)
- Cecilia Diceglie
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20054 Segrate, Italy; (C.D.); (C.M.); (A.S.); (A.L.D.); (R.P.)
| | - Gaia Maria Anelli
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, 20157 Milano, Italy; (G.M.A.); (F.L.); (C.N.); (I.C.)
| | - Cristina Martelli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20054 Segrate, Italy; (C.D.); (C.M.); (A.S.); (A.L.D.); (R.P.)
| | - Anais Serati
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20054 Segrate, Italy; (C.D.); (C.M.); (A.S.); (A.L.D.); (R.P.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, 20157 Milano, Italy; (G.M.A.); (F.L.); (C.N.); (I.C.)
| | - Alessia Lo Dico
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20054 Segrate, Italy; (C.D.); (C.M.); (A.S.); (A.L.D.); (R.P.)
| | - Fabrizia Lisso
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, 20157 Milano, Italy; (G.M.A.); (F.L.); (C.N.); (I.C.)
| | - Francesca Parisi
- Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospital, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, 20154 Milano, Italy;
| | - Chiara Novielli
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, 20157 Milano, Italy; (G.M.A.); (F.L.); (C.N.); (I.C.)
| | - Renata Paleari
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20054 Segrate, Italy; (C.D.); (C.M.); (A.S.); (A.L.D.); (R.P.)
| | - Irene Cetin
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, 20157 Milano, Italy; (G.M.A.); (F.L.); (C.N.); (I.C.)
- Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospital, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, 20154 Milano, Italy;
| | - Luisa Ottobrini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20054 Segrate, Italy; (C.D.); (C.M.); (A.S.); (A.L.D.); (R.P.)
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 20054 Segrate, Italy
- Correspondence: (L.O.); (C.M.); Tel.: +39-02-503-30346 (L.O.); +39-02-503-19883 (C.M.)
| | - Chiara Mandò
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, 20157 Milano, Italy; (G.M.A.); (F.L.); (C.N.); (I.C.)
- Correspondence: (L.O.); (C.M.); Tel.: +39-02-503-30346 (L.O.); +39-02-503-19883 (C.M.)
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Caputo M, Bullara V, Mele C, Samà MT, Zavattaro M, Ferrero A, Daffara T, Leone I, Giachetti G, Antoniotti V, Longo D, De Pedrini A, Marzullo P, Remorgida V, Prodam F, Aimaretti G. Gestational Diabetes Mellitus: Clinical Characteristics and Perinatal Outcomes in a Multiethnic Population of North Italy. Int J Endocrinol 2021; 2021:9474805. [PMID: 34987576 PMCID: PMC8720593 DOI: 10.1155/2021/9474805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
AIM To evaluate clinical characteristics and perinatal outcomes in a heterogeneous population of Caucasians born in Italy and High Migration Pressure Countries (HMPC) women with GDM living in Piedmont, North Italy. METHODS We retrospectively analyzed data from 586 women referring to our unit (2015-2020). Epidemiological (age and country of origin) and clinical-metabolic features (height, weight, family history of DM, parity, previous history of GDM, OGTT results, and GDM treatment) were collected. The database of certificates of care at delivery was consulted in relation to neonatal/maternal complications (rates of caesarean sections, APGAR score, fetal malformations, and neonatal anthropometry). RESULTS 43.2% of women came from HMPC; they were younger (p < 0.0001) and required insulin treatment more frequently than Caucasian women born in Italy (χ 2 = 17.8, p=0.007). Higher fasting and 120-minute OGTT levels and gestational BMI increased the risk of insulin treatment (OGTT T0: OR = 1.04, CI 95% 1.016-1.060, p=0.005; OGTT T120: OR = 1.01, CI 95% 1.002-1.020, p=0.02; BMI: OR = 1.089, CI 95% 1.051-1.129, p < 0.0001). Moreover, two or more diagnostic OGTT glucose levels doubled the risk of insulin therapy (OR = 2.03, IC 95% 1.145-3.612, p=0.016). We did not find any association between ethnicities and neonatal/maternal complications. CONCLUSIONS In our multiethnic GDM population, the need for intensive care and insulin treatment is high in HPMC women although the frequency of adverse peripartum and newborn outcomes does not vary among ethnic groups. The need for insulin therapy should be related to different genetic backgrounds, dietary habits, and Nutrition Transition phenomena. Thus, nutritional intervention and insulin treatment need to be tailored.
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Affiliation(s)
- M. Caputo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - V. Bullara
- SCDU Endocrinologia, AOU “Maggiore della Carità” Novara, Novara, Italy
| | - C. Mele
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - M. T. Samà
- SCDU Endocrinologia, AOU “Maggiore della Carità” Novara, Novara, Italy
| | - M. Zavattaro
- SCDU Endocrinologia, AOU “Maggiore della Carità” Novara, Novara, Italy
| | - A. Ferrero
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - T. Daffara
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - I. Leone
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - G. Giachetti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - V. Antoniotti
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - D. Longo
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - A. De Pedrini
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - P. Marzullo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- IRCCS Istituto Auxologico Italiano, Laboratory of Metabolic Research, Novara, Italy
| | - V. Remorgida
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - F. Prodam
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - G. Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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